E-SCAPE New tools and new opportunities for the localization of Expo 2015 general interest services along the Canale Cavour, a backbone of the Milan-Turin urban region

Final publication of the Alta Scuola Politecnica project "E-SCAPE New tools and new opportunities for the localization of Expo 2015 general interest services along the Canale Cavour, a backbone of the Milan-Turin urban region"

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Social media mapping, as a catalyst for social realm actions

The following paper focuses on the fact how to formulate a new methodological framework approach of information-based technologies in sense of enhancing the cultural heritage appropriate to the conditions of the contemporary city. Digital technologies should be used to identify techniques and methods to deal with the urban stratification, to help in fostering community ties, sense of the belonging towards places, thereby expanding the traditional disciplinary boundaries. The users interactions can contribute in shaping digital social innovation. This study aims at demonstrating that a users□ involvement might lead to a successful mode of designing and spreading the innovation that could contribute to a further development and creating the higher quality of life in the public sphere. Nowadays, one of the main ideas is framing how the spread of social media and digital technologies can influence the behavior of the people, in particular during the big social events, like concerts, sport manifestations. The problem to face is to understand and measure the hidden data, rhythms and guidelines, during the individual or mass stroke in the virtual world. In fact, this invisible space of social media is giving us possibility to reveal new principles in big - scale behavioral reaction. The social services, as Twitter, Facebook etc. are very useful for this type of analysis, especially when they are seen through the prism of social excitement, when the enthusiasm of people rises as their activity on social networks

Boosting the consciousness of the public concerning the post-war architecture in the urban city envelope

The research focuses on the fact how to formulate the attitude on the design lines of action that should be implemented to stimulate greater awareness of the wider public audience to the contemporary architectural heritage in the urban realm. Considering as the collection a whole set of the urban architectural elements, linked together by the paths, that are using the narrative process as stimulus for he valorisation of the cultural heritage, but above all the potential of the enhancement process by both tangible (physical architecture) and intangible (history, memory) properties. By identifying problems, strategies and actions to implement, in sense of bringing the knowledge towards the wider spectators in the innovative way, but without breaking the nexus with the physical dimension of the built architectural heritage. The work is investigating as methodological approach the novel design processes that are happening with the architecture of the XXth century after the WWII and what strategies of valorisation could be used to make the wider layperson audience more familiar with the social and cultural value of the ’’totalitarian’’ architecture that usually is not on the track of traditional tourists. The work explores the sensory, structural and cultural aspects of new urban clusters and re-examines existing praxis complexities of what constitutes architectural space in the real-time data context. Through narration and on site experience it is possible to create a tighter link with the user itself in the space, in a particular location and specific time. The fist point regards the narrative process, needed to convey story to the audience, by keeping its attention on the high level, giving us the possibility to embed the local intangible heritage value in each user and spread it throughout the custom narrative thematic paths. These paths of contemplation, with the in-situ experience are needed for action of shifting user interest from the professionals towards ordinary users, that should be implemented by the fragments of the narrative stories that are involving the audience and spreading the knowledge, created to narrate the memory and history through relations and customized paths. The process includes both top-down approaches of space making, as well as bottom-up ones of appropriation. The proposal is taking the socialist architecture as a rich heritage with variety of typologically different elements able to provide reactions to the contemporary inputs, where we are actually discovering new possibilities for connections between physical and digital space, that begin to coexist and co-react. The on-going study considers as pilot site the New Belgrade city, in Serbia, by creating a repertory of the buildings for the valorisation process of the city museum. It should be pointed out that further investigation would give a possibility to blur borders between the ordinary user and modern arch. heritage, through as well novel use of ICTs. The appropriation towards this kind of heritage should be done by cancelling the boundary throughout the soft strategies in sense of creating the metamorphic atmosphere of intermediation in perception of the so-called diffused urban museum