Caratterizzazione degli edifici non residenziali ad uso scolastico della PA siciliana

La presente relazione finale descrive le ricerche svolte, in seno all’accordo di collaborazione tra l’ENEA e il Dipartimento dell’Energia, ingegneria dell’Informazione e modelli Matematici (DEIM) dell’Università di Palermo. L’accordo di collaborazione è titolato “Caratterizzazione degli edifici scolastici nella Regione Sicilia”. La relazione è suddivisa in due sezioni: la prima, Parte A, illustra lo studio condotto per la caratterizzazione degli edifici non residenziali ad uso scolastico della PA siciliana; la seconda, Parte B, descrive lo stato dell’arte del “Ventilative Cooling” con riferimento particolare ad alcuni casi-studio reali, nel contesto della partecipazione del DEIM alle attività dell’IEA EBC ANNEX 62”. Nel corso dell’annualità precedente è stata effettuata un’analisi della consistenza, dello stato, e delle tipologie di involucro più significative del patrimonio edilizio scolastico siciliano, utilizzando dati statistici disponibili in letteratura e indagini di campo. Nel corso di questa annualità si è identificato un ristretto campione di edifici scolastici rappresentativo del patrimonio edilizio siciliano. Si tratta di tre edifici adibiti a strutture scolastiche relative a differenti gradi di istruzione: una scuola elementare, una media ed una superiore. In particolare, l’edificio che ospita la scuola elementare ha subito negli ultimi anni estesi interventi di ristrutturazione e riqualificazione energetica; il confronto tra le prestazioni energetiche dell’edificio riqualificato con quelle relative agli altri due edifici campione ha permesso di valutare i risparmi energetici indotti dall’introduzione di nuove normative di settore sugli edifici scolastici. Gli edifici analizzati sono sufficientemente rappresentativi della eterogeneità del patrimonio edilizio scolastico siciliano poiché si tratta di: - edifici differenti posti nelle zone climatiche B e C, che caratterizzano più del 65% dei Comuni siciliani, - edifici dalle caratteristiche termofisiche differenti: trasmittanze (U) tipiche delle costruzioni degli anni ’70 (Usuperfici_verticali>1 W/(m2 K)) ed edifici recentemente ristrutturati (U conforme al DPR n. 59/2009), - edifici che ospitano scuole di differente ordine e grado. Lo studio è stato sviluppato a partire da un approccio preliminare di raccolta ed analisi dei dati per ciascun edificio. L’analisi sistematica dei casi-studio ha consentito di desumere le caratteristiche fondamentali per la modellizzazione: stratigrafia, spessori e qualità termofisica dell’involucro edilizio, apporti termici interni causati da apparecchiature elettroniche ed illuminanti, livelli di occupazione in ogni zona dell’edificio e relativi apporti termici interni, caratteristiche degli impianti termici e modalità di funzionamento. L’analisi non ha tralasciato di esaminare “abitudini” e “pratiche comuni” utilizzate nella gestione degli immobili, come ad esempio la tendenza degli occupanti ad aprire le finestre o a utilizzare schermature solari in alcune fasce orarie nel corso dell’anno. Il passaggio seguente ha riguardato la suddivisione di ognuno dei tre edifici in opportune zone termiche, secondo logiche di uguale destinazione d’uso, di assimilabilità geometrica e di gestione comune di diversi locali da parte dello stesso impianto termico con le stesse regolazioni. Il software di calcolo prescelto per l’implementazione dei modelli è stato TRNSYS 17.01. La struttura geometrica di ogni edificio è stata dettagliatamente modellizzata in 3D tramite il software Google Sketchup; tali modelli sono successivamente stati importati in ambiente TRNSYS. Ogni modello è stato costruito implementando accuratamente le informazioni raccolte nella fase preliminare, integrandolo con le informazioni relative agli occupanti e alla descrizione dei carichi interni dell’edificio. Le logiche di funzionamento, di regolazione e d’uso degli impianti termici sono state implementate in ognuno dei modelli. L’analisi delle prestazioni energetiche dei tre edifici è stata effettuata tramite un set di indicatori sintetici, al fine di ottenere dei valori di riferimento e di benchmark per il patrimonio edilizio scolastico della Regione Sicilia; tra di essi il fabbisogno energetico per riscaldamento annuo, il fabbisogno energetico per riscaldamento annuo riferito alla superficie in pianta o al numero di studenti. La seconda parte del lavoro illustra lo stato dell’arte del “Ventilative Cooling” (raffrescamento per ventilazione) e tratta le tecniche di controllo passive e attive della movimentazione dei flussi d’aria all’interno degli ambienti confinati. L’importanza dello studio di tali tecniche è generata da un crescente interesse nell’uso della ventilazione quale strategia per garantire anche il comfort ambientale nel periodo estivo e nelle stagioni intermedie, limitando il ricorso ai sistemi di refrigerazione in un’ottica di risparmio energetico. Il lavoro è stato sviluppato nel novero delle attività dell’ “International Energy Agency – Energy in buildings and communities Annex 62, Ventilative Cooling”. Il DEIM partecipa ai lavori della Subtask A dell’Annex 62 suddetto, che focalizza il suo interesse sulla simulazione termofisica e sull’analisi del contesto legislativo a scala internazionale. Il gruppo di lavoro del DEIM ha partecipato al primo meeting dell’Annex 62, svoltosi all’Ecole Polytechnique Federale de Lausanne (EPFL) in Svizzera in qualità di “observer”; i lavori sono stati focalizzati principalmente sul completamento del report interno sullo stato dell’arte nelle pratiche di “Ventilative Cooling”. Il contributo del DEIM ai lavori dell’Annex 62 è relativo: - all’analisi dello stato dell’arte del “Ventilative Cooling” e alle potenziali applicazioni e implementazioni di tali contributi nella legislazione locale italiana; - alla modellizzazione del “Ventilative Cooling”

