Efficacy of somatostatine analogues in survival and quality of life of a frail patient with poorly differentiated biliary neuroendocrine tumour

We describe the case of a 71-year-old woman with poorly differentiated neuroendocrine tumor of third distal biliary duct and osteolytic metastasis. The patient was evaluated as a third stage of Balducci’s criteria for the recognition of frailty. The patient received radiotherapy and octreotide LAR. This treatment allowed a good tumour progression rate (18 months), a good quality of life and a good survival (35 months). The case report describes the role of octreotide in the therapy of neuroendocrine tumours, and underlines the importance of a multidisciplinary management of cancer in frail patients

Artichoke Industrial Waste in Durum Wheat Bread: Effects of Two Different Preparation and Drying Methods of Flours and Evaluation of Quality Parameters during Short Storage

'Violetto di Ramacca' is a local variety of artichoke grown in Sicily (Southern Italy), known for its purple color with green streaks. In this study, the effects of two different preparation and drying methods (method A, fresh sample oven-dried at 40 °C for 48 h then mixed and ground into flour; and B, minced and frozen sample oven-dried at 40 °C for 24 h then blended and ground into flour) for flours from different parts of the artichoke (bracts, stems, and mix), used at different percentages of integration (5, 7.5, and 10%), in combination with re-milled semolina, have been evaluated. The polyphenol contents of the flours produced with the two methods were measured. The results showed significant differences between the methods and samples, with a range from 9.09 mg GAE/g d.m. (bracts 100%, method A) to 2.62 mg/g (mix 100%, method B). The values were then lowered in the flour products with supplements ranging from 0.96 mg GAE/g (bract flour 10%, method A) to 0.11 mg GAE/g (mixed flour 7.5%, method B). As the amounts of polyphenols increased, the antioxidant activity increased, with a range that varied in the pure flour from 8.59 mg trolox eq/g d.m. (bract flour, method A) to 3.83 mg trolox eq/g d.m. (mixed flour, method B). These flours were also analyzed for color, highlighting a clear difference between methods A (greener) and B (browner). The flours thus obtained were used to produce breads, which were evaluated for their physicochemical characteristics during 4 days of storage. The results showed a reduction in volumes and heights, an increase in the percentage of integration of the artichoke flours, a greater quantity of moisture in the integrated breads, and a lower reduction in the structural characteristics during storage compared to the control breads. The TPA was conducted on the breads from T0 to T4, highlighting that, although initially more compact, the integrated breads offered less alteration of the values during storage. The aw ranged from 0.63 (mix flour 5%, method B) to 0.90 (bract flour 5%, method B). The amounts of polyphenols (from 0.57 mg GAE/g in bread with bracts at 10% (method A) to 0.13 mg GAE/g in bread with mix 5% (method B)) and the antioxidant activity (from 0.55 mg trolox eq/g d.m. in bread with bract flour 10% (method A) to 0.14% mg trolox eq/g d.m. in bread with mix flour) were also evaluated, showing a trend similar to the values obtained in the flours. Colorimetric tests highlighted a color more similar to wholemeal bread in the loaves produced with method B. Statistical factor analysis and cluster analysis were conducted for all trials

A statistical approach for the correlation between Cerchar Abrasivity Index and Uniaxial Compressive Strength of rocks

In any underground excavation project, choosing the best excavation technique and careful preliminary assessments of wear costs and production rates are crucial aspects to consider. The production rate and costs of tools, as well as the frequency of tool replacement, deeply affect the duration and cost-effectiveness of the whole project. Among the rock-specific characteristics affecting tool wear, Cerchar abrasivity index (CAI) and uniaxial compressive strength (UCS) play an important role. In this article, the relationship between these two parameters was examined by regression analyses for 237 different rocks with the aim to define a preliminary and expected wear potential of three groups of rocks: sedimentary, metamorphic and igneous rocks. The analysis of the results showed that 86 % of the igneous rocks analysed have a CAI > 2, which is a medium or high level of abrasiveness. In sedimentary rocks, over 70 % of the samples are characterised by low abrasiveness behaviour (CAI < 2). Results obtained for these rocks can represent an instrument for predicting the abrasiveness potential of a rock when the UCS is known associating it with an expected range value of CAI. Metamorphic rocks, on the other hand, cannot be classified in specific ranges of UCS and CAI. For this rock group, therefore, a univocal tool for forecasting could not have been obtained, but analyses of rock type and quartz content show that the mineralogical content cannot be considered the only parameter for a wear analysis

