Occurrence of two Norovirus outbreaks in the same cafeteria in one week

In October 2017, two outbreaks of gastroenteritis (GE) occurred among patrons of a cafeteria in Italy in one week. Virological and bacteria investigations on stool samples, environment and food were conducted to identify the infectious agents and the possible source of infection. Forty-five cases occurred in the two outbreaks, including 13 laboratory-confirmed cases of norovirus GI. Nine staff members were interviewed, six were confirmed positive for NoV GI and 3 experienced GE symptoms. Bacteria faecal indicators and other bacteria pathogens were not detected in either environmental swab samples or food. A low level of NoV GII was detected in two environmental swab samples. The same GI.6 strain was identified in cases related to both outbreaks, suggesting a common source of infection. Since the two outbreaks occurred in one week, the NoV contamination could have persisted in the cafeteria. Furthermore, virological investigation revealed confirmed cases among food handlers who had worked at the cafeteria between and during the two outbreaks. Several studies highlighted the importance of excluding symptomatic food handlers to prevent contamination of foods and environment

Cross-sectional study of hepatitis E virus (HEV) circulation in Italian pig farms

OHEJP Project: BIOPIGEE Foodborne transmission is considered the main way of spreading zoonotic hepatitis E virus (HEV) infection in Europe. In recent years, the human cases of hepatitis E in subjects without history of travel in endemic areas have raised, suggesting that domestic HEV transmission is increasing. Pork products with or without liver, are often indicated as the source of many human foodborne HEV cases as well as small outbreaks. Pigs are recognized as the main reservoir of the zoonotic HEV-3 genotype, the most frequently detected in human cases in the EU. In the absence of a harmonized surveillance of HEV circulation, data on prevalence are heterogeneous but confirm a widespread circulation of HEV-3 in pig herds across EU. HEV-3 can pass through the food chain from farm to fork when infected animals are slaughtered. In Italy, several studies reported the circulation of HEV-3 in pig farms, but results are heterogeneous due to dierent methodologies applied. In the present study, we performed a survey over 51 pig herds belonging to three main types of farms: breeding, fattening and farrow-to- finish. HEV-RNA was analyzed by broad range Real-time RT-PCR on 20 samples for each farm, obtained by pooling together feces from 10 individuals. Overall, HEV RNA was confirmed on 150 fecal pooled samples out of 1,032 (14.5%). At least one positive pooled sample was detected from 18 farms out of 51 tested (35.3%). By lowering the number of infected pigs at primary production, the risk of HEV-3 entering into the food chain can be reduced. Hence, information on HEV circulation in herds is highly relevant for choosing preventive measures and deserves development of a monitoring program and further investigations

Biosecurity measures to control hepatitis E virus on European pig farms

Hepatitis E virus (HEV) genotype 3 is a prevalent zoonotic pathogen in European pig farms, posing a significant public health risk primarily through the foodborne route. The study aimed to identify effective biosecurity measures for controlling HEV transmission on pig farms, addressing a critical gap in current knowledge. Utilizing a cross-sectional design, fecal samples from gilts, dry sows, and fatteners were collected on 231 pig farms of all farm types across nine European countries. Real-time RT-PCR was employed to test these samples for HEV. Simultaneously, a comprehensive biosecurity questionnaire captured data on various potential measures to control HEV. The dependent variable was HEV risk, categorized as lower or higher based on the percentage of positive pooled fecal samples on each farm (25% cut-off). The data were analyzed using generalized linear models (one for finisher samples and one for all samples) with a logit link function with country and farm type as a priori fixed factors. The results of the final multivariable models identified key biosecurity measures associated with lower HEV risk, which were the use of a hygienogram in the breeding (OR: 0.06, p = 0.001) and/or fattening area after cleaning (OR: 0.21, p = 0.019), the presence of a quarantine area (OR: 0.29, p = 0.025), testing and/or treating purchased feed against Salmonella (OR: 0.35, p = 0.021), the presence of other livestock species on the farm, and having five or fewer persons in charge of the pigs. Contrary to expectations, some biosecurity measures were associated with higher HEV risk, e.g., downtime of 3 days or longer after cleaning in the fattening area (OR: 3.49, p = 0.005) or mandatory handwashing for farm personnel when changing barn sections (OR: 3.4, p = 0.026). This novel study unveils critical insights into biosecurity measures effective in controlling HEV on European pig farms. The identification of both protective and risk-associated measures contributes to improving strategies for managing HEV and underscores the complexity of biosecurity in pig farming

