Hierarchical Traffic Management of Multi-AGV Systems With Deadlock Prevention Applied to Industrial Environments

This paper concerns the coordination and the traffic management of a group of Automated Guided Vehicles (AGVs) moving in a real industrial scenario, such as an automated factory or warehouse. The proposed methodology is based on a three-layer control architecture, which is described as follows: 1) the Top Layer (or Topological Layer) allows to model the traffic of vehicles among the different areas of the environment; 2) the Middle Layer allows the path planner to compute a traffic sensitive path for each vehicle; 3) the Bottom Layer (or Roadmap Layer) defines the final routes to be followed by each vehicle and coordinates the AGVs over time. In the paper we describe the coordination strategy we propose, which is executed once the routes are computed and has the aim to prevent congestions, collisions and deadlocks. The coordination algorithm exploits a novel deadlock prevention approach based on time-expanded graphs. Moreover, the presented control architecture aims at grounding theoretical methods to an industrial application by facing the typical practical issues such as graphs difficulties (load/unload locations, weak connections,), a predefined roadmap (constrained by the plant layout), vehicles errors, dynamical obstacles, etc. In this paper we propose a flexible and robust methodology for multi-AGVs traffic-aware management. Moreover, we propose a coordination algorithm, which does not rely on ad hoc assumptions or rules, to prevent collisions and deadlocks and to deal with delays or vehicle motion errors. Note to Practitioners-This paper concerns the coordination and the traffic management of a group of Automated Guided Vehicles (AGVs) moving in a real industrial scenario, such as an automated factory or warehouse. The proposed methodology is based on a three-layer control architecture, which is described as follows: 1) the Top Layer (or Topological Layer) allows to model the traffic of vehicles among the different areas of the environment; 2) the Middle Layer allows the path planner to compute a traffic sensitive path for each vehicle; 3) the Bottom Layer (or Roadmap Layer) defines the final routes to be followed by each vehicle and coordinates the AGVs over time. In the paper we describe the coordination strategy we propose, which is executed once the routes are computed and has the aim to prevent congestions, collisions and deadlocks. The coordination algorithm exploits a novel deadlock prevention approach based on time-expanded graphs. Moreover, the presented control architecture aims at grounding theoretical methods to an industrial application by facing the typical practical issues such as graphs difficulties (load/unload locations, weak connections, ), a predefined roadmap (constrained by the plant layout), vehicles errors, dynamical obstacles, etc. In this paper we propose a flexible and robust methodology for multi-AGVs traffic-aware management. Moreover, we propose a coordination algorithm, which does not rely on ad hoc assumptions or rules, to prevent collisions and deadlocks and to deal with delays or vehicle motion errors

Polymyositis following Pandemic Influenza A (H1N1) and 2009-10 Seasonal Trivalent Vaccines

Sporadic associations between inflammatory myopathies with vaccinations were described in the literature, raising the possible trigger value of vaccines in the development of these autoimmune disorders. Here, we reported the clinical history of 3 patients who developed polymyositis complicated by interstitial lung disease (2 cases) and dermatomyositis (1 case), after influenza A (H1N1) vaccination

Diagnosi e gestione dell’ anafilassi nel dipartimento di emergenza urgenza: revisione della casistica clinica dell’ anno 2014

Anaphylaxis is defined by the World Allergy Association as “a serious, life-threatening generalized or systemic hypersensitivity reaction” and “a serious allergic reaction that is rapid in onset and might cause death”. There are not many clinical studies about the diagnosis and the management of anaphylaxis. This is a study made in the Emergency Department of Nuovo Ospedale Civile S. Agostino Estense of Modena lasted 1 year. Patients discharged or hospitalized with the diagnosis of allergic reaction, anaphylaxis, urticaria, and angioedema have been considered. 45 patients were included in the study. Cutaneous symptoms were the most frequent (93,3%), followed by respiratory symptoms (73,3%), cardiovascular symptoms (44,4%) and gastroenteric symptoms (13,3%). The management of anaphylaxis was not good because epinephrine was administred only in 24,4% of patients. At the discharge, counselling was made in 70,6% of patients. As the international medical literature underlines, it is necessary to improve the management of anaphylaxis above all the treatment (epinephrine must be the first drug to administer in the ED) and the counselling