Laboratory Test Campaign Aimed at the Analysis of an Uncommon Wear Phenomenon in a Marble Quarry

The use of ornamental stones has a historical value that makes them strategically precious in Italy; marble can offer high performance in architectural applications, even though the variability of the rock mass requires detailed studies to optimize the exploitation techniques and reduce waste. Italy is world famous for its marble, which is extracted mainly through chainsaw cutting machines, which are currently used intensively due to their high-safety working conditions compared to alternative techniques and for their great versatility, especially in underground applications. Although this cutting technique is well-rooted, an uncommon problem of tool wear was found in the quarry under study, which strongly affected productivity. A series of laboratory test were carried out to estimate the wear potential of the rock and the suitability of the tools. The Cerchar abrasivity test highlighted a mean wear potential for the marble of 2.77, while microhardness outcomes pointed out the presence of quartz veins in the tested material (values over 10,000 MPa). Finally, additives typically used in the conditioning process of EPB machines in tunneling were tested with the purpose of reducing the extent of wear. A reduction of about 50% in the wear (in terms of weight lost) was obtained for a moisture content of 9%

Laboratory Test Campaign Aimed at the Analysis of an Uncommon Wear Phenomenon in a Marble Quarry

The use of ornamental stones has a historical value that makes them strategically precious in Italy; marble can offer high performance in architectural applications, even though the variability of the rock mass requires detailed studies to optimize the exploitation techniques and reduce waste. Italy is world famous for its marble, which is extracted mainly through chainsaw cutting machines, which are currently used intensively due to their high-safety working conditions compared to alternative techniques and for their great versatility, especially in underground applications. Although this cutting technique is well-rooted, an uncommon problem of tool wear was found in the quarry under study, which strongly affected productivity. A series of laboratory test were carried out to estimate the wear potential of the rock and the suitability of the tools. The Cerchar abrasivity test highlighted a mean wear potential for the marble of 2.77, while microhardness outcomes pointed out the presence of quartz veins in the tested material (values over 10,000 MPa). Finally, additives typically used in the conditioning process of EPB machines in tunneling were tested with the purpose of reducing the extent of wear. A reduction of about 50% in the wear (in terms of weight lost) was obtained for a moisture content of 9%

Climate change and future groundwater level projections for the Salento Aquifer (Italy)

