Ecological effects of multiple stressors on a deep lake (Lago Maggiore, Italy) integrating neo and palaeolimnological approaches

To understand interactions of lake physical characteristics, trophic dynamics and climate in Lago Maggiore, we compare longterm limnological and meteorological monitoring data and results from sediment cores. We include analyses of nutrients, pigments, diatoms and cladoceran microfossils. Over the past decades, caloric content increased. Eutrophication from the 1960s to early 1980s was followed by oligotrophication. DDTs, PCBs and Hg showed high contamination in the \u2760s, compared to point source inputs in the \u2790s. Algal biomass was predicted by total pigments and some algal specific carotenoids. Following nutrient enrichment, Chydorus sphaericus, and total abundance of cladocerans changed inversely with trophic status. Fewer large Daphnia since the late \u2780s matched an increase in with subfossil Eubosmina mucro lengths. Both were explained by the 10-fold increase in Bythotrephes longimanus from 1987 to 1993, when an increase of its mean annual population density occurred during warmer winter and springs. Bythotrephes remained abundant and further increased during the following 10 years as water temperature increased. We conclude that warmer water affects food chains indirectly by changing habitat use and predator-prey interactions. Relative abundances of Daphnia and its peak population density in the warm year of the oligotrophic period (2003) were close to the record from the mesotrophic period in 1982, supporting the hypothesis that warming can produce a eutrophication-like signal. The study illustrates the complexity of biological responses to synchronous changes in multiple drivers (e.g., eutrophication, fish introduction, ban of fish harvesting, chemical pollution, and climate) and, despite this complexity, how Lago Maggiore responded to multiple stressors

Study of the Application of CCUS in a WtE Italian Plant

Municipal Solid Waste (MSW) contains materials of biogenic and non-biogenic origin. When incinerated, the biogenic component produces CO2, which does not lead to an increase in atmospheric CO2 levels. For WtE plants operating on MSW with a significant biogenic component, Carbon Capture Utilization and Storage (CCUS) can provide a path to negative CO2 emissions by producing energy and managing locally produced waste. This work focuses on the study of a process for treating a flue gas stream from WtE in an Italian context, i.e. the incinerator plant located in Como, to remove CO2 that is, then, planned to be utilized. The CO2 capture process is based on chemical absorption by two different amine solvents: MonoEthanolAmine and Piperazine. The design of the CO2 removal section has been carried out specifically for the considered flue gas to be treated, containing about 7 mol % CO2, by selecting the main process parameters (e.g., absorber packing height, regenerator packing height, lean loading, gas inlet temperature, solvent inlet temperature, regenerator pressure) in order to optimize the reboiler duty and the water requirement. The performances of the two processes have been compared for the same 90 % removal of CO2

Management of pericarditis

Pericarditis is an inflammatory syndrome involving pericardium, which is a double-walled sac consisting of two leaves, a serous visceral layer in contact with the myocardium (pericardium) and a parietal fibrous one, delimiting a cavity (pericardial cavity) containing pericardial fluid. Pericarditis may occur isolated or as a manifestation of a systemic disorder. Diagnosis and correct management of pericarditis can be difficult and its natural history is often characterized by a lot of relapses. Treatment of acute pericarditis should target the underlying etiology. The diagnosis is based on characteristic clinical findings, electrocardiogram, and echocardiography. The goals of treatment are relief of pain, resolution of inflammation (and, if present, pericardial effusion), and prevention of recurrence. Despite a significant impairment of the quality of life, pericarditis usually has good long-term outcomes

Future-proofing hydrogeology by revising groundwater monitoring practice

Groundwater is an important global resource and its sustainable use faces major challenges. New methods and advances in computational science could lead to much improved understanding of groundwater processes and subsurface properties. A closer look at current groundwater monitoring practice reveals the need for updates with a special focus on the benefits of high-frequency and high-resolution datasets. To future-proof hydrogeology, this technical note raises awareness about the necessity for improvement, provides initial recommendations and advocates for the development of universal guidelines

Antimicrobial Prophylaxis in Neonates and Children Undergoing Dental, Maxillo-Facial or Ear-Nose-Throat (ENT) Surgery: A RAND/UCLA Appropriateness Method Consensus Study

