« Je suis un petit peu alchimiste » : la collision des genres littéraires dans la Trilogie allemande de L.-F. Céline

La Trilogie allemande de L.-F. Céline demeure encore aujourd’hui une œuvre difficile à définir. Selon une interprétation fort répandue, la voix du romancier a désormais fait place au regard du chroniqueur. À l’inverse, une autre interprétation pose l’accent sur la prédominance de la dimension fictive. Si on ne serait mettre en discussion le statut romanesque de la Trilogie, il est plus difficile d’établir avec exactitude à quel genre de roman on est confronté. La séparation des genres narratifs, statutairement labile chez Céline, est définitivement abolie en fonction d’une architecture qui fait entrer en collision le roman et les mémoires autobiographiques, la chronique et le commentaire. Mais cette opération n’a rien à voir avec la posture ironique qui sera typique de l’écrivain postmoderne : souvenir, témoignage, digression et transposition trouvent leur véritable sens dans une interaction perpétuelle qui fait écho à la désarticulation du monde, et la transcende au même temps.L.-F. Céline’s Trilogie allemande is a work that is still difficult to define today. Following a current interpretation, the voice of the novelist has given way to the chronicler’s perspective. Another interpretative path emphasizes the predominance of the fictional dimension. If we would not question the fictional status of the Trilogie, it is more difficult to establish exactly what kind of novel we are dealing with. The separation of narrative genres, which is notoriously fleeting in Celine’s case, is definitively abolished following an architecture that conjoins novel and autobiographical memories, chronicle and commentary. This operation, though, has nothing to do with the ironic posture that will be typical of the postmodern writer : memory, testimony, digression and transposition find their true meaning in a perpetual interaction that echoes and transcends the disarticulation of the simultaneous world

Heritage-led ontologies: Digital platform for supporting the regeneration of cultural and historical sites

The increasing application of digital technologies to cultural heritage (CH) is wide and well documented, including a variety of tools such as digital archives, online guides and HBIM repositories. Several vocabularies and ontologies were designed to order heritage data and make CH more accessible and exploitable. However, these tools have often focused on a particular dimension of CH producing high value in separate sectors (e.g. access to conservation of historic buildings and data valorisation for restoration of heritage assets) but lacking ways for adapting or replicating the model to urban complex systems. Moreover, many studies and tools show large effort in cataloguing and archiving, but less in providing tools for designing and managing. The ROCK platform, developed within the Horizon 2020 (H2020) funded project ROCK (GA 730280), addresses the need for a management and interventionoriented interoperable tool, aimed at storing, visualizing, elaborating and linking data on cultural heritage. The use of already existing ontologies was not sufficient for developing a tool to deal with the complexity of urban systems and heterogeneous data sources. Instead, a participative methodology was set in place for the development of a context-based semantic framework to define the needs and requirements of heritage-led regeneration actions

Agronomic performance of 21 new disease resistant winegrape varieties grown in northeast Italy

The goal of the field trial was to evaluate the agronomic performance of 21 (10 red and 11 white) winegrape varieties obtained from recent breeding programmes for disease resistance developed in Hungary, Germany, and Italy. The tested red varieties were as follows: ‘Cabernet Carbon’, ‘Cabernet Eidos’, ‘Cabernet Volos’, ‘Julius’, ‘Merlot Khorus’, ‘Merlot Kanthus’, ‘Monarch’, ‘Prior’, UD. 31.103, ‘Vinera’. The tested white varieties were as follows: ‘Aromera’, ‘Bronner’, ‘Fleurtai’, ‘Johanniter’, ‘Muscaris’, ‘Souvignier Gris’, ‘Sauvignon Kretos’, ‘Sauvignon Nepis’, ‘Sauvignon Rytos’, ‘Solaris’, ‘Soreli’. ‘Merlot’ (red) and ‘Glera’ (white) were included as control. The experimental vineyard was established in Castelfranco Veneto on the plain, in 2014. Spray treatments were applied against downy and powdery mildew, by using only copper and sulphur. Grape production, grape quality, and phenology were recorded over a six-year-period, while disease resistance (downy mildew, powdery mildew, black rot and anthracnose) was detected only during a few years. The most significant findings were: a) all varieties showed a good level of downy mildew resistance, especially ‘Cabernet Carbon’, ‘Monarch’, ‘Prior’, UD 31.103, ‘Muscaris’, ‘Solaris’, ‘Souvignier Gris’, ‘Bronner’, ‘Fleurtai’, ‘Aromera’; b) no powdery mildew attacks were detected in any variety; c) ‘Monarch’, ‘Muscaris’, ‘Solaris’ and ‘Souvignier Gris’ also showed a high level of resistance towards black rot and anthracnose; d) red grape varieties had an earlier bud burst as compared to ‘Merlot’, and, concerning ripening, some varieties were earlier than ‘Merlot’, other ones were later; e) white varieties had a later bud burst but an earlier ripening time as compared to ‘Glera’; f) grape production and quality changed significantly depending on the varieties, being titratable acidity higher than 6.4 g L-1 tartaric acid and pH lower than 3.5; also the year affected in a significant way those parameters as well as the interaction between the genotype and the year. In conclusion, the tested varieties behaved positively in terms of environmental sustainability

Intestinal Permeability is Increased in Children Born Preterm, with Persistent Growth Delay and Intrauterine Growth Restriction

Intrauterine growth restriction (IUGR) is a clinical condition in which foetus cannot develop its own growth potential..

