Medicare Hospital Readmissions Reduction Program

Outlines national health reform provisions to reduce readmissions by publishing readmission data, lowering Medicare payments to hospitals with high readmission rates, and pairing such hospitals with patient safety organizations. Considers implications

Prospettive agronomiche e nutraceutiche del Goji (Lycium barbarum L.) coltivato in ambiente mediterraneo.

Negli ultimi anni nei Paesi Europei sta aumentando l’interesse per l’innovazione anche nel settore alimentare soprattutto in termini di alimenti destinati ad incrementare la salute dell’uomo. Il Lycium barbarum L., appartenente alla famiglia delle solanaceae, comunemente conosciuto come Goji, è una specie originaria dell’Himalaya e ormai comunemente coltivata in Cina. Qui, già da molti anni viene utilizzato come ingrediente di numerosi piatti tipici e come componente di diversi medicinali con proprietà decisamente ampie come ad esempio le patologie del fegato, il diabete, patologia cardio-vascolari, benefici alla vista nonché per le sue proprietà anticancro. Ciò deriva dalle sue marcate attività antiossidanti ed antiinfiammatorie, ed antibatteriche. Lo scopo della sperimentazione è stato quello di verificare le performances agronomiche e nutraceutiche di questa specie allevata in ambiente Mediterraneo. Sotto un profilo agronomico la specie si è dimostrata compatibile con tale ambiente sia sotto l’aspetto fotoperiodico che termico anche se l’estate 2012 ha messo a dura prova la tolleranza di questa specie agli eccessi termici. Sotto un profilo nutraceutico questa specie ha confermato gli elevati standard qualitativi anche se essi non hanno raggiunto i valori rilevati nella sua area asiatica di coltivazione come da dati bibliografici. In particolare, il comunque elevato potere antiossidante è risultato derivare soprattutto da composti fenolici ed in minore entità da carotenoidi e vitamina C. In questo ambito lo stadio fenologico di maturazione dei frutti ha giocato un ruolo cruciale dal momento che l’invaiatura (frutti giallo-arancio) hanno mostrato i valori maggiori di antiossidanti (metodo FRAP) rispetto gli stadi precedenti (frutti verdi) o successivi (frutti rossi). Sono inoltre emersi dati incoraggianti in termini dei più importanti microelementi come nel caso di Cu, Mg, Fe e Zn. Futuri studi sanno necessari per: 1) verificare gli standard organolettici dei frutti prodotti nel nostro ambiente; 2) ottimizzare la scelta dell’area di coltivazione in termini di altitudine di questa specie di origine montana; 3) stabilire le relazioni tra agrotecnica e proprietà nutraceutiche dei frutti di questa potenziale coltura innovativa nel panorama agronomico Mediterraneo

Fourth case of louse-borne relapsing fever in Young Migrant, Sicily, Italy, December 2015. Mini Review Article

Objectives Currently louse-borne relapsing fever (LBRF) is primarily found in limited endemic foci in Ethiopia, Somalia and Sudan; no case of imported LBRF has been reported in Europe in the 9 years prior to 2015. The aim of our paper is to describe a new case of imported LBRF detected in Sicily, Italy, and to review all cases reported in migrants arrived in Europe in the last 10 years. Study design Mini review of all published cases of louse-borne relapsing fever in Europe in the last 10 years. Methods A computerized search without language restriction was conducted using PubMed combining the terms ‘(louse-borne relapsing fever or LBRF or recurrentis) and (refugee or Europe or migrant)’ without limits. Furthermore, the ‘Ahead-of-Print Articles’ of the top 10 journals (ranked by Impact factor – Web of Science) of Infectious diseases and of Epidemiology were checked. Results Our search identified 26 cases of LBRF between July and October 2015 in migrants recently arrived in Europe: 8 had been described in Italy; 1 in Switzerland; 2 in the Netherlands; 15 in Germany. We describe data regarding the clinical characteristics, diagnostic methods, therapy and outcome of these patients and of the new case. Conclusions LBRF by Borrelia recurrentis should be considered among the clinical hypotheses in migrants presenting with fever, headache, chills, sweating, arthralgia, myalgia, dizziness, nausea and vomiting

A systematic review on omics data (metagenomics, metatranscriptomics, and metabolomics) in the role of microbiome in gallbladder disease

