The reconversion of the Litoranea Venetian Waterway: an opportunity to rethink the eastern Venetian coastal system

This article investigates the relationship between territory and infrastructure in order to offering new ideas for the management and design of coastal landscapes. As a case study, are exposed the results of a project concerning the Venetian Litoranea Waterway, an old waterway that flows along the Adriatic venetian coast. The need for reactivate the waterway - now under-utilized and never fully completed – becomes an opportunity to study a broad-minded approach, based on the analysis of the of both the environmental and economic issue. The aim of the work is to provide a model able to face with the problems afflicting the entire coastal system and provide a valid alternative to the current seafront employment strategies. The concept of combining skills deriving from civil engineering, economics, and landscape architecture, is fundamental in order to studying a wide-ranging approach to the problems emerging from the analysis and the critical issues affecting the coast and the entire waterway system. This point of view permit to obtaining results usually not taking into account by ordinary planning. On the basis of the problems affecting the Adriatic coast under examination - such as coastalerosion,subsidenceandsaltwater intrusion - the project proposes a radical transformation of the reclamations area surrounding the waterway, towards a more resilient and less burdensome structure to manage. By the creation of a wet buffer, developed along the waterway, makes it possible to unveil new opportunities for tourism exploitation linked to the lagoon areas, which can be used as a flywheel to implement compensation and financing of the project itself. The process would able to obtaining a safer and more cost- effective territory. The entire approach contemplatesalarge-scaleorganizationof urban development, using planning tools capable of modifying coastal morphology, supporting trends of erosive phenomena. The deepening of the relationships that arises from the process of urbanization of the soil, together with the awareness of the variability of economic contexts and environmental conditions, become the starting point for the development of new synergies between infrastructures, tourist offer and coastal occupation processes

Satisfaction with control of systemic lupus erythematosus and lupus nephritis: physician and patient perspectives

Neelufar Mozaffarian,1 Steve Lobosco,2 Peng Lu,3 Adam Roughley,2 Gabriela Alperovich4 1Clinical Development, AbbVie Inc., North Chicago, USA; 2Adelphi Real World Ltd., Macclesfield, UK; 3Clinical Development, AbbVie Inc., Worcester, MA, USA; 4Global Medical Affairs Immunology, AbbVie Inc., Madrid, Spain Purpose: Patient satisfaction with disease control of systemic lupus erythematosus (SLE) is an important component of medical management. This analysis evaluated patient and physician satisfaction with disease control of SLE, factors associated with satisfaction/dissatisfaction, and the degree of physician–patient concordance of these parameters. Patients and methods: Data were extracted from the US Adelphi Real World Lupus Disease Specific Programme®, a cross-sectional survey of 50 rheumatologists, 25 nephrologists, and their patients with non-nephritis SLE (NNSLE) or lupus nephritis (LN). Results: Physicians reported moderate or severe disease activity in 25.0% of patients with NNSLE and in 50.5% of patients with LN, and were satisfied with disease control in 78.6% (132/168) and 73.8% (152/206) of patients, respectively. For patients, 75.8% (75/99) with NNSLE were satisfied with their current treatment, compared with 65.5% (74/113) with LN. Physician–patient agreement (70.7%) on the level of satisfaction was “slight” (kappa =0.1445) for NNSLE; patients were more frequently dissatisfied than physicians with regard to joint tenderness, fatigue, anxiety, pain on movement, malar rash, and photosensitivity. Physician–patient agreement (71.4%) on the level of satisfaction was “fair” (kappa =0.3695) for LN; patients expressed greater dissatisfaction than physicians for headache, photosensitivity, and anxiety, whereas physicians were more dissatisfied with regard to joint swelling, kidney function, and blood pressure control. In general, patients with NNSLE or LN who were dissatisfied (or whose physicians were dissatisfied) were more likely to have joint swelling, joint stiffness, malar rash, hair loss, depression, and fatigue, have moderate or severe disease, or to be currently experiencing disease flare. Conclusion: These data highlight the patient and physician dissatisfaction with real-world disease control of SLE. Keywords: lupus, satisfaction, concordance, agreement, disease contro

