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Mobility as a Service (MaaS) opportunities have received great attention both in the literature and in practical implementations, as well as projects and specific case studies. Even though the well-known expected potentialities, however there are still issues to be solved, which range from platform implementations to user’s role for making effective the system. From the user side perspective, particularly important are those aspects as reliability and effectiveness of many available travel services, often managed by a unique platform. In other words, how much in MaaS schemes the offered combination of transport modes promising a “seamless and efficient experience” – included connection times and fares – potentially is able to meet users’ expectations. Starting from the above perspective, this paper proposes an agent-based framework to simulate MaaS programs by using diachronic representations of the transport services offered by the different stakeholders that share the MaaS platform. In particular, the attractiveness of some MaaS programs have been compared to the one of private cars for the same trip, from a user’s perspective, in a simulated agent-based urban scenario. The obtained results, although simulated in this preliminary test, show that the proposed framework would both provide suitable mobility solutions by using the potentialities of the diachronic network approach and capture user’s preferences. Particularly, the user propensity to change private cars towards shared solutions increases as congestion in private car network increases.

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Increasing road traffic levels in urban areas require actions and policies to manage and control the number of road users. Travelers' choices of transport modes, particularly private cars, that generate the main share of road traffic levels, depend on many factors, which include both personal preferences and level-of-service variables. Understanding how travelers choose transport modes according to the above factors is an important challenge in order to adopt the most suitable policies and facilitate a sustainable mobility. In the literature, behavioral models have been mainly proposed in order to both estimate mode choice percentages and capture travel behaviors by suitable estimation of some parameters associated to the above factors. However, behavior is complex in itself and the mechanisms underlying user behavior might be difficult to be captured by traditional models. In this paper, a neuro-fuzzy approach is proposed to extract mode choice decision rules by evaluating different sets of rules and different membership functions of the neuro-fuzzy model. Particularly, to determine which inputs are the most relevant in such decision process, fuzzy curves and surfaces have been considered in order to take into account nonlinear effects. The neuro-fuzzy model proposed in this paper has been thought to be embedded in an agent-based methodological framework where user agents - representing travelers - make travel choices based on the rules learnt by means of the neuro-fuzzy system.

Functional reserve of organs and systems is known to be relevant in predicting immunochemotherapy tolerance. Age and comorbidities, assessed by the cumulative illness rating scale (CIRS), have been used to address chemotherapy intensity. In the ibrutinib era, it is still unclear whether age, CIRS, and Eastern Cooperative Oncology Group performance status (ECOG-PS) retain their predictive role on treatment vulnerability. In this series of 712 patients with chronic lymphocytic leukemia (CLL) treated with ibrutinib outside clinical trials, baseline ECOG-PS and neutropenia resulted as the most accurate predictors of treatment feasibility and outcomes. Age did not independently influence survival and ibrutinib tolerance, indicating that not age per se, but age-related conditions, may affect drug management. We confirmed the role of CIRS . 6 as a predictor of a poorer progression- and event-free survival (PFS, EFS). The presence of a severe comorbidity was significantly associated with permanent dose reductions (PDRs), not translating into worse outcomes. As expected, del(17p) and/or TP53mut and previous therapies affected PFS, EFS, and overall survival. No study so far has analyzed the influence of concomitant medications and CYP3A inhibitors with ibrutinib. In our series, these factors had no impact, although CYP3A4 inhibitors use correlated with Cox regression analysis, with an increased risk of PDR. Despite the limitation of its retrospective nature, this large study confirmed the role of ECOG-PS as the most accurate predictor of ibrutinib feasibility and outcomes, and importantly, neutropenia emerged as a relevant tool influencing patients’ vulnerability. Although CIRS > 6 retained a significant impact on PFS and EFS, its value should be confirmed by prospective studies.

