The theoretical grid. An antifragile strategy for Rome post-COVID mobility

Mobility represents a central issue for sustainable urban planning and regeneration processes in large cities, concerning the impact on environmental quality, equity, and social inclusion. However, the pandemic has strongly affected mobility trends, influenced by international and national social distancing measures and new "safe” lifestyles. Thus, many cities have been adopting mobility emergency strategies for urban resilience. In this context, as a result of a research developed in the framework of a collaboration between Roma Tre University and the Sapienza University of Rome, this essay proposes an "antifragile” strategy for Rome's "post-COVID” mobility, adaptable to other European metropolitan contexts, based on an integrated approach to urban planning and mobility. The research methodology is articulated in three phases: the analysis of the main scientific references related to urban resilience and antifragility concerning the relations between urban form, ways of living and mobility models in pre- and postpandemic scenarios, the study of the main ongoing practices in European cities and the proposal for an antifragile strategy for the city of Rome based on the theoretical grid. The theoretical grid is an urban grammar that proposes a model of reorganization for the city based on elementary urban units and defines an integrated strategy for the reorganization of mobility, the reconfiguration of local flows, and the regeneration of public space. This grammar is declined in specific ways according to the different urban fabrics, within an articulation in four "cities,” the historical city, the consolidated city, the modernist city, the peripheral urban fringes. © 2023 Elsevier Inc. All rights reserved.

Phenocomb, a Tool for Evaluating Complex Phenotypes in High-Dimension Cytometry Datasets

Background Modern cytometry can simultaneously measure dozens of markers, empowering investigation of complex phenotypes. However, manual gating relies on previous biological knowledge, and clustering/dimension-reduction tools fail to capture discrete phenotypes. Consequently, complex phenotypes with potential biological importance are often overlooked. To address this, we developed PhenoComb, an R package that allows agnostic exploration of complex phenotypes by assessing the frequencies of all marker combinations in cytometry datasets. Methods PhenoComb uses signal intensity thresholds to assign markers to discrete states (e.g. negative, low, high). As Pheno- Comb works in a memory-safe manner, time and disk space are the only constraints to the number of markers and discrete states that can be evaluated. Next, the number of cells per sample from all possible marker combinations are counted and frequencies assessed. PhenoComb provides several approaches to perform statistical comparisons, evaluate the relevance of phenotypes, and assess the independence of identified phenotypes. PhenoComb also allows users to guide analysis by adjusting several function arguments such as identifying parent populations of interest, filtering low-frequency populations, and defining a maximum marker complexity. PhenoComb is compatible with local computer or server-based use. Results In testing of PhenoComb's performance on synthetic datasets, computation on 16 markers was completed in the scale of minutes and up to 26 markers in hours. We applied PhenoComb to two publicly available datasets: an HIV flow cytometry dataset (12 markers and 421 samples) and the COVIDome CyTOF dataset (40 markers and 99 samples). In the HIV dataset, PhenoComb identified immune phenotypes associated with HIV seroconversion, including those highlighted in the original publication. In the COVID dataset, we identified several immune phenotypes with altered frequencies in infected individuals relative to healthy individuals. Conclusions PhenoComb is a unique and powerful tool for agnostically assessing phenotypes. By more fully utilizing the high-dimension data in single cell datasets, PhenoComb empowering exploratory data analysis and discovery of phenotypes for further characterization.

Post-Covid cities and mobility A proposal for an antifragile strategy in Rome

Mobility is considered a central topic for urban regeneration in metropolitan cities, in relation to the impact on traffic congestion, air pollution, public space quality, social inclusion. During the Covid-19 pandemic, mobility patterns have been strongly affected by the spread of the virus and the social distancing measures. In the last months, many cities have adopted mobility strategies for urban resilience, to face the crisis by the reorganization of infrastructures and networks with a glance at a prevention of an unsustainable return to private transport in the post-covid phase. In this context, the research illustrated in this paper, developed within a collaboration between Sapienza University of Rome and Roma Tre University, aims to propose an "anti-fragile" strategy for "post covid Rome", adaptable to other contexts of European cities, starting from an integrated approach to urban planning and mobility. The research methodology has articulated the activities into three phases. The phase of analysis of the phenomena and the main scientific references relating to urban resilience and antifragility, highlighting the the relationship between urban form and mobility models. The second phase relates to the study of the main ongoing strategies and practices in some European metropolitan cities. The third phase proposes an operational hypothesis of an antifragile strategy for Rome highlighting the relevance of mobility transition. In the conclusion, the paper defines guidelines for urban regeneration combining the results of the case studies and the experimentation.

