Innovative methods on territorial vulnerability study for the preparation of emergency plans

In recent years, we have witnessed natural events that have had impressive effects on the city and its inhabitants, highlighting a great vulnerability of the territories. In this context, the National Civil Protection has forced local administrations to adopt an Emergency Plan based on risk analysis. The proposed contribution illustrates the application of an innovative methodology that focuses, for the estimation of the vulnerability, on the urban / construction analysis and the operation of emergency health care facilities

Measuring Age-Friendly Housing: A Framework

An ageing population raises the question of providing adequate housing that enables older people to age in place without losing autonomy and independence. Except for the issue of accessibility, no framework exists that specifically outlines a standard to achieve and, as a result, interventions on existing or on new buildings may be inconsistent without leading to a desired rise in living standards. This research addresses this issue by presenting a framework for the assessment of the age-appropriateness of housing through a number of metrics that detect and identify physical and non-physical features of a home environment to enable ageing in place. The study combines data from a qualitative systematic literature review of 93 papers and qualitative data from structured interviews with four experts in the field. As a result, 71 metrics were identified, divided into eight main domains, to describe the framework. This paper provides an improved understanding of the housing features that enable ageing in place. The tool categorizes and rates qualitative and quantitative aspects that contribute to the age-friendliness of housing, resulting in an easy to adopt assessment framework. This is a valuable means for stakeholders engaged in improving the current housing stock or in constructing new buildings for older people

Evaluation of factors and approaches affecting emergency department space planning

Purpose – This paper aims to evaluate emergency department (ED) design space planning approaches and draw lessons for developing more resilient and integrated ED guidelines. Two key objectives have been set; these include: exploring potential factors affecting the ED performance, and investigate how ED space planning is addressed internationally through the evaluation of international case studies and design guidelines. Design/methodology/approach – A robust research method has been adopted including comprehensive literature review in addition to 76 case studies from Italy and the USA. Findings – Findings show that the important factors in defining ED space requirements are attendance variability, vulnerable groups and mass casualty events. The study concludes that current design guidelines and approaches need to be updated to meet with the current and future demand by taking into account design performance: effectiveness, efficiency and resilience, to avoid underestimating ED space; and that the US EDs are in a better position, than Italian EDs, to increase capacity when needed. Originality/value – The contribution of this study is in providing a tangible “understanding” of factors influencing ED design and prepares a firm ground to develop more resilient and integrated design guidelines, able to meet current, exceptional and long-term needs of EDs. The study also shows that research can provide a valuable contribution to improve ED design which needs to feed more inpractice to improve design process and guidelines

Evaluation of factors and approaches affecting emergency department space planning

Purpose – This paper aims to evaluate emergency department (ED) design space planning approaches and draw lessons for developing more resilient and integrated ED guidelines. Two key objectives have been set; these include: exploring potential factors affecting the ED performance, and investigate how ED space planning is addressed internationally through the evaluation of international case studies and design guidelines. Design/methodology/approach – A robust research method has been adopted including comprehensive literature review in addition to 76 case studies from Italy and the USA. Findings – Findings show that the important factors in defining ED space requirements are attendance variability, vulnerable groups and mass casualty events. The study concludes that current design guidelines and approaches need to be updated to meet with the current and future demand by taking into account design performance: effectiveness, efficiency and resilience, to avoid underestimating ED space; and that the US EDs are in a better position, than Italian EDs, to increase capacity when needed. Originality/value – The contribution of this study is in providing a tangible “understanding” of factors influencing ED design and prepares a firm ground to develop more resilient and integrated design guidelines, able to meet current, exceptional and long-term needs of EDs. The study also shows that research can provide a valuable contribution to improve ED design which needs to feed more inpractice to improve design process and guidelines

Myocarditis and pericarditis in individuals exposed to the Ad26.COV2.S, BNT162b2 mRNA, or mRNA-1273 SARS-CoV-2 vaccines

