Metodi e pratiche per il recupero delle identità ed il miglioramento della sicurezza nei centri terremotati dell’appennino centrale

The study, through the presentation of the researches and studies made the last years in support of the municipality of Arquata del Tronto,  means to give a contribution to outline a method of facing the rebuilding of the Central Italy’s historical towns and villages damaged by 2016 seismic events.Villages are among the place in which, more than everywhere, the local and social identity characters of community are assembled.This is noticed immediately after a catastrophic event when people involved ask themselves how to take their identity back and, at the same time, how to secure their future in safe houses, safe public building and safe common areas.These two concepts: place’s local identity restoration or conservation and guarantee of safety in case of catastrophic events, must necessarily lead the rebuilding process of the villages stroked by earthquakes.The identity characteristics of places landscape, settlements, urban fabric, buildings and building techniques are basic data to consider in defining a post-catastrophic action that wants link structural improvement with identity preservation.These identity marks should be inflected according to the different types of actions to face: restauration and prevention, rebuilding, reconstitution of urban memory. Metodi e pratiche per il recupero delle identità ed il miglioramento della sicurezza nei centri terremotati dell’appennino centraleL’intervento, attraverso la presentazione degli studi e delle ricerche portate avanti in questi anni a supporto dell’amministrazione locale del Comune di Arquata del Tronto, intende dare un contributo alla definizione di un metodo per affrontare la ricostruzione dei centri storici dell’Italia Centrale devastati dagli eventi sismici del 2016.I centri storici sono tra i luoghi dove maggiormente si condensano i caratteri identitari di un popolo e questo lo si riscontra soprattutto quando, subito dopo un evento catastrofico, le popolazioni colpite si interrogano su come riappropriarsi della propria identità ed assicurarsi un futuro in case, edifici e spazi pubblici sicuri.Questi due concetti chiave: ripristino o conservazione dell’identità di un luogo, e garanzia di sicurezza di fronte agli eventi catastrofici, dovranno necessariamente orientare il processo di ricostruzione dei borghi colpiti dai terremoti.I caratteri identitari dei luoghi, alle varie scale (paesaggio, aggregato, tessuto, tipi edilizi, tecniche costruttive) sono i dati di base dai quali non si può prescindere nella definizione di un intervento post-catastrofe che voglia coniugare il miglioramento strutturale con il mantenimento dell’identità.Questi caratteri identitari, questi dati di funzionamento, vanno declinati a seconda degli scenari d’intervento che ci si trova a dover affrontare: restauro e prevenzione; ricostruzione integrale; ricostruzione della memoria urbana. L’intervento, attraverso la presentazione degli studi e delle ricerche portate avanti in questi anni a supporto dell’amministrazione locale del Comune di Arquata del Tronto, intende dare un contributo alla definizione di un metodo per affrontare la ricostruzione dei centri storici dell’Italia Centrale devastati dagli eventi sismici del 2016.I centri storici sono tra i luoghi dove maggiormente si condensano i caratteri identitari di un popolo e questo lo si riscontra soprattutto quando, subito dopo un evento catastrofico, le popolazioni colpite si interrogano su come riappropriarsi della propria identità ed assicurarsi un futuro in case, edifici e spazi pubblici sicuri.Questi due concetti chiave: ripristino o conservazione dell’identità di un luogo, e garanzia di sicurezza di fronte agli eventi catastrofici, dovranno necessariamente orientare il processo di ricostruzione dei borghi colpiti dai terremoti.I caratteri identitari dei luoghi, alle varie scale (paesaggio, aggregato, tessuto, tipi edilizi, tecniche costruttive) sono i dati di base dai quali non si può prescindere nella definizione di un intervento post-catastrofe che voglia coniugare il miglioramento strutturale con il mantenimento dell’identità.Questi caratteri identitari, questi dati di funzionamento, vanno declinati a seconda degli scenari d’intervento che ci si trova a dover affrontare: restauro e prevenzione; ricostruzione integrale; ricostruzione della memoria urbana. Methods and Practices to Rebuild Local Identity and Improve Structural Safety of Earthquake Villages of Central ApenninesThe study, through the presentation of the researches and studies made the last years in support of the municipality of Arquata del Tronto,  means to give a contribution to outline a method of facing the rebuilding of the Central Italy’s historical towns and villages damaged by 2016 seismic events.Villages are among the place in which, more than everywhere, the local and social identity characters of community are assembled.This is noticed immediately after a catastrophic event when people involved ask themselves how to take their identity back and, at the same time, how to secure their future in safe houses, safe public building and safe common areas.These two concepts: place’s local identity restoration or conservation and guarantee of safety in case of catastrophic events, must necessarily lead the rebuilding process of the villages stroked by earthquakes.The identity characteristics of places landscape, settlements, urban fabric, buildings and building techniques are basic data to consider in defining a post-catastrophic action that wants link structural improvement with identity preservation.These identity marks should be inflected according to the different types of actions to face: restauration and prevention, rebuilding, reconstitution of urban memory

