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First-order linear temporal logic (FOLTL) is a flexible and expressive formalism capable of naturally describing complex behaviors and properties. Although the logic is in general highly undecidable, the idea of using it as a specification language for the verification of complex infinite-state systems is appealing. However, a missing piece, which has proved to be an invaluable tool in dealing with other temporal logics, is an automaton model capable of capturing the logic. In this paper we address this issue, by defining and studying such a model, which we call first-order automaton. We define this very general class of automata, and the corresponding notion of regular first-order language, showing their closure under most common language-theoretic operations. We show how they can capture any FOLTL formula over any signature and theory, and provide sufficient conditions for the semi-decidability of their non-emptiness problem. Then, to show the usefulness of the formalism, we prove the decidability of monodic FOLTL, a classic result known in the literature, with a simpler and direct proof.

Background: A structured approach involves systematic management of trauma patients. We aim to conduct an overview of reviews about the clinical efficacy and safety of structured approach (i.e., primary and secondary survey) by guideline checklist compared to non-structured approach (i.e. clinical examination); moreover, routine screening whole-body computer tomography (WBCT) was compared to non-routine WBCT in patients with suspected major trauma.Methods: We systematically searched MEDLINE (PubMed), EMBASE and Cochrane Database of Systematic Reviews up to 3 May 2022. Systematic reviews (SRs) that investigated the use of a structured approach compared to a non-structured approach were eligible. Two authors independently extracted data, managed the overlapping of primary studies belonging to the included SRs and calculated the corrected covered area (CCA). The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.Results: We included nine SRs investigating two comparisons in stable trauma patients: structured approach vs non-structured approach (n = 1) and routine WBCT vs non-routine WBCT (n = 8). The overlap of included primary studies was generally high across outcomes (CCA ranged between 20.85 and 42.86%) with some discrepancies in the directions of effects across reviews. The application of a structured approach by checklist may improve adherence to guidelines (e.g. Advanced Trauma Life Support) during resuscitation and might lead to a reduction in mortality among severely injured patients as compared to clinical examination (Adjusted OR 0.51; 95% CI 0.30-0.89; p = 0.018; low certainty of evidence). The use of routine WBCT seems to offer little to no effects in reducing mortality and time spent in emergency room or department, whereas non-routine WBCT seems to offer little to no effects in reducing radiation dose, intensive care unit length of stay (LOS) and hospital LOS (low-to-moderate

Purpose:The effect of systemic hemostatic agents initiated during pre-hospital care of severely injured patients with ongoing bleeding or traumatic brain injury (TBI) remains controversial. A systematic review and meta-analysis was therefore conducted to assess the effectiveness and safety of systemic hemostatic agents as an adjunctive therapy in people with major trauma and hemorrhage or TBI in the context of developing the Italian National Institute of Health guidelines on major trauma integrated management. Methods:PubMed, Embase, and Cochrane Library databases were searched up to October 2021 for studies that investigated pre-hospital initiated treatment with systemic hemostatic agents. The certainty of evidence was evaluated with the Grading of Recommendations Assessment, Development, and Evaluation approach, and the quality of each study was determined with the Cochrane risk-of-bias tool. The primary outcome was overall mortality, and secondary outcomes included cause-specific mortality, health-related quality of life, any adverse effects and blood product use, hemorrhage expansion, and patient-reported outcomes. Results:Five trials of tranexamic acid (TXA) met the inclusion criteria for this meta-analysis. With a high certainty of evidence, when compared to placebo TXA reduced mortality at 24 h (relative risk = 0.83, 95% confidence interval = 0.73-0.94) and at 1 month among trauma patients (0.91, 0.85-0.97). These results depend on the subgroup of patients with significant hemorrhage because in the subgroup of TBI there are no difference between TXA and placebo. TXA also reduced bleeding death and multiple organ failure whereas no difference in health-related quality of life. Conclusion:Balancing benefits and harms, TXA initiated in the pre-hospital setting can be used for patients experiencing major trauma with significant hemorrhage since it reduces the risk of mortality at 24 h and one month with no difference in terms of adverse effects when compared to p

In this extended abstract, we discuss about Linear Temporal Logic Modulo Theories over finite traces (LTL_f^MT), a temporal logic that we recently introduced with the goal of providing an equilibrium between generality of the formalism and decidability of the logic. After recalling its distinguishing features, we discuss some future applications.

BACKGROUND Early detection of critical bleeding by accurate tools can help ensure rapid delivery of blood products to improve outcomes in major trauma patients. We conducted a systematic review to evaluate the accuracy of risk tools to predict critical bleeding in patients with major trauma. METHODS PubMed, Embase, and CENTRAL were searched up to February 2021 for studies investigating risk tools to predict critical bleeding for major trauma people in prehospital and emergency department. We followed the Preferred Reporting Items for Systematic Review and Meta-Analysis of Diagnostic Test Accuracy study guidelines. Two independent authors included studies, extracted data, appraised the quality using the Quality Assessment of Diagnostic Accuracy Studies 2 and assessed the certainty of evidence (CoE) using the Grading of Recommendations Assessment, Development and Evaluation methodology. Sensitivity, specificity, and the receiver operating characteristics curve for all selected triage tools. RESULTS Eighty-nine observational studies for adults and 12 observational studies for children met our inclusion criteria. In adults, we found 23 externally validated and 28 unvalidated tools; in children, 3 externally validated tools and 5 unvalidated. In the externally validated tools, we identified those including clinical, laboratory, and ultrasound assessments. Among tools including only a clinical assessment, the Shock Index showed high sensitivity and specificity with the CoE ranging from very low to moderate in adults, as well as Shock Index Pediatric Age adjusted with a moderate CoE. We found that tools using clinical, laboratory, and ultrasound assessments were overall more accurate than those tools without all three components. CONCLUSION Clinicians should consider risk tools to predict critical bleeding in a time-sensitive setting like major life-threatening trauma. The Shock Index and Shock Index Pediatric Age adjusted are easy and handy tools to predict critical bleed

Background: Systematic reviews can apply the Appraisal of Guidelines for Research & Evaluation (AGREE) II tool to critically appraise clinical practice guidelines (CPGs) for treating low back pain (LBP); however, when appraisals differ in CPG quality rating, stakeholders, clinicians, and policy-makers will find it difficult to discern a unique judgement of CPG quality. We wanted to determine the proportion of overlapping CPGs for LBP in appraisals that applied AGREE II. We also compared inter-rater reliability and variability across appraisals. Methods: For this meta-epidemiological study we searched six databases for appraisals of CPGs for LBP. The general characteristics of the appraisals were collected; the unit of analysis was the CPG evaluated in each appraisal. The inter-rater reliability and the variability of AGREE II domain scores for overall assessment were measured using the intraclass correlation coefficient and descriptive statistics. Results: Overall, 43 CPGs out of 106 (40.6%) overlapped in seventeen appraisals. Half of the appraisals (53%) reported a protocol registration. Reporting of AGREE II assessment was heterogeneous and generally of poor quality: overall assessment 1 (overall CPG quality) was rated in 11 appraisals (64.7%) and overall assessment 2 (recommendation for use) in four (23.5%). Inter-rater reliability was substantial/perfect in 78.3% of overlapping CPGs. The domains with most variability were Domain 6 (mean interquartile range [IQR] 38.6), Domain 5 (mean IQR 28.9), and Domain 2 (mean IQR 27.7). Conclusions: More than one third of CPGs for LBP have been re-appraised in the last six years with CPGs quality confirmed in most assessments. Our findings suggest that before conducting a new appraisal, researchers should check systematic review registers for existing appraisals. Clinicians need to rely on updated CPGs of high quality and confirmed by perfect agreement in multiple appraisals.