Groundwater is a vital source of fresh water in many areas of the&nbsp; Mediterranean Basin and it will become increasingly important due to climate&nbsp; change and the resulting intensification in water scarcity. The Salento peninsula&nbsp; (Puglia region) in southern Italy is no exception, where groundwater is the main&nbsp; source mostly for drinking and irrigation purposes. In fact, the karst nature of the&nbsp; Salento territory allows the presence of groundwater resources rather than&nbsp; surface water resources. The recharge conditions of this aquifer are very complex&nbsp; since its geological and hydrogeological structures are complex. In addition to&nbsp; this, the scarcity of data prevents to understand all the phenomena as a whole&nbsp; and to setup integrated surface/groundwater models that could be useful for&nbsp; investigating the impacts of climate change on the Salento groundwater&nbsp; resources. However, for the Salento area, a direct correlation between&nbsp; hydrological variables (precipitation and temperature) and groundwater levels&nbsp; (GWLs) has been shown. In particular, despite the complexity of the aquifer, it is&nbsp; possible to define potential linear relationships between observed meteorological indices, such as the Standardized Precipitation Index (SPI) and the Standardized&nbsp; Precipitation Evapotranspiration Index (SPEI), and GWLs collected in monitoring&nbsp; wells. In most cases, there are high correlation coefficients between SPI/SPEI and&nbsp; GWLs for long accumulation periods of the climate variables, in the order of 18&nbsp; months. This, for the aquifer studied, reflects the attenuated response of&nbsp; groundwater to precipitation/precipitation-evapotranspiration signals. In this&nbsp; work, we use future projections of SPIs and SPEIs for the Salento area to estimate&nbsp; the possible impacts of climate change on the groundwater resource. In&nbsp; particular, for this study, we computed SPI and SPEI projections, until the end of&nbsp; this century, from future precipitation and temperature data of an ensemble of&nbsp; Regional Climate Models (RCMs) of the EURO-CORDEX initiative, under two climate scenarios, namely the RCP4.5 and the RCP8.5. Prior to their use, the raw&nbsp; RCM data were downscaled/bias corrected to properly represent the observed&nbsp; climate in the study area. Under the hypothesis that the observed linear&nbsp; relationships between meteorological indices and GWLs remain valid over time,&nbsp; we obtained future projections of GWLs from the projections of SPIs/SPEIs. The&nbsp; analysis of the future GWLs has been conducted at short-, medium- and long term. The use of an ensemble of climate models allows in evaluating the&nbsp; uncertainty of the results. As long as a high correlation between meteorological&nbsp; indices and GWLs exists, the approach used in this work can be easily applicable&nbsp; to other study areas

Effects of innovative and conventional sanitizing treatments on the reduction of Saccharomycopsis fibuligera defects on industrial durum wheat bread

Wickerhamomyces anomalus, Hyphopichia burtonii and Saccharomycopsis fibuligera are spoilage yeasts causing chalk mold defects on sliced bread packaged under modified atmosphere. The first objective of this study, carried out in a bread-making company for two consecutive years, was to genetically identify yeasts isolated from spoiled sliced bread in Modified Atmosphere Packaging (MAP) and to determine the dominant species among identified strains. The second objective was to evaluate the effects of hydrogen peroxide and silver solution 12% (HPS) treatment in the leavening cells and cooling chambers, in comparison with the conventional Ortho-Phenylphenol (OPP) fumigating treatment, on the incidence of chalk defects of the commercialized products. One-hundred percent of the isolated yeasts were identified as S. fibuligera, while H. burtonii and W. anomalus were not detected. Concerning mean water activity (aw) and moisture content values, packaged bread samples were, respectively, included in the range 0.922–0.940 and 33.40–35.39%. S. fibuligera was able to grow in a wide range of temperature (11.5 to 28.5 °C) and relative humidity (70.00 to 80.17%) in the processing environments, and product aw < 0.94. Compared to OPP, the combined treatment with hydrogen peroxide and silver solution, in association with MAP, reduced to a negligible level yeast contamination of industrial sliced bread. The identification of the spoilage organisms and a comprehensive understanding of the combined effects of aw, pO2/pCO2 inside the packages, environmental conditions and sanitizing treatment on the growth behaviour is essential for future development of adequate preventive process strategies against chalk mold defects

Risk factors and action thresholds for the novel coronavirus pandemic. Insights from the Italian Society of Nephrology COVID-19 Survey

