SARS-CoV-2 transmission patterns in educational settings during the Alpha wave in Reggio-Emilia, Italy

: Different monitoring and control policies have been implemented in schools to minimize the spread of SARS-CoV-2. Transmission in schools has been hard to quantify due to the large proportion of asymptomatic carriers in young individuals. We applied a Bayesian approach to reconstruct the transmission chains between 284 SARS-CoV-2 infections ascertained during 87 school outbreak investigations conducted between March and April 2021 in Italy. Under the policy of reactive quarantines, we found that 42.5% (95%CrI: 29.5-54.3%) of infections among school attendees were caused by school contacts. The mean number of secondary cases infected at school by a positive individual during in-person education was estimated to be 0.33 (95%CrI: 0.23-0.43), with marked heterogeneity across individuals. Specifically, we estimated that only 26.0% (95%CrI: 17.6-34.1%) of students and school personnel who tested positive during in-person education caused at least one secondary infection at school. Positive individuals who attended school for at least 6 days before being isolated or quarantined infected on average 0.49 (95%CrI: 0.14-0.83) secondary cases. Our findings provide quantitative insights on the contribution of school transmission to the spread of SARS-CoV-2 in young individuals. Identifying positive cases within 5 days after exposure to their infector could reduce onward transmission at school by at least 30%

"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 \ub1 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys

Delirium in a sub-intensive care unit for the elderly: occurrence and risk factors

The objective was to study occurrence and risk factors of delirium in a new model of care, the Sub-Intensive Care Unit for the elderly (SICU), which is a level of care between that offered by ordinary wards and intensive care

Patogenesi della colelitiasi. II. Colelitiasi pigmentaria.

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Stability against temperature and external agents of vesicles composed of archaeal bolaform lipids and egg PC

The bolaform lipid PLE extracted from the thermophilic archaeon Sulfolobus solfataricus and its mixtures with egg phosphatidylcholine (egg PC) have been used to prepare sonicated vesicles. The leakage of entrapped calcein was continuously monitored by fluorescence dequenching. The half times of leakage have been used to compare vesicle stability under different conditions of temperature, lipid composition and presence of destabilizing agents like Ca2+ ions and poly(ethylene glycol) (PEG). It has been found that leakage is primarily modulated by the monopolar/bipolar lipid ratio. In particular, the half time of leakage for vesicles formed from a mixture of the polar lipid extract (PLE) and egg PC is characterized by a maximum at about 1:2 molar ratio. The free energy of mixing has been evaluated from pressure-area isotherms on monolayers at the air/water interface. The results indicate a non monotonous behaviour of the excess free energy of mixing as a function of the molar ratio and the occurrence of a minimum at a fixed molar ratio. The possible formation of a complex is discussed and compared with previous calorimetric measurements on similar compounds

Effect of physical constraints on the mechanisms of membrane fusion: bolaform lipid vesicles as model systems.

Bolaform lipid vesicles were used to study the effect of physical constraints on membrane fusion. In these vesicles the membrane is organized in a single monolayer, because of the presence of covalent bonds in its middle plane. Therefore, the formation of fusion intermediates is subject to higher energy barriers and greater geometrical constraints than is usual in bilayer membranes. Bolaform lipids were extracted from the thermophilic archaeon Sulfolobus solfataricus. These lipids can be divided into two classes, the monosubstituted molecules, in which one of the polar heads is glycerol, and the bisubstituted molecules, endowed with two complex polar heads. The fusion process in vesicles composed of different mixtures of monosubstituted/bisubstituted molecules was studied by means of fluorescence techniques. Ca2+ or poly(ethylene glycol) was employed as a fusogenic agent. We found that fusion of such constrained membranes is still possible, provided that molecules able to mediate a structural rearrangement of the membrane are present. This condition is fulfilled by monosubstituted molecules, which are able to partition the glycerol headgroup in the apolar moiety. In addition, the presence of traces (approximately 5%) of the monopolar compound diphytanylglycerol is an important factor for fusion to occur. On the contrary, vesicles formed by bisubstituted molecules are unable to fuse, irrespective of the fusogen employed

Predictors for a Good Recovery After Subacute Geriatric Care

Background and aims. We wanted to investigate eight different geriatric assessment tests regarding the prediction of 1) a good recovery (ability to return to own home or transfer to further rehabilitation), and 2) a poor recovery (discharge to nursing home, hospice, acute hospitals or death) in elderly patients treated in a subacute geriatric hospital ward. Methods. Consecutive 664 community-dwelling patients aged ≥ 70 years, transferred from acute medical and geriatric wards to a subacute geriatric ward were included. Demographic data and eight different geriatric assessment tests were recorded, and odds ratio for having a good versus poor recovery was assessed with logistic regression analysis. Results. Improvement in Barthel index (OR = 6.77, 95% CI 3.41-13.45, p 0.75, p < 0.001) was demonstrated between several of the functional assessment tests. Conclusions. Functional assessments with Barthel index at admission to the subacute ward and one day before discharge, as well as evaluation with MMSE and GDS once during the stay in the subacute ward, gave the optimal prediction of short term recovery. Further assessment with other overlapping functional tests may be redundant