12 research outputs found
Communication and visiting policies in Italian intensive care units during the first COVID-19 pandemic wave and lockdown: a nationwide survey
Background: During the first coronavirus disease 2019 (COVID-19) pandemic wave, an unprecedented number of patients with respiratory failure due to a new, highly contagious virus needed hospitalization and intensive care unit (ICU) admission. The aim of the present study was to describe the communication and visiting policies of Italian intensive care units (ICUs) during the first COVID-19 pandemic wave and national lockdown and compare these data with prepandemic conditions. Methods: A national web-based survey was conducted among 290 Italian hospitals. Each ICU (active between February 24 and May 31, 2020) was encouraged to complete an individual questionnaire inquiring the hospital/ICU structure/organization, communication/visiting habits and the role of clinical psychology prior to, and during the first COVID-19 pandemic wave. Results: Two hundred and nine ICUs from 154 hospitals (53% of the contacted hospitals) completed the survey (202 adult and 7 pediatric ICUs). Among adult ICUs, 60% were dedicated to COVID-19 patients, 21% were dedicated to patients without COVID-19 and 19% were dedicated to both categories (Mixed). A total of 11,102 adult patients were admitted to the participating ICUs during the study period and only approximately 6% of patients received at least one visit. Communication with family members was guaranteed daily through an increased use of electronic devices and was preferentially addressed to the same family member. Compared to the prepandemic period, clinical psychologists supported physicians more often regarding communication with family members. Fewer patients received at least one visit from family members in COVID and mixed-ICUs than in non-COVID ICUs, l (0 [0–6]%, 0 [0–4]% and 11 [2–25]%, respectively, p < 0.001). Habits of pediatric ICUs were less affected by the pandemic. Conclusions: Visiting policies of Italian ICUs dedicated to adult patients were markedly altered during the first COVID-19 wave. Remote communication was widely adopted as a surrogate for family meetings. New strategies to favor a family-centered approach during the current and future pandemics are warranted
Recurrence of pelecypod-associated cholera in Sardinia
pgs. 1124-1127NOT AVAILABLE IN HOUSE EAShttp://gbic.tamug.edu/request.ht
LIFE AForClimate: approcci predittivi per una selvicoltura del faggio in sintonia con il clima
La variabilità del clima nella pianificazione della gestione forestale: il progetto LIFE AforClimate
Climate variability in forest management planning: The LIFE AForClimate project.
Previous research experiences have shown that climate variability can play a relevant role in forest planning and management within a climate change scenario. In forest planning and management, yield tables, site quality indices, age classes, and rates of growth are some of the most frequently used parameters and tools. However, these ‘traditional’ methods do not include the influence of climate variability on forest growth over time, although it is one of the main influencing factors in tree growth. Changes in climate determine changes in thermo-pluviometric regimes that often have a marked influence on forest growth trends. Forest biomass, resilience, and carbon sequestration may be damaged unless forest planning and management implement the relationships between climate variability and trends of tree growth. The absence of an approach that implements the relationships between climate variability and tree growth as an ordinary tool for forest planning and management can have significant negative effects on forest biomass, resilience and carbon sequestration. The project AForClimate (Adaption of FORest management to CLIMATE variability: an ecological approach - LIFE15 CCA/IT/000089) aims to adapt forest management to climate change by defining an effective method for estimating the impacts of climate variability on growth of the forest. In this, AForClimate aims to manage forests in order to preserve their resilience, promote their natural renewal and distribute the wood mass harvested over periods with climatic conditions favourable to growth. The project targets beech ecosystems given their economic and ecological importance at European level. In Europe there are about 15 million hectares of beech forests that grow mainly in mountain areas of central and southern Europe, from sea level up to 1,800 m altitude. The expected results of the project are:
(i) adapt forest management to climate change in the project areas;
(ii) develop a detailed forecasting model for forest management that takes into account climate variability over time;
(iii) build a monitoring scheme to assess, at the end of the project, the impacts of the management approach in terms of forest growth and regeneration;
(iv) elaborate a prototype of Decision Support System to plan forest management in a climate change scenario.
