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

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

La fin de non-recevoir nell'esperienza del processo civile francese: storia e funzioni di un istituto

Il presente studio è dedicato alla categoria delle fins de non-recevoir, un istituto proprio dell'ordinamento processuale francese che si pone accanto alle exceptions de procédure e alle défenses au fond e che, solo superficialmente, può essere assimilata alla categoria delle condizioni dell'azione. Ciò malgrado, nel diritto processuale civile francese regnano ancora oggi numerose incertezze attorno alla natura della fin de non-recevoir, una constatazione che potrà  risultare sorprendente a proposito di un istituto apparso in Francia nel XIV secolo e che non ha più cessato, a partire da quel momento, di essere sollevato davanti a corti e tribunali. Invero, come si avrà  modo di illustrare nel corso di questa dissertazione, questa incertezza ha un'anima antica che solo in parte è stata riscattata dai nuovi approdi, specie in materia di teoria dell'azione, raggiunti dalla dottrina francese nel corso del XX secolo

The dimensional structure of the Positive and Negative Syndrome Scale in first-episode schizophrenia spectrum disorders: an Exploratory Graph Analysis from the OPTiMiSE trial

Acknowledgements: This study was funded by the European Commission Seventh Framework. Programme (HEALTH-F2-2010-242114).The Positive and Negative Syndrome Scale (PANSS) is the most widely used rating scale to assess psychotic symptoms in patients with schizophrenia and other primary psychoses. However, a definitive consensus regarding its dimensional structure remains elusive. The present work aims to determine the number of dimensions of the scale through a network analysis approach in a sample of individuals experiencing first-episode schizophrenia spectrum disorder (FE-SSD) with minimal or no prior exposure to antipsychotic treatment. Baseline data of 446 participants (age 25.96 ± 5.99 years, 70% males) enrolled in the OPTiMiSE trial were analysed. Exploratory Graph Analysis (EGA) was conducted to evaluate the dimensionality of the PANSS, and a bootstrap approach (bootEGA) was employed to assess model stability. The analysis was replicated, excluding unstable items with stability values below 0.75, until a stable model was achieved. The analysis of the 30 items of the PANSS revealed inadequate structural consistency, resulting in the exclusion of 9 unstable items. The final model comprised 21 symptoms distributed across four communities (Positive, Cognitive/Disorganised, Excited/Aggressive and Negative) but lacked a depressive domain. In conclusion, we propose a concise version of the PANSS, incorporating 21 items, to better assess the core symptoms of the first episode of SSD. This revised version provides clinicians with a robust psychometric tool with reduced administration time, but the complementary administration of a dedicated instrument for evaluating affective symptoms is advisable

Second youth of a metal-free dehydrogenation catalyst: when gamma-al2o3 meets coke under oxygen- and steam-free conditions

International audienceThe role of carbonaceous deposits (coke) formed in dehydrogenation catalysis has been extensively investigated over the last few decades mainly with respect to the deactivation of metal-based and metal-free heterogeneous catalysts. Although much less emphasized, coke deposits grown on selected metal oxides have also been described as active and selective phases for alkene dehydrogenation under an oxidative or non-oxidative atmosphere. This work describes the straightforward preparation of “coked” γ-Al2O3 composites and their catalytic performance in the ethylbenzene (EB) direct dehydrogenation (DDH) to styrene (ST) under steam- and oxygen-free conditions. The study unveils the effective potentiality of a catalytic system already known to the scientific community but never employed for EB DDH under severe conditions, close to those commonly used in industrial plants (600 °C, 10 vol % EB/He, GHSV = 3000 h–1). Such a simple catalytic system has revealed a significant stability on long-term trials (≥150 h) and markedly high ST selectivity (≥97%) along with process rates (λ up to 16.3 mmolST gcat–1 h–1) that are the highest claimed so far for related carbon systems at work in the process. Furthermore, the outlined performance of our composites in DDH is close to that claimed for classical iron-based industrial catalysts operating in the presence of a large amount of steam. γ-Al2O3 precoking with an aliphatic C-source has shown additional beneficial effects on the ultimate γ-Al2O3@C performance in DDH. These findings pave the way for the development of cheap and durable dehydrogenation catalysts. They rewrite (in part at least) the role of coke in a challenging heterogeneous process while offering important hints to the comprehension of the reaction mechanism promoted by plain C-sites

2020 Dataset on local gambling regulations in Italy

The dataset provides the complete enumeration of gambling policies implemented by Italian Municipalities between 2003 and 2021. The dataset comprises information on all municipalities existing in 2017 and following years (thus considering also merging). The following variables are available: Municipality ISTAT Code (ID), Municipality Name (Name) Province, Region, Researcher, and a series of variables identifying the number and the type of rulings adopted ('regolamento', 'ordinanza' and 'delibera'). The rulings are distinguished between identified and downloaded or only identified (because the document is no longer available). Additional variables describe municipal activism with other administrative acts (Anti-gambling Manifesto, events, projects or tax reductions). Overall, the dataset comprises 8031 units

Four-year effectiveness, safety and drug retention rate of secukinumab in psoriatic arthritis: a real-life Italian multicenter cohort

objectives: to evaluate over a 48-month follow-up period the: 1) long-term effectiveness and safety; 2) drug retention rate (DRR); 3) impact of comorbidities and bDMARDs line on MDA and DAPSA remission/low disease activity (LDA) of secukinumab in a multicenter Italian cohort of PsA patients. methods: consecutive PsA patients receiving secukinumab were followed prospectively in Italian centers between 2016 and 2023. disease characteristics, previous/ongoing treatments, comorbidities and follow-up duration were recorded. Treatment response was evaluated at 6 and 12 months after initiation, and every year up to 48 months (T48). DRR was assessed according to clinical and demographic features, comorbidities and bDMARDs line. adverse events (AE) were recorded. results: six hundred eighty-five patients [42.5% male] were enrolled; 32.9% naïve received secukinumab; 74.2% had ≥ 1 comorbidity. overall, secukinumab yielded improved outcomes at T48: naïve maintained lower disease activity vs. non-naïve [DAPSA 4.0 (1.4-8.1) vs. 6.0 (2.2-10.4);p = 0.04]; 76.9% naïve and 66.2% non-naïve achieved MDA; MDA no comorbidities vs. 1-3 comorbidities 78.8% vs. 73.3% (p < 0.05), and MDA no comorbidities vs. > 3 comorbidities 78.8% vs. 48.7% (p < 0.001). DAPSA-REM and DAPSA-LDA rates were higher in naïve patients, albeit similar between those without comorbidities vs. 1-3 comorbidities, and slightly lower in those with > 3 comorbidities. treatment was discontinued in 233 patients due to loss of effectiveness, and in 41 due to AE. the overall DRR at T48 was 66%, with differences according to bDMARDs line (p < 0.001), use of combined csDMARDs (p = 0.016), BMI (p = 0.037) and mono/oligoarthritis vs. polyarthritis (p = 0.012). conclusions: secukinumab proved safe and effective, and patients achieved sustained remission with a notable drug retention rate at 4 years