Thermal and spectral dimension of (generalized) Snyder noncommutative spacetimes

We report an investigation of the Snyder noncommutative spacetime and of some of its most natural generalizations, also looking at them as a powerful tool for comparing different notions of dimensionality of a quantum spacetime. It is known that (generalized-)Snyder noncommutativity, while having rich off-shell implications (kinematical Hilbert space), does not affect on-shell particles (physical Hilbert space), and we argue that physically meaningful notions of dimensionality should describe such spacetimes as trivially four-dimensional, without any running with scales. By studying the thermodynamics of a gas of massless particles living on these spacetimes, we find that indeed the Snyder model and its generalizations have constant thermal dimension of four. We also compute the spectral dimension of the Snyder model and its generalizations, finding that, as a result of its sensitivity to off-shell properties, it runs from the standard value of four in the infrared towards lower values in the ultraviolet limit

AHP‐Aided Evaluation of Logistic and Transport Solutions in a Seaport

The chapter reports on the application of the analytic hierarchy process (AHP) to a strategic decision in the transport sector, concerning the reconfiguration of the railway infrastructure of the seaport of Trieste. The proposed solutions should not only solve some technical and operational problems of the terminal, but they could allow the port to be included in the Trans‐European Network‐Transport Programme (TEN‐T), promoted by the European Union and aimed to develop the Trans‐European Networks of Transport. Accordingly, the selection of the solution with the most promising potential to satisfy the goals of the TEN‐T policy is a fundamental stage of the project. The case study is an actual AHP application to an evaluation process concerning a pre‐feasibility study of strategic solutions in the logistics and transport fields. Some practical aspects regarding the application of the AHP and the building of the model, when several stakeholders are involved in the decision process, are highlighted and discussed

Budget impact analysis of sofosbuvir-based regimens for the treatment of HIV/HCV-coinfected patients in northern Italy: A multicenter regional simulation

Objectives: Chronic hepatitis C virus (HCV) is a leading cause of hospitalization and death in populations coinfected with human immunodeficiency virus (HIV). Sofosbuvir (SOF) is a pan-genotypic drug that should be combined with other agents as an oral treatment for HCV. We performed a 5-year horizon budget impact analysis of SOF-based regimens for the management of HIV/HCV-coinfected patients. Methods: A multicenter, prospective evaluation was conducted, involving four Italian Infectious Diseases Departments (Galliera, San Martino, Sanremo, and La Spezia). All 1,005 genotype-coinfected patients (30% cirrhotics) under observation were considered (patients in all disease-stages were considered: chronic hepatitis C, cirrhosis, transplant, hepatocellular carcinoma). Disease stage costs per patient were collected; the expected disease progression in the absence of treatment and sustained virological response (SVR) success rate for SOF-based regimens were calculated based on the literature and expert opinion. Drug prices were based on what the National Health Service paid for them. The comparison of \u201cno treatment\u201d disease progression costs versus the economic impact of SOF-based regimens was investigated. Results: Over the following 5 years, the disease progression scenario resulted in direct costs of approximately \u20ac54 million. Assuming an SVR success rate of 90%, average SOF-based regimens cost up to \u20ac50,000 per person, resulting in a final cost of more than \u20ac56 million, so this option is not economically viable. At the average price of \u20ac12,000, SOF-based regimens, expense was \u20ac17 million, saving 68%. At this price level, the economic resources invested in treating mild to moderate fibrosis stage patients would be equal to the amount of direct costs of disease management in this stage, resulting in a valid return of investment in the short-term. Conclusion: Given the high rates of SVR, in the Italian Healthcare System, SOF-based regimens, price is a determinant and a predictor of the overall cost for the Hepatitis C patient\u2019s management. At the average price per therapy of \u20ac12,000 over the next 5 years, SOF-based regimens are becoming highly sustainable

Considerazioni psicopatologiche, sociali e giuridiche sul mobbing: un’esperienza clinica nell’ospedale generale

