Balloon Aortic Valvuloplasty as Bridge-to-Decision in High Risk Patients with Severe Aortic Valve Stenosis

Background. A sizable group of patients with symptomatic aortic stenosis (AS) can undergo neither surgical aortic valve replacement (AVR) nor transcatheter aortic valve implantation (TAVI) because of clinical contraindications. The aim of this study was to assess the potential role of balloon aortic valvuloplasty (BAV) as a “bridge-to-decision” in selected patients with severe AS and potentially reversible contraindications to definitive treatment. Methods. We retrospectively enrolled 645 patients who underwent first BAV at our Institution between July 2007 and December 2012. Of these, the 202 patients (31.2%) who underwent BAV as bridge-to-decision (BTD) requiring clinical re-evaluation represented our study population. BTD patients were further subdivided in 5 groups: low left ventricular ejection fraction; mitral regurgitation grade ≥3; frailty; hemodynamic instability; comorbidity. The main objective of the study was to evaluate how BAV influenced the final treatment strategy in the whole BTD group and in its single specific subgroups. Results. Mean logistic EuroSCORE was 23.5±15.3%, mean age was 81±7 years. Mean transaortic gradient decreased from 47±17 mmHg to 33±14 mmHg. Of the 193 patients with BTD-BAV who received a second heart team evaluation, 72.5% were finally deemed eligible for definitive treatment (25.4%for AVR; 47.2% for TAVI): respectively, 96.7% of patients with left ventricular ejection fraction recovery; 70.5% of patients with mitral regurgitation reduction; 75.7% of patients who underwent BAV in clinical hemodynamic instability; 69.2% of frail patients and 68% of patients who presented relevant comorbidities. 27.5% of the study population was deemed ineligible for definitive treatment and treated with standard therapy/repeated BAV. In-hospital mortality was 4.5%, cerebrovascular accident occurred in 1% and overall vascular complications were 4% (0.5% major; 3.5% minor). Conclusions. Balloon aortic valvuloplasty should be considered as bridge-to-decision in high-risk patients with severe aortic stenosis who cannot be immediate candidates for definitive percutaneous or surgical treatment.

Vision-Based Solutions for Human-Robot Collaboration in Industrial Workcells

Industrial robots are both versatile and high performant, enabling the flexible automation typical of the modern Smart Factories. For safety reasons, however, they must be relegated inside closed fences and/or virtual safety barriers, to keep them strictly separated from human operators. This can be a limitation in some scenarios in which it is useful to combine the human cognitive skill with the accuracy and repeatability of a robot, or simply to allow a safe coexistence in a shared workspace. Collaborative robots (cobots), on the other hand, are intrinsically limited in speed and power in order to share workspace and tasks with human operators, and feature the very intuitive hand guiding programming method. Cobots, however, cannot compete with industrial robots in terms of performance, and are thus useful only in a limited niche, where they can actually bring an improvement in productivity and/or in the quality of the work thanks to their synergy with human operators. The limitations of both the pure industrial and the collaborative paradigms can be overcome by combining industrial robots with artificial vision. In particular, vision can be exploited for a real-time adjustment of the pre-programmed task-based robot trajectory, by means of the visual tracking of dynamic obstacles (e.g. human operators). This strategy allows the robot to modify its motion only when necessary, thus maintain a high level of productivity but at the same time increasing its versatility. Other than that, vision offers the possibility of more intuitive programming paradigms for the industrial robots as well, such as the programming by demonstration paradigm. These possibilities offered by artificial vision enable, as a matter of fact, an efficacious and promising way of achieving human-robot collaboration, which has the advantage of overcoming the limitations of both the previous paradigms yet keeping their strengths.

Weak reasoning argumentative theory. A dialogical approach for the discovery of philosophy in high schools

In the literature on philosophical practices, despite the crucial role that argumentation plays in these activities, no specific argumentative theories have ever been proposed to assist the figure of the facilitator in conducting philosophical dialogue and to enhance student’s critical thinking skills. The dissertation starts from a cognitive perspective that challenges the classic Cartesian notion of rationality by focusing on limits and biases of human reasoning. An argumentative model (WRAT – Weak Reasoning Argumentative Theory) is then outlined in order to respond to the needs of philosophical dialogue. After justifying the claim that this learning activity, among other inductive methodologies, is the most suitable for critical thinking education, I inquired into the specific goal of ‘arguing’ within this context by means of the tools provided by Speech Act Theory: the speaker’s intention is to construct new knowledge by questioning her own and other’s beliefs. The model proposed has been theorized on this assumption, starting from which the goals, and, in turn, the related norms, have been pinpointed. In order to include all the epistemic attitudes required to accomplish the complex task of arguing in philosophical dialogue, I needed to integrate two opposed cognitive accounts, Dual Process Theory and Evolutionary Approach, that, although they provide incompatible descriptions of reasoning, can be integrated to provide a normative account of argumentation. The model, apart from offering a theoretical contribution to argumentation studies, is designed to be applied to the Italian educational system, in particular to classes in technical and professional high schools belonging to the newly created network Inventio. This initiative is one of the outcomes of the research project by the same name, which also includes an original Syllabus, research seminars, a monitoring action and publications focused on introducing philosophy, in the form of workshop activities, into technical and professional schools.

