Improvement of the Sustainability of Existing School Buildings According to the Leadership in Energy and Environmental Design (LEED)® Protocol: A Case Study in Italy

School-age students spend much of their time in school buildings. The sustainability of these buildings should be a priority as better comfort with a high indoor air quality contributes to an improvement in the conditions for learning. Although new school buildings are often built with high standards of sustainability and energy efficiency, the existing school building stock is generally characterised by very poor quality. The energy retrofit of existing school buildings in recent years is part of the policies of the European Union and, consequently, of the Member States. However, rarely do these measures consider aspects other than energy. This paper proposes and discusses a feasibility study which provides a considerable improvement in the environmental quality of 14 school buildings located in northern Italy: the objective is to ensure the requirements for Leadership in Energy and Environmental Design (LEED) ® certification. The analysis considers both the technical and economic aspects. The study shows that there is a technical feasibility: the credits are between 42 and 54, moreover the major cost (the cost of building envelope and heating systems retrofit is 82.9% of the total cost) is due to the improvement of energy efficiency. The improvement of sustainability is therefore a reasonable strategy even if the application of the LEED Protocol in the Italian context involves some critical issues that are discussed in the paper

The role of GP’s compensation schemes in diabetes care: evidence from panel data

The design of incentive schemes that improve quality of care is a central issue for the healthcare sector. Nowadays we observe many pay-for-performance programs, where payment is contingent on meeting indicators of provider effort, but also other alternative strategies have been introduced, for example programs rewarding physicians for participation in diseases management plans. Although it has been recognised that incentive-based remuneration schemes can have an impact on GP behaviour, there is still weak empirical evidence on the extent to which such programs influence health outcomes. We investigate the impact of financial incentives in Regional and Local Health Authority contracts for primary care in the Italian Region Emilia Romagna for the years 2003-05. We focus on avoidable hospitalisations (Ambulatory Care Sensitive Conditions) for patients affected by type 2 diabetes mellitus, for which the assumption of responsibility and the adoption of clinical guidelines are specifically rewarded. We estimate a panel count data model using a Negative Binomial distribution to test the hypothesis that, other things equal, patients under the responsibility of GPs receiving a higher share of their income through these programs are less likely to experience avoidable hospitalisations. Our findings support the hypothesis that financial transfers may contribute to improve quality of care, even when they are not based on the ex-post verification of performances

Incentives In Primary Care and Their Impact on Potentially Avoidable Hospital Admissions

Financial incentives in primary care have been often introduced with the purpose of improving appropriateness of care and containing demand. We usually observe pay-for-performance programs, but alternatives have been also implemented, such as pay-for-participation in improvement activities and pay-for-compliance with clinical guidelines. Here, we assess the influence of different programs which ensure extra-payments to GPs, for containing episodes of avoidable hospitalisations. Our dataset covers patients and GPs of the Italian region Emilia-Romagna for year 2005, and we control for a wide range of factors potentially influencing GPs’ behaviour. By separating pay-for-performance from pay-for-participation and pay-for-compliance programs, we estimate the impact on the probability of (inappropriate) hospitalisation of financial incentives included in contracts between GPs and the NHS. As dependent variable, we consider two different sets of conditions, for both of which timely and effective primary care should be able to limit the need of hospital admission. The first is based on 27 medical DRGs that Emilia-Romagna identifies as at risk of inappropriateness in primary care, while the second refers to the internationally recognised ACSCs (ambulatory care-sensitive conditions). We show that pay-for-performance schemes may have a significant effect over aggregate indicators of appropriateness, while the effectiveness of pay-for-participation schemes is adequately captured only by taking into account subpopulations affected by specific diseases. Moreover, the same incentive scheme has fairly different effects on the two sets of indicators used, with performance improvements limited to the target explicitly addressed by the policy maker (i.e. the list of 27 DRGs). This evidence is consistent with the idea that a “tunnel vision” effect may occur when public authorities promote and monitor specific sets of objectives, as proxies for more general improvements in health care practices

Study of faecal parameters and body condition in dogs with a diet supplemented with Lactobacillus acidophilus D2/CSL (CECT 4529)

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Radical improvement of signs and symptoms in systemic lupus erythematosus when treated with hemodiafiltration with endogenous reinfusion dialysis

Lupus nephritis is one of the most serious complications of systemic lupus erythematosus (SLE). In the kidney immune complexes (ICs) and autoantibodies activate mesangial cells that secrete the cytokines that further amplify inflammatory processes. We present a case of a 42-year-old woman presented Lupus Nephritis, with periods of exacerbation of SLE, with necrotic-like skin lesions, psoriatic arthritis without skin psoriasis, purpura to lower limb, petechial rash, joint pain, fever, eyelid edema with bilateral conjunctival hyperemia and itching When she was subjected to Hemodiafiltration with Endogenous Reinfusion (HFR) dialysis treatment with super high flux membrane Synclear 02 (SUPRA treatment), fever and joint pain was reduced immediately, subsequently all of her skin damages are reduced and she gradually decreased quantity of prednisone and immunosuppressor per die until completely suspend. As well known that SUPRA treatment remove cytokine from blood ; moreover was used the High-performance liquid chromatography coupled with Quadrupole Time-of-flight Mass Spectrometer (HPLC-QTOF-MS) for identification of proteins captured by resin bed during a dialysis session of the patient. With this technique was identified several biomarker of kidney injuries, uremic toxins, fragments of Immunoglobulins, antigen involved in anti-phospholipid syndrome and a new marker (α-defensin) that correlate significantly with disease activity. The removal of these different proteins can explain the improvement in the patient’s symptoms and the normalization of her LES, confirming that SUPRA are a suitable technique for LN treatment

