In Tuscany, Italy, New Delhi metallo-beta-lactamase-producing carbapenem-resistant Enterobacterales (NDM-CRE) have increased since November 2018. Between November 2018 and October 2019, 1,645 samples ...were NDM-CRE-positive: 1,270 (77.2%) cases of intestinal carriage, 129 (7.8%) bloodstream infections and 246 (14.9%) infections/colonisations at other sites.
were prevalent (1,495; 90.9%), with ST147/NDM-1 the dominant clone. Delayed outbreak identification and response resulted in sustained NDM-CRE transmission in the North-West area of Tuscany, but successfully contained spread within the region.
This contribution describes a case study of a “do-it-yourself” (DIY) opensource service and related product to help combating the COVID-19 emergency. It illustrates the birth of LHF Connect, a ...project designed to facilitate communication between patients isolated in COVID-19 hospitals’ ward and their relatives. LHF Connect is a teleoperated robot that can move in autonomy around the hospital. A User Centered Design approach, methods and specific tools helped in managing crucial steps of the design process such as i) the collection of needs coming from the context, stakeholders and end-users; ii) defining the service blueprint; iii) imagining finishing concepts; and iv) managing the communication activities. The initiative has been promoted by a multidisciplinary team of researchers (mainly roboticists with the help of specific competences coming from Design discipline).
The objective of this study was to verify if the enrollement of patients aged over sixty-five (over 65), in the territorial assistance programs of a mountain area, has reduced and optimized the ...volume of hospitalizations. During 2009, 422 patients over 65 who were non self-sufficient, with iso-severity level (IL) from 5 to 0 (Regione Toscana, Decreto n. 1354 del 25 Marzo 2010), were enrolled in home care programs. These data were processed despite the following analytical limitations: 1) inability to provide all tax codes (entered manually in database), the corrisponding personal data; 2) necessity to make cross-comparisons among numerous archives of data from different sources; and 3) lack to identify the outcome indicators for each patient. The assisted patients are characterized by a very high hospitalization rate. Among the main diseases, the following needed at least one hospitalization: dementia, stroke, cancer, osteoarticular diseases, cerebrovascular disease and Parkinson's disease. Therefore it is necessary to re-evaluate the current procedures adopted for the management of chronic diseases in the elderly in their own homes.
The aims of the study were to measure the paediatric, off-label use of drugs in the Italian hospital setting and to reveal areas for priority intervention by investigating the therapeutic indications ...most involved. Prescriptions given to all children admitted to nine general paediatric hospital wards from December 1998 to February 1999 were analysed. In total, 4265 prescriptions were given to 1461 children, 10 of which were unlicensed and excluded from further analysis. Sixty percent of prescriptions (range between centres: 44-71%) were off-label and concerned 89% of children receiving medications (80-96%). The main drug classes were antibacterials, antiasthmatics and analgesics, and represented 56% of off-label prescriptions. Paracetamol (385 prescriptions) and beclomethasone (339) were the generic substances most often used off-label. The most common off-label categories were dosage/frequency (50% of prescriptions), indication and lack of paediatric licence (7% each). Fifty-four per cent of all indications that led to off-label prescribing involved only respiratory problems, fever, respiratory tract infections and bronchospasm.
Despite prescription profile differences among centres, off-label use was high everywhere. Immediate action for more rational drug use is necessary and requires not only regulatory intervention but also a more evidence-based, therapeutic approach.
Lake systems are essential for the environment, the biosphere, and humans but are highly impacted by anthropogenic activities accentuated by climate change. Understanding how lake ecosystems change ...due to human impacts and natural forces is crucial to managing their current state and possible future restoration. The high sensitivity of shallow closed lakes to natural and anthropogenic forcing makes these lacustrine ecosystems highly prone to variations in precipitation and sedimentation processes. These variation processes, occurring in the water column, produce geochemical markers or proxies recorded in lake sedimentary archives. This study investigated specific proxies on high-resolution sedimentary archives (2–3 years resolution) of the Trasimeno lake (Central Italy). The Trasimeno lake underwent three different hydrological phases during the twentieth century due to several fluctuations induced mainly by human activities and climate change. The Trasimeno lake, a large and shallow basin located in the Mediterranean area, is a good case study to assess the effects of intense anthropogenic activity related to agriculture, tourism, industry, and climate changes during the Anthropocene. The aim is to identify the main characteristics of the main sedimentary events in the lake during the last 150 years, determining the concentrations of major and trace elements, the amount of organic matter, and the mineralogical composition of the sediments. This type of work demonstrates that studying sediment archives at high resolution is a viable method for reconstructing the lake’s history through the evolution/trends of the geochemical proxies stored in the sediment records. This effort makes it possible to assess past anthropogenic impact and, under the objectives of the European Green Deal (zero-pollution ambition for a toxic-free environment), to monitor, prevent, and remedy pollution related to soil and water compartments.
