How to reduce erroneous Emergency Department admissions for the frail elderly

Background. Readmission after a first hospitalization is a common occurrence. It may be due to incomplete treatment, poor care for underlying problems or reflect bad coordination with health services at the time of discharge. The aim of this study was to identify the factors and classify the pathologies that expose elderly patients to erroneous access to the Emergency/Urgency Department (EUD).Study design. Retrospective observational study.Materials and methods. From January 2016 to December 2019 we studied patients who had at least one readmission to the EUD in the six months following discharge. All EUD accesses of the same patient that occurred for the problem treated during the previous hospitalization were identified. Data was provided by the University Hospital of Siena. Patients were stratified by age, gender, and municipality of residence. We used an ICD-9-CM coding system to describe health problems. Statistical analysis was carried out with Stata software.Results. We studied 1,230 patients (46.6% females) the mean age was 78.2 +/- 14.3. Most of them, 721 (58.6%) were >= 80 years old, 334 (27.1%) were 65-79, 138 (11.2%) were 41-64, and only 37 (3.0%) were <= 40. Patients who lived in Municipality of Siena had a lower probability to return than to those living in other municipalities (OR 0.76; 95%CI: 0.62-0.93; p<0,05). The main causes of readmission for >= 65 years old were "symptoms, signs and ill-defined conditions" (18.3%), "respiratory diseases" (15.0%), "injury and poisoning" (14.1%), "cardiovascular diseases" (11.8%), "classification of factors influencing health status and contact with health services" (9.8%), "genitourinary diseases" (6.6%) and "digestive diseases (5.7%).Conclusions. We observed that patients residing a greater distance from the hospital facilitates the risk of readmission. The factors that were exposed could be used to identify frequent users and initiate measures to reduce their access

Carbon Fibers Waste Recovery via Pyro-Gasification: Semi-Industrial Pilot Plant Testing and LCA

Carbon-fiber-reinforced polymers (CFRPs) are increasingly used in a variety of applications demanding a unique combination of mechanical properties and lightweight characteristics such as automotive and aerospace, wind turbines, and sport and leisure equipment. This growing use, however, has not yet been accompanied by the setting of an adequate recycling industry, with landfilling still being the main management route for related waste and end-of-life products. Considering the fossil-based nature of carbon fibers, the development of recovery and recycling technologies is hence prioritized to address the environmental sustainability challenges in a bid to approach mitigating the climate emergency and achieving circularity in materials’ life cycles. To this aim, we scaled up and tested a novel semi-industrial pilot plant to pyrolysis and subsequent oxidation of uncured prepreg offcuts and cured waste of CFRPs manufacturing. The environmental performance of the process proposed has been evaluated by means of a life cycle assessment to estimate the associated carbon footprint and cumulative energy demand according to three scenarios. The scale-up of the process has been performed by investigating the influence of the main parameters to improve the quality of the recovered fibers and the setting of preferable operating conditions. The pyro-gasification process attested to a reduction of 40 kgCO2 eq per kg of recycled CFs, compared to virgin CFs. If the pyro-gasification process was implemented in the current manufacturing of CFRPs, the estimated reduction of the carbon footprint, depending on the composite breakdown, would result in 12% and 15%. This reduction may theoretically increase up to 59–73% when cutting and trimming waste-optimized remanufacturing is combined with circular economy strategies based on the ideal recycling of CFRPs at end-of-life

Isolamento do vírus Influenza A em pulmões de suínos.

Projeto/Plano de Ação: 02.11.01.006

Effect of nickel on the microstructure and mechanical property of die-cast Al–Mg–Si–Mn alloy

The effect of nickel on the microstructure and mechanical properties of a die-cast Al–Mg–Si–Mn alloy has been investigated. The results show that the presence of Ni in the alloy promotes the formation of Ni-rich intermetallics. These occur consistently during solidification in the die-cast Al–Mg–Si–Mn alloy across different levels of Ni content. The Ni-rich intermetallics exhibit dendritic morphology during the primary solidification and lamellar morphology during the eutectic solidification stage. Ni was found to be always associated with iron forming AlFeMnSiNi intermetallics, and no Al3Ni intermetallic was observed when Ni concentrations were up to 2.06 wt% in the alloy. Although with different morphologies, the Ni-rich intermetallics were identified as the same AlFeMnSiNi phase bearing a typical composition of Al[100–140](Fe,Mn)[2–7]SiNi[4–9]. With increasing Ni content, the spacing of the α-Al–Mg2Si eutectic phase was enlarged in the Al–Mg–Si–Mn alloy. The addition of Ni to the alloy resulted in a slight increase in the yield strength, but a significant decrease in the elongation. The ultimate tensile strength (UTS) increased slightly from 300 to 320 MPa when a small amount (e.g. 0.16 wt%) of Ni was added to the alloy, but further increase of the Ni content resulted in a decrease of the UTS.The Engineering and Physical Sciences Research Council (EPSRC), Technology Strategy Board (TSB) and Jaguar Land Rover (JLR) in the United Kingdom

Low incidence but poor prognosis of complicated coeliac disease: A retrospective multicentre study.

