Comparing energy system optimization models and integrated assessment models: Relevance for energy policy advice

Background

The transition to a climate neutral society such as that envisaged in the European Union Green Deal requires careful and comprehensive planning. Integrated assessment models (IAMs) and energy system optimisation models (ESOMs) are both commonly used for policy advice and in the process of policy design. In Europe, a vast landscape of these models has emerged and both kinds of models have been part of numerous model comparison and model linking exercises. However, IAMs and ESOMs have rarely been compared or linked with one another.

Methods

This study conducts an explorative comparison and identifies possible flows of information between 11 of the integrated assessment and energy system models in the European Climate and Energy Modelling Forum. The study identifies and compares regional aggregations and commonly reported variables. We define harmonised regions and a subset of shared result variables that enable the comparison of scenario results across the models.

Results

The results highlight how power generation and demand development are related and driven by regional and sectoral drivers. They also show that demand developments like for hydrogen can be linked with power generation potentials such as onshore wind power. Lastly, the results show that the role of nuclear power is related to the availability of wind resources.

Conclusions

This comparison and analysis of modelling results across model type boundaries provides modellers and policymakers with a better understanding of how to interpret both IAM and ESOM results. It also highlights the need for community standards for region definitions and information about reported variables to facilitate future comparisons of this kind. The comparison shows that regional aggregations might conceal differences within regions that are potentially of interest for national policy makers thereby indicating a need for national-level analysis.

ERS International Congress 2023: highlights from the Airway Diseases Assembly

In this review, early career and senior members of Assembly 5 (Airway Diseases, Asthma, COPD and Chronic Cough) present key recent findings pertinent to airway diseases that were presented during the European Respiratory Society International Congress 2023 in Milan, Italy, with a particular focus on asthma, COPD, chronic cough and bronchiectasis. During the congress, an increased number of symposia, workshops and abstract presentations were organised. In total, 739 abstracts were submitted for Assembly 5 and the majority of these were presented by early career members. These data highlight the increased interest in this group of respiratory diseases.

Forearm bisection task suggests an alteration in body schema in patients with functional movement disorders (motor conversion disorders)

OBJECTIVES

To explore potential alterations of the Body Schema, the implicit sensorimotor representation of one's own body, in patients with Functional Movement Disorders (FMD, Motor Conversion Disorders), characterized by neurological symptoms of altered voluntary motor function that cannot be explained by typical medical conditions. This investigation is prompted by the potential dissociation from their reportedly intact sense of ownership.

METHODS

10 FMD patients and 11 healthy controls (HC) underwent the Forearm Bisection Task, aimed at assessing perceived body metrics, which consists in asking the subject, blindfolded, to repeatedly point at the perceived middle point of their dominant forearm with the index finger of their contralateral hand, and a psychometric assessment for anxiety, depression, alexithymia, and tendency to dissociation.

RESULTS

FMD patients bisected their forearm more proximally (with an increased shift towards their elbow equal to 7.5%) with respect to HC; average bisection point was positively associated with anxiety levels in the whole sample, and with the tendency to dissociation in the FMD group.

CONCLUSIONS

FMD patients perceive their forearm as shorter than HC, suggesting an alteration of their Body Schema. The Body Schema can go through short- and long-term updates in the life course, mainly related to the use of each body segment; we speculate that, despite FMD being a disorder of functional nature, characterized by variability and fluctuations in symptomatology, the lack of sense of agency over a body part might be interpreted by the nervous system as disuse and hence influence the Body Schema, as deficits of organic etiology do.

Mycophenolate and azathioprine efficacy in interstitial lung disease: a systematic review and meta-analysis

OBJECTIVES

Mycophenolate mofetil (MMF) and azathioprine (AZA) are immunomodulatory treatments in interstitial lung disease (ILD). This systematic review aimed to evaluate the efficacy of MMF or AZA on pulmonary function in ILD.

DESIGN

Population included any ILD diagnosis, intervention included MMF or AZA treatment, outcome was delta change from baseline in per cent predicted forced vital capacity (%FVC) and gas transfer (diffusion lung capacity of carbon monoxide, %DLco). The primary endpoint compared outcomes relative to placebo comparator, the secondary endpoint assessed outcomes in treated groups only.

ELIGIBILITY CRITERIA

Randomised controlled trials (RCTs) and prospective observational studies were included. No language restrictions were applied. Retrospective studies and studies with high-dose concomitant steroids were excluded.

DATA SYNTHESIS

The systematic search was performed on 9 May. Meta-analyses according to drug and outcome were specified with random effects, I2 evaluated heterogeneity and Grading of Recommendations, Assessment, Development and Evaluation evaluated certainty of evidence. Primary endpoint analysis was restricted to RCT design, secondary endpoint included subgroup analysis according to prospective observational or RCT design.

RESULTS

A total of 2831 publications were screened, 12 were suitable for quantitative synthesis. Three MMF RCTs were included with no significant effect on the primary endpoints (%FVC 2.94, 95% CI -4.00 to 9.88, I2=79.3%; %DLco -2.03, 95% CI -4.38 to 0.32, I2=0.0%). An overall 2.03% change from baseline in %FVC (95% CI 0.65 to 3.42, I2=0.0%) was observed in MMF, and RCT subgroup summary estimated a 4.42% change from baseline in %DLCO (95% CI 2.05 to 6.79, I2=0.0%). AZA studies were limited. All estimates were considered very low certainty evidence.

CONCLUSIONS

There were limited RCTs of MMF or AZA and their benefit in ILD was of very low certainty. MMF may support preservation of pulmonary function, yet confidence in the effect was weak. To support high certainty evidence, RCTs should be designed to directly assess MMF efficacy in ILD.

PROSPERO REGISTRATION NUMBER

CRD42023423223.

Autistic traits, sensory sensitivity and eating disturbances in a sample of young adults referring to a generalized mental health clinic

PURPOSE

The relationship between autistic traits and eating disturbances has been given considerable attention over the last decades. The rise of a dimensional approach to psychopathology has expanded the way we think about autism, acknowledging that subthreshold autistic manifestations span across the general population and are more pronounced in psychiatric patients. Here we investigated the prevalence of eating disorders and its potential relationship with autistic traits and sensory sensitivity in a group of patients who were referred for the first time to a mental health outpatient clinic, without a formal diagnosis yet.

METHODS

259 young adults (between 18 and 24 years old) completed: the Eating Attitude Test (EAT-26), the Swedish Eating Assessment for Autism Spectrum Disorders (SWEAA), the Autism Quotient (AQ), the Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R), and the Sensory Perception Quotient-Short Form 35 item (SPQ-SF35).