What is the role of the placebo effect for pain relief in neurorehabilitation? Clinical implications from the Italian consensus conference on pain in neurorehabilitation

Background: It is increasingly acknowledged that the outcomes of medical treatments are influenced by the context of the clinical encounter through the mechanisms of the placebo effect. The phenomenon of placebo analgesia might be exploited to maximize the efficacy of neurorehabilitation treatments. Since its intensity varies across neurological disorders, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCP) summarized the studies on this field to provide guidance on its use. Methods: A review of the existing reviews and meta-analyses was performed to assess the magnitude of the placebo effect in disorders that may undergo neurorehabilitation treatment. The search was performed on Pubmed using placebo, pain, and the names of neurological disorders as keywords. Methodological quality was assessed using a pre-existing checklist. Data about the magnitude of the placebo effect were extracted from the included reviews and were commented in a narrative form. Results: 11 articles were included in this review. Placebo treatments showed weak effects in central neuropathic pain (pain reduction from 0.44 to 0.66 on a 0-10 scale) and moderate effects in postherpetic neuralgia (1.16), in diabetic peripheral neuropathy (1.45), and in pain associated to HIV (1.82). Moderate effects were also found on pain due to fibromyalgia and migraine; only weak short-term effects were found in complex regional pain syndrome. Confounding variables might have influenced these results. Clinical implications: These estimates should be interpreted with caution, but underscore that the placebo effect can be exploited in neurorehabilitation programs. It is not necessary to conceal its use from the patient. Knowledge of placebo mechanisms can be used to shape the doctor-patient relationship, to reduce the use of analgesic drugs and to train the patient to become an active agent of the therapy

Exploring Cosmic Origins with CORE: Cosmological Parameters

We forecast the main cosmological parameter constraints achievable with theCORE space mission which is dedicated to mapping the polarisation of the CosmicMicrowave Background (CMB). CORE was recently submitted in response to ESA'sfifth call for medium-sized mission proposals (M5). Here we report the resultsfrom our pre-submission study of the impact of various instrumental options, inparticular the telescope size and sensitivity level, and review the great,transformative potential of the mission as proposed. Specifically, we assessthe impact on a broad range of fundamental parameters of our Universe as afunction of the expected CMB characteristics, with other papers in the seriesfocusing on controlling astrophysical and instrumental residual systematics. Inthis paper, we assume that only a few central CORE frequency channels areusable for our purpose, all others being devoted to the cleaning ofastrophysical contaminants. On the theoretical side, we assume LCDM as ourgeneral framework and quantify the improvement provided by CORE over thecurrent constraints from the Planck 2015 release. We also study the jointsensitivity of CORE and of future Baryon Acoustic Oscillation and Large ScaleStructure experiments like DESI and Euclid. Specific constraints on the physicsof inflation are presented in another paper of the series. In addition to thesix parameters of the base LCDM, which describe the matter content of aspatially flat universe with adiabatic and scalar primordial fluctuations frominflation, we derive the precision achievable on parameters like thosedescribing curvature, neutrino physics, extra light relics, primordial heliumabundance, dark matter annihilation, recombination physics, variation offundamental constants, dark energy, modified gravity, reionization and cosmicbirefringence. (ABRIDGED

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

L'acquifero confinato in ghiaie della piana costiera di Pisa: aggiornamento dei dati idrogeologico-geochimici e considerazioni sull'intrusione marina.