Abstract BACKGROUND: Coeliac disease is a chronic enteropathy characterized by an increased mortality caused by its complications, mainly refractory coeliac disease, small bowel carcinoma and abdominal lymphoma. Aim of the study was to study the epidemiology of complications in patients with coeliac disease. METHODS: Retrospective multicenter case-control study based on collection of clinical and laboratory data. The incidence of complicated coeliac disease was studied among coeliac patients directly diagnosed in four Italian centres. Patients referred to these centres after a diagnosis of coeliac disease and/or complicated coeliac disease in other hospitals were therefore excluded. RESULTS: Between 1/1999 and 10/2011, 1840 adult coeliac patients were followed up for 7364.3 person-years. Fourteen developed complications. Since five patients died, at the end of the observation period (10/2011), the prevalence of complicated coeliac disease was 9/1835 (1/204, 0.49%, 95% CI 0.2-0.9%). The annual incidence of complicated coeliac disease in the study period was 14/7364 (0.2%, 95% CI 0.1-0.31%). Although complications tend to occur soon after the diagnosis of coeliac disease, Kaplan-Meier curve analysis showed that they can actually occur at any time after the diagnosis of coeliac disease. CONCLUSIONS: Complications of coeliac disease in our cohort were quite rare, though characterised by a very high mortality

Material efficiency strategies to reducing greenhouse gas emissions associated with buildings, vehicles, and electronics - A review

As one quarter of global energy use serves the production of materials, the more efficient use of these materials presents a significant opportunity for the mitigation of greenhouse gas (GHG) emissions. With the renewed interest of policy makers in the circular economy, material efficiency (ME) strategies such as light-weighting and downsizing of and lifetime extension for products, reuse and recycling of materials, and appropriate material choice are being promoted. Yet, the emissions savings from ME remain poorly understood, owing in part to the multitude of material uses and diversity of circumstances and in part to a lack of analytical effort. We have reviewed emissions reductions from ME strategies applied to buildings, cars, and electronics. We find that there can be a systematic trade-off between material use in the production of buildings, vehicles, and appliances and energy use in their operation, requiring a careful life cycle assessment of ME strategies. We find that the largest potential emission reductions quantified in the literature result from more intensive use of and lifetime extension for buildings and the light-weighting and reduced size of vehicles. Replacing metals and concrete with timber in construction can result in significant GHG benefits, but trade-offs and limitations to the potential supply of timber need to be recognized. Repair and remanufacturing of products can also result in emission reductions, which have been quantified only on a case-by-case basis and are difficult to generalize. The recovery of steel, aluminum, and copper from building demolition waste and the end-of-life vehicles and appliances already results in the recycling of base metals, which achieves significant emission reductions. Higher collection rates, sorting efficiencies, and the alloy-specific sorting of metals to preserve the function of alloying elements while avoiding the contamination of base metals are important steps to further reduce emissions

A multicentre case control study on complicated coeliac disease: two different patterns of natural history, two different prognoses.

Abstract Background: Coeliac disease is a common enteropathy characterized by an increased mortality mainly due to its complications. The natural history of complicated coeliac disease is characterised by two different types of course: patients with a new diagnosis of coeliac disease that do not improve despite a strict gluten-free diet (type A cases) and previously diagnosed coeliac patients that initially improved on a gluten-free diet but then relapsed despite a strict diet (type B cases). Our aim was to study the prognosis and survival of A and B cases. Methods: Clinical and laboratory data from coeliac patients who later developed complications (A and B cases) and sex- and age-matched coeliac patients who normally responded to a gluten-free diet (controls) were collected among 11 Italian centres. Results: 87 cases and 136 controls were enrolled. Complications tended to occur rapidly after the diagnosis of coeliac disease and cumulative survival dropped in the first months after diagnosis of complicated coeliac disease. Thirty-seven cases died (30/59 in group A, 7/28 in group B). Type B cases presented an increased survival rate compared to A cases. Conclusions: Complicated coeliac disease is an extremely serious condition with a high mortality and a short survival. Survival depends on the type of natural history. Keyword: Celiac disease, Complications, EATL, Prognosis, Glutens, Gluten-free die

Non-Celiac Gluten Sensitivity: The New Frontier of Gluten Related Disorders

Non Celiac Gluten sensitivity (NCGS) was originally described in the 1980s and recently a “re-discovered” disorder characterized by intestinal and extra-intestinal symptoms related to the ingestion of gluten-containing food, in subjects that are not affected with either celiac disease (CD) or wheat allergy (WA). Although NCGS frequency is still unclear, epidemiological data have been generated that can help establishing the magnitude of the problem. Clinical studies further defined the identity of NCGS and its implications in human disease. An overlap between the irritable bowel syndrome (IBS) and NCGS has been detected, requiring even more stringent diagnostic criteria. Several studies suggested a relationship between NCGS and neuropsychiatric disorders, particularly autism and schizophrenia. The first case reports of NCGS in children have been described. Lack of biomarkers is still a major limitation of clinical studies, making it difficult to differentiate NCGS from other gluten related disorders. Recent studies raised the possibility that, beside gluten, wheat amylase-trypsin inhibitors and low-fermentable, poorly-absorbed, short-chain carbohydrates can contribute to symptoms (at least those related to IBS) experienced by NCGS patients. In this paper we report the major advances and current trends on NCG