RESULTS

23.55% of participants scored above the cut-off at the EAT-26, suggesting that they presented a risk for eating disorders and should be assessed by a specialized clinician; associations emerged between hypersensitivity in the touch and vision domain and both the EAT-26 and the SWEAA; the presence of autistic traits was largely associated with eating disturbances.

CONCLUSIONS

This study underlines the significance of the eating domain as a central psychopathological feature in the distress experienced by young adults with general psychiatric symptoms and psychological suffering; it adds evidence to the association between autistic traits and eating disorders and opens to new research questions about the role of subthreshold autistic traits in general psychopathology.

LEVEL OF EVIDENCE

Level I: Evidence obtained from experimental studies.

First Dark Matter Search with Nuclear Recoils from the XENONnT Experiment

We report on the first search for nuclear recoils from dark matter in the form of weakly interacting massive particles (WIMPs) with the XENONnT experiment, which is based on a two-phase time projection chamber with a sensitive liquid xenon mass of 5.9 ton. During the (1.09±0.03)  ton yr exposure used for this search, the intrinsic ^{85}Kr and ^{222}Rn concentrations in the liquid target are reduced to unprecedentedly low levels, giving an electronic recoil background rate of (15.8±1.3)  events/ton yr keV in the region of interest. A blind analysis of nuclear recoil events with energies between 3.3 and 60.5 keV finds no significant excess. This leads to a minimum upper limit on the spin-independent WIMP-nucleon cross section of 2.58×10^{-47}  cm^{2} for a WIMP mass of 28  GeV/c^{2} at 90% confidence level. Limits for spin-dependent interactions are also provided. Both the limit and the sensitivity for the full range of WIMP masses analyzed here improve on previous results obtained with the XENON1T experiment for the same exposure.

Involvement of Myofascial Spiral Chains of the Lower Limb in Semi-unipodal Balance: A Pilot Study

Introduction Single-leg stance has been extensively studied for functional evaluation, therapeutic exercise, sports training, and fall prevention. However, the motor strategies of the supporting limb have been investigated only at the ankle level. It is not known, at the hip, how the muscular system reacts to medial and lateral imbalances. We hypothesize, based on a myofascial chain approach, that the balance is managed by the front and back spiral chains. The aim of this work was to perform a preliminary experimental analysis to verify the spiral chain hypothesis, testing a method to investigate the motor strategies underlying equilibrium. Methods Five healthy subjects (i.e. without neurological or orthopedic pathologies affecting the upright position) underwent perturbations of their monopodal balance while a surface electromyographic analysis of gluteus maximus, gluteus medius, adductor longus (ADD), tibialis anterior (TA), and peroneus longus (PL) was executed. The percentage of electrical activation with respect to maximal contraction was calculated for each muscle investigated. The coordination in activation between the hip and ankle muscles was analyzed by the Pearson correlation coefficient. Results Of the studied muscles, TA (43% of maximal contraction) and gluteus medius (28%) had the average highest reaction to lateral imbalance and the highest correlation coefficient (0.89, p-value<0.01); PL (35%) and ADD (16%) were the most relevant in counteracting the medial imbalance (correlation coefficient=0.83, p-value<0.01).  Conclusion The study was performed on a few subjects, and the muscles of the lower limb were only partially investigated. However, the consistency of the results with former experimental studies provided preliminary evidence of the adequacy of the method adopted. The correlation of hip and ankle muscle activations was in line with the spiral chain hypothesis.

Searching for Heavy Dark Matter near the Planck Mass with XENON1T

Multiple viable theoretical models predict heavy dark matter particles with a mass close to the Planck mass, a range relatively unexplored by current experimental measurements. We use 219.4 days of data collected with the XENON1T experiment to conduct a blind search for signals from multiply interacting massive particles (MIMPs). Their unique track signature allows a targeted analysis with only 0.05 expected background events from muons. Following unblinding, we observe no signal candidate events. This Letter places strong constraints on spin-independent interactions of dark matter particles with a mass between 1×10^{12} and 2×10^{17}  GeV/c^{2}. In addition, we present the first exclusion limits on spin-dependent MIMP-neutron and MIMP-proton cross sections for dark matter particles with masses close to the Planck scale.

How to Treat Type B Aortic Dissections in the Presence of an Aberrant Right Subclavian Artery: A Systematic Review

An aberrant right subclavian artery (ARSA) is the most common congenital variant of the aortic arch. Usually, this variation is largely asymptomatic, but sometimes it may be involved in aortic dissection (AD). Surgical management of this condition is challenging. The therapeutic options have been enriched in recent decades by establishing individualized endovascular or hybrid procedures. Whether these less invasive approaches bear advantages, and how they have changed the treatment of this rare pathology, is still unclear. Therefore, we conducted a systematic review. We performed a review of literature from the past 20 years (from January 2000 until February 2021) complying with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. All reported patients treated for Type B AD in the presence of an ARSA were identified and classified into three groups according to the received therapy (open, hybrid, and total endovascular). Patient characteristics, as well as in-hospital mortality, and major and minor complications were determined and statistically analyzed. We identified 32 relevant publications comprising 85 patients. Open arch repair has been offered to younger patients, but significantly less often in symptomatic patients needing urgent repair. Therefore, the maximum aortic diameter was also significantly larger in the open repair group compared with that in the hybrid or total endovascular repair group. Regarding the endpoints, we did not find significant differences. The literature review revealed that open surgical therapies are preferred in patients presenting with chronic dissections and larger aortic diameters, most likely because they are unsuitable for endovascular aortic repair. Hybrid and total endovascular approaches are more often applied in emergency situations, where aortic diameters remain smaller. All therapies demonstrated good, early, and midterm outcomes. But, these therapies carry potential risks in the long term. Therefore, long-term follow-up data are urgently needed to validate that these therapies are sustainable.

Prevalence and determinants of hip pain in non-ambulatory cerebral palsy children: a retrospective cohort study

BACKGROUND

Hip pain is common in cerebral palsy children, particularly at Gross-Motor Function Classification System level IV-V. It is associated to hip displacement and relates to the migration percentage. Recent literature suggested early reconstructive bone surgery, as the best approach to prevent hip luxation, then hip pain. Still, high rates of hip pain are reported.

AIM

To investigate prevalence and determinants of hip pain in an Italian cerebral palsy sample.

DESIGN

Single-center retrospective cohort study.

