Cooperative coevolution approach to multi-community resilience design

LAUREA MAGISTRALENonostante i significativi progressi nell'investigazione e applicazione di misure di sicurezza e nella strutturazione di protocolli di risposta affidabili negl’ultimi anni, le communities - agglomerati sociali interconnessi - restano altamente vulnerabili a disastri naturali e causati dall’uomo. L’aumentare della complessità e dell’interconnessione dei sistemi di infrastruttura che sostengono le funzionalità delle communities ha imposto una crescente enfasi sulla loro resilienza. Il recupero post-disastro è un passo fondamentale nello sviluppo di communities resilienti. Tale processo è influenzato dall’allocazione di risorse da communities differenti e dalla scelta di investire nel recupero dei sistemi di infrastruttura o in soluzioni locali di emergenza. Ne segue che la resilienza di una community emerge dal processo decisionale coordinato tra le communities impattate e da una soluzione di trade-off tra investimenti globali e locali. Questa tesi propone una metodologia per il recupero resiliente di sistemi di infrastruttura interdipendenti guidato dal processo decisionale multi-communitiy, sostenuto da un approccio cooperative coevolution. Il modello di simulazione sviluppato fornisce uno strumento per aiutare la gestione del recupero resiliente post-disastro. La metodologia è testata su casi studio di letteratura con lo scopo di valutare criticamente i risultati e discutere le caratteristiche più importanti.Despite significant progress in the investigation and deployment of security and safety measures and in the structuring of reliable response protocols in recent years, communities are showing to be still highly vulnerable to natural and man-made hazards. The increasing complexity and interconnectivity of infrastructure systems, which make the critical lifeline of communities has led to a strong emphasis on communities’ resilience. Recovery after disruptions is a key step for building the resilience of communities. This process is influenced by the allocation of resources from different communities and the choice between investments on infrastructure recovery or local emergency solutions. Therefore, the overall community resilience emerges from the coordinated decision-making among the impacted communities and from the trade-off between global and local investments. This work proposes a methodology for the resilient recovery of interdependent infrastructure systems driven by multi-community decision making, sustained by a cooperative coevolution approach to optimization. The developed simulation model constitutes a practical tool for restoration management. The methodology is tested on benchmark case studies in order to critically evaluate the results and to cope with the computational burden. Moreover, the characteristic of the methodology and its flexibility are discussed

Narrazione e territorio. Un approccio narrativo all'identità territoriale per l'innovazione sociale

LAUREA MAGISTRALELa tesi riflette sulla relazione tra narrazione ed identità territoriale. Nello specifico indaga la capacità delle storie di influire sul modo in cui le persone si relazionano al territorio, e propone di sfruttare il coinvolgimento con i personaggi per rafforzare il senso di appartenenza degli abitanti rispetto al quartiere in cui vivono. La narrazione è una funzione della mente, con la quale ordiniamo e creiamo la realtà. La prima parte della tesi, affronta la letteratura sul tema della narrazione e ne evidenzia il ruolo nella costruzione di immaginari. Viene quindi condotta una riflessione sugli usi dello storytelling, approfondendo quelli volti al territorio e all’innovazione sociale, in cui la narrazione viene utilizzata per creare senso di comunità e appartenenza. La tesi riflette inoltre su quali siano gli elementi che definiscono l’identità territoriale ed in che modo questa sia legata all’identità personale, per individuare i fattori emotivi che determinano comportamenti diversi nei confronti del territorio. Successivamente analizza strutture e modelli narrativi, tra cui lo schema del “viaggio dell’eroe” di Vogler e il metodo di costruzione del mondo narrativo proposto da Pinardi e De Angelis, per poi concentrarsi sul ruolo dei personaggi nel coinvolgimento del pubblico. La parte progettuale sviluppa un mondo narrativo ed una strategia transmediale con l’obbiettivo di promuovere innovazione sociale, valorizzando l’identità dei quartieri di Dergano e Bovisa. L’approccio adottato parte dai personaggi e propone una particolare relazione narrativa fra questi, i luoghi finzionali ed i luoghi reali a cui si riferisce. La tesi riflette sul progetto nato nell’ambito del laboratorio di sintesi, alla luce dell’approfondimento teorico condotto.The thesis reflects on the connection between narrative and territorial identity. It investigates the ability of stories to influence the way people relate to the territory, and proposes to use the characters involvement to strengthen the inhabitants sense of belonging to their neighborhood. Narration is a mind function, we use to order and create reality. The first part of the thesis deals with narration literature and highlights its role in imaginaries construction. There is a reflection on the uses of storytelling, focusing on those for territory and social innovation, in which the narration aim to create a sense of community and belonging. The thesis also reflects on which elements define territorial identity and how this is linked to personal identity, in order to identify the emotional factors influencing different behaviors towards the territory. It then analyzes narrative structures and models, including Vogler's Hero’s journey scheme and the narrative world building method proposed by Pinardi and De Angelis, focusing on the role of the characters involving the public. The design part develops a narrative world and a transmedia strategy aiming to social innovation, by underlining the identity of Dergano and Bovisa districts. The approach adopted starts from the characters and proposes a particular narrative relationship between these, the fictional places and the real ones they refers to. The thesis reflects on the project born within the synthesis laboratory, in the light of the theoretical study conducted

