We describe the first case of acute cardiac injury directly linked to myocardial localization of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) in a 69‐year‐old patient with flu‐like ...symptoms rapidly degenerating into respiratory distress, hypotension, and cardiogenic shock. The patient was successfully treated with venous‐arterial extracorporeal membrane oxygenation (ECMO) and mechanical ventilation. Cardiac function fully recovered in 5 days and ECMO was removed. Endomyocardial biopsy demonstrated low‐grade myocardial inflammation and viral particles in the myocardium suggesting either a viraemic phase or, alternatively, infected macrophage migration from the lung.
Despite progress in clinical care for patients with coronavirus disease 2019 (COVID-19)
, population-wide interventions are still crucial to manage the pandemic, which has been aggravated by the ...emergence of new, highly transmissible variants. In this study, we combined the SIDARTHE model
, which predicts the spread of SARS-CoV-2 infections, with a new data-based model that projects new cases onto casualties and healthcare system costs. Based on the Italian case study, we outline several scenarios: mass vaccination campaigns with different paces, different transmission rates due to new variants and different enforced countermeasures, including the alternation of opening and closure phases. Our results demonstrate that non-pharmaceutical interventions (NPIs) have a higher effect on the epidemic evolution than vaccination alone, advocating for the need to keep NPIs in place during the first phase of the vaccination campaign. Our model predicts that, from April 2021 to January 2022, in a scenario with no vaccine rollout and weak NPIs (Formula: see text = 1.27), as many as 298,000 deaths associated with COVID-19 could occur. However, fast vaccination rollouts could reduce mortality to as few as 51,000 deaths. Implementation of restrictive NPIs (Formula: see text = 0.9) could reduce COVID-19 deaths to 30,000 without vaccinating the population and to 18,000 with a fast rollout of vaccines. We also show that, if intermittent open-close strategies are adopted, implementing a closing phase first could reduce deaths (from 47,000 to 27,000 with slow vaccine rollout) and healthcare system costs, without substantive aggravation of socioeconomic losses.
A new generation of Wireless Local Area Networks (WLANs) will make its appearance in the market in the forthcoming years based on the amendments to the IEEE 802.11 standards that have recently been ...approved or are under development. Examples of the most expected ones are IEEE 802.11aa (Robust Audio Video Transport Streaming), IEEE 802.11ac (Very-high throughput at < 6 GHz), IEEE 802.11af (TV White Spaces) and IEEE 802.11ah (Machine-to-Machine communications) specifications. The aim of this survey is to provide a comprehensive overview of these novel technical features and the related open technical challenges that will drive the future WLAN evolution. In contrast to other IEEE 802.11 surveys, this is a use case oriented study. Specifically, we first describe the three key scenarios in which next-generation WLANs will have to operate. We then review the most relevant amendments for each of these use cases focusing on the additional functionalities and the new technologies they include, such as multi-user MIMO techniques, groupcast communications, dynamic channel bonding, spectrum databases and channel sensing, enhanced power saving mechanisms and efficient small data transmissions. We also discuss the related work to highlight the key issues that must still be addressed. Finally, we review emerging trends that can influence the design of future WLANs, with special focus on software-defined MACs and the internet-working with cellular systems.
Over the last few years, standardisation efforts are consolidating the role of the Routing Protocol for Low-Power and Lossy Networks (RPL) as the standard routing protocol for IPv6-based Wireless ...Sensor Networks (WSNs). Although many core functionalities are well defined, others are left implementation dependent. Among them, the definition of an efficient link-quality estimation (LQE) strategy is of paramount importance, as it influences significantly both the quality of the selected network routes and nodes’ energy consumption. In this paper, we present RL-Probe, a novel strategy for link quality monitoring in RPL, which accurately measures link quality with minimal overhead and energy waste. To achieve this goal, RL-Probe leverages both synchronous and asynchronous monitoring schemes to maintain up-to-date information on link quality and to promptly react to sudden topology changes, e.g. due to mobility. Our solution relies on a reinforcement learning model to drive the monitoring procedures in order to minimise the overhead caused by active probing operations. The performance of the proposed solution is assessed by means of simulations and real experiments. Results demonstrated that RL-Probe helps in effectively improving packet loss rates, allowing nodes to promptly react to link quality variations as well as to link failures due to node mobility.