Background and objectives: End stage renal disease (ESRD) patients are exposed to the risk of ionizing radiation during repeated imaging studies. The variability in diagnostic imaging policies and the accompanying radiation doses across various renal units is still unknown. We studied this variability at the centre level and quantified the associated radiation doses at the patient level. Methods: Fourteen Italian nephrology departments enrolled 739 patients on haemodialysis and 486 kidney transplant patients. The details of the radiological procedures performed over one year were recorded. The effective doses and organ doses of radiation were estimated for each patient using standardized methods to convert exposure parameters into effective and organ doses Results: Computed tomography (CT) was the major contributor (> 77%) to ionizing radiation exposure. Among the haemodialysis and kidney transplant patients, 15% and 6% were in the high (≥ 20 mSv per year) radiation dose groups, respectively. In haemodialysis patients, the most exposed organs were the liver (16 mSv), the kidney (15 mSv) and the stomach (14 mSv), while the uterus (6.2 mSv), the lung (5.7 mSv) and the liver (5.5 mSv) were the most exposed in kidney transplant patients. The average cumulative effective dose (CED) of ionizing radiation among centres in this study was highly variable both in haemodialysis (from 6.4 to 18.8 mSv per patient-year; p = 0.018) and even more so in kidney transplant (from 0.6 to 13.7 mSv per patient-year; p = 0.002) patients. Conclusions: Radiation exposure attributable to medical imaging is high in distinct subgroups of haemodialysis and transplant patients. Furthermore, there is high inter-centre variability in radiation exposure, suggesting that nephrology units have substantially different clinical policies for the application of diagnostic imaging studies.

Flying vehicles are receiving more and more attention and are becoming an opportunity to start a new urban mobility paradigm. The most interesting feature of flying cars is the expected opportunity they could offer to reduce congestion, traffic jams and the loss of time to move between origin/destination pairs in urban contexts. In this perspective, urban air mobility might meet the concept of "sustainable mobility", intended as the ideal model of a transport system that minimizes the environmental impacts by maximizing efficiency and travel speed. For transport engineering planning issues, further knowledge is required in this field to understand the effects that a possible urban air mobility system, including the ground traffic component, could have in terms of sustainable mobility in the above meaning. This paper contributes to this topic by providing an analysis of different urban flying car scenarios by using an agent-based approach with different traffic conditions. The preliminary results obtained on some test networks and focusing on travel cost effects suggest that the expected advantages the flying car will depend on trip origin/destination points, average distances travelled in the urban contexts and the location of transition nodes, which are introduced as interchange nodes between aerial and ground mode.

In the last decades, individual urban traffic flows have increased all over the world with a consequent growth of road congestion and environmental pollution. In this context, car-pooling is an interesting car-based alternative to satisfy the individual mobility demand by optimizing the car loading factor with respect to the number of passengers, provided that all the participants share trip origin and destination in the same time slot. To make the system more appealing, this paper proposes an on-demand car-pooling service adopting variable fares, on the basis of trip length and number of participants. Multi-agent, reputation and recommender system technologies in synergy with a routing algorithm have been used to this aim. Experiments on simulated data proved the potentiality of the proposed approach.

In the next years, flying cars are expected to become a real opportunity to realize Urban Air Mobility (UAM) systems. Most of the appeal is given by the opportunity of avoiding congestion, gaining time and reducing environmental impacts with respect to conventional mobility. However, UAM implementation is not trivial as it has several implications in manifold areas like safety, security, traffic control, legal issues and urban design among the others. To investigate on the impacts of UAM, a dedicated agent-based framework has been designed. The results of some preliminary tests carried out to verify the capabilities of this simulator are presented.

