Ganando oportunidades de confort

Después de una etapa de construcción desmedida, el actual contexto de crisis económica y sobre todo ambiental propicia la necesidad de replantearse el modelo de ciudad que se está proponiendo en la actualidad y si realmente se debe seguir creciendo. Considerando que por una parte, el sector de la construcción es el que genera un mayor porcentaje de las emisiones de CO2 y por otra, que las previsiones de crecimiento poblacional muestran que hacia el año 2050 habrá una estabilización del crecimiento, realmente no existe una necesidad de continuar edificando. Por lo que la rehabilitación cobrará y de hecho está cobrando un nuevo protagonismo ofreciendo una gran oportunidad para reducir las emisiones del parque de viviendas existente. Contradictoriamente a esta situación, la actual normativa de eficiencia energética se centra en la obra nueva y en las grandes reformas, dejando al margen un porcentaje muy elevado del parque de viviendas existente. Algunos países de la Unión Europea ya han aprobado políticas nacionales enfocadas a reducir el consumo energético y las emisiones de sus edificios de aquí al 2020, con objetivos y exigencias de eficiencia bien definidos, tanto para nuevas construcciones como para las ya existentes. Aparece por lo tanto la necesidad de cambio en un sector que es responsable de gran parte de la extracción de materiales de la corteza terrestre, culpable de una parte considerable de consumo energético y de emisiones de CO2. Un primer paso para abordar la rehabilitación energética pasa por comprender el comportamiento térmico de los edificios y el peso que tienen los diferentes actores que intervienen en la consecución del confort térmico y de la demanda. Siendo éste uno de los objetivos del trabajo. Este estudio es un primer diagnóstico, no una solución. Se “juega” con el edificio mediante el planteamiento de distintos escenario de ocupación, usuario, ventilación etc. para poder analizar la repercusión de cada uno de ellos tanto en la temperatura interior como en la demanda. La rehabilitación debería ser entendida no solamente como una oportunidad para mejorar los edificios, sino que también como una manera de “rehabilitar” a los usuarios. Tal y como se mostrará tan importante es uno como el otro. Ambos deberían ir en una misma dirección, ya que para obtener el mejor resultado no se puede confiar solamente en el edificio sino que se trata de la suma de pequeños factores lo que lleva a reducir al máximo la demanda y en consecuencia las emisiones de gases de efecto invernadero

Management of a pregnant woman with fibromuscular dysplasia

No abstract available

In-Hospital Glucose Monitoring: Adequacy and Resource Management

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European Survey on Scholarly Practices and Digital Needs in the Arts and Humanities

This report summarizes the statistical analysis of the findings of a web-based survey conducted by the Digital Methods and Practices Observatory (DiMPO), a working group under VCC2 of the DARIAH research infrastructure (Digital Research Infrastructure for the Arts and Humanities). In order to provide an evidence-based, up-to-date, and meaningful account of the emerging information practices, needs and attitudes of arts and humanities researchers in the evolving European digital scholarly environment, the web survey involved a transnational team of researchers from more than a dozen countries, and addressed digitally-enabled research practices, attitudes and needs in all areas of Europe and across different arts and humanities disciplines and contexts

Blood pressure response to renal denervation is correlated with baseline blood pressure variability: a patient-level meta-analysis

Background: Sympathetic tone is one of the main determinants of blood pressure (BP) variability and treatment-resistant hypertension. The aim of our study was to assess changes in BP variability after renal denervation (RDN). In addition, on an exploratory basis, we investigated whether baseline BP variability predicted the BP changes after RDN. Methods: We analyzed 24-h BP recordings obtained at baseline and 6 months after RDN in 167 treatmentresistant hypertension patients (40% women; age, 56.7 years; mean 24-h BP, 152/90 mmHg) recruited at 11 expert centers. BP variability was assessed by weighted SD [SD over time weighted for the time interval between consecutive readings (SDiw)], average real variability (ARV), coefficient of variation, and variability independent of the mean (VIM). Results: Mean office and 24-h BP fell by 15.4/6.6 and 5.5/ 3.7 mmHg, respectively (P < 0.001). In multivariable-adjusted analyses, systolic/diastolic SDiw and VIM for 24-h SBP/DBP decreased by 1.18/0.63 mmHg (P 0.01) and 0.86/0.42 mmHg (P 0.05), respectively, whereas no significant changes in ARV or coefficient of variation occurred. Furthermore, baseline SDiw (P ¼ 0.0006), ARV (P ¼ 0.01), and VIM (P ¼ 0.04) predicted the decrease in 24-h DBP but not 24-h SBP after RDN. Conclusion: RDN was associated with a decrease in BP variability independent of the BP level, suggesting that responders may derive benefits from the reduction in BP variability as well. Furthermore, baseline DBP variability estimates significantly correlated with mean DBP decrease after RDN. If confirmed in younger patients with less arterial damage, in the absence of the confounding effect of drugs and drug adherence, baseline BP variability may prove a good predictor of BP response to RDN