Growth of artificial intelligence and machine learning (ML) methodology has been explosive in recent years. In this class of procedures, computers get knowledge from sets of experiences and provide forecasts or classification. In genome-wide based prediction (GWP), many ML studies have been carried out. This chapter provides a description of main semiparametric and nonparametric algorithms used in GWP in animals and plants. Thirty-four ML comparative studies conducted in the last decade were used to develop a meta-analysis through a Thurstonian model, to evaluate algorithms with the best predictive qualities. It was found that some kernel, Bayesian, and ensemble methods displayed greater robustness and predictive ability. However, the type of study and data distribution must be considered in order to choose the most appropriate model for a given problem.

In the context of verification of data-aware processes, a formal approach based on satisfiability modulo theories (SMT) has been considered to verify parameterised safety properties. This approach requires a combination of model-theoretic notions and algorithmic techniques based on backward reachability. We introduce here Ontology-Based Processes, which are a variant of one of the most investigated models in this spectrum, namely simple artifact systems (SASs), where, instead of managing a database, we operate over a description logic (DL) ontology. We prove that when the DL is expressed in (a slight extension of) RDFS, it enjoys suitable model-theoretic properties, and that by relying on such DL we can define Ontology-Based Processes to which backward reachability can still be applied. Relying on these results we are able to show that in this novel setting, verification of safety properties is decidable in PSPACE.

The impact of voids on structural metal performance has been investigated in the context of two case studies: nanovoids as strengtheners in irradiated materials, and void growth size effects during ductile failure.Nanovoid Strengthening: When nanoscale in diameter, voids can act as obstacles to dislocation motion, resulting in strengthening reminiscent of precipitation hardening. This is especially relevant to irradiated metals in applications such as nuclear power plants. Local regions of very highly concentrated nanovoid defect clusters within irradiated metals are observed to cause material strengthening, meaning bulk yielding behavior is altered from what is expected in the original material design. However, it is not yet possible to reliably predict the consequence of nanovoids in metals with existing models, as they are not informed by the fundamental mechanisms behind this response. To address this, the meso-scale simulation technique Phase Field Dislocation Dynamics (PFDD) is applied to the problem in Chapter 2. This technique is an energetic framework within which rigorous discrete dislocation physics is applied, and which allows for larger simulation cell sizes than are commonly available to lower-length-scale methods.Surprisingly, the critical stress is found to scale linearly with the ratio of the intrinsic to unstable stacking fault energies, and to scale directly with the linear void fraction. This novel empirical strengthening model is named the Linear Fraction (LF) Model, and is thought to be driven by the dynamic constriction and extension of the stacking fault width as the two dissociated partials of an fcc dislocation bow around a nanovoid obtacle. This deviates from the expected line-tension-approximation mechanism due to bowing around an obstacle, which has until now been used to inform analytical predictive models. Remarkably, this new strengthening trend holds for the vast majority of fcc metals and void size arrays tested, and in Chapter 3 it

Conformance checking is a key process mining task to confront the normative behavior imposed by a process model with the actual behavior recorded in a log. While this problem has been extensively studied for pure control-flow processes, data-aware conformance checking has received comparatively little attention. In this paper, we tackle the conformance checking problem for the challenging scenario of processes that combine data and control-flow dimensions. Concretely, we adopt the formalism of data Petri nets (DPNs) and show how solid, well-established automated reasoning techniques from the area of Satisfiability Modulo Theories (SMT) can be effectively harnessed to compute conformance metrics and optimal data-aware alignments. To this end, we introduce the CoCoMoT (Computing Conformance Modulo Theories) framework, with a fourfold contribution. First, we show how SMT allows to leverage SAT-based encodings for the pure control-flow setting to the data-aware case. Second, we introduce a novel preprocessing technique based on a notion of property-preserving clustering, to speed up the computation of conformance checking outputs. Third, we show how our approach extends seamlessly to the more comprehensive conformance checking artifacts of multi- and anti-alignments. Fourth, we describe a proof-of-concept implementation based on state-of-the-art SMT solvers, and report on experiments. Finally, we discuss how CoCoMoT directly lends itself to further process mining tasks like log analysis by clustering and model repair, and the use of SMT facilitates the support of even richer multi-perspective models, where, for example, more expressive DPN guards languages are considered or generic datatypes (other than integers or reals) are employed.

Background: Evidence-based practice (EBP) is being rapidly adopted by the Italian physiotherapy community, although a knowledge gap persists at clinical level with consequent lack of integration of EBP into ground roots practice. Teaching of EBP during the Bachelor of Science (BSc) undergraduate course in physiotherapy likely has a vital role to play in the spread of knowledge, providing a grounding in the fundamental concepts of EBP. The aim of the present study was to investigate the prevalence of EBP educational content in Italian BSc courses in physiotherapy. Methods: This is a cross-sectional study during which characteristics of EBP teaching in BSc degree courses of physiotherapy in Italy were collected from institutional websites during the period May to September 2021 with an update in August 2022. We used the STrengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines for our manuscript.Results: Forty-two physiotherapy BSc degree programs were retrieved, accounting for all the BSc delivered in the 2021–2022 academic year. Fourteen of these (33.3%) did not report EBP content. Northern universities provided EBP content in 16 out of 18 (88%) degree courses. Central Italian universities provided EBP content in 6 out of 9 (66.6%) degree courses. Southern universities delivered EBP content in 3 out of 9 (33.3%) degree courses. The universities of Sicily and Sardinia provided EBP content in 2 out of 5 (40%) degree courses. The degree courses taught in public universities were more likely to contain EBP material (25 out of 37, 67.4%), compared to those taught within the private system (3 out of 5, 60%). Conclusions: The prevalence of EBP content within physiotherapy BSc degree programs in Italy can be considered suboptimal, with both regional differences and according to the system (public vs private). The results of this study could be used as a stimulus fo