SETTING

Inpatient and outpatient.

POPULATION

Patients with spastic or dyskinetic cerebral palsy, Gross-Motor Function Classification System level IV or V, age 0-18.

METHODS

A chart review was implemented to report hip pain, as a dichotomous variable (pain/no pain), age, sex, cerebral palsy subtype, Gross-Motor Function level, lumbar scoliosis, migration percentage, previous orthopedic surgery, or botulinum injections, oral or intrathecal baclofen, drug-resistant epilepsy, assistive devices for standing or walking. Descriptive statistics and a multivariate logistic stepwise regression were performed.

RESULTS

A total of 504 subjects were included: 302 level V, 209 females, 432 spastics. The mean length of follow-up was 6 years. The overall prevalence of hip pain was 8.9% (6.3% were at level V) and of hip dislocation was 19% (15.9% were at level V). Just 39% of dislocated hips were painful. Children at spastic subtype and level V were predominantly affected. Botulinum and soft tissue surgery related to lower rates of hip pain, without statistical significance. Age (OR 1.19, 95%CI 1.14-1.25, P value 0.000), sex (OR 1.72, 95%CI 1.18-2.52, P value 0.005), migration percentage (OR 1.02, 95%CI 1.02-1.03, P value 0.000) and lumbar scoliosis (OR 1.32, 95%CI 0.86-2.01, P value 0.200) resulted significant independent determinants of hip pain.

CONCLUSIONS

Hip pain relates with the migration percentage, but not all dislocated hips become painful. Hip pain may be transient and requires a targeted and individualized approach. Children at spastic subtype and level V were predominantly affected. Age and sex are confirmed as determinants. Specific validated measures are to be implemented to assess hip pain.

CLINICAL REHABILITATION IMPACT

Considering severe non-ambulatory cerebral palsy patients, pain and quality of life should be considered as outcomes, in the management of hip luxation.

Hip subluxation in Italian cerebral palsy children and its determinants: a retrospective cohort study

The study's aim was two-fold: to describe the trend of hip subluxation in the largest sample of Italian nonambulatory cerebral palsy (CP) children ever published; to investigate its determinants. This single-centre retrospective cohort study included patients with spastic or dyskinetic CP, Gross Motor Function Classification System (GMFCS) level IV or V, age 0-18 years, having been referred to our unit before March 2020. The hip subluxation was measured by means of the migration percentage (MP). Other data were gathered such as sex, CP subtype, GMFCS level, presence of drug-resistant epilepsy, age, use of walkers with weight relief or standing devices, previous botulinum injection or hip surgery, oral or intrathecal baclofen and hip pain. Multiple linear stepwise regression was performed and descriptive statistics are provided. Spastic CP had MP maximum increase in early ages, with GMFCS level V values persistently higher than level IV. The dyskinetic subtype showed a slower increase of the MP, with GMFCS level IV presenting similar or higher values, compared to level V. Age, CP severity and spastic subtype are the main determinants. The stepwise multiple regression analysis demonstrated that weight relief walking and standing assistive devices, combined with botulinum contributed to reduce the MP progression. Dyskinetic CP showed overall lower MP values and a more variable behaviour relative to age and GMFCS level, compared to the spastic subtype. Standing and walking assistive devices, with partial or total weight relief, combined with individually targeted botulinum injections, should be considered in the management of bilateral nonambulatory CP patients, to prevent hip subluxation or its recurrence after surgery.

Search for New Physics in Electronic Recoil Data from XENONnT

We report on a blinded analysis of low-energy electronic recoil data from the first science run of the XENONnT dark matter experiment. Novel subsystems and the increased 5.9 ton liquid xenon target reduced the background in the (1, 30) keV search region to (15.8±1.3)  events/(ton×year×keV), the lowest ever achieved in a dark matter detector and ∼5 times lower than in XENON1T. With an exposure of 1.16 ton-years, we observe no excess above background and set stringent new limits on solar axions, an enhanced neutrino magnetic moment, and bosonic dark matter.

Redefining a minimal rehabilitation assessment protocol for severe acquired brain injuries

BACKGROUND

The assessment of patients with severe Acquired Brain Injury (sABI) is mandatory in every phase and setting of care, and requires a multidimensional and interdisciplinary approach, to develop the individual rehabilitation project, and monitor long-term functional outcomes. In 2001 the Italian Society of Physical and Rehabilitation Medicine (SIMFER) published the minimal assessment protocol for traumatic sABI, providing a comprehensive, standardized functional assessment based on the International Classification of Functioning, Disability and Health (ICF), 2001. In 2007, a new protocol was published, extended to all sABI patients (PMGCA). In 2019, the SIMFER appointed a working group to provide a revised, updated version: the PMGCA2020.

AIM

The purpose of this study was to describe the minimal assessment protocol to be applied at every stage and setting of the care process of patients with sABI.

METHODS

The working group, including one neurologist and 11 physiatrists experts in sABI rehabilitation, performed a review of the international recommendations for sABI assessment focusing on the following key words: "sABI assessment," "sABI rehabilitation," "sABI prognostic factors," "sABI rehabilitation assessment," "sABI outcome," in MEDLINE. Revision and integration proposals by each member were written and motivated, discussed and voted.

RESULTS

The PMGCA2020 is addressed to sABI adult patients. It investigates the main clinical problems of sABI at any time of the rehabilitation pathway. It includes a demographic/anamnestic section, a clinical/functional assessment section and an outcome measures section following the ICF model of functioning and the model of the construction of the rehabilitation project.

CONCLUSIONS

The PMGCA2020 provides an updated tool for the multidimensional rehabilitation assessment of sABI patients, at any stage of the rehabilitation pathway. Further studies will allow the validation of this minimum set of variables paving the way to an assessment standardization of patients with sABI in the rehabilitation settings.

CLINICAL REHABILITATION IMPACT

This minimum set of variables, defining patient's functioning and clinical status and outcomes, at every stage and setting of the care process to provide a framework for the standardization of the clinical evaluation of patients with sABI in rehabilitation settings.

Material radiopurity control in the XENONnT experiment

The selection of low-radioactive construction materials is of the utmost importance for rare-event searches and thus critical to the XENONnT experiment. Results of an extensive radioassay program are reported, in which material samples have been screened with gamma-ray spectroscopy, mass spectrometry, and \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$^{222}$$\end{document}222Rn emanation measurements. Furthermore, the cleanliness procedures applied to remove or mitigate surface contamination of detector materials are described. Screening results, used as inputs for a XENONnT Monte Carlo simulation, predict a reduction of materials background (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\sim $$\end{document}∼17%) with respect to its predecessor XENON1T. Through radon emanation measurements, the expected \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$^{222}$$\end{document}222Rn activity concentration in XENONnT is determined to be 4.2 (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$^{+0.5}_{-0.7}$$\end{document}-0.7+0.5) \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\upmu $$\end{document}μBq/kg, a factor three lower with respect to XENON1T. This radon concentration will be further suppressed by means of the novel radon distillation system.

