Towards a network around civic agriculture in the Province of Pisa

This paper aims at exploring the pathway towards the creation of a network around the principles of civic agriculture in the Province of Pisa (Tuscany, Italy). The research is part of the process towards a local Food Plan, aimed at coordinating public policies, civil society and private initiatives, to foster the access to a healthy and sustainable diet. In this context, the experiences of civic agriculture have played an important role, highlighting the centrality of agriculture in the animation of rural areas and in the rural-urban relationship and becoming a point of intersection amongst several vital areas for local communities. The research methods consisted in a first monitoring of civic agriculture experiences, a second round of in-depth interviews and in a more targeted focus group. The research has confirmed the presence of an expressed willingness to create a network of farms engaged on issues of sustainable food and sustainable local development. However, some critical points emerged with respect to the process of network building. Brokerage activities appear crucial to reinforce the relationships amongst the farmers and civil and institutional actors engaged in food related issues

Food networks: collective action and local development. The role of organic farming as boundary object

This article aims at analyzing the innovation potential of a local food network, which sees different actors that cooperate to build a local organic food production-provision system and progressively develop a broader mobilization on food issues, health and sustainability. The case analyzed is that of Crisoperla, an association located in Italy, between Tuscany and Liguria, which involves organic farmers, social farming and fishermen cooperatives, consumers’ groups and association and agronomists. The analysis is based on the empirical data collected in the 3-year European project SOLINSA (FP7, 2011–2014). The focus is on the role of organic farming and organic food as a boundary object, a binder element around which actors involved work in order to develop common visions, languages and goals and organize their activities. These processes are, in fact, at the basis of the organizational consolidation of the association as well as of the growth of its political awareness and its willingness and capacity to interact with the outside both at local and higher levels

A transition towards sustainable food systems in Europe

A growing number of voices – among others the European Economic and Social Committee (EESC, 2017) - have highlighted the need to change the overarching infrastructure of food-related policies. They claim that the European Union does not have a food policy . For example, the General Food Law addresses food safety issues, but not nutrition. Regulations aimed at reducing the environmental impacts of food production are not built in connection with how food is consumed. There are regulations that encourage production systems to improve product quality, but the link to sustainability is not clear. There are rules that regulate information and communication to consumers, but a reference to sustainability is missing. Common Agricultural Policy grants subsidies to 'green' production processes, but most of them concern primarily production actors. Distribution of financial resources over these instruments is largely disproportionate. Often these payments are not linked to clear outcomes and impacts. How could a food policy contribute to shaping sustainable food systems in Europe? It is time for policy makers, academics, and civil society to take a step back and reflect upon appropriate policies infrastructures for transition toward food sustainability. This challenge implies a pervasive process that addresses in a consistent and coherent way the multidimensionality of food – environmental, social, economic, health, ethical and resilience implications - and takes into consideration the reciprocal influences between production, distribution and consumption and their links with broader socio-ecological and socio-technical systems. This process should reorganize food-related policy instruments around societal goals and put in place the necessary instruments to enable the social and institutional change, overcoming barriers. This report proposes a conceptual framework and carries out an assessment of the existing policy infrastructure with the purpose of suggesting points of entry for policy-led transition towards food sustainability in Europe. The system perspective adopted allows us to apply one of the key principles of sustainable development as well as sustainable consumption and implies that policies aiming at sustainability should address consumption issues as well as production patterns. The challenge for a new policy approach is to put in place coordinated policy tools that can affect directly or indirectly this process of alignment, linking together self-responsibility with freedom to act. Rather than pursuing an ambitious program of redesign of the agricultural policy into a broader food policy, we suggest a ‘bottom up’ process of construction of a food policy mix around strategic goals aimed at the integration and coherence between policies, together with the reorganization of existing tools and the introduction of new tools to fill existing gaps. The introduction of strategic tools - such as the EU Sustainable Food Assessment and Action Plan, proposed by the EESC (2017) at the EU level, or urban food strategies at the local level - can contribute to develop new representations of the food system, update policy objectives, verify the adequacy of existing policy instruments with respect to new objectives, identify missing policy instruments and mobilize all stakeholders to build a coherent set of policies. This report lays down some criteria on which this process should be activated

Understanding the role of the Agriculture Knowledge and Innovation System in the Italian agroenergy sector: the case of biogas adoption in Tuscany