Background Evidence-based practice (EBP) is being rapidly adopted by the Italian physiotherapy community, although a knowledge gap persists at clinical level with consequent lack of integration of EBP into ground roots practice. Teaching of EBP during the Bachelor of Science (BSc) undergraduate course in physiotherapy likely has a vital role to play in the spread of knowledge, providing a grounding in the fundamental concepts of EBP. The aim of the present study was to investigate the prevalence of EBP educational content in Italian BSc courses in physiotherapy. Methods This is a cross-sectional study during which characteristics of EBP teaching in BSc degree courses of physiotherapy in Italy were collected from institutional websites during the period May to September 2021 with an update in August 2022. We used the STrengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines for our manuscript. Results Forty-two physiotherapy BSc degree programs were retrieved, accounting for all the BSc delivered in the 2021–2022 academic year. Fourteen of these (33.3%) did not report EBP content. Northern universities provided EBP content in 16 out of 18 (88%) degree courses. Central Italian universities provided EBP content in 6 out of 9 (66.6%) degree courses. Southern universities delivered EBP content in 3 out of 9 (33.3%) degree courses. The universities of Sicily and Sardinia provided EBP content in 2 out of 5 (40%) degree courses. The degree courses taught in public universities were more likely to contain EBP material (25 out of 37, 67.4%), compared to those taught within the private system (3 out of 5, 60%). Conclusions The prevalence of EBP content within physiotherapy BSc degree programs in Italy can be considered suboptimal, with both regional differences and according to the system (public vs private). The results of this study could be used as a stimulus for increasing investment in the teaching of EBP in Italian physiotherapy degree cour

Real-world processes operate on objects that are inter-dependent. To accurately reflect the nature of such processes, object-centric process mining techniques are needed, notably conformance checking. However, while the object-centric perspective has recently gained traction, few concrete process mining techniques have been presented so far. Moreover, existing approaches are severely limited in their abilities to keep track of object identity and object dependencies. Consequently, serious problems in logs remain undetected. In this paper, we present a new formalism that combines the key modelling features of two existing approaches, in particular the ability of object-centric Petri nets to capture one-to-many relations and the one of Petri nets with identifiers to compare and synchronize objects based on their identity. We call the resulting formalism 'object-centric Petri nets with identifiers', and define alignments and the conformance checking task for this setting. We propose a conformance checking approach for such nets based on an encoding in satisfiability modulo theories (SMT), and illustrate how it can be effectively used to overcome shortcomings of earlier work. To assess its practicality, we perform an evaluation on data from the literature.

The need to model and analyse dynamic systems operating over complex data is ubiquitous in AI and neighboring areas, in particular business process management. Analysing such data-aware systems is a notoriously difficult problem, as they are intrinsically infinite-state. Existing approaches work for specific datatypes, and/or limit themselves to the verification of safety properties. In this paper, we lift both such limitations, studying for the first time linear-time verification for so-called data-aware processes modulo theories (DMTs), from the foundational and practical point of view. The DMT model is very general, as it supports processes operating over variables that can store arbitrary types of data, ranging over infinite domains and equipped with domain-specific predicates. Specifically, we provide four contributions. First, we devise a semi-decision procedure for linear-time verification of DMTs, which works for a very large class of datatypes obeying to mild model-theoretic assumptions. The procedure relies on a unique combination of automata-theoretic and cover computation techniques to respectively deal with linear-time properties and datatypes. Second, we identify an abstract, semantic property that guarantees the existence of a faithful finite-state abstraction of the original system, and show that our method becomes a decision procedure in this case. Third, we identify concrete, checkable classes of systems that satisfy this property, generalising several results in the literature. Finally, we present an implementation and a first experimental evaluation.

We study Linear Temporal Logic Modulo Theories over Finite Traces (LTLfMT), a recently introduced extension of LTL over finite traces (LTLf) where propositions are replaced by first-order formulas and where first-order variables referring to different time points can be compared. In general, LTLfMT was shown to be semi-decidable for any decidable first-order theory (e.g., linear arithmetics), with a tableau-based semi-decision procedure. In this paper we present a sound and complete pruning rule for the LTLfMT tableau. We show that for any LTLfMT formula that satisfies an abstract, semantic condition, that we call finite memory, the tableau augmented with the new rule is also guaranteed to terminate. Last but not least, this technique allows us to establish novel decidability results for the satisfiability of several fragments of LTLfMT, as well as to give new decidability proofs for classes that are already known., Comment: Extended version of a conference paper accepted at the 26th European Conference on Artificial Intelligence (ECAI 2023)

Background. Major trauma describes serious injuries requiring lifesaving interventions or resulting in long-term disability; it represents about 8% of all deaths worldwide. Specific guidelines can help reduce deaths and disabilities, provided they adhere to high quality and trustworthiness standards. This article aims at introducing the development process of the Istituto Superiore di Sanità, ISS (Italian National Institute of Health) guideline for major trauma integrated management. Methods. We applied the ISS methodological standards including the GRADE-ADOLOPMENT approach for adoption, adaptation, and de novo development of trustworthy guidelines. Results. The scope was formulated by the multidisciplinary panel with stakeholders’ involvement; two guidelines were identified as appropriate sources for adolopment. Forty questions from the two source guidelines were prioritised and five new ones formulated. New systematic reviews or updates were conducted for each clinical question, Evidence to Decision frameworks developed or re-assessed and the recommendations formulated after public consultations and external review. The policy on conflicts of interest was applied throughout the process. Conclusions. Through a broad expertise representation, the early and wide stakeholders’ participation, a continual process for disclosure and management of conflict of interests and the transparency of the process, ISS standards are proving to be an efficient model for developing trustworthy clinical guidance.

Background: We conducted a systematic review to evaluate and compare the accuracy of pre-hospital triage tools for major trauma in the context of the development of the Italian National Institute of Health guidelines on major trauma integrated management. Methods: PubMed, Embase, and CENTRAL were searched up to November 2019 for studies investigating pre-hospital triage tools. The ROC (receiver operating characteristics) curve and net clinical benefit for all selected triage tools were performed. Quality assessment was performed using the Quality Assessment of Diagnostic Accuracy Studies–2. Certainty of the evidence was judged with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results: We found 15 observational studies of 13 triage tools for adults and 11 for children. In adults, according to the ROC curve and the net clinical benefit, the most reliable tool was the Northern French Alps Trauma System (TRENAU), adopting injury severity score (ISS) > 15 as reference (sensitivity (Sn), 0.92; specificity (Sp), 0.41; 1 study; sample size, 2572; high certainty of the evidence). When mortality as reference was considered, the pre-hospital triage tool with the best net clinical benefit trajectory was the New Trauma Score (NTS) < 18 (Sn, 0.82; Sp, 0.86; 1 study; sample size, 1001; moderate certainty of the evidence). In children, high variability among all triage tools for sensitivity and specificity was found. Conclusion: Sensitivity and specificity varied across all available pre-hospital trauma triage tools. TRENAU and NTS are the best accurate triage tools for adults, whereas in the pediatric area a large variability prevents any firm conclusion.