Diversity of options to eliminate fossil fuels and reach carbon neutrality across the entire European energy system

Disagreements persist on how to design a self-sufficient, carbon-neutral European energy system. To explore the diversity of design options, we develop a high-resolution model of the entire European energy system and produce 441 technically feasible system designs that are within 10% of the optimal economic cost. We show that a wide range of systems based on renewable energy are feasible, with no need to import energy from outside Europe. Model solutions reveal considerable flexibility in the choice and geographical distribution of new infrastructure across the continent. Balanced renewable energy supply can be achieved either with or without mechanisms such as biofuel use, curtailment, and expansion of the electricity network. Trade-offs emerge once specific preferences are imposed. Low biofuel use, for example, requires heat electrification and controlled vehicle charging. This exploration of the impact of preferences on system design options is vital to inform urgent, politically difficult decisions for eliminating fossil fuel imports and achieving European carbon neutrality.

Chronic cough in adults: recommendations from an Italian intersociety consensus

BACKGROUND

Chronic cough (CC) is a burdensome health problem in adult and older people, with a major impact on quality of life. Its management is often troublesome, and many guidelines have been released. Notwithstanding, a proportion of cases still do not reach a definite diagnosis and resolutive treatment. A coordinated approach between different specialists would be highly recommended, but its implementation in clinical practice suffers from the lack of shared protocols and poor awareness of the problem. The present consensus document has been implemented to address these issues.

AIMS

To develop evidence-based recommendations for the management of adults with CC.

METHODS

A 12-member expert task force of general practitioners, geriatricians, pneumologists, allergologists, otorhynolaringologists and gastroenterologists was established to develop evidence-based recommendations for the diagnostic and therapeutic approach to subjects with CC. A modified Delphi approach was used to achieve consensus, and the US Preventive Services Task Force system was used to rate the strength of recommendations and the quality of evidence.

RESULTS

A total of 56 recommendations were proposed, covering 28 topics and concerning definitions and epidemiology, pathogenesis and etiology, diagnostic and therapeutic approach along with the consideration of specific care settings.

CONCLUSION

These recommendations should ease the management of subjects with CC by coordinating the expertise of different specialists. By providing a convenient list of topics of interest, they might assist in identifying unmet needs and research priorities.

A retrospective cohort study about hip luxation in non-ambulatory cerebral palsy patients: The point of no return

PURPOSE

The migration percentage is a widely used criterion for surgery in displaced hips. Literature suggests that no hip can spontaneously improve if the migration percentage exceeds 45%, in a mixed population of cerebral palsy children. The aim of the present article was to identify the point of no return of the migration percentage in a selected sample of non-ambulatory cerebral palsy children, being the most exposed to hip luxation.

METHODS

This single-center retrospective cohort study included patients with spastic or dyskinetic cerebral palsy, Gross Motor Function Classification System level IV or V, age 0-18, having at least three pelvic radiographies, excluding radiographies relative to hips having previously undergone surgery. The following information was collected: sex, cerebral palsy subtype, Gross Motor Function Classification System level, presence of drug-resistant epilepsy, migration percentage, age at assessment, use of walking or standing assistive devices, previous botulinum injection, oral or intrathecal baclofen, and hip pain. Data were analyzed at the level of the individual hips. Descriptive statistics were presented. Receiver operating characteristic curve analysis was conducted to investigate which value of the migration percentage could be adopted as the "point of no return": that is, the cutoff value beyond which no migration percentage reduction, by more than 5%, could be expected.

RESULTS

The optimal cutoff value was identified as migration percentage ≥50%, with a sensitivity of 84.5% and a specificity of 100% (p-value <0.001).

CONCLUSION

Based on the present study, migration percentage ≥50% is the "point of no return" for Gross Motor Function Classification System IV-V cerebral palsy patients, representing the cutoff value beyond which no spontaneous cerebral palsy reduction may be expected, unless addressing surgery.

LEVEL OF EVIDENCE

level II-retrospective study.

Prevalence and features of delirium in older patients admitted to rehabilitation facilities: a multicenter study

BACKGROUND

Delirium is thought to be common across various settings of care; however, still little research has been conducted in rehabilitation.

AIM

We investigated the prevalence of delirium, its features and motor subtypes in older patients admitted to rehabilitation facilities during the three editions of the "Delirium Day project".

METHODS

We conducted a cross-sectional study in which 1237 older patients (age ≥ 65 years old) admitted to 50 Italian rehabilitation wards during the three editions of the "Delirium Day project" (2015 to 2017) were included. Delirium was evaluated through the 4AT and its motor subtype with the Delirium Motor Subtype Scale.

RESULTS

Delirium was detected in 226 patients (18%), and the most recurrent motor subtype was mixed (37%), followed by hypoactive (26%), hyperactive (21%) and non-motor one (16%). In a multivariate Poisson regression model with robust variance, factors associated with delirium were: disability in basic (PR 1.48, 95%CI: 1.17-1.9, p value 0.001) and instrumental activities of daily living (PR 1.58, 95%CI: 1.08-2.32, p value 0.018), dementia (PR 2.10, 95%CI: 1.62-2.73, p value < 0.0001), typical antipsychotics (PR 1.47, 95%CI: 1.10-1.95, p value 0.008), antidepressants other than selective serotonin reuptake inhibitors (PR 1.3, 95%CI: 1.02-1.66, p value 0.035), and physical restraints (PR 2.37, 95%CI: 1.68-3.36, p value < 0.0001).

CONCLUSION

This multicenter study reports that 2 out 10 patients admitted to rehabilitations had delirium on the index day. Mixed delirium was the most prevalent subtype. Delirium was associated with unmodifiable (dementia, disability) and modifiable (physical restraints, medications) factors. Identification of these factors should prompt specific interventions aimed to prevent or mitigate delirium.

The association between low skeletal muscle mass and delirium: results from the nationwide multi-centre Italian Delirium Day 2017

Introduction

Delirium and sarcopenia are common, although underdiagnosed, geriatric syndromes. Several pathological mechanisms can link delirium and low skeletal muscle mass, but few studies have investigated their association. We aimed to investigate (1) the association between delirium and low skeletal muscle mass and (2) the possible role of calf circumference mass in finding cases with delirium.

