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

MTSI-BERT: A Session-aware Knowledge-based Conversational Agent

n the last years, the state of the art of NLP research has made a huge step forward. Since the release of ELMo (Peters et al., 2018), a new race for the leading scoreboards of all the main linguistic tasks has begun. Several models have been published achieving promising results in all the major NLP applications, from question answering to text classification, passing through named entity recognition. These great research discoveries coincide with an increasing trend for voice-based technologies in the customer care market. One of the next biggest challenges in this scenario will be the handling of multi-turn conversations, a type of conversations that differs from single-turn by the presence of multiple related interactions. The proposed work is an attempt to exploit one of these new milestones to handle multi-turn conversations. MTSI-BERT is a BERT-based model achieving promising results in intent classification, knowledge base action prediction and end of dialogue session detection, to determine the right moment to fulfill the user request. The study about the realization of PuffBot, an intelligent chatbot to support and monitor people suffering from asthma, shows how this type of technique could be an important piece in the development of future chatbots

First records of defensive tail vibration in the Italian Aesculapian Snake, Zamenis lineatus (Camerano, 1891)

We report for the first time defensive tail vibration in the Italian Aesculapian Snake, Zamenis lineatus (Camerano, 1891

Coniugare tradizione, innovazione e sicurezza alimentare nei prodotti di salumeria tipici della toscana: contributo alla definizione del modello di produzione di un Salame Toscano a ridotto contenuto di sale e di grasso.

Le aspettative dei consumatori chiedono ai produttori di salumi tradizionali di innovare verso prodotti con qualità nutrizionali correlabili alla riduzione di sale e di grasso, inducendo il settore ad affrontare modifiche complesse ai processi produttivi. Il presente lavoro descrive i presupposti motivazionali, la scelta degli strumenti di comunicazione al consumatore, gli standard di sicurezza alimentare, i requisiti merceologici, e le modalità con cui perseguire l’ottenimento di un Salame Toscano innovativo per qualità salutistiche conseguenti alla riduzione di sale e di grasso. Il modello proposto indica la metodologia con cui possono essere raggiunti obbiettivi eterogenei, quali contenuti nutrizionali, sicurezza alimentare, requisiti merceologici, caratteri organolettici, nella realizzazione del Salame Toscano a ridotto contenuto di sale e di grasso

Cetacean Poxvirus in two striped dolphins (Stenella coeruleoalba) stranded on the Tyrrhenian coast of Italy: histopathological, ultrastructural, biomolecular, and ecotoxicological findings

Tattoo skin disease (TSD) is a poxviral disease typical of cetaceans. Two juvenile and well-preserved male striped dolphins (Stenella coeruleoalba), found stranded along the Tuscany and Latium coasts of Italy in 2015 and 2016, respectively, showed typical skin lesions ascribable to TSD. Histological, ultrastructural and biomolecular investigations confirmed a poxviral aetiology for the aforementioned skin lesions. To our knowledge, this should be the first report of TSD in cetaceans stranded along the Italian coastline. As organochlorines like PCBs and DDTs are known to be highly immunotoxic, the tissue loads of these contaminants were evaluated, in order to increase our knowledge on their potential role as well as on the relationships between the level of exposure to these pollutants and poxviral infection's occurrence

Monitoring of foodborne pathogens in raw cow milk in Tuscany

Raw milk consumption in Italy has increased over the last few years and although raw milk is characterised by cold chain, short shelf-life and the duty of boiling before domestic consumption, it is still considered a hazard. From 2010 to 2013 a monitoring survey of raw milk sold through vending machines was carried out to investigate the occurrence of several foodborne pathogens stipulated in the national legal requirements, <em>i.e.</em> <em>Listeria monocytogenes</em>, <em>Campylobacter</em> spp., Salmonella spp., <em>Escherichia coli</em> O:157 and coagulase-positive <em>Staphylococci</em>. A total of 127 raw milk samples were collected from 19 dairy herds in Tuscany Region, Italy. In addition, the milk samples were tested for the presence and count of Yersinia genus. Results shown that only one sample was positive for non verocytotoxin- producing <em>E. coli</em> O:157, whereas a total of 38 samples (29.9%) were postive for <em>Yersinia</em> genus; of the total 39 isolated bacteria, 23.6% were <em>Y. enterocolitica</em>, 2.4% <em>Y. kristenseni</em> and 4.7% <em>Y. frederiksenii</em>. None isolate was enteropathogenic; serotypes O:5 and O:8 were found in 16.6 and 13.3% of the isolates respectively, whereas none of the serotypes tested was detected in 70% of the isolates. The most probable number method revealed a count value between 0.03 and 24 MPN/mL. Based on these data a general assurance on health safety of raw milk produced and sold in Tuscany could be assessed

First report on the occurrence of Listeria monocytogenes ST121 strain in a dolphin brain.