Background: Multiple studies regarding the use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in patients with non-compressible torso injuries and uncontrolled haemorrhagic shock were recently published. To date, the clinical evidence of the efficacy of REBOA is still debated. We aimed to conduct a systematic review assessing the clinical efficacy and safety of REBOA in patients with major trauma and uncontrolled haemorrhagic shock. Methods: We systematically searched MEDLINE (PubMed), EMBASE and CENTRAL up to June 2020. All randomized controlled trials and observational studies that investigated the use of REBOA compared to resuscitative thoracotomy (RT) with/without REBOA or no-REBOA were eligible. We followed the PRISMA and MOOSE guidelines. Two authors independently extracted data and appraised the risk of bias of included studies. Effect sizes were pooled in a meta-analysis using random-effects models. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation methodology. Primary outcomes were mortality, volume of infused blood components, health-related quality of life, time to haemorrhage control and any adverse effects. Secondary outcomes were improvement in haemodynamic status and failure/success of REBOA technique. Results: We included 11 studies (5866 participants) ranging from fair to good quality. REBOA was associated with lower mortality when compared to RT (aOR 0.38; 95% CI 0.20–0.74), whereas no difference was observed when REBOA was compared to no-REBOA (aOR 1.40; 95% CI 0.79–2.46). No significant difference in health-related quality of life between REBOA and RT (p = 0.766). The most commonly reported complications were amputation, haematoma and pseudoaneurysm. Sparse data and heterogeneity of reporting for all other outcomes prevented any estimate. Conclusions: Our findings on overall mortality suggest a positive effect of REBOA among non-compressible torso injuries when c

Trauma is one of the leading causes of uncontrolled haemorrhage, death, and disability. Use of a tourniquet can be considered an optimal anti-haemorrhagic resource, in pre-hospital and emergency settings, and its lifesaving effect is clinically contradictory. This review aims to assess the clinical efficacy of the tourniquet in the emergency pre-hospital care setting for the management of haemorrhage. We conducted the systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, the PRISMA statement. We searched the following electronic databases: EMBASE, MEDLINE, and Cochrane-CENTRAL. All studies included were appraised for risk of bias. Prevalent primary outcomes were mortality and use of blood products. Secondary outcomes were related to adverse effects. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach (GRADE). Four studies were involved (1762 trauma patients). The adjusted odds ratio (aOR) of 0.47 (95% confidence Interval (CI) 0.19-1.16; three studies; 377 patients) for overall mortality estimates did not give a clear indication of the benefits of emergency pre-hospital tourniquets (PH-TQ) versus no pre-hospital tourniquet (NO PH-TQ) placement. The adjusted mean difference for blood product use was −3.28 (95% CI −11.22, 4.66) for packed red blood cells (pRBC) and −4.80 (95% CI −5.61, −3.99) for plasma, respectively. The certainty of evidence was downgraded to very low for all outcomes. Our results suggest an unclear effect of emergency pre-hospital tourniquet placement on overall mortality and blood product use. However, this systematic review highlights the availability of only observational studies and the absence of high quality RCTs assessing the efficacy of PH-TQs. Randomized controlled trials are needed.

Objectives. The purpose of this study was to explore the prevalence, personal- and work-related exposures, and signs and symptoms among physical therapists during the first wave of coronavirus disease 2019 (COVID-19) in Italy. Methods. This cross-sectional, survey-based study collected demographic and exposure data from physical therapists from April to May 2020. All physical therapists working in inpatient and outpatient care in Italy were eligible. A self-administered questionnaire was distributed among all eligible physical therapists to collect (1) demographic characteristics, (2 3) personaland work-related exposures, and (4) signs and symptoms of COVID-19. Factors associated with a COVID-19 positive nasopharyngeal swab (NPS) were explored through logistic regression models and multivariate methods. Results. A total of 15,566 respondents completed the survey, with a response rate of 43.3%, achieving high statistical precision (99% CI, 1% type I error). Among physical therapists who received NPS testing, 13.1% (95% CI=12.1 14.1%) had a positive result, with a peak reached in March 2020 (36%). The top 5 symptoms were fatigue and tiredness (69.1%), loss of smell (64.5%), aches and pains (60.8%), loss of taste (58.3%), and headache (51.1%). No symptoms were reported by 8.9%. Working in a health care institution (odds ratio [OR]=12.0; 95% CI=7.8 18.4), being reallocated to a different unit (OR=1.9; 95% CI=1.3 2.7), and changing job tasks (OR=1.6; 95% CI=1.2 2.3) increased the risk of being COVID-19 positive. In therapists with a confirmed diagnosis of COVID-19, comorbidities were associated with male sex and age older than 51 years. Conclusion. During the first wave in Italy, almost 1 out of 7 physical therapists tested positive on the COVID-19 NPS test. Considering personal- andwork-related exposures, health care organizations should adopt preventionmeasures and adequate preparedness to prevent high rate of infections during future pandemics. Impact. This is the lar

Background: Coronavirus disease 2019 (COVID-19) broke out in China in December 2019 and now is a pandemic all around the world. In Italy, Northern regions were hit the hardest during the first wave. We aim to explore the prevalence and the exposure characteristics of physiotherapists (PTs) working in different Italian regions during the first wave of COVID-19. Methods: Between April and May 2020 a structured anonymous online survey was distributed to all PTs registered in the National Professional Registry to collect prevalence data of a confirmed diagnosis of COVID-19 (i.e., nasopharyngeal swab and/or serological test). A bottom-up agglomerative nesting hierarchical clustering method was applied to identify groups of regions based on response rate. Multivariable logistic regression was used to explore personal and work-related factors associated with a confirmed diagnosis of COVID-19. Results: A total of 15,566 PTs completed the survey (response rate 43.3%). The majority of respondents (57.7%) were from Northern regions. Considering all respondents, the number of confirmed COVID-19 cases in Northern and Central Italy, was higher compared to those in Southern Italy (6.9% vs. 1.8%, P < 0.001); focusing the analysis on respondents who underwent nasopharyngeal swab and/or serological test led to similar findings (14.1% vs. 6.4%, P < 0.001). Working in Northern and Central regions was associated with a higher risk of confirmed diagnosis of COVID-19 compared to Southern regions (OR 3.4, 95%CI 2.6 to 4.3). PTs working in Northern and Central regions were more likely to be reallocated to a different unit and changing job tasks, compared to their colleagues working in the Southern regions (10.5% vs 3.7%, P < 0.001). Conclusions: Work-related risk factors were differently distributed between Italian regions at the time of first pandemic wave, and PTs working in the Northern and Central regions were more at risk of a confirmed diagnosis of COVID-19, especially when w