Background: Anemia is a common complication of chronic kidney disease (CKD), but its incidence in nephrology settings is poorly investigated. Similarly, the risks of adverse outcomes associated with new-onset anemia are not known. Methods: We performed a pooled analysis of three observational cohort studies including 1031 non-anemic CKD patients with eGFR <60 mL/min/1.73 m2 regularly followed in renal clinics. We estimated the incidence of mild anemia (hemoglobin 11-12 g/dL in women and 11-13 g/dL in men) and severe anemia (hemoglobin <11 g/dL or use of erythropoiesis-stimulating agents) during a 3-year follow-up period. Thereafter we estimated the risk of end-stage kidney disease (ESKD) and all-cause death associated with new-onset mild and severe anemia. Results: The mean age was 63 ± 14 years, 60% were men and 20% had diabetes. The mean estimated glomerular filtration rate (eGFR) was 37 ± 13 mL/min/1.73 m2 and the median proteinuria was 0.4 g/day [interquartile range (IQR) 0.1-1.1]. The incidence of mild and severe anemia was 13.7/100 patients-year and 6.2/100 patients-year, respectively. Basal predictors of either mild or severe anemia were diabetes, lower hemoglobin, higher serum phosphate, eGFR <30 mL/min/1.73 m2 and proteinuria >0.50 g/day. Male sex, moderate CKD (eGFR 30-44 mL/min/1.73 m2) and moderate proteinuria (0.15-0.50 g/day) predicted only mild anemia. The incidence of anemia increased progressively with CKD stages (from 8.77 to 76.59/100 patients-year) and the proteinuria category (from 13.99 to 25.02/100 patients-year). During a median follow-up of 3.1 years, 232 patients reached ESKD and 135 died. Compared with non-anemic patients, mild anemia was associated with a higher adjusted risk of ESKD {hazard ratio [HR] 1.42 [95% confidence interval (CI) 1.02-1.98]} and all-cause death [HR 1.55 (95% CI 1.04-2.32)]. Severe anemia was associated with an even higher risk of ESKD [HR 1.73 (95% CI 1.20-2.51)] and death [HR 1.83 (95% CI 1.05-3.19)].

Incidence of kidney replacement therapy (KRT) stabilizes or declines both in Europe and in the US; however, it is predictable that global prevalence of KRT will double by 2030. In this paper, we focus on the patterns of incidence, mortality, and prevalence of KRT in Italy, and we compare, when possible, the findings with other countries. The Italian Dialysis and Transplantation Registry (IDTR) currently collects aggregate data from regional registries. In Italy, KRT yearly incidence is around 160 patients per million population (pmp). This incidence showed an increasing trend up until 2011 with an average annual percentage change (AAPC) of 1.8%, after which it stabilized. Older age is an important determinant for KRT incidence, and it is strongly associated with the variability between Italian regions. Incidence is very stable within patients less than 50 years old; however, it greatly differs between regions for patients over 75 years old, ranging from 400 to 900 pmp. Moreover, the incidence for patients over 50 years old declined from 366 pmp in 2011 to 285 in 2017. An age-period-cohort (APC) model showed a very strong cohort effect, which shows the decline in incidence seems mainly due to the better health conditions of people born after 1940. Mortality rate in KRT patients was 109 per 1000 patient-year (py) between 2011 and 2017 with great differences among treatment modalities: 162 per 1000 py in haemodialysis, 117 per 1000 py in peritoneal dialysis, and 16 per 1000 py in kidney transplantation. Premature death is better detected by the standard expected years of life lost (YLL). The distribution of YLL rate per age shows a sharp increase between 40 and 70 years old both in haemodialysis and peritoneal dialysis patients with an AAPC of 5.2% and 4.1% respectively. Transplanted patients experience a very low YLL rate at any age. KRT prevalence was 1118 pmp in 2017 and it should be close to 1175 pmp by 2025 with a projected increase of transpla

In recent years the increasing rate of vehicular traffic due to private mobility caused congestion and environmentalimpacts in urban contexts all over the world. To face such problems an important contribution might be given bytransit systems. However, transit systems are characterized by a discontinuous spatial and time coverage so that other formsof mobility, like car-sharing, can be an effective complementto it by providing the same flexibility and comfort of private cars. Several studies confirmed that car-sharing is almost as highly appreciated as private cars but having the advantage of lower costs. For such reasons, in recent years the car-sharing market increased continuously as it has been resulting more and more attractive for investors, although its market shareremains limited. To encourage the car-sharing philosophy, from one hand traditional car-sharing companies are trying to reduce operational costs to offer lower fares and, from the other hand, several individual owners are starting to share their cars suitablysupported by technology. To promote car-sharing activities, in this paper a multi-agent system able to monitor car-sharing users’driving habits is proposed. In particular, agents assist users in improving their driving, as well as in building their individualreputation measures over time. Such reputation scores can beused to allow the access to car-sharing services and personalized fares. Experiments on real and simulated data are encouragingand show the potentiality of this proposal.

