Lean-ing method in an emergency department of the italian epicenter of the covid-19 outbreak: When the algorithm makes difference

The Lean method entails a set of standardized processes intending to optimize resources, reduce waste, and improve results. Lean has been proposed as an operative model for the Covid-19 outbreak. Herein, we summarized data resulted from the Lean model adoption in an Emergency Department of the Lombardy region, the Italian epicenter of the pandemic, to critically appraise its effectiveness and feasibility. The Lean algorithm was applied in the Humanitas Clinical and Research Hospital, Milan, north of Italy. At admission, patients underwent outdoor pre-triage for fe-ver, respiratory, and gastrointestinal symptoms, with a focus on SpO2. Based on these data, they were directed to the most appropriate area for the Covid-19 first-level screening. High-risk patients were assisted by trained staff for second-level screening and planning of treatment. Out of 7.778 patients, 21.9% were suspected of SARS-CoV-2 infection. Mortality was 21.9% and the infection rate in health workers was 4.8%. The lean model has proved to be effective in optimizing the overall management of Covid-19 patients in an emergency setting. It allowed for screening of a large volume of patients, while also limiting the health workers’ infection rate. Further studies are necessary to validate the suggested approach

Exploitation of drainage water heat: A novel solution experimented at the Brenner Base Tunnel

Deep tunnels in permeable fractured rock-masses and under high piezometric levels can drain notable volumes of warm water, which are collected under gravity in specific conduits towards the portals, where heat can be exploited. The utilization of this energy source is generally narrowed by the limited presence of end-users near the portals, while other promising heating and cooling needs can be found directly along the tunnel length. The work presents the design, construction and installation of a geothermal system prototype exploiting the drainage water heat directly inside the tunnel. The prototype was named Smart Flowing due to the peculiarity of its heat exchange process. The system was realized and installed inside the exploratory tunnel of the Brenner Base Tunnel, near the border between Italy and Austria. The Smart Flowing modules were built outside and later moved inside the tunnel, where they were placed and assembled concurrently to the advancement of the Tunnel Boring Machine. A design procedure was proposed and validated against a testing and monitoring campaign. The data from the experimental activity confirmed that the drainage water flow guarantees long-term stabilization of circulating water temperature and fast heat recovery afterwards, thus securing the considerable power and performance values of a water-water heat pump connected to the system. A sensitivity analysis allowed the reproduction of different working scenarios, in order to generalize the application of Smart Flowing beyond the specific installation context

A new in situ test for the assessment of the rock-burst alarm threshold during tunnelling

Rock-burst is one of the most serious risks associated with hard rock tunnelling and mining at high depths. Monitoring of acoustic emissions emitted by the rock-mass during excavation and their interpretation now permits the early assessment of failure events and makes the safe management of the construction works possible. A reliable set-up of the alarm threshold is thus fundamental for the correct implementation of the procedures planned to minimise rock-burst related risk. This paper focuses on a novel in situ test specifically developed to provide an experimental basis for a more accurate assessment of the alarm threshold during tunnelling, representative of the local geomechanical conditions. The test, thanks to the compression induced by two flat jacks at the tunnel side wall, produces an artificial failure process during which acoustic emissions are measured and correlated to the mechanical response of the rock-mass, without the typical limitations of scale that characterised the laboratory experiments. The new methodology, named the Mules method, was successfully tested during the excavation of some stretches of the Brenner Base Tunnel in the Brixner granite, affected by mild spalling episodes. The case-history is fully described in the paper to illustrate the practical application of the proposed approach

Clinical outcomes in the second versus first pandemic wave in italy: Impact of hospital changes and reorganization

The region of Lombardy was the epicenter of the COVID‐19 outbreak in Italy. Emergency Hospital 19 (EH19) was built in the Milan metropolitan area during the pandemic’s second wave as a facility of Humanitas Clinical and Research Center (HCRC). The present study aimed to assess whether the implementation of EH19 was effective in improving the quality of care of COVID‐19 patients during the second wave compared with the first one. The demographics, mortality rate, and in‐hospital length of stay (LOS) of two groups of patients were compared: the study group involved patients admitted at HCRC and managed in EH19 during the second pandemic wave, while the control group included patients managed exclusively at HCRC throughout the first wave. The study and control group included 903 (56.7%) and 690 (43.3%) patients, respectively. The study group was six years older on average and had more pre‐existing comorbidities. EH19 was associated with a decrease in the intensive care unit admission rate (16.9% vs. 8.75%, p < 0.001), and an equal decrease in invasive oxygen therapy (3.8% vs. 0.23%, p < 0.001). Crude mortality was similar but overlap propensity score weighting revealed a trend toward a potential small decrease. The adjusted difference in LOS was not significant. The implementation of an additional COVID‐ 19 hospital facility was effective in improving the overall quality of care of COVID‐19 patients during the first wave of the pandemic when compared with the second. Further studies are necessary to validate the suggested approach

Lung microbiome in idiopathic pulmonary fibrosis and other interstitial lung diseases

