A Unifying Algorithm for Conditional, Probabilistic Planning

Several recent papers describe algorithms for generating conditional and/or probabilistic plans. In this paper, we synthesize this work, and present a unifying algorithm that incorporates and clarifies the main techniques that have been developed in the previous literature. Our algorithm decouples the search-control strategy for conditional and/or probabilistic planning from the underlying plan-refinement process. A similar decoupling has proven to be very useful in the analysis of classical planning algorithms, and we suspect it can be at least as useful here, where the search-control decisions are even more crucial. We describe an extension of conditional, probabilistic planning, to provide candidates for decision-theoretic assessment, and describe the reasoning about failed branches and side-effects that is needed for this purpose

A Very Rare Cause of Shoulder Weakness: Concurrent Traumatic Neuropathies of Accessory, Long Thoracicus, and Suprascapular Nerves

Accessory nerve is one of the most sensitive cranial nerves to injury, and its injuries are usually caused by iatrogenic interventions. As many other causes can mimic its clinical presentation, careful physical examination should be performed while evaluating a patient suspected of accessory neuropathy. In this report, we aimed to illustrate a very rare case with concurrent traumatic cranial neuropathies of accessory nerve, suprascapular nerve, and long thoracicus. A 16-year-old boy was admitted with complaints of shoulder weakness and pain following a trauma of strain injury. He had first taken the misdiagnosis of brachial plexopathy; however, after a detailed physical examination and electrophysiological study, the diagnosis of concurrent traumatic neuropathies of accessory, suprascapular, and long thoracicus nerves was made. In our opinion, during evaluation of these rare traumatic neuropathies, detailed clinical evaluations combined with detailed electromyography investigations may give crucial data for the proper diagnosis

Medication use in Italian nursing homes: preliminary results from the national monitoring system

Background: The aging population has increased concerns about the affordability, quality, and nature of long-term care for older people, emphasizing the role of nursing homes. Unlike acute hospital and primary care, there is a lack of drug consumption data in long-term care to understand regional or national healthcare policies. Objectives: This study aimed to describe medication consumption by older adults and expenditure in Italian nursing homes (NHs). Methods: Data on drug consumption and costs from the administrative medicine informational flows that detect medicines packages supplied to patients in health facilities and NHs were used. Data on the characteristics of the healthcare residence were from the Italian Health Ministry. Records for the year 2019, selecting the nursing homes exclusively providing elderly or mixed (elderly and disabled) were used. Results: In 2019, the total expenditure on medicines in NHs amounted to 25.38 million euros, the average cost to 1.30 and the expenditure per bed to 436.18 euros. Cardiovascular drugs were the highest-consuming therapeutic class (177.0 defined daily doses—DDDs/100 days of NH stay; 22.2% of total) followed by drugs acting on the alimentary tract and metabolism (167.6% and 21.0%) and blood drugs (160.4% and 20.1%). The treatment of hypertension and heart failure was widely the most frequently used, with the consumption being driven mainly by furosemide and ramipril. Antiulcer drugs were used on average in more than half of the days of NH stay (58.5 DDDs/100 days of NH stay), representing a therapeutic category for which deprescribing initiatives are recommended. On average, almost all patients received a dose of benzodiazepines, antipsychotics and antidepressants (37.6, 35.9, and 17.7 DDDs/100 days of NH stay, respectively), confirming the high prevalence of use for these medicines. Antibiotics reached 6.8 DDDs/100 days of NH stay. Conclusion: The availability of data in this specific setting allows the identification of the main interventions toward improving appropriateness and represents a challenge for drug utilization research. Data from this study suggest that proton pump inhibitors (PPIs), benzodiazepines and antibacterials can be areas of improving prescribing appropriateness

Adverse Events in Italian Nursing Homes During the COVID-19 Epidemic. A National Survey

