Browsing Isolated Population Data

BACKGROUND: In our studies of genetically isolated populations in a remote mountain area in the center of Sardinia (Italy), we found that 80–85% of the inhabitants of each village belong to a single huge pedigree with families strictly connected to each other through hundreds of loops. Moreover, intermarriages between villages join pedigrees of different villages through links that make family trees even more complicated. Unfortunately, none of the commonly used pedigree drawing tools are able to draw the complete pedigree, whereas it is commonly accepted that the visual representation of families is very important as it helps researchers in identifying clusters of inherited traits and genotypes. We had a representation issue that compels researchers to work with subsets extracted from the overall genealogy, causing a serious loss of information on familiar relationships. To visually explore such complex pedigrees, we developed PedNavigator, a browser for genealogical databases properly suited for genetic studies. RESULTS: The PedNavigator is useful for genealogical research due to its capacity to represent family relations between persons and to make a visual verification of the links during family history reconstruction. As for genetic studies, it is helpful to follow propagation of a specific set of genetic markers (haplotype), or to select people for linkage analysis, showing relations between various branch of a family tree of affected subjects. AVAILABILITY: PedNavigator is an application integrated into a Framework designed to handle data for human genetic studies based on the Oracle platform. To allow the use of PedNavigator also to people not owning the same required informatics infrastructure or systems, we developed PedNavigator Lite with mainly the same features of the integrated one, based on MySQL database server. This version is free for academic users, and it is available for download from our sit

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

How do cardiologists select patients for dual antiplatelet therapy continuation beyond 1 year after a myocardial infarction? Insights from the EYESHOT Post-MI Study

Background: Current guidelines suggest to consider dual antiplatelet therapy (DAPT) continuation for longer than 12 months in selected patients with myocardial infarction (MI). Hypothesis: We sought to assess the criteria used by cardiologists in daily practice to select patients with a history of MI eligible for DAPT continuation beyond 1 year. Methods: We analyzed data from the EYESHOT Post-MI, a prospective, observational, nationwide study aimed to evaluate the management of patients presenting to cardiologists 1 to 3 years from the last MI event. Results: Out of the 1633 post-MI patients enrolled in the study between March and December 2017, 557 (34.1%) were on DAPT at the time of enrolment, and 450 (27.6%) were prescribed DAPT after cardiologist assessment. At multivariate analyses, a percutaneous coronary intervention (PCI) with multiple stents and the presence of peripheral artery disease (PAD) resulted as independent predictors of DAPT continuation, while atrial fibrillation was the only independent predictor of DAPT interruption for patients both at the second and the third year from MI at enrolment and the time of discharge/end of the visit. Conclusions: Risk scores recommended by current guidelines for guiding decisions on DAPT duration are underused and misused in clinical practice. A PCI with multiple stents and a history of PAD resulted as the clinical variables more frequently associated with DAPT continuation beyond 1 year from the index MI

Moral structure

Chapter 12 provides a comprehensive overview of the moral structure of each of the three realms of Dante’s afterlife: Hell, Purgatory and Paradise. It examines Dante’s sources, ethical criteria, and topography, as well as his representation of moral structure in the narrative itself, and its political implications. The first section analyses the four principal regions of Hell through Virgil’s rationale: the circles of incontinence, the ‘rings’ of violence, the ‘pouches’ of simple fraud, and the pit of treacherous fraud. It then explores the three groups of souls that Virgil strikingly leaves out: the ‘neutrals’, the virtuous pagans in Limbo, and the heretics. The second section addresses four key differences between Infernal and Purgatorial suffering, explains the moral theories of disordered love and the seven capital sins underpinning the seven terraces of Dante’s Purgatory, and examines the theologically original antechamber of Purgatory, and the Earthly Paradise at the mountain’s summit. The third section highlights Dante’s distinction between what Paradise is and how it is conveyed, and shows how his layered vision of Paradise overlaps the scheme of the four cardinal and three theological virtues with the theory of astral influence on personality.Postprin

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Using smart PPE (Personal Protective Equipment) in waste management. Advantages and disadvantages

Once hazards for workers are highlighted, engineering and administrative controls should be adopted in workplaces and, finally, Personal Protective Equipment (PPE). In Italy, INAIL is involved in studying the application of the national plan “Industry 4.0” to safety in workplaces and in improving the protective systems’ performances through the use of “Industry 4.0” devices. Smart PPE are “Industry 4.0” products representing the most interesting way to increase protection standards in risk management. Smart PPE are advanced PPE, integrating materials, sensors and ICT solutions enhancing product multi-functionality. Many functions can be integrated in Smart PPE: health and environmental monitoring; wireless communication; personal localization (GPS) and geographic information system (GIS); cooling and heating; additional functions as an emergency stop or hazard reduction; smart textiles; wireless tracking and identification; physical security information management; augmented reality. There are advantages and disadvantages in using these items, to be taken into account for workers’ safety. The aim of this study is to provide an overview of smart PPE’s pros and consreferring to every phase of solid waste management, one of the most hazardous employment sectors in Europe, where PPE are essential to reduce risks. Moreover, some interesting features of existing smart PPE will be pointed out, such as the communication based on Bluetooth or RFID TAGs and sensors, the face recognition, or the integration of augmented reality. Finally, the first results of INAIL’s project about a smart PPE will be illustrated. At the end of the project activities this item will be available free of charge

Yield and nitrogen fixation potential from white lupine grown in rainfed Mediterranean environments

ABSTRACT There is renewed interest in white lupine (Lupinus albus L.), which is appreciated for its high protein content, full range of essential amino acids and as N source to rainfed cropping systems. Unfortunately, information on its N2 fixation ability is limited. This study aimed to: (i) quantify the N2 fixation ability of white lupine crop at the plot field scale in three different environments of Sardinia (Italy) under Mediterranean climate; (ii) determine the allocation of the plant-fixed N into different organs; and (iii) establish the relationship between fixed N and DM within plant organs. In a 2-year experiment, N2 fixation was estimated using the 15N isotopic dilution method. The productive performances and ability of white lupine to fix N2 widely differed in the three environments; peak values exceeded 300 kg ha−1 of fixed N. There were significant differences in the quantity of fixed N found in each plant organ at physiological maturity with 5, 20, 19 and 57 % of fixed N partitioned to roots, shoots, pod valves and grain, respectively. After grain harvesting, the net N balance ranged from negative values to 160 kg N ha−1. The relationship between fixed N and DM yield indicated 60, 34, 8 and 6 kg of fixed N per t of grain, pod valves, shoots and root, respectively, showing that fixed N preferentially accumulated in seeds at physiological maturity. Due to its high potential for N2 fixation and N benefit, white lupine represents a valuable crop option under rainfed Mediterranean conditions