Obesity management: Attitudes and practice of Italian endocrinologists

IntroductionObesity is a global pandemic and is cause of serious concern in all regions of the world. It is important to raise the attention of health care professionals in order to provide early treatment of patients with obesity. Obesity management, however, varies greatly amongst endocrinologists with respect to attitudes to diagnosis and treatment. Aim of this study was to identify practices and needs of Italian endocrinologists with respect to people with obesity.MethodsIn this study, all members of the Italian Association of Clinical Endocrinologists (AME) were invited to participate in a web-based survey concerning the management of obesity.ResultsThe response rate was 24.1% (542/2248). Nutritional and obesity problems were reported as major areas of interest by 29.4% of the participants. A large proportion of patients seeking an endocrine consultation for other reasons are affected by obesity, but one in five respondents addressed the issue in 25% or less of the cases, while one in three always dealt with the problem. Obesity was managed personally/within a dedicated team by 42.6% of participants, while the remainders referred the patient to a dietician/nutritionist or a 2nd level center for obesity therapy. Metformin was used in a median of 30% of the patients (Interquartile range: 10-50) and liraglutide in 10% of the cases (IQR 0-30), while orlistat (median 0%; IQR 0-10) and naltrexone/bupropion (median 0%; IQR 0-5) were seldom prescribed. Cost of therapy was considered as the major limitation to the use of anti-obesity drugs, affecting adherence to long-term treatment. According to 41.9% of respondents, psychological support should be offered to all patients with obesity. Finally, 56% of participants believe that the availability of new drugs will increase the number of patients candidate to drug therapy.DiscussionIn conclusion, it is of primary importance to raise the awareness of endocrinologists towards the problem of obesity and increase their confidence in managing this pathological condition

A pharmacoeconomic analysis from Italian guidelines for the management of prolactinomas

Background: Prolactinoma, the most common pituitary adenoma, is usually treated with dopamine agonist (DA) therapy like cabergoline. Surgery is second-line therapy, and radiotherapy is used if surgical treatment fails or in relapsing macroprolactinoma. Objective: This study aimed to provide economic evidence for the management of prolactinoma in Italy, using a cost-of-illness and cost-utility analysis that considered various treatment options, including cabergoline, bromocriptine, temozolomide, radiation therapy, and surgical strategies. Methods: The researchers conducted a systematic literature review for each research question on scientific data- bases and surveyed a panel of experts for each therapeutic procedure's specific drivers that contributed to its total cost. Results: The average cost of the first year of treatment was euro2,558.91 and euro3,287.40 for subjects with micro- prolactinoma and macroprolactinoma, respectively. Follow-up costs from the second to the fifth year after ini- tial treatment were euro798.13 and euro1,084.59 per year in both groups. Cabergoline had an adequate cost-utility profile, with an incremental cost-effectiveness ratio (ICER) of euro3,201.15 compared to bromocriptine, based on a willingness-to-pay of euro40,000 per quality-adjusted life year (QALY) in the reference economy. Endoscopic sur- gery was more cost-effective than cabergoline, with an ICER of euro44,846.64. Considering a willingness-to-pay of euro40,000/QALY, the baseline findings show cabergoline to have high cost utility and endoscopic surgery just a tad above that. Conclusions: Due to the favorable cost-utility profile and safety of surgical treatment, pituitary surgery should be considered more frequently as the initial therapeutic approach. This management choice could lead to better outcomes and an appropriate allocation of healthcare resources

Water-repellent cellulose fiber networks with multifunctional properties.

We demonstrate a simple but highly efficient technique to introduce multifunctional properties to cellulose fiber networks by wetting them with ethyl-cyanoacrylate monomer solutions containing various suspended organic submicrometer particles or inorganic nanoparticles. Solutions can be applied on cellulosic surfaces by simple solution casting techniques or by dip coating, both being suitable for large area applications. Immediately after solvent evaporation, ethyl-cyanoacrylate starts cross-linking around cellulose fibers under ambient conditions because of naturally occurring surface hydroxyl groups and adsorbed moisture, encapsulating them with a hydrophobic polymer shell. Furthermore, by dispersing various functional particles in the monomer solutions, hydrophobic ethyl-cyanoacrylate nanocomposites with desired functionalities can be formed around the cellulose fibers. To exhibit the versatility of the method, cellulose sheets were functionalized with different ethyl-cyanoacrylate nanocomposite shells..

Alkali-Activated Mortars for Sustainable Building Solutions: Effect of Binder Composition on Technical Performance

There is a growing interest in the construction sector in the use of sustainable binders as an alternative to ordinary Portland cement, the production of which is highly impacting on the environment, due to high carbon dioxide emissions and energy consumption. Alkali-activated binders, especially those resulting from low-cost industrial by-products, such as coal fly ash or metallurgical slag, represent a sustainable option for cement replacement, though their use is more challenging, due to some technological issues related to workability or curing conditions. This paper presents sustainable alkali-activated mortars cured in room conditions and based on metakaolin, fly ash, and furnace slag (both by-products resulting from local sources) and relevant blends, aiming at their real scale application in the building sector. The effect of binder composition—gradually adjusted taking into consideration technical and environmental aspects (use of industrial by-products in place of natural materials in the view of resources saving)—on the performance (workability, compressive strength) of different mortar formulations, is discussed in detail. Some guidelines for the design of cement-free binders are given, taking into consideration the effect of each investigated alumino-silicate component. The technical feasibility to produce the mortars with standard procedures and equipment, the curing in room conditions, the promising results achieved in terms of workability and mechanical performance (from 20.0 MPa up to 52.0 MPa), confirm the potential of such materials for practical applications (masonry mortars of class M20 and Md). The cement-free binders resulting from this study can be used as reference for the development of mortars and concrete formulations for sustainable building materials production