Defining Quantitative Targets for Topsoil Organic Carbon Stock Increase in European Croplands: Case Studies With Exogenous Organic Matter Inputs

The EU Mission Board for Soil Health and Food proposed a series of quantitative targets for European soils to become healthier. Among them, current soil organic carbon (SOC) concentration losses in croplands (0.5% yr(-1) on average at 20 cm depth) should be reversed to an increase of 0.1-0.4% yr(-1) by 2030. Quantitative targets are used by policy makers to incentivize the implementation of agricultural practices that increase SOC stocks. However, there are different approaches to calculate them. In this paper, we analyzed the effect of exogenous organic matter (EOM) inputs on the evolution of SOC stocks, with a particular focus on the new European targets and the different approaches to calculate them. First, we illustrated through two case-study experiments the different targets set when the SOC stock increase is calculated considering as reference: 1) the SOC stock level at the onset of the experiment and 2) the SOC stock trend in a baseline, i.e., a control treatment without EOM addition. Then, we used 11 long-term experiments (LTEs) with EOM addition in European croplands to estimate the amount of carbon (C) input needed to reach the 0.1 and 0.4% SOC stock increase targets proposed by the Mission Board for Soil Health and Food, calculated with two different approaches. We found that, to reach a 0.1 and 0.4% increase target relative to the onset of the experiment, 2.51 and 2.61 Mg C ha(-1) yr(-1) of additional C input were necessary, respectively. Reaching a 0.1 and 0.4% increase target relative to the baseline required 1.38 and 1.77 Mg C ha(-1) yr(-1) of additional input, respectively. Depending on the calculation method used, the estimated amounts of additional C input required to reach each quantitative target were significantly different from each other. Furthermore, the quality of C input as represented by the C retention rate of the additional organic material (EOM and crop residue), had a significant effect on the variation of SOC stocks. Our work highlights the necessity to take into consideration the additional C input required to increase SOC stocks, especially for soils with decreasing SOC stocks, when targets are set independently of the baseline

Chronic Intestinal Disorders in Humans and Pets: Current Management and the Potential of Nutraceutical Antioxidants as Alternatives

Chronic intestinal disorders (CID) are characterized by persistent, or recurrent gastrointestinal (GI) signs present for at least three weeks. In human medicine, inflammatory bowel disease (IBD) is a group of chronic GI diseases and includes Crohn’s disease (CD) and ulcerative colitis (UC). On the other hand, the general term chronic enteropathies (CE) is preferred in veterinary medicine. Different therapeutic approaches to these diseases are used in both humans and pets. This review is focused on the use of traditional therapies and nutraceuticals with specific antioxidant properties, for the treatment of CID in humans and animal patients. There is strong evidence of the antioxidant properties of the nutraceuticals included in this review, but few studies report their use for treating CID in humans and none in animals. Despite this fact, the majority of the nutraceuticals described in the present article could be considered as promising alternatives for the regular treatment of CID in human and veterinary medicine

Lattice radiation therapy in clinical practice: a systematic review

Purpose: Lattice radiation therapy (LRT) is an innovative type of spatially fractionated radiation therapy. It aims to increase large tumors control probability by administering ablative doses without an increased toxicity. Considering the rising number of positive clinical experiences, the objective of this work is to evaluate LRT safety and efficacy. Method: Reports about LRT clinical experience were identified with a systematic review conducted on four different databases (namely, Medline, Embase, Scopus, and Cochrane Library) through the August 2022. Only LRT clinical reports published in English and with the access to the full manuscript text were considered as eligible. The 2020 update version PRISMA statement was followed. Results: Data extraction was performed from 12 eligible records encompassing 7 case reports, 1 case series, and 4 clinical studies. 81 patients (84 lesions) with a large lesion ranging from 63.2 cc to 3713.5 cc were subjected to exclusive, hybrid, and metabolism guided LRT. Excluding two very severe toxicity with a questionable relation with LRT, available clinical experience seem to confirm LRT safety. When a complete response was not achieved 3-6 months after LRT, a median lesion reduction approximately ≥50 % was registered. Conclusion: This systematic review appear to suggest LRT safety, especially for exclusive LRT. The very low level of evidence and the studies heterogeneity preclude drawing definitive conclusions on LRT efficacy, even though an interesting trend in terms of lesions reduction has been described