The influence of career histories on team perfomance in new product development: a study of the video game industry

The purpose of this research is to contribute to the literature on organizational demography and new product development by investigating how diverse individual career histories impact team performance. Moreover we highlighted the importance of considering also the institutional context and the specific labour market arrangements in which a team is embedded, in order to interpret correctly the effect of career-related diversity measures on performance. The empirical setting of the study is the videogame industry, and the teams in charge of the development of new game titles. Video games development teams are the ideal setting to investigate the influence of career histories on team performance, since the development of videogames is performed by multidisciplinary teams composed by specialists with a wide variety of technical and artistic backgrounds, who execute a significant amounts of creative thinking. We investigate our research question both with quantitative methods and with a case study on the Japanese videogame industry: one of the most innovative in this sector. Our results show how career histories in terms of occupational diversity, prior functional diversity and prior product diversity, usually have a positive influence on team performance. However, when the moderating effect of the institutional setting is taken in to account, career diversity has different or even opposite effect on team performance, according to the specific national context in which a team operates.

MicroRNAs expression analysis in high grade gliomas

Several biomarkers had been proposed as useful parameters to better define the prognosis or to delineate new target therapy strategies for glioblastoma (GBM) patients. MicroRNAs could represent interesting molecules, for their role in tumorigenesis and cancer progression and for their specific tissue expression. Although many studies have tried to identify a specific microRNAs signature for glioblastoma, by now an exhaustive GBM microRNAs profile is far to be well defined. In this work we set up a real-time qPCR, based on LNA primers, to investigate the expression of 19 microRNAs in brain tumors, focusing our attention on GBMs. MiRNAs expression in 30 GBM paired FFPE-Fresh/Frozen samples was firstly analyzed. The good correlation obtained comparing miRNAs results confirmed the feasibility of performing miRNAs analysis starting from FFPE tissues. This leads to many advantages, as a good disposal of archival tumor and normal brain specimens and the possibility to verify the percentage of tumor cells in the analyzed sample. In the second part we compared 3 non-neoplastic brain references to use as control in miRNAs analysis. Normal adjacent the tumor, epileptic specimens and a commercial total RNA were analyzed for miRNAs expression and results showed that different non-neoplastic controls could lead to important discrepancies in GBM miRNAs profiles. Analyzing 50 FFPE GBMs using all 3 non-neoplastic references, we defined a putative GBM miRNAs signature: mir-10b, miR-21 and miR-27a resulted upregulated, while miR-7, miR-9, miR-26a, miR-31, miR-101, miR-137, miR-222 and miR-330 were downregulated. Comparing miRNAs expression among GBM group and gliomas of grade I, II and III, we obtained 3 miRNAs (miR-10b, mir-34a and miR-101) showing a different regulation status between high grade and low grade gliomas. Intriguingly, miR-10b was upregulated in high grade and significantly downregulated in low grade gliomas, suggesting that could be a candidate for a GBM target therapy.

Operating System Contribution to Composable Timing Behaviour in High-Integrity Real-Time Systems

The development of High-Integrity Real-Time Systems has a high footprint in terms of human, material and schedule costs. Factoring functional, reusable logic in the application favors incremental development and contains costs. Yet, achieving incrementality in the timing behavior is a much harder problem. Complex features at all levels of the execution stack, aimed to boost average-case performance, exhibit timing behavior highly dependent on execution history, which wrecks time composability and incrementaility with it. Our goal here is to restitute time composability to the execution stack, working bottom up across it. We first characterize time composability without making assumptions on the system architecture or the software deployment to it. Later, we focus on the role played by the real-time operating system in our pursuit. Initially we consider single-core processors and, becoming less permissive on the admissible hardware features, we devise solutions that restore a convincing degree of time composability. To show what can be done for real, we developed TiCOS, an ARINC-compliant kernel, and re-designed ORK+, a kernel for Ada Ravenscar runtimes. In that work, we added support for limited-preemption to ORK+, an absolute premiere in the landscape of real-word kernels. Our implementation allows resource sharing to co-exist with limited-preemptive scheduling, which extends state of the art. We then turn our attention to multicore architectures, first considering partitioned systems, for which we achieve results close to those obtained for single-core processors. Subsequently, we shy away from the over-provision of those systems and consider less restrictive uses of homogeneous multiprocessors, where the scheduling algorithm is key to high schedulable utilization. To that end we single out RUN, a promising baseline, and extend it to SPRINT, which supports sporadic task sets, hence matches real-world industrial needs better. To corroborate our results we present findings from real-world case studies from avionic industry.

Non-thermal emission in High Frequency Peaked blazars towards the Square Kilometer Array era

In this thesis work we will explore and discuss the properties of the gamma-ray sources included in the first Fermi-LAT catalog of sources above 10 GeV (1FHL), by considering both blazars and the non negligible fraction of still unassociated gamma-ray sources (UGS, 13%). We perform a statistical analysis of a complete sample of hard gamma-ray sources, included in the 1FHL catalog, mostly composed of HSP blazars, and we present new VLBI observations of the faintest members of the sample. The new VLBI data, complemented by an extensive search of the archives for brighter sources, are essential to gather a sample as large as possible for the assessment of the significance of the correlation between radio and very high energy (E>100 GeV) emission bands. After the characterization of the statistical properties of HSP blazars and UGS, we use a complementary approach, by focusing on an intensive multi-frequency observing VLBI and gamma-ray campaign carried out for one of the most remarkable and closest HSP blazar Markarian 421.