Abstract Listeria monocytogenes (Lm) is a ubiquitous bacterium that causes the foodborne illness, listeriosis. Clonal complexes (CC), such as CC121, are overrepresented in the food production industry, and are rarely reported in animals and the environment. Working within a European-wide project, we investigated the routes by which strains are transmitted from environments and animals to food and the food production environment (FPE). In this context, we report, for the first time, the occurrence of a ST121 (CC121) strain isolated from a dolphin brain. The genome was compared with the genomes of 376 CC121 strains. Genomic comparisons showed that 16 strains isolated from food were the closest to the dolphin strain. Like most of the food strains analyzed here, the dolphin strain included genomic features (transposon Tn6188, plasmid pLM6179), both described as being associated with the strain’s adaptation to the FPE. Like all 376 strains, the dolphin strain contained a truncated actA gene and inlA gene, both described as being associated with attenuated virulence. Despite this fact, the strain was able to cross blood-brain barrier in immunosuppressed dolphin exposed polychlorinated biphenyl and invaded by parasites. Our data suggest that the dolphin was infected by a food-related strain released into the Mediterranean Sea. View Full-Text LISTADAP

Incidence of Hospitalisation and Emergency Department Visits for Pneumococcal Disease in Children, Adolescents, and Adults in Liguria, Italy: A Retrospective Analysis from 2012–2018

Streptococcus pneumoniae infection is responsible for significant morbidity and mortality, particularly in young children and older adults. The aim of this study was to investigate the incidence of hospitalisation and emergency department (ED) visits in relation to episodes of pneumococcal disease (PD) following the introduction of pneumococcal conjugate vaccines (PCVs) into the Liguria region of Italy. Between 2012 and 2018, episodes of all-cause pneumonia (80,152), pneumococcal-specific pneumonia (1254), unspecified pneumonia (66,293), acute otitis media (AOM; 17,040), and invasive PD (IPD; 1788) were identified from in-patient claims, ED and hospital discharge records, and the Liguria Chronic Condition Data Warehouse. In children p p < 0.001). Pneumococcal and unspecified pneumonia hospital admissions increased significantly during the study period, considerably affecting those ≥ 65 years of age. IPD hospitalisations varied across all age groups, but a significant change was not observed. Despite pneumococcal vaccination, substantial burden remains for PD in children and adults in Liguria, Italy

Economic burden of pneumococcal disease in children in Liguria, Italy

Vaccinations against Streptococcus pneumoniae are included in infant immunization programs globally. However, a substantial burden due to pneumococcal disease (PD) remains. This study aimed to estimate the cost of emergency department (ED) visits and hospitalizations associated with invasive pneumococcal disease, all-cause pneumonia, and acute otitis media in children <15 years of age in the Liguria region of Italy between 2012 and 2018. The retrospective cohort study used data from the Liguria Region Administrative Health Databases and the Ligurian Chronic Condition Data Warehouse, which contain information on hospital stays, outpatient visits, laboratory/imaging techniques, surgical procedures, and pharmaceutical prescriptions. Patients with one or more ED or inpatient claim for PD (based on International Classification of Diseases, Ninth Revision, Clinical Modification codes) were included. Cost of ED visits and hospitalizations were estimated from the diagnosis-related group system and procedures performed in the ED. In Ligurian children <15 years of age during 2012–2018, the median annual number of hospitalizations plus ED visits due to PD was 4,009, and the median estimated annual cost was €3.6 million. All-cause pneumonia accounted for the majority of hospitalization costs during the study period. Number and costs of ED visits and hospitalizations increased from 2012 to 2018. Despite widespread infant immunization in Liguria, economic costs due to PD-associated ED visits and hospitalizations remained high in children 0–14 years of age