Acute Q Fever Presenting with Multi-Organ Failure: Re-Evaluation of the Initial Diagnosis

We present the case of a 48-year-old man admitted to the critical care unit with atrial fibrillation, and acute heart and kidney failure accompanied by coagulopathy and an abnormal liver test. Initially diagnosed as a non-ST elevation myocardial infarction, re-evaluation of the case led to the consideration of severe sepsis. Q fever and leptospirosis were the most probable causes and empiric treatment was initiated. A complete recovery was achieved following treatment.

Ventricular Fibrillation in Patient with Multi-vessel Coronary Spasm Four Days after the Initiation of Oral Beta-blocker

We describe a case of ventricular fibrillation occurring in a patient with multi-vessel coronary spasm after the initiation of an oral beta-blocker. A 56-year-old man began to experience chest discomfort and his computed tomography revealed intermediate coronary stenoses. He was administered medications including an oral beta-blocker but suddenly collapsed while walking 4 days later. An automated external defibrillator detected ventricular fibrillation and delivered successful electrical cardioversion. An acetylcholine provocation test after stabilization of the status revealed triple-vessel coronary spasm. Beta-blockers may provoke exacerbation of coronary spasm and result in lethal arrhythmia.

A Case Against Fancy Decorated Drinks: Multi-Organ Failure After Drinking a Mojito Cocktail

We present the first case of gastro-intestinal perforation caused by a mint twig decorating a cocktail drink. A 76-year-old man was enjoying his Mojito cocktail on a cruise ship near Mexico when he accidently swallowed a mint twig, resulting in ileum perforation. This led to a cascade of events, eventually resulting in life-threatening multi-organ failure. Given this rare but potentially severe complication and the increasing popularity of decorated drinks, a less ‘fancy’ presentation for cocktails and similar drinks may be warranted.

Evaluation of the cytotoxic and genotoxic effects of benchmark multi-walled carbon nanotubes in relation to their physicochemical properties

To contribute with scientific evidence to the grouping strategy for the safety assessment of multi-walled carbon nanotubes (MWCNTs), this work describes the investigation of the cytotoxic and genotoxic effects of four benchmark MWCNTs in relation to their physicochemical characteristics, using two types of human respiratory cells. The cytotoxic effects were analysed using the clonogenic assay and replication index determination. A 48h-exposure of cells revealed that NM-401 was the only cytotoxic MWCNT in both cell lines, but after 8-days exposure, the clonogenic assay in A549 cells showed cytotoxic effects for all the tested MWCNTs. Correlation analysis suggested an association between the MWCNTs size in cell culture medium and cytotoxicity. No induction of DNA damage was observed after any MWCNTs in any cell line by the comet assay, while the micronucleus assay revealed that both NM-401 and NM-402 were genotoxic in A549 cells. NM-401 and NM-402 are the two longest MWCNTs analyzed in this work, suggesting that length may be determinant for genotoxicity. No induction of micronuclei was observed in Beas-2B cell line and the different effect in both cell lines is explained in view of the size-distribution of MWCNTs in the cell culture medium, rather than cell's specificities.

Feasibility study and flow scheduling optimization of a multi-product pipeline system

The first goal of this study is to analyse a real-world multiproduct onshore pipeline system in order to verify its hydraulic configuration and operational feasibility by constructing a simulation model step by step from its elementary building blocks that permits to copy the operation of the real system as precisely as possible. The second goal is to develop this simulation model into a user-friendly tool that one could use to find an “optimal” or “best” product batch schedule for a one year time period. Such a batch schedule could change dynamically as perturbations occur during operation that influence the behaviour of the entire system. The result of the simulation, the ‘best’ batch schedule is the one that minimizes the operational costs in the system. The costs involved in the simulation are inventory costs, interface costs, pumping costs, and penalty costs assigned to any unforeseen situations. The key factor to determine the performance of the simulation model is the way time is represented. In our model an event based discrete time representation is selected as most appropriate for our purposes. This means that the time horizon is divided into intervals of unequal lengths based on events that change the state of the system. These events are the arrival/departure of the tanker ships, the openings and closures of loading/unloading valves of storage tanks at both terminals, and the arrivals/departures of trains/trucks at the Delivery Terminal. In the feasibility study we analyse the system’s operational performance with different Head Terminal storage capacity configurations. For these alternative configurations we evaluated the effect of different tanker ship delay magnitudes on the number of critical events and product interfaces generated, on the duration of pipeline stoppages, the satisfaction of the product demand and on the operative costs. Based on the results and the bottlenecks identified, we propose modifications in the original setup.