The European energy strategy towards 2020 involves increasing the production of renewable energy by agriculture (agroenergy) for moving towards a bio-based economy. The climate deal reached at the COP 21 conference in Paris (2015) supports the position of the EU concerning the sustainable promotion of agroenergy, as it allows save greenhouse gas emissions compared to fossil-based energy. However, the diffusion of agroenery in the Mediterranean area is modest and uneven, compared to northern European countries, may be due to the low endowment of productive factors. Besides policy, the debate around the diffusion of agroenergy is particularly lively within the academy. To date, agricultural economists have mainly approached the process of agroenergy adoption on farm through econometric or mathematical programming models. The former aim at explaining the underlying determinants of farmers’ investment choices (revealed or stated). The latter simulate the choices of profit-maximising farmers under different policy or market conditions. Beside rational behaviour, both methodologies assume that farmers can access perfect information, thus missing to investigate knowledge transfer and the role of research and extension services in technology adoption and diffusion. Against this background, this paper deals with knowledge transfer in the agroenergy sector and focuses on the role of networks in that transfer. We also consider the impact of those networks on the transaction costs associated with agroenergy adoption. The aim of this study is understanding the process of biogas diffusion in a region of the Mediterranean area. The paper would add to the literature on innovation in agriculture by depicting the Agricultural Knowledge and Innovation System behind the diffusion of agroenergy and by identifying the structural components of that system. With this objective in mind, we consider the diffusion of biogas in Tuscany, a NUTS3 region in Italy. We selected Tuscany because prospective biogas adopters should radically change the structure of their farms and because geography and farming systems of Tuscany allow use that region as a proxy for northern areas of the Mediterranean basin. The methodology involves social network analysis, which allows pinpoint the role of the different interest groups in knowledge transfer and the extent to which knowledge management has shaped the biogas sector in Tuscany. Preliminary results highlight the central position of few major knowledge producers from the research sector, which, however, poorly interact among them and with intermediary organisations. In turn, knowledge transfer downstream seems a weakness of the network. Apparently, adopters are self-sufficient in terms of knowledge gathering during the innovation-decision phase. Missing significant intermediaries, adopters may become reliant on technical support and face high transaction costs. Given the irreversibility of biogas adoption, disconnection could significantly affect the costs for daily management. When evenly distributed, small biogas-to-electricity plants may help the distributed generation, while allowing comply with EU’s Renewables Directive. However, the lack of coordination among the components of the Agricultural Knowledge and Innovation System may hinder the sustainable diffusion of biogas, with the rise of intensive entrepreneurial agro energy farming

Fertility after "only B-Lynch" suture: A case report and literature review

Abstract Objective A new fertility assessment after a B-Lynch suture without a concomitant uterine devascularization is proposed. Case Report The case of a 37-year-old woman who experienced postpartum hemorrhage due to uterine atony during cesarean delivery of the previous pregnancy is reported. A B-Lynch brace suturing technique, not associated to any other hemostatic surgical procedure, was carried out. One year later and after an uncomplicated pregnancy of 39 weeks, the patient delivered a healthy infant by an elective cesarean section. Only omental adhesions were found on the anterior surface of the uterus as a consequence of the previous B-Lynch suture. Conclusion The B-Lynch hemostatic surgical procedure, alone, does not seem to have a negative impact on fertility. Additional clinical evidences in a greater case-series of patients are needed to assess the value of the method for fertility preservation

Genetic Testing and Counselling in Hypertrophic Cardiomyopathy: Frequently Asked Questions

Genetic counselling and genetic testing in hypertrophic cardiomyopathy (HCM) represent an integral part of the diagnostic algorithm to confirm the diagnosis, distinguish it from phenocopies, and suggest tailored therapeutic intervention strategies. Additionally, they enable cascade genetic testing in the family. With the implementation of Next Generation Sequencing technologies (NGS), the interpretation of genetic data has become more complex. In this regard, cardiologists play a central role, aiding geneticists to correctly evaluate the pathogenicity of the identified genetic alterations. In the ideal setting, geneticists and cardiologists must work side by side to diagnose HCM as well as convey the correct information to patients in response to their many questions and concerns. After a brief overview of the role of genetics in the diagnosis of HCM, we present and discuss the frequently asked questions by HCM patients throughout our 20-year genetic counselling experience. Appropriate communication between the team and the families is key to the goal of delivering the full potential of genetic testing to our patients