Object. The  authors  intend  to  estimate  in  depth  the  following  questions:1) To  define  mobbing  and  how  to  detect  its  characteristics,  considering  the  psychopathological  questions  and  the  legal  medical  implications.2) To  try  to  analize  psychological  factors,  individual  and  organisational,  that  contribute  to  the  onset  of  mobbing.3) To  present  the  results  of   clinical  experience,  developed  by  the  collaboration established  with  the  Working  Medicine  Section  of  S. Martino  Hospital  in  Genoa. Methods. 237  persons  reporting  to  be  victims  of  a  mobbing  situation  have  undergone  a  psychodiagnostic  interview and  a  clinical  psychological  assessment  with  mental  tests (WAIS,  short  MMPI,  Rorschach).  The  compilation  of  specific  questionnaires  has  been  proposed  to detect  the  characteristics  of  mobbing  situation  and  the  sequential  subjective  symptoms reported  by  the  patients.Results.  In  75%  of  cases,  patients  presented  a  negative  anamnesis  for  psychiatric  disorders. They  had  enough  items  to  be  included  in  the  Adjustment  Disorder  (in  its  different  subdivisions).Conclusions.  In  the  majority  of  cases,  psychiatric  symptoms  reported  by  job  distress  victims  were  strictly  related  to  the  mobbing  experience,  that  causes  such  a  trend  of  stressing  and  painful  events  that  constitute  a  significant  risk  for  the  psycho-physical  integrity  of  a  person,  independent  of  previous  factors.  This  result  have  induced  the  Authors  to  analize  in  depth  some  of  the  legal  questions  about  the  detection  of  mobbing  and  the  contingent  compensation  of  undergone  damages.Gli Autori  si  propongono  di:1) Definire  il  mobbing  ed  individuare  le  caratteristiche  del fenomeno,  tenendo  presenti  le  problematiche  psicopatologiche  e  le  implicazioni  medico-legali;2) Analizzare  i  fattori  psicologici,  individuali  ed  organizzativi, che  contribuiscono  all'insorgenza  del  mobbing;3) Presentare  i  risultati  di  un’esperienza  clinica  nata  dalla  collaborazione tra  la  Clinica  Psichiatrica  e  l’U.O.  di  Medicina  del  Lavoro  dell’Azienda Ospedaliera  Universitaria San Martino  di  Genova.Metodo.  237  persone  che  riferivano  una  situazione  di  mobbing  a  loro  danno  sono  state sottoposte  a  colloquio  psicodiagnostico  e  a  valutazione  psicologica  clinica  mediante reattivi  mentali  (WAIS,  MMPI abbreviato,  Rorschach).  È  stata  inoltre  proposta  la compilazione  di  specifici  questionari  per  rilevare  le  caratteristiche  della  situazione  mobbizzante  e  i  conseguenti  sintomi  soggettivi  lamentati  dai  pazienti.Risultati.  Nel  75%  dei casi  i  pazienti  hanno  presentato  anamnesi  negativa  per disturbi  di interesse  psichiatrico,  rispondendo  invece ai  criteri  del  DSM-IV-TR  per  il  Disturbo  dell'Adattamento  (nelle  sue  varie  sottospecie).Conclusioni.  Nella  gran  maggioranza  dei  casi, i sintomi psichici  lamentati  dalle vittime  di disadattamento  lavorativo  risultano  in  stretta  connessione  con  l’esperienza  mobbizzante,  che innesca  una  serie  di  eventi  stressanti  e  dolorosi  tali  da  costituire  un  rischio  significativo  per l'integrità  psico-fisica  della  persona,  indipendentemente  da  variabili  preesistenti.  Questo  riscontro  ha  spinto  gli  Autori  ad  approfondire  alcune  problematiche  medico-legali  inerenti  il  riconoscimento  del  mobbing  e  l'eventuale  risarcibilità  dei  danni  subiti

Is it still worthwhile to perform quarterly CD4+ T lymphocyte cell counts on HIV-1 infected stable patients?