Graphical abstract
Pancreatic neuroendocrine tumors (pan-NENs) represent an increasingly common indication for pancreatic resection, but there are few data regarding possible recurrence after surgery. The aim of the ...study was to describe the frequency, timing, and patterns of recurrence after resection for pan-NENs with consequent implications for postoperative follow-up.
We performed a retrospective analysis of pan-NENs resected between 1990 and 2015 at The Pancreas Institute, University of Verona Hospital Trust. Predictors of recurrence were assessed. Survival analysis was conducted using the Kaplan-Meier and conditional survival (CS) methods.
The cohort consisted of 487 patients with a median follow-up of 71 months. Recurrence developed in 12.3%: 54 (11.1%) liver metastases, 11 (2.3%) local recurrence, 10 (2.1%) nodal recurrence, and 8 (1.6%) metastases in other organs. Thirty-one (6.4%) died due to disease recurrence. Size > 21 mm, G3 grade, nodal metastasis, and vascular infiltration were independent predictors of overall recurrence. Recurrence occurred either during the first year of follow-up (n = 9), or after 10 years (n = 4). CS analysis revealed that nonfunctioning G1 pan-NEN ≤20 mm without nodal metastasis or vascular invasion had a negligible risk of developing recurrence. In the present series, after 5 years of follow-up without developing recurrence, tumor recurrence occurred only in the form of liver metastases.
Recurrence of pan-NENs is rare and is predicted by tumor size, nodal metastasis, grading, and vascular invasion. Patients with G1 pan-NEN without nodal metastasis and vascular invasion may be considered cured by surgery. After 5 years without recurrence, follow-up should focus on excluding the development of liver metastases.
A multi-methodic analysis was performed on five samples of fly ashes coming from different biomasses. The aim of the study was to evaluate their possible re-use and their dangerousness to people and ...the environment. Optical granulometric analyses indicated that the average diameter of the studied fly ashes was around 20 µm, whereas only ~1 vol% had diameters lower that 2.5 µm. The chemical composition, investigated with electron probe microanalysis, indicated that all the samples had a composition in which Ca was prevalent, followed by Si and Al. Large contents of K and P were observed in some samples, whereas the amount of potentially toxic elements was always below the Italian law thresholds. Polycyclic aromatic hydrocarbons were completely absent in all the samples coming from combustion plants, whereas they were present in the fly ashes from the gasification center. Quantitative mineralogical content, determined by Rietveld analysis of X-ray powder diffraction data, indicated that all the samples had high amorphous content, likely enriched in Ca, and several K and P minerals, such as sylvite and apatite. The results obtained from the chemo-mineralogical study performed make it possible to point out that biomass fly ashes could be interesting materials (1) for amendments in clayey soils, as a substitution for lime, to stimulate pozzolanic reactions and improve their geotechnical properties, thus, on the one hand, avoiding the need to mine raw materials and, on the other hand, re-cycling waste; and (2) as agricultural fertilizers made by a new and ecological source of K and P.
A new technology was tested to improve the cooking efficiency of the raw mixture for Portland clinker production by the use of nano-Ca(OH)
. A decrease in the free lime concentration after the firing ...of approximately 35% and 55% in the nano-added clinkers burned at 1350 °C and 1450 °C, respectively, with respect to the standard Portland clinkers was observed. Moreover, in the nano-added clinkers, a slight decrease in alite (C3S), of approximately 2-4 wt%, and increase in belite (C2S), of approximately 5-6 wt%, were observed. Despite these variations, the C2S and C3S abundance lies within the ranges for standard Portland clinkers. The results showed that the nano-addition leads to an increase of the raw mixtures' cooking efficiency. The relatively low energy required for the clinker firing could be used to increase the plant productivity and decrease the CO
emissions during clinker burning. The decrease of the work index of the clinkers produced by the use of the nano-Ca(OH)
also contributes to the energy saving during clinker grinding. Differences were also found in the pore size distribution among nano-added clinkers and the standard Portland clinker. The smallest porosities with the modal volume lying in the class of 3∙10
mm
were found to increase by the use of nano-Ca(OH)
. However, the pore volumes higher than 2.0∙10
mm
decreased in the nano-added clinkers.
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