Geoinformatic methodologies and quantitative tools for detecting hotspots and for multicriteria ranking and prioritization: application on biodiversity monitoring and conservation

Chi ha la responsabilità di gestire un’area protetta non solo deve essere consapevole dei problemi ambientali dell’area ma dovrebbe anche avere a disposizione dati aggiornati e appropriati strumenti metodologici per esaminare accuratamente ogni singolo problema. In effetti, il decisore ambientale deve organizzare in anticipo le fasi necessarie a fronteggiare le prevedibili variazioni che subirà la pressione antropica sulle aree protette. L’obiettivo principale della Tesi è di natura metodologica e riguarda il confronto tra differenti metodi statistici multivariati utili per l’individuazione di punti critici nello spazio e per l’ordinamento degli “oggetti ambientali” di studio e quindi per l’individuazione delle priorità di intervento ambientale. L’obiettivo ambientale generale è la conservazione del patrimonio di biodiversità. L’individuazione, tramite strumenti statistici multivariati, degli habitat aventi priorità ecologica è solamente il primo fondamentale passo per raggiungere tale obiettivo. L’informazione ecologica, integrata nel contesto antropico, è un successivo essenziale passo per effettuare valutazioni ambientali e per pianificare correttamente le azioni volte alla conservazione. Un’ampia serie di dati ed informazioni è stata necessaria per raggiungere questi obiettivi di gestione ambientale. I dati ecologici sono forniti dal Ministero dell’Ambiente Italiano e provengono al Progetto “Carta della Natura” del Paese. I dati demografici sono invece forniti dall’Istituto Italiano di Statistica (ISTAT). I dati si riferiscono a due aree geografiche italiane: la Val Baganza (Parma) e l’Oltrepò Pavese e Appennino Ligure-Emiliano. L’analisi è stata condotta a due differenti livelli spaziali: ecologico-naturalistico (l’habitat) e amministrativo (il Comune). Corrispondentemente, i risultati più significativi ottenuti sono: 1. Livello habitat: il confronto tra due metodi di ordinamento e determinazione delle priorità, il metodo del Vettore Ideale e quello della Preminenza, tramite l’utilizzo di importanti metriche ecologiche come il Valore Ecologico (E.V.) e la Sensibilità Ecologica (E.S.), fornisce dei risultati non direttamente comparabili. Il Vettore Ideale, non essendo un procedimento basato sulla ranghizzazione dei valori originali, sembra essere preferibile nel caso di paesaggi molto eterogenei in senso spaziale. Invece, il metodo della Preminenza probabilmente è da preferire in paesaggi ecologici aventi un basso grado di eterogeneità intesa nel senso di differenze non troppo grandi nel E.V. ed E.S. degli habitat. 2. Livello comunale: Al fine di prendere delle decisioni gestionali ed essendo gli habitat solo delle suddivisioni naturalistiche di un dato territorio, è necessario spostare l’attenzione sulle corrispondenti unità amministrative territoriali (i Comuni). Da questo punto di vista, l’introduzione della demografia risulta essere un elemento centrale oltre che di novità nelle analisi ecologico-ambientali. In effetti, l’analisi demografica rende il risultato di cui al punto 1 molto più realistico introducendo altre dimensioni (la pressione antropica attuale e le sue tendenze) che permettono l’individuazione di aree ecologicamente fragili. Inoltre, tale approccio individua chiaramente le responsabilità ambientali di ogni singolo ente territoriale nei riguardi della difesa della biodiversità. In effetti un ordinamento dei Comuni sulla base delle caratteristiche ambientali e demografiche, chiarisce le responsabilità gestionali di ognuno di essi. Un’applicazione concreta di questa necessaria quanto utile integrazione di dati ecologici e demografici viene discussa progettando una Rete Ecologica (E.N.). La Rete cosi ottenuta infatti presenta come elemento di novità il fatto di non essere “statica” bensì “dinamica” nel senso che la sua pianificazione tiene in considerazione il trend di pressione antropica al fine di individuare i probabili punti di futura fragilità e quindi di più critica gestione.Who has the responsibility to manage a conservation zone, not only must be aware of environmental problems but should have at his disposal updated databases and appropriate methodological instruments to examine carefully each individual case. In effect he has to arrange, in advance, the necessary steps to withstand the foreseeable variations in the trends of human pressure on conservation zones. The essential objective of this Thesis is methodological that is to compare different multivariate statistical methods useful for environmental hotspot detection and for environmental prioritization and ranking. The general environmental goal is the conservation of the biodiversity patrimony. The individuation, through multidimensional statistical tools, of habitats having top ecological priority, is only the first basic step to accomplish this aim. Ecological information integrated in the human context is an essential further step to make environmental evaluations and to plan correct conservation actions. A wide series of data and information has been necessary to accomplish environmental management tasks. Ecological data are provided by the Italian Ministry of the Environment and they refer to the Map of Italian Nature Project database. The demographic data derives from the Italian Institute of Statistics (ISTAT). The data utilized regards two Italian areas: Baganza Valley and Oltrepò Pavese and Ligurian-Emilian Apennine. The analysis has been carried out at two different spatial/scale levels: ecological-naturalistic (habitat level) and administrative (Commune level). Correspondingly, the main obtained results are: 1. Habitat level: comparing two ranking and prioritization methods, Ideal Vector and Salience, through important ecological metrics like Ecological Value (E.V.) and Ecological Sensitivity (E.S.), gives results not directly comparable. Being not based on a ranking process, Ideal Vector method seems to be used preferentially in landscapes characterized by high spatial heterogeneity. On the contrary, Salience method is probably to be preferred in ecological landscapes characterized by a low degree of heterogeneity in terms of not large differences concerning habitat E.V. and E.S.. 2. Commune level: Being habitat only a naturalistic partition of a given territory, it is necessary, for management decisions, to move towards the corresponding administrative units (Communes). From this point of view, the introduction of demography is an essential element of novelty in environmental analysis. In effect, demographic analysis makes the goal at point 1 more realistic introducing other dimensions (actual human pressure and its trend) which allows the individuation of environmentally fragile areas. Furthermore this approach individuates clearly the environmental responsibility of each administrative body for what concerns the biodiversity conservation. In effect communes’ ranking, according to environmental/demographic features, clarify the responsibilities of each administrative body. A concrete application of this necessary and useful integration of ecological and demographic data has been developed in designing an Ecological Network (E.N.).The obtained E.N. has the novelty to be not “static” but “dynamic” that is the network planning take into account the demographic pressure trends in the individuation of the probable future fragile points

