Expert consensus regarding drivers of antimicrobial stewardship in companion animal veterinary practice: a Delphi study

Antimicrobial resistance (AMR) is a global challenge facing both human and animal healthcare professionals; an effective response to this threat requires a ‘One-Health’ approach to antimicrobial stewardship (AMS) to preserve important antibiotics for urgent clinical need. However, understanding of barriers and enablers to effective AMS behaviour in companion animal veterinary practice is currently limited. We conducted a Delphi study of 16 nationally recognised experts from UK-based veterinary policymakers, university academics and leaders of professional bodies. This Delphi study sought to identify veterinary behaviours which experts believe contribute to AMR and form vital aspects of AMS. Analysis of Delphi findings indicated a perceived hierarchy of behaviours, the most influential being antibiotic prescribing behaviours and interactions with clients. Other veterinary behaviours perceived as being important related to interactions with veterinary colleagues; infection control practices; and the use of diagnostic tests to confirm infection. Key barriers and enablers to AMS within each of these behavioural domains were identified. Specific interventions to address important barriers and enablers are recommended. To the authors’ knowledge, this is the first study to establish expert consensus at a national level about which ‘behaviours’ (aspects of veterinarian practice) should be targeted in relation to AMR and AMS in companion animal veterinary practice

Towards (R)evolving Cities Urban fragilities and prospects in the 21st century

Towards (R)evolving Cities: Urban Fragilities and Prospects in the 21st century first questions how we perceive the ‘intelligence’ of a city. The New Frontier of development for urban civilisations certainly includes digital and technological evolution, but it does not consider technology to be the final answer to all contemporary cities’ problems. The formidable challenges of the COVID-19 pandemic have thrown existing urban fragilities into stark relief. At the same time however they have highlighted the potential of digital solutions for reaching a new level of interconnected civility. (R)evolving cities evolve by adopting the principles of the circular economy in the higher interest of their citizens’ well-being: they consume therefore without devouring, recycle as much as possible what they metabolize, limit the effects of their ecological footprint and ultimately lead their inhabitants, with maternal guidance and care, to a new idea of citizenship. As protagonists of this evolutionary leap, the citizens of (R)evolving cities will abandon their predatory approach, reaching a higher stage of integration in the ecosystem and becoming more respectful of reciprocal relationships. (R)evolving cities are above all ‘polite’ cities, or rather cities whose citizens are consciously educated in the principles of sustainable development, the essential basis for contemporary civil coexistence

ZEB Prototype Controlled by a Machine Learning System

This communication concerns a research project by the Interdepartmental Research Centre for Territory Construction Restoration and Environment (CITERA) of Sapienza University of Rome in collaboration with ENEA (Italian National Agency for New Technologies, Energy and Sustainable Economic Development) based on the realization of a 1:1 scale demonstrator of a Zero Energy Building that allows continuous experimentation of new technologies for innovative photovoltaic systems, efficient storage systems and high-performance envelope materials. In particular a measurement protocol has been developed for both the overall efficiency of the building and the individual technological components with a view to a comparative critical analysis of the integration of the individual components in the building-system complex. All the technological systems has been used in Solar Decathlon Middle East 2018 competition in Dubai. The project concerns the development of a control and management system for photovoltaic energy production systems for the ZEB prototype, based on an intelligent self-learning system (AI) able to optimize the parameters of self-produced electricity supply based on real consumption of air conditioning equipment, electrical power supply to the equipment, access control and safety equipment. The most immediate result concerns the integrated design of both the hardware systems for the production and use of electricity and the algorithms that continuously measure parameters such as grid load, consumption and electricity production, and which takes into account weather forecasts, energy tariffs, and learns the trend of electricity consumers through the use of artificial intelligence

La Città fragile: dalla Smart alla (R)evolving city

Il superamento del concetto di Smart city per arrivare a quello di (R)evolving city, mette innanzi tutto in discussione cosa si debba intendere per ‘intelligenza’ di una città. Certamente la Nuova frontiera per lo sviluppo delle civiltà urbane ricomprende l’evoluzione tecnologica, ma non considera la tecnologia come la risposta definitiva a tutti i problemi delle città contemporanee. La (R)evolving city evolve introitando i principi dell’economia circolare, nell’interesse superiore del benessere dei suoi cittadini, e dunque consuma senza divorare, ricicla il più possibile ciò che metabolizza, contiene gli effetti della propria impronta ecologica ed in ultima analisi guida con materna e gentile cura i suoi abitanti ad un concetto nuovo di cittadinanza. Come attori del cambiamento evolutivo dei sistemi urbani, i cittadini della (R)evolving city abbandonano l’approccio predatorio evolvendo ad uno stadio superiore di organismi, integrati nell'ecosistema e rispettosi delle reciproche relazioni. La (R)evolving city è soprattutto una città ‘educata’, o meglio una città i cui cittadini sono consapevolmente educati ai principi dello sviluppo sostenibile, considerati come base oramai imprescindibile della convivenza civile contemporanea

Recurrence following anastomotic leakage after surgery for carcinoma of the distal esophagus and gastroesophageal junction. a systematic review

BACKGROUND: Esophageal cancer is the ninth most common cancer. The only potentially curative treatment is surgical resection, which unfortunately is still associated with major complications, the most important being anastomotic leakage, currently with an overall rate of up to 26% morbidity. The aim of this systematic review was to evaluate the relationship between anastomotic leakage and recurrence of disease. MATERIALS AND METHODS: A literature search was systematically performed. Seven out of 312 articles dated between 2009 and 2018 fulfilled the selection for a total of 5,433 patients. RESULTS: The frequency of anastomotic leakage ranged from 7.2 to 11.2%. Patients affected by anastomotic leakage had a recurrence rate of 9-56%. CONCLUSION: Closer follow-up or even more aggressive oncological therapy should be considered for patients affected by anastomotic leakage after surgery for carcinoma of the distal esophagus and gastroesophageal junction