Analisi della suscettibilità da frana a scala di bacino (Bacino del Fiume Arno, Toscana-Umbria, Italia)

In questa nota vengono presentati i metodi applicati e i risultati ottenuti in una recente analisi della pericolosità da frana, condotta sul territorio del Bacino del Fiume Arno nell’ambito di una convenzione tra l’Autorità di Bacino e il Dipartimento di Scienze della Terra dell’Università di Firenze (2002-2005). Tutti i dati acquisiti, confluiti in una banca dati GIS, sono stati sintetizzati in carte tematiche e in una carta inventario delle frane. La sovrapposizione dei fattori predisponenti selezionati (pendenza, litologia, uso del suolo, curvatura di profilo e area drenata) ha permesso di definire le unità elementari per il trattamento statistico (Unità Territoriali Omogenee: UTO). La valutazione della pericolosità è stata estesa alle aree prive di movimenti franosi utilizzando metodi statistici multivariati implementati in Reti Neurali Artificiali. L’area di studio è stata suddivisa in cinque Macroaree morfologicamente e geologicamente omogenee: per ogni Macroarea, i predittori neurali sono stati addestrati su un opportuno sottoinsieme di dati, applicando poi i migliori all’intero data-set al fine di generare valori previsti dell’indice di suscettibilità per ogni UTO. Infine, i valori di uscita sono stati riclassificati in differenti livelli di pericolosità in base a criteri di soglia e validati per confronto con l’inventario. Una percentuale di area in frana compresa tra l’81 e il 96% risulta correttamente classificata dalla previsione nelle varie Macroare

Adjunctive therapy with vitamin c and thiamine in patients treated with steroids for refractory septic shock: A propensity matched before-after, case-control study

Purpose: Triple therapy with steroids, vitamin C and thiamine has been recently proposed as a safe and beneficial in patients with sepsis. In 2017, we added the use of intravenous vitamin C and thiamine in septic shock patients receiving low dose hydrocortisone because poorly responsive to vasopressors. Aim of this study is to verify whether triple therapy rather than steroids alone can improve outcome in patients with refractory shock. Materials and methods: In this before-after retrospective analysis, we compared septic shock patients admitted to our intensive care unit (ICU) who received triple therapy from June 2017 to November 2019 to septic shock patients who received only hydrocortisone from January 2015 to June 2017. Patients of the two study periods were matched 1:1 using a propensity score model. Results: A final cohort of 56 patients treated with triple therapy were matched to 56 patients treated only with steroids. Triple therapy reduced the length of mechanical ventilation (p = 0,01) and showed a trend in lowering the 30-day and hospital mortality compared to therapy with only hydrocortisone. Conclusions: Although with significant limitations, our experience indicated that triple therapy seems to provide an improvement of clinical outcomes in patients with refractory septic shock

Guide-wire replacement of a mini-midline catheter with a central venous catheter: A retrospective study on 63 cases

Background: Achieving a reliable venous access in a particular subset of patients and/or in emergency settings can be challenging and time-consuming. Furthermore, many hospitalized patients do not meet the criteria for central venous catheter positioning, unless an upgrade of the treatment is further needed. The mini-midline catheter has already showed to be reliable and safe as a stand-alone device, since it is easily and rapidly inserted and can indwell up to 1 month. Methods: In this further case series, we retrospectively evaluated data from 63 patients where a previously inserted mini-midline catheter was upgraded to a central venous catheter (the devices inserted in the arm replaced by peripherally inserted central catheter and others inserted “off-label” in the internal jugular replaced by single lumen centrally inserted central catheter), being used as introducer for the Seldinger guidewire. Results: The guidewire replacement was been made even early (after 1 day) or late (more than 10 days), usually following a need for an upgrade in treatment. No early or late complications were reported. Conclusion: According to the preliminary data we collected, this converting procedure seems to be feasible and risk-free, since neither infectious nor thrombotic complications were reported

Randomised controlled trial comparing efficacy and safety of high versus low Low-Molecular Weight Heparin dosages in hospitalized patients with severe COVID-19 pneumonia and coagulopathy not requiring invasive mechanical ventilation (COVID-19 HD): a structured summary of a study protocol.

