Retrofit de la construcción mediante paneles prefabricados: una reseña del estado del arte = Building Retrofit through prefabricated panels: an overview on the state of the art

The main aim of this paper is to provide an overview of the use of prefabricated panels in external building retrofitting. Building retrofit represents a pivotal point in terms of energy efficiency, connected to the great amount of existing buildings, both public and private, all around Europe. The need of intervention is underlined by different European Directives, as well as by Horizon 2020 roadmap. Many research works and projects are focusing on the theme of prefabrication in retrofit, stressing the importance of this strategy. The review of the state of the art shows several approaches in terms of prefabricated panels: a critical classification of these projects distinguish between systems based on large and small panels, systems for extensions based on structural panels, and partially prefabricated systems. The classification is useful as it can help in understanding further development of prefabricated panels, underlining the advantages and disadvantages of the systems. The main challenges are linked to design, fabrication, transport and installation. An overview of those issues is also provided, stressing the main innovation fields to be further investigated, and the possible future developments of prefabrication in building retrofit

Identification of technological and installation-related parameters for a multi-criteria approach to building retrofit

Building retrofit is a main concern to reach EU de-carbonisation goals of 2050. Façade retrofit plays a pivotal role in the reduction of energy consumption in buildings: several strategies are in fact available, both in terms of on-site systems and prefabricated elements. The research question arising regards therefore how to choose the best-suiting residential retrofit strategy between different technological systems. In this sense, a current lack of diffusion of Decision Support Systems between can be underlined, as decisions mainly derive from previous experiences. An optimizing strategy that could express the goals of the many actors involved in the building process is required. In order to consider the impact of different criteria on the choice, multi-criteria methodologies could be effective. Existing similar methods mostly focus uniquely on energy performance, or follow the categories of environment, economy and society. What is currently lacking in available tools regards production-linked and technological aspects, related to e.g. façade morphology, and building site features. The aim of this paper is to identify relevant parameters related to installation and economy aspects, for a multi-criteria approach to be used in the choice of the most suitable building retrofit strategy. The methodological approach is therefore provided, and the choice of parameters, carried out by means of interview with actors of the building process, is explained. The criteria selection and the subsequent criteria weighting phase is to be carried out by means of interviews and surveys to the actors involved in the building process. The application on case-studies will offer the opportunity to assess the effectiveness of the method

Una alleanza tra mondo della ricerca e imprese per l\u2019occupazione dei giovani. Per una via italiana al modello Fraunhofer Gesellschaft

L\u2019Italia \ue8 una delle economie sviluppate dell\u2019area OCSE con il minor numero di ricercatori, progettisti, creativi e innovatori che lavorano nel settore privato. Dato di per s\ue9 paradossale per un sistema imprenditoriale che compete in una economia di rete aperta e su mercati globali. Secondo la dottrina economica non vi \ue8 infatti Paese in grado di percorrere un robusto cammino di crescita e di sviluppo senza fare affidamento a politiche pubbliche di supporto alla formazione del capitale umano e all\u2019inserimento nel tessuto produttivo di figure professionali dotate di elevate competenze, conoscenze e propensione al cambiamento. La capacit\ue0 delle imprese, non solo quelle grandi ma anche quelle medie e piccole, di produrre risposte tempestive e puntuali agli equilibri dei mercati sempre pi\uf9 circostanziali e sensibili a repentini cambiamenti della domanda, \ue8 assoggettata alla disponibilit\ue0 di risorse umane altamente qualificate e idonee a gestire una produzione discontinua dei beni entro una logica di continuit\ue0 di processo. Figure professionali in possesso di competenze elevate e ibride per natura: progettisti, creativi, innovatori e ricercatori che integrano lavoro, apprendimento, ricerca e progettazione generando un elevato valore aggiunto in termini di innovazione nei processi produttivi e/o dei modi di erogare servizi

technical scientific support for the definition of the project for the reconstruction of school buildings involved in seismic events

This research regards the development of the project of the new school of San Severino Marche. The school is located in a region severely affected by the earthquake, and for this reason the design of the new building was based on a high degree of structural capacity, as well as strong innovations on typological and technological level, in accordance with specific educational needs. The research work is developed through a BIM approach that allowed the proper coordination of the disciplines involved

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Prescription appropriateness of anti-diabetes drugs in elderly patients hospitalized in a clinical setting: evidence from the REPOSI Register