Lifestyle medicine and psychological well-being toward health promotion: a cross-sectional study on Palermo (Southern Italy) undergraduates

(1) Aim: To assess the attitude toward Lifestyle Medicine and healthy behaviours among students in the healthcare area and to demonstrate its association to psychological well-being; (2) Methods: A cross-sectional study is conducted among 508 undergraduates of the University of Palermo (140 (27.6%) in the healthcare area and 368 (72.4%) in the non-healthcare area), during the academic year 2018–2019. Psychological well-being is measured through two dimensions of eudaimonia and hedonia, using the 10-item Hedonic and Eudaimonic Motives for Activities-Revised (HEMA-R) scale, with answers coded on a 7-point scale. The association between demographic and modifiable behavioural risk factors for chronic diseases is assessed through crude and adjusted Odds ratios with 95% confidence intervals; (3) Results: Orientation to both hedonia and eudaimonia is significantly associated to the Mediterranean diet (ORAdj = 2.28; 95% CI = (1.42–3.70)) and drinking spirits less than once a week (ORAdj = 1.89; 95% CI = (1.10–3.27)) and once a week or more (ORAdj = 6.02; 95% CI = (1.05–34.52)), while these conditions occur together less frequently for current smokers (ORAdj = 0.38; 95% CI = (0.18–0.81)). Students inclined to well-being consider healthcare professionals as models for their patients and all people in general (OR = 1.96, 95% CI = (1.28–3.00)); (4) Conclusions: The positive relation found between a virtuous lifestyle and psychological well-being suggests the construction, development and cultivation of individual skills are a means to succeed in counteracting at risk behaviours for health

Pseudo-rheumatic manifestations of limping: Camptodactyly–arthropathy–coxa vara–pericarditis syndrome: Single case report and review of the literature

Camptodactyly–arthropathy–coxa vara–pericarditis (CACP) syndrome is a rare genetic disease characterized by tetrad camptodactyly, noninflammatory arthropathy, coxa vara deformity, and pericardial effusion. Arthropathy typically affects large joints and presents with joint swelling in the absence of other signs of inflammation. We described the case of a girl affected by CACP syndrome caused by a novel compound heterozygous variant in proteoglycan 4 gene (c.2831_2832insT; c.3892C > T) and associated with temporomandibular involvement. The patient received treatment with intra-articular hyaluronic acid injections, which presented rapid but transient improvements of pain and range of motion. A literature review of previously reported CACP patients has been performed. Of the patients. 69.2% (101 out of 146) were Middle Eastern, and 65.7% (96) were consanguineous. The median age of onset was 24 months (interquartile range of 12–36 months), and median age of diagnosis was 96 months (interquartile range of 48–156 months). Arthropathy was always present, mainly involving hips (95.2%), knees (92.4%), wrists (87.7%), elbows (79.5%), and ankles (57.5%). Camptodactyly and pericardial effusion were described, respectively, in 97.3% (142) and 15.1% (22) of patients. The main radiological findings were coxa vara (95.2%), femoral changes (64.4%), intraosseus cysts (14.4%), and bone erosion (5%). Of the patients, 32.9% (48) had received a previous juvenile idiopathic arthritis diagnosis. CACP syndrome can be easily misdiagnosed with juvenile idiopathic arthritis. A prolonged lack of response to immunosuppressive therapy associated with typical clinical and radiological features should prompt consideration of this rare syndrome