Il livello in ghiaie dell’acquifero multistrato della Pianura di Pisa, che si trova in generale ad una profondità compresa tra 50 e 100 m sotto il livello del mare ed è spesso circa 10-20 m, costituisce un acquifero confinato interessato da numerosi pozzi di emungimento. Esso contiene certamente una delle principali risorse idriche per approvvigionamento idropotabile, industriale e agricolo, sebbene, in diversi casi, l’acqua non sia di ottima qualità. Al fine di valutare se nell'area costiera pisana meridionale, compresa tra il Fiume Arno e il Canale Scolmatore, tale importante acquifero sia interessato da fenomeni di intrusione marina, nonché per conoscere i meccanismi di miscelazione tra acque dolci e acqua di mare, è stato effettuato uno studio multidisciplinare mediante correlazioni idrostratigrafiche, rilevamento dei livelli piezometrici e analisi chimiche ed isotopiche delle acque. In particolare, sono state effettuate due campagne di misura (Settembre 2013 e Febbraio 2014). In ciascun punto di misura è stato rilevato il livello piezometrico riferendolo al livello del mare, aree con superficie piezometrica particolarmente depressa sono state rinvenute nella parte più meridionale dell’area di studio (zona Calambrone) ed in quella più interna settentrionale (zona S. Piero a Grado). I dati isotopici al momento disponibili sono quelli relativi alla campagna di Giugno 2013, i cui dati chimici sono stati analizzati in precedenti lavori di Tesi riguardo al medesimo progetto. I campioni di acqua raccolti lungo costa, entro 1,5-2 Km dalla linea di riva, mostrano composizione chimica e δ18O‰ indicativi di mescolamento tra acque di falda e acqua di mare. Questo fenomeno, in accordo con le osservazioni piezometriche, risulta più marcato nel settore meridionale dell’area, verso il Canale Scolmatore. La maggior parte degli altri campioni analizzati, raccolti fino a 5 Km dalla linea di riva, non è interessata da fenomeni di intrusione marina; in questi casi, le acque sotterranee mostrano le stesse caratteristiche rinvenute nella parte interna della Pianura di Pisa, con un TDS relativamente basso e valori di δ18O‰ indicativi di quote medie di ricarica maggiori delle quote locali. Soltanto due campioni, raccolti in prossimità dell’Arno nella parte più interna a Nord, mostrano caratteristiche chimiche ed isotopiche attribuibili alla presenza di acqua di mare. In tali casi, i valori di δ18O‰ mostrano chiaramente che l’intrusione di acqua di mare non avviene direttamente nell'orizzonte ghiaioso, ma attraverso gli acquiferi sabbiosi superficiali, che, in questa zona sono in contatto diretto con le ghiaie più profonde