365noBackground and aim: Over 80% (365/454) of the nation’s centers participated in the Italian Society of Nephrology COVID-19 Survey. Out of 60,441 surveyed patients, 1368 were infected as of April 23rd, 2020. However, center-specific proportions showed substantial heterogeneity. We therefore undertook new analyses to identify explanatory factors, contextual effects, and decision rules for infection containment. Methods: We investigated fixed factors and contextual effects by multilevel modeling. Classification and Regression Tree (CART) analysis was used to develop decision rules. Results: Increased positivity among hemodialysis patients was predicted by center location [incidence rate ratio (IRR) 1.34, 95% confidence interval (CI) 1.20–1.51], positive healthcare workers (IRR 1.09, 95% CI 1.02–1.17), test-all policy (IRR 5.94, 95% CI 3.36–10.45), and infected proportion in the general population (IRR 1.002, 95% CI 1.001–1.003) (all p < 0.01). Conversely, lockdown duration exerted a protective effect (IRR 0.95, 95% CI 0.94–0.98) (p < 0.01). The province-contextual effects accounted for 10% of the total variability. Predictive factors for peritoneal dialysis and transplant cases were center location and infected proportion in the general population. Using recursive partitioning, we identified decision thresholds at general population incidence ≥ 229 per 100,000 and at ≥ 3 positive healthcare workers. Conclusions: Beyond fixed risk factors, shared with the general population, the increased and heterogeneous proportion of positive patients is related to the center’s testing policy, the number of positive patients and healthcare workers, and to contextual effects at the province level. Nephrology centers may adopt simple decision rules to strengthen containment measures timely.nonenoneNordio M.; Reboldi G.; Di Napoli A.; Quintaliani G.; Alberici F.; Postorino M.; Aucella F.; Messa P.; Brunori G.; Brunori G.; Bosco M.; Malberti F.; Mandreoli M.; Mazzaferro S.; Movilli E.; Ravera M.; Salomone M.; Santoro D.; PostorinoLimido M.A.; Bonomini M.; Stingone A.; Maccarone M.; Di Loreto E.; Stacchiotti L.; Malandra R.; Chiarella S.; D'Agostino F.; Fuiano G.; Nicodemo L.; Bonofiglio R.; Greco S.; Mallamaci F.; Barreca E.; Caserta C.; Bruzzese V.; Galati D.; Tramontana D.; Viscione M.; Chiuchiolo L.; Tuccillo S.; Sepe M.; Vitale F.; Ciriana E.; Santoro D.; Martignetti V.; Caserta D.; Stizzo A.; Romano A.; Iulianiello G.; Cascone E.; Minicone P.; Chiricone D.; Delgado G.; Barbato A.; Celentano S.; Molfino I.; Coppola S.; Raiola I.; Abategiovanni M.; Borrelli S.; Margherita C.; Bruno F.; Ida M.; Aliperti E.; Potito D.; Cuomo G.; De Luca M.; Merola M.; Botta C.; Garofalo G.; Alinei P.; Paglionico C.; Roano M.; Vitale S.; Ierardi R.; Fimiani V.; Conte G.; Di Natale G.; Romano M.; Di Marino V.; Scafarto A.; Meccariello S.; Pecoraro C.; Di Stazio E.; Di Meglio E.; Cuomo A.; Maresca B.; Rotaia E.; Capasso G.; Auricchio M.; Pluvio C.; Maddalena L.; De Maio A.; Palladino G.; Buono F.; Gigliotti G.; Mandreoli M.; Mancini E.; La Manna G.; Storari A.; Mosconi G.; Cappelli G.; Scarpioni R.; Gregorini M.; Rigotti A.; Mancini W.; Bianco F.; Boscutti G.; Amici G.; Tosto M.; Fini R.; Pace G.; Cioffi A.; Boccia E.; Di Lullo L.; Di Zazzo G.; Simonelli R.; Bondatti F.; Miglio L.; Rifici N.; Treglia A.; Muci M.; Baldinelli G.; Rizzi E.; Lonzi M.; De Cicco C.; Forte F.; De Paolis P.; Grandaliano G.; Cuzziol C.; Torre V.M.; Sfregola P.; Rossi V.; Fabio G.; Flammini A.; Filippini A.; Onorato L.; Vendola F.; Di Daniela N.; Alfarone C.; Scabbia L.; Ferrazzano M.; Grotta B.D.; Gamberini M.; Fazzari L.; Mene P.; Morgia A.; Catucci A.; Palumbo R.; Puliti M.; Marinelli R.; Polito P.; Marrocco F.; Morabito S.; Rocca