Surgical site infections (SSIs) represent a potential complication in surgical procedures, mainly because clean/contaminated surgery involves organs that are normally colonized by bacteria. Dental, maxillo-facial and ear-nose-throat (ENT) surgeries are among those that carry a risk of SSIs because the mouth and the first respiratory tracts are normally colonized by a bacterial flora. The aim of this consensus document was to provide clinicians with recommendations on surgical antimicrobial prophylaxis in neonates (<28 days of chronological age) and pediatric patients (within the age range of 29 days-18 years) undergoing dental, maxillo-facial or ENT surgical procedures. These included: (1) dental surgery; (2) maxilla-facial surgery following trauma with fracture; (3) temporo-mandibular surgery; (4) cleft palate and cleft lip repair; (5) ear surgery; (6) endoscopic paranasal cavity surgery and septoplasty; (7) clean head and neck surgery; (8) clean/contaminated head and neck surgery and (9) tonsillectomy and adenoidectomy. Due to the lack of pediatric data for the majority of dental, maxillo-facial and ENT surgeries and the fact that the recommendations for adults are currently used, there is a need for ad hoc studies to be rapidly planned for the most deficient areas. This seems even more urgent for interventions such as those involving the first airways since the different composition of the respiratory microbiota in children compared to adults implies the possibility that surgical antibiotic prophylaxis schemes that are ideal for adults may not be equally effective in children

Chronic constipation diagnosis and treatment evaluation: The "CHRO.CO.DI.T.E." study

Background: According to Rome criteria, chronic constipation (CC) includes functional constipation (FC) and irritable bowel syndrome with constipation (IBS-C). Some patients do not meet these criteria (No Rome Constipation, NRC). The aim of the study was is to evaluate the various clinical presentation and management of FC, IBS-C and NRC in Italy. Methods: During a 2-month period, 52 Italian gastroenterologists recorded clinical data of FC, IBS-C and NRC patients, using Bristol scale, PAC-SYM and PAC-QoL questionnaires. In addition, gastroenterologists were also asked to record whether the patients were clinically assessed for CC for the first time or were in follow up. Diagnostic tests and prescribed therapies were also recorded. Results: Eight hundred seventy-eight consecutive CC patients (706 F) were enrolled (FC 62.5%, IBS-C 31.3%, NRC 6.2%). PAC-SYM and PAC-QoL scores were higher in IBS-C than in FC and NRC. 49.5% were at their first gastroenterological evaluation for CC. In 48.5% CC duration was longer than 10 years. A specialist consultation was requested in 31.6%, more frequently in IBS-C than in NRC. Digital rectal examination was performed in only 56.4%. Diagnostic tests were prescribed to 80.0%. Faecal calprotectin, thyroid tests, celiac serology, breath tests were more frequently suggested in IBS-C and anorectal manometry in FC. More than 90% had at least one treatment suggested on chronic constipation, most frequently dietary changes, macrogol and fibers. Antispasmodics and psychotherapy were more frequently prescribed in IBS-C, prucalopride and pelvic floor rehabilitation in FC. Conclusions: Patients with IBS-C reported more severe symptoms and worse quality of life than FC and NRC. Digital rectal examination was often not performed but at least one diagnostic test was prescribed to most patients. Colonoscopy and blood tests were the "first line" diagnostic tools. Macrogol was the most prescribed laxative, and prucalopride and pelvic floor rehabilitation represented a "second line" approach. Diagnostic tests and prescribed therapies increased by increasing CC severity

Geographical heterogeneity of clinical and serological phenotypes of systemic sclerosis observed at tertiary referral centres. The experience of the Italian SIR-SPRING registry and review of the world literature

Introduction: Systemic sclerosis (SSc) is characterized by a complex etiopathogenesis encompassing both host genetic and environmental -infectious/toxic- factors responsible for altered fibrogenesis and diffuse microangiopathy. A wide spectrum of clinical phenotypes may be observed in patients' populations from different geographical areas. We investigated the prevalence of specific clinical and serological phenotypes in patients with definite SSc enrolled at tertiary referral centres in different Italian geographical macro-areas. The observed findings were compared with those reported in the world literature.Materials and methods: The clinical features of 1538 patients (161 M, 10.5%; mean age 59.8 +/- 26.9 yrs.; mean disease duration 8.9 +/- 7.7 yrs) with definite SSc recruited in 38 tertiary referral centres of the SPRING (Systemic sclerosis Progression INvestiGation Group) registry promoted by Italian Society of Rheumatology (SIR) were obtained and clustered according to Italian geographical macroareas.Results: Patients living in Southern Italy were characterized by more severe clinical and/or serological SSc phenotypes compared to those in Northern and Central Italy; namely, they show increased percentages of diffuse cutaneous SSc, digital ulcers, sicca syndrome, muscle involvement, arthritis, cardiopulmonary symptoms, interstitial lung involvement at HRCT, as well increased prevalence of serum anti-Scl70 autoantibodies. In the same SSc population immunusppressive drugs were frequently employed. The review of the literature underlined the geographical heterogeneity of SSc phenotypes, even if the observed findings are scarcely comparable due to the variability of methodological approaches.Conclusion: The phenotypical differences among SSc patients' subgroups from Italian macro-areas might be correlated to genetic/environmental co-factors, and possibly to a not equally distributed national network of information and healthcare facilities

Type 1 Autoimmune Pancreatitis in Europe: Clinical Profile and Response to Treatment.