To assess whether high doses of Low Molecular Weight Heparin (LMWH) (i.e. Enoxaparin 70 IU/kg twice daily) compared to standard prophylactic dose (i.e., Enoxaparin 4000 IU once day), in hospitalized patients with COVID19 not requiring Invasive Mechanical Ventilation [IMV], are: a)more effective in preventing clinical worsening, defined as the occurrence of at least one of the following events, whichever comes first: 1.Death2.Acute Myocardial Infarction [AMI]3.Objectively confirmed, symptomatic arterial or venous thromboembolism [TE]4.Need of either: a.Continuous Positive Airway Pressure (Cpap) or Non-Invasive Ventilation (NIV) orb.IMV in patients who at randomisation were receiving standard oxygen therapy5.IMV in patients who at randomisation were receiving non-invasive mechanical ventilationb)Similar in terms of major bleeding risk TRIAL DESIGN: Multicentre, randomised controlled, superiority, open label, parallel group, two arms (1:1 ratio), in-hospital study

Development of post-COVID-19 cardiovascular events: An analysis of clinical features and risk factors from a single hospital retrospective study

Cardiovascular complications after a SARS-CoV-2 infection are a phenomenon of relevant scientific inter-est. The aim of this study was to analyze the onset of post-COVID-19 cardiovascular events in patients hospitalized in a tertiary care center. This is a retrospective study conducted on patients hospitalized over a period of three months. The patients were older than 18 years of age and had a diagnosis of COVID-19 infection confirmed from a nasopharyngeal swab sample. Anamnestic and clinical-laboratory data were collected. Cardiovascular events at 30 days were defined as follows: arrhythmias, myocardial infarction, myocarditis, and pulmonary embolism. Univariate analysis (Student\u2019s t-test or Mann-Whitney U test, as appropriate) and multivariate analysis (multinomial logistic regression) were applied to the data. A total of 394 patients were included; they were mostly males and had a median age of 65.5 years. Previous cardiovascular disease was present in 14.7% of patients. Oxygen therapy was required for 77.9%, and 53% received anticoagulant therapy. The overall 30-day mortality was 20.3%. A cardiovascular event developed in 15.7% of the subjects. These were mainly pulmonary embolism (9.4%), followed by arrhythmias (3.3%), myocardial infarction (2.3%), and myocarditis (0.8%). Patients who developed cardiovascular events upon univariate analysis were significantly older, with major comorbidities, a more compromised respiratory situation, and a higher mortality rate. Multivariate analysis revealed independent factors that were significantly associated with the development of cardiovascular events: hypertension, endotracheal intubation, and age older than 75 years. In patients with COVID-19, the development of a cardiovascular event occurs quite frequently and is mainly seen in elderly subjects with comorbidities (especially hypertension) in the presence of a severe respiratory picture

Marked T cell activation, senescence, exhaustion and skewing towards TH17 in patients with Covid-19 pneumonia.