R.; Nazzaro L.; Lavini R.; Iamundo V.; Chiappini M.; Casarci M.; Morosetti M.; Hassan S.; Alfarone C.; Ferrazzano M.; Firmi G.; Galliani M.; Serraiocco M.; Feriozzi S.; Valentini W.; Sacco P.; Garibotto G.; Cappelli V.; Saffioti C.; Repetto M.; Rolla D.; Lorenz M.; Pedrini L.; Polonioli D.; Galli E.; Ruggenenti P.; Scolari F.; Bove S.; Costantino E.; Bracchi M.; Mangano S.; Depetri G.; Malberti F.; La Milia V.; Farina M.; Zecchini S.; Savino R.; Melandri M.; Guastoni C.; Paparella M.; Gallieni M.; Minetti E.; Bisegna S.; Messa P.; Righetti M.; Badalamenti S.; Guastoni C.; Alberghini E.; Bertoli S.; Fabbrini P.; Albrizio P.; Rampino T.; Colturi C.; Rombola G.; Lucatello A.; Guerrini E.; Ranghino A.; Lenci F.; Fanciulli E.; Santarelli S.; Damiani C.; Garofalo D.; Sopranzi F.; Santoferrara A.; Di Luca M.; Galiotta P.; Brigante M.; Manganaro M.; Maffei S.; Berto I.; Besso L.; Viglino G.; Besso L.; Cusinato S.; ChiarinottiChiappero D.F.; Tognarelli G.; Gianoglio B.; Salomone M.; Forneris G.; Biancone L.; Savoldi S.; Vitale C.; Boero R.; Filiberti O.; Borzumati M.; Gesualdo L.; Lomonte C.; Gernone G.; Pallotta G.; Di Paolo S.; Vernaglione L.; Specchio A.; Stallone G.; Dell'Aquila R.; Aucella F.; Sandri G.; Russo F.; Napoli M.; Marangi A.; Morrone L.; Di Stratis C.; Fresu A.; Cicu F.; Murtas S.; Manca O.; Pani A.; Pilloni M.; Pistis R.; Cadoni M.; Contu B.; Logias F.; Ivaldi R.; Fancello S.; Cossu M.; Lepori G.; Lepori G.; Vittoria S.; Battiati E.; Arnone M.; Rome M.; Barbera A.; Granata A.; Collura G.; Dico C.L.; Pugliese G.; Di Natale E.; Rizzari G.; Cottone L.; Longo N.; Battaglia G.; Marcantoni C.; Giannetto G.; Tumino G.; Randazzo F.; Bellissimo L.; Faro F.L.; Grippaldi F.; Urso S.; Quattrone G.; Todaro I.; Vincenzo D.; Murgo A.; Masuzzo M.; Pisacane A.; Monardo P.; Santoro D.; Pontorierro M.; Quari C.; Bauro A.; Chimenz R.R.; Alfio D.; Girasole F.; Cascio A.L.; Caviglia A.; Tornese F.; Sirna F.; Altieri C.; Cusumano R.; Saveriano V.; La Corte A.; Locascio G.; Rotolo U.; Rome M.; Musso S.; Risuglia L.; Blanco G.; Minardo G.; Castellino S.; Zappulla Z.; Randone S.; Di Francesca M.; Cassetti C.C.; Oddo G.; Buscaino G.; Mucaria F.; Barraco V.I.; Di Martino A.; Mucaria F.; Rallo D.; Dani L.; Campolo G.; Manescalchi F.; Biagini M.; Agate M.; Panichi V.; Casani A.; Traversari L.; Garosi G.; Brunori G.; Tabbi M.; Selvi A.; Cencioni L.; Fagugli R.; Timio F.; Leveque A.; Manes M.; Mennella G.; Calo L.; Fiorini F.; Abaterusso C.; Calzavara P.; Nordio M.; Meneghel G.; Bonesso C.; Gambaro G.; Gammaro L.; Rugiu C.; Dell'Aquila R.; Dell'Aquila R.; Ronco C.; Rugiu C.Nordio, M.; Reboldi, G.; Di Napoli, A.; Quintaliani, G.; Alberici, F.; Postorino, M.; Aucella, F.; Messa, P.; Brunori, G.; Brunori, G.; Bosco, M.; Malberti, F.; Mandreoli, M.; Mazzaferro, S.; Movilli, E.; Ravera, M.; Salomone, M.; Santoro, D.; Postorinolimido, M. A.; Bonomini, M.; Stingone, A.; Maccarone, M.; Di Loreto, E.; Stacchiotti, L.; Malandra, R.; Chiarella, S.; D'Agostino, F.; Fuiano, G.; Nicodemo, L.; Bonofiglio, R.; Greco, S.; Mallamaci, F.; Barreca, E.; Caserta, C.; Bruzzese, V.; Galati, D.; Tramontana, D.; Viscione, M.; Chiuchiolo, L.; Tuccillo, S.; Sepe, M.; Vitale, F.; Ciriana, E.; Santoro, D.; Martignetti, V.; Caserta, D.; Stizzo, A.; Romano, A.; Iulianiello, G.; Cascone, E.; Minicone, P.; Chiricone, D.; Delgado, G.; Barbato, A.; Celentano, S.; Molfino, I.; Coppola, S.; Raiola, I.; Abategiovanni, M.; Borrelli, S.; Margherita, C.; Bruno, F.; Ida, M.; Aliperti, E.; Potito, D.; Cuomo, G.; De Luca, M.; Merola, M.; Botta, C.; Garofalo, G.; Alinei, P.; Paglionico, C.; Roano, M.; Vitale, S.; Ierardi, R.; Fimiani, V.; Conte, G.; Di Natale, G.; Romano, M.; Di Marino, V.; Scafarto, A.; Meccariello, S.; Pecoraro, C.; Di Stazio, E.; Di