Superior color rendering with a phosphor-converted blue-cyan monolithic light-emitting diode

The future generation of modern illumination should not only be cheap and highly efficient, but also demonstrate high quality of light, light which allows better color differentiation and fidelity. Here we are presenting a novel approach to create a white solid-state light source providing ultimate color rendition necessary for a number of applications. The proposed semi-hybrid device combines a monolithic blue-cyan light emitting diode (MBC LED) with a green-red phosphor mixture. It has shown a superior color rendering index (CRI), 98.6, at correlated color temperature of around 3400 K. The MBC LED epi-structure did not suffer from the efficiency reduction typical for monolithic multi-color emitters and was implemented in the two most popular chip designs: “epi-up” and “flip-chip”. Redistribution of the blue and cyan band amplitudes in the white-light emission spectrum, using the operating current, is found to be an effective tool for fine tuning the color characteristics. (Figure presented.).

Analisi multi-obiettivo in ottica lean-green della reverse logistics dei veicoli a fine vita (ELV)

La gestione del fine vita dei prodotti è un argomento di interesse attuale per le aziende; sempre più spesso l’imprese non possono più esimersi dall’implementare un efficiente sistema di Reverse Logistics. Per rispondere efficacemente a queste nuove esigenze diventa fondamentale ampliare i tradizionali sistemi logistici verso tutte quelle attività svolte all’interno della Reverse Logitics. Una gestione efficace ed efficiente dell’intera supply chain è un aspetto di primaria importanza per un’azienda ed incide notevolmente sulla sua competitività; proprio per perseguire questo obiettivo, sempre più aziende promuovono politiche di gestione delle supply chain sia Lean che Green. L’obiettivo di questo lavoro, nato dalle esigenze descritte sopra, è quello di applicare un modello innovativo che consideri sia politiche di gestione Lean, che dualmente politiche Green, alla gestione di una supply chain del settore automotive, comprendente anche le attività di gestione dei veicoli fuori uso (ELV). Si è analizzato per prima cosa i principi base e gli strumenti utilizzati per l’applicazione della Lean Production e del Green supply chain management e in seguito si è analizzato le caratteristiche distintive della Reverse Logistics e in particolare delle reti che trattano i veicoli a fine vita. L’obiettivo finale dello studio è quello di elaborare e implementare, tramite l’utilizzo del software AMPL, un modello di ottimizzazione multi-obiettivo (MOP- Multi Objective Optimization) Lean e Green a una Reverse Supply Chain dei veicoli a fine vita. I risultati ottenuti evidenziano che è possibile raggiungere un ottimo compromesso tra le due logiche. E' stata effettuata anche una valutazione economica dei risultati ottenuti, che ha evidenziato come il trade-off scelto rappresenti anche uno degli scenari con minor costi.

Aragonite-based scaffold for the treatment of knee osteochondral defects: results of a prospective multi-center trial at 2 years' follow-up