Methods

The analyses were conducted employing the cross-sectional “Delirium Day” initiative, on patient 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes and hospices in Italy in 2017. Delirium was diagnosed as a 4 + score at the 4-AT scale. Low skeletal muscle mass was operationally defined as calf circumference ≤ 34 cm in males and ≤ 33 cm in females. Logistic regression models were used to investigate the association between low skeletal muscle mass and delirium. The discriminative ability of calf circumference was evaluated using non-parametric ROC analyses.

Results

A sample of 1675 patients was analyzed. In total, 73.6% of participants had low skeletal muscle mass and 24.1% exhibited delirium. Low skeletal muscle mass and delirium showed an independent association (OR: 1.50; 95% CI 1.09–2.08). In the subsample of patients without a diagnosis of dementia, the inclusion of calf circumference in a model based on age and sex significantly improved its discriminative accuracy [area under the curve (AUC) 0.69 vs 0.57, p < 0.001].

Discussion and conclusion

Low muscle mass is independently associated with delirium. In patients without a previous diagnosis of dementia, calf circumference may help to better identify those who develop delirium.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40520-021-01950-8.

Dispersion of the surface phonons in semiconductor/topological insulator Si/Bi2Te3 heterostructure studied by high resolution Brillouin spectroscopy

The dynamics and dispersion of surface phonons in heterostructure semiconductor/ topological insulator Si/Bi₂Te₃ was investigated using high resolution Brillouin light scattering method in the GHz frequency range. Both Rayleigh and Sezawa surface acoustic waves have been observed for wave vectors ranging from 0.006 to 0.023 nm^-1. Anomaly in dispersion relations ω(q) for both surface waves were detected for the wave vector q = 0.016 nm^-1. The finite element method (FEM) was used to simulate the observed shapes of ω(q) and to find the deformation profiles of surface acoustic waves. We attribute the observed changes to the coupling between low energy electrons and surface phonons. The coupling between helical Dirac states and surface phonons is discussed in the frame of accessible theoretical models.

Correlation analysis of vibration modes in physical vapour deposited Bi2Se3 thin films probed by the Raman mapping technique

In this work, the Raman spectroscopy mapping technique is used for the analysis of mechanical strain in Bi₂Se₃ thin films of various (3-400 nm) thicknesses synthesized by physical vapour deposition on amorphous quartz and single-layer graphene substrates. The evaluation of strain effects is based on the correlation analysis of in-plane (E² _g) and out-of-plane (A² _1g) Raman mode positions. For Bi₂Se₃ films deposited on quartz, experimental datapoints are scattered along the line with a slope of ∼0.85, related to the distribution of hydrostatic strain. In contrast to quartz/Bi₂Se₃ samples, for graphene/Bi₂Se₃ heterostructures with the same thicknesses, an additional negative slope of ∼-0.85, which can be associated with the distribution of the in-plane (a-b) biaxial tensile strain due to the film-substrate lattice mismatch, is observed. The algorithm of phonon deformation potential (PDP) calculation based on the proposed strain analysis for the 3 nm thick Bi₂Se₃ film deposited on the graphene substrate, where the strain is considered to be coherent across the thickness, is demonstrated. The PDPs for biaxial in-plane strain of the Bi₂Se₃ 3 nm film in in-plane and out-of-plane modes are equal to -7.64 cm^-1/% and -6.97 cm^-1/%, respectively.

Residual respiratory impairment after COVID-19 pneumonia

INTRODUCTION

The novel coronavirus SARS-Cov-2 can infect the respiratory tract causing a spectrum of disease varying from mild to fatal pneumonia, and known as COVID-19. Ongoing clinical research is assessing the potential for long-term respiratory sequelae in these patients. We assessed the respiratory function in a cohort of patients after recovering from SARS-Cov-2 infection, stratified according to PaO2/FiO2 (p/F) values.

METHOD

Approximately one month after hospital discharge, 86 COVID-19 patients underwent physical examination, arterial blood gas (ABG) analysis, pulmonary function tests (PFTs), and six-minute walk test (6MWT). Patients were also asked to quantify the severity of dyspnoea and cough before, during, and after hospitalization using a visual analogic scale (VAS). Seventy-six subjects with ABG during hospitalization were stratified in three groups according to their worst p/F values: above 300 (n = 38), between 200 and 300 (n = 30) and below 200 (n = 20).

RESULTS

On PFTs, lung volumes were overall preserved yet, mean percent predicted residual volume was slightly reduced (74.8 ± 18.1%). Percent predicted diffusing capacity for carbon monoxide (DLCO) was also mildly reduced (77.2 ± 16.5%). Patients reported residual breathlessness at the time of the visit (VAS 19.8, p < 0.001). Patients with p/F below 200 during hospitalization had lower percent predicted forced vital capacity (p = 0.005), lower percent predicted total lung capacity (p = 0.012), lower DLCO (p < 0.001) and shorter 6MWT distance (p = 0.004) than patients with higher p/F.

CONCLUSION

Approximately one month after hospital discharge, patients with COVID-19 can have residual respiratory impairment, including lower exercise tolerance. The extent of this impairment seems to correlate with the severity of respiratory failure during hospitalization.

Total organic carbon as a proxy for metal release from biostabilized wastes

In this study, we introduce a simple screening method to predict the metal release from biostabilized wastes as a function of the total organic carbon (TOC) content of the sample. The method relies on a model that simulates the release of dissolved organic carbon (DOC) as a function of the applied liquid to solid (L/S) ratio. The metal release is then estimated using generic empirical DOC to metal correlation coefficients (K_DOC,Me) extrapolated from the literature. Specifically, the results of leaching tests carried out on different types of biowastes and biostabilized wastes were used to calculate the upper and lower K_DOC,Me values that can be expected for common metals of concern (Al, Ba, Cr, Cu, Mo, Ni, Pb, V, and Zn). The statistical analysis of the estimated empirical coefficients highlighted that for most of the investigated metals, the adoption of generic DOC to metal correlation coefficients introduces relatively low uncertainties. The quartiles ratio (QR calculated as the ratio of third and first quartile) of the K_DOC,Me coefficients extrapolated from the literature was indeed below 3 for Cu, Ni, and Zn and below 5 for Al, Ba, Cr, Pb, and V. Only for Mo, the QR was around 10 indicating that for this element, DOC can be a poor indicator of the release expected as a function of the applied L/S. Furthermore, by performing a sensitivity analysis, we found that the experimental conditions only slightly influence the metals release predicted by the model. Based on this evidence, simple nomograms that estimate the cumulative metal release in percolation column tests as a function of the applied L/S are provided. Furthermore, a simple equation that predicts the cumulative metal release expected at L/S of 10 L/kg is presented. The application of the latter to the results of percolation column tests carried out on 8 mechanical biological treatment (MBT) waste samples highlighted that the predicted metals release was close to the measured values with deviations within a factor of 5 for all the investigated metals.