Background: In the last twenty years routine T CD4+ lymphocyte (CD4) cell count has proved to be a key factor to determine the stage of HIV infection and start or discontinue of prophylaxis for opportunistic infections. However, several studies recently showed that in stable patients on cART a quarterly CD4 cell count monitoring results in limited (or null) clinical relevance. The research is intended to investigate whether performing quarterly CD4 cell counts in stable HIV-1 patients is still recommendable and to provide a forecast of the cost saving that could be achieved by reducing CD4 monitoring in such a category of patients. Methods: The study is based on data referring to all HIV-infected patients > 18 years of age being treated at two infectious diseases units located in the metropolitan area of Genoa, Italy. The probability of CD4 cell counts dropping below a threshold value set at 350 cells/mm3 is assessed using confidence intervals and Kaplan-Meier survival estimates, whereas multivariate Cox analysis and logistic regression are implemented in order to identify factors associated with CD4 cell count falls below 350 cells/mm3. Results: Statistical analysis reveals that among stable patients the probability of maintaining CD4 >350 cell/mm3 is more than 98%. Econometric models indicate that HCV co-infection and HIV-RNA values >50 copies/mL in previous examinations are associated with CD4 falls below 350 cells/mm3. Moreover, results suggest that the cost saving that could be obtained by reducing CD4 examinations ranges from 33% to 67%. Conclusions: Empirical findings show that patients defined as stable at enrollment are highly unlikely to experience a CD4 value <350 cell/mm3 in the space/arc of a year. The research supports a recommendation for annual CD4 monitoring in stable HIV-1 patients

Eating Disorders in Hospitalized School-Aged Children and Adolescents during the COVID-19 Pandemic: A Cross-Sectional Study of Discharge Records in Developmental Ages in Italy

Eating disorders (EDs) are characterized by behavioral and cognitive aspects that result in a significant impairment of an individual’s well-being. COVID-19 pandemic consequences negatively impacted healthcare services and people’s mental health. Particularly, in developmental ages, difficulties in coping with the situation could have had an impact on eating behaviors. Therefore, the aim of this study was to assess EDs’ hospitalization trend before, during and after the pandemic peak to evaluate whether it has been influenced. A retrospective cross-sectional study was conducted on the hospital discharge forms of patients from 5 to 19 years old in Piedmont, which is a region in northern Italy. Overall, hospitalization, age, and gender-specific rates due to EDs that occurred in 2020 and 2021 were compared to those that occurred in 2018–2019. Since 2020, there has been a 55% reduction in overall hospitalizations, while the total proportion of EDs admissions has doubled from 2020 to 2021 (from 13.9‰ to 22.2‰). Significant hospitalization rate increases were observed both in 15–19 and in 10–14 females’ age groups in 2021. Non-significant increases were observed in all males’ age groups. The increase in hospitalizations for EDs should be further investigated, as it might be the tip of an iceberg not yet acknowledged

Trend of estimated glomerular flitration rate in a large cohort of HIV mother-to -child infected patients, an observational multicenter study from 2010 to 2018

Background: People vertically infected with HIV (PVI-HIV) are a special population, due to exposition since birth to HIV and antiretroviral therapy (ART). Among ART, Tenofovir disoproxil fumarate (TDF) was widely used in recent years, but there are few data on safety in these patients; in particular, data about estimated glomerular filtration rate (eGFR) trend in this population. Aim of our study is to evaluate eGFR trend in a multicentre cohort of PVI-HIV exposed to TDF

Time to change the single-centre approach to management of patients with tuberculosis: a novel network platform with automatic data import and data sharing

Time to change the single-centre approach to TB http://ow.ly/lCeM30hBcbB

Percutaneous mitral valve repair with the MitraClip system: acute results from a real world setting

This study sought to evaluate the feasibility and early outcomes of a percutaneous edge-to-edge repair approach for mitral valve regurgitation with the MitraClip((R)) system (Evalve, Inc., Menlo Park, CA, USA).Patients were selected for the procedure based on the consensus of a multidisciplinary team. The primary efficacy endpoint was acute device success defined as clip placement with reduction of mitral regurgitation to < 2+. The primary acute safety endpoint was 30-day freedom from major adverse events, defined as the composite of death, myocardial infarction, non-elective cardiac surgery for adverse events, renal failure, transfusion of > 2 units of blood, ventilation for > 48 h, deep wound infection, septicaemia, and new onset of atrial fibrillation. Thirty-one patients (median age 71, male 81%) were treated between August 2008 and July 2009. Eighteen patients (58%) presented with functional disease and 13 patients (42%) presented with organic degenerative disease. A clip was successfully implanted in 19 patients (61%) and two clips in 12 patients (39%). The median device implantation time was 80 min. At 30 days, there was an intra-procedural cardiac tamponade and a non-cardiac death, resulting in a primary safety endpoint of 93.6% [95% confidence interval (CI) 77.2-98.9]. Acute device success was observed in 96.8% of patients (95% CI 81.5-99.8). Compared with baseline, left ventricular diameters, diastolic left ventricular volume, diastolic annular septal-lateral dimension, and mitral valve area significantly diminished at 30 days.Our initial results with the MitraClip device in a very small number of patients indicate that percutaneous edge-to-edge mitral valve repair is feasible and may be accomplished with favourable short-term safety and efficacy results