A versatile class of composite materials composed of functional filler particles in polymer matrices are increasingly used in high-performance applications that leverage their adaptable mechanical, electrical, thermal, and other functional properties. The choice of constituent materials largely determines these properties: for example, long fibers redistribute stress efficiently, highly conductive filler particles impart their conductivity to the material, and combinations of ionic and electrically conductive fillers with energy storage materials increase the capacity of battery electrodes. The performance of these composites, however, is highly dependent on the internal arrangement of particles. Consequently, controlling this internal structure enables property improvements and novel functionalities. In particular, combining microstructure control with the design freedom of 3D printing presents opportunities to maximize the performance of functional components by spatially modulating properties and their directionality (e.g. reinforcing high-stress regions, prescribing electrical interconnects, or directing heat away from hot spots), as well as introducing novel combinations of properties.To develop this structural control in printed materials, this work utilizes pressure fields to assemble filler particles into patterns within composites during 3D printing. Particle patterns are engineered to improve material properties by leveraging microscopic acoustic forces on particles, tailoring the particle arrangement for improvements in the functionality of the material. This acoustic patterning technique is integrated into 3D printing with attention to processing constraints (e.g. component and feature sizes, material properties, cost, throughput rate, etc.) required in existing and emerging technological applications. In particular, 3D printed composites with high electrical or thermal conductivity, which are simultaneously mechanically flexible or strain-tolerant, are

A versatile class of composite materials composed of functional filler particles in polymer matrices are increasingly used in high-performance applications that leverage their adaptable mechanical, electrical, thermal, and other functional properties. The choice of constituent materials largely determines these properties: for example, long fibers redistribute stress efficiently, highly conductive filler particles impart their conductivity to the material, and combinations of ionic and electrically conductive fillers with energy storage materials increase the capacity of battery electrodes. The performance of these composites, however, is highly dependent on the internal arrangement of particles. Consequently, controlling this internal structure enables property improvements and novel functionalities. In particular, combining microstructure control with the design freedom of 3D printing presents opportunities to maximize the performance of functional components by spatially modulating properties and their directionality (e.g. reinforcing high-stress regions, prescribing electrical interconnects, or directing heat away from hot spots), as well as introducing novel combinations of properties.To develop this structural control in printed materials, this work utilizes pressure fields to assemble filler particles into patterns within composites during 3D printing. Particle patterns are engineered to improve material properties by leveraging microscopic acoustic forces on particles, tailoring the particle arrangement for improvements in the functionality of the material. This acoustic patterning technique is integrated into 3D printing with attention to processing constraints (e.g. component and feature sizes, material properties, cost, throughput rate, etc.) required in existing and emerging technological applications. In particular, 3D printed composites with high electrical or thermal conductivity, which are simultaneously mechanically flexible or strain-tolerant, are

Modeling and verification of dynamic systems operating over a relational representation of states are increasingly investigated problems in AI, Business Process Management, and Database Theory. To make these systems amenable to verification, the amount of information stored in each relational state needs to be bounded, or restrictions are imposed on the preconditions and effects of actions. We introduce the general framework of relational action bases (RABs), which generalizes existing models by lifting both these restrictions: unbounded relational states can be evolved through actions that can quantify both existentially and universally over the data, and that can exploit numerical datatypes with arithmetic predicates. We then study parameterized safety of RABs via (approximated) SMT-based backward search, singling out essential meta-properties of the resulting procedure, and showing how it can be realized by an off-the-shelf combination of existing verification modules of the state-of-the-art MCMT model checker. We demonstrate the effectiveness of this approach on a benchmark of data-aware business processes. Finally, we show how universal invariants can be exploited to make this procedure fully correct., Comment: Extended version of the conference paper 'Safety Verification and Universal Invariants for Relational Action Bases' by the same authors, accepted at the 32nd International Joint Conference on Artificial Intelligence (IJCAI 2023)

This paper studies Linear Temporal Logic over Finite Traces (LTLf) where proposition letters are replaced with first-order formulas interpreted over arbitrary theories, in the spirit of Satisfiability Modulo Theories. The resulting logic, called LTLf Modulo Theories (LTLfMT), is semi-decidable. Nevertheless, its high expressiveness comes useful in a number of use cases, such as model-checking of data-aware processes and data-aware planning. Despite the general undecidability of these problems, being able to solve satisfiable instances is a compromise worth studying. After motivating and describing such use cases, we provide a sound and complete semi-decision procedure for LTLfMT based on the SMT encoding of a one-pass tree-shaped tableau system. The algorithm is implemented in the BLACK satisfiability checking tool, and an experimental evaluation shows the feasibility of the approach on novel benchmarks., Comment: Extended version of a conference paper accepted at the 31st International Joint Conference on Artificial Intelligence (IJCAI-ECAI 2022)

Interpolation is an essential tool in software verification, where first-order theories are used to constrain datatypes manipulated by programs. In this paper, we introduce the datatype theory of contiguous arrays with maxdiff, where arrays are completely defined in their allocation memory and for which maxdiff returns the max index where they differ. This theory is strictly more expressive than the array theories previously studied. By showing via an algebraic analysis that its models strongly amalgamate, we prove that this theory admits quantifier-free interpolants and, notably, that interpolation transfers to theory combinations. Finally, we provide an algorithm that significantly improves the ones for related array theories: it relies on a polysize reduction to general interpolation in linear arithmetics, thus avoiding impractical full terms instantiations and unbounded loops., Comment: arXiv admin note: text overlap with arXiv:2010.07082

Logs of real-life processes often feature uncertainty pertaining the recorded timestamps, data values, and/or events. We consider the problem of checking conformance of uncertain logs against data-aware reference processes. Specifically, we show how to solve it via SMT encodings, lifting previous work on data-aware SMT-based conformance checking to this more sophisticated setting. Our approach is modular, in that it homogeneously accommodates for different types of uncertainty. Moreover, using appropriate cost functions, different conformance checking tasks can be addressed. We show the correctness of our approach and witness feasibility through a proof-of-concept implementation., Comment: Extended version of a conference paper accepted at the 20th International Conference on Business Process Management (BPM 2022)