Meglio, E.; Cuomo, A.; Maresca, B.; Rotaia, E.; Capasso, G.; Auricchio, M.; Pluvio, C.; Maddalena, L.; De Maio, A.; Palladino, G.; Buono, F.; Gigliotti, G.; Mandreoli, M.; Mancini, E.; La Manna, G.; Storari, A.; Mosconi, G.; Cappelli, G.; Scarpioni, R.; Gregorini, M.; Rigotti, A.; Mancini, W.; Bianco, F.; Boscutti, G.; Amici, G.; Tosto, M.; Fini, R.; Pace, G.; Cioffi, A.; Boccia, E.; Di Lullo, L.; Di Zazzo, G.; Simonelli, R.; Bondatti, F.; Miglio, L.; Rifici, N.; Treglia, A.; Muci, M.; Baldinelli, G.; Rizzi, E.; Lonzi, M.; De Cicco, C.; Forte, F.; De Paolis, P.; Grandaliano, G.; Cuzziol, C.; Torre, V. M.; Sfregola, P.; Rossi, V.; Fabio, G.; Flammini, A.; Filippini, A.; Onorato, L.; Vendola, F.; Di Daniela, N.; Alfarone, C.; Scabbia, L.; Ferrazzano, M.; Grotta, B. D.; Gamberini, M.; Fazzari, L.; Mene, P.; Morgia, A.; Catucci, A.; Palumbo, R.; Puliti, M.; Marinelli, R.; Polito, P.; Marrocco, F.; Morabito, S.; Rocca, R.; Nazzaro, L.; Lavini, R.; Iamundo, V.; Chiappini, M.; Casarci, M.; Morosetti, M.; Hassan, S.; Alfarone, C.; Ferrazzano, M.; Firmi, G.; Galliani, M.; Serraiocco, M.; Feriozzi, S.; Valentini, W.; Sacco, P.; Garibotto, G.; Cappelli, V.; Saffioti, C.; Repetto, M.; Rolla, D.; Lorenz, M.; Pedrini, L.; Polonioli, D.; Galli, E.; Ruggenenti, P.; Scolari, F.; Bove, S.; Costantino, E.; Bracchi, M.; Mangano, S.; Depetri, G.; Malberti, F.; La Milia, V.; Farina, M.; Zecchini, S.; Savino, R.; Melandri, M.; Guastoni, C.; Paparella, M.; Gallieni, M.; Minetti, E.; Bisegna, S.; Messa, P.; Righetti, M.; Badalamenti, S.; Guastoni, C.; Alberghini, E.; Bertoli, S.; Fabbrini, P.; Albrizio, P.; Rampino, T.; Colturi, C.; Rombola, G.; Lucatello, A.; Guerrini, E.; Ranghino, A.; Lenci, F.; Fanciulli, E.; Santarelli, S.; Damiani, C.; Garofalo, D.; Sopranzi, F.; Santoferrara, A.; Di Luca, M.; Galiotta, P.; Brigante, M.; Manganaro, M.; Maffei, S.; Berto, I.; Besso, L.; Viglino, G.; Besso, L.; Cusinato, S.; Chiarinottichiappero, D. F.; Tognarelli, G.; Gianoglio, B.; Salomone, M.; Forneris, G.; Biancone, L.; Savoldi, S.; Vitale, C.; Boero, R.; Filiberti, O.; Borzumati, M.; Gesualdo, L.; Lomonte, C.; Gernone, G.; Pallotta, G.; Di Paolo, S.; Vernaglione, L.; Specchio, A.; Stallone, G.; Dell'Aquila, R.; Aucella, F.; Sandri, G.; Russo, F.; Napoli, M.; Marangi, A.; Morrone, L.; Di Stratis, C.; Fresu, A.; Cicu, F.; Murtas, S.; Manca, O.; Pani, A.; Pilloni, M.; Pistis, R.; Cadoni, M.; Contu, B.; Logias, F.; Ivaldi, R.; Fancello, S.; Cossu, M.; Lepori, G.; Lepori, G.; Vittoria, S.; Battiati, E.; Arnone, M.; Rome, M.; Barbera, A.; Granata, A.; Collura, G.; Dico, C. L.; Pugliese, G.; Di Natale, E.; Rizzari, G.; Cottone, L.; Longo, N.; Battaglia, G.; Marcantoni, C.; Giannetto, G.; Tumino, G.; Randazzo, F.; Bellissimo, L.; Faro, F. L.; Grippaldi, F.; Urso, S.; Quattrone, G.; Todaro, I.; Vincenzo, D.; Murgo, A.; Masuzzo, M.; Pisacane, A.; Monardo, P.; Santoro, D.; Pontorierro, M.; Quari, C.; Bauro, A.; Chimenz, R. R.; Alfio, D.; Girasole, F.; Cascio, A. L.; Caviglia, A.; Tornese, F.; Sirna, F.; Altieri, C.; Cusumano, R.; Saveriano, V.; La Corte, A.; Locascio, G.; Rotolo, U.; Rome, M.; Musso, S.; Risuglia, L.; Blanco, G.; Minardo, G.; Castellino, S.; Zappulla, Z.; Randone, S.; Di Francesca, M.; Cassetti, C. C.; Oddo, G.; Buscaino, G.; Mucaria, F.; Barraco, V. I.; Di Martino, A.; Mucaria, F.; Rallo, D.; Dani, L.; Campolo, G.; Manescalchi, F.; Biagini, M.; Agate, M.; Panichi, V.; Casani, A.; Traversari, L.; Garosi, G.; Brunori, G.; Tabbi, M.; Selvi, A.; Cencioni, L.; Fagugli, R.; Timio, F.; Leveque, A.; Manes, M.; Mennella, G.; Calo, L.; Fiorini, F.; Abaterusso, C.; Calzavara, P.; Nordio, M.; Meneghel, G.; Bonesso, C.; Gambaro, G.; Gammaro, L.; Rugiu, C.; Dell'Aquila, R.; Dell'Aquila, R.; Ronco, C.; Rugiu, C