Psychological aspects in the management of patients with essential hypertension

The hypertensive patient is the most stable phenotype in psychosomatic medicine. Hypertensive patients represent a vulnerable population that deserves special attention from health care providers and systems, and psychosomatic medicine may be an important tool in the management of high blood pressure. Depression, anxiety disorders and personality features are often associated with elevated blood pressure (BP) and they may have a role in the development of mild high-renin essential hypertension. Besides, "white coat" hypertension and "masked" hypertension demonstrate how clinic blood pressure could be strongly related to trait anxiety. Hypertension is largely asymptomatic, and patients often have little understanding of the importance of achieving BP control. Medication adverse effects may become an important factor in poor adherence to the treatment and the antidepressant use increases the risk of hypertension. So, the challenge in the management of hypertensive patients is the adherence to non-pharmacological and behavioural treatments for hypertension

Real world effectiveness of subcutaneous semaglutide in type 2 diabetes: A retrospective, cohort study (Sema-MiDiab01)

IntroductionAim of the present study was to evaluate the real-world impact of once-weekly (OW) subcutaneous semaglutide on different end-points indicative of metabolic control, cardiovascular risk factors, and beta-cell function in type 2 diabetes (T2D).MethodsThis was a retrospective, observational study conducted in 5 diabetes clinics in Italy. Changes in HbA1c, fasting blood glucose (FBG), body weight, blood pressure, lipid profile, renal function, and beta-cell function (HOMA-B) during 12 months were evaluated.ResultsOverall, 594 patients (97% GLP-1RA naïve) were identified (mean age 63.9 ± 9.5 years, 58.7% men, diabetes duration 11.4 ± 8.0 years). After 6 months of treatment with OW semaglutide, HbA1c levels were reduced by 0.90%, FBG by 26 mg/dl, and body weight by 3.43 kg. Systolic blood pressure, total and LDL-cholesterol significantly improved. Benefits were sustained at 12 months. Renal safety was documented. HOMA-B increased from 40.2% to 57.8% after 6 months (p<0.0001).DiscussionThe study highlighted benefits of semaglutide on metabolic control, multiple CV risk factors, and renal safety in the real-world. Semaglutide seems to be an advisable option for preservation of β-cell function and early evidence suggests it might have a role in modifying insulin resistance (HOMA-IR), the pathogenetic basis of prediabetes and T2D

Psychological treatments and psychotherapies in the neurorehabilitation of pain. Evidences and recommendations from the italian consensus conference on pain in neurorehabilitation

BACKGROUND: It is increasingly recognized that treating pain is crucial for effective care within neurological rehabilitation in the setting of the neurological rehabilitation. The Italian Consensus Conference on Pain in Neurorehabilitation was constituted with the purpose identifying best practices for us in this context. Along with drug therapies and physical interventions, psychological treatments have been proven to be some of the most valuable tools that can be used within a multidisciplinary approach for fostering a reduction in pain intensity. However, there is a need to elucidate what forms of psychotherapy could be effectively matched with the specific pathologies that are typically addressed by neurorehabilitation teams. OBJECTIVES: To extensively assess the available evidence which supports the use of psychological therapies for pain reduction in neurological diseases. METHODS: A systematic review of the studies evaluating the effect of psychotherapies on pain intensity in neurological disorders was performed through an electronic search using PUBMED, EMBASE, and the Cochrane Database of Systematic Reviews. Based on the level of evidence of the included studies, recommendations were outlined separately for the different conditions. RESULTS: The literature search yielded 2352 results and the final database included 400 articles. The overall strength of the recommendations was medium/low. The different forms of psychological interventions, including Cognitive-Behavioral Therapy, cognitive or behavioral techniques, Mindfulness, hypnosis, Acceptance and Commitment Therapy (ACT), Brief Interpersonal Therapy, virtual reality interventions, various forms of biofeedback and mirror therapy were found to be effective for pain reduction in pathologies such as musculoskeletal pain, fibromyalgia, Complex Regional Pain Syndrome, Central Post-Stroke pain, Phantom Limb Pain, pain secondary to Spinal Cord Injury, multiple sclerosis and other debilitating syndromes, diabetic neuropathy, Medically Unexplained Symptoms, migraine and headache. CONCLUSIONS: Psychological interventions and psychotherapies are safe and effective treatments that can be used within an integrated approach for patients undergoing neurological rehabilitation for pain. The different interventions can be specifically selected depending on the disease being treated. A table of evidence and recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation is also provided in the final part of the pape