Diabetes is an increasing global health burden with the highest prevalence (24.0%) observed in elderly people. Older diabetic adults have a greater risk of hospitalization and several geriatric syndromes than older nondiabetic adults. For these conditions, special care is required in prescribing therapies including anti- diabetes drugs. Aim of this study was to evaluate the appropriateness and the adherence to safety recommendations in the prescriptions of glucose-lowering drugs in hospitalized elderly patients with diabetes. Data for this cross-sectional study were obtained from the REgistro POliterapie-Società Italiana Medicina Interna (REPOSI) that collected clinical information on patients aged ≥ 65 years acutely admitted to Italian internal medicine and geriatric non-intensive care units (ICU) from 2010 up to 2019. Prescription appropriateness was assessed according to the 2019 AGS Beers Criteria and anti-diabetes drug data sheets.Among 5349 patients, 1624 (30.3%) had diagnosis of type 2 diabetes. At admission, 37.7% of diabetic patients received treatment with metformin, 37.3% insulin therapy, 16.4% sulfonylureas, and 11.4% glinides. Surprisingly, only 3.1% of diabetic patients were treated with new classes of anti- diabetes drugs. According to prescription criteria, at admission 15.4% of patients treated with metformin and 2.6% with sulfonylureas received inappropriately these treatments. At discharge, the inappropriateness of metformin therapy decreased (10.2%, P < 0.0001). According to Beers criteria, the inappropriate prescriptions of sulfonylureas raised to 29% both at admission and at discharge. This study shows a poor adherence to current guidelines on diabetes management in hospitalized elderly people with a high prevalence of inappropriate use of sulfonylureas according to the Beers criteria

Antidiabetic Drug Prescription Pattern in Hospitalized Older Patients with Diabetes

Objective: To describe the prescription pattern of antidiabetic and cardiovascular drugs in a cohort of hospitalized older patients with diabetes. Methods: Patients with diabetes aged 65 years or older hospitalized in internal medicine and/or geriatric wards throughout Italy and enrolled in the REPOSI (REgistro POliterapuie SIMI—Società Italiana di Medicina Interna) registry from 2010 to 2019 and discharged alive were included. Results: Among 1703 patients with diabetes, 1433 (84.2%) were on treatment with at least one antidiabetic drug at hospital admission, mainly prescribed as monotherapy with insulin (28.3%) or metformin (19.2%). The proportion of treated patients decreased at discharge (N = 1309, 76.9%), with a significant reduction over time. Among those prescribed, the proportion of those with insulin alone increased over time (p = 0.0066), while the proportion of those prescribed sulfonylureas decreased (p < 0.0001). Among patients receiving antidiabetic therapy at discharge, 1063 (81.2%) were also prescribed cardiovascular drugs, mainly with an antihypertensive drug alone or in combination (N = 777, 73.1%). Conclusion: The management of older patients with diabetes in a hospital setting is often sub-optimal, as shown by the increasing trend in insulin at discharge, even if an overall improvement has been highlighted by the prevalent decrease in sulfonylureas prescription

The “Diabetes Comorbidome”: A Different Way for Health Professionals to Approach the Comorbidity Burden of Diabetes

(1) Background: The disease burden related to diabetes is increasing greatly, particularly in older subjects. A more comprehensive approach towards the assessment and management of diabetes’ comorbidities is necessary. The aim of this study was to implement our previous data identifying and representing the prevalence of the comorbidities, their association with mortality, and the strength of their relationship in hospitalized elderly patients with diabetes, developing, at the same time, a new graphic representation model of the comorbidome called “Diabetes Comorbidome”. (2) Methods: Data were collected from the RePoSi register. Comorbidities, socio-demographic data, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), and functional status (Barthel Index), were recorded. Mortality rates were assessed in hospital and 3 and 12 months after discharge. (3) Results: Of the 4714 hospitalized elderly patients, 1378 had diabetes. The comorbidities distribution showed that arterial hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and COPD (22.7%), were the more frequent in subjects with diabetes. The graphic comorbidome showed that the strongest predictors of death at in hospital and at the 3-month follow-up were dementia and cancer. At the 1-year follow-up, cancer was the first comorbidity independently associated with mortality. (4) Conclusions: The “Diabetes Comorbidome” represents the perfect instrument for determining the prevalence of comorbidities and the strength of their relationship with risk of death, as well as the need for an effective treatment for improving clinical outcomes

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population