HJB equations for the optimal control of differential equations with delay in the control variable

We study a class of optimal control problems with state constraint, where the state equation is a differential equation with delays in the control variable. This class of problems arises in some economic applications, in particular in optimal advertising problems. The optimal control problem is embedded in a suitable Hilbert space and the associated Hamilton- Jacobi-Bellman (HJB) equation is considered in this space. It is proved that the value function is continuous with respect to a weak norm and that it solves in the viscosity sense the associated HJB equation. The main result is the proof of a directional C1 regularity for the value function. This result represents the starting point to define a feedback map in classical sense going towards a verification theorem and the construction of optimal feedback controls for the problem

Randomized comparison of awake nonresectional versus nonawake resectional lung volume reduction surgery

ObjectiveThe study objective was to assess in a randomized controlled study (NCT00566839) the comparative results of awake nonresectional or nonawake resectional lung volume reduction surgery.MethodSixty-three patients were randomly assigned by computer to receive unilateral video-assisted thoracic surgery lung volume reduction surgery by a nonresectional technique performed through epidural anesthesia in 32 awake patients (awake group) or the standard resectional technique performed through general anesthesia in 31 patients (control group). Primary outcomes were hospital stay and changes in forced expiratory volume in 1 second. During follow-up, the need of contralateral treatment because of loss of postoperative benefit was considered a failure event as death.ResultsIntergroup comparisons (awake vs control) showed no difference in gender, age, and body mass index. Hospital stay was shorter in the awake group (6 vs 7.5 days, P = .04) with 21 versus 10 patients discharged within 6 days (P = .01). At 6 months, forced expiratory volume in 1 second improved significantly in both study groups (0.28 vs 0.29 L) with no intergroup difference (P = .79). In both groups, forced expiratory volume in 1 second improvements lasted more than 24 months. At 36 months, freedom from contralateral treatment was 55% versus 50% (P = .5) and survival was 81% versus 87% (P = .5).ConclusionsIn this randomized study, awake nonresectional lung volume reduction surgery resulted in significantly shorter hospital stay than the nonawake procedure. There were no differences between study groups in physiologic improvements, freedom from contralateral treatment, and survival. We speculate that compared with the nonawake procedure, awake lung volume reduction surgery can offer similar clinical benefit but a faster postoperative recovery

Deviations from the Schmidt-Kennicutt relations during early galaxy evolution

We utilize detailed time-varying models of the coupled evolution of stars and the HI, H_2, and CO-bright H_2 gas phases in galaxy-sized numerical simulations to explore the evolution of gas-rich and/or metal-poor systems, expected to be numerous in the Early Universe. The inclusion of the CO-bright H_2 gas phase, and the realistic rendering of star formation as an H_2-regulated process (and the new feedback processes that this entails) allows the most realistic tracking of strongly evolving galaxies, and much better comparison with observations. We find that while galaxies eventually settle into states conforming to Schmidt-Kennicutt (S-K) relations, significant and systematic deviations of their star formation rates (SFRs) from the latter occur, especially pronounced and prolonged for ... ...This indicates potentially serious limitations of (S-K)-type relations as reliable sub-grid elements of star formation physics in simulations of structure formation in the Early Universe. We anticipate that galaxies with marked deviations from the S-K relations will be found at high redshifts as unbiased inventories of total gas mass become possible with ALMA and the EVLA.Comment: 13 pages, 3 figures, accepted for publication in the Astrophysical Journa

Molecular gas, CO, and star formation in galaxies: emergent empirical relations, feedback, and the evolution of very gas-rich systems

We use time-varying models of the coupled evolution of the HI, H_2 gas phases and stars in galaxy-sized numerical simulations to: a) test for the emergence of the Kennicutt-Schmidt (K-S) and the H_2-pressure relation, b) explore a realistic H_2-regulated star formation recipe which brings forth a neglected and potentially significant SF-regulating factor, and c) go beyond typical galactic environments (for which these galactic empirical relations are deduced) to explore the early evolution of very gas-rich galaxies. In this work we model low mass galaxies (M_{\rm baryon} \le 10^9 \msun), while incorporating an independent treatment of CO formation and destruction, the most important tracer molecule of H2 in galaxies, along with that for the H2 gas itself. We find that both the K-S and the H_2-pressure empirical relations can robustly emerge in galaxies after a dynamic equilibrium sets in between the various ISM states, the stellar component and its feedback. (abridged)Comment: 32 pages, 9 figures, accepted for publication in Ap

Monitoring and modulation of respiratory drive in patients with acute hypoxemic respiratory failure in spontaneous breathing

