Effectiveness of cardiac resynchronization therapy in heart failure patients with valvular heart disease: comparison with patients affected by ischaemic heart disease or dilated cardiomyopathy. The InSync/InSync ICD Italian Registry

AimsTo analyse the effectiveness of cardiac resynchronization therapy (CRT) in patients with valvular heart disease (a subset not specifically investigated in randomized controlled trials) in comparison with ischaemic heart disease or dilated cardiomyopathy patients.Methods and resultsPatients enrolled in a national registry were evaluated during a median follow-up of 16 months after CRT implant. Patients with valvular heart disease treated with CRT (n = 108) in comparison with ischaemic heart disease (n = 737) and dilated cardiomyopathy (n = 635) patients presented: (i) a higher prevalence of chronic atrial fibrillation, with atrioventricular node ablation performed in around half of the cases; (ii) a similar clinical and echocardiographic profile at baseline; (iii) a similar improvement of LVEF and a similar reduction in ventricular volumes at 6-12 months; (iv) a favourable clinical response at 12 months with an improvement of the clinical composite score similar to that occurring in patients with dilated cardiomyopathy and more pronounced than that observed in patients with ischaemic heart disease; (v) a long-term outcome, in term of freedom from death or heart transplantation, similar to patients affected by ischaemic heart disease and basically more severe than that of patients affected by dilated cardiomyopathy.ConclusionIn 'real world' clinical practice, CRT appears to be effective also in patients with valvular heart disease. However, in this group of patients the outcome after CRT does not precisely overlap any of the two other groups of patients, for which much more data are currently available

Sustainable biomass power plant location in the Italian Emilia-Romagna region

Biomass power plants are very promising for reducing carbon oxides emissions, because they provide energy with a carbon-neutral process. Biomass comes from trees and vegetables, so they provide a renewable type of energy. However, biomass plants location, along with their provisioning basins, are heavily regulated by economical aspects, often without careful consideration of their environmental footprint. For example, some Italian biomass plants import from overseas palm-tree oil that is economically convenient. However, the energy consumed for the oil transportation is definitely greater than the energy produced by the palm-tree oil burning. In this way biomass power plants turn out to be environmentally inefficient, even if they produce renewable energy. We propose an Integer Linear Programming approach for defining the energy and cost-efficient biomass plant location along with the corresponding provisioning basin. In addition, the model enables to evaluate existing plants and their energy and cost efficiency. Our study is based on real data gathered in the Emilia-Romagna region of Italy. Finally, this optimization tool is just a small part of a wider perspective that is aimed to define decision support tools for the improvement of regional planning and its precise strategic environmental assessment

Improving Quality and Efficiency in Home Health Care: an application of Constraint Logic Programming for the Ferrara NHS unit

Although sometimes it is necessary, no one likes to stay in a hospital, and patients who need to stay in bed but do not require constant medical surveillance prefer their own bed at home. At the same time, a patient in a hospital has a high cost for the community, that is not acceptable if the patient needs service only a few minutes a day. For these reasons, the current trend in Europe and North-America is to send nurses to visit patients in their home: this choice reduces costs for the community and gives better quality of life to patients. On the other hand, it introduces the combinatorial problem of assigning patients to the available nurses in order to maximize the quality of service, without having nurses travel for overly long distances. In this paper, we describe the problem as a practical application of Constraint Logic Programming. We first introduce the problem, as it is currently addressed by the nurses in the National Health Service (NHS) in Ferrara, a mid-sized city in the North of Italy. Currently, the nurses solve the problem by hand, and this introduces several inefficiencies in the schedules. We formalize the problem, obtained by interacting with the nurses in the NHS, into a Constraint Logic Programming model. In order to solve the problem efficiently, we implemented a new constraint that tackles with the routing part of the problem. We propose a declarative semantics for the new constraint, and an implementation based on an external solver

Improving Quality and Efficiency in Home Health Care: an application of Constraint Logic Programming for the Ferrara NHS unit

Although sometimes it is necessary, no one likes to stay in a hospital, and patients who need to stay in bed but do not require constant medical surveillance prefer their own bed at home. At the same time, a patient in a hospital has a high cost for the community, that is not acceptable if the patient needs service only a few minutes a day. For these reasons, the current trend in Europe and North-America is to send nurses to visit patients in their home: this choice reduces costs for the community and gives better quality of life to patients. On the other hand, it introduces the combinatorial problem of assigning patients to the available nurses in order to maximize the quality of service, without having nurses travel for overly long distances. In this paper, we describe the problem as a practical application of Constraint Logic Program- ming. We first introduce the problem, as it is currently addressed by the nurses in the National Health Service (NHS) in Ferrara, a mid-sized city in the North of Italy. Currently, the nurses solve the problem by hand, and this introduces several inefficiencies in the schedules. We formalize the problem, obtained by interacting with the nurses in the NHS, into a Con- straint Logic Programming model. In order to solve the problem efficiently, we implemented a new constraint that tackles with the routing part of the problem. We propose a declarative semantics for the new constraint, and an implementation based on an external solver

Integrating Abductive Logic Programming and Description Logics in a Dynamic Contracting Architecture