Question: Which is the most effective conservative intervention for patients with non-specific chronic neck pain (CNSNP)? Design: A systematic review and network meta-analysis of randomised clinical trials. Participants: Adults with CNSNP of at least 3 months duration. Interventions: All available pharmacological and non-pharmacological interventions. Outcome measures: The primary outcomes were pain intensity and disability. The secondary outcome was adverse events. Results: Overall, 119 RCTs (12,496 patients; 32 interventions) were included. Risk of bias was low in 50.4% of trials, unclear in 22.7% and high in 26.9%. Compared with inert treatment, a combination of active and/or passive multimodal non-pharmacological inventions (eg, exercise and manual therapy) were effective for pain on a 0-to-10 scale at 1 month (MD range 0.84 to 3.74) and at 3 to 6 months (MD range 1.06 to 1.49), and effective on disability on a 0-to-100 scale at 1 month (MD range 10.26 to 14.09) and 3 to 6 months (MD range 5.60 to 16.46). These effects ranged from possible to definite clinical relevance. Compared with inert treatment, anti-inflammatory drugs alone or in combination with another non-pharmacological treatment did not reduce pain at 1 month or 3 to 6 months. At 12 months, no superiority was found over inert treatment on both outcomes. Most mild adverse events were experienced following acupuncture/dry needling intervention. On average, the evidence varied from low to very low certainty. Conclusions: While multimodal non-pharmacological interventions may reduce pain and disability for up to 3 to 6 months of follow-up when compared with inert treatment, the evidence was very uncertain about their effects. Better quality and larger trials are needed to improve the certainty of evidence.

Background: Non-specific low back pain (LBP) is the leading cause of disability worldwide. Acute LBP usually has a good prognosis, with rapid improvement within the first 6 weeks. However, the majority of patients develop chronic LBP and suffer from recurrences. For clinical management, a plethora of treatments is currently available but evidence of the most effective options is lacking. The objective of this study will be to identify the most effective interventions to relieve pain and reduce disability in acute and sub-acute non-specific LBP. Methods/design: We will search electronic databases (MEDLINE, Embase, CENTRAL) from inception onwards. The eligible population will be individuals with non-specific LBP older than 18 years, both males and females, who experience pain less than 6 weeks (acute) or between 6 and 12 weeks (subacute). Eligible interventions and comparators will include all conservative rehabilitation or pharmacological treatments provided by any health professional; the only eligible study design will be a randomized controlled trial. The primary outcomes will be pain intensity and back-specific functional status. Secondary outcomes will be any adverse events. Studies published in languages other than English will also potentially be included. Two reviewers will independently screen the titles and abstracts retrieved from a literature search, as well as potentially relevant full-text articles. General characteristics, potential effect modifiers, and outcome data will be extracted from the included studies, and the risk of bias will be appraised. Conflicts at all levels of screening and abstraction will be resolved through team discussions. After describing the results of the review, if appropriate, a random effects meta-analysis and network meta-analysis will be conducted in a frequentist setting, assuming equal heterogeneity across all treatment comparisons and accounting for correlations induced by multi-arm studies using a multivariate normal m

Background: Non-specific low back pain (LBP) is the leading cause of disability worldwide. Acute LBP usually has a good prognosis, with rapid improvement within the first 6 weeks. However, the majority of patients develop chronic LBP and suffer from recurrences. For clinical management, a plethora of treatments is currently available but evidence of the most effective options is lacking. The objective of this study will be to identify the most effective interventions to relieve pain and reduce disability in acute and sub-acute non-specific LBP. Methods/design: We will search electronic databases (MEDLINE, Embase, CENTRAL) from inception onwards. The eligible population will be individuals with non-specific LBP older than 18 years, both males and females, who experience pain less than 6 weeks (acute) or between 6 and 12 weeks (subacute). Eligible interventions and comparators will include all conservative rehabilitation or pharmacological treatments provided by any health professional; the only eligible study design will be a randomized controlled trial. The primary outcomes will be pain intensity and back-specific functional status. Secondary outcomes will be any adverse events. Studies published in languages other than English will also potentially be included. Two reviewers will independently screen the titles and abstracts retrieved from a literature search, as well as potentially relevant full-text articles. General characteristics, potential effect modifiers, and outcome data will be extracted from the included studies, and the risk of bias will be appraised. Conflicts at all levels of screening and abstraction will be resolved through team discussions. After describing the results of the review, if appropriate, a random effects meta-analysis and network meta-analysis will be conducted in a frequentist setting, assuming equal heterogeneity across all treatment comparisons and accounting for correlations induced by multi-arm studies using a multivariate normal m

In the context of verification of data-aware processes, a formal approach based on satisfiability modulo theories (SMT) has been considered to verify parameterised safety properties of so-called artifactcentric systems. This approach requires a combination of model-theoretic notions and algorithmic techniques based on backward reachability. We introduce here a variant of one of the most investigated models in this spectrum, namely simple artifact systems (SASs), where, instead of managing a database, we operate over a description logic (DL) ontology expressed in (a slight extension of) RDFS. This DL, enjoying suitable model-theoretic properties, allows us to define DL-based SASs to which backward reachability can still be applied, leading to decidability in PSpace of the corresponding safety problems.

In the context of verification of data-aware processes, a formal approach based on satisfiability modulo theories (SMT) has been considered to verify parameterised safety properties of so-called artifactcentric systems. This approach requires a combination of model-theoretic notions and algorithmic techniques based on backward reachability. We introduce here a variant of one of the most investigated models in this spectrum, namely simple artifact systems (SASs), where, instead of managing a database, we operate over a description logic (DL) ontology expressed in (a slight extension of) RDFS. This DL, enjoying suitable model-theoretic properties, allows us to define DL-based SASs to which backward reachability can still be applied, leading to decidability in PSpace of the corresponding safety problems.

In this paper we highlight a yet unexplored dimension in BPM in general, and conformance checking, in particular. While a breadth of research has focused in differentiating conforming versus nonconforming process executions, little it is known about the difference between different conforming traces. This is of particular importance in the light of the fact that not all conforming executions are equal: some achieve the intended outcome better than others. In this position paper, we demonstrate why existing model-driven and data-driven techniques are not enough to attack the problem in its full generality, and that novel methods to combine them in ways that have not yet been explored are essential within BPM.

In the context of verification of data-aware processes, a formal approach based on satisfiability modulo theories (SMT) has been considered to verify parameterised safety properties of so-called artifactcentric systems. This approach requires a combination of model-theoretic notions and algorithmic techniques based on backward reachability. We introduce here a variant of one of the most investigated models in this spectrum, namely simple artifact systems (SASs), where, instead of managing a database, we operate over a description logic (DL) ontology expressed in (a slight extension of) RDFS. This DL, enjoying suitable model-theoretic properties, allows us to define DL-based SASs to which backward reachability can still be applied, leading to decidability in PSpace of the corresponding safety problems.