Monitoring the last Apennine glacier: recent in situ campaigns and modelling of Calderone glacial apparatus

The Calderone glacier is at present the most southern glacier in Europe (42° 28' 15’’ N). The little apparatus (about 20.000 m2 in surface area) has been giving an interesting response both to short- and long-term climatic variations which resulted in a considerable reduction in surface area and volume. The glacial apparatus is split into two ice bodies (glacierets) since 2000. The two glacierets are located in a deep northward valley below the top of the Corno Grande (2912 m asl) in the centre of the Gran Sasso d’Italia mountain range (Central Italy). Such glacial apparatus has been subjected to a strong reduction, with a loss of total surface area of about 50% and thickness of about 65%with respect to the hypothetical size (about 105.00 m2 and 55 m at the Little Ice Age). Since early 90s the Calderone glacier has been subjected to several multidisciplinary field campaigns to monitor and evaluate its role as an environmental indicator in the framework of global warming. Starting from historical series related to more than a century of records, the variability of the different glacier properties has been estimated by using classical geomorphologic methods as well as in situ and remote sensing techniques. In particular, the last field campaigns, in 2015, 2016 and 2019, have been carried out using Ground Penetrating Radar equipped with different antenna frequencies, drone-based survey, snow pit measurements and chemical-physical sampling. The measurement campaigns have been complemented by a regional climate analysis, spanning the last fifty years, and snowpack modelling initialized with microphysical snow data (e.g., snow density, crystal shape and size, hardness). The snowpack chemical analyses include the main and trace elements, soluble inorganic and organic ions, EC/OC and PAH, with different spatial resolution depending on the analytes. We present here the methodological approach used and some preliminary results

Acute Delta Hepatitis in Italy spanning three decades (1991–2019): Evidence for the effectiveness of the hepatitis B vaccination campaign

Updated incidence data of acute Delta virus hepatitis (HDV) are lacking worldwide. Our aim was to evaluate incidence of and risk factors for acute HDV in Italy after the introduction of the compulsory vaccination against hepatitis B virus (HBV) in 1991. Data were obtained from the National Surveillance System of acute viral hepatitis (SEIEVA). Independent predictors of HDV were assessed by logistic-regression analysis. The incidence of acute HDV per 1-million population declined from 3.2 cases in 1987 to 0.04 in 2019, parallel to that of acute HBV per 100,000 from 10.0 to 0.39 cases during the same period. The median age of cases increased from 27 years in the decade 1991-1999 to 44 years in the decade 2010-2019 (p < .001). Over the same period, the male/female ratio decreased from 3.8 to 2.1, the proportion of coinfections increased from 55% to 75% (p = .003) and that of HBsAg positive acute hepatitis tested for by IgM anti-HDV linearly decreased from 50.1% to 34.1% (p < .001). People born abroad accounted for 24.6% of cases in 2004-2010 and 32.1% in 2011-2019. In the period 2010-2019, risky sexual behaviour (O.R. 4.2; 95%CI: 1.4-12.8) was the sole independent predictor of acute HDV; conversely intravenous drug use was no longer associated (O.R. 1.25; 95%CI: 0.15-10.22) with this. In conclusion, HBV vaccination was an effective measure to control acute HDV. Intravenous drug use is no longer an efficient mode of HDV spread. Testing for IgM-anti HDV is a grey area requiring alert. Acute HDV in foreigners should be monitored in the years to come

