User needs analysis for the definition of operational coastal services

According to the global growth of the “Blue economy”, coastal zones are under pressure from both land and marine side economic activities. The fragmentation of sectorial interests and legislation along the coasts has led to the need for bridging knowledge (data/information and methods/tools) and governance (decision-makers at every level) in order to ensure sustainable economic development and social and ecosystem resilience. This poses the need for an interaction process that associates user needs to the European and national legislative framework to create a policy-oriented demand of Copernicus Earth Observation services in coastal areas. Such goals need a strong and effective system to monitor compliance and to assess the progress of the legislation. This study aims at identifying potential gaps in the current Copernicus product offer for the monitoring of the coastal sector through the elicitation of stakeholder requirements. The methodology is applied to the Italian landscape of users, but it is scalable at European level. The results provide a clear overview of the coastal user requirements, highlighting the common need of integrated information for the management, and represents the basis for defining the coastal services

MIGLIORAMENTO DELLA NEUROPATIA PERIFERICA ED AUTONOMA DURANTE 18 MESI DI INFUSIONE CONTINUA DI INSULINA PER VIA SOTTOCUTANEA IN DIABETICI DI TIPO I

MIGLIORAMENTO DELLA NEUROPATIA PERIFERICA III SIMPOSIO INTERNAZIONALE SUL DIABETE MONTECATINI OTTOBRE 198

Nasal/orotracheal tube switch to reduce length of mechanical ventilation in neurocritical patients: A propensity score matched analysis

Introduction and objectives: Nasotracheal intubation was advocated to increase patients comfort and tube tolerance, but no study showed a clear benefit of nasotracheal intubation over orotracheal intubation. Neurocritically ill patients are a fragile group with specific requirements regarding ventilation and sedation. The aim of this study was to evaluate whether nasotracheal intubation might reduce length of mechanical ventilation in neurocritically ill patients. Materials and methods: We conducted a retrospective cohort study with propensity matched analysis including all patients who underwent prolonged mechanical ventilation in the neurocritical Intensive Care Unit. Results: A total of 4030 patients were admitted during the period of interest and 312 entered the final analysis. Propensity score analysis identified 74 matched couples. Length of mechanical ventilation in patients who underwent early nasotracheal intubation resulted to be statistically significantly shorter than patients who underwent orotracheal intubation. Accordingly, length of sedation was significantly lower in patients with nasotracheal intubation, while no difference in complications occurred with similar length of stay. Conclusions: In critical care units using nasotracheal intubation in the standard management of patients, the nasotracheal route was associated with lesser need for sedatives leading to shorter mechanical ventilation in neurocritical patients. However, causality has to be proven by future randomized controlled trials

Predictors of deep-vein thrombosis in subarachnoid hemorrhage: a retrospective analysis

Background: Subarachnoid hemorrhage is a severe subtype of hemorrhagic stroke, and deep-vein thrombosis is a frequent complication detected in these patients. In addition to other well-established risk factors, the early activation of coagulation systems present in patients with subarachnoid hemorrhage could potentially play a role in the incidence of deep-vein thrombosis. This study aims to identify possible predictors for deep-vein thrombosis related to subarachnoid hemorrhage. Methods: We conducted a retrospective cohort study on patients with a diagnosis of subarachnoid hemorrhage who presented to our institution between 1 January 2014 and 1 August 2018. We reviewed electronic medical records and analyzed several parameters such as Fisher scale, World Federation of Neurosurgical Surgeons scale, aneurysm site, surgical or endovascular treatment, decompressive craniectomy, vasospasm, infection (meningitis and pneumonia), presence of motor deficit, length of stay in the ICU, length of hospital stay, number of days under ventilator support, d-dimer at hospitalization, and the time to thromboprophylaxis (days). Results: The univariate analysis showed that intraparenchymal cerebral hemorrhage, d-dimer at hospitalization, the time to thromboprophylaxis, motor deficit, and aneurysm located at the internal carotid artery were statistically significant factors. Intraparenchymal cerebral hemorrhage (OR 2,78 95%CI 1.07\u20137.12), motor deficit (OR 3.46; 95%CI 1.37\u20139.31), and d-dimer at hospitalization (OR 1.002 95% CI 1.001\u20131.003) were demonstrated as independent risk factors for deep-vein thrombosis. Length of hospital stay was also found to be significantly longer in patients who developed deep-vein thrombosis (p value 0.018). Conclusion: Elevated d-dimer level at the time of hospitalization, motor deficit, and the presence of an intraparenchymal hemorrhage are independent risk factors for deep-vein thrombosis. Patients with DVT also had a significantly longer hospital stay. Even though further studies are needed, patients with elevated d-dimer at hospitalization and intraparenchymal cerebral hemorrhage may benefit from a more aggressive screening strategy for deep-vein thrombosis

Influence of glucoregulation with continuous subcutaneous insulin infusion on nerve conduction velocity and beat to beat variation in diabetics

Limited and contrasting data are available on the relationship between metabolic control and diabetic neuropathy. In eight type I diabetics peripheral and autonomic neuropathy were studied, first in conditions of poor metabolic control and then after one and three months during which an improved control of glycemic levels had been obtained by continuous subcutaneous insulin infusion. Autonomic neuropathy was investigated by evaluating beat to beat variation during deep breathing; peripheral neuropathy by measuring maximum motor conduction velocity of peroneal and median nerves and sensory conduction velocity of median nerve. Our data showed significant improvement of motor conduction velocity in both nerves studied, whilst sensory conduction velocity did not show any significant variation. The changes observed in beat to beat variation in five subjects with initially abnormal scores might reflect an improvement in autonomic nervous function, even if long-term studies are needed