IMPORTANCE: There is a high level of public and professional interest related to potential safety issues of the COVID-19 vaccines; however, no serious adverse cardiovascular events were reported in phase 3 randomized controlled trials of their safety and efficacy. Moreover, none of the case series from the United States (US) of these potential complications have been population-based.OBJECTIVES: To estimate the reporting rates of myocarditis and pericarditis in the US using the Vaccine Adverse Event Reporting System (VAERS), and to assess if these adverse events were disproportionally reported among the different COVID-19 vaccines.DESIGN SETTING AND PARTICIPANTS: All cases of myocarditis and pericarditis from VAERS reported up to July 28, 2021.EXPOSURE: Single-dose Ad26.COV2.S, BNT162b2 mRNA, or mRNA-1273 SARS-CoV-2 vaccinations.MAIN OUTCOMES AND MEASURES: Reporting rates were computed by dividing the total number of cases of myocarditis and pericarditis (combined) by the total number of vaccine doses administered. Disproportionality analyses were performed to evaluate disproportional reporting of myocarditis and pericarditis for the Ad26.COV2.S and mRNA-1273 vaccines vs. the BNT162b2 mRNA vaccine.RESULTS: By July 28, 2021, 1392, 699, and 68 cases of myocarditis or pericarditis had been reported out of 1.91, 1.38, and 1.33 million administered doses of the BNT162b2 mRNA, mRNA-1273, and Ad26.COV2.S COVID-19 vaccines, respectively. Median times to event were 3 days, 3 days, and 9 days for the BNT162b2 mRNA, mRNA-1273, and Ad26.COV2.S COVID-19 vaccines. The reporting rates for myocarditis or pericarditis were 0.00073 (95% confidence interval, 95% CI 0.00069-0.00077), 0.00051 (95% CI 0.00047-0.00055), and 0.00005 events per dose (95% CI 0.00004-0.00006) for the BNT162b2 mRNA, mRNA-1273, and Ad26.COV2.S COVID-19 vaccines, respectively. Myocarditis and pericarditis were disproportionally reported following the BNT162b2 mRNA vaccine when compared with the other vaccines, using both disproportionality measures.CONCLUSIONS AND RELEVANCE: We found reporting rates of myocarditis and pericarditis to be less than 0.1% after COVID-19 vaccination. Rates were highest for the BNT162b2 mRNA vaccine, followed by the mRNA-1273 and Ad26.COV2.S, respectively. However, the reporting rates of myocarditis and pericarditis secondary to vaccination remains less common than those seen for SARS-CoV-2 infection.</p

Effects of sex hormones on bronchial reactivity during the menstrual cycle

Background: Many asthmatic women complain of symptom exacerbations in particular periods, i.e. during pregnancy and menstrual cycles (perimenstrual asthma: PMA)". The goal of this study was to study the effect of the luteal and follicular phases of the menstrual cycle on bronchial reactivity (BR) in a group of asthmatic women. Methods: For this purpose, 36 pre-menopausal women were enrolled and underwent testing for resting pulmonary function, measurement of the diffusing capacity of the lung for carbon monoxide (DLCO), and airway responsiveness to methacholine in the follicular and luteal phases of their menstrual cycles. We also measured plasma hormone levels and levels of cyclic adenosine monophosphate (cAMP; a mediator of bronchial smooth muscle contraction) and testosterone in induced sputum samples. Results: Our study showed that about 30% of the asthmatic women had decreased PC20FEV1.0 in the follicular phase of menstrual cycle with a significant correlation between PC20FEV1.0 and serum testosterone levels. Moreover, marked increases in sputum testosterone levels (mean = 2.6-fold increase) together with significant increases in sputum cAMP concentrations (mean = 3.6-fold increases) were observed during the luteal phase of asthmatic patients, suggesting that testosterone contributes to the pathophysiology of PMA. We excluded the possibility that testosterone directly inhibits phosphodiesterase (PDE) activity as incubating PDE with testosterone in vitro did not reduce PDE catalytic activity. Conclusions: In conclusion, our data show that PC20FEV1.0 was decreased in the follicular phase of the menstrual cycle in about 30% of women and was associated with lower cAMP levels in sputum samples, which may contribute to bronchoconstriction. Our results also suggest a link between PMA and testosterone levels. However, whether these findings are of clinical significance in terms of the management of asthma or asthma worsening during the menstrual cycle needs further investigation

Comparison of different sets of immunological tests to identify treatable immunodeficiencies in adult bronchiectasis patients