Phase-rectified signal averaging method to predict perinatal outcome in infants with very preterm fetal growth restriction- a secondary analysis of TRUFFLE-trial

BACKGROUND: Phase-rectified signal averaging, an innovative signal processing technique, can be used to investigate quasi-periodic oscillations in noisy, nonstationary signals that are obtained from fetal heart rate. Phase-rectified signal averaging is currently the best method to predict survival after myocardial infarction in adult cardiology. Application of this method to fetal medicine has established significantly better identification than with short-term variation by computerized cardiotocography of growth-restricted fetuses. OBJECTIVE: The aim of this study was to determine the longitudinal progression of phase-rectified signal averaging indices in severely growth-restricted human fetuses and the prognostic accuracy of the technique in relation to perinatal and neurologic outcome. STUDY DESIGN: Raw data from cardiotocography monitoring of 279 human fetuses were obtained from 8 centers that took part in the multicenter European “TRUFFLE” trial on optimal timing of delivery in fetal growth restriction. Average acceleration and deceleration capacities were calculated by phase-rectified signal averaging to establish progression from 5 days to 1 day before delivery and were compared with short-term variation progression. The receiver operating characteristic curves of average acceleration and deceleration capacities and short-term variation were calculated and compared between techniques for short- and intermediate-term outcome. RESULTS: Average acceleration and deceleration capacities and short-term variation showed a progressive decrease in their diagnostic indices of fetal health from the first examination 5 days before delivery to 1 day before delivery. However, this decrease was significant 3 days before delivery for average acceleration and deceleration capacities, but 2 days before delivery for short-term variation. Compared with analysis of changes in short-term variation, analysis of (delta) average acceleration and deceleration capacities better predicted values of Apgar scores <7 and antenatal death (area under the curve for prediction of antenatal death: delta average acceleration capacity, 0.62 [confidence interval, 0.19–1.0]; delta short-term variation, 0.54 [confidence interval, 0.13–0.97]; P=.006; area under the curve for prediction Apgar <7: average deceleration capacity <24 hours before delivery, 0.64 [confidence interval, 0.52–0.76]; short-term variation <24 hours before delivery, 0.53 [confidence interval, 0.40–0.65]; P=.015). Neither phase-rectified signal averaging indices nor short-term variation showed predictive power for developmental disability at 2 years of age (Bayley developmental quotient, <95 or <85). CONCLUSIONS: The phase-rectified signal averaging method seems to be at least as good as short-term variation to monitor progressive deterioration of severely growth-restricted fetuses. Our findings suggest that for short-term outcomes such as Apgar score, phase-rectified signal averaging indices could be an even better test than short-term variation. Overall, our findings confirm the possible value of prospective trials based on phase-rectified signal averaging indices of autonomic nervous system of severely growth-restricted fetuses

The TRUFFLE study; fetal monitoring indications for delivery in 310 IUGR infants with 2 year's outcome delivered before 32 weeks of gestation.