In the context of verification of data-aware processes, a formal approach based on satisfiability modulo theories (SMT) has been considered to verify parameterised safety properties of so-called artifactcentric systems. This approach requires a combination of model-theoretic notions and algorithmic techniques based on backward reachability. We introduce here a variant of one of the most investigated models in this spectrum, namely simple artifact systems (SASs), where, instead of managing a database, we operate over a description logic (DL) ontology expressed in (a slight extension of) RDFS. This DL, enjoying suitable model-theoretic properties, allows us to define DL-based SASs to which backward reachability can still be applied, leading to decidability in PSpace of the corresponding safety problems.

In this paper we highlight a yet unexplored dimension in BPM in general, and conformance checking, in particular. While a breadth of research has focused in differentiating conforming versus nonconforming process executions, little it is known about the difference between different conforming traces. This is of particular importance in the light of the fact that not all conforming executions are equal: some achieve the intended outcome better than others. In this position paper, we demonstrate why existing model-driven and data-driven techniques are not enough to attack the problem in its full generality, and that novel methods to combine them in ways that have not yet been explored are essential within BPM.

In the context of verification of data-aware processes, a formal approach based on satisfiability modulo theories (SMT) has been considered to verify parameterised safety properties of so-called artifactcentric systems. This approach requires a combination of model-theoretic notions and algorithmic techniques based on backward reachability. We introduce here a variant of one of the most investigated models in this spectrum, namely simple artifact systems (SASs), where, instead of managing a database, we operate over a description logic (DL) ontology expressed in (a slight extension of) RDFS. This DL, enjoying suitable model-theoretic properties, allows us to define DL-based SASs to which backward reachability can still be applied, leading to decidability in PSpace of the corresponding safety problems.

In this paper we highlight a yet unexplored dimension in BPM in general, and conformance checking, in particular. While a breadth of research has focused in differentiating conforming versus nonconforming process executions, little it is known about the difference between different conforming traces. This is of particular importance in the light of the fact that not all conforming executions are equal: some achieve the intended outcome better than others. In this position paper, we demonstrate why existing model-driven and data-driven techniques are not enough to attack the problem in its full generality, and that novel methods to combine them in ways that have not yet been explored are essential within BPM.

In the context of verification of data-aware processes (DAPs), a formal approach based on satisfiability modulo theories (SMT) has been considered to verify parameterised safety properties of so-called artifact-centric systems. This approach requires a combination of model-theoretic notions and algorithmic techniques based on backward reachability. We introduce here a variant of one of the most investigated models in this spectrum, namely simple artifact systems (SASs), where, instead of managing a database, we operate over a description logic (DL) ontology expressed in (a slight extension of) RDFS. This DL, enjoying suitable model-theoretic properties, allows us to define DL-based SASs to which backward reachability can still be applied, leading to decidability in PSPACE of the corresponding safety problems.

Conformance checking is a key process mining task for comparing the expected behavior captured in a process model and the actual behavior recorded in a log. While this problem has been extensively studied for pure control-flow processes, conformance checking with multi-perspective processes is still at its infancy. In this paper, we attack this challenging problem by considering processes that combine the data and control-flow dimensions. In particular, we adopt data Petri nets (DPNs) as the underlying reference formalism, and show how solid, well-established automated reasoning techniques can be effectively employed for computing conformance metrics and data-aware alignments. We do so by introducing the CoCoMoT (Computing Conformance Modulo Theories) framework, with a fourfold contribution. First, we show how SAT-based encodings studied in the pure control-flow setting can be lifted to our data-aware case, using SMT as the underlying formal and algorithmic framework. Second, we introduce a novel preprocessing technique based on a notion of property-preserving clustering, to speed up the computation of conformance checking outputs. Third, we provide a proof-of-concept implementation that uses a state-of-the-art SMT solver and report on preliminary experiments. Finally, we discuss how CoCoMoT directly lends itself to a number of further tasks, like multi- and anti-alignments, log analysis by clustering, and model repair.

Background: Coronavirus disease 2019 (COVID-19) broke out in China in December 2019 and now is a pandemic all around the world. In Italy, Northern regions were hit the hardest during the first wave. We aim to explore the prevalence and the exposure characteristics of physiotherapists (PTs) working in different Italian regions during the first wave of COVID-19. Methods: Between April and May 2020 a structured anonymous online survey was distributed to all PTs registered in the National Professional Registry to collect prevalence data of a confirmed diagnosis of COVID-19 (i.e., nasopharyngeal swab and/or serological test). A bottom-up agglomerative nesting hierarchical clustering method was applied to identify groups of regions based on response rate. Multivariable logistic regression was used to explore personal and work-related factors associated with a confirmed diagnosis of COVID-19. Results: A total of 15,566 PTs completed the survey (response rate 43.3%). The majority of respondents (57.7%) were from Northern regions. Considering all respondents, the number of confirmed COVID-19 cases in Northern and Central Italy, was higher compared to those in Southern Italy (6.9% vs. 1.8%, P < 0.001); focusing the analysis on respondents who underwent nasopharyngeal swab and/or serological test led to similar findings (14.1% vs. 6.4%, P < 0.001). Working in Northern and Central regions was associated with a higher risk of confirmed diagnosis of COVID-19 compared to Southern regions (OR 3.4, 95%CI 2.6 to 4.3). PTs working in Northern and Central regions were more likely to be reallocated to a different unit and changing job tasks, compared to their colleagues working in the Southern regions (10.5% vs 3.7%, P < 0.001). Conclusions: Work-related risk factors were differently distributed between Italian regions at the time of first pandemic wave, and PTs working in the Northern and Central regions were more at risk of a confirmed diagnosis of COVID-19, especially when working in

Acute pyelonephritis (aPN) is defined as a severe form of urinary tract infection. Despite its severity and the high incidence in the community setting, there is no consensus on the optimal duration of treatment. The aim was to compare effectiveness and tolerability of short-versus long-course treatment with the same antibiotic agent in patients with aPN. We searched MEDLINE (PubMed), EMBASE and CENTRAL up to June 2016 for randomized controlled trials (RCTs). Three pairs of authors independently extracted data and appraised risk of bias. We included 4 RCTs (439 participants). Short antibiotic treatment lasted from 4 to 14 days and long treatment from 7 to 42 days but was at least 2 days longer than the corresponding short-course. At the end of treatment, we did not find any significant differences in clinical success [risk ratio (RR) 1.01; 95% confidence interval (CI), 0.96-1.07, moderate quality evidence] as well as in microbiological success (RR 0.99; 95% CI, 0.92-1.07, very low-quality evidence). At 4-6 weeks after the end of treatment there were no significant differences in clinical relapses (RR 1.20,95% CI 0.43-3.30, very low-quality evidence) and re-infection of other germs (RR 2.40; 95% CI, 0.68-8.49, very low-quality evidence), even if short-term therapy seemed to have more risk of recurrences (RR 2.39, 95% CI 1.19-4.83, very low quality of evidence). The incidence of any adverse effect seemed to be lower with the short-term therapy, though the results are not statistically significant (RR 0.63, 95% CI 0.39-1.02, low quality evidence). Short-term treatment for aPN seems to be equivalent to long-term treatment in terms of clinical and microbiological success at the end of treatment or tolerability. The only relevant difference is the frequency of recurrence of the same biological germ up to 4-6 weeks after the end of treatment, which is significantly higher with the short-term therapy