Microbiotas are the range of microorganisms (mainly bacteria and fungi) colonizing multicellular, macroscopic organisms. They are crucial for several metabolic functions affecting the health of the host. However, difficulties hamper the investigation of microbiota composition in cultivating microorganisms in standard growth media. For this reason, our knowledge of microbiota can benefit from the analysis of microbial macromolecules (DNA, transcripts, proteins, or by-products) present in various samples collected from the host. Various omics technologies are used to obtain different data. Metagenomics provides a taxonomical profile of the sample. It can also be used to obtain potential functional information. At the same time, metatranscriptomics can characterize members of a microbiome responsible for specific functions and elucidate genes that drive the microbiotas relationship with its host. Thus, while microbiota refers to microorganisms living in a determined environment (taxonomy of microorganisms identified), microbiome refers to the microorganisms and their genes living in a determined environment and, of course, metagenomics focuses on the genes and collective functions of identified microorganisms. Metabolomics completes this framework by determining the metabolite fluxes and the products released into the environment. The gallbladder is a sac localized under the liver in the human body and is difficult to access for bile and tissue sampling. It concentrates the bile produced in the hepatocytes, which drains into bile canaliculi. Bile promotes fat digestion and is released from the gallbladder into the upper small intestine in response to food. Considered sterile originally,recent data indicate that bile microbiota is associated with the biliary tract’s inflammation and carcinogenesis. The sample size is relevant for omic studies of rare diseases, such as gallbladder carcinoma. Although in its infancy, the study of the biliary microbiota has begun taking advantage of several omics strategies, mainly based on metagenomics, metabolomics, and mouse models. Here, we show that omics analyses from the literature may provide a more comprehensive image of the biliary microbiota. We review studies performed in this environmental niche and focus on network-based approaches for integrative studies

Nitrogen Deposition Effects on Soil Properties, Microbial Abundance, and Litter Decomposition Across Three Shrublands Ecosystems From the Mediterranean Basin

Atmospheric nitrogen (N) inputs in the Mediterranean Basin are projected to increase due to fossil fuel combustion, fertilizer use, and the exacerbation of agricultural production processes. Although increasing N deposition is recognized as a major threat to ecosystem functioning, little is known about how local environmental conditions modulate ecosystem function response to N addition, particularly in the context of Mediterranean-Basin ecosystems. Here, we assess how N addition affects important ecosystem properties associated with litter decomposition, soil physical-chemical properties, soil extracellular enzymatic activity and microbial abundance across three long-term N addition experimental sites in the Mediterranean Basin. Sites were located in El Regajal (Madrid, Spain), Capo Caccia (Alghero, Italy), and Arrábida (Lisbon, Portugal) and are all representative of Mediterranean shrublands. No common pattern for litter decomposition process or other studied variables emerged among the control plots of the studied sites. Nitrogen supply only affected soil pH, a major driver of decomposition, in two out of three experimental sites. Moreover, when we explored the role of N addition and soil pH in controlling litter decay, we found that the effects of these factors were site-dependent. Our results point out to local ecosystem features modulating N addition effects in controlling litter decomposition rates in Mediterranean ecosystems, suggesting that the responses of soil functioning to N deposition are site-dependent. These findings provide further knowledge to understand contrasting ecosystem responses to N additions based on a single field experiments

Superinfections caused by carbapenem-resistant Enterobacterales in hospitalized patients with COVID-19: a multicentre observational study from Italy (CREVID Study)

Objectives To describe clinical characteristics and outcomes of COVID-19 patients who developed secondary infections due to carbapenem-resistant Enterobacterales (CRE). Methods Retrospective observational study including COVID-19 patients admitted to 12 Italian hospitals from March to December 2020 who developed a superinfection by CRE. Superinfection was defined as the occurrence of documented bacterial infection >48 h from admission. Patients with polymicrobial infections were excluded. Demographic, clinical characteristics and outcome were collected. Isolates were classified as KPC, metallo-beta-lactamase (MBL) and OXA-48-producing CRE. A Cox regression analysis was performed to identify factors independently associated with 30 day mortality. Results Overall, 123 patients (median age 66 years, IQR 59-75) were included. The majority of infections occurred in the ICU (81, 65.9%), while 42 (34.1%) in medical wards. The most common types of infection were bloodstream infections (BSI) (n = 64, 52%), followed by urinary-tract infections (UTI) (n = 28, 22.8%), hospital-acquired/ventilator-associated pneumonia (HAP/VAP) (n = 28, 22.8%), intra-abdominal infections (n = 2, 1.6%) and skin infections (n = 1, 0.8%). Sixty-three (51.2%) infections were caused by KPC-, 54 (43.9%) by MBL-, and 6 (4.8%) by OXA-48-producing CRE. Thirty-day mortality was 33.3% (41/123). On Cox regression analysis, HAP/VAP compared with UTI (HR 7.23, 95% CI 2.09-24.97, P = 0.004), BSI compared with UTI (HR 3.96, 95% CI, 1.33-11.77, P = 0.004), lymphopenia on admission (HR 3, 95% CI 1.44-6.26, P = 0.003) and age (HR 1.05, 95% CI 1.02-1.08, P = 0.002) were predictors of 30 day mortality. Conclusions Superinfections by CRE were associated with high risk of 30 day mortality in patients with COVID-19. HAP/VAP was the strongest predictor of death in these patients

Nitrogen deposition effects on soil properties, microbial abundance, and litter decomposition across three shrublands ecosystems from the Mediterranean Basin