PURPOSE: To evaluate the clinical and MRI outcomes after the implantation of a nanostructured cell free aragonite-based scaffold in patients affected by knee chondral and osteochondral lesions. METHODS: 126 patients (94 men, 32 women; age 32.7±8.8 years) were included according to the following criteria: grade III or IV chondra/osteochondral lesions in the femoral condyles or throclea; 2) no limb axial deviation (i.e. varus or valgus knee > 5°); 3) no signs of knee instability; 4) no concurrent tibial or patellar chondral/osteochondral defects. All patients were treated by arthrotomic implantation of an aragonite based-scaffold by a press-fit technique. Patients were prospectively evaluated by IKDC, Tegner, Lysholm and KOOS scores preoperatively and then at 6, 12, 18 and 24-months follow-up. MRI was also performed to evaluate the amount of defect filling by regenerated cartilage. Failures were defined as the need for re-intervention in the index knee within the follow-up period. RESULTS: Average defect size was 2±1.3 cm2 and in most cases a single scaffold was used. A significant improvement in each clinical score was recorded from basal level to 24 months’ follow-up. In particular, the IKDC subjective score increased from 42.14±16 to 70.94±24.69 and the Tegner score improved from 2.95±1.90 to 4.82±1.85 (p<0.0005). Lysholm score and all the subscales of KOOS showed a similar trend over time. Age of the patient at implantation, size of the defect and BMI were correlated with lower clinical outcome. The presence of OA didn’t influence the clinical results. MRI evaluation showed a significant increase in defect filling over time, with the highest value reached at 24 months. Failures occurred in eleven patients (8.7%). CONCLUSION: The aragonite-based biomimetic osteochondral scaffold proved to be safe, and encouraging clinical and radiographic outcomes were documented up to 2 years’ follow-up.

A multi-methodological approach for the study of polymorphism in organic pigments and pharmaceuticals

The study of polymorphism has an important role in several fields of materials science, because structural differences lead to different physico-chemical properties of the system. This PhD work was dedicated to the investigation of polymorphism in Indigo, Thioindigo and Quinacridone, as case studies among the organic pigments employed as semiconductors, and in Paracetamol, Phenytoin and Nabumetone, chosen among some commonly used API. The aim of the research was to improve the understanding on the structures of bulk crystals and thin films, adopting Raman spectroscopy as the method of choice, while resorting to other experimental techniques to complement the gathered information. Different crystalline polymorphs, in fact, may be conveniently distinguished by their Raman spectra in the region of the lattice phonons (10-150 cm-1), the frequencies of which, probing the inter-molecular interactions, are very sensitive to even slight modifications in the molecular packing. In particular, we have used Confocal Raman Microscopy, which is a powerful, yet simple, technique for the investigation of crystal polymorphism in organic and inorganic materials, being capable of monitoring physical modifications, chemical transformations and phase inhomogeneities in crystal domains at the micrometre scale. In this way, we have investigated bulk crystals and thin film samples obtained with a variety of crystal growth and deposition techniques. Pure polymorphs and samples with phase mixing were found and fully characterized. Raman spectroscopy was complemented mainly by XRD measurements for bulk crystals and by AFM, GIXD and TEM for thin films. Structures and phonons of the investigated polymorphs were computed by DFT methods, and the comparison between theoretical and experimental results was used to assess the relative stability of the polymorphs and to assist the spectroscopic investigation. The Raman measurements were thus found to be able to clarify ambiguities in the phase assignments which otherwise the other methods were unable to solve.

Design of experiment in drug development: optimal allocations in multi-arm clinical trials and design space for multi-step processes

In this thesis, we deal with the design of experiments in the drug development process, focusing on the design of clinical trials for treatment comparisons (Part I) and the design of preclinical laboratory experiments for proteins development and manufacturing (Part II). In Part I we propose a multi-purpose design methodology for sequential clinical trials. We derived optimal allocations of patients to treatments for testing the efficacy of several experimental groups by also taking into account ethical considerations. We first consider exponential responses for survival trials and we then present a unified framework for heteroscedastic experimental groups that encompasses the general ANOVA set-up. The very good performance of the suggested optimal allocations, in terms of both inferential and ethical characteristics, are illustrated analytically and through several numerical examples, also performing comparisons with other designs proposed in the literature. Part II concerns the planning of experiments for processes composed of multiple steps in the context of preclinical drug development and manufacturing. Following the Quality by Design paradigm, the objective of the multi-step design strategy is the definition of the manufacturing design space of the whole process and, as we consider the interactions among the subsequent steps, our proposal ensures the quality and the safety of the final product, by enabling more flexibility and process robustness in the manufacturing.