Prescription appropriateness of anti-diabetes drugs in elderly patients hospitalized in a clinical setting: evidence from the REPOSI Register

Diabetes is an increasing global health burden with the highest prevalence (24.0%) observed in elderly people. Older diabetic adults have a greater risk of hospitalization and several geriatric syndromes than older nondiabetic adults. For these conditions, special care is required in prescribing therapies including anti- diabetes drugs. Aim of this study was to evaluate the appropriateness and the adherence to safety recommendations in the prescriptions of glucose-lowering drugs in hospitalized elderly patients with diabetes. Data for this cross-sectional study were obtained from the REgistro POliterapie-Società Italiana Medicina Interna (REPOSI) that collected clinical information on patients aged ≥ 65 years acutely admitted to Italian internal medicine and geriatric non-intensive care units (ICU) from 2010 up to 2019. Prescription appropriateness was assessed according to the 2019 AGS Beers Criteria and anti-diabetes drug data sheets.Among 5349 patients, 1624 (30.3%) had diagnosis of type 2 diabetes. At admission, 37.7% of diabetic patients received treatment with metformin, 37.3% insulin therapy, 16.4% sulfonylureas, and 11.4% glinides. Surprisingly, only 3.1% of diabetic patients were treated with new classes of anti- diabetes drugs. According to prescription criteria, at admission 15.4% of patients treated with metformin and 2.6% with sulfonylureas received inappropriately these treatments. At discharge, the inappropriateness of metformin therapy decreased (10.2%, P < 0.0001). According to Beers criteria, the inappropriate prescriptions of sulfonylureas raised to 29% both at admission and at discharge. This study shows a poor adherence to current guidelines on diabetes management in hospitalized elderly people with a high prevalence of inappropriate use of sulfonylureas according to the Beers criteria

Antidiabetic Drug Prescription Pattern in Hospitalized Older Patients with Diabetes

Objective: To describe the prescription pattern of antidiabetic and cardiovascular drugs in a cohort of hospitalized older patients with diabetes. Methods: Patients with diabetes aged 65 years or older hospitalized in internal medicine and/or geriatric wards throughout Italy and enrolled in the REPOSI (REgistro POliterapuie SIMI—Società Italiana di Medicina Interna) registry from 2010 to 2019 and discharged alive were included. Results: Among 1703 patients with diabetes, 1433 (84.2%) were on treatment with at least one antidiabetic drug at hospital admission, mainly prescribed as monotherapy with insulin (28.3%) or metformin (19.2%). The proportion of treated patients decreased at discharge (N = 1309, 76.9%), with a significant reduction over time. Among those prescribed, the proportion of those with insulin alone increased over time (p = 0.0066), while the proportion of those prescribed sulfonylureas decreased (p < 0.0001). Among patients receiving antidiabetic therapy at discharge, 1063 (81.2%) were also prescribed cardiovascular drugs, mainly with an antihypertensive drug alone or in combination (N = 777, 73.1%). Conclusion: The management of older patients with diabetes in a hospital setting is often sub-optimal, as shown by the increasing trend in insulin at discharge, even if an overall improvement has been highlighted by the prevalent decrease in sulfonylureas prescription

The “Diabetes Comorbidome”: A Different Way for Health Professionals to Approach the Comorbidity Burden of Diabetes

(1) Background: The disease burden related to diabetes is increasing greatly, particularly in older subjects. A more comprehensive approach towards the assessment and management of diabetes’ comorbidities is necessary. The aim of this study was to implement our previous data identifying and representing the prevalence of the comorbidities, their association with mortality, and the strength of their relationship in hospitalized elderly patients with diabetes, developing, at the same time, a new graphic representation model of the comorbidome called “Diabetes Comorbidome”. (2) Methods: Data were collected from the RePoSi register. Comorbidities, socio-demographic data, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), and functional status (Barthel Index), were recorded. Mortality rates were assessed in hospital and 3 and 12 months after discharge. (3) Results: Of the 4714 hospitalized elderly patients, 1378 had diabetes. The comorbidities distribution showed that arterial hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and COPD (22.7%), were the more frequent in subjects with diabetes. The graphic comorbidome showed that the strongest predictors of death at in hospital and at the 3-month follow-up were dementia and cancer. At the 1-year follow-up, cancer was the first comorbidity independently associated with mortality. (4) Conclusions: The “Diabetes Comorbidome” represents the perfect instrument for determining the prevalence of comorbidities and the strength of their relationship with risk of death, as well as the need for an effective treatment for improving clinical outcomes

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

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