Geoinformatic methodologies and quantitative tools for detecting hotspots and for multicriteria ranking and prioritization: application on biodiversity monitoring and conservation

Chi ha la responsabilità di gestire un’area protetta non solo deve essere consapevole dei problemi ambientali dell’area ma dovrebbe anche avere a disposizione dati aggiornati e appropriati strumenti metodologici per esaminare accuratamente ogni singolo problema. In effetti, il decisore ambientale deve organizzare in anticipo le fasi necessarie a fronteggiare le prevedibili variazioni che subirà la pressione antropica sulle aree protette. L’obiettivo principale della Tesi è di natura metodologica e riguarda il confronto tra differenti metodi statistici multivariati utili per l’individuazione di punti critici nello spazio e per l’ordinamento degli “oggetti ambientali” di studio e quindi per l’individuazione delle priorità di intervento ambientale. L’obiettivo ambientale generale è la conservazione del patrimonio di biodiversità. L’individuazione, tramite strumenti statistici multivariati, degli habitat aventi priorità ecologica è solamente il primo fondamentale passo per raggiungere tale obiettivo. L’informazione ecologica, integrata nel contesto antropico, è un successivo essenziale passo per effettuare valutazioni ambientali e per pianificare correttamente le azioni volte alla conservazione. Un’ampia serie di dati ed informazioni è stata necessaria per raggiungere questi obiettivi di gestione ambientale. I dati ecologici sono forniti dal Ministero dell’Ambiente Italiano e provengono al Progetto “Carta della Natura” del Paese. I dati demografici sono invece forniti dall’Istituto Italiano di Statistica (ISTAT). I dati si riferiscono a due aree geografiche italiane: la Val Baganza (Parma) e l’Oltrepò Pavese e Appennino Ligure-Emiliano. L’analisi è stata condotta a due differenti livelli spaziali: ecologico-naturalistico (l’habitat) e amministrativo (il Comune). Corrispondentemente, i risultati più significativi ottenuti sono: 1. Livello habitat: il confronto tra due metodi di ordinamento e determinazione delle priorità, il metodo del Vettore Ideale e quello della Preminenza, tramite l’utilizzo di importanti metriche ecologiche come il Valore Ecologico (E.V.) e la Sensibilità Ecologica (E.S.), fornisce dei risultati non direttamente comparabili. Il Vettore Ideale, non essendo un procedimento basato sulla ranghizzazione dei valori originali, sembra essere preferibile nel caso di paesaggi molto eterogenei in senso spaziale. Invece, il metodo della Preminenza probabilmente è da preferire in paesaggi ecologici aventi un basso grado di eterogeneità intesa nel senso di differenze non troppo grandi nel E.V. ed E.S. degli habitat. 2. Livello comunale: Al fine di prendere delle decisioni gestionali ed essendo gli habitat solo delle suddivisioni naturalistiche di un dato territorio, è necessario spostare l’attenzione sulle corrispondenti unità amministrative territoriali (i Comuni). Da questo punto di vista, l’introduzione della demografia risulta essere un elemento centrale oltre che di novità nelle analisi ecologico-ambientali. In effetti, l’analisi demografica rende il risultato di cui al punto 1 molto più realistico introducendo altre dimensioni (la pressione antropica attuale e le sue tendenze) che permettono l’individuazione di aree ecologicamente fragili. Inoltre, tale approccio individua chiaramente le responsabilità ambientali di ogni singolo ente territoriale nei riguardi della difesa della biodiversità. In effetti un ordinamento dei Comuni sulla base delle caratteristiche ambientali e demografiche, chiarisce le responsabilità gestionali di ognuno di essi. Un’applicazione concreta di questa necessaria quanto utile integrazione di dati ecologici e demografici viene discussa progettando una Rete Ecologica (E.N.). La Rete cosi ottenuta infatti presenta come elemento di novità il fatto di non essere “statica” bensì “dinamica” nel senso che la sua pianificazione tiene in considerazione il trend di pressione antropica al fine di individuare i probabili punti di futura fragilità e quindi di più critica gestione.Who has the responsibility to manage a conservation zone, not only must be aware of environmental problems but should have at his disposal updated databases and appropriate methodological instruments to examine carefully each individual case. In effect he has to arrange, in advance, the necessary steps to withstand the foreseeable variations in the trends of human pressure on conservation zones. The essential objective of this Thesis is methodological that is to compare different multivariate statistical methods useful for environmental hotspot detection and for environmental prioritization and ranking. The general environmental goal is the conservation of the biodiversity patrimony. The individuation, through multidimensional statistical tools, of habitats having top ecological priority, is only the first basic step to accomplish this aim. Ecological information integrated in the human context is an essential further step to make environmental evaluations and to plan correct conservation actions. A wide series of data and information has been necessary to accomplish environmental management tasks. Ecological data are provided by the Italian Ministry of the Environment and they refer to the Map of Italian Nature Project database. The demographic data derives from the Italian Institute of Statistics (ISTAT). The data utilized regards two Italian areas: Baganza Valley and Oltrepò Pavese and Ligurian-Emilian Apennine. The analysis has been carried out at two different spatial/scale levels: ecological-naturalistic (habitat level) and administrative (Commune level). Correspondingly, the main obtained results are: 1. Habitat level: comparing two ranking and prioritization methods, Ideal Vector and Salience, through important ecological metrics like Ecological Value (E.V.) and Ecological Sensitivity (E.S.), gives results not directly comparable. Being not based on a ranking process, Ideal Vector method seems to be used preferentially in landscapes characterized by high spatial heterogeneity. On the contrary, Salience method is probably to be preferred in ecological landscapes characterized by a low degree of heterogeneity in terms of not large differences concerning habitat E.V. and E.S.. 2. Commune level: Being habitat only a naturalistic partition of a given territory, it is necessary, for management decisions, to move towards the corresponding administrative units (Communes). From this point of view, the introduction of demography is an essential element of novelty in environmental analysis. In effect, demographic analysis makes the goal at point 1 more realistic introducing other dimensions (actual human pressure and its trend) which allows the individuation of environmentally fragile areas. Furthermore this approach individuates clearly the environmental responsibility of each administrative body for what concerns the biodiversity conservation. In effect communes’ ranking, according to environmental/demographic features, clarify the responsibilities of each administrative body. A concrete application of this necessary and useful integration of ecological and demographic data has been developed in designing an Ecological Network (E.N.).The obtained E.N. has the novelty to be not “static” but “dynamic” that is the network planning take into account the demographic pressure trends in the individuation of the probable future fragile points