Foscolo critico

Il volume, primo della collana open access dei "Quaderni di Gargnano", ospita i contributi presentati al XV Convegno internazionale di Letteratura italiana "Gennaro Barbarisi", tenutosi a Gargnano del Garda dal 24 al 26 settembre 2012. Il "Quaderno", dedicato al Foscolo critico, accoglie contributi di Giovanni Biancardi, Arnaldo Bruni, Andrea Campana, Massimo Castellozzi, Gustavo Costa, Alfredo Cottignoli, Christian Del Vento, Sandro Gentili, Franco Longoni, Ilaria Mangiavacchi, Donatella Martinelli, Giuseppe Natale, Enzo Neppi, Matteo Palumbo, Elena Parrini Cantini, Chiara Piola Caselli. \uc8 aperto da una Prefazione di Claudia Berra, Paolo Borsa e Giulia Ravera.This volume on "Foscolo critico" is the first volume of the "Quaderni di Gargnano", an open access book series which publishes the Proceedings of the "Gennaro Barbarisi" International Conferences on Italian Literature, held in Gargnano del Garda. It contains contributions by Giovanni Biancardi, Arnaldo Bruni, Andrea Campana, Massimo Castellozzi, Gustavo Costa, Alfredo Cottignoli, Christian Del Vento, Sandro Gentili, Franco Longoni, Ilaria Mangiavacchi, Donatella Martinelli, Giuseppe Natale, Enzo Neppi, Matteo Palumbo, Elena Parrini Cantini, Chiara Piola Caselli, preceded by a Preface by the Editor: Claudia Berra, Paolo Borsa, Giulia Ravera

What is the role of the placebo effect for pain relief in neurorehabilitation? Clinical implications from the Italian consensus conference on pain in neurorehabilitation

Background: It is increasingly acknowledged that the outcomes of medical treatments are influenced by the context of the clinical encounter through the mechanisms of the placebo effect. The phenomenon of placebo analgesia might be exploited to maximize the efficacy of neurorehabilitation treatments. Since its intensity varies across neurological disorders, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCP) summarized the studies on this field to provide guidance on its use. Methods: A review of the existing reviews and meta-analyses was performed to assess the magnitude of the placebo effect in disorders that may undergo neurorehabilitation treatment. The search was performed on Pubmed using placebo, pain, and the names of neurological disorders as keywords. Methodological quality was assessed using a pre-existing checklist. Data about the magnitude of the placebo effect were extracted from the included reviews and were commented in a narrative form. Results: 11 articles were included in this review. Placebo treatments showed weak effects in central neuropathic pain (pain reduction from 0.44 to 0.66 on a 0-10 scale) and moderate effects in postherpetic neuralgia (1.16), in diabetic peripheral neuropathy (1.45), and in pain associated to HIV (1.82). Moderate effects were also found on pain due to fibromyalgia and migraine; only weak short-term effects were found in complex regional pain syndrome. Confounding variables might have influenced these results. Clinical implications: These estimates should be interpreted with caution, but underscore that the placebo effect can be exploited in neurorehabilitation programs. It is not necessary to conceal its use from the patient. Knowledge of placebo mechanisms can be used to shape the doctor-patient relationship, to reduce the use of analgesic drugs and to train the patient to become an active agent of the therapy