Variazioni del filtrato glomerulare (eGFR) in una coorte di pazienti nati con HIV, risultati di uno studio osservazionale dal 2009 al 2018

Introduzione e scopo dello studio I pazienti nati con infezione da HIV rappresentano una popolazione speciale a causa dell\u2019esposizione fin dalla nascita ad HIV e alla terapia antiretrovirale di combinazione (cART). Molti pazienti hanno assunto tenofovir disoproxil fumarato (TDF) per necessit\ue0 anche se i dati in questa coorte sono scarsi. Inoltre vi sono pochi dati in letteratura relativi all\u2019andamento dell\u2019eGFR in questa popolazione. Scopo del nostro studio \ue8 di valutare le variazioni dell\u2019eGFR nei pazienti con infezione da HIV materno-fetale in follow-up nella nostra coorte. Materiali e metodi Studio osservazionale retrospettivo monocentrico nel periodo 2010-2018. Il dato \ue8 stato associato alla cART in corso. Abbiamo arruolato i pazienti con diagnosi di HIV trasmessa alla nascita ed estratto i dati delle cART e degli esami ematici dal sistema informatico ReteligureHIV (www.reteligureHIV.it) per il periodo in analisi. Abbiamo raccolto i dati del peso corporeo e altezza dalle cartelle cliniche. Abbiamo calcolato l\u2019eGFR con la formula di Cockroft-Gault nei pazienti maggiorenni al 2018, con la revised Schwartz equation nei minorenni. Abbiamo stratificato il dato con la cART effettuata (TDF, TAF, inibitore proteasi (PI), analogo non nucleosidico (NNRTI), inibitore integrasi (INI)). Risultati La nostra coorte \ue8 composta da 39 pazienti, di questi ne abbiamo arruolati 34, 5 sono stati esclusi per mancanza di dati. Il tempo di osservazione medio \ue8 di 8,8 anni (range 7-9). Le femmine 18 (53%), et\ue0 media di 18 anni nel 2010 (range 6-28). 30 pazienti (88%) hanno effettuato cART contenente TDF per almeno 1 anno, 19 (55%) hanno associato TDF+PI per almeno 1 anno, 14 (41%) TDF+NNRTI, 12 (35%) TDF+INI. 4 pazienti (12%) non hanno mai assunto TDF. Abbiamo osservato una riduzione mediana dell\u2019eGFR di 1,83 mL/min/anno (16,5 mL/min in 9 anni di studio). La riduzione \ue8 maggiore nel gruppo di pazienti in terapia con TDF+INI (3,7 mL/min/anno), minore per i pazienti in terapia con TDF+NNRTI (2,2 mL/min/anno) e TDF+PI (1,44 mL/min/anno). Abbiamo inoltre osservato un miglioramento dell\u2019eGFR mediano totale di 5 mL/min tra il 2017 e il 2018, anno in cui 23 pazienti (68%) hanno iniziato terapia con TAF. Nel solo gruppo esposto a TDF+INI abbiamo osservato un peggioramento dell\u2019eGFR anche nel 2018 (-5 mL/min). Conclusioni Il nostro studio ha evidenziato un peggioramento progressivo dell\u2019eGFR, come atteso in una popolazione esposta al virus HIV e alla cART. Il miglioramento osservato nel 2018 \ue8 un dato interessante, alla luce dell\u2019arrivo del TAF. Il peggioramento del filtrato con INI potrebbe dipendere dall\u2019associazione con DTG. Il proseguimento del follow-up \ue8 necessario per valutare l\u2019andamento negli anni futuri