Upright BPPV Protocol: Feasibility of a New Diagnostic Paradigm for Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo Compared to Standard Diagnostic Maneuvers

Background: The diagnosis of benign paroxysmal positional vertigo (BPPV) involving the lateral semicircular canal (LSC) is traditionally entrusted to the supine head roll test, also known as supine head yaw test (SHYT), which usually allows identification of the pathologic side and BPPV form (geotropic vs. apogeotropic). Nevertheless, SHYT may not always allow easy detection of the affected canal, resulting in similar responses on both sides and intense autonomic symptoms in patients with recent onset of vertigo. The newly introduced upright head roll test (UHRT) represents a diagnostic maneuver for LSC-BPPV, supplementing the already-known head pitch test (HPT) in the sitting position. The combination of these two tests should enable clinicians to determine the precise location of debris within LSC, avoiding disturbing symptoms related to supine positionings. Therefore, we proposed the upright BPPV protocol (UBP), a test battery exclusively performed in the upright position, including the evaluation of pseudo-spontaneous nystagmus (PSN), HPT and UHRT. The purpose of this multicenter study is to determine the feasibility of UBP in the diagnosis of LSC-BPPV. Methods: We retrospectively reviewed the clinical data of 134 consecutive patients diagnosed with LSC-BPPV. All of them received both UBP and the complete diagnostic protocol (CDP), including the evaluation of PSN and data resulting from HPT, UHRT, seated-supine positioning test (SSPT), and SHYT. Results: A correct diagnosis for LSC-BPPV was achieved in 95.5% of cases using exclusively the UBP, with a highly significant concordance with the CDP (p < 0.000, Cohen's kappa = 0.94), regardless of the time elapsed from symptom onset to diagnosis. The concordance between UBP and CDP was not impaired even when cases in which HPT and/or UHRT provided incomplete results were included (p < 0.000). Correct diagnosis using the supine diagnostic protocol (SDP, including SSPT + SHYT) or the sole SHYT was achieved in 85.1% of cases, with similar statistical concordance (p < 0.000) and weaker strength of relationship (Cohen's kappa = 0.80). Conclusion: UBP allows correct diagnosis in LSC-BPPV from the sitting position in most cases, sparing the patient supine positionings and related symptoms. UBP could also allow clinicians to proceed directly with repositioning maneuvers from the upright position

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0–4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2–6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates