Cluster of legionnaires’ disease in an Italian prison

Background: Legionella pneumophila (Lp) is the most common etiologic agent causing Legionnaires’ Disease (LD). Water systems offer the best growth conditions for Lp and support its spread by producing aerosols. From 2015 to 2017, the Regional Reference Laboratory of Clinical and Environmental Surveillance of Legionellosis of Palermo monitored the presence of Lp in nine prisons in Western Sicily. During this investigation, we compared Lp isolates from environmental samples in a prison located in Palermo with isolates from two prisoners in the same prison. Methods: We collected 93 water samples from nine Sicilian prisons and the bronchoalveolar lavages (BALs) of two prisoners considered cases of LD. These samples were processed following the procedures described in the Italian Guidelines for the Prevention and Control of Legionellosis of 2015. Then, genotyping was performed on 19 Lp colonies (17 from water samples and 2 from clinical samples) using the Sequence-Based Typing (SBT) method, according to European Study Group for Legionella Infections (ESGLI) protocols. Results: Lp serogroup (sg) 6 was the most prevalent serogroup isolated from the prisons analyzed (40%), followed by Lp sg 1 (16%). Most of all, in four penitentiary institutions, we detected a high concentration of Lp >104 Colony Forming Unit/Liter (CFU/L). The environmental molecular investigation found the following Sequence Types (STs) in Lp sg 6: ST 93, ST 292, ST 461, ST 728, ST 1317 and ST 1362, while most of the isolates in sg 1 belonged to ST 1. We also found a new ST that has since been assigned the number 2451 in the ESGLI-SBT database. From the several Lp sg 1 colonies isolated from the two BALs, we identified ST 2451. Conclusions: In this article, we described the results obtained from environmental and epidemiological investigations of Lp isolated from prisons in Western Sicily. Furthermore, we reported the first cluster of Legionnaires’ in an Italian prison and the molecular typing of Lp sg 1 from one prison’s water system and two BALs, identified the source of the contamination, and discovered a new ST

RELAP5-3D thermal hydraulic analysis of the target cooling system in the SPES experimental facility

The SPES (Selective Production of Exotic Species) experimental facility, under construction at the Italian National Institute of Nuclear Physics (INFN) Laboratories of Legnaro, Italy, is a second generation Isotope Separation On Line (ISOL) plant for advanced nuclear physic studies. The UCx target-ion source system works at temperature of about 2273 K, producing a high level of radiation (10^5 Sv/h), for this reason a careful risk analysis for the target chamber is among the major safety issues. In this paper, the obtained results of thermofluid-dynamics simulations of accidental transients in the SPES target cooling system are reported. The analysis, performed by using the RELAP5-3D 2.4.2 qualified thermal-hydraulic system code, proves good safety performance of this system during different accidental conditions

Lung function with carvedilol and bisoprolol in chronic heart failure: is beta selectivity relevant?

BACKGROUND: Carvedilol is a beta-blocker with similar affinity for beta1- and beta2 receptors, while bisoprolol has higher beta1 affinity. The respiratory system is characterized by beta2-receptor prevalence. Airway beta receptors regulate bronchial tone and alveolar beta receptors regulate alveolar fluid re-absorption which influences gas diffusion. AIMS: To compare the effects of carvedilol and bisoprolol on lung function in patients with chronic heart failure (CHF). METHODS AND RESULTS: We performed a double-blind, cross-over study in 53 CHF patients. After 2 months of full dose treatment with either carvedilol or bisoprolol, we assessed lung function by salbutamol challenge, carbon monoxide lung diffusion (DLCO), including membrane conductance (DM), and gas exchange during exercise. FEV1 and FVC were similar; after salbutamol FEV1 was higher with bisoprolol (p<0.04). DLco was 82+/-21% of predicted with carvedilol and 90+/-20% with bisoprolol (p<0.01) due to DM changes. Peak VO2 was 17.8+/-4.5 mL/min/kg on bisoprolol and 17.0+/-4.6 on carvedilol, (p<0.05) with no differences in bronchial tone (same expiratory time) throughout exercise. Differences were greater in the 22 subjects with DLCO<80%. CONCLUSION: Carvedilol and bisoprolol have different effects on DLCO and response to salbutamol. DLCO differences, being DM related, are due to changes in active membrane transport which is under alveolar beta2-receptor control. Peak VO2 was slightly higher with bisoprolol particularly in CHF patients with reduced DLCO

An Efficient Monte Carlo-based Probabilistic Time-Dependent Routing Calculation Targeting a Server-Side Car Navigation System

Incorporating speed probability distribution to the computation of the route planning in car navigation systems guarantees more accurate and precise responses. In this paper, we propose a novel approach for dynamically selecting the number of samples used for the Monte Carlo simulation to solve the Probabilistic Time-Dependent Routing (PTDR) problem, thus improving the computation efficiency. The proposed method is used to determine in a proactive manner the number of simulations to be done to extract the travel-time estimation for each specific request while respecting an error threshold as output quality level. The methodology requires a reduced effort on the application development side. We adopted an aspect-oriented programming language (LARA) together with a flexible dynamic autotuning library (mARGOt) respectively to instrument the code and to take tuning decisions on the number of samples improving the execution efficiency. Experimental results demonstrate that the proposed adaptive approach saves a large fraction of simulations (between 36% and 81%) with respect to a static approach while considering different traffic situations, paths and error requirements. Given the negligible runtime overhead of the proposed approach, it results in an execution-time speedup between 1.5x and 5.1x. This speedup is reflected at infrastructure-level in terms of a reduction of around 36% of the computing resources needed to support the whole navigation pipeline