Beginning in December 2019, the 2019 novel coronavirus disease (COVID-19) has caused a pneumonia epidemic that began in Wuhan, China, and is rapidly spreading throughout the whole world. Italy is the ...hardest hit country after China. Considering the deleterious consequences of malnutrition, which certainly can affect patients with COVID-19, the aim of this article is to present a pragmatic protocol for early nutritional supplementation of non-critically ill patients hospitalized for COVID-19 disease. It is based on the observation that most patients present at admission with severe inflammation and anorexia leading to a drastic reduction of food intake, and that a substantial percentage develops respiratory failure requiring non-invasive ventilation or even continuous positive airway pressure.
High-calorie dense diets in a variety of different consistencies with highly digestible foods and snacks are available for all patients. Oral supplementation of whey proteins as well as intravenous infusion of multivitamin, multimineral trace elements solutions are implemented at admission. In the presence of 25-hydroxyvitamin D deficit, cholecalciferol is promptly supplied. If nutritional risk is detected, two to three bottles of protein-calorie oral nutritional supplements (ONS) are provided. If <2 bottles/d of ONS are consumed for 2 consecutive days and/or respiratory conditions are worsening, supplemental/total parenteral nutrition is prescribed.
We are aware that our straight approach may be debatable. However, to cope with the current emergency crisis, its aim is to promptly and pragmatically implement nutritional care in patients with COVID-19, which might be overlooked despite being potentially beneficial to clinical outcomes and effective in preventing the consequences of malnutrition in this patient population.
•Novel coronavirus disease (COVID-19) is spreading throughout the world and if nutritional care is not promptly implemented, malnutrition will affect also patients with the disease.•Most infected patients present with severe inflammation and anorexia leading to a drastic reduction of food intake; a large percentage develop respiratory failure.•A pragmatic protocol for early nutritional supplementation of patients with COVID-19 not in the intensive care unit was implemented.•Every effort should be made to avoid or limit underfeeding in patients with COVID-19, even if it means struggling against insurmountable difficulties due to the emergency scenario.
One of the most engaging challenges for mobile operators today is how to manage the exponential data traffic increase. Mobile data offloading stands out as a promising and low-cost solution to reduce ...the burden on the cellular network. To make this possible, we need a new hybrid network paradigm that leverages the existence of multiple alternative communication channels. This entails significant modifications in the way data are handled, affecting also the behavior of network protocols. In this paper, we present a comprehensive survey of data offloading techniques in cellular networks and extract the main requirements needed to integrate data offloading capabilities into today's mobile networks. We classify existing strategies into two main categories, according to their requirements in terms of content delivery guarantees: delayed and nondelayed offloading. We overview the technical aspects and discuss the state of the art in each category. Finally, we describe in detail the novel functionalities needed to implement mobile data offloading in the access network, as well as current and future research challenges in the field, with an eye toward the design of hybrid architectures.
Ride-hailing with autonomous electric vehicles and shared autonomous electric vehicle (SAEV) systems are expected to become widely used within this decade. These electrified vehicles can be key ...enablers of the shift to intermittent renewable energy by providing electricity storage to the grid and offering demand flexibility. In order to accomplish this goal, practical smart charging strategies for fleets of SAEVs must be developed. In this work, we present a scalable, flexible, and practical approach to optimise the operation of SAEVs including smart charging based on dynamic electricity prices. Our approach integrates independent optimisation modules with a simulation model to overcome the complexity and scalability limitations of previous works. We tested our solution on real transport and electricity data over four weeks using a publicly available dataset of taxi trips from New York City. Our approach can significantly lower charging costs and carbon emissions when compared to an uncoordinated charging strategy, and can lead to beneficial synergies for fleet operators, passengers, and the power grid.
PDF
