Diffusion on non exactly decimable tree-like fractals

We calculate the spectral dimension of a wide class of tree-like fractals by solving the random walk problem through a new analytical technique, based on invariance under generalized cutting-decimation transformations. These fractals are generalizations of the NTD lattices and they are characterized by non integer spectral dimension equal or greater then 2, non anomalous diffusion laws, dynamical dimension splitting and absence of phase transitions for spin models.Comment: 5 pages Latex, 3 figures (figures are poscript files

Evaluation of the prognostic value of impaired renal function on clinical progression in a large cohort of HIV-infected people seen for care in Italy

Whilst renal dysfunction, especially mild impairment (60 die;ve (Icona) Foundation Study collected between January 2000 and February 2014 with at least two creatinine values available. eGFR (CKD-epi) and renal dysfunction defined using a priori cut-offs of 60 (severely impaired) and 90 ml/min/1.73m2 (mildly impaired). Characteristics of patients were described after stratification in these groups and compared using chi-square test (categorical variables) or Kruskal Wallis test comparing median values. Follow-up accrued from baseline up to the date of the CCVD or AIDS related events or death or last available visit. Kaplan Meier curves were used to estimate the cumulative probability of occurrence of the events over time. Adjusted analysis was performed using a proportional hazards Cox regression model. We included 7,385 patients, observed for a median follow-up of 43 months (interquartile range [IQR]: 21-93 months). Over this time, 130 cerebro-cardiovascular events (including 11 deaths due to CCVD) and 311 AIDS-related events (including 45 deaths) were observed. The rate of CCVD events among patients with eGFR >90, 60-89, <60 ml/min, was 2.91 (95% CI 2.30-3.67), 4.63 (95% CI 3.51-6.11) and 11.9 (95% CI 6.19-22.85) per 1,000 PYFU respectively, with an unadjusted hazard ratio (HR) of 4.14 (95%CI 2.07-8.29) for patients with eGFR <60 ml/min and 1.58 (95%CI 1.10-2.27) for eGFR 60-89 compared to those with eGFR ≥90. Of note, these estimates are adjusted for traditional cardiovascular risk factors (e.g. smoking, diabetes, hypertension, dyslipidemia). Incidence of AIDS-related events was 9.51 (95%CI 8.35-10.83), 6.04 (95%CI 4.74-7.71) and 25.0 (95% CI 15.96-39.22) per 1,000 PYFU, among patients with eGFR >90, 60-89, <60 ml/min, respectively, with an unadjusted HR of 2.49 (95%CI 1.56-3.97) for patients with eGFR <60 ml/min and 0.68 (95%CI 0.52-0.90) for eGFR 60-89. The risk of AIDS events was significantly lower in mild renal dysfunction group even after adjustment for HIV-related characteristics. Our data confirm that impaired renal function is an important risk marker for CCVD events in the HIV-population; importantly, even those with mild renal impairment (90<60)&gt

Economic consequences of investing in anti-HCV antiviral treatment from the Italian NHS perspective : a real-world-based analysis of PITER data

OBJECTIVE: We estimated the cost consequence of Italian National Health System (NHS) investment in direct-acting antiviral (DAA) therapy according to hepatitis C virus (HCV) treatment access policies in Italy. METHODS: A multistate, 20-year time horizon Markov model of HCV liver disease progression was developed. Fibrosis stage, age and genotype distributions were derived from the Italian Platform for the Study of Viral Hepatitis Therapies (PITER) cohort. The treatment efficacy, disease progression probabilities and direct costs in each health state were obtained from the literature. The break-even point in time (BPT) was defined as the period of time required for the cumulative costs saved to recover the Italian NHS investment in DAA treatment. Three different PITER enrolment periods, which covered the full DAA access evolution in Italy, were considered. RESULTS: The disease stages of 2657 patients who consecutively underwent DAA therapy from January 2015 to December 2017 at 30 PITER clinical centres were standardized for 1000 patients. The investment in DAAs was considered to equal €25 million, €15 million, and €9 million in 2015, 2016, and 2017, respectively. For patients treated in 2015, the BPT was not achieved, because of the disease severity of the treated patients and high DAA prices. For 2016 and 2017, the estimated BPTs were 6.6 and 6.2 years, respectively. The total cost savings after 20 years were €50.13 and €55.50 million for 1000 patients treated in 2016 and 2017, respectively. CONCLUSIONS: This study may be a useful tool for public decision makers to understand how HCV clinical and epidemiological profiles influence the economic burden of HCV

Response to raltegravir-based salvage therapy in HIV-infected patients with hepatitis C virus or hepatitis B virus coinfection