How to finance energy renovation of residential buildings: Review of current and emerging financing instruments in the EU

The Paris Agreement goals require net-zero CO2 emissions by mid-century. The European Commission in its recent proposal for climate and energy strategy for 2050 indicated the need for more intensified actions to substantially improve the energy performances of buildings. With the rate of new construction in Europe, the challenge is to increase both the pace and depth of building energy renovations. Several barriers inhibit the wide uptake of comprehensive energy renovations, including the inability or inertia to finance upfront costs of energy renovations. Despite various policies implemented to address some of these barriers, current investments in buildings remain at suboptimal levels. The paper reviews current financing practices for energy renovations and investigates some innovative instruments with a special focus on their applicability to residential buildings. In addition to “traditional” financial schemes such as subsidies, tax incentives, and loans, the paper assesses innovative financing schemes: On property tax and on-bill financing, energy efficiency mortgages, and energy efficiency feed-in tariffs. The paper also investigates the concept of one-stop shops for building renovations and crowdfunding. The paper offers an assessment of the characteristics, benefits, and challenges of each analyzed financing instrument and provides policy recommendations for their successful implementation. In general, as financing instruments involve different stakeholders and due to complex nature of the sector, there is no single solution to accelerate energy renovation investment in buildings. The emerging financial models offer the potential to address the long-standing barriers to investment in energy efficiency. This article is categorized under: Energy Efficiency > Economics and Policy Energy Efficiency > Climate and Environment Energy and Climate > Economics and Policy

hMENA11a contributes to HER3-mediated resistance to PI3K inhibitors in HER2-overexpressing breast cancer cells.

Human Mena (hMENA), an actin regulatory protein of the ENA/VASP family, cooperates with ErbB receptor family signaling in breast cancer. It is overexpressed in high-risk preneoplastic lesions and in primary breast tumors where it correlates with HER2 overexpression and an activated status of AKT and MAPK. The concomitant overexpression of hMENA and HER2 in breast cancer patients is indicative of a worse prognosis. hMENA is expressed along with alternatively expressed isoforms, hMENA11a and hMENAΔv6 with opposite functions. A novel role for the epithelial-associated hMENA11a isoform in sustaining HER3 activation and pro-survival pathways in HER2-overexpressing breast cancer cells has been identified by reverse phase protein array and validated in vivo in a series of breast cancer tissues. As HER3 activation is crucial in mechanisms of cell resistance to PI3K inhibitors, we explored whether hMENA11a is involved in these resistance mechanisms. The specific hMENA11a depletion switched off the HER3-related pathway activated by PI3K inhibitors and impaired the nuclear accumulation of HER3 transcription factor FOXO3a induced by PI3K inhibitors, whereas PI3K inhibitors activated hMENA11a phosphorylation and affected its localization. At the functional level, we found that hMENA11a sustains cell proliferation and survival in response to PI3K inhibitor treatment, whereas hMENA11a silencing increases molecules involved in cancer cell apoptosis. As shown in three-dimensional cultures, hMENA11a contributes to resistance to PI3K inhibition because its depletion drastically reduced cell viability upon treatment with PI3K inhibitor BEZ235. Altogether, these results indicate that hMENA11a in HER2-overexpressing breast cancer cells sustains HER3/AKT axis activation and contributes to HER3-mediated resistance mechanisms to PI3K inhibitors. Thus, hMENA11a expression can be proposed as a marker of HER3 activation and resistance to PI3K inhibition therapies, to select patients who may benefit from these combined targeted treatments. hMENA11a activity could represent a new target for antiproliferative therapies in breast cancer

Responsiveness to sensory cues using the Timed Up and Go test in patients with Parkinson's disease: a prospective cohort study.

Objective: To test the effectiveness of the Timed Up and Go (TUG) test to define responsiveness to auditory and visual cues in patients with Parkinson's disease. Methods: Consecutive patients > 50 years old were enrolled if they were classified as stage 1–3 of the Hoehn and Yahr scale; scored ≤ 45 on part III of the Unified Parkinson's Disease Rating Scale; > 23 on the Mini-Mental State Examination; and were able to perform the TUG test without assistance. Within-subject analysis identified positive-responders, negative-responders and non-responders. TUG times with and without sensory cues were studied among all patients, and among responders only using the Friedman Test. Results: Twenty-two patients (16 men, 6 women), mean age 72.4 years (standard deviation (SD) 8.7 years) were included. Basal mean TUG time was 12.3 (SD 4.0). TUG times after visual cues (11.7 (SD 4.8)) were lower than in basal conditions (p = 0.006), whereas TUG times after auditory cues were not (p > 0.05). In the 16 patients who were positive-responders, mean TUG times after visual (11.0 (SD 3.1)) and auditory (11.3 (SD 3.6)) cues were lower than in basal conditions (12.5 (SD 3.8)) (p = 0.0002). Conclusion: The TUG test may be used to tailor the rehabilitation programme in patients with Parkinson's disease, identifying those who respond to visual and auditory cueing