Is Left Ventricular Assist Device Deactivation Ethically Acceptable? A Study on the Euthanasia Debate

In the last decades, new technologies have improved the survival of patients affected by chronic illnesses. Among them, left ventricular assist device (LVAD) has represented a viable solution for patients with advanced heart failure (HF). Even though the LVAD prolongs life expectancy, patients' vulnerability generally increases during follow up and patients' request for the device withdrawal might occur. Such a request raises some ethical concerns in that it directly hastens the patient's death. Hence, in order to assess the ethical acceptability of LVAD withdrawal, we analyse and examine an ethical argument, widely adopted in the literature, that we call the "descriptive approach", which consists in giving a definition of life-sustaining treatment to evaluate the ethical acceptability of treatment withdrawal. Focusing attention on LVAD, we show criticisms of this perspective. Finally, we assess every patient's request of LVAD withdrawal through a prescriptive approach, which finds its roots in the criterion of proportionality

Leonardo Drone Contest Autonomous Drone Competition: Overview, Results, and Lessons Learned from Politecnico di Milano Team

In this paper, the Politecnico di Milano solutions proposed for the Leonardo Drone Contest (LDC) are presented. The Leonardo Drone Contest is an annual autonomous drone competition among universities, which has already seen the conclusion of its second edition. In each edition, the participating teams were asked to design and build an autonomous multicopter, capable of accomplishing complex tasks in an indoor urban-like environment. To reach this goal, the designed systems should be capable of navigating in a Global Navigation Satellite System (GNSS)-denied environment with autonomous decision making, online planning and collision avoidance capabilities. In this light, the authors describe the first two editions of the competition, i.e., their rules, objectives and overview of the proposed solutions. While the first edition is presented as relevant for the experience and takeaways acquired from it, the second edition solution is analyzed in detail, providing both the simulation and experimental results obtained

Long-acting bronchodilators improve exercise capacity in COPD patients : a systematic review and meta-analysis

Background: We carried out a systematic review and meta-analysis with the aim to evaluate the efficacy of long-acting bronchodilators on exercise capacity in COPD patients. Methods: The endpoints were the efficacy of long-acting bronchodilators (altogether, and by single classes) vs. placebo in modifying endurance time (ET), inspiratory capacity (IC) and dyspnea during exercise, taking into consideration the outcomes according to different patients' inclusion criteria and exercise methodology. Results: Twenty-two studies were deemed eligible for analysis. Weighted mean increase in ET resulted of 67 s (95% CI ranges from 55 to 79). For isotime IC and dyspnea during exercise, weighted improvements were 195 ml (162-229), and - 0.41 units (- 0.56 to - 0.27), respectively. The increase in trough IC was 157 ml (138-175). We found a trend in favour of LAMA compared to LABA in terms of ET. In the 11 studies which reported a value of functional residual capacity > 120% as inclusion criterion, weighted mean increase in endurance time was 94 s (65 to 123); however we did not find any significant correlation between ET and mean trough IC (P: 0.593). The improvement of ET in the 5 studies using walking as exercise methodology resulted of 58 s (- 4 to 121). Conclusions: Long-acting bronchodilators improve exercise capacity in COPD. The main effect of long-acting bronchodilators seems to be a decrease of basal IC rather than a modification of dynamic hyperinflation during exercise. The efficacy in terms of endurance time seems higher in studies which enrolled patients with hyperinflation, with a similar efficacy on walking or cycling

Combinations of QT-prolonging drugs: towards disentangling pharmacokinetic and pharmaco-dynamic effects in their potentially additive nature.

Background: Whether arrhythmia risks will increase if drugs with electrocardiographic (ECG) QT-prolonging properties are combined is generally supposed but not well studied. Based on available evidence, the Arizona Center for Education and Research on Therapeutics (AZCERT) classification defines the risk of QT prolongation for exposure to single drugs. We aimed to investigate how combining AZCERT drug categories impacts QT duration and how relative drug exposure affects the extent of pharmacodynamic drug–drug interactions. Methods: In a cohort of 2558 psychiatric inpatients and outpatients, we modeled whether AZCERT class and number of coprescribed QT-prolonging drugs correlates with observed rate-corrected QT duration (QTc) while also considering age, sex, inpatient status, and other QTc-prolonging risk factors. We concurrently considered administered drug doses and pharmacokinetic interactions modulating drug clearance to calculate individual weights of relative exposure with AZCERT drugs. Because QTc duration is concentration-dependent, we estimated individual drug exposure with these drugs and included this information as weights in weighted regression analyses. Results: Drugs attributing a ‘known’ risk for clinical consequences were associated with the largest QTc prolongations. However, the presence of at least two versus one QTc-prolonging drug yielded nonsignificant prolongations [exposure-weighted parameter estimates with 95% confidence intervals for ‘known’ risk drugs + 0.93 ms (–8.88;10.75)]. Estimates for the ‘conditional’ risk class increased upon refinement with relative drug exposure and coadministration of a ‘known’ risk drug as a further risk factor. Conclusions: These observations indicate that indiscriminate combinations of QTc-prolonging drugs do not necessarily result in additive QTc prolongation and suggest that QT prolongation caused by drug combinations strongly depends on the nature of the combination partners and individual drug exposure. Concurrently, it stresses the value of the AZCERT classification also for the risk prediction of combination therapies with QT-prolonging drugs

Leonardo Drone Contest 2021: Politecnico di Milano team architecture

In this paper, the winning solution of the second edition of the Leonardo Drone Contest (LDC), an autonomous drone competition, is presented. The participating teams were asked to design and build an autonomous system, capable of accomplishing complex tasks in an indoor urban-like environment. To reach this goal, the designed system should be capable of navigating in a Global Navigation Satellite System (GNSS)-denied environment with autonomous decision making, online planning and collision avoidance capabilities. In this light, the authors describe the competition, its rules and objectives, as well as the proposed solution in terms of hardware, software and algorithms