Natural History of MYH7-Related Dilated Cardiomyopathy

BACKGROUND Variants in myosin heavy chain 7 (MYH7) are responsible for disease in 1% to 5% of patients with dilated cardiomyopathy (DCM); however, the clinical characteristics and natural history of MYH7-related DCM are poorly described. OBJECTIVES We sought to determine the phenotype and prognosis of MYH7-related DCM. We also evaluated the influence of variant location on phenotypic expression. METHODS We studied clinical data from 147 individuals with DCM-causing MYH7 variants (47.6% female; 35.6 +/- 19.2 years) recruited from 29 international centers. RESULTS At initial evaluation, 106 (72.1%) patients had DCM (left ventricular ejection fraction: 34.5% +/- 11.7%). Median follow-up was 4.5 years (IQR: 1.7-8.0 years), and 23.7% of carriers who were initially phenotype-negative developed DCM. Phenotypic expression by 40 and 60 years was 46% and 88%, respectively, with 18 patients (16%) first diagnosed at <18 years of age. Thirty-six percent of patients with DCM met imaging criteria for LV noncompaction. During follow-up, 28% showed left ventricular reverse remodeling. Incidence of adverse cardiac events among patients with DCM at 5 years was 11.6%, with 5 (4.6%) deaths caused by end-stage heart failure (ESHF) and 5 patients (4.6%) requiring heart transplantation. The major ventricular arrhythmia rate was low (1.0% and 2.1% at 5 years in patients with DCM and in those with LVEF of <= 35%, respectively). ESHF and major ventricular arrhythmia were significantly lower compared with LMNA-related DCM and similar to DCM caused by TTN truncating variants. CONCLUSIONS MYH7-related DCM is characterized by early age of onset, high phenotypic expression, low left ventricular reverse remodeling, and frequent progression to ESHF. Heart failure complications predominate over ventricular arrhythmias, which are rare. (C) 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation

Infusione di diuretici dell'ansa ad alto dosaggio in pazienti con scompenso cardiaco congestizio: effetti sulla funzione renale e sul quadro clinico-strumentale

Insufficienza renale e scompenso cardiaco sono condizioni frequentemente associate e risultano correlate tra loro da una complessa rete di meccanismi fisiopatologici. L’esistenza di una disfunzione renale in pazienti con scompenso cardiaco è associata a un aggravamento della prognosi, si accompagna a resistenza alla terapia diuretica e risulta spesso di ostacolo nell’impostazione del trattamento. Questo studio ha valutato l’efficacia e la sicurezza dei diuretici dell’ansa, somministrati in infusione continua, in una popolazione di 40 pazienti ricoverati per riacutizzazione di scompenso cardiaco, con particolare attenzione alle variazioni degli indici di funzione renale nell’arco del ricovero. I pazienti sono stati sottoposti a follow-up per un periodo di 6 mesi dalla dimissione. Nell’intera popolazione, il trattamento ha determinato un netto decremento ponderale, associato a riduzione della pressioni di riempimento e dei livelli di BNP. Si è osservato, nel periodo corrispondente al ricovero, un miglioramento della funzione renale, valutata per mezzo dei livelli plasmatici di creatinina e del GFR calcolato con la formula MDRD. L’andamento della funzione renale nel periodo di follow-up non ha evidenziato alcun peggioramento significativo della stessa. I pazienti sono stati suddivisi in due gruppi in base all’entità del deficit di funzione renale (GFR superiore o inferiore a 45 ml/min) documentato all’ingresso. Dal confronto della caratteristiche di base è emerso che i pazienti con disfunzione renale più grave presentavano valori inferiori di natriemia associati a livelli marcatamente inferiori di emoglobina ed ematocrito, mentre i dati strumentali ecocardiografici erano sovrapponibili nei due gruppi. I pazienti con funzione renale inizialmente più compromessa hanno mostrato un miglioramento più importante degli indici di funzione renale durante il ricovero. Non si è individuata una correlazione tra il grado di disfunzione renale al momento del ricovero e l’incidenza di nuovi episodi di riacutizzazione di scompenso cardiaco durate il periodo di follow-up. Kidney insufficiency and heart failure are commonly associated and are correlated through a complex network of pathophysiological mechanisms. The occurrence of renal impairment in patients with heart failure is associated to worsened prognosis, it is accompanied by diuretic resistance and often represents an obstacle to therapeutic management. The present study evaluates the efficacy and safety of loop diuretics, administered by means of continuous infusion, in a cohort of 40 patients hospitalized for acute decompensated heart failure, with a particular attention to variations of renal function indicators during the period of hospital care. Follow up period was 6 months for the entire group of patients. In the entire group, the treatment determined a net body weight decrease, associated to a reduction of the filling pressure and BNP levels. During hospitalization, we observed an improvement of renal function; the latter was evaluated by means of creatinine plasma levels and GFR calculated with the MDRD formula. During follow-up, we did not detect significant worsening of renal function. Patients were divided in two groups based on the severity of renal function impairment (GFR higher or lower than 45 ml/min) evaluated at the time of admission. The comparison of the baseline properties showed that patients with more severe renal dysfunction had also lower sodium levels associated with significantly lower levels of hemoglobin and hematocrit, while echocardiography parameters were similar in the groups. Patients showing severely compromised renal function from the beginning underwent a more pronounced improvement of the renal function itself during hospitalization. We did not detect any correlation of the entity of renal dysfunction at the time of admission and the occurrence of new hospitalization for acute decompensated heart failure during follow-up