Background: The results of meta-analyses are all too often elusive, making it difficult to interpret their relevance for clinical practice. Reporting them in minimal important difference (MID) units could improve the interpretation of evidence in meta-analyses. The aim of this study was to compare, via calculation of MID units, outcomes after multidisciplinary biopsychosocial rehabilitation (MBR) versus usual care for pain relief in chronic low back pain (LBP). Methods: We re-analyzed the data of a published Cochrane review on MBR. To attribute a MID to each pain instrument, we first searched the literature for MIDs. The MID was imputed for instruments without an established MID. We compared outcomes after MBR versus usual care for chronic LBP in the short (<3 months), mid (>3 and<12 months), and long (≥12 months) term. The results of the meta-analyses are reported in MID units and interpreted as follows: if the overall effect size was greater than 1, many patients gained clinically important benefits, if it lay between 0.5 and 1.0, an appreciable number benefited, and if it fell below 0.5 few did. Results: Improvement in back pain was observed in an appreciable number of patients in the short- and medium-term after MBR: the MID was lower but still close to 1 (0.75 and 0.86 MID units, respectively). MBR probably had little or no benefit for the majority of patients in the long-term, where the MID approached 0 (0.27 MID units, confidence interval 0.07-0.48). Conclusions: Meta-analyses expressed in MID units may offer better insight into the clinical relevance of MBR: the intervention is highly recommended for reducing pain in the short- and medium-term but cannot be recommended for long-term pain reduction since the benefit decays rapidly.

AIMS The aim of this dissertation was to evaluate mechanical LBP rehabilitation interventions based on randomized controlled trials (RCTs). In particular, the following part were investigated: the reporting of important aspects of an intervention, the clinical relevance of an intervention and the synthesis of the evidence through multiple interventions treatments. METHODS To assess reporting of different components of study design and assess the clinical relevance in RCTs, a systematic search for all RCTs included in Cochrane systematic reviews (SRs) on LBP published in The Cochrane Database of Systematic Reviews was performed. The description of sample size, interventions, outcomes, and clinical relevance of each RCT was evaluated, independently by two of the investigators, using dedicate extraction forms. To assess the clinical relevance in MA, a Cochrane review focusing on multidisciplinary biopsychosocial rehabilitation (MBR) in short, medium and long terms was selected as a case-study: we re-analysed the data using a MID (minimal important difference) units approach and discussed the implications of this approach compared to the traditional one. Results were expressed in MID units and gave a clinical meaningful interpretation. To estimate the best efficacious intervention, a NMA was implemented using random-effects models within a frequentist setting assuming equal heterogeneity across all comparisons and all ranking probabilities for each treatment outcome in acute LBP interventions as case study were estimated. RESULTS To appraise reporting quality, 185 eligible RCTs from all Cochrane SRs focused on LBP rehabilitation interventions were found. All items necessary for a full replication of the intervention were present only in 33 RCTs (17.8%). Thirty-six different outcomes were investigated across all RCTs. The 2 most commonly reported outcomes were pain (n= 165 RCTs; 89.2%) and disability (n= 118 RCTs; 63.8%). Pain and disability outcomes were found replicabl, AIMS The aim of this dissertation was to evaluate mechanical LBP rehabilitation interventions based on randomized controlled trials (RCTs). In particular, the following part were investigated: the reporting of important aspects of an intervention, the clinical relevance of an intervention and the synthesis of the evidence through multiple interventions treatments. METHODS To assess reporting of different components of study design and assess the clinical relevance in RCTs, a systematic search for all RCTs included in Cochrane systematic reviews (SRs) on LBP published in The Cochrane Database of Systematic Reviews was performed. The description of sample size, interventions, outcomes, and clinical relevance of each RCT was evaluated, independently by two of the investigators, using dedicate extraction forms. To assess the clinical relevance in MA, a Cochrane review focusing on multidisciplinary biopsychosocial rehabilitation (MBR) in short, medium and long terms was selected as a case-study: we re-analysed the data using a MID (minimal important difference) units approach and discussed the implications of this approach compared to the traditional one. Results were expressed in MID units and gave a clinical meaningful interpretation. To estimate the best efficacious intervention, a NMA was implemented using random-effects models within a frequentist setting assuming equal heterogeneity across all comparisons and all ranking probabilities for each treatment outcome in acute LBP interventions as case study were estimated. RESULTS To appraise reporting quality, 185 eligible RCTs from all Cochrane SRs focused on LBP rehabilitation interventions were found. All items necessary for a full replication of the intervention were present only in 33 RCTs (17.8%). Thirty-six different outcomes were investigated across all RCTs. The 2 most commonly reported outcomes were pain (n= 165 RCTs; 89.2%) and disability (n= 118 RCTs; 63.8%). Pain and disability outcomes were found replicabl

Background: The results of meta-analyses are all too often elusive, making it difficult to interpret their relevance for clinical practice. Reporting them in minimal important difference (MID) units could improve the interpretation of evidence in meta-analyses. The aim of this study was to compare, via calculation of MID units, outcomes after multidisciplinary biopsychosocial rehabilitation (MBR) versus usual care for pain relief in chronic low back pain (LBP). Methods: We re-analyzed the data of a published Cochrane review on MBR. To attribute a MID to each pain instrument, we first searched the literature for MIDs. The MID was imputed for instruments without an established MID. We compared outcomes after MBR versus usual care for chronic LBP in the short (<3 months), mid (>3 and<12 months), and long (≥12 months) term. The results of the meta-analyses are reported in MID units and interpreted as follows: if the overall effect size was greater than 1, many patients gained clinically important benefits, if it lay between 0.5 and 1.0, an appreciable number benefited, and if it fell below 0.5 few did. Results: Improvement in back pain was observed in an appreciable number of patients in the short- and medium-term after MBR: the MID was lower but still close to 1 (0.75 and 0.86 MID units, respectively). MBR probably had little or no benefit for the majority of patients in the long-term, where the MID approached 0 (0.27 MID units, confidence interval 0.07-0.48). Conclusions: Meta-analyses expressed in MID units may offer better insight into the clinical relevance of MBR: the intervention is highly recommended for reducing pain in the short- and medium-term but cannot be recommended for long-term pain reduction since the benefit decays rapidly.