Objectives To define the impact of coinfection with hepatitis B virus (HBV) or hepatitis C virus (HCV) on viroimmunological response to raltegravir-based salvage regimens that also include new HIV inhibitors such as maraviroc, darunavir and etravirine. Methods We used data from a national observational study of patients starting raltegravir-based regimens to compare virological suppression and CD4 cell change from baseline in patients with and without concomitant HBV or HCV infection. Results Overall, 275 patients (107 coinfected and 168 non-coinfected) were evaluated. Coinfected patients were more commonly former intravenous drug users and had a longer history of HIV infection and higher baseline aminotransferase levels. Both HIV-RNA and CD4 response were similar in the two groups. Mean time to first HIV-RNA copy number &lt;50 copies/mL was 4.1 months (95% CI 3.5–4.6) in non-coinfected patients and 3.9 months (95% CI 3.3–4.5) in coinfected patients (hazard ratio 1.039, 95% CI 0.761–1.418, P = 0.766, log-rank test). The risk of developing new grade 3–4 hepatic adverse events was significantly higher in coinfected patients (hazard ratio 1.779, 95% CI 1.123–2.817, P = 0.009). The two groups of coinfected and non-coinfected patients had similar rates of interruption of any baseline drug (hazard ratio 1.075, 95% CI 0.649–1.781, P = 0.776) and of raltegravir (hazard ratio 1.520, 95% CI 0.671–3.447, P = 0.311). Few AIDS-defining events and deaths occurred. Conclusions Viroimmunological response to regimens based on raltegravir and other recent anti-HIV inhibitors is not negatively affected by coinfection with HBV or HCV. Liver toxicity, either pre-existing or new, is more common in coinfected patients, but with no increased risk of treatment interruption.</br

Response to raltegravir-based salvage therapy in HIV-infected patients with hepatitis C virus or hepatitis B virus coinfection

none22OBJECTIVES: To define the impact of coinfection with hepatitis B virus (HBV) or hepatitis C virus (HCV) on viroimmunological response to raltegravir-based salvage regimens that also include new HIV inhibitors such as maraviroc, darunavir and etravirine. METHODS: We used data from a national observational study of patients starting raltegravir-based regimens to compare virological suppression and CD4 cell change from baseline in patients with and without concomitant HBV or HCV infection. RESULTS: Overall, 275 patients (107 coinfected and 168 non-coinfected) were evaluated. Coinfected patients were more commonly former intravenous drug users and had a longer history of HIV infection and higher baseline aminotransferase levels. Both HIV-RNA and CD4 response were similar in the two groups. Mean time to first HIV-RNA copy number <50 copies/mL was 4.1 months (95% CI 3.5-4.6) in non-coinfected patients and 3.9 months (95% CI 3.3-4.5) in coinfected patients (hazard ratio 1.039, 95% CI 0.761-1.418, P = 0.766, log-rank test). The risk of developing new grade 3-4 hepatic adverse events was significantly higher in coinfected patients (hazard ratio 1.779, 95% CI 1.123-2.817, P = 0.009). The two groups of coinfected and non-coinfected patients had similar rates of interruption of any baseline drug (hazard ratio 1.075, 95% CI 0.649-1.781, P = 0.776) and of raltegravir (hazard ratio 1.520, 95% CI 0.671-3.447, P = 0.311). Few AIDS-defining events and deaths occurred. CONCLUSIONS: Viroimmunological response to regimens based on raltegravir and other recent anti-HIV inhibitors is not negatively affected by coinfection with HBV or HCV. Liver toxicity, either pre-existing or new, is more common in coinfected patients, but with no increased risk of treatment interruption.openWeimer LE; Fragola V; Floridia M; Guaraldi G; Ladisa N; Francisci D; Bellagamba R; Degli Antoni A; Parruti G; Giacometti A; Manconi PE; Vivarelli A; D'Ettorre G; Mura MS; Cicalini S; Preziosi R; Sighinolfi L; Verucchi G; Libertone R; Tavio M; Sarmati L; Bucciardini R on behalf of the ISS-NIA Study GroupWeimer LE; Fragola V; Floridia M; Guaraldi G; Ladisa N; Francisci D; Bellagamba R; Degli Antoni A; Parruti G; Giacometti A; Manconi PE; Vivarelli A; D'Ettorre G; Mura MS; Cicalini S; Preziosi R; Sighinolfi L; Verucchi G; Libertone R; Tavio M; Sarmati L; Bucciardini R on behalf of the ISS-NIA Study Grou

Prospective Study on Incidence, Risk Factors and Outcome of Recurrent Clostridioides difficile Infections