Older people living in nursing homes (NHs) are particularly vulnerable in the ongoing COVID-19 pandemic, due to the high prevalence of chronic diseases and disabilities (e.g., dementia). The phenomenon of adverse events (AEs), intended as any harm or injury resulting from medical care or to the failure to provide care, has not yet been investigated in NHs during the pandemic. We performed a national survey on 3,292 NHs, either public or providing services both privately and within the national health system, out of the 3,417 NHs covering the whole Italian territory. An online questionnaire was addressed to the directors of each facility between March 24 and April 27, 2020. The list of NHs was provided by the Dementia Observatory, an online map of Italian services for people with dementia, which was one of the objectives of the implementation of the Italian National Dementia Plan. About 26% of residents in the Italian NHs for older people listed within the Dementia Observatory site had dementia. The objective of our study was to report the frequency of AEs that occurred during the months when SARS-CoV-2 spreading rate was at its highest in the Italian NHs and to identify which conditions and attributes were most associated with the occurrence of AEs by means of multivariate regression logistic analysis. Data are referred to 1,356 NHs that participated in the survey. The overall response rate was 41.2% over a time-period of six weeks (from March 24 to May 5). About one third of the facilities (444 out of 1,334) (33.3%) reported at least 1 adverse event, with a total of 2,000 events. Among the included NHs, having a bed capacity higher than the median of 60 beds (OR=1.57, CI95% 1.17–2.09; p=0.002), an observed increased in the use of psychiatric drugs (OR=1.80, CI95% 1.05–3.07; p=0.032), adopting physical restraint measures (OR=1.97, CI95% 1.47–2.64; p<0.001), residents hospitalized due to flu-like symptoms (OR =1.73, CI95% 1.28–2.32; p<0.001), and being located in specific geographic areas (OR=3.59, CI95% 1.81–7.08; OR = 2.90, CI95% 1.45–5.81 and OR = 4.02, CI05% 2.01–8.04 for, respectively, North-West, North-East and Centre vs South, p<0.001) were all factors positively associated to the occurrence of adverse events in the facility. Future recommendations for the management and care of residents in NHs during the COVID-19 pandemic should include specific statements for the most vulnerable populations, such as people with dementia

Standard Penetration Test-Based Probabilistic and Deterministic Assessment of Seismic Soil Liquefaction Potential

This paper presents new correlations for assessment of the likelihood of initiation (or “triggering”) of soil liquefaction. These new correlations eliminate several sources of bias intrinsic to previous, similar correlations, and provide greatly reduced overall uncertainty and variance. Key elements in the development of these new correlations are (1) accumulation of a significantly expanded database of field performance case histories; (2) use of improved knowledge and understanding of factors affecting interpretation of standard penetration test data; (3) incorporation of improved understanding of factors affecting site-specific earthquake ground motions (including directivity effects, site-specific response, etc.); (4) use of improved methods for assessment of in situ cyclic shear stress ratio; (5) screening of field data case histories on a quality/uncertainty basis; and (6) use of high-order probabilistic tools (Bayesian updating). The resulting relationships not only provide greatly reduced uncertainty, they also help to resolve a number of corollary issues that have long been difficult and controversial including: (1) magnitude-correlated duration weighting factors, (2) adjustments for fines content, and (3) corrections for overburden stress

Nonlinear ultrasound modelling and validation of fatigue damage

Nonlinear ultrasound techniques have shown greater sensitivity to microcracks and they can be used to detect structural damages at their early stages. However, there is still a lack of numerical models available in commercial finite element analysis (FEA) tools that are able to simulate the interaction of elastic waves with the materials nonlinear behaviour. In this study, a nonlinear constitutive material model was developed to predict the structural response under continuous harmonic excitation of a fatigued isotropic sample that showed anharmonic effects. Particularly, by means of Landau׳s theory and Kelvin tensorial representation, this model provided an understanding of the elastic nonlinear phenomena such as the second harmonic generation in three-dimensional solid media. The numerical scheme was implemented and evaluated using a commercially available FEA software LS-DYNA, and it showed a good numerical characterisation of the second harmonic amplitude generated by the damaged region known as the nonlinear response area (NRA). Since this process requires only the experimental second-order nonlinear parameter and rough damage size estimation as an input, it does not need any baseline testing with the undamaged structure or any dynamic modelling of the fatigue crack growth. To validate this numerical model, the second-order nonlinear parameter was experimentally evaluated at various points over the fatigue life of an aluminium (AA6082-T6) coupon and the crack propagation was measured using an optical microscope. A good correlation was achieved between the experimental set-up and the nonlinear constitutive model

Determinants of postnatal spleen tissue regeneration and organogenesis

Abstract The spleen is an organ that filters the blood and is responsible for generating blood-borne immune responses. It is also an organ with a remarkable capacity to regenerate. Techniques for splenic auto-transplantation have emerged to take advantage of this characteristic and rebuild spleen tissue in individuals undergoing splenectomy. While this procedure has been performed for decades, the underlying mechanisms controlling spleen regeneration have remained elusive. Insights into secondary lymphoid organogenesis and the roles of stromal organiser cells and lymphotoxin signalling in lymph node development have helped reveal similar requirements for spleen regeneration. These factors are now considered in the regulation of embryonic and postnatal spleen formation, and in the establishment of mature white pulp and marginal zone compartments which are essential for spleen-mediated immunity. A greater understanding of the cellular and molecular mechanisms which control spleen development will assist in the design of more precise and efficient tissue grafting methods for spleen regeneration on demand. Regeneration of organs which harbour functional white pulp tissue will also offer novel opportunities for effective immunotherapy against cancer as well as infectious diseases