Background and aimsAutoimmune pancreatitis (AIP) is an immune-mediated disease of the pancreas with distinct pathophysiology and manifestations. Our aims were to characterize type 1 AIP in a large pan-European cohort and study the effectiveness of current treatment regimens.MethodsWe retrospectively analyzed adults diagnosed since 2005 with type 1 or not-otherwise-specified AIP in 42 European university hospitals. Type 1 AIP was uniformly diagnosed using specific diagnostic criteria. Patients with type 2 AIP and those who had undergone pancreatic surgery were excluded. The primary endpoint was complete remission, defined as the absence of clinical symptoms and resolution of the index radiological pancreatic abnormalities attributed to AIP.ResultsWe included 735 individuals with AIP (69% male; median age 57 years; 85% White). Steroid treatment was started in 634 patients, of whom 9 (1%) were lost to follow-up. The remaining 625 had a 79% (496/625) complete, 18% (111/625) partial, and 97% (607/625) cumulative remission rate, while 3% (18/625) did not achieve remission. No treatment was given in 95 patients, who had a 61% complete (58/95), 19% partial (18/95), and 80% cumulative (76/95) spontaneous remission rate. Higher (≥0.4 mg/kg/day) corticosteroid doses were no more effective than lower ( 2 weeks (OR 0.908; 95%CI 0.818-1.009). Elevated IgG4 levels were independently associated with a decreased chance of complete remission (OR 0.639; 95%CI 0.427-0.955). Relapse occurred in 30% of patients. Relapses within 6 months of remission induction were independent of the steroid tapering duration, induction treatment duration, and total cumulative dose.ConclusionPatients with type 1 AIP and elevated IgG4 level may need closer monitoring. For remission induction, a starting dose of 0.4 mg/kg/day for 2 weeks followed by a short taper period seems effective. This study provides no evidence to support more aggressive regimens

Security for IP multimedia applications over heterogeneous networks

Personal mobile multimedia services are rapidly become popular. They leverage the combination of mobile and Internet-based communications, the increased capabilities of the third generation of mobile communications (3G), and the flexibility of a common transport and service platform. Cost and quality are critical factors for the success of IP multimedia services. 3G is based on hetereogeneous networks, characterized by a mixture of wired and wireless links with very different requirements on the communication itself. Furthermore, the "always best connected" paradigm requires the design of the new applications to accomodate different types of access. It turns out that the cellular link is typically the most constrained, e.g. in terms of limited bandwidth and high delay, especially when IP is used as transport. Security is an important aspect of the service. Never before has this awareness been more present, not only among technicians, but also among users. Users want the possibility to protect themselves and their data and private matters, in a way that no one else can interfere and that private communications are guaranteed to remain private. The use of the Internet as a common transport backbone, a notoriously open and adverse environment, and in general the use of the IP technology, which is receiving a bad (media) reputation in terms of the security breaches it opens, calls for an end-to-end security solution for IP multimedia services. There are also scenarios where end-to-end protection of other information is an absolute must, for example public safety communication, catastrophe and emergency communication, corporate, or government communication. This research addresses the design of a security solution for IP multimedia, striving in particular for the promotion of end-to-end security on a large scale. This research builds on the concept of a "transport-friendly" security solution: security always comes at a cost, hence it is important to control its impact on services, otherwise security is generally sacrificed. This research focused on the protection of the media traffic. It first identified the requirements that arise from IP multimedia applications in hetereogeneous networks, examined existing security solutions, and concluded that they did not fullfil the requirements raised by 3G environments. This has motivated the design of two new security protocols that are transport-friend to meet the identified requirements, so as to have a low impact on services. These two protocols have then been integrated to provide a security solution for IP multimedia in hetereogeneous networks. The research leading to this licentiate has been mostly conducted in the IETF (a standardisation body), and its results were also adopted byothers, e.g. 3GPP services.QC 20101125</p