Breaking the deadlock

Many of the proposed approaches to the semantic web have a substantial drawback. They are all based on the idea that web pages (or more generally, resources), will contain semantic annotations that would allow remote agents to access them. However the problem of the creation of those annotations is seldom addressed. Manual creation of the annotations is not a feasible option, except in a few experimental cases. We propose an approach based on Language Processing techniques that addresses this issue, at least for textual resources (which still constitute the vast majority of the material available on the web). Documents are analized fully automatically and converted into a semantic annotation, which can then be stored together with the original documents. It is this annotation that constitutes the machine understandable resource that remote agents can query. A semi-automatic approach is also considered, in which the system suggests candidate annotations and the user simply has to approve or reject them. Advantages and drawbacks of both approaches are discussed

Skin Involvement in Psoriatic Arthritis Worsens Overall Disease Activity, Patient-Reported Outcomes, and Increases Healthcare Resource Utilization: An Observational, Cross-Sectional Study

INTRODUCTION: Psoriatic arthritis (PsA) is an inflammatory arthropathy that exhibits heterogeneity in clinical presentation and severity of skin and joint symptoms. This heterogeneity results in an incomplete understanding of the relationship between the skin and joint components of PsA, and their relative impact on PsA disease activity and patient-reported outcomes. The objective of the study was to Investigate the clinical presentation of joint and active skin symptom involvement and the associated impact on physician- and patient-reported outcomes [patient global assessment (PtGA), health-related quality of life (HRQoL), and physical function), and healthcare resource burden in patients with PsA. METHODS: This was a retrospective analysis of the Adelphi 2015 PsA Disease Specific Programme, a real-world, cross-sectional survey of rheumatologists and their consulting PsA patients from the USA and Europe (France, Germany, Italy, Spain, and UK). The sample included data collected during the fourth quarter of 2015, on 1201 patients from 410 rheumatologists. Physician-reported joint and active skin symptom involvement were investigated for associations with clinical outcomes, patient/physician-reported outcomes, and healthcare resource utilization (HCRU). RESULTS: The majority of patients with PsA with documented skin involvement had both joint and active skin involvement (80.9%, njoint+skin = 515, njoint only = 122, noverall = 637). Patients with skin involvement possessed a more severe global clinical profile, and the PsA clinical symptom severity profile positively correlated with skin severity. Physician global assessment scores were not significantly different in patients with joint-only involvement vs. joint with active skin involvement. Patients with skin involvement in PsA possessed significantly worse PtGA scores and increased HCRU. CONCLUSION: Patients with PsA involving both joint and active skin symptoms exhibit a more severe overall disease state, worse patient-reported outcomes, and increased HCRU relative to patients with joint-only involvement in PsA. These results indicate that treating skin involvement should be considered along with treating joint involvement in patients with PsA. FUNDING: Eli Lilly and Company.unique-id: ISI:000451884400009status: publishe

Understanding remission in real-world lupus patients across five European countries

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease associated with increased mortality and significant personal, psychological and socioeconomic consequences. An agreed definition of remission is needed and lacking. We sought to visualize 'remission in SLE' in European patients considered by their physicians to be 'in remission' by comparing the reported symptom burden as reported by treating physicians for patients considered to be 'in remission' and those not considered to be 'in remission'. Data for 1227 patients drawn from a multinational, real-world survey of patients with SLE consulting practising rheumatologists and nephrologists in France, Germany, Italy, Spain, and the UK show that physicians classed their patients as 'in remission' despite a considerable ongoing symptom burden and intensive immunosuppressive medication. Patients considered to be 'in remission' still had a mean of 2.68 current symptoms vs 5.48 for those considered to be not 'in remission' (p < 0.0001). The most common symptoms among those seen to be 'in remission' were joint symptoms, fatigue, pain, mucocutaneous involvement, haematological manifestations and kidney abnormalities. The current analysis highlights important ongoing disease activity, symptom burden and immunosuppressive medication in European patients with SLE considered by their treating physician to be 'in remission'. For a further improvement of outcome, there is an urgent need for an international consensus on the definitions for remission among patients with SLE