Optimization of design and management of a hydroponic greenhouse by using BIM application software

The paper deals with hydroponic greenhouses that can be used both for crops cultivation and as a space for hosting events, thanks to its transformability characteristics. The project combines the concepts of circular economy and agricultural activity, creating environmentally sustainable hydroponic greenhouses, from the design to the management phase, thanks to the use of a multidisciplinary BIM approach (Building Information Modelling). The use of application software in BIM logic such as MC4® Energy and Arch Energy (Tool developed by Sapienza University of Rome) for the energetic performance evaluation and Tally® Environmental Impact Tool for LCA Analysis, has improved the design of a modular and flexible architecture, energy-efficient and water-efficient, with advanced climate control. The project offers a possible solution to the main future challenges of food production such as the limited space, the urbanization process, the scarce availability of resources such as water, fossil fuels, minerals and the increasing demands of consumers in terms of functionality and product quality

La gestione digitale dei sistemi urbani. Una chiave per affrontare le sfide della sostenibilità ambientale nel settore edilizio

Il problema della sostenibilità ambientale è sempre più critico, in particolare nelle aree ad alta densità abitativa e urbane, dove l’impatto delle attività umane è significativo. La sostenibilità si riferisce alla capacità di mantenere un equilibrio tra l’uso delle risorse naturali e la conservazione dell’ambiente. Attualmente, i sistemi urbani e l’ambiente costruito sono responsabili di circa il 75% delle emissioni di gas serra a livello globale e consumano circa il 75% delle risorse energetiche del pianeta. Inoltre, oltre il 65% della popolazione mondiale vive e lavora nelle città, concentrando le attività emissive in tali contesti

Sustainable Restoration of Cultural Heritage in the digital era

The reprocessing, preservation, and maintenance of the wide historical architectural heritage in Italy represent one of the main challenges of digitalization; not only it is one of the oldest among in Europe, but it is also widespread across the country between cities and rural areas.  The care of such an aging built environment needs a carefully planned approach that can take advantage of new technologies such as Historical/Heritage Building Information Modelling (H-BIM) and Digital Twin (DT). The final goal is to promote a long-term sustainable restoration with high qualitative standards. Usually, the topic of sustainability is discussed for new constructions where it is of fundamental importance to save materials, energy, land use and to reduce the carbon footprint. However, being the number of historical buildings elevate in Italy, the concept shall be extended also to them, that are way more fragile if compared to the surrounding. Moreover, cultural heritage is connected to specific challenges that need to be addressed. What was happened in Aquila region after the earthquake of 2019 must not happen again. Digital technologies can be used to prevent such a catastrophic event, preventing and limiting damages, providing evaluable information, and realizing a tool that can be shared among the stakeholders to restore the physical and cultural value of an historical building also in case of extreme events

Is acidemia at birth a risk factor for functional gastrointestinal disorders?

Functional gastrointestinal disorders (FGIDs) are common in early childhood. It has been demonstrated that neonatal acidemia at delivery can lead to significant neonatal morbidity. The primary aim of this study was to evaluate the relationship between acidemia at birth and the development of FGIDs, as regurgitation, colic, and constipation, in term infants. Term newborns born at the Foggia University Hospital, Italy during the year 2020 were included in the study. As per routine clinical practice, a cord blood gas analysis on a blood sample drawn from the umbilical artery (UA) of each infant immediately after birth was performed, and Apgar score was recorded. One year after birth, each infant's parents were interviewed through a phone call to investigate development of FGIDs, feeding practices, and morbidities. During the study period, 1574 term newborns met the inclusion criteria. The prevalence of infantile colic, regurgitation, and constipation was higher in infants with low UA pH (colic 51.5% vs. 25.4%, p < 0.001; regurgitation 30.6% vs. 15.2%, p < 0.001; constipation 24.6% vs. 16.0%, p = 0.015), with infants having moderate-severe acidemia facing the highest risk for all the examined FGIDs. In binary logistic regression analyses, UA pH and perinatal antibiotic exposure proved to be independently associated with the later diagnosis of each FGID. Conclusion: Newborns with acidemia at birth appear to face a higher risk of FGIDs in infancy. Avoiding low cord blood pH should continue to be the goal for obstetricians, while enhanced long-term surveillance for infants who experienced birth acidemia should be required

Experimental envelopes and their integration in the building information modeling energy simulation process

The present contribution deals with an ongoing Italian research which includes several steps and it is approaching to its final stage. The main goal is analysing and testing the feasibility of municipal waste reuse for designing building envelopes for Near Zero Energy Buildings (NZEB), so as to contribute to the decreasing demand for energy and improve eco-friendly waste management in urban areas. First, prefab building components have been designed using selected waste and their thermal and acoustic behaviours have been calculated, according to the European rules; then the economic costs of the obtained building envelopes have been assessed and compared to common building structures to verify their possible appeal on the Italian market, and finally the components have been assembled in the project for a small NZEB building: a didactic classroom for the Mira Porte Primary School (Venice, Italy). This paper refers to the in-depth elaboration of the project, mainly concerning fire and pollutant protection, and it focuses on the reliability check of the Building Information Modeling (BIM) parametric model, especially as concerns non-conventional materials and components. The relative building energy behaviour has been obtained exporting the BIM energy simulation model using the EC770 Integrated Design for Revit plug-in. Finally, a comparison between the results obtained with the traditional energy assessment (according to D.M. 26/06/2015) and those using the BIM model has been made to evaluate the interoperability between architectural modeling software and the energy simulation one