An updating on Cryptosporidium parvum in the water buffalo

A cross-sectional survey of Cryptosporidium parvum infection in the water buffalo was carried out in central Italy. The survey was carried out on a sample of 90 farms, selected using a grid approach within a Geographical Information System, followed by proportional allocation. On each farm, faecal samples were collected from three to five asymptomatic buffalo calves, aged from 1 to 9 weeks (total number = 347). Each sample was tested for the presence of copro-antigens of C. parvum using a commercially available ELISA. Out of the 90 farms, 22 (24.4%) resulted positive. With respect to animals, out of the 347 faecal samples, 51 (14.7%) were found to have antigens of C. parvum. The results of the logistic regression model showed a positive association between the positivity to C. parvum and the high number of buffaloes on farms

Shape and construction of brick vaults. Criteria, methods and tools for a possible catalogue

The use of cloister vaults in the construction of noble buildings, as covering elements for square or rectangular rooms, is widespread and well-known. The geometric continuity at the intrados makes generally possible the execution all over the span of frescoes, stucco and decorations. The construction of brick vaults, from the late Middle Age, was sped up by limiting the centering to the wooden planks arches that were instrumental in the profile determination. Nowadays, the availability of several procedures, phases and tools for carrying out a survey allows to draw reliable assumptions about the construction methods and the execution time. It is mandatory to determine the properties of the binders, the shape and dimensions of the bricks, and to carry out a comparison between the geometry of the intrados surface and the evidences emerging at the extrados. The support of the laser scanner technique allows to accurately identify the surface profile and thickness. All these indications, in turn, are useful, in view of an interpretation of the structural behavior, to identify weaknesses, and to highlight contributing factors of instability (if any). In addition, Italian culture lacks systematic studies that indicate a reliable common pattern among the different types of vaults. Similar intrados shapes are often characterized by radically different patterns that are rarely taken into account from the structural point of view. The culture of stereotomy, in France and Spain, takes this interpretation of vaults for granted, while more systematic studies, in German-speaking countries, offer a broad and solid framework. The Italian technical literature was in Modern Age relatively scarce and showed limited attention to structural problems, and this fact contributes to widen this gap. Providing a variety of accurate surveys, aware of the aforementioned framework and the related shortcomings, will enable to overcome them. As a matter of fact, an element like the vault characterizes the Italian built heritage, but in the structural analysis there is often an oversimplification of some geometrical properties, limited to hurriedly measure thicknesses and intrados profiles, something that may lead to wrong conclusions. The paper focuses on a well-documented case, the Magio Grasselli palace in Cremona, where late medieval existing buildings were partially dismantled and modified in a modern aristocratic palace, designed by architect Francesco Pescaroli starting after 1658 until the end of the century. However, only the part of the building facing the main street and the part of the room overlooking the inner court were completed. The construction was resumed only after 1760: the wing facing the court and garden was completed, and all the rooms of the main floor, including the entrance hall, were covered with cloister vaults. Later on, the part of the building overlooking the main street was transformed. Here also, five rooms facing the street were vaulted, but only the central room, entirely painted by Giovanni Manfredini (1785), was completed, while three other unfinished rooms were subdivided in the Nineteenth century. The cloister vaults of two main rooms show different construction systems, although they were built almost at the same time. In the one overlooking the court, the bricks were laid on edge in concentric rows that seem parallel to the walls of the room, but are slightly arranged upwards. The irregularities are compensated by the longitudinal key joints. Wall-ribs systems at the extrados (the so-called Italian frenelli) connected to reinforcing arches, which could have served as base framework, contribute to the global stability of the structure. Thus, the vault seems to be constructed without continuous centering. Again, the large dimensions and the almost square shapes of the room overlooking the street suggest a construction through subsequent phases. Here the arches, visible from the extrados, were the centering outlining the profile of the vault, and enabled to build it without the support of planks. In order to understand the similarities and differences, the construction techniques and the state of damage of the two halls vaults, an integrated survey using laser scanners, photogrammetry and thermographic investigations was carried out. Such a survey allowed understanding the vault morphology and the masonry pattern, highlighting certain critical aspects of the structural elements, the kind of instability and decay, and the crack patterns mechanisms. More in detail, the three-dimensional model of the intrados of the hall, obtained from the laser scanner clouds, has been integrated with the three dimensional model of the masonry pattern, visible from the extrados, obtained from an elaboration of photogrammetric images. The current structure is a frame vault, characterized by two large and respectively transverse and longitudinal arches which divide the surface in nine squares and support thinner vaults, made of tiles (3-5 cm), widely used since the Sixteenth century. The investigation of easily detectable extrados parts makes a deeper knowledge of such constructions possible: it allows a better interpretation of recurring situations, even more problematic to be detected. This interpretation, however, cannot be carried out without an accurate survey integrated by thermography that can be extensively used at the intrados surfaces. In addition, the patient reconstruction and understanding of a constructive richness, made of recurrent elements and specific features, allow sketching a mixed pattern of workers and constructive knowledge. This process may result into current geographical updatable abaci, such as the French repertoires; from the point of view of innovation, it could lead to BIM libraries of vaulted elements that should be, however, not aimed at flattening and oversimplifying these valuable items to a unique parametric matrix, “copy-and-pasteable” at will, with mere changes of dimensions. Unfortunately, an oversimplification of complex elements (such as vaults) is the rule in the application of BIM to the cultural heritage. This oversimplification is the demonstration of incomplete knowledge and deviate interpretation of BIM that should be used, on the contrary, to better handle differences and peculiarities. Through the concept itself of instances consisting of unique and complex elements, “hic et nunc” to every object, the families are enriched; what is different is the point of view that should be aimed not at unifying, but at the comprehension and rendering of the acquired knowledge. As testified by some recent experiences, BIM models support this different approach to modeling, although still in a rather complex way (even if the rendering of a complex model is always complex). The availability of a detailed three-dimensional model allows a backward knowledge of the construction technique, maybe not in its entirety, but sufficient enough to explain and highlight that the provision and use of centering in the constructive phase, as previously mentioned, “changes” the geometric shape by creating multiple variations. The archival, metric and thermographic information concerning the Magio Grasselli palace are abundant and considerable, and are integrated with the plurality of data, essential to define an elevated standard of documentation, which allows to justify both detailed hypotheses on the construction techniques, and classification criteria. It is important, however, to subject the whole to a critical examination, in order to define principles effectively shared and aimed at building a reference system, whose absence was already pointed out