Internet of Things (IoT) is an emerging paradigm for cooperation among physical objects provided with computational and communication capabilities. The great amount of interactions occurring within the IoT environments expose IoT users and interconnected objects to security and privacy risks. Consequently, adding security and privacy into the IoT domain is fundamental for a wider IoT diusion. In open and dynamic IoT environments such problems are more relevant for the greater possibility of anomalous behaviors and the adoption of approaches uniquely based on authentication methods could result infeasible and/or inadequate for creating an eective trustworthiness atmosphere. A possible solution, widely applied and investigated in dierent fields, is represented by trust- and reputation-based systems. To tackle the issues above we conceived a distributed reputation model along with a framework to manage information about IoT devices reputation. In particular, the model provides some countermeasures to detect malicious or cheating devices. To test the performance of our proposal, a set of experiments simulating the vehicular mobility on a basic urban network has been executed by providing promising results.

In the last decades, private cars caused an increasinggrowth of urban traffic flows all over the world with a consequent increase of environmental pollution and road congestion. In this context, Car-Pooling is an alternative car-based solutionfor private mobility that optimizes the car loading factor with respect to the number of passengers, although it requires that all the participants share trip origin and destination at the sametime. To make the system more appealing, an on-demand service adopting variable fares on the basis of trip length and number of participants is proposed in this paper. Multi-agent, reputation and blockchain technologies are used and a suitable dynamic routing algorithm has been developed. Experiments on simulated data prove the potentiality of this approach.

A main question in urban environments is the continuous growth of private mobility with its negative effects such as traffic congestion and pollution. To mitigate them, it is important to promote different forms of mobility among the citizens. Car-sharing systems give users the same flexibility and comfort of private cars but at smaller costs. For this reason, car-sharing has continuously increased its market share although rather slowly. To boost such growth, car-sharing systems needs to increase vehicle fleet, improve company profits and, at the same time, make it more affordable for consumers. In this paper the promotion of car-sharing by reputation is proposed. Neural networks have been used to identify drivers’ habits in using car-sharing vehicles. To verify the effectiveness of the proposed approach, some experiments based on real and simulated data were carried out with promising results.

The hypomethylating agent azacitidine (AZA) is used to treat higher-risk myelodysplastic syndromes (HR-MDS) and elderly patients with low-blast count acute myeloid leukemia (LBC-AML). Platelet recovery is an early predictor of AZA response. We prospectively studied the expression profile of transcription factors, critical for late megakaryopoiesis and changes in their expression after AZA treatment in patients with HR-MDS and LBC-AML enrolled in the BMT-AZA trial (EudraCT number 2010-019673-15). Twenty-five additional patients with low-risk (LR)-MDS were also studied. At the time of diagnosis, GATA2 mRNA levels were significantly higher in MDS as compared to controls, with increasing levels from LR- to HR-MDS/AML. RUNX1 expression was also significantly higher in MDS, as compared to controls, but no differences were found between LR- and HR-MDS. Looking at biomarkers of response, we found that patients AZA responsive had higher basal GATA1 and lower FLI1 expression, compared to those with stable or progressive disease after treatment. Univariate analysis showed that increased GATA2 mRNA expression was associated with a worse overall survival. Our findings suggest that high GATA2 expression is a poor prognostic marker for survival in patients with HR-MDS and LBC-AML treated with azacitidine. Moreover, GATA1 and FLI1 mRNA expression may predict response to AZA treatment.

In the last decades, transport demand has increasedquickly due to several concurrent factors. The negative impacts ofincreased demand have many effects on both travelers themselvesand communities and some actions need to mitigate them. Tothis purpose, progresses in different scientific fields as computerscience, electronic, communication as well as studies on new andmore sophisticated traffic simulation models contributed to realizeIntelligent Transport Systems (ITSs), which provide advancedtransport services for a better and efficient use of transport networks.The adoption of the software agent technology has givena significant contribution to the ITS development, due to theircapability to both simulate traffic scenarios at different levelsof detail and provide intelligent decision-making frameworks.Intelligent agents make it possible to study human behaviors andmachine-to-machine interactions with the aim to simulate, controland manage transportation networks. Given their relevance, inthe last years a great body of researches and surveys have beenproposed in the literature on this matter. This paper wantsto contribute by providing an overview of the most significantadvancements produced during the period 2013- 2015.