Risk factors and action thresholds for the novel coronavirus pandemic. Insights from the Italian Society of Nephrology COVID-19 Survey

Background and aim: Over 80% (365/454) of the nation\u2019s centers participated in the Italian Society of Nephrology COVID-19 Survey. Out of 60,441 surveyed patients, 1368 were infected as of April 23rd, 2020. However, center-specific proportions showed substantial heterogeneity. We therefore undertook new analyses to identify explanatory factors, contextual effects, and decision rules for infection containment. Methods: We investigated fixed factors and contextual effects by multilevel modeling. Classification and Regression Tree (CART) analysis was used to develop decision rules. Results: Increased positivity among hemodialysis patients was predicted by center location [incidence rate ratio (IRR) 1.34, 95% confidence interval (CI) 1.20\u20131.51], positive healthcare workers (IRR 1.09, 95% CI 1.02\u20131.17), test-all policy (IRR 5.94, 95% CI 3.36\u201310.45), and infected proportion in the general population (IRR 1.002, 95% CI 1.001\u20131.003) (all p &lt; 0.01). Conversely, lockdown duration exerted a protective effect (IRR 0.95, 95% CI 0.94\u20130.98) (p &lt; 0.01). The province-contextual effects accounted for 10% of the total variability. Predictive factors for peritoneal dialysis and transplant cases were center location and infected proportion in the general population. Using recursive partitioning, we identified decision thresholds at general population incidence 65 229 per 100,000 and at 65 3 positive healthcare workers. Conclusions: Beyond fixed risk factors, shared with the general population, the increased and heterogeneous proportion of positive patients is related to the center\u2019s testing policy, the number of positive patients and healthcare workers, and to contextual effects at the province level. Nephrology centers may adopt simple decision rules to strengthen containment measures timely

