Risk Assessment of Legionellosis in Cardiology Units.

Infective Endocarditis (IE) is a disease with high morbidity and mortality. Nowadays, in addition to classic pathogens were isolated exigent Gram negative bacteria as A. baumannii, A. lwoffii, C. burnetii, Bartonella, Chlamydia and Legionella. We present our experience of Legionella isolations in environmental sample (water and air) collected from the Cardiology units belonging a two hospitals in Messina (Italy). Sample size  has been established in function of hospital beds. A total of 80 samples were carried out. 30 and 50, respectively in the first and in the second structure: 55 of water and 25 of aerosol.The positivity of 30% of the water samples analyzed  and 15% of those aerosol strengthens the conviction of the need for greater environmental monitoring, especially in the wards at high risk.

Cardiac implantable devices and takotsubo syndrome. A rare but potential eventuality

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La formazione degli insegnanti della secondaria in Italia e in Germania

From an educational-historical point of view this book analyses the cultural models that underlie the conception and organisation of secondary teacher education and the professionalisation of future secondary school teachers in Europe. These models, based on different conceptions of school, citizenship and the teaching profession, have an enormous influence on school policy. Taking the examples of Italy and Germany, the complex history of teacher education is reconstructed and analysed. The articles deal, in a long-term perspective, with the emergence of national models of teacher education at the end of the 18th century, their consolidation in the 19th and 20th centuries and their transnational transformations between past and present

habitat use and movement patterns in the endangered ground beetle species carabus olympiae coleoptera carabidae

One of the most compelling challenges for conservation biologists is the preservation of species with restricted ranges. Carabus olympiae Sella, 1855, a ground beetle species inhabiting two small areas in the western Italian Alps, is an example of a steno-endemic and endangered insect species. Despite the fact that this species is historically well known to professional and ama- teur entomologists, its autecology is virtually unknown. In the present study we used pitfall traps to study habitat selection and phe- nology, and radiotelemetry to measure differences in movement parameters between sexes, habitats and periods. Data from pitfall trapping suggested that C. olympiae actively selects both shrubberies (alpen rose Rhododendron ferrugineum and bilberry Vaccinium myrtillus) and beech forests and avoids pastures, and that population size peaks in July. All radio-tagged individuals (n = 21) moved without a preferred direction, and were more active at night than by day. Males covered greater distances and had more tortuous tra- jectories than females. Distances covered in forests and alpen rose shrubberies were not significantly different, but paths in beech forests were more convoluted than in shrubberies. The movement pattern observed fits the requirements of a typical "olfactory- tactile" insect predator that looks for prey by systematically exploring its territory. Movement parameters suggested that both beech forests and alpen rose shrubberies are suitable for this species and indicated that the spatial distribution of shrubs in shrubberies can constrain trajectories. The implications for conservation are: (i) any human intervention which results in enlargement of the present coverage of pastures should be controlled; (ii) forest management may be tolerated, with the condition that alpen rose shrubberies remain or develop after tree-cutting; (iii) once a shrubbery has established, it should be preserved through appropriate managem ent

Le aree prioritarie per la biodiversità della provincia di Novara. Una proposta multidisciplinare

Con questa ricerca sono state individuate le Aree prioritarie per la conservazione della biodiversità della provincia di Novara quale operazione di partenza al fine di disegnare, in una fase successiva, la Rete Ecologica Provinciale su basi naturalistiche. A questa operazione hanno partecipato 26 naturalisti esperti, ossia dotati di competenze personali pregresse e di adeguata conoscenza del territorio della provincia di Novara, per i seguenti 6 temi focali: (a) Flora e vegetazione, (b) Invertebrati, (c) Anfibi e Rettili, (d) Uccelli, (e) Mammiferi, (f) Ecosistemi acquatici e pesci. Agli esperti è stato chiesto di individuare i temi focali più rappresentativi per la loro disciplina e di assegnare in modo comparativo un valore naturalistico di aree diverse del territorio provinciale. La metodologia adottata, basata sull'ottenimento delle informazioni dirette da parte dei maggiori esperti presenti sul territorio, è stata integrata per porzioni del territorio poco esplorato con un'analisi in ambiente GIS sulla base di database dell'uso del suolo e delle pressioni antropiche. Questo ha permesso di cartografare le aree più importanti per la conservazione della biodiversità. La gap analysis delle Aree prioritarie con le Aree protette e con altre categorie di tutela del territorio già presenti (parchi e riserve naturali, SIC, ZPS), ha permesso di valutare l'efficacia di queste seconde per la conservazione della biodiversità. Le Aree prioritarie sono state effettivamente localizzate quasi totalmente ma non esclusivamente in Aree protette. Tuttavia, l'insieme delle Aree protette del territorio novarese escludeva porzioni significative di territori di elevato valore per la biodiversità, ora meglio definiti con questa ricerca

Quantitative comparison between amyloid deposition detected by (99m)Tc-Diphosphonate imaging and myocardial deformation evaluated by strain echocardiography in transthyretin-related cardiac amyloidosis.