We provide an in-depth investigation of the T cell compartment and functionality, cytokine production and plasma levels in a total of 39 patients affected by Covid-19 pneumonia. At admission, patients were lymphopenic; for all, SARS-CoV-2 was detected in a nasopharyngeal swab specimen by real-time RT-PCR, and pneumonia was subsequently confirmed by X-rays. Detailed 18-parameter flow cytometry coupled with unsupervised data analysis revealed that patients showed similar percentages of CD4+ and CD8+ T cells, but a decreased absolute number in both populations. For CD4+ T lymphocytes, we found a significant decrease in the number of na\uefve, central and effector memory cells and an increased percentage of terminally differentiated cells, regulatory T cells, and of those that were activated or that were expressing PD1 and CD57 markers. Studies on chemokine receptors and lineage-specifying transcription factors revealed that, among CD4+ T cells, patients displayed a lower percentage of cells expressing CCR6 or CXCR3, and of those co-expressing CCR6 and CD161, but higher percentages of 62 CXCR4+ or CCR4+ cells. No differences were noted in the expression of T-bet or GATA-3. Analyses of patients' CD8+ T cells showed decreased numbers of na\uefve and central memory and increased amounts of activated cells, accompanied by increased percentages of activated cells and of lymphocytes expressing CD57, PD1, or both. CD8+ T cells expressed lower percentages of CCR6+, CXCR3+ or T-bet+ cells and of CXCR3+,T-bet+ or CCR6+,CD161+ lymphocytes. We also found higher percentages of cells expressing CCR4+, CXCR4 or GATA-3. Analyses of lymphocyte proliferation revealed that terminally differentiated CD4+ and CD8+ T cell from patients had a lower proliferative index than controls, whereas cellular bioenergetics, measured by the quantification of mitochondrial oxygen consumption and extracellular acidification rate, was similar in CD4+ T cells from both groups. We measured plasma level of 31 cytokines linked to inflammation, including T helper (TH)type-1 and TH2 cytokines, chemokines, galectins, pro- and anti-inflammatory mediators, finding that most were dramatically increased in Covid-19 patients, confirming the presence of a massive cytokine storm. Analysis of the production of different cytokines after stimulation by anti-CD3/CD28 monoclonal antibodies revealed that patients not only had a high capacity to produce tumour necrosis factor (TNF)-\u3b1, interferon (IFN)-\u3b3 and interleukin (IL)-2, but also showed a significant skewing of CD4+ T cells towards the TH17 phenotype. A therapeutic approach now exists based on the administration of drugs that block IL-6pathway, and seems to improve the disease. IL-17 is crucial in recruiting and activating neutrophils, cells that can migrate to the lung and are heavily involved in the pathogenesis of Covid-19. We show here that a skewing of activated T cells towards the TH17 functional phenotype exists in Covid-19 patients. We therefore suggest that blocking the IL-17 pathway by biological drugs that are already used to treat different pathologies could provide a novel, additional strategy to improve the health of patients infected by SARS-CoV-2

JLB: a flexible and effective device in critical patients. Review of clinical cases

JLB catheter (Deltamed Inc) is an alternative way to manage difficult venous access; it is placed under US-guidance in large bore veins, with an easy-sterile approach. Internal jugular vein (IJV) is the first choice for cannulation, followed by subclavian or deep upper-arm veins. The catheter is available in different lengths and gauges, it allows high flow rates and can be left in place up to 30 days. From June 2015 to March 2017, JLB has been positioned in 409 patients: in 354 as primary access in IJV, brachial or subclavian vein; in 55 cases JLB became an introducing line for the Seldinger guidewire and further CVC positioning. All clinical cases were reviewed selecting those with greater clinical relevance. We report 8 cases in which JLB resulted determinant for the patient treatment: a 16 years old obese girl born with perinatal distress, a 78 years old obese woman with hemorrhagic shock caused by gastrointestinal bleeding, a 40 years old man with severe hypokalemia, a 30 years old man with severe sepsis, a 40 years old man with Becker’s muscular dystrophy and severe sepsis, a 40 years old man with multiple myeloma who had to carry out cycles of chemotherapy, a 76 years old man with CMV pancolitis and myelofibrosis who needed parenteral nutrition, antiviral therapy and frequent blood and platelets transfusion. Moreover, it has been useful in elderly patients who needed to carry out palliative care for seniority or cancer lasting up to 30 days . In our experience the JLB catheter is safe, easy to place, quick and cost –effective. It is a valid solution either in unstable patients requiring an immediate access in emergency and stable patients with difficult venous access, in which invasive devices can be considered an over-treatment