Background and Objectives: Renal toxicity due to tenofovir (TDF) has been largely described in patients with HIV infection. However, other antiretroviral drugs (such as atazanavir [ATV], especially when boosted by ritonavir, ATV/r) could perpetuate some degrees of renal impairment with or without TDF co-administration. Also, possible benefits of stopping TDF in patients without renal diseases is not well known. This study aimed at exploring evolution of renal function and lipid profile after switching from tenofovir/emtricitabine (TDF/FTC) to abacavir/lamivudine (ABC/3TC), maintaining the ATV/r component of the regimen. Methods: Patients in the Italian MASTER Cohort, who switched from TDF/FTC plus ATV/r to ABC/3TC plus ATV/r were included, provided that major renal diseases were not diagnosed before switching (i.e., baseline). Serum creatinine, estimated glomerular filtration rate (eGFR), total cholesterol, HDL and triglycerides were evaluated at baseline and at month 18 after switching. Results: 126 patients were selected (80% males). Patients were mostly Italians (92%). 79% had undetectable HIV-RNA and 44% were coinfected by HBV and/or HCV. Median age at switch was 47 years (IQR 43-55). A small but significant decrease in serum creatinine [from 1.06 mg/dl (SD: 0.3) to 0.94 mg/dl (SD: 0.2); p<0.001] with an improvement in eGFR [from 86.8 ml/min (SD: 33) to 96.4 ml/min (SD: 37); p<0.001] were observed in per protocol analysis at month 18. Also ITT analysis showed a decrease in mean serum creatinine [from 1.08 mg/dl (SD: 0.35) to 0.95 mg/dl (SD: 0.24); p<0.001] with an improvement in mean eGFR [from 86.9 ml/min/1.73m2 (SD: 24.11) to 95.8 ml/min/1.73m2 (SD: 19.99); p<0.001]. Total cholesterol increased [from 188 mg/dl (SD: 42) to 206 mg/dl (SD: 44); p<0.001] but also HDL increased as well [from 46 mg/dl (SD: 14) to 54 mg/dl (SD: 19); p=0.015]. An increase in triglycerides concentration was observed [from 162 mg/dl (SD: 144) to 214 mg/dl (SD: 109); p=0.0

No abstract (Epidemiology_statistics), non disponibile (Epidemiology_statistics)

No abstract (Epidemiology_statistics), non disponibile (Epidemiology_statistics)

Randomized trials and observational cohorts reported higher rates of virological suppression after highly active antiretroviral therapy (HAART) including efavirenz (EFV), compared with boosted protease inhibitors (PIs). Correlations with immunological and clinical outcomes are unclear. Patients of the Italian MASTER cohort who started HAART from 2000 to 2010 were selected. Outstanding outcome (composite outcome for success (COS)) was introduced. We evaluated predictors of COS (no AIDS plus CD4+ count >500/mm3 plus HIV-RNA <500 copies/mL) and of eight single outcomes either at month 6 or at year 3. Multivariable logistic regression was conducted. There were 6259 patients selected. Patients on EFV (43%) were younger, had greater CD4+ count, presented with AIDS less frequently, and more were Italians. At year 3, 90% of patients had HIV RNA <500 copies/mL, but only 41.4% were prescribed EFV, vs. 34.1% prescribed boosted PIs achieved COS (p <0.0001). At multivariable analysis, patients on lopinavir/ritonavir had an odds ratio of 0.70 for COS at year 3 (p <0.0001). Foreign origin and positive hepatitis C virus-Ab were independently associated with worse outcome (OR 0.54, p <0.0001 and OR 0.70, p 0.01, respectively). Patients on boosted PIs developed AIDS more frequently either at month 6 (13.8% vs. 7.6%, p <0.0001) or at year 3 (17.1% vs. 13.8%, p <0.0001). At year 3, deaths of patients starting EFV were 3%, vs. 5% on boosted PIs (p 0.008). In this study, naïve patients on EFV performed better than those on boosted PIs after adjustment for imbalances at baseline. Even when virological control is achieved, COS is relatively rare. Hepatitis C virus-positive patients and those of foreign origin are at risk of not obtaining COS.