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The ecological management effectiveness (EME) of Marine Protected Areas (MPAs) is the degree to which MPAs reach their ecological goals. The significant variability of EME among MPAs has been partly explained by MPA design, management and implementation features (e.g. surface area, enforcement, age of protection). We investigated EME variability by employing, for the first time, Organization Science. Eight Mediterranean MPAs were taken into account as case studies to explore the relationships between EME and MPA features, such as: 1) organizational size (i.e. the ratio between the number of full-time employees and the total MPA surface area), 2) management performance (i.e. the level of effort exerted to enhance and sustain the MPA management, including enforcement), 3) total surface area, and 4) MPA age. The log-response ratios of fish biomass and density in protected vs unprotected (control) areas were used as a proxy of EME. Management performance, organizational size and, to a lesser extent, MPA age were positively correlated with the log-response ratio of fish biomass, whereas total surface area did not display a significant role. None of the four features considered was significantly correlated with the log-response ratio of fish density. Based on our findings, we argue that the employment of Organization Science in the management effectiveness assessment can assist MPA managers to reach MPAs goals more effectively, with a more efficient use of available resources.

The Gateway Location Problem is the core of a new system for Hazardous Material routing, whose risk mitigation potentials have been assessed in case of static demand. We investigate the impact of flexibility in gateway location and allocation decisions in case of variable demand, and provide a tool to support decision makers in establishing a trade off between infrastructure costs and risk mitigation targets. [ABSTRACT FROM AUTHOR]

In this paper, we evaluate the schedulability of traffic with arbitrary end-to-end deadline constraints in Wireless Mesh Networks (WMNs). We formulate the problem as a mixed integer linear optimization problem, and show that, depending on the flow aggregation policy used in the network, the problem can be either convex or non-convex. We optimally solve the problem in both cases, and prove that the schedulability does depend on the aggregation policy. This allows us to derive rules of thumb to identify which policy improves the schedulability with a given traffic. Furthermore, we propose a heuristic solution strategy that allows good suboptimal solutions to the scheduling problem to be computed in relatively small times, comparable to those required for online admission control in relatively large WMNs. [ABSTRACT FROM AUTHOR]

Objective Status epilepticus (SE) is considered a life-threatening medical emergency. First-line treatment with antiepileptic drugs (AEDs) consists of intravenous benzodiazepines followed by phenytoin. SE is considered refractory (RSE) when unresponsive to standard doses of the first two AEDs. Scarce evidence is available to support specific guidelines for the management of RSE in either adults or children. This study aimed to assess the efficacy and tolerability of intravenous (iv) lacosamide (LCM) in children affected by RSE. Method Children with RSE who were treated with ivLCM were included in the study. Efficacy was defined as the cessation of seizures after administration of ivLCM, with no need for any further antiepileptic drug. All patients had been unsuccessfully treated following standard protocols before ivLCM was administered. Results Eleven children entered the study (mean age: 9.4 years). Etiology was symptomatic in 7 patients (63%). RSE was convulsive (focal or generalized) in 6 patients and nonconvulsive in 5. The mean initial bolus dose of LCM was 8.6 mg/kg. The drug, which was used as a fourth or later option, was effective in stopping RSE in 45% of patients, with seizures terminating within 12 h in three children. No serious adverse events attributable to LCM were reported. Conclusions LCM might be an effective and well-tolerated AED in children with RSE. [ABSTRACT FROM AUTHOR]

Abstract: In Home Care optimization, operators have to be assigned to patients by taking into account compatibility skill constraints, and patient visits have to be scheduled in a given planning horizon. Moreover, operator tours have to be determined. Integer Linear Programming models have been proposed which use the concept of patterns, i.e. a priori scheduling profiles, to combine the diverse decision levels. Computational results on real instances show that pattern generation policies are crucial to address scheduling and routing in large Home Care instances. [Copyright &y& Elsevier]