Atmospheric nitrogen (N) inputs in the Mediterranean Basin are projected to increase due to fossil fuel combustion, fertilizer use, and the exacerbation of agricultural production processes. Although increasing N deposition is recognized as a major threat to ecosystem functioning, little is known about how local environmental conditions modulate ecosystem function response to N addition, particularly in the context of Mediterranean-Basin ecosystems. Here, we assess how N addition affects important ecosystem properties associated with litter decomposition, soil physical-chemical properties, soil extracellular enzymatic activity and microbial abundance across three long-term N addition experimental sites in the Mediterranean Basin. Sites were located in El Regajal (Madrid, Spain), Capo Caccia (Alghero, Italy), and Arrábida (Lisbon, Portugal) and are all representative of Mediterranean shrublands. No common pattern for litter decomposition process or other studied variables emerged among the control plots of the studied sites. Nitrogen supply only affected soil pH, a major driver of decomposition, in two out of three experimental sites. Moreover, when we explored the role of N addition and soil pH in controlling litter decay, we found that the effects of these factors were site-dependent. Our results point out to local ecosystem features modulating N addition effects in controlling litter decomposition rates in Mediterranean ecosystems, suggesting that the responses of soil functioning to N deposition are sitedependent. These findings provide further knowledge to understand contrasting ecosystem responses to N additions based on a single field experiments

Epidemiology and Microbiology of Skin and Soft Tissue Infections: Preliminary Results of a National Registry

Skin and soft tissue infections (SSTIs) represent a wide range of clinical conditions characterized by a considerable variety of clinical presentations and severity. Their aetiology can also vary, with numerous possible causative pathogens. While other authors previously published analyses on several types of SSTI and on restricted types of patients, we conducted a large nationwide surveillance programme on behalf of the Italian Society of Infectious and Tropical Diseases to assess the clinical and microbiological characteristics of the whole SSTI spectrum, from mild to severe life-threatening infections, in both inpatients and outpatients. Twenty-five Infectious Diseases (ID) Centres throughout Italy collected prospectively data concerning both the clinical and microbiological diagnosis of patients affected by SSTIs via an electronic case report form. All the cases included in our database, independently from their severity, have been managed by ID specialists joining the study while SSTIs from other wards/clinics have been excluded from this analysis. Here, we report the preliminary results of our study, referring to a 12-month period (October 2016–September 2017). During this period, the study population included 254 adult patients and a total of 291 SSTI diagnoses were posed, with 36 patients presenting more than one SSTIs. The type of infection diagnosed, the aetiological micro-organisms involved and some notes on their antimicrobial susceptibilities were collected and are reported herein. The enrichment of our registry is ongoing, but these preliminary results suggest that further analysis could soon provide useful information to better understand the national epidemiologic data and the current clinical management of SSTIs in Italy

Antifungal susceptibility of invasive yeast isolates in Italy: the GISIA3 study in critically ill patients

<p>Abstract</p> <p>Background</p> <p>Yeasts are a common cause of invasive fungal infections in critically ill patients. Antifungal susceptibility testing results of clinically significant fungal strains are of interest to physicians, enabling them to adopt appropriate strategies for empiric and prophylactic therapies. We investigated the antifungal susceptibility of yeasts isolated over a 2-year period from hospitalised patients with invasive yeast infections.</p> <p>Methods</p> <p>638 yeasts were isolated from the blood, central venous catheters and sterile fluids of 578 patients on general and surgical intensive care units and surgical wards. Etest strips and Sensititre panels were used to test the susceptibility of the isolates to amphotericin B, anidulafungin, caspofungin, fluconazole, itraconazole, posaconazole and voriconazole in 13 laboratories centres (LC) and two co-ordinating centres (CC). The Clinical and Laboratory Standards Institute (CLSI) reference broth microdilution method was used at the CCs for comparison.</p> <p>Results</p> <p>Etest and Sensititre (LC/CC) MIC₉₀values were, respectively: amphotericin B 0.5/0.38, 1/1 mg/L; anidulafungin 2/1.5 and 1/1 mg/L; caspofungin 1/0.75 and 0.5/0.5 mg/L; fluconazole 12/8 and 16/16 mg/L; itraconazole 1/1.5, 0.5/0.5 mg/L; posaconazole 0.5 mg/L and voriconazole 0.25 mg/L for all. The overall MIC₉₀values were influenced by the reduced susceptibility of <it>Candida parapsilosis </it>isolates to echinocandins and a reduced or lack of susceptibility of <it>Candida glabrata </it>and <it>Candida krusei </it>to azoles, in particular fluconazole and itraconazole. Comparison of the LC and CC results showed good Essential Agreement (90.3% for Etest and 92.9% for Sensititre), and even higher Categorical Agreement (93.9% for Etest and 96% for Sensititre); differences were observed according to the species, method, and antifungal drug. No cross-resistance between echinocandins and triazoles was detected.</p> <p>Conclusions</p> <p>Our data confirm the different antifungal susceptibility patterns among species, and highlight the need to perform antifungal susceptibility testing of clinically relevant yeasts. With the exception of a few species (e.g. <it>C. glabrata </it>for azoles and <it>C. parapsilosis </it>for echinocandins), the findings of our study suggest that two of the most widely used commercial methods (Etest and Sensititre) provide valid and reproducible results.</p