Emergency Department Visits for Pediatric Infectious Conditions Decrease After COVID-19

Study Objective: Following the arrival of COVID-19 in the New York metropolitan area in March 2020, pediatric ED visits markedly decreased. Possible reasons for this include parental reluctance to bring their children to the ED due to fear of exposure and mandates to socially isolate (which may have also decreased infectious disease transmission) and increasing use of telemedicine. Our goal was to determine whether ED visits for some common pediatric infectious conditions changed following the arrival of COVID-19 in our area. Methods: Design: Retrospective cohort. Setting: EDs of 28 hospitals within 150 miles of New York City. Of these, 5 hospitals had dedicated pediatric EDs. Hospitals were teaching or non-teaching and rural, suburban or urban. Annual ED volumes were from 12,000 to 122,000. Population: consecutive ED patients ≤ 18 years old between March 1 and November 30 in 2019 and 2020. Data analysis: We arbitrarily chose to examine the following conditions: otitis media, bronchiolitis, streptococcal pharyngitis, croup and diarrhea, identified by the International Classification of Diseases codes, version 10. We tallied total visits and visits for each of these diagnoses in 2019 and 2020 time periods. We report the percentage changes in visits from 2019 to 2020 along with their 95% confidence intervals (CIs). Results: The database contained 300,627 visits in 2019 and 2020. From 2019 to 2020, total visits decreased by 58%, from 211,018 in 2019 to 89,609 in 2020. Visits in 2019 and 2020 respectively, were: otitis media (7080, 1775);bronchiolitis (2041, 267);streptococcal pharyngitis (2813, 863);croup (2547, 389) and diarrhea (3533, 900). This represents the following decreases from 2019 to 2020: otitis media 75% (95% CI 73-76%), bronchiolitis 87% (95% CI 85-88%), streptococcal pharyngitis 69% (95% CI 67-71%), croup 85% (95% CI 83-86%) and diarrhea 74% (95% CI 73-76%). Conclusion: Total pediatric ED visits and visits for specific infectious conditions markedly decreased following the arrival of COVID-19 in our area. Further studies are needed to investigate the impact that the reduction in ED visits had on patient clinical outcomes.

Proposal for a Serious Game to Assist in the Daily Care of Children with ASD Before Covid-19

Autism Spectrum Disorder (ASD) is a condition of neurodevelopment characterized by changes in social communication, restricted interests, and repetitive behaviors. Many children with ASD need different types of intervention (behavioral, language, social, occupational, among others). Since the appearance of Covid-19 in December 2019, a state of world pandemic has been established. In Brazil, it started in March 2020. The lives of millions of people in the country have been drastically changed: schools have closed in their face-to-face mode, people began to leave home only in extreme need, and health care was changed to the virtual model. Children with autism had their appointments reduced or canceled and, after a few months, changed to an online version. The use of masks has become mandatory throughout the country. These children now need to live in a different environment than they did a long time ago. It becomes, for example, more difficult for them to understand what people say due to the use of masks. Thus, this project aims to present a serious game in which the child can train his/her ability to understand the words now spoken by people using a face protection mask, without the possibility of the visual feature of the facial face mimic. The game was validated by nine speech therapists and, subsequently, by fourteen children diagnosed with ASD who already do speech therapy sessions online. It happened during one of the sessions. Then, both groups answered a satisfaction questionnaire conducted by the speech therapist, adapted to their characteristics. © 2021, Springer Nature Switzerland AG.

Prevalence of nutritional risk and malnutrition during and after hospitalization for COVID-19 infection: Preliminary results of a single-centre experience.