The risk of infection by African swine fever virus in European swine through boar movement and legal trade of pigs and pig meat

African swine fever (ASF) is currently spreading westwards throughout Europe and eastwards into China, with cases occurring in both wild boar and domestic pigs. A generic risk assessment framework is used to determine the probability of first infection with ASF virus (ASFV) at a fine spatial scale across European Union Member States. The framework aims to assist risk managers across Europe with their ASF surveillance and intervention activities. Performing the risk assessment at a fine spatial scale allows for hot-spot surveillance, which can aid risk managers by directing surveillance or intervention resources at those areas or pathways deemed most at risk, and hence enables prioritization of limited resources. We use 2018 cases of ASF to estimate prevalence of the disease in both wild boar and pig populations and compute the risk of initial infection for 2019 at a 100 km2 cell resolution via three potential pathways: legal trade in live pigs, natural movement of wild boar, and legal trade in pig meat products. We consider the number of pigs, boar and amount of pig meat entering our area of interest, the prevalence of the disease in the origin country, the probability of exposure of susceptible pigs or boar in the area of interest to introduced infected pigs, boar, or meat from an infected pig, and the probability of transmission to susceptible animals. We provide maps across Europe indicating regions at highest risk of initial infection. Results indicate that the risk of ASF in 2019 was predominantly focused on those regions which already had numerous cases in 2018 (Poland, Lithuania, Hungary, Romania, and Latvia). The riskiest pathway for ASFV transmission to pigs was the movement of wild boar for Eastern European countries and legal trade of pigs for Western European countries. New infections are more likely to occur in wild boar rather than pigs, for both the pig meat and wild boar movement pathways. Our results provide an opportunity to focus surveillance activities and thus increase our ability to detect ASF introductions earlier, a necessary requirement if we are to successfully control the spread of this devastating disease for the pig industry

THE HBIM ANALYSIS OF THE GEOMETRY TO UNDERSTAND THE CONSTRUCTIVE TECHNIQUE: THE USE OF THE <i>TROMPE</i> VOLUME IN A BRICK VAULT

The construction of brick-vaulted systems between the 16th and 18th centuries is a typical mark among the noble buildings in large part of Northern Italy. Nowadays they are still a witness of a high level of constructive knowledge by workers, formalized in historical treatises and manuals supporting a literature of theories and practices known since ancient times. The way a vault is geometrically built, regardless of its typology, is not unique and it differs in treatises, according to its location in time and space. The consequence is the generation of “mixed” solutions, where the result of the final volume is achieved by the integration of different generative models and spatial solutions. The observation of cloister vaults, apparently similar to each other but built adopting different constructive techniques within a single building, Magio Grasselli Palace in Cremona, helped to understand this topic

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&nbsp;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

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 &lt; 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

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

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 &lt; 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

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