Abstract: Purpose: This multicenter, prospective study investigates the efficacy and safety of lacosamide adjunctive therapy in pediatric and adult patients with uncontrolled epilepsy. Method: This study was carried out between September 2010 and December 2011 at 16 Italian and 1 German neurologic centers. Lacosamide was added to the baseline therapy at a starting dose of 1mg/kg/day in patients aged <16 years (group A) and 100mg daily in subjects aged 16 and older (group B), and titrated to the target dose, ranging from 3 to 12mg/kg/day or from 100 to 600mg daily, respectively. After completing the titration period, patients entered a 12-month maintenance period and they were followed up at 3, 6 and 12 months. The primary assessment of efficacy was based on the change from baseline in seizure frequency per 28 days and was evaluated at 3, 6 and 12 months as follows: number and proportion of 100% responders, 50% responders, non-responders and worsening patients. Safety evaluation was also performed at 3, 6 and 12 months. Results: A total of 118 patients (59 group A, 59 group B) with uncontrolled generalized and focal epilepsy were enrolled. Patient mean±SD age was 15.9±6.80 years and the age range was 4–38 years. At 3-month evaluation, of 118 treated patients 56 subjects (47.4% group A; 47.4% group B; p =0.8537) experienced at least a 50% reduction in seizure frequency. At 6 and 12-month follow-up, the 50% responders were 57 (52.5% group A; 44.1% group B; p =0.4612) and 51 (47.4% group A; 39% group B; p =0.4573), respectively. Thirty-five subjects (30.5% group A; 28.8% group B; p =1) experienced side effects during the treatment period. The most common adverse events were dyspepsia for group A and dizziness for group B. Conclusion: Lacosamide may be a useful and safe pharmacological treatment option for both pediatric and adult patients with uncontrolled seizures. [Copyright &y& Elsevier]

Abstract: Medical treatment of Dravet syndrome is disappointing. Ketogenic Diet and neurostimulation procedures as Vagus Nerve Stimulation (VNS) and Deep Brain Stimulation are in ongoing evaluation. In the present study, the long-term effectiveness of VNS on seizures, cognition and behavior was retrospectively evaluated in eight young patients with DS and medically refractory epilepsy (mean age at VNS implant: 10.28 years, range: 5–25). The average duration of treatment was 54 months (range: 12–120). Compared to baseline (mean: 55; standard deviation: 83, range: 4–200), the mean number of monthly seizures after VNS implantation was 39 ± 67 at 3 months, 42 ± 67 at 6 months and 38 ± 69 at twelve months (not significant comparisons). In particular, VNS produced a mean seizure rate reduction of 12% at three months, 6% at six months, and 31% at twelve months. All patients but three experienced some reduction in seizure burden (range: 33–61%) at twelve months. Seizure outcome after one year of stimulation was rated as Mc Hugh class II (50–79% reduction in seizure frequency) in four patients, class III (<50% reduction) in one patient and class V (no improvement) in three patients. In this small case series of patients with DS, VNS therapy had a clinically significant effect in reducing seizures at twelve months in four of the eight patients. Even in patients in whom seizure reduction was not dramatic, a slight improvement in alertness and communicative skills was seen. The long-term clinical course of two selected cases is discussed. [ABSTRACT FROM AUTHOR]

The gorgonians Paramuricea clavata (Risso, 1826) and Eunicella cavolini (Koch, 1887) are important habitat-forming species within the Mediterranean coralligenous habitats, creating complex, three-dimensional forests that greatly contribute to the underwater landscape of the coastal hard grounds. Dense forests of both species are present within the Portofino Marine Protected Area (Ligurian Sea, NW Mediterranean Sea), showing a distinct bathymetric separation and site-specific differences. Quantitative evidences obtained with a monitoring census conducted in 2016 in 16 sites within the MPA support the existence of a widespread damage on these populations partially due to the mechanical injuries inflicted by recreational and professional demersal fishing gears. Considering all the studied populations, it resulted that 53% of the colonies of P. clavata and 36% of the colonies of E. cavolini were showing traces of impact, of which 10% in P. clavata and 7% in E. cavolini were due to direct entanglements with lost longlines. In the last decades, recurrent massive mortalities related to temperature anomalies and storms, have greatly reduced the gorgonian populations in this area and fishing impact severely affects survived or recovering colonies. Considering the vulnerable status of these species, and the increasing stress due to climate change, a correct management of the anthropic pressures is strongly needed to help preserving these relevant ecosystems. Image 1 • - Paramuricea clavata and Eunicella cavolini are important ecosystem-engineers. • -Dense forests of these species thrive inside the Portofino MPA (NW Mediterranean). • -51% of P. clavata and 36% of E. cavolini colonies were impacted by fishing gears. • -The density of impacted colonies was strongly related to the fishing effort in the area. • -A management of fishing pressures is needed to preserve these relevant ecosystems. [ABSTRACT FROM AUTHOR]

