A database on flash flood events in Campania, southern Italy, with an evaluation of their spatial and temporal distribution

Abstract. This study presents an historical database of flash flood events in the Campania region of southern Italy. The study focuses on small catchments characterized by intermittent flow, generally occurring during and after heavy rainstorms, which can be hydrologically defined as small Mediterranean catchments. As the outlet zones of these catchments (consisting mainly of alluvial fans or fan deltas) are highly urbanized in Campania, the population living in the delivery areas is exposed to high risk. Detailed scrutiny and critical analysis of the existing literature, and of the data inventory available, allowed us to build a robust database consisting of about 500 events from 1540 to 2015, which is continuously updated. Since this study is the first step of a longer project to perform a hazard analysis, information about time and site of occurrence is known for all events. As for the hazard analysis envisaged, collecting information about past events could provide information on future events, in terms of damage and also spatial and temporal occurrence. After introducing the issue of flash floods in Italy we then describe the geological and geomorphological settings of the study area. The database is then presented, illustrating the methodology used in collecting information and its general structure. The collected data are then discussed and the statistical data analysis presented

Accounting for frailty and multimorbidity when interpreting high-sensitivity troponin I tests in oldest old

Background Older patients evaluated in Emergency Departments (ED) for suspect Myocardial Infarction (MI) frequently exhibit unspecific elevations of serum high-sensitivity troponin I (hs-TnI), making interpretation particularly challenging for emergency physicians. The aim of this longitudinal study was to identify the interaction of multimorbidity and frailty with hs-TnI levels in older patients seeking emergency care. Methods A group of patients aged≥75 with suspected MI was enrolled in our acute geriatric ward immediately after ED visit. Multimorbidity and frailty were measured with Cumulative Illness Rating Scale (CIRS) and Clinical Frailty Scale (CFS), respectively. The association of hs-TnI with MI (main endpoint) was assessed by calculation of the Area Under the Receiver-Operating Characteristic Curve (AUROC), deriving population-specific cut-offs with Youden test. The factors associated with hs-TnI categories, including MI, CFS and CIRS, were determined with stepwise multinomial logistic regression. The association of hs-TnI with 3-month mortality (secondary endpoint) was also investigated with stepwise logistic regression. Results Among 268 participants (147 F, median age 85, IQR 80–89), hs-TnI elevation was found in 191 cases (71%, median 23 ng/L, IQR 11–65), but MI was present in only 12 cases (4.5%). hs-TnI was significantly associated with MI (AUROC 0.751, 95% CI 0.580–0.922, p = 0.003), with an optimal cut-off of 141 ng/L. hs-TnI levels ≥141 ng/L were significantly associated with CFS (OR 1.58, 95% CI 1.15–2.18, p = 0.005), while levels <141 ng/L were associated with the cardiac subscore of CIRS (OR 1.36, 95% CI 1.07–1.71, p = 0.011). CFS, but not hs-TnI levels, predicted 3-month mortality. Conclusions In geriatric patients with suspected MI, frailty and cardiovascular multimorbidity should be carefully considered when interpreting emergency hs-TnI testing

Implementing a multidisciplinary rapid geriatric observation unit for non-critical older patients referred to hospital: observational study on real-world data

Background: Geriatric rapid observation units may represent an alternative to hospitalization in older patients with non-critical acute illness. Aims: To describe the characteristics and outcomes of patients admitted to a geriatric observation unit called URGe (Unità Geriatrica Rapida), implemented in an Italian hospital and characterized by multidisciplinary medical staff with geriatric expertise, fast-track access to diagnostic resources, regular use of point-of-care ultrasound and predicted length of stay (LOS) < 72 h. Methods: The medical records of patients admitted to URGe during a 3-month period (452 subjects, 247 F and 205 M, median age 82 years, IQR 77-87) were retrospectively examined. The primary study endpoint was transferral from URGe to regular wards. Baseline covariates included demographics, comprehensive geriatric assessment, acute illnesses, comorbidities, vital signs and routine laboratory tests. Results: Despite elevated burden of multimorbidity (median number of chronic diseases 4, IQR 2-5) and frailty (median Rockwood Clinical Frailty Scale score 4, IQR 3-6), only 137 patients (30.3%) required transferral from URGe to regular wards. The main factors positively associated with this outcome were Rockwood score, fever, cancer and red cell distribution width (P < 0.05 on multivariate logistic regression model). The rate of complications (mortality, delirium, and falls) during URGe stay was low (0.5%, 7% and 2%, respectively). Overall duration of hospital stay was lower than that of a group of historical controls matched by age, sex, main diagnosis, multimorbidity and frailty. Conclusions: The URGe model of acute geriatric care is feasible, safe and has the potential of reducing unnecessary hospitalizations of older patients

Rationale and design of an independent randomised controlled trial evaluating the effectiveness of aripiprazole or haloperidol in combination with clozapine for treatment-resistant schizophrenia

