Environmental History of Migration (EHM): its roots and most recent developments. An interview with Marco Armiero

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Biomarkers in Acute Coronary Syndrome

Background: Evaluation of patients who present to the hospital with acute undifferentiated chest pain or other symptoms and signs suggestive of Acute Coronary Syndrome (ACS) is often a clinical challenge. The initial assessment, requiring a focused history (including risk factors analysis), a physical examination, an electrocardiogram (EKG) and serum cardiac marker determination, is time-consuming and troublesome. Recent investigations have indicated that increases in biomarkers of necrosis, inflammation, ischemia and myocardial stretch may provide earlier assessment of overall patient risk, help in identifying the adequate diagnostic and therapeutic management for each patient and allow for prevention of substantial numbers of new events. Approach and Content: The purpose of this review is to provide an overview of the characteristics of several biomarkers that may have potential clinical utility to identify ACS patients. Patho-physiology, analytical and clinical characteristics have been evaluated for each marker, underlying the properties for potential routine clinical use. Summary: The biomarkers discussed in this review are promising and might lead to improved diagnosis and risk stratification of patients with ACS, however their clinical application requires further studies. It is important to define their clinical role as diagnostic markers, their predictive value and the specificity, standardization and detection limits of the assays

cardiotoxicity induced by anticancer drugs the role of biomarkers

Anticancer therapy-induced cardiotoxicity still remains a serious problem, strongly affecting both quality of life and overall survival of oncologic patients. The most effective approach for minimizing cardiotoxicity is its early detection and prompt prophylactic treatment initiation. According to the current standard for monitoring cardiac function, cardiotoxicity is usually detected only when a functional impairment has already occurred, precluding any chance of preventing its development. Over the last decade, however, measurement of serum cardio-specific biomarkers has emerged, resulting in a cost-effective diagnostic tool for early identification of patients more prone to developing cardiotoxicity, in whom a preventive pharmacological strategy and a closer cardiac monitoring are of crucial importance

High-sensitivity troponin assays for the early rule-out or diagnosis of acute myocardial infarction in people with acute chest pain: a systematic review and cost-effectiveness analysis.

BACKGROUND: Early diagnosis of acute myocardial infarction (AMI) can ensure quick and effective treatment but only 20% of adults with emergency admissions for chest pain have an AMI. High-sensitivity cardiac troponin (hs-cTn) assays may allow rapid rule-out of AMI and avoidance of unnecessary hospital admissions and anxiety. OBJECTIVE: To assess the clinical effectiveness and cost-effectiveness of hs-cTn assays for the early (within 4 hours of presentation) rule-out of AMI in adults with acute chest pain. METHODS: Sixteen databases, including MEDLINE and EMBASE, research registers and conference proceedings, were searched to October 2013. Study quality was assessed using QUADAS-2. The bivariate model was used to estimate summary sensitivity and specificity for meta-analyses involving four or more studies, otherwise random-effects logistic regression was used. The health-economic analysis considered the long-term costs and quality-adjusted life-years (QALYs) associated with different troponin (Tn) testing methods. The de novo model consisted of a decision tree and Markov model. A lifetime time horizon (60 years) was used. RESULTS: Eighteen studies were included in the clinical effectiveness review. The optimum strategy, based on the Roche assay, used a limit of blank (LoB) threshold in a presentation sample to rule out AMI [negative likelihood ratio (LR-) 0.10, 95% confidence interval (CI) 0.05 to 0.18]. Patients testing positive could then have a further test at 2 hours; a result above the 99th centile on either sample and a delta (Δ) of ≥ 20% has some potential for ruling in an AMI [positive likelihood ratio (LR+) 8.42, 95% CI 6.11 to 11.60], whereas a result below the 99th centile on both samples and a Δ of < 20% can be used to rule out an AMI (LR- 0.04, 95% CI 0.02 to 0.10). The optimum strategy, based on the Abbott assay, used a limit of detection (LoD) threshold in a presentation sample to rule out AMI (LR- 0.01, 95% CI 0.00 to 0.08). Patients testing positive could then have a further test at 3 hours; a result above the 99th centile on this sample has some potential for ruling in an AMI (LR+ 10.16, 95% CI 8.38 to 12.31), whereas a result below the 99th centile can be used to rule out an AMI (LR- 0.02, 95% CI 0.01 to 0.05). In the base-case analysis, standard Tn testing was both most effective and most costly. Strategies considered cost-effective depending upon incremental cost-effectiveness ratio thresholds were Abbott 99th centile (thresholds of < £6597), Beckman 99th centile (thresholds between £6597 and £30,042), Abbott optimal strategy (LoD threshold at presentation, followed by 99th centile threshold at 3 hours) (thresholds between £30,042 and £103,194) and the standard Tn test (thresholds over £103,194). The Roche 99th centile and the Roche optimal strategy [LoB threshold at presentation followed by 99th centile threshold and/or Δ20% (compared with presentation test) at 1-3 hours] were extendedly dominated in this analysis. CONCLUSIONS: There is some evidence to suggest that hs-CTn testing may provide an effective and cost-effective approach to early rule-out of AMI. Further research is needed to clarify optimal diagnostic thresholds and testing strategies. STUDY REGISTRATION: This study is registered as PROSPERO CRD42013005939. FUNDING: The National Institute for Health Research Health Technology Assessment programme

Historical tools and current societal challenges: reflections on a collection of environmental migration cases

Through considering a "Geo Archive" as a tool of history, this paper explores several conundrums concerning environmental migration in social sciences. It demonstrates how historical perspectives can problematize and unsettle various automatisms that are widely present in journalistic, public, and policy discourses. Through examples from the Geo Archive, the article illustrates how unavoidable historical dimensions can enrich our understandings on the interaction between environmental issues and migration flows. This paper engages with an open access "archive in-the-making". This Geo Archive includes case studies of migration flows and puts those flows in conversation with environmental transformations and climatic changes. The analysed collection presents high-profile stories which are representative samples of different approaches, temporalities, geographies, sources of information, narratives, and scales. This endeavour encompasses different disciplines and fields of expertise: environmental humanities, IT and communication experts, and political ecology. The archive places itself within the realms of public history, environmental history, and history of the present and aims to reach out to wider audiences. This digital humanities project stemmed from a support action funded by the EU initiative Horizon 2020 titled CLISEL whose overarching goal was to analyse and better inform institutional responses and policies addressing climate refugees and migrants

Socio-ecological colonial transfers : trajectories of the fascist agricultural enterprise in Libya (1922–43)

First published online: 24 March 2021This paper intertwines the two historiographical concerns of migration and colonialism by exploring the case of Italian rule in North Africa from 1922 to 1943 and by adopting the analytic ground of the environment. The role played by the environment in targeting and shaping specific social groups, forming and grounding specific policies, creating and preventing social and natural transfers, has been overshadowed until now, particularly in relation to Italian colonialism. This study articulates the Fascist agricultural enterprise in Libya around the watershed event of the colony's 1932 pacification. To illustrate its development, it looks at the environment-making processes and transfers entailed in the transformation of the Italian colonial project. This reconstruction contributes to the environmental history subfields of migration and colonialism and invites historians to further explore the first decade of Italian rule in Libya and not to limit historical explorations to the lens of settler colonialism.This article was published Open Access with the support from the EUI Library through the CRUI - CUP Transformative Agreement (2020-2022