OBJECTIVE: In the TRUFFLE study on outcome of early fetal growth restriction women were allocated to three timing of delivery plans according to antenatal monitoring strategies based on reduced computerized cardiotocographic heart rate short term variation (c-CTG STV) , early Ductus Venosus (DV p95) or late DV (DV noA) changes. However, many infants were per protocol delivered because of 'safety net' criteria, or for maternal indications, or 'other fetal indications' or after 32 weeks of gestation when the protocol was not applied anymore. It was the objective of the present post-hoc sub-analysis to investigate the indications for delivery in relation to outcome at 2 years in infants delivered before 32 weeks, to come to a further refinement of management proposals. METHODS: we included all 310 cases of the TRUFFLE study with known outcome at 2 years corrected age and 7 perinatal and infant deaths, apart from 7 cases with an inevitable death. Data were analyzed according to the randomization allocation and specified for the intervention indication. RESULTS: overall only 32% of fetuses born alive were delivered according to the specified monitoring parameter for indication for delivery. 38% were delivered because of safety net criteria, 15% because of other fetal reasons and 15% because of maternal reasons. In the c-CTG arm 51% of infants were delivered because of reduced STV. In the DV p95 arm 34% were delivered because of an abnormal DV and in the DV no A wave arm only 10% of cases were delivered accordingly. The majority of fetuses in the DV arms delivered for safety net criteria were delivered because of spontaneous decelerations. Two year's intact survival was highest in the combined DV arms as compared to the c-CTG arm (p = 0.05 when life born, p = 0.21 including fetal death), with no difference between the DV arms. Poorer outcome in the c-CTG arm was restricted to fetuses delivered because of decelerations in the safety net subgroup. Infants delivered because of maternal reasons had the highest birth weight and a non-significant higher intact survival. CONCLUSIONS: In this sub-analysis of fetuses delivered before 32 weeks the majority of infants were delivered for other reasons than according to the allocated CTG or DV monitoring strategy. Since in the DV arms CTG criteria were used as safety net criteria, but in the c-CTG arms no DV safety net criteria were applied, we speculate that the slightly poorer outcome in the CTG arm might be explained by absence of DV data. Optimal timing of delivery of the early IUGR fetus may therefore best be achieved by monitoring them longitudinally with DV and CTG monitoring

Longitudinal study of computerised cardiotocography in early fetal growth restriction.

OBJECTIVES: To explore if in early fetal growth restriction (FGR) the longitudinal pattern of short-term fetal heart rate (FHR) variation (STV) can be used for identifying imminent fetal distress and if abnormalities of FHR registration associate with two-year infant outcome. METHODS: The original TRUFFLE study assessed if in early FGR the use of ductus venosus Doppler pulsatility index (DVPI), in combination with a safety-net of very low STV and / or recurrent decelerations, could improve two-year infant survival without neurological impairment in comparison to computerised cardiotocography (cCTG) with STV calculation only. For this secondary analysis we selected women, who delivered before 32 weeks, and who had consecutive STV data for more than 3 days before delivery, and known infant two-year outcome data. Women who received corticosteroids within 3 days of delivery were excluded. Individual regression line algorithms of all STV values except the last one were calculated. Life table analysis and Cox regression analysis were used to calculate the day by day risk for a low STV or very low STV and / or FHR decelerations (DVPI group safety-net) and to assess which parameters were associated to this risk. Furthermore, it was assessed if STV pattern, lowest STV value or recurrent FHR decelerations were associated with two-year infant outcome. RESULTS: One hundred and fourty-nine women matched the inclusion criteria. Using the individual STV regression lines prediction of a last STV below the cCTG-group cut-off had a sensitivity of 0.42 and specificity of 0.91. For each day after inclusion the median risk for a low STV(cCTG criteria) was 4% (Interquartile range (IQR) 2% to 7%) and for a very low STV and / or recurrent decelerations (DVPI safety-net criteria) 5% (IQR 4 to 7%). Measures of STV pattern, fetal Doppler (arterial or venous), birthweight MoM or gestational age did not improve daily risk prediction usefully. There was no association of STV regression coefficients, a last low STV or /and recurrent decelerations with short or long term infant outcomes. CONCLUSION: The TRUFFLE study showed that a strategy of DVPI monitoring with a safety-net delivery indication of very low STV and / or recurrent decelerations could increase infant survival without neurological impairment at two years. This post-hoc analysis demonstrates that in early FGR the day by day risk of an abnormal cCTG as defined by the DVPI protocol safety-net criteria is 5%, and that prediction of this is not possible. This supports the rationale for cCTG monitoring more often than daily in these high-risk fetuses. Low STV and/or recurrent decelerations were not associated with adverse infant outcome and it appears safe to delay intervention until such abnormalities occur, as long as DVPI is in the normal range