Central Venous Stenosis after Hemodialysis: Case Reports and Relationships to Catheters and Cardiac Implantable Devices

The appropriate vascular access for hemodialysis in patients with cardiac implantable electronic devices (CIED) is undefined. We describe two cases of end-stage renal disease patients with CIED and tunneled central venous catheter (CVC) who developed venous cava stenosis: (1) a 70-year-old man with sinus node disease and pacemaker in 2013, CVC, and a Brescia-Cimino forearm fistula in 2015; (2) a 75-year-old woman with previous ventricular arrhythmia with implanted defibrillator in 2014 and CVC in 2016. In either case, after about 1 year from CVC insertion, patients developed superior vena cava (SVC) syndrome due to stenosis diagnosed by axial computerized tomography. In case 1, the patient was not treated by angioplasty of SVC and removed CVC with partial resolving of symptoms. In case 2, a percutaneous transluminal angioplasty with placement of a new CVC was required. To analyze these reports in the context of available literature, we systematically reviewed studies that have analyzed the presence of central venous stenosis associated with the simultaneous presence of CIED and CVC. Five studies were found; two indicated an increased incidence of central venous stenosis, while three did not find any association. While more studies are definitely needed, we suggest that these patients may benefit from epicardial cardiac devices and the insertion of devices directly into the ventriculus. If the new devices are unavailable or contraindicated, peritoneal dialysis or intensive conservative treatment in older patients may be proposed as alternative options

Development of a tool to optimize economic and environmental feasibility of food waste chains

11 figures, 6 tables.-- Supplementary information available.The Sustainable Development Goal 12.3 focuses on food and its inedible parts that exit the supply chain and thus are lost or wasted. This work addresses the food waste problem by presenting the development of a tool to design business models to reduce the production of food waste. This has been developed within the LIFE16 project iRexfo, coordinated by the University of Perugia. The tool aims at transferring the results obtained in a pilot region (Umbria, Italy) to 4 other regions in Europe. It has been coded in Python and has a graphical user interface (GUI) to insert inputs and display outputs. The GUI has been developed in FLASK and it is hosted in the website of PythonAnywhere. A case study on the application of the software is also presented, mainly based on data retrieved in the Umbria region, Italy. Together with economic analysis, also, environmental assessment is performed.Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. i-REXFO LIFE (LIFE16ENV/IT/000547) is a project funded by the EU under the LIFE 2016 program. This work has been partially funded by the GTCLC-NEG project that has received funding from the European Union’s Horizon 2020 research and innovation program under the Marie Sklodowska-Curie grant agreement No. 101018756.Peer reviewe

Stakeholders' views on the global guidelines for the sustainable use of non‐native trees

A large number of non‐native trees (NNTs) have been introduced globally and widely planted, contributing significantly to the world's economy. Although some of these species present a limited risk of spreading beyond their planting sites, a growing number of NNTs are spreading and becoming invasive leading to diverse negative impacts on biodiversity, ecosystem functions and human well‐being. To help minimize the negative impacts and maximize the economic benefits of NNTs, Brundu et al. developed eight guidelines for the sustainable use of NNTs globally—the Global Guidelines for the Use of NNTs (GG‐NNTs). Here, we used an online survey to assess perceptions of key stakeholders towards NNTs, and explore their knowledge of and compliance with the GG‐NNTs. Our results show that stakeholders are generally aware that NNTs can provide benefits and cause negative impacts, often simultaneously and they consider that their organization complies with existing regulations and voluntary agreements concerning NNTs. However, they are not aware of or do not apply most of the eight recommendations included in the GG‐NNTs. We conclude that effectively managing invasions linked to NNTs requires both more communication efforts using an array of channels for improving stakeholder awareness and implementation of simple measures to reduce NNT impacts (e.g. via GG‐NNTs), and a deeper understanding of the barriers and reluctance of stakeholders to manage NNT invasions. Read the free Plain Language Summary for this article on the Journal blog

Exploring the Zoonotic Potential of Mycobacterium avium Subspecies paratuberculosis through Comparative Genomics

A comparative genomics approach was utilised to compare the genomes of Mycobacterium avium subspecies paratuberculosis (MAP) isolated from early onset paediatric Crohn's disease (CD) patients as well as Johne's diseased animals. Draft genome sequences were produced for MAP isolates derived from four CD patients, one ulcerative colitis (UC) patient, and two non-inflammatory bowel disease (IBD) control individuals using Illumina sequencing, complemented by comparative genome hybridisation (CGH). MAP isolates derived from two bovine and one ovine host were also subjected to whole genome sequencing and CGH. All seven human derived MAP isolates were highly genetically similar and clustered together with one bovine type isolate following phylogenetic analysis. Three other sequenced isolates (including the reference bovine derived isolate K10) were genetically distinct. The human isolates contained two large tandem duplications, the organisations of which were confirmed by PCR. Designated vGI-17 and vGI-18 these duplications spanned 63 and 109 open reading frames, respectively. PCR screening of over 30 additional MAP isolates (3 human derived, 27 animal derived and one environmental isolate) confirmed that vGI-17 and vGI-18 are common across many isolates. Quantitative real-time PCR of vGI-17 demonstrated that the proportion of cells containing the vGI-17 duplication varied between 0.01 to 15% amongst isolates with human isolates containing a higher proportion of vGI-17 compared to most animal isolates. These findings suggest these duplications are transient genomic rearrangements. We hypothesise that the over-representation of vGI-17 in human derived MAP strains may enhance their ability to infect or persist within a human host by increasing genome redundancy and conferring crude regulation of protein expression across biologically important regions