Trend in potassium intake and Na/K ratio in the Italian adult population between the 2008 and 2018 CUORE project surveys

Background and aims: Low potassium intake, in addition to high sodium, has been associated with higher risk of hypertension and CVD. The Study assessed habitual potassium intake and sodium/potassium ratio of the Italian adult population from 2008 to 2012 to 2018–2019 based on 24-h urine collection, in the framework of the CUORE Project/MINISAL-GIRCSI/MENO SALE PIU’ SALUTE national surveys. Methods and results: Data were from cross-sectional surveys of randomly selected age-and-sex stratified samples of resident persons aged 35–74 years in 10 (out of 20) Italian regions. Urinary electrolyte and creatinine measurements were performed in a central laboratory. Analyses considered 942 men and 916 women, examined in 2008–2012, and 967 men and 1010 women, examined in 2018–2019. In 2008–2012, the age-standardized mean of potassium intake (urinary potassium accounts for 70% of potassium intake) was 3147 mg (95% CI 3086–3208) in men and 2784 mg (2727–2841) in women, whereas in 2018–2019, it was 3043 mg (2968–3118) and 2561 mg (2508–2614) respectively. In 2008–2012, age-adjusted prevalence of persons with an adequate potassium intake (i.e. ≥ 3510 mg/day) was 31% (95% CI 28–34%) for men and 18% (16–21%) for women; in 2018–2019, it was 26% (23–29%) and 12% (10–14%) respectively. The sodium/potassium ratio significantly decreased both in men and women. Conclusions: The average daily potassium intake of the Italian general adult population remains lower than the WHO and EFSA recommended level. These results suggest the need of a revision to strengthen initiatives for the promotion of an adequate potassium intake at the population level

Trend of salt intake measured by 24-h urine collection in the Italian adult population between the 2008 and 2018 CUORE project surveys

Background and aims: The WHO Global Action Plan for the Prevention of non-communicable diseases (NCDs) recommends a 30% relative reduction in mean population salt/sodium intake. The study assessed the trend in the habitual salt intake of the Italian adult population from 2008 to 2012 to 2018–2019 based on 24-h urinary sodium excretion, in the framework of the CUORE Project/MINISAL-GIRCSI/MENO SALE PIU’ SALUTE national surveys. Methods and results: Data were from cross-sectional surveys of randomly selected age and sex–stratified samples of resident persons aged 35–74 years in 10 (out of 20) Italian Regions distributed in North, Centre and South of the Country. Urinary sodium and creatinine measurements were carried out in a central laboratory. The analyses included 942 men and 916 women examined in 2008–2012, and 967 men and 1010 women examined in 2018–2019. The age-standardized mean daily population salt (sodium chloride) intake was 10.8 g (95% CI 10.5–11.1) in men and 8.3 g (8.1–8.5) in women in 2008–2012 and respectively 9.5 g (9.3–9.8) and 7.2 g (7.0–7.4) in 2018–2019. A statistically significant (p<0.0001) salt intake reduction was thus observed over 10 years for both genders, and all age, body mass index (BMI) and educational classes. Conclusions: The average daily salt intake of the Italian general adult population remains higher than the WHO recommended level, but a significant reduction of 12% in men and 13% in women has occurred in the past ten years. These results encourage the initiatives undertaken by the Italian Ministry of Health aimed at the reduction of salt intake at the population level

Quantum Cosmology of Generalized Two--Dimensional Dilaton Gravity Models

The quantum cosmology of two-dimensional dilaton-gravity models is investigated. A class of models is mapped onto the constrained oscillator-ghost-oscillator model. A number of exact and approximate solutions to the corresponding Wheeler-DeWitt equation are presented. A wider class of minisuperspace models that can be solved in this fashion is identified. Supersymmetric extensions to the induced gravity theory and the bosonic string theory are then considered and closed-form solutions to the associated quantum constraints are derived. The possibility of applying the third-quantization procedure to two-dimensional dilaton-gravity is briefly discussed.Comment: 28 pages, late