Detecting the stepwise propagation of the Eastern Sicily thrust belt (Italy): insight from thermal and thermochronological constraints

An extensive dataset of vitrinite reflectance, FTIR parameters on organic matter, illite content in mixed layers illite-smectite, apatite fission tracks and U-Th/He dating has been used to reconstruct the stepwise propagation of the Eastern Sicily fold-and-thrust belt during Late Palaeogene and Neogene times. The results indicate that the fold-and-thrust belt is divisible into two levels of thermal maturity. These levels consist of a less evolved level of thermal maturity that records limited sedimentary burial and minor heating, and a more evolved level of thermal maturity that indicates tectonic burial and exhumation at different times. Deformation and exhumation of shallowly buried units are linked to wedge forward propagation by low-angle thrusts, whereas the evolution of deeply buried units is associated with tectonic imbrications by duplex formation and steep thrusts. The two tectonic styles alternate during evolution of the fold-and-thrust belt under low erosion rates

OBSIDIAN - real-world evidence of originator to biosimilar drug switch in juvenile idiopathic arthritis

Limited data about use of biosimilars (BIOs) are available in children with JIA. This study therefore aimed to evaluate long-term efficacy and safety of switching from etanercept (ETA) and adalimumab (ADA) originators to their biosimilars (BIOs), in children with JIA, in a real-world setting

Association of Adams-Oliver syndrome with pulmonary arterio-venous malformation in the same family: a further support to the vascular hypothesis

Adams-Oliver syndrome (AOS) is a rare disease characterized by congenital scalp defects, terminal transverse limb defects and cutis marmorata telangiectatica. A significant incidence of cardiac and vascular malformations has been reported, leading to the hypothesis of a vascular defect early involved in the pathogenesis. We report two members of the same family with previously diagnosed AOS based on clinical phenotype and later recognized to have pulmonary arterio-venous malformation (PAVM). None of the subjects fulfilled current diagnostic criteria of hereditary hemorrhagic telangiectasia, which is the most common cause of PAVM. The occurrence of PAVM in AOS lends support to the hypothesis that endothelial specific abnormalities could be a patho-physiological mechanism in its development. Therefore, the role of screening for PAVM in clinical management of subjects with AOS should deserve further studies

A Rapid Antigen Detection Test to Diagnose SARS-CoV-2 Infection Using Exhaled Breath Condensate by A Modified Inflammacheck® Device

Background: The standard test that identifies the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is based on reverse transcriptase-polymerase chain reaction (RT-PCR) from nasopharyngeal (NP) swab specimens. We compared the accuracy of a rapid antigen detection test using exhaled breath condensate by a modified Inflammacheck® device with the standard RT-PCR to diagnose SARS-CoV-2 infection. Methods: We performed a manufacturer-independent, cross-sectional, diagnostic accuracy study involving two Italian hospitals. Sensitivity, specificity, positive (PLR) and negative likelihood ratio (NLR), positive (PPV) and negative predictive value (NPV) and diagnostic accuracy with 95% confidence intervals (95% CI) of Inflammacheck® were calculated using the RT-PCR results as the standard. Further RT-PCR tests were conducted on NP specimens from test positive subjects to obtain the Ct (cycle threshold) values as indicative evidence of the viral load. Results: A total of 105 individuals (41 females, 39.0%; 64 males, 61.0%; mean age: 58.4 years) were included in the final analysis, with the RT-PCR being positive in 13 (12.4%) and negative in 92 (87.6%). The agreement between the two methods was 98.1%, with a Cohen’s κ score of 0.91 (95% CI: 0.79–1.00). The overall sensitivity and specificity of the Inflammacheck® were 92.3% (95% CI: 64.0%–99.8%) and 98.9% (95% CI: 94.1%–100%), respectively, with a PLR of 84.9 (95% CI: 12.0–600.3) and a NLR of 0.08 (95% CI: 0.01–0.51). Considering a 12.4% disease prevalence in the study cohort, the PPV was 92.3% (95% CI: 62.9%–98.8%) and the NPV was 98.9% (95% CI: 93.3%–99.8%), with an overall accuracy of 98.1% (95% CI: 93.3%–99.8%). The Fagan’s nomogram substantially confirmed the clinical applicability of the test in a realistic scenario with a pre-test probability set at 4%. Ct values obtained for the positive test subjects by means of the RT-PCR were normally distributed between 26 and 38 cycles, corresponding to viral loads from light (38 cycles) to high (26 cycles). The single false negative record had a Ct value of 33, which was close to the mean of the cohort (32.5 cycles). Conclusions: The modified Inflammacheck® device may be a rapid, non-demanding and cost-effective method for SARS-CoV-2 detection. This device may be used for routine practice in different healthcare settings (community, hospital, rehabilitation)