The project feasibility will be demonstrated in three Italian regions (Molise, Sicily, and Tuscany) thanks to the support of three territorial partners responsible for management in their respective areas of competence: Molise Region, Sicily Region, and Mountain Union of the Mugello Municipalitie
LIFE AForClimate: approcci predittivi per una selvicoltura del faggio in sintonia con il clima
Numerosi studi hanno dimostrato che l’incremento delle temperature medie stagionali e le variazioni nel regime stagionale delle precipitazioni influenzano direttamente la variabilità di crescita dei popolamenti forestali. Conoscere la risposta delle foreste alla variabilità del clima è propedeutica a calibrare gli interventi selvicolturali per garantire minore stress alle piante e una migliore efficienza ecosistemica. Il progetto LIFE AForClimate (LIFE15 CCA/IT/000089 - Adaption of FORest management to CLIMATE variability: an ecological approach) mira a fornire soluzioni concrete per realizzare una gestione forestale efficace nell’adattamento ai cambiamenti climatici e definire un metodo per la stima degli impatti della variabilità del clima sulla crescita dei boschi di faggio. Grazie a questo cambiamento d’approccio rispetto alla gestione forestale classica, AForClimate intende raggiungere i seguenti risultati: i) elaborare un modello previsionale dettagliato per la pianificazione della gestione forestale delle faggete che prenda in considerazione la variabilità climatica nel tempo, in modo da conservarne la resilienza, favorire la rinnovazione naturale e distribuire i prelievi legnosi in periodi con condizioni climatiche favorevoli all’accrescimento; ii) sviluppare uno schema di costante monitoraggio climatico per valutare, a fine progetto, gli impatti dell’approccio alla gestione in termini di crescita del bosco e di rinnovazione; iii) sviluppare ed implementare un prototipo di Sistema di Supporto alle Decisioni per pianificare la gestione forestale in uno scenario di cambiamenti climatici. Il progetto viene sviluppato in tre aree forestali e geografiche diverse rappresentative dei tre habitat di faggeta presenti nel territorio italiano secondo un gradiente latitudinale: faggete nord appenniniche senza impronta mediterranea (Mugello, Toscana), faggete appenniniche ad impronta mediterranea (Matese, Molise), faggete mediterranee con siccità estiva (Monti Nebrodi, Sicilia). Questo contributo oltre a presentare il progetto, ne riporta i risultati preliminari ottenuti nei primi due anni
A new approach for an adaptive forest management planning to improve resilience of beech forests in relation to climate change: the LIFE AForClimate project
Vita.Flash conversion remains a necessary choice for high-speed Analog-to-Digital (A/D) conversion, despite its many disadvantages. Such conversion, by nature, involves 2^N sampling elements for an N bit converter. The differences in the signal delays to each of these sampling elements results in sampling the wrong value of the input, and gives rise to a systematic voltage error in a sequence of sampled voltages. The mechanisms that give rise to such delay differences, normally referred to as dynamic errors, are analyzed. Converter's dynamic performance in the presence of these errors is simulated using high level simulations. Simulating the converter's dynamic behavior, expressed as its Signal-to-Noise plus Distortion ratio (SNDR), using accurate timing simulators such as SPICE, is known to be computationally intensive. Furthermore, such simulations do not necessarily incorporate all of the dynamic errors in the converter. A methodology is presented herein, where the converter's dynamic performance is simulated without excessive CPU time. All of the dynamic errors in the converter are lumped into a single effective timing error of the sampling clock. The timing error is a function of the input signal dynamics as well as the physical layout of the converter. An 8-bit Flash converter, with practical layout and circuits, is taken as an example, and its dynamic performance is simulated using this methodology. Computer usage time on the order of a few hours has been achieved with this methodology to obtain the SNDR of the converter. The accuracy of the simulation is expected to be comparable to that of SPICE. Testing the dynamic performance of high-speed converters requires function generators with a linearity better than that of the converter under test. A novel compensation algorithm is presented which allows one to test the converter using function generators with nonlinearities comparable to or larger than those in the converter. The algorithm uses two sets of measurements: one set taken with the function generator and the A /D converter, and another taken with an all-pass filter inserted between the function generator and the A/D converter. Simulation results indicate that A/D converters with a SNDR of 60-70dB can be measured with an absolute accuracy of better than 0.2dB using a function generator that has ~40dB distortion components
A new approach for an adaptive forest management planning to improve resilience of beech forests in relation to climate change: the LIFE AForClimate project
Albumin replacement in patients with severe sepsis or septic shock
BACKGROUND:
Although previous studies have suggested the potential advantages of albumin administration in patients with severe sepsis, its efficacy has not been fully established.
METHODS:
In this multicenter, open-label trial, we randomly assigned 1818 patients with severe sepsis, in 100 intensive care units (ICUs), to receive either 20% albumin and crystalloid solution or crystalloid solution alone. In the albumin group, the target serum albumin concentration was 30 g per liter or more until discharge from the ICU or 28 days after randomization. The primary outcome was death from any cause at 28 days. Secondary outcomes were death from any cause at 90 days, the number of patients with organ dysfunction and the degree of dysfunction, and length of stay in the ICU and the hospital.
RESULTS:
During the first 7 days, patients in the albumin group, as compared with those in the crystalloid group, had a higher mean arterial pressure (P=0.03) and lower net fluid balance (P<0.001). The total daily amount of administered fluid did not differ significantly between the two groups (P=0.10). At 28 days, 285 of 895 patients (31.8%) in the albumin group and 288 of 900 (32.0%) in the crystalloid group had died (relative risk in the albumin group, 1.00; 95% confidence interval [CI], 0.87 to 1.14; P=0.94). At 90 days, 365 of 888 patients (41.1%) in the albumin group and 389 of 893 (43.6%) in the crystalloid group had died (relative risk, 0.94; 95% CI, 0.85 to 1.05; P=0.29). No significant differences in other secondary outcomes were observed between the two groups.
CONCLUSIONS:
In patients with severe sepsis, albumin replacement in addition to crystalloids, as compared with crystalloids alone, did not improve the rate of survival at 28 and 90 days. (Funded by the Italian Medicines Agency; ALBIOS ClinicalTrials.gov number, NCT00707122.