222 Rn emanation measurements for the XENON1T experiment

The selection of low-radioactive construction materials is of utmost importance for the success of low-energy rare event search experiments. Besides radioactive contaminants in the bulk, the emanation of radioactive radon atoms from material surfaces attains increasing relevance in the effort to further reduce the background of such experiments. In this work, we present the 222 Rn emanation measurements performed for the XENON1T dark matter experiment. Together with the bulk impurity screening campaign, the results enabled us to select the radio-purest construction materials, targeting a 222 Rn activity concentration of 10 μ Bq / kg in 3.2 t of xenon. The knowledge of the distribution of the 222 Rn sources allowed us to selectively eliminate problematic components in the course of the experiment. The predictions from the emanation measurements were compared to data of the 222 Rn activity concentration in XENON1T. The final 222 Rn activity concentration of ( 4.5 ± 0.1 ) μ Bq / kg in the target of XENON1T is the lowest ever achieved in a xenon dark matter experiment.

Search for Coherent Elastic Scattering of Solar ^{8}B Neutrinos in the XENON1T Dark Matter Experiment

We report on a search for nuclear recoil signals from solar ^{8}B neutrinos elastically scattering off xenon nuclei in XENON1T data, lowering the energy threshold from 2.6 to 1.6  keV. We develop a variety of novel techniques to limit the resulting increase in backgrounds near the threshold. No significant ^{8}B neutrinolike excess is found in an exposure of 0.6  t×y. For the first time, we use the nondetection of solar neutrinos to constrain the light yield from 1-2 keV nuclear recoils in liquid xenon, as well as nonstandard neutrino-quark interactions. Finally, we improve upon world-leading constraints on dark matter-nucleus interactions for dark matter masses between 3 and 11  GeV c^{-2} by as much as an order of magnitude.

Deep Learning for Historical Document Analysis and Recognition-A Survey

Nowadays, deep learning methods are employed in a broad range of research fields. The analysis and recognition of historical documents, as we survey in this work, is not an exception. Our study analyzes the papers published in the last few years on this topic from different perspectives: we first provide a pragmatic definition of historical documents from the point of view of the research in the area, then we look at the various sub-tasks addressed in this research. Guided by these tasks, we go through the different input-output relations that are expected from the used deep learning approaches and therefore we accordingly describe the most used models. We also discuss research datasets published in the field and their applications. This analysis shows that the latest research is a leap forward since it is not the simple use of recently proposed algorithms to previous problems, but novel tasks and novel applications of state of the art methods are now considered. Rather than just providing a conclusive picture of the current research in the topic we lastly suggest some potential future trends that can represent a stimulus for innovative research directions.

Sarilumab use in severe SARS-CoV-2 pneumonia

BACKGROUND

Interleukin-6 signal blockade showed preliminary beneficial effects in treating inflammatory response against SARS-CoV-2 leading to severe respiratory distress. Herein we describe the outcomes of off-label intravenous use of Sarilumab in severe SARS-CoV-2-related pneumonia.

METHODS

53 patients with SARS-CoV-2 severe pneumonia received intravenous Sarilumab; pulmonary function improvement or Intensive Care Unit (ICU) admission rate in medical wards, live discharge rate in ICU treated patients and safety profile were recorded. Sarilumab 400 mg was administered intravenously on day 1, with eventual additional infusion based on clinical judgement, and patients were followed for at least 14 days, unless previously discharged or dead.

FINDINGS

Of the 53 SARS-CoV-2pos patients receiving Sarilumab, 39(73·6%) were treated in medical wards [66·7% with a single infusion; median PaO2/FiO2:146(IQR:120-212)] while 14(26·4%) in ICU [92·6% with a second infusion; median PaO2/FiO2: 112(IQR:100-141.5)].Within the medical wards, 7(17·9%) required ICU admission, 4 of whom were re-admitted to the ward within 5-8 days. At 19 days median follow-up, 89·7% of medical inpatients significantly improved (46·1% after 24 h, 61·5% after 3 days), 70·6% were discharged from the hospital and 85·7% no longer needed oxygen therapy. Within patients receiving Sarilumab in ICU, 64·2% were discharged from ICU to the ward and 35·8% were still alive at the last follow-up. Overall mortality rate was 5·7%.

INTERPRETATION

IL-6R inhibition appears to be a potential treatment strategy for severe SARS-CoV-2 pneumonia and intravenous Sarilumab seems a promising treatment approach showing, in the short term, an important clinical outcome and good safety.

Transmitted drug resistance to NRTIs and risk of virological failure in naïve patients treated with integrase inhibitors

OBJECTIVES

Nucleoside reverse transcriptase inhibitor (NRTI) transmitted drug resistance mutations (TDRMs) could increase the risk of virological failure (VF) of first-line integrase strand transfer inhibitor (InSTI)-based regimens.

METHODS

Patients starting two NRTIs (lamivudine/emtricitabine plus abacavir/tenofovir) plus raltegravir or dolutegravir were selected from the EuResist cohort. The role of NRTI genotypic susceptibility score and of specific TDRMs in VF (i.e. two consecutive viral loads > 50 HIV-1 RNA copies/mL or a single viral load ≥ 200 copies/mL after 3 months from antiretroviral therapy start) was evaluated in the overall population and according to the InSTI employed.

RESULTS

From 2008 to 2017, 1095 patients were eligible for the analysis (55.5% men, median age 39 years). In all, 207 VFs occurred over 1023 patient-years of follow-up. The genotypic susceptibility score (GSS) had no effect on the risk of VF in the overall population. However, the presence of M184V/I independently predicted VF of raltegravir- but not dolutegravir-based therapy when compared with a fully-active backbone [adjusted hazard ratio (aHR) = 3.09, P = 0.035], particularly when associated with other non-thymidine analogue mutations (aHR = 27.62, P = 0.004). Higher-zenith HIV-RNA and lower nadir CD4 counts independently predicted VF.

