Withdrawal of mechanical ventilation in amyotrophic lateral sclerosis patients: a multicenter Italian survey

Background: Law 219/2017 was approved in Italy in December 2017, after a years-long debate on the autonomy of healthcare choices. This Law, for the first time in Italian legislation, guarantees the patient's right to request for withdrawal of life-sustaining treatments, including mechanical ventilation (MV). Objective: To investigate the current status of MV withdrawal in amyotrophic lateral sclerosis (ALS) patients in Italy and to assess the impact of Law 219/2017 on this practice. Methods: We conducted a Web-based survey, addressed to Italian neurologists with expertise in ALS care, and members of the Motor Neuron Disease Study Group of the Italian Society of Neurology. Results: Out of 40 ALS Italian centers, 34 (85.0%) responded to the survey. Law 219/2017 was followed by an increasing trend in MV withdrawals, and a significant increase of neurologists involved in this procedure (p 0.004). However, variations across Italian ALS centers were observed, regarding the inconsistent involvement of community health services and palliative care (PC) services, and the intervention and composition of the multidisciplinary team. Conclusions: Law 219/2017 has had a positive impact on the practice of MV withdrawal in ALS patients in Italy. The recent growing public attention on end-of-life care choices, along with the cultural and social changes in Italy, requires further regulatory frameworks that strengthen tools for self-determination, increased investment of resources in community and PC health services, and practical recommendations and guidelines for health workers involved

Numerical investigation on the seismic residual capacity of reinforced concrete beams’ plastic hinges

This research work aims to investigate the seismic residual capacity of earthquake-damaged beams’ plastic hinges, to support the decision-making in repair versus demolition. To this end, refined numerical models of reinforced concrete beams with different structural details are implemented in the finite element software DIANA. For each analysed configuration, capacity-reduction factors for stiffness (λk), strength (λQ), and deformation/ductility (λD) are derived to simulate the effects of different damaging earthquakes. Results show that, even for a slight level of damage, a non-negligible reduction of plastic hinges’ seismic capacity is observed, especially in terms of stiffnes