Distributed Large-scale Mixed-Integer Optimization with Application to Energy and Multi-robot Networks

Several decision and control tasks in cyber-physical networks can be formulated as large- scale optimization problems with coupling constraints. In these "constraint-coupled" problems, each agent is associated to a local decision variable, subject to individual constraints. This thesis explores the use of primal decomposition techniques to develop tailored distributed algorithms for this challenging set-up over graphs. We first develop a distributed scheme for convex problems over random time-varying graphs with non-uniform edge probabilities. The approach is then extended to unknown cost functions estimated online. Subsequently, we consider Mixed-Integer Linear Programs (MILPs), which are of great interest in smart grid control and cooperative robotics. We propose a distributed methodological framework to compute a feasible solution to the original MILP, with guaranteed suboptimality bounds, and extend it to general nonconvex problems. Monte Carlo simulations highlight that the approach represents a substantial breakthrough with respect to the state of the art, thus representing a valuable solution for new toolboxes addressing large-scale MILPs. We then propose a distributed Benders decomposition algorithm for asynchronous unreliable networks. The framework has been then used as starting point to develop distributed methodologies for a microgrid optimal control scenario. We develop an ad-hoc distributed strategy for a stochastic set-up with renewable energy sources, and show a case study with samples generated using Generative Adversarial Networks (GANs). We then introduce a software toolbox named ChoiRbot, based on the novel Robot Operating System 2, and show how it facilitates simulations and experiments in distributed multi-robot scenarios. Finally, we consider a Pickup-and-Delivery Vehicle Routing Problem for which we design a distributed method inspired to the approach of general MILPs, and show the efficacy through simulations and experiments in ChoiRbot with ground and aerial robots.

Progetto di Sistemi di Regolazione dell'Alimentazione ad Alta Affidabilità per Processori Multi-Core

Quasi tutti i componenti del FIVR (regolatore di tensione Buck che fornisce l'alimentazione ai microprocessori multi-core) sono implementati sul die del SoC e quindi soffrono di problemi di affidabilità associati allo scaling della tecnologia microelettronica. In particolare, la variazione dei parametri di processo durante la fabbricazione e i guasti nei dispostivi di switching (circuiti aperti o cortocircuiti). Questa tesi si svolge in ambito di un progetto di ricerca in collaborazione con Intel Corporation, ed è stato sviluppato in due parti: Inizialmente è stato arricchito il lavoro di analisi dei guasti su FIVR, svolgendo un accurato studio su quelli che sono i principali effetti dell’invecchiamento sulle uscite dei regolatori di tensione integrati su chip. Successivamente è stato sviluppato uno schema di monitoraggio a basso costo in grado di rilevare gli effetti dei guasti più probabili del FIVR sul campo. Inoltre, lo schema sviluppato è in grado di rilevare, durante il tempo di vita del FIVR, gli effetti di invecchiamento che inducono un incorretto funzionamento del FIVR. Lo schema di monitoraggio è stato progettato in maniera tale che risulti self-checking nei confronti dei suoi guasti interni, questo per evitare che tali errori possano compromettere la corretta segnalazione di guasti sul FIVR.