Clinical Syndromes Related to SARS-CoV-2 Infection and Vaccination in Pediatric Age: A Narrative Review

This narrative review aims to report the main clinical manifestations, therapeutic strategies, outcomes, and complications of acute SARS-CoV-2 infection in childhood and to summarize the data relating the SARS-CoV-2 vaccination efficacy and safety in pediatric age. SARS-CoV-2 infection mostly occurs asymptomatically in the pediatric population, while multisystem inflammatory syndrome in children (MIS-C) represents the most severe coronavirus disease 2019 (COVID-19)-related illness, a life-threatening event with a high morbidity rate. After the development of SARS-CoV-2 vaccines and their subsequent approval in children, the rate of infection as well as the number of its related complications have shown a drastic decrease. Fully vaccinated children are protected from the risk of developing a severe disease and a similar protective role has been observed in the reduction of complications, in particular MIS-C. However, long-lasting immunity has not been demonstrated, booster doses have been required, and reinfection has been observed. With regards to vaccine safety, adverse events were generally mild to moderate in all age groups: local adverse events were the most commonly reported. Nevertheless, a potential association between SARS-CoV-2 vaccine and the subsequent development of inflammatory manifestations has been suggested. Myocarditis has rarely been observed following vaccination; it appeared to be more frequent among adolescent males with a mild clinical course leading to a complete recovery. SARS-CoV-2 vaccine-related MIS-C cases have been described, although a univocal definition and an exact time interval with respect to vaccination has not been reported, thus not establishing a direct causal link. Current evidence about COVID-19 vaccination in children and adolescents suggest that benefits outweigh potential risks. Long-term data collection of the post-authorization safety surveillance programs will better define the real incidence of SARS-CoV-2 vaccine-related complications in the pediatric population

Obesity Duration Is Associated to Pulmonary Function Impairment in Obese Subjects

Obesity is associated with pulmonary function disturbances. We hypothesized that lung function decreases with increasing duration of obesity. We evaluated pulmonary function tests (PFTs) in 188 nonsmoking subjects with primary obesity (aged 8-76 years; 36% with systemic hypertension). Duration of obesity was assessed by questionnaire in adults, and by height and weight growth patterns in children. Asthma and/or other allergic diseases were investigated by standardized questionnaires. BMI and BMI-standard deviation scores (SDS) were 38.7 and 2.4 kg/m(2), respectively. Forty-six percent of patients were atopic. Among subjects with ever asthma (33%), 20 had current asthma (11% of the total). Forced vital capacity (FVC), forced expiratory volume in 1 s, total lung capacity (TLC), and functional residual capacity (FRC) were 103, 104, 95, and 76% predicted, respectively. Mean duration of obesity was 8.3 years. Compared with subjects who had been obese for ≤5 years, patients who had been obese for >15 years had significantly lower values on PFTs (P < 0.05). In subjects with systemic hypertension, PFTs were lower than in patients without hypertension (P < 0.01). Duration of obesity was significantly related to all PFTs (P ≤ 0.001). In a multiple regression analysis where duration and severity of obesity, hypertension, atopy, asthma, and family history of atopic diseases were independent variables, duration of obesity was a predictor of lower PFTs (P < 0.01). Of the remaining variables, only hypertension contributed to lower lung volumes. In obese individuals, lung function was significantly lower in subjects with greater years of obesity. Fat loss programs should be encouraged to prevent late pulmonary function impairment