Methods and results 28 patients with transthyretin mutation and a group of 14 controls underwent echocardiography to quantify left ventricular (LV) dimensions and function, and global (G) longitudinal (L), radial (R) and circumferential (C) strain (S). 99mTc-3, 3-diphosphono-1, 2-propanodicarboxylic-acid-scintigraphy (99mTc-DPD) was used to quantify cardiac amyloidosis (CA). 99mTc-DPD revealed accumulation in 14 of 28 patients (CA-group) and no accumulation (no CA-group) in 14 patients. Cardiac accumulation was mild-moderate in 5 (Mild-Moderate CA-group) and severe in 9 patients (Severe CA-group). Severe CA-group showed higher values of LV septal thickness (LVST), posterior wall thickness and E/E' ratio than the no CA-group and the control group (adj. p<0.05). Ejection fraction was similar among groups (p=0.65). GLS was lower (p=<0.001) in severe CA-group (-12.2 ± 4.5) respect to no CA-group (-19.3 ± 3.0) and to the control group (-20.9 ± 2.5). On the contrary, GCS and GRS were lower (p=<0.05) in mild-moderate CA-group (-10.8 ± 4.1 and 9.5 ± 5.7, respectively) respect to the severe CA-group (-18.9 ± 5.1 and 23.9 ± 6.3 respectively), no CA-group (-19.2 ± 4.1 and 28.4 ± 10.2 respectively) and the control group (-23.9 ± 4.4 and 29.9 ± 8.7 respectively). A correlation was found between the scintigraphic heart retention (HR) index and LVST (r=0.72; p<0.001) and E/E' (r=0.46; p=0.03). An inverse tendency was observed between HR and GLS (r=−0.40; p=0.06)

Patent foramen ovale and paradoxical coronary artery embolism: rare event with great clinical relevance

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Patient‐centered digital biomarkers for allergic respiratory diseases and asthma: The ARIA‐EAACI approach – ARIA‐EAACI Task Force Report

Biomarkers for the diagnosis, treatment and follow-up of patients with rhinitis and/ or asthma are urgently needed. Although some biologic biomarkers exist in specialist care for asthma, they cannot be largely used in primary care. There are no validated biomarkers in rhinitis or allergen immunotherapy (AIT) that can be used in clinical practice. The digital transformation of health and health care (including mHealth) places the patient at the center of the health system and is likely to optimize the practice of allergy. Allergic Rhinitis and its Impact on Asthma (ARIA) and EAACI (European Academy of Allergy and Clinical Immunology) developed a Task Force aimed at proposing patient-reported outcome measures (PROMs) as digital biomarkers that can be easily used for different purposes in rhinitis and asthma. It first defined control digital biomarkers that should make a bridge between clinical practice, randomized controlled trials, observational real-life studies and allergen challenges. Using the MASK-air app as a model, a daily electronic combined symptom-medication score for allergic diseases (CSMS) or for asthma (e-DASTHMA), combined with a monthly control questionnaire, was embedded in a strategy similar to the diabetes approach for disease control. To mimic real-life, it secondly proposed quality-of- life digital biomarkers including daily EQ-5D visual analogue scales and the bi-weekly RhinAsthma Patient Perspective (RAAP). The potential implications for the management of allergic respiratory diseases were proposed.info:eu-repo/semantics/publishedVersio

Rationale and design of an independent randomised controlled trial evaluating the effectiveness of aripiprazole or haloperidol in combination with clozapine for treatment-resistant schizophrenia

<p>Abstract</p> <p>Background</p> <p>One third to two thirds of people with schizophrenia have persistent psychotic symptoms despite clozapine treatment. Under real-world circumstances, the need to provide effective therapeutic interventions to patients who do not have an optimal response to clozapine has been cited as the most common reason for simultaneously prescribing a second antipsychotic drug in combination treatment strategies. In a clinical area where the pressing need of providing therapeutic answers has progressively increased the occurrence of antipsychotic polypharmacy, despite the lack of robust evidence of its efficacy, we sought to implement a pre-planned protocol where two alternative therapeutic answers are systematically provided and evaluated within the context of a pragmatic, multicentre, independent randomised study.</p> <p>Methods/Design</p> <p>The principal clinical question to be answered by the present project is the relative efficacy and tolerability of combination treatment with clozapine plus aripiprazole compared with combination treatment with clozapine plus haloperidol in patients with an incomplete response to treatment with clozapine over an appropriate period of time. This project is a prospective, multicentre, randomized, parallel-group, superiority trial that follow patients over a period of 12 months. Withdrawal from allocated treatment within 3 months is the primary outcome.</p> <p>Discussion</p> <p>The implementation of the protocol presented here shows that it is possible to create a network of community psychiatric services that accept the idea of using their everyday clinical practice to produce randomised knowledge. The employed pragmatic attitude allowed to randomly allocate more than 100 individuals, which means that this study is the largest antipsychotic combination trial conducted so far in Western countries. We expect that the current project, by generating evidence on whether it is clinically useful to combine clozapine with aripiprazole rather than with haloperidol, provides physicians with a solid evidence base to be directly applied in the routine care of patients with schizophrenia.</p> <p>Trial Registration</p> <p><b>Clincaltrials.gov Identifier</b>: NCT00395915</p