Sistemi di Regolazione dell'Alimentazione Affidabili per Processori Multi-Core

I moderni processori multi-core ad elevate prestazioni sono alimentati da regolatori di tensione integrati direttamente sul chip. Questi regolatori forniscono a ciascun power domain la tensione ottimale sulla base della sua attività, monitorata da una Power Control Unit. Questo consente da un lato di ottenere una riduzione dei consumi, dall'altro di avere un boost delle prestazioni in particolari contesti. Tali regolatori integrati sul die sono affetti da guasti e fenomeni di aging, che possono compromettere il corretto funzionamento del circuito. Questi problemi non sono tollerabili in contesti caratterizzati da esigenze di elevata reliability, come l'autonomous driving. Dunque, è stato sviluppato un monitor per rivelare on-line eventuali guasti che possono verificarsi durante il normale funzionamento sul campo. In caso di guasto il monitor è in grado di dare un'indicazione d'errore, che può essere utilizzata per attivare delle procedure di recovery. La soluzione proposta, basata su un approccio completamente differente rispetto a quello suggerito dallo standard ISO 26262, beneficia, rispetto a quest'ultima, di costi nettamente inferiori e prestazioni superiori. Il monitor può essere calibrato automaticamente per compensare le variazioni dei parametri di processo ed i fenomeni di aging che possono affliggere il monitor stesso. È stata verificata la self-checking ability del monitor rispetto a guasti di tipo transistor stuck-on, transistor stuck-open e bridging resistivo, risultando Totally Self-Checking rispetto all'insieme di guasti considerato.

Development of novel multi-substituted apatite nanophases with advanced functionalities for bone regeneration

In the field of bone substitutes is highly researched an innovative material able to fill gaps with high mechanical performances and able to stimulate cell response, permitting the complete restoration of the bone portion. In this respect, the synthesis of new bioactive materials able to mimic the compositional, morphological and mechanical features of bone is considered as the elective approach for effective tissue regeneration. Hydroxyapatite (HA) is the main component of the inorganic part of bone. Additionally ionic substitution can be performed in the apatite lattice producing different effects, depending from the selected ions. Magnesium, in substitution of calcium, and carbonate, in substitution of phosphate, extensively present in the biological bones, are able to improve properties naturally present in the apatitic phase, (i.e. biomimicry, solubility e osteoinductive properties). Other ions can be used to give new useful properties, like antiresorptive or antimicrobial properties, to the apatitic phase. This thesis focused on the development of hydroxyapatite nanophases with multiple ionic substitutions including gallium, or zinc ions, in association with magnesium and carbonate, with the purpose to provide double synergistic functionality as osteogenic and antibacterial biomaterial. Were developed bioactive materials based on Sr-substituted hydroxyapatite in the form of sintered targets. The obtained targets were treated with Pulsed Plasma Deposition (PED) resulting in the deposition of thin film coatings able to improve the roughness and wettability of PEEK, enhancing its osteointegrability. Were investigated heterogeneous gas-solid reactions, addressed to the biomorphic transformations of natural 3D porous structures into bone scaffolds with biomimetic composition and hierarchical organization, for application in load-bearing sites. The kinetics of the different reactions of the process were optimized to achieve complete and controlled phase transformation, maintaining the original 3-D morphology. Massive porous scaffolds made of ion-substituted hydroxyapatite and bone-mimicking structure were developed and tested in 3-D cell culture models.

Robust Adaptive Control with Applications to Multi-Agent Systems and Mobile Robotics

This thesis deals with robust adaptive control and its applications, and it is divided into three main parts. The first part is about the design of robust estimation algorithms based on recursive least squares. First, we present an estimator for the frequencies of biased multi-harmonic signals, and then an algorithm for distributed estimation of an unknown parameter over a network of adaptive agents. In the second part of this thesis, we consider a cooperative control problem over uncertain networks of linear systems and Kuramoto systems, in which the agents have to track the reference generated by a leader exosystem. Since the reference signal is not available to each network node, novel distributed observers are designed so as to reconstruct the reference signal locally for each agent, and therefore decentralizing the problem. In the third and final part of this thesis, we consider robust estimation tasks for mobile robotics applications. In particular, we first consider the problem of slip estimation for agricultural tracked vehicles. Then, we consider a search and rescue application in which we need to drive an unmanned aerial vehicle as close as possible to the unknown (and to be estimated) position of a victim, who is buried under the snow after an avalanche event. In this thesis, robustness is intended as an input-to-state stability property of the proposed identifiers (sometimes referred to as adaptive laws), with respect to additive disturbances, and relative to a steady-state trajectory that is associated with a correct estimation of the unknown parameter to be found.