Potenziale di cambiamento di reti innovative operanti nel campo delle produzioni animali: un'analisi nel contesto europeo

La questione della sostenibilità dei sistemi agro-zootecnici e le modalità attraverso cui realizzare un percorso di transizione in tale direzione è oggetto di un crescente interesse sia per il mondo accademico sia per quello degli operatori del settore. L’obiettivo di questa tesi va nella direzione di analizzare le strategie di supporto all’innovazione per la sostenibilità nel settore agro-zootecnico e veterinario, al fine di individuare dei metodi per l’organizzazione del sistema dell’assistenza tecnica rispondente alle sfide e alle crisi che il settore si trova ad affrontare. In questa tesi si propone un approccio di rete allo studio delle innovazioni per la sostenibilità, che considera l’integrazione di competenze e abilità e la co-creazione di conoscenza provenienti da diversi ambiti di attività (scientifico, tecnico, operativo) come presupposti per la definizione di strategie di azione per affrontare le sfide del settore agro-zootecnico. Con input teorici provenienti dalla multilevel-perspective on socio-technical transition e dalla teoria dei boundary objects è stato predisposto un quadro per l’analisi di due casi di studio di reti di innovazione – il Consorzio Vacche Rosse e la rete di produttori di Razza Rossa Reggiana e l’Associazione Crisoperla) - al fine di comprenderne l’organizzazione, il funzionamento e quali elementi di supporto (tecnico, economico) sono stati efficaci nel facilitare i rispettivi percorsi di transizione. L’analisi dei casi di studio ha consentito di mettere in evidenza l’importanza dell’azione collettiva attorno ad un comune obiettivo al fine di realizzare pratiche agricole e zootecniche sostenibili; inoltre, la presenza di boundary objects e l’attività di alcuni attori (o gruppi di attori) si sono rivelati elementi chiave per il successo delle due iniziative. Quanto emerso consente di porre l’attenzione sull’opportunità di indirizzare il sistema di assistenza tecnica in agricoltura verso metodi di supporto che agevolino la cooperazione fra aziende e che facilitino l’azione verso comuni obiettivi di sostenibilità di aziende agricole, università e amministrazioni pubbliche

Cardiopulmonary interaction and weaning: role of perioperative echocardiography in the cardiac surgical patient

The process of weaning from mechanical ventilation imposes an additional workload on the cardiovascular system, which may result in impaired myocardial function, increase in left ventricular filling pressure and respiratory distress. These mechanisms may ultimately result in weaning failure and need for prolonged respiratory support, which in turn increases the length of stay in the intensive care unit and the risk of complications. Among surgical patients, those undergoing heart surgery are particularly susceptible to cardiac dysfunction induced by weaning because of inadequate cardiovascular reserve. Early identification of patients at risk has potential therapeutic implications. The aim of this study was to depict the pathophysiological changes in hemodynamics assessed by echocardiography during the steps of weaning and to identify possible predictors of weaning failure. We enrolled 34 consecutive patients undergoing isolated coronary artery bypass grafting in our institution; data were collected by intraoperative transesophageal echocardiography before sternotomy (T0), and by transthoracic echocardiography at the beginning of weaning (T1) and at the time of extubation (T2). Weaning failure was defined as deferral of planned extubation or respiratory failure needing reintubation or non-invasive mechanical ventilation within 48 hours. Left ventricular outflow tract velocity–time index (LVOT-VTI) and ventricular-arterial coupling (VAC) measured at the beginning of the weaning process showed a significant correlation with outcome, with LVOT-VTI emerging as the best predictor of weaning failure. Significant increase in E/e’ suggested a cardiogenic etiology of respiratory distress in patients who failed the weaning trial. Overall, our study showed that serial assessment of hemodynamic parameters by means of echocardiography is feasible in cardiac surgical patients and can provide insight into pathophysiological changes during weaning. Although these preliminary data need to be confirmed in a larger population sample, LVOT-VTI emerged as a promising predictor of subsequent weaning failure