In Semantic Web technologies, searching for a service means to identify components that can potentially satisfy the user needs in terms of outputs and effects (discovery), and that, when invoked by the customer, can fruitfully interact with her (contracting). In this paper, we present an application framework that encompasses both the discovery and the contracting steps, in a unified search process. In particular, we accommodate service discovery by ontology based reasoning, and contracting by automated reasoning about policies published in a formal language. To this purpose, we consider a formal approach grounded on computational Logic, and Abductive Logic Programming in particular. We propose a framework, called SCIFF Reasoning Engine, able to establish, by ontological and abductive reasoning, if a semantic web service and a requester can fruitfully inter-operate, taking as input the behavioural interfaces of both the participants, and producing as output a sort of a contract

A Computational Logic Application Framework for Service Discovery and Contracting

In Semantic Web technologies, searching for a service means identifying components that can potentially satisfy user needs in terms of inputs and outputs (discovery) and devise a fruitful interaction with the customer (contracting). In this paper, the authors present an application framework that encompasses both the discovery and the contracting steps in a unified search process. In particular, the authors accommodate service discovery by ontology-based reasoning and contracting by reasoning about behavioural interfaces, published in a formal language. To this purpose, the authors consider a formal approach grounded on Computational Logic. They define, illustrate, and evaluate a framework, called SCIFF Reasoning Engine (SRE), which can establish if a Semantic Web Service and a requester can fruitfully inter-operate, by computing a possible interaction plan based on the behavioural interfaces of both. The same operational machinery used for contracting can be used for runtime verification

Left ventricular ejection fraction overcrossing 35% after one year of cardiac resynchronization therapy predicts long term survival and freedom from sudden cardiac death: single center observational experience

Background Reverse remodeling and increased LVEF after CRT correlate with survival and heart failure hospitalizations, but their relationship with the risk of SCD is unclear. We aimed to evaluate whether exceeding a threshold value of 35% for left ventricular ejection fraction (LVEF) 1 year after cardiac resynchronization therapy (CRT) predicts survival and freedom from sudden cardiac death (SCD). Methods 330 patients who survived ≥ 6 months after CRT (males 80%, age 62 ± 11 years) were grouped according to 1-year LVEF ≤ 35% (Group 1, n = 187, 57%) or > 35% (Group 2, n = 143, 43%). According to changes vs. baseline (reduction of left end-systolic volume [LVESV] ≥ 10% or increase of LVEF% > 10 units), patients were also classified as echocardiographic (Echo) non-responders (Group A, n = 152, 46%) or responders (Group B, n = 178, 54%). Results At baseline, LVESV volume was larger and LVEF was lower in Group 1 vs. Group 2 (p 35% was associated with freedom from SCD/VF. Conclusions LVEF > 35% after 1 year of CRT characterizes a favorable long-term outcome, with a very low risk for SCD

The impact of covid-19 pandemic and lockdown restrictions on cardiac implantable device recipients with remote monitoring

From 2020, many countries have adopted several restrictions to limit the COVID-19 pandemic. The forced containment impacted on healthcare organizations and the everyday life of patients with heart disease. We prospectively analyzed data recorded from implantable defibrillators and/or cardiac resynchronization devices of Italian patients during the lockdown (LDP), post-lockdown period (PLDP) and a control period (CP) of the previous year. We analyzed device data of the period 9 March 2019–31 May 2020 of remotely monitored patients from 34 Italian centers. Patients were also categorized according to areas with high/low infection prevalence. Among 696 patients, we observed a significant drop in median activity in LDP as compared to CP that significantly increased in the PLDP, but well below CP (all p < 0.0001). The median day heart rate and heart rate variability showed a similar trend. This behavior was associated during LDP with a significant increase in the burden of atrial arrhythmias (p = 0.0150 versus CP) and of ventricular arrhythmias [6.6 vs. 1.5 per 100 patient-weeks in CP; p = 0.0026]; the latter decreased in PLDP [0.3 per 100 patient-weeks; p = 0.0035 vs. LDP]. No modifications were recorded in thoracic fluid levels. The high/low prevalence of COVID-19 infection had no significant impact. We found an increase in the arrhythmic burden in LDP coupled with a decrease in physical activity and heart rate variability, without significant modifications of transthoracic impedance, independent from COVID-19 infection prevalence. These findings suggest a negative impact of the COVID-19 pandemic, probably related to lockdown restrictions

Report on the gravimetric, magnetometric, bathymetric activities during Cruise PANSTR10 with R/V Urania: Panarea and Stromboli, Aeolian Islands, 2010-02-05 - 2010-02-15.

We present the shipboard activities and preliminary results of Cruise PANSTR10((2010-02-05 2010-02-15)) with R/V Urania. The cruise was scheduled to acquire high resolution magnetometric and gravimetric data on the Panarea and Stromboli volcanic edifices. In addition to this, swath bathymetry and CTD casts were obtained, and five OBS were launched N of Alicudi and on the lineament Stromboli-Marsili, aiming at collecting active and passive seismological data in the Aeolian and Calabrian Arcs