Prescription appropriateness of anti-diabetes drugs in elderly patients hospitalized in a clinical setting: evidence from the REPOSI Register

Diabetes is an increasing global health burden with the highest prevalence (24.0%) observed in elderly people. Older diabetic adults have a greater risk of hospitalization and several geriatric syndromes than older nondiabetic adults. For these conditions, special care is required in prescribing therapies including anti- diabetes drugs. Aim of this study was to evaluate the appropriateness and the adherence to safety recommendations in the prescriptions of glucose-lowering drugs in hospitalized elderly patients with diabetes. Data for this cross-sectional study were obtained from the REgistro POliterapie-Società Italiana Medicina Interna (REPOSI) that collected clinical information on patients aged ≥ 65 years acutely admitted to Italian internal medicine and geriatric non-intensive care units (ICU) from 2010 up to 2019. Prescription appropriateness was assessed according to the 2019 AGS Beers Criteria and anti-diabetes drug data sheets.Among 5349 patients, 1624 (30.3%) had diagnosis of type 2 diabetes. At admission, 37.7% of diabetic patients received treatment with metformin, 37.3% insulin therapy, 16.4% sulfonylureas, and 11.4% glinides. Surprisingly, only 3.1% of diabetic patients were treated with new classes of anti- diabetes drugs. According to prescription criteria, at admission 15.4% of patients treated with metformin and 2.6% with sulfonylureas received inappropriately these treatments. At discharge, the inappropriateness of metformin therapy decreased (10.2%, P < 0.0001). According to Beers criteria, the inappropriate prescriptions of sulfonylureas raised to 29% both at admission and at discharge. This study shows a poor adherence to current guidelines on diabetes management in hospitalized elderly people with a high prevalence of inappropriate use of sulfonylureas according to the Beers criteria

Antidiabetic Drug Prescription Pattern in Hospitalized Older Patients with Diabetes

Objective: To describe the prescription pattern of antidiabetic and cardiovascular drugs in a cohort of hospitalized older patients with diabetes. Methods: Patients with diabetes aged 65 years or older hospitalized in internal medicine and/or geriatric wards throughout Italy and enrolled in the REPOSI (REgistro POliterapuie SIMI—Società Italiana di Medicina Interna) registry from 2010 to 2019 and discharged alive were included. Results: Among 1703 patients with diabetes, 1433 (84.2%) were on treatment with at least one antidiabetic drug at hospital admission, mainly prescribed as monotherapy with insulin (28.3%) or metformin (19.2%). The proportion of treated patients decreased at discharge (N = 1309, 76.9%), with a significant reduction over time. Among those prescribed, the proportion of those with insulin alone increased over time (p = 0.0066), while the proportion of those prescribed sulfonylureas decreased (p < 0.0001). Among patients receiving antidiabetic therapy at discharge, 1063 (81.2%) were also prescribed cardiovascular drugs, mainly with an antihypertensive drug alone or in combination (N = 777, 73.1%). Conclusion: The management of older patients with diabetes in a hospital setting is often sub-optimal, as shown by the increasing trend in insulin at discharge, even if an overall improvement has been highlighted by the prevalent decrease in sulfonylureas prescription

The “Diabetes Comorbidome”: A Different Way for Health Professionals to Approach the Comorbidity Burden of Diabetes

(1) Background: The disease burden related to diabetes is increasing greatly, particularly in older subjects. A more comprehensive approach towards the assessment and management of diabetes’ comorbidities is necessary. The aim of this study was to implement our previous data identifying and representing the prevalence of the comorbidities, their association with mortality, and the strength of their relationship in hospitalized elderly patients with diabetes, developing, at the same time, a new graphic representation model of the comorbidome called “Diabetes Comorbidome”. (2) Methods: Data were collected from the RePoSi register. Comorbidities, socio-demographic data, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), and functional status (Barthel Index), were recorded. Mortality rates were assessed in hospital and 3 and 12 months after discharge. (3) Results: Of the 4714 hospitalized elderly patients, 1378 had diabetes. The comorbidities distribution showed that arterial hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and COPD (22.7%), were the more frequent in subjects with diabetes. The graphic comorbidome showed that the strongest predictors of death at in hospital and at the 3-month follow-up were dementia and cancer. At the 1-year follow-up, cancer was the first comorbidity independently associated with mortality. (4) Conclusions: The “Diabetes Comorbidome” represents the perfect instrument for determining the prevalence of comorbidities and the strength of their relationship with risk of death, as well as the need for an effective treatment for improving clinical outcomes

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population