Background: Limited and wide-ranging data are available on the recurrent Clostridioides difficile infection (rCDI) incidence rate. Methods: We performed a cohort study with the aim to assess the incidence of and risk factors for rCDI. Adult patients with a first CDI, hospitalized in 15 Italian hospitals, were prospectively included and followed-up for 30 d after the end of antimicrobial treatment for their first CDI. A case\u2013control study was performed to identify risk factors associated with 30-day onset rCDI. Results: Three hundred nine patients with a first CDI were included in the study; 32% of the CDI episodes (99/309) were severe/complicated; complete follow-up was available for 288 patients (19 died during the first CDI episode, and 2 were lost during follow-up). At the end of the study, the crude all-cause mortality rate was 10.7% (33 deaths/309 patients). Two hundred seventy-one patients completed the follow-up; rCDI occurred in 21% of patients (56/271) with an incidence rate of 72/10,000 patient-days. Logistic regression analysis identified exposure to cephalosporin as an independent risk factor associated with rCDI (RR: 1.7; 95% CI: 1.1\u20132.7, p = 0.03). Conclusion: Our study confirms the relevance of rCDI in terms of morbidity and mortality and provides a reliable estimation of its incidence

Attivita' di donazione, prelievo e trapianto di organi. Report 2003

On the cover: Report AIRT 2003Consiglio Nazionale delle Ricerche - Biblioteca Centrale - P.le Aldo Moro, 7 , Rome / CNR - Consiglio Nazionale delle RichercheSIGLEITItal

Energy content and carbon emission audit of building materials

The main thesis examined in this research is that "the embedded energy of construction is much more significant than the operational energy for buildings in a tropical country such as Sri Lanka". All building elements (e.g. brickwall), materials (e.g. bricks) and "primitive" raw materials (e.g. clay) are placed in an aggregation-decomposition hierarchy. The process analysis carried out here basically captures most of the energy inputs associated with levels 1 and 2 in the IFIAS (1974) scheme, and accounts for around 90% of the embedded energy in a product. These calculations are based on Tonnes of Oil Equivalent (TOE). The data required to estimate these embedded energies were collected from building materials manufacturers. A computerised database was implemented using a relational database management system. This can be used to represent and calculate the embedded energies and carbon coefficients of building materials and elements that are hierarchically arranged. It can also handle multiple sources of data and perform calculations to give the average, maximum and minimum embedded energies, which are also classified according to fuel type and process stage. Though the analysis was done assuming that the final building is located in the City of Colombo, these database values can be used, with some caution, for buildings even outside the Colombo City or District. The embedded energy requirements were also calculated on the basis of the lowest quality energy (bio-equivalent energy), in addition to the more conventional basis of TOE. According to energy quality calculations carried out (based on efficiency considerations), 1GJ of energy from electricity is equivalent to 5 GJ of biomass energy, 1 GJ of fossil fuel energy is equivalent to 1.8 GJ of biomass energy and 1 GJ of electrical energy is equivalent to 2.78 GJ of fossil fuel energy. It is seen that the price per unit of biomass energy based on the actual prices of products is around one third of the actual price per unit of biomass energy. For fossil fuel and electricity on the other hand, the actual prices of products are much higher than the actual prices of the energy sources used for their production. In order to minimise adverse energy effects and to give a beneficial effect to halting global warming, policy measures to promote timber products are desirable. It is also seen that though materials which use timber fuels (e.g. bricks and tiles) consume more energy, the use of timber fuels is more competitive when compared on a bio-equivalent unit basis. Furthermore, with respect to carbon emissions, wood fuels are considered to be self sustaining. The use of timber, whether as a construction material or a fuel, will require properly planned re-forestation strategies. The energy contribution from walls for a typical two storey house is from 10 - 44%; for a single storey house it is from 29 - 49%. The contribution from roofs for the two storey house is from 4 - 7%, whereas it is 8 - 16% for the single storey house. The contribution from windows is 0.6 - 3% for the single storey house and 0.2 - 4.5% for the two storey. house. The contribution from the floor slab for the two storey house is 6 - 7%. The above ranges are a result of the difference of the between the use of low and high energy materials. The ratio between total embedded energy and annual operational energy for the buildings selected lies between 14 to 35 for the houses while for an office building with air conditioning loading it is 5. Though air conditioning has a large contribution towards the annual operational energy of a building, the total number of air conditioned buildings are small for a developing country such as Sri Lanka. Nevertheless, the results of the analysis show that the focus of energy efficient designs for buildings with air conditioning has to be on the operational energy. On the other hand, for houses, which are largely not air conditioned, the way to promote efficiency is by reducing the embedded energy through the appropriate choice of building materials. This is borne out not only by the high ratio of construction to operational energy ratio obtained, but also by the fact that the ratios for houses with low energy materials is almost half those for the houses with high energy materials. Key Words : Embedded Energy, Process Analysis, Building Materials, Carbon Emissions, Energy Databas