CONCLUSIONS

NRTI backbone TDRMs increased the risk of VF with raltegravir-based but not dolutegravir-based regimens.

Appropriate admission to rehabilitation: definition of a set of criteria through the Delphi Method

Background

Controlling inappropriateness of care, a widespread phenomenon, should be a global target in order to improve the quality of care, save money and ensure system sustainability. Inappropriateness is a relevant issue in public health and in rehabilitation medicine specifically. In fact, admitting a patient to a rehabilitation hospital or unit is a complex decision also due to the absence of shared and objective admission criteria. Aim of this study is to define clinical admission criteria and rules in rehabilitation medicine.

Methods

A three-round Delphi survey was conducted on a sample of rehabilitation medicine experts skilled in both rehabilitation and healthcare organization. The two initial rounds consisted of an electronic online questionnaire concerning appropriateness of admission to intensive rehabilitation while in the third one a report of the results was provided to the participants. The experts had to score their agreement with each item in the questionnaires, based on either a Likert scale or a dichotomous statement. Consensus between the experts was assessed.

Results

A total of 53 health professionals completed the Delphi survey. 19 out of 20 Italian regions were represented. The first round consisted of 8 multiple-choice questions questionnaire. The second round was designed thanks to the suggestions provided by the panelists in the previous one and consisted of a twelve items questionnaire. At the end of the survey, eight criteria of appropriateness of admission to rehabilitation were identified and five rules defining an appropriate admission to a rehabilitation facility were elaborated.

Conclusions

This study represents an attempt to create a worthwhile and reliable tool for a more conscious clinical practice in admission to rehabilitation, based on a set of shared criteria and rules.

Key messages

Improving appropriateness in healthcare delivery must be a primary goal in public health and in rehabilitation medicine specifically. Delphi method was applied to define shared clinical admission criteria and rules in rehabilitation.

Appropriateness of admission to rehabilitation: definition of a set of criteria and rules through the application of the Delphi method

BACKGROUND

Controlling inappropriateness of care is an essential issue, especially in rehabilitation medicine. In fact, admitting a patient to a rehabilitation hospital or unit is a complex decision also due to the absence of shared and objective admission criteria.

AIM

The aim was to define clinical admission criteria and rules in rehabilitation medicine.

DESIGN

Survey based on the application of the Delphi method on a sample of rehabilitation medicine experts.

SETTING

Administration of electronic online questionnaires concerning appropriateness of admission to intensive rehabilitation.

POPULATION

Volunteer sample of 53 experts with the following inclusion criteria: being members of the Italian Society of Physical and Rehabilitation Medicine, having practical experience in the research field, agreeing to the confidentiality of the information and being skilled in both rehabilitation and healthcare organization.

METHODS

A three-round Delphi survey was conducted according to international guidelines. The two initial rounds consisted of an electronic online questionnaire while in the third one a report of the results was provided to the participants. The experts had to score their agreement with each item in the questionnaires, based on either a Likert scale or a dichotomous statement. Consensus between the experts was assessed.

RESULTS

A total of 53 health professionals completed the Delphi survey. 19 out of 20 Italian regions were represented. The first round consisted of 8 multiple-choice questions. The second round was designed according to the suggestions provided by the panelists in the previous one and consisted of a twelve items questionnaire. At the end of the survey, seven criteria of appropriateness of admission to rehabilitation were identified and five rules defining an appropriate admission to a rehabilitation facility were elaborated.

CONCLUSIONS

This study represents an attempt to create a worthwhile and reliable tool for a more conscious clinical practice in admission to rehabilitation, based on a set of shared criteria and rules.

CLINICAL REHABILITATION IMPACT

To increase appropriateness of admission to rehabilitation. Improving appropriateness in healthcare delivery must be a primary goal in order to improve healthcare quality, save money and ensure system sustainability.

Primary Intracranial Squamous Cell Carcinoma with a Fatal Course

Intracranial squamous cell carcinomas (SCCs) are extremely rare. They can be primary or represent a degeneration of an epidermoid cyst (EC). We report the case of a patient operated, with an endoscopic transnasal approach, for a primary intracranial SCC. The optimal management for patients with primary intracranial SCC or ECs which have undergone malignant degeneration has yet to be identified.

SLC22A2 variants and dolutegravir levels correlate with psychiatric symptoms in persons with HIV

BACKGROUND

Neuropsychiatric symptoms (NPs) have been reported with dolutegravir use. We hypothesized that increasing dolutegravir trough concentrations (Ctrough) and/or polymorphism in the SLC22A2 gene, encoding the organic cation transporter-2 (OCT2), which is involved in monoamine clearance in the CNS and is inhibited by dolutegravir, might be associated with NPs.

METHODS

A cross-sectional cohort of HIV-positive patients treated with a dolutegravir-containing regimen underwent determination of allelic discrimination for SLC22A2 808 C → A polymorphism and dolutegravir Ctrough. The Symptom Checklist-90-R [investigating 10 psychiatric dimensions and reporting a general severity index (GSI)], a self-reported questionnaire and the Mini-International Neuropsychiatric Interview were offered to investigate current NPs. The effects of dolutegravir Ctrough and the SLC22A2 gene variant on NPs were explored by multivariable logistic regression.

RESULTS

A cohort of 203 patients was analysed: 71.4% were male, with median age 51 years and 11 years of ART exposure. Median time on dolutegravir was 18 months. Dolutegravir was associated with different antiretroviral combinations (mainly lamivudine, 38.9%, and abacavir/lamivudine, 35.5%). SLC22A2 CA genotype was independently associated with an abnormal GSI [adjusted OR (aOR) 2.43; P = 0.072], anxiety (aOR 2.61; P = 0.044), hostility (aOR 3.76; P = 0.012) and with moderate to severe headache (aOR 5.55; P = 0.037), and dolutegravir Ctrough was associated with hostility (fourth versus first quartile aOR 6.70; P = 0.007) and psychoticism (fourth versus first quartile aOR 19.01; P = 0.008). Other NPs were not associated with SLC22A2 polymorphism or dolutegravir Ctrough.

CONCLUSIONS

A variant of the OCT2-encoding gene, in addition to or in synergy with higher dolutegravir Ctrough, is associated with a set of NPs observed during dolutegravir therapy.

P951Autonomic nervous function and excitability of the accessory pathway in pediatric patients with Wolff-Parkinson-White ECG

Abrupt loss of preexcitation identifies low-risk Wolff-Parkinson-White (WPW). We hypothesize that the autonomous nervous system (ANS) modulates the conduction of the accessory pathway (AP).