Immunological tests; BronchiectasisPruebas inmunologicas; BronquiectasiasProves immunològiques; BronquiectasiesBackground The reported prevalence of immunodeficiencies in bronchiectasis patients is variable depending on the frequency and extent of immunological tests performed. European Respiratory Society guidelines recommend a minimum bundle of tests. Broadening the spectrum of immunological tests could increase the number of patients diagnosed with an immunodeficiency and those who could receive specific therapy. The primary objective of the present study was to assess the performance of different sets of immunological tests in diagnosing any, primary, secondary or treatable immunodeficiencies in adults with bronchiectasis. Methods An observational, cross-sectional study was conducted at the Bronchiectasis Program of the Policlinico University Hospital in Milan, Italy, from September 2016 to June 2019. Adult outpatients with a clinical and radiological diagnosis of bronchiectasis underwent the same immunological screening during the first visit when clinically stable consisting of: complete blood count; immunoglobulin (Ig) subclass tests for IgA, IgG, IgM and IgG; total IgE; lymphocyte subsets; and HIV antibodies. The primary endpoint was the prevalence of patients with any immunodeficiencies using five different sets of immunological tests. Results A total of 401 bronchiectasis patients underwent the immunological screening. A significantly different prevalence of bronchiectasis patients diagnosed with any, primary or secondary immunodeficiencies was found across different bundles. 44.6% of bronchiectasis patients had a diagnosis of immunodeficiency when IgG subclasses and lymphocyte subsets were added to the minimum bundle suggested by the guidelines. Conclusion A four-fold increase in the diagnosis of immunodeficiencies can be found in adults with bronchiectasis when IgG subclasses and lymphocyte subsets are added to the bundle of tests recommended by guidelines

Improving ageing resilience of current and future housing

The World Health Organisation reported that people aged 65 years or above will account for 1.5 billion of the world’s population by 2050, rising from 524 million in 2010. Ageing population brings together a series of implications and co-morbidities: non-communicable diseases; elderly related impairments; physical or cognitive impairments. Current demographics make architects to reflect on the future of housing. The question is: How to design houses able to support social inclusivity for elderly people? How to adapt the housing stock considering the increasing dependency of the ageing population? The relationship between the built environment and health has been widely studied in the general population. Furthermore, studies on the effect of the built environment, especially on elderly people are spreading. This project aims to identify the features of the home environment able to support elderly people to age positively and live independently in their community. Existing evidence on the impact of the built environment and housing on elderly people were interrogated and the adaptation of existing dwellings were investigated to identify current models and trends. Initial findings show that, even if interesting projects have been developed, there is still the need to support innovative housing models to enable current and future housing stock to support elderly people to age positively and live independently in their community

Comparison of different sets of immunological tests to identify treatable immunodeficiencies in adult bronchiectasis patients

BACKGROUND: The reported prevalence of immunodeficiencies in bronchiectasis patients is variable depending on the frequency and extent of immunological tests performed. European Respiratory Society guidelines recommend a minimum bundle of tests. Broadening the spectrum of immunological tests could increase the number of patients diagnosed with an immunodeficiency and those who could receive specific therapy. The primary objective of the present study was to assess the performance of different sets of immunological tests in diagnosing any, primary, secondary or treatable immunodeficiencies in adults with bronchiectasis. METHODS: An observational, cross-sectional study was conducted at the Bronchiectasis Program of the Policlinico University Hospital in Milan, Italy, from September 2016 to June 2019. Adult outpatients with a clinical and radiological diagnosis of bronchiectasis underwent the same immunological screening during the first visit when clinically stable consisting of: complete blood count; immunoglobulin (Ig) subclass tests for IgA, IgG, IgM and IgG; total IgE; lymphocyte subsets; and HIV antibodies. The primary endpoint was the prevalence of patients with any immunodeficiencies using five different sets of immunological tests. RESULTS: A total of 401 bronchiectasis patients underwent the immunological screening. A significantly different prevalence of bronchiectasis patients diagnosed with any, primary or secondary immunodeficiencies was found across different bundles. 44.6% of bronchiectasis patients had a diagnosis of immunodeficiency when IgG subclasses and lymphocyte subsets were added to the minimum bundle suggested by the guidelines. CONCLUSION: A four-fold increase in the diagnosis of immunodeficiencies can be found in adults with bronchiectasis when IgG subclasses and lymphocyte subsets are added to the bundle of tests recommended by guidelines