Fulminant ulcerative colitis in a healthy pregnant woman

This case report concerns a 25-year-old patient with 6-7 bloody stools/d, abdominal pain, tachycardia, and weight loss occurring during the third trimester of pregnancy. Severe ulcerative colitis complicated by toxic megacolon and gravidic sepsis was diagnosed by clinical evaluation, colonoscopy, and rectal biopsy that were performed safely without risk for the mother or baby. The patient underwent a cesarean section at 28+6 wk gestation. The baby was transferred to the neonatal intensive care unit of our hospital and survived without complications. Fulminant colitis was managed conservatively by combined colonoscopic decompression and medical treatment. Although current European guidelines describe toxic megacolon as an indication for emergency surgery for both pregnant and non-pregnant women, thanks to careful monitoring, endoscopic decompression, and intensive medical therapy with nutritional support, we prevented the woman from having to undergo emergency pancolectomy. Our report seems to suggest that conservative management may be a helpful tool in preventing pancolectomy if the patient's condition improves quickly. Otherwise, surgery is mandatory

Gonadal Function in Male Patients With Metastatic Renal Cell Cancer Treated With Sunitinib

Background/aim: Single-agent tyrosine kinase inhibitors are still prescribed as first-line treatment to a relevant subgroup of patients with metastatic renal cell carcinoma (mRCC). These agents are known to cause disfunction of many endocrine glands (e.g., thyroid). In this two-step trial, we aimed to assess gonadal function among male patients with mRCC treated with sunitinib. Patients and methods: We enrolled a first cross-sectional cohort of pre-treated (>6 months) patients and a subsequent cohort of treatment-naïve patients who were prospectively followed-up. All patients were screened for hypogonadism and received a Functional Assessment of Cancer Therapy - General (FACT-G) questionnaire at study entry and after 6 months of therapy. Patients who were candidates for testosterone replacement therapy (TRT) also received a FACT-G questionnaire at baseline and 3 months after supplementation. Results: Among the 30 enrolled patients, the prevalence of hypogonadism was found to be higher in those receiving sunitinib for a longer period (27.3% at baseline, 41.7% in the first 6 months, and 68.4% after 9 months of therapy). The testosterone level of patients correlated with quality of life (R=0.32). A total of six patients received TRT, with a significant improvement in their global quality of life after the first 3 months of treatment. Conclusion: An increasing prevalence of hypogonadism was seen among male patients who received long-term treatment with sunitinib. TRT was associated with relevant improvements in quality of life. These findings corroborate similar published observations and encourage the assessment of gonadal function in male patients with mRCC under treatment with sunitinib

Osteoblastic flare in a patient with advanced gastric cancer after treatment with pemetrexed and oxaliplatin: implications for response assessment with RECIST criteria

<p>Abstract</p> <p>Background</p> <p>The RECIST guidelines are commonly used in phase II and III clinical trials. The correct definition of response can be controversial in some situations, as in the case we describe.</p> <p>Case presentation</p> <p>A 43 year-old man with advanced gastric cancer was enrolled in a phase II trial where he was treated with pemetrexed 500 mg/m²plus oxaliplatin 120 mg/m²every 3 weeks. At baseline, the target lesions were lymph-nodes, and the non-target lesions were small pulmonary nodules. At first re-evaluation, the target lesions showed partial response and the non-target lesions showed complete response, but new diffuse osteoblastic lesions appeared. The investigator decided to continue treatment until the second re-evaluation. CT scan confirmed the response of the target and non-target lesions, while the osteoblastic lesions did not change.</p> <p>Conclusion</p> <p>The appearance of osteoblastic lesions after an active antitumor treatment, a phenomenon known as flare, can complicate the definition of the best overall response using RECIST criteria. This possibility should be considered by oncologists involved in clinical trials.</p