Non-invasive respiratory support, namely, non-invasive ventilation, continuous positive airway pressure, and high-flow nasal cannula, has been increasingly used worldwide to treat acute hypoxemic respiratory failure, giving the benefits of keeping spontaneous breathing preserved. In this scenario, monitoring and controlling respiratory drive could be helpful to avoid patient self-inflicted lung injury and promptly identify those patients that require an upgrade to invasive mechanical ventilation. In this review, we first describe the physiological components affecting respiratory drive to outline the risks associated with its hyperactivation. Further, we analyze and compare the leading strategies implemented for respiratory drive monitoring and discuss the sedative drugs and the non-pharmacological approaches used to modulate respiratory drive during non-invasive respiratory support. Refining the available techniques and rethinking our therapeutic and monitoring targets can help critical care physicians develop a personalized and minimally invasive approach

Sizes and ages of SDSS ellipticals: Comparison with hierarchical galaxy formation models

In a sample of about 45,700 early-type galaxies extracted from SDSS, we find that the shape, normalization, and dispersion around the mean size-stellar mass relation is the same for young and old systems, provided the stellar mass is greater than 3*10^10 Msun. This is difficult to reproduce in pure passive evolution models, which generically predict older galaxies to be much more compact than younger ones of the same stellar mass. However, this aspect of our measurements is well reproduced by hierarchical models of galaxy formation. Whereas the models predict more compact galaxies at high redshifts, subsequent minor, dry mergers increase the sizes of the more massive objects, resulting in a flat size-age relation at the present time. At lower masses, the models predict that mergers are less frequent, so that the expected anti-correlation between age and size is not completely erased. This is in good agreement with our data: below 3*10^10 Msun, the effective radius R_e is a factor of ~2 lower for older galaxies. These successes of the models are offset by the fact that the predicted sizes have other serious problems, which we discuss.Comment: 13 pages, 9 Figures, 1 Table. Accepted by MNRA

HABITAT: An IoT Solution for Independent Elderly

In this work, a flexible and extensive digital platform for Smart Homes is presented, exploiting the most advanced technologies of the Internet of Things, such as Radio Frequency Identification, wearable electronics, Wireless Sensor Networks, and Artificial Intelligence. Thus, the main novelty of the paper is the system-level description of the platform flexibility allowing the interoperability of different smart devices. This research was developed within the framework of the operative project HABITAT (Home Assistance Based on the Internet of Things for the Autonomy of Everybody), aiming at developing smart devices to support elderly people both in their own houses and in retirement homes, and embedding them in everyday life objects, thus reducing the expenses for healthcare due to the lower need for personal assistance, and providing a better life quality to the elderly users

How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice

An explainable model of host genetic interactions linked to COVID-19 severity

We employed a multifaceted computational strategy to identify the genetic factors contributing to increased risk of severe COVID-19 infection from a Whole Exome Sequencing (WES) dataset of a cohort of 2000 Italian patients. We coupled a stratified k-fold screening, to rank variants more associated with severity, with the training of multiple supervised classifiers, to predict severity based on screened features. Feature importance analysis from tree-based models allowed us to identify 16 variants with the highest support which, together with age and gender covariates, were found to be most predictive of COVID-19 severity. When tested on a follow-up cohort, our ensemble of models predicted severity with high accuracy (ACC = 81.88%; AUCROC = 96%; MCC = 61.55%). Our model recapitulated a vast literature of emerging molecular mechanisms and genetic factors linked to COVID-19 response and extends previous landmark Genome-Wide Association Studies (GWAS). It revealed a network of interplaying genetic signatures converging on established immune system and inflammatory processes linked to viral infection response. It also identified additional processes cross-talking with immune pathways, such as GPCR signaling, which might offer additional opportunities for therapeutic intervention and patient stratification. Publicly available PheWAS datasets revealed that several variants were significantly associated with phenotypic traits such as "Respiratory or thoracic disease", supporting their link with COVID-19 severity outcome.A multifaceted computational strategy identifies 16 genetic variants contributing to increased risk of severe COVID-19 infection from a Whole Exome Sequencing dataset of a cohort of Italian patients

Carriers of ADAMTS13 Rare Variants Are at High Risk of Life-Threatening COVID-19

Thrombosis of small and large vessels is reported as a key player in COVID-19 severity. However, host genetic determinants of this susceptibility are still unclear. Congenital Thrombotic Thrombocytopenic Purpura is a severe autosomal recessive disorder characterized by uncleaved ultra-large vWF and thrombotic microangiopathy, frequently triggered by infections. Carriers are reported to be asymptomatic. Exome analysis of about 3000 SARS-CoV-2 infected subjects of different severities, belonging to the GEN-COVID cohort, revealed the specific role of vWF cleaving enzyme ADAMTS13 (A disintegrin-like and metalloprotease with thrombospondin type 1 motif, 13). We report here that ultra-rare variants in a heterozygous state lead to a rare form of COVID-19 characterized by hyper-inflammation signs, which segregates in families as an autosomal dominant disorder conditioned by SARS-CoV-2 infection, sex, and age. This has clinical relevance due to the availability of drugs such as Caplacizumab, which inhibits vWF-platelet interaction, and Crizanlizumab, which, by inhibiting P-selectin binding to its ligands, prevents leukocyte recruitment and platelet aggregation at the site of vascular damage