This paper experimentally investigates the relationships among three major stakeholders that are involved in drug inventory management at Intensive Care Units (ICUs), namely: i) nurses, who in person manage drug orders and carry out storage operations, ii) clinicians, who choose the therapy and shape demand, and iii) the hospital management, who is in charge of the economic sustainability of the hospital. As a case study, we consider the ICU ward of a major Italian public hospital and we focus on antibiotics. We exploit a previously developed Mixed Integer Linear Programming model which decides, for each drug, when and how much to order, and we improve it by adding different sets of constraints to represent each stakeholders' point of view. By solving three generalized models, each of which ties the satisfaction of a single stakeholder to different thresholds, we explore the mutual effects of taking explicitly into account different perspectives within the inventory policy. We implemented an instance generator, built on the basis of empirical probability distributions extracted from a large set of observed historical data and representing the decision flow ruling drugs prescription. Extensive experiments have been carried out on a set of realistic instances provided by the generator. Results based on our test case not only provide computational evidence to intuitive relations among stakeholders, but also suggest possible levels of compromise. Improved stakeholder satisfaction would also benefit the patient, the passive stakeholder who is the ultimate subject of the caring process. • Addresses stakeholder involvement in drug inventory policies at a hospital ward. • Advocates stakeholder involvement in policy design. • Experimentally investigates the relationships among pivotal stakeholders. [ABSTRACT FROM AUTHOR]

The main aims of Marine Protected Areas (MPAs) are the conservation of natural habitats and their biological resources, together with the promotion of an eco-compatible economic fruition. In Mediterranean MPAs, the main threats for hard bottom benthic communities come from fishing and mass tourism, in terms of boating and SCUBA diving. The Portofino MPA (Ligurian Sea, North-western Mediterranean Sea) is one of the top diving destinations in Europe and currently hosts an average of 40,000 dives per year, which are mainly carried out along coralligenous cliffs, a habitat of European Community interest, particularly vulnerable to mechanical damages due to the fragility of its numerous calcified species. The aim of this paper is to evaluate the effects of recreational SCUBA diving on benthic ecosystems characterised by the presence of red coral and other associated fragile species. The impact was assessed through the analysis of the biomasses of target organisms (Corallium rubrum, Leptopsammia pruvoti, Madracis pharensis , and six species of bryozoans) whose fragments were found in the sediments at the base of the cliff. The amounts of these fragments inside the detritus in highly frequented sites were significantly higher than those measured in undisturbed sites, of up to 10 times. Our data suggested a recurrent mechanical action, with also very recent breakages, as demonstrated by the occurrence of living, freshly detached organisms. Red coral and other calcified species may be sensitive also to natural (heavy storms) and human (fishing) mechanical pressures other than diving: the characterization of these impacts in the study sites, however, indicates divers frequentation as the major contributor to the damages inflicted and suggests the need for specific management measures. • Evaluation of SCUBA diving effects on calcified, fragile species. • Comparison among two frequented and two pristine sites in the Portofino MPA. • Impact assessed comparing specimens' abundance on cliff and in underlying sediment. • Target species fragments in sediments 10 times higher in highly frequented dive spots. • MPA management urges to find a balance between fruition and mitigation of impacts. [ABSTRACT FROM AUTHOR]

The recent SARS CoV-02 pandemic has put enormous pressure on intensive care staff, making it imperative to relieve them of repetitive tasks with little added value such as drug replenishment. We propose a decision support system based on a hybrid policy to manage the inventory of critical drugs with low and intermittent demand at an Intensive Care Unit (ICU). Demand forecasting is at the heart of any inventory policy. We claim that in the ICU setting drug demand patterns must be therapy based. Heterogeneous data have been collected during an on site study, and information have been extracted to provide a faithful abstract representation of the ward as a system, as well as the potential evolutions of ICU patients clinical conditions. Together with medical guidelines, this provides the foundation of a therapy based demand forecasting tool. This study integrates schedule optimization and demand forecasting, and exploits simulation for evaluation purpose in the long run. At the beginning of every period, drug orders are optimally scheduled with respect to forecast demand. Then, scheduled orders are deployed day by day and confronted with the real demand in a simulated environment. Potential stock outs trigger rush orders to restore safety stocks. The comparison between the proposed policy and a standard policy mimicking current practice in an ICU ward shows that information on therapy patterns can be successfully incorporated into drug replenishment processes to reduce the number of rush orders, a primary goal in designing an efficient system., Competing Interests: The authors have declared that no competing interests exist.