Interstitial lung diseases represent a heterogeneous and wide group of diseases in which factors leading to disease initiation and progression are not fully understood. Recent evidence suggests that the lung microbiome might influence the pathogenesis and progression of interstitial lung diseases. In recent years, the utilization of culture-independent methodologies has allowed the identification of complex and dynamic communities of microbes, in patients with interstitial lung diseases. However, the potential mechanisms by which these changes may drive disease pathogenesis and progression are largely unknown. The aim of this review is to discuss the role of the altered lung microbiome in several interstitial lung diseases. Untangling the host–microbiome interaction in the lung and airway of interstitial lung disease patients is a research priority. Thus, lung dysbiosis is a potentially treatable trait across several interstitial lung diseases, and its proper characterization and treatment might be crucial to change the natural history of these diseases and improve outcomes

Targeted cell delivery of mesenchymal stem cell therapy for cardiovascular disease applications: a review of preclinical advancements

Cardiovascular diseases (CVD) continue to be the leading cause of morbidity and mortality globally and claim the lives of over 17 million people annually. Current management of CVD includes risk factor modification and preventative strategies including dietary and lifestyle changes, smoking cessation, medical management of hypertension and cholesterol lipid levels, and even surgical revascularization procedures if needed. Although these strategies have shown therapeutic efficacy in reducing major adverse cardiovascular events such as heart attack, stroke, symptoms of chronic limb-threatening ischemia (CLTI), and major limb amputation significant compliance by patients and caregivers is required and off-target effects from systemic medications can still result in organ dysfunction. Stem cell therapy holds major potential for CVD applications but is limited by the low quantities of cells that are able to traffic to and engraft at diseased tissue sites. New preclinical investigations have been undertaken to modify mesenchymal stem cells (MSCs) to achieve targeted cell delivery after systemic administration. Although previous reviews have focused broadly on the modification of MSCs for numerous local or intracoronary administration strategies, here we review recent preclinical advances related to overcoming challenges imposed by the high velocity and dynamic flow of the circulatory system to specifically deliver MSCs to ischemic cardiac and peripheral tissue sites. Many of these technologies can also be applied for the targeted delivery of other types of therapeutic cells for treating various diseases

Autoantibodies against chemokines post-SARS-CoV-2 infection correlate with disease course

Infection with severe acute respiratory syndrome coronavirus 2 associates with diverse symptoms, which can persist for months. While antiviral antibodies are protective, those targeting interferons and other immune factors are associated with adverse coronavirus disease 2019 (COVID-19) outcomes. Here we discovered that antibodies against specific chemokines were omnipresent post-COVID-19, were associated with favorable disease outcome and negatively correlated with the development of long COVID at 1 yr post-infection. Chemokine antibodies were also present in HIV-1 infection and autoimmune disorders, but they targeted different chemokines compared with COVID-19. Monoclonal antibodies derived from COVID-19 convalescents that bound to the chemokine N-loop impaired cell migration. Given the role of chemokines in orchestrating immune cell trafficking, naturally arising chemokine antibodies may modulate the inflammatory response and thus bear therapeutic potential

Non-invasive mechanical ventilation in patients with diffuse interstitial lung diseases

Background: To evaluate noninvasive ventilation (NIV) in diffuse interstitial lung diseases (DILD) patients with acute respiratory failure (ARF) according to baseline radiological patterns and the etiology of ARF. Methods: In a multicenter, observational, retrospective study, consecutive DILD patients undergoing NIV because of an episode of ARF were evaluated in six Italian high dependency units. Three groups of patients were identified based on the etiology of ARF: those with pneumonia (Group A), those with acute exacerbation of fibrosis, (Group B) and those with other triggers (Group C). Clinical failure was defined as any among in-hospital mortality, endotracheal intubation and extra-corporeal membrane oxygenation use. Results: Among the 60 patients enrolled (63% males; median age: 71 years), pneumonia (42%) and acute exacerbation of fibrosis (39%) were the two most frequent causes of ARF. A significant increase of PaO2/FiO(2) ratio during NIV treatment was detected in Group A (p = 0.010), but not in Group B. No significant difference in PaO2/FiO(2) ratio, PaCO2 and pH values during NIV treatment was detected in patients with a radiological pattern of usual interstitial pneumonia (UIP) and non-specific interstitial pneumonia (NSIP). 22 patients (37%) suffered for a clinical failure. No significant differences in the study outcome were detected in Group A vs. Group B, as well as among patients with a radiological pattern of UIP vs. NSIP. Conclusions: NIV treatment should be individualized in DILD patients with ARF according to the etiology, but not the baseline radiological pattern, in order to improve oxygenation

The Astronomical Orientation of Ancient Greek Temples

Despite its appearing to be a simple question to answer, there has been no consensus as to whether or not the alignments of ancient Greek temples reflect astronomical intentions. Here I present the results of a survey of archaic and classical Greek temples in Sicily and compare them with temples in Greece. Using a binomial test I show strong evidence that there is a preference for solar orientations. I then speculate that differences in alignment patterns between Sicily and Greece reflect differing pressures in the expression of ethnic identity