Risk factors and action thresholds for the novel coronavirus pandemic. Insights from the Italian Society of Nephrology COVID-19 Survey

Background and aim: Over 80% (365/454) of the nation’s centers participated in the Italian Society of Nephrology COVID-19 Survey. Out of 60,441 surveyed patients, 1368 were infected as of April 23rd, 2020. However, center-specific proportions showed substantial heterogeneity. We therefore undertook new analyses to identify explanatory factors, contextual effects, and decision rules for infection containment. Methods: We investigated fixed factors and contextual effects by multilevel modeling. Classification and Regression Tree (CART) analysis was used to develop decision rules. Results: Increased positivity among hemodialysis patients was predicted by center location [incidence rate ratio (IRR) 1.34, 95% confidence interval (CI) 1.20–1.51], positive healthcare workers (IRR 1.09, 95% CI 1.02–1.17), test-all policy (IRR 5.94, 95% CI 3.36–10.45), and infected proportion in the general population (IRR 1.002, 95% CI 1.001–1.003) (all p &lt; 0.01). Conversely, lockdown duration exerted a protective effect (IRR 0.95, 95% CI 0.94–0.98) (p &lt; 0.01). The province-contextual effects accounted for 10% of the total variability. Predictive factors for peritoneal dialysis and transplant cases were center location and infected proportion in the general population. Using recursive partitioning, we identified decision thresholds at general population incidence ≥ 229 per 100,000 and at ≥ 3 positive healthcare workers. Conclusions: Beyond fixed risk factors, shared with the general population, the increased and heterogeneous proportion of positive patients is related to the center’s testing policy, the number of positive patients and healthcare workers, and to contextual effects at the province level. Nephrology centers may adopt simple decision rules to strengthen containment measures timely