Surprising High Hydrophobicity of Polymer Networks from Hydrophilic Components

We report a simple and inexpensive method of fabricating highly hydrophobic novel materials based on interpenetrating networks of polyamide and poly­(ethyl cyanoacrylate) hydrophilic components. The process is a single-step solution casting from a common solvent, formic acid, of polyamide and ethyl cyanoacrylate monomers. After casting and subsequent solvent evaporation, the in situ polymerization of ethyl cyanoacrylate monomer forms polyamide-poly­(ethyl cyanoacrylate) interpenetrating network films. The interpenetrating networks demonstrate remarkable waterproof properties allowing wettability control by modulating the concentration of the components. In contrast, pure polyamide and poly­(ethyl cyanoacrylate) films obtained from formic acid solutions are highly hygroscopic and hydrophilic, respectively. The polymerization of ethyl cyanoacrylate in the presence of polyamide promotes molecular interactions between the components, which reduce the available hydrophilic moieties and render the final material hydrophobic. The wettability, morphology, and thermo-physical properties of the polymeric coatings were characterized. The materials developed in this work take advantage of the properties of both polymers in a single blend and above all, due to their hydrophobic nature and minimal water uptake, can extend the application range of the individual polymers where water repellency is required

Towards Greener Concrete: The Challenges of SUS-CON Project

Portland cement production is an energy-intensive process responsible for a significant share of the total CO2 production. Its replacement with low carbon binders from by-products of industrial processes is a sustainable alternative for innovative construction materials. In addition, the combination of low carbon binders with recycled aggregates results in a more sustainable concrete, also contributing to reduce waste amounts sent to landfills or incinerators. SUS-CON (SUStainable, innovative and energy-efficient CONcrete, based on the integration of all-waste materials) project (Funded by EC under FP7 (call EeB-NMP.2011-1/3, grant agreement no. 285463).), aimed at developing new concepts and technologies to integrate secondary raw materials in the concrete production cycle, resulting in cost-effective, lightweight and insulating concretes with reduced embodied energy and CO2 footprint. This paper presents a comprehensive overview of the technical work carried out during the Project. The work was structured in three major phases: 1. material research, leading to set-up and assess eco-sustainable concretes with recycled aggregates (e.g. waste polyurethane foams, mixed plastic scraps, end-of-life tyres and plastics from electrical and electronic equipment) and low carbon alkali activated binders (e.g. pulverized fly ash from power stations and blast furnace slags from steel plants); 2. industrial implementation, validating the developed technologies in industrially relevant environment through pre-cast components and ready-mixed concrete production and pilot buildings construction; 3. industrial uptake, creating the bases for transferring results and methodologies by environmental and economical assessments (LCA, LCC, HSE) and certification issues. Mechanical, insulation and fire resistance properties of SUS-CON components were tested; energy efficiency performances of SUS-CON pilot buildings were also monitored. © Springer International Publishing AG 2018. Bam; Cement and Beton Centrum; et al.; Rijkswaterstaat - Ministry of Infrastructure and the Environment; Van Hattum en Blankevoort; VolkerInfr

Innovative recycling of end of life silicon PV panels: ReSiELP

In Europe, an increasing amount of End of Life (EoL) photovoltaic silicon (PV) panels is expected to be collected in the next 20 years. The silicon PV modules represent a new type of electronic waste that shows challenges and opportunities. ReSiELP was a European project that aimed at recovery of valuable materials (aluminum, glass, copper, silicon, and silver) from EoL silicon PV modules. During the project a pilot plant, constituted by a furnace, a gas abatement system, an apparatus for the mechanical separation and a hydrometallurgical plant was designed and built. The pilot plan was realized to upscale recycling technology to TRL 7, with a 1500 panels/ year capacity. The feasibility of industrial-scale recovery and the reintegration of all recovered materials in their appropriate value chain was investigated. The results obtained showed that 2N purity silicon and 2N purity silver can be recovered with high efficiency. In order to realize a zero-waste plant, a hydrometallurgical process was developed for the wastewater treatment. Moreover, the use of recovered glass for building materials was investigated and the obtained performance seemed comparable with commercial products

Sustainable concrete: design and testing

Producing concrete with secondary raw materials is an excellent way to contribute to a mor

Reuse and Recycling of CDW Materials and Structures in Energy Efficient Prefabricated Elements for Building Refurbishment and Construction - RE4

The EU Waste Framework Directive 2008/98/EC states that all member states should take all necessary measures in order to achieve at least 70% re-use, recycling or other recovery of non-hazardous Construction and Demolition Waste (CDW) by 2020. In response, the Horizon 2020 RE4 project consortium (REuse and REcycling of CDW materials and structures in energy efficient pREfabricated elements for building REfurbishment and construction) consisting of 12 research and industrial partners across Europe, plus a research partner from Taiwan, was set up. For its success, the approach of the project was manifold, developing sorting technologies to first improve upon the quality of recycled aggregate. Simultaneously, CDW streams were assessed for quality and novel applications developed for timber, aggregate, and plastic waste in a variety of products including structural (e.g. beams, columns, slabs) and non-structural (e.g. building blocks, insulation panels, tiles) elements. With all products considered, innovative building concepts have been designed in a bid to improve future recycling of the products by promoting prefabricated construction methods and modular design to ease future recycling and increase value of the construction industry. The developed technologies and products will be put to the test in different test sites in building a 2 storey house containing at least 65% of CDW in the next 6 to 12 months