<p>Abstract</p> <p>Background</p> <p>One third to two thirds of people with schizophrenia have persistent psychotic symptoms despite clozapine treatment. Under real-world circumstances, the need to provide effective therapeutic interventions to patients who do not have an optimal response to clozapine has been cited as the most common reason for simultaneously prescribing a second antipsychotic drug in combination treatment strategies. In a clinical area where the pressing need of providing therapeutic answers has progressively increased the occurrence of antipsychotic polypharmacy, despite the lack of robust evidence of its efficacy, we sought to implement a pre-planned protocol where two alternative therapeutic answers are systematically provided and evaluated within the context of a pragmatic, multicentre, independent randomised study.</p> <p>Methods/Design</p> <p>The principal clinical question to be answered by the present project is the relative efficacy and tolerability of combination treatment with clozapine plus aripiprazole compared with combination treatment with clozapine plus haloperidol in patients with an incomplete response to treatment with clozapine over an appropriate period of time. This project is a prospective, multicentre, randomized, parallel-group, superiority trial that follow patients over a period of 12 months. Withdrawal from allocated treatment within 3 months is the primary outcome.</p> <p>Discussion</p> <p>The implementation of the protocol presented here shows that it is possible to create a network of community psychiatric services that accept the idea of using their everyday clinical practice to produce randomised knowledge. The employed pragmatic attitude allowed to randomly allocate more than 100 individuals, which means that this study is the largest antipsychotic combination trial conducted so far in Western countries. We expect that the current project, by generating evidence on whether it is clinically useful to combine clozapine with aripiprazole rather than with haloperidol, provides physicians with a solid evidence base to be directly applied in the routine care of patients with schizophrenia.</p> <p>Trial Registration</p> <p><b>Clincaltrials.gov Identifier</b>: NCT00395915</p

La dimensione della sostenibilit\ue0 politica-istituzionale: il caso studio dell\u2019IPA del Camposampierese

Nel contesto istituzionale di un regime democratico, le politiche per la sostenibilit\ue0 dello sviluppo di un territorio sono strettamente correlate a pratiche di \u201cbuona governance \u201d dello sviluppo dello stesso territorio. Lla sostenibilit\ue0 istituzionale inoltre attiene essenzialmente alla dimensione dinamica e non statica di un\u2019istituzione. Essa consiste pertanto nella capacit\ue0 che una istituzione ha di sopravvivere nel tempo senza erodere le risorse a sua disposizione, senza dover ricorrere continuativamente al supporto esterno e svolgendo le funzioni a cui \ue8 preposta. La sostenibilit\ue0 istituzionale ha quindi a che fare con l\u2019autonomia organizzativa, una leadership fortemente legittimata e spiccate capacit\ue0 di apprendimento e adattamento. In questa accezione, quindi, la sostenibilit\ue0 \ue8 una propriet\ue0 di una istituzione che prescinde dalle politiche di sviluppo sostenibile, ma che pu\uf2 caratterizzare qualunque tipo di istituzione: una universit\ue0, un\u2019impresa, un ospedale, un\u2019agenzia della pubblica amministrazione (Stato apparato), un organo decisionale. Alla luce di queste premesse, il saggio focalizza l\u2019attenzione sulla definizione di un set di indicatori di sostenibilit\ue0 istituzionale costruito con la partecipazione attiva di uno specifico territorio, quello dell\u2019Intesa Programmatica d'Area del Camposampierese (Alta Padovana), a partire dal quale leggere e interpretare i fabbisogni informativi orientati all\u2019azione e al policy making

Accounting Gut Microbiota as the Mediator of Beneficial Effects of Dietary (Poly)phenols on Skeletal Muscle in Aging

Sarcopenia, the age-related loss of muscle mass and function increasing the risk of disability and adverse outcomes in older people, is substantially influenced by dietary habits. Several studies from animal models of aging and muscle wasting indicate that the intake of specific polyphenol compounds can be associated with myoprotective effects, and improvements in muscle strength and performance. Such findings have also been confirmed in a smaller number of human studies. However, in the gut lumen, dietary polyphenols undergo extensive biotransformation by gut microbiota into a wide range of bioactive compounds, which substantially contribute to bioactivity on skeletal muscle. Thus, the beneficial effects of polyphenols may consistently vary across individuals, depending on the composition and metabolic functionality of gut bacterial communities. The understanding of such variability has recently been improved. For example, resveratrol and urolithin interaction with the microbiota can produce different biological effects according to the microbiota metabotype. In older individuals, the gut microbiota is frequently characterized by dysbiosis, overrepresentation of opportunistic pathogens, and increased inter-individual variability, which may contribute to increasing the variability of biological actions of phenolic compounds at the skeletal muscle level. These interactions should be taken into great consideration for designing effective nutritional strategies to counteract sarcopenia