Approcci e metodi di monitoraggio in applicazioni di geologia

Il presente lavoro di Tesi è finalizzato allo studio e al monitoraggio di alcuni fenomeni franosi tramite l’integrazione di tecniche di rilievo e controllo tradizionali e metodi geomatici. I siti individuati per questo studio sono caratterizzati da diverse tipologie di dissesto e di condizioni al contorno. Sono stati scelti una scarpata sub-verticale in località La Fornace nel Comune di Montespertoli (FI) e il versante San Martino all’interno dell’ex-area mineraria di Santa Barbara nei territori comunali di Cavriglia (AR) e Figline Valdarno (FI). L’area della Fornace, a Montespertoli, presenta una vulnerabilità ai fenomeni di dissesto idrogeologico ormai storica, la cui evoluzione retrogressiva col tempo determina la minaccia o il diretto coinvolgimento degli edifici tuttora presenti. La pendice, alta una cinquantina di metri, è caratterizzata da una successione di argilla limosa a cui seguono sabbie limose con elementi più grossolani. I dissesti si manifestano prevalentemente al contatto tra litotipi diversi sotto forma di movimenti rotazionali e roto-traslativi sino a frane miste. Fenomeni di crollo si manifestano in presenza di balze, costituite da sabbie cementate, interessate da fratture talora beanti. La presenza di opere di sostegno materializzate negli anni ha garantito la sicurezza degli edifici che non mostrano lesioni, tuttavia si evidenzia che l’azione retrogressiva dei fenomeni ha iniziato lo scalzamento al piede delle opere stesse lasciando prevedere futuri deterioramenti delle condizioni di sicurezza. Per tali motivi sono state intraprese attività di monitoraggio volte alla realizzazione di opere di presidio per contrastare l’evoluzione gravitativa del versante. Successivamente all’analisi delle relazioni geologico-tecniche e della bibliografia relative all’area di interesse, sono stati svolti un rilievo aerofotogrammetrico e uno studio geomorfologico dell’area in frana. In particolare, il lavoro ha riguardato la produzione di un Modello Digitale di Elevazione (DEM) e di ortofoto di alta risoluzione, di supporto al rilievo geormofologico, allo scopo di produrre dati aggiornati funzionali a cartografare le forme e i corpi geomorfologici più evidenti. È stata altresì condotta una campagna di indagini geognostiche che è consistita in un sondaggio a carotaggio continuo per il prelievo di campioni di terreno che sono stati sottoposti a prove di laboratorio e nell’esecuzione di una prospezione sismica con tecnica MASW (Multichannel Analysis of Surface Waves) per definire la categoria di sottosuolo. Nell’ambito delle attività di monitoraggio svolte le misure con estensimetro a filo non hanno evidenziato spostamenti significativi, così come le letture inclinometriche non hanno restituito valori indicativi di possibili movimenti in atto. I rilievi multitemporali della scarpata con tecnica laser scanner terrestre mostrano invece la presenza di ampie zone di erosione dove l’asportazione di materiale avviene ad opera delle acque superficiali e piccoli fenomeni di crollo. In base ai risultati delle indagini eseguite si propone nell’ambito della Tesi di proseguire il monitoraggio con le strumentazioni già installate e di integrarle con altre di nuova realizzazione. Si suggeriscono inoltre nuove attività di controllo ed eventuali misure di intervento. Il versante San Martino all’interno dell’ex-area mineraria di Santa Barbara (Comune di Cavriglia - AR e Figline Valdarno - FI) ha un’estensione di circa 500 m e un’altezza di 185 m, sviluppandosi lungo una pendenza media di 19-20°. Si tratta di un versante modellato nel corso degli scavi per la realizzazione del “cavo Allori”. Il versante è costituito essenzialmente da rocce argillitico-calcaree appartenenti al complesso delle Argille Scagliose in facies di olistostroma inglobato nella formazione del Macigno. Il versante San Martino è interessato da fenomeni gravitativi di grandi dimensioni che si sono sviluppati nel corso delle attività di scavo in risposta alle modificazioni morfologiche indotte dall’uomo. Nell’ambito del progetto di recupero ambientale dell’area, in seguito alla cessata coltivazione mineraria, sono state effettuate attività di monitoraggio dei movimenti gravitativi residui con tecniche integrate per la durata di 3 anni; ulteriori controlli sono tuttora in corso. È stata condotta una campagna di indagini geognostiche che è consistita in sondaggi a carotaggio continuo e/o a distruzione, nel prelievo di campioni di terreno che sono stati sottoposti a prove di laboratorio e nell’esecuzione di indagini geofisiche per la caratterizzazione geotecnica dei terreni. Con l’obiettivo di comprendere i fattori che determinano il movimento sono stati svolti rilievi aerofotogrammetrici per la produzione di nuvole di punti multitemporali, da cui è stato possibile interpretare le evidenze geomorfologiche e correlarle con le risultanze derivanti dalle altre tecniche di monitoraggio. Le analisi topografiche e inclinometriche hanno permesso di determinare localmente direzione, velocità ed entità degli spostamenti superficiali e profondi del versante. Inoltre, è stato eseguito il monitoraggio piezometrico per la ricerca dei tempi e modi di risposta del versante in relazione alle precipitazioni e alle oscillazioni piezometriche. I risultati ottenuti dalle varie indagini hanno permesso la realizzazione del modello geotecnico del versante e la definizione delle condizioni idrauliche per l’analisi di stabilità, condotta con un metodo all’equilibrio limite, tramite il software Rocscience® Slide. Anche in questo caso, nell’ambito della Tesi, si propongono possibili interventi di stabilizzazione del versante

Multitemporal Terrestrial Laser Scanning for Marble Extraction Assessment in an Underground Quarry of the Apuan Alps (Italy)

This article focuses on the use of Terrestrial Laser Scanning (TLS) for change detection analysis of multitemporal point clouds datasets. Two topographic surveys were carried out during the years 2016 and 2017 in an underground marble quarry of the Apuan Alps (Italy) combining TLS with Global Navigation Satellite System (GNSS) and Total Station (TS) studies. Multitemporal 3D point clouds were processed and compared with the aim of identifying areas subjected to significant material extraction. Point clouds representing changed areas were converted into triangular meshes in order to compute the volume of extracted material over one year of quarrying activities. General purpose of this work is to show a valid method to examine the morphological changes due to raw material extraction with the focus of highlighting benefits, accuracies and drawbacks. The purpose of the executed survey was that of supporting the planning of quarrying activities in respect of regional rules, safety and commercial reasons