BACKGROUND & AIMS: The effect of the COVID-19 infection on nutritional status is not well established. Worldwide epidemiological studies have begun to investigate the incidence of malnutrition during hospitalization for COVID-19. The prevalence of malnutrition during follow-up after COVID-19 infection has not been investigated yet. The primary objective of the present study was to estimate the prevalence of the risk of malnutrition in hospitalized adult patients with COVID-19, re-evaluating their nutritional status during follow-up after discharge. The secondary objective was to identify factors that may contribute to the onset of malnutrition during hospitalization and after discharge. METHODS: We enrolled 142 COVID-19 patients admitted to Careggi University Hospital. Nutritional parameters were measured at three different timepoints for each patient: upon admission to hospital, at discharge from hospital and 3 months after discharge during follow-up. The prevalence of both the nutritional risk and malnutrition was assessed. During the follow-up, the presence of nutritional impact symptoms (NIS) was also investigated. An analysis of the association between demographic and clinical features and nutritional status was conducted. RESULTS: The mean unintended weight loss during hospitalization was 7.6% (p < 0.001). A positive correlation between age and weight loss during hospitalization was observed (r = 0.146, p = 0.08). Moreover, for elderly patients (>61 years old), a statistically significant correlation between age and weight loss was found (r = 0.288 p = 0.05). Patients admitted to an Intensive Care Unit (ICU) or Intermediate Care Unit (IMCU) had a greater unintended weight loss than patients who stayed in a standard care ward (5.46% vs 1.19%; p < 0.001). At discharge 12 patients were malnourished (8.4%) according to the ESPEN definition. On average, patients gained 4.36 kg (p < 0.001) three months after discharge. Overall, we observed a weight reduction of 2.2% (p < 0.001) from the habitual weight measured upon admission. Patients admitted to an ICU/IMCU showed a higher MUST score three months after discharge (Cramer's V 0.218, p = 0.035). With regard to the NIS score, only 7 patients (4.9%) reported one or more nutritional problems during follow-up. CONCLUSIONS: The identification of groups of patients at a higher nutritional risk could be useful with a view to adopting measures to prevent worsening of nutritional status during hospitalization. Admission to an ICU/IMCU, age and length of the hospital stay seem to have a major impact on nutritional status. Nutritional follow-up should be guaranteed for patients who lose more than 10% of their habitual weight during their stay in hospital, especially after admission to an ICU/IMCU.

91 Where Have All the Children Gone? The Effects of COVID-19 on Pediatric Emergency Department Visits

Study Objectives: Our syndromic surveillance system of patient chief complaints showed a marked rise in respiratory complaints on March 10th, 2020 as Covid19 arrived in our region. Subsequently, pediatric visits to the emergency department (ED) markedly decreased, likely due to recommendations for quarantine and fear of contracting the virus. Our goal was to determine the extent of decrease in ED visits for several common pediatric conditions for which parents normally would have sought emergency care. Methods: This was a retrospective cohort design. The setting was at the EDs of 28 hospitals within 150 miles of New York City. Hospitals were teaching or non-teaching and rural, suburban or urban;7 hospitals had separate pediatric EDs. Annual ED volumes of pediatric patients were from 3000 to 43,000. Population: Consecutive pediatric patients (age ≤ 21yrs) seen by ED physicians between January 1 and April 30 in 2019 and 2020. Data analysis: We chose to examine the monthly visits for the following using ICD-10 codes: anxiety, appendicitis, asthma, headaches, seizure, and urinary tract infection (UTI). We computed the changes in monthly visits for March and April from 2019 to 2020. We used chi-square to test for statistical significance. We set alpha at 0.002, using the Bonferroni correction for multiple comparisons. Results: Our database contained 222,302 total pediatric visits. Compared to 2019, total visits in January and February 2020 increased by 15% and 4%, respectively, but in March and April they decreased by 36% and 81%, respectively. Visits in March and April 2020, compared to the same months in 2019, decreased by 17% and 76%, respectively, for anxiety;by 29% and 34%;for appendicitis;by 40% and 91% for asthma;by 17% and 76% for headache;by 13%, and 60% for seizures;and by 46% and 79% for UTIs. All p-values for comparisons were statistically significant, p<0.002, except, in March, for seizures (p=0.25), appendicitis (p=0.007) and headache (p=0.02). Conclusion: We found a marked decrease in ED visits for several common pediatric conditions after COVID-19 arrived in our region. We suspect that this decrease was due to recommendations for quarantine during this pandemic as well as fear of exposure to COVID-19. Further studies are needed to determine if this has led to complications due to delay in seeking medical care.