PURPOSE

To compare heart rate variability (HRV) in children with (WPWi) and without (WPWp) intermittent preexcitation. 

METHODS

The study conforms to the Declaration of Helsinki. 

18 WPW children and controls performed ECG Holter for HRV analysis. Intermittent preexcitation was defined as abrupt loss of WPW pattern. Kolmogorov-Smirnov test confirmed normal distribution of data. T-test and Fisher"s exact test were used for continuous and categorical variables. Multivariate regression excluded the effect of potential confounders (figure 1 shows correlation between HRV and HR). 

RESULTS

WPWi (11/18, 61.1%) have higher HRV as compared with WPWp. Despite WPWp patients are younger, with higher HR, corrected multivariate analysis confirmed significant differences (table 1), also between WPW patients and controls. 

CONCLUSIONS

WPW patients have lower HRV. WPWp may have worst autonomic control to the excitability of AP.

Table 1 WPW (n = 18)A WPWi (n = 11)B WPWp (n = 7)C Controls (n = 18)D P value A vs. D P value B vs. C P value B vs. D P valueC vs. D Age 7.6 ± 4 10.1 ± 4.2 4.1 ± 2.9 7.8 ± 4.7 0.9 &lt;0.01 0.1 0.03 24 hours mean HR 92.8 ± 15.9 81.1 ± 11.2 104.9 ± 12.6 90.3 ± 16.5 0.7 &lt;0.01 0.03 0.07 pNN50 20 ± 11.4 30.5 ± 11.8 14.7 ± 9.9 24.3 ± 13.4 &lt;0.001 &lt;0.001 &lt;0.001 &lt;0.001 RMSSD 53 ± 19.1 68.8 ± 21.4 44.6 ± 14.7 59.4 ± 22.2 &lt;0.001 &lt;0.001 &lt;0.001 &lt;0.01 ASDNN 64.9 ± 21.1 78.4 ± 20.7 48.8 ± 11.8 66.9 ± 22.9 &lt;0.001 &lt;0.001 &lt;0.001 &lt;0.001 SDANN 108.2 ± 39.8 127.9 ± 36 77.5 ± 16.9 108.3 ± 38.8 &lt;0.001 &lt;0.01 &lt;0.001 &lt;0.01 VLF 7.4 ± 0.8 7.8 ± 0.4 6.9 ± 0.5 7.5 ± 0.6 &lt;0.001 &lt;0.001 &lt;0.001 &lt;0.001 LF 6.8 ± 0.8 7.3 ± 0.4 6.4 ± 0.4 6.9 ± 0.6 &lt;0.001 &lt;0.001 &lt;0.001 &lt;0.001 HF 6.6 ± 0.8 7.1 ± 0.7 6.2 ± 0.6 6.7 ± 0.8 &lt;0.001 &lt;0.01 &lt;0.001 &lt;0.01 LF/HF 1.4 ± 0.8 1.4 ± 0.7 1.4 ± 0.6 1.4 ± 0.6 0.2 0.3 0.05 0.7 VarIndex% 4.8 ± 1.4 5.8 ± 1.2 4.4 ± 1.4 5.3 ± 1.4 &lt;0.001 &lt;0.01 &lt;0.01 &lt;0.01 Total Power 8.2 ± 0.7 8.6 ± 0.4 7.8 ± 0.4 8.3 ± 0.6 &lt;0.001 &lt;0.001 &lt;0.001 &lt;0.001 Frequent SVB 2 (11%) 1 (9.1%) 1 (14%) 0 0.5 1.0 0.4 0.3 SVT 1 (5.6%) 1 (9.1%) 0 0 n.a. n.a. n.a. n.a. P values from multivariate analysis and t-test for age and HR. HR: heart rate; WPWi: intermittent preexcitation; WPWp: persistent preexcitation; VarIndex%: variability index (%); SVB: supraventricular beats; SVT: supra ventricular tachycardia. Values are expressed as mean ± SD for age, HR and time domain variables (ms). Variables in the frequency domain are expressed as ln. P &lt;0.05: significant.

Abstract Figure 1

Rehabilitation and respiratory management in the acute and early post-acute phase. "Instant paper from the field" on rehabilitation answers to the COVID-19 emergency

COVID-19 is a respiratory infectious disease that can cause respiratory, physical and psychological long-term dysfunctions in patients. First recommendations on respiratory management were published, but they were not based on the specific needs due to COVID-19. In this paper we share the early experiences from the clinical field in Northern Italy, where the epidemic started in February. This paper summarizes the second webinar on COVID-19 (230 live attendees, 11,600 viewers of the recorded version) organized by the Italian Society of Physical and Rehabilitation Medicine about rehabilitation and in particular respiratory management in the acute (Intensive Care Unit [ICU]) and immediate post-acute phases. There is the need to prepare for the post-acute phase. ICU length of stay is relatively long, with immobilization in prone position. Some specific problems are described, including severe muscle weakness and fatigue, joint stiffness, dysphagia, (neuro)psychological problems, impaired functioning concerning mobility, activities of daily life and work. A lot is yet unknown and patients can experience long-term consequences as we know from the literature on the postintensive care syndrome, but COVID-19 has unique features to be investigated and understood. As a colleague stated during the Covinar: this is a marathon, not a sprint….

Evidence-Based Medicine and Clinical Practice: the first Italian attempt to define the appropriateness of rehabilitation admission criteria through the application of the Delphi method

BACKGROUND

One of the consequences of today's global economic crisis is the need to control healthcare spending, in particular by improving the level of appropriateness. Thus, admission to rehabilitation has become an issue, especially as regards inappropriateness of resource allocation. The scientific literature suggests that more attention should be paid to the problem of clinical appropriateness in order to better identify the patients' actual needs. For the first time in Italy, this study aims at defining the appropriateness of intensive rehabilitation admission criteria through use of the Delphi method involving a panel of national experts.

MATERIAL AND METHODS

A three-round Delphi survey was conducted according to international guidelines. Electronic questionnaires were individually sent via e-mail to ensure the participants' anonymity throughout the process. Questions were mostly based on rehabilitation literature.

RESULTS

During the Delphi process, a total of 79 items were submitted to a heterogenous panel of rehabilitation experts who were asked to express their level of agreement to the item contents on a five-point Likert scale. At the end of the survey, a list of 19 appropriate criteria for admission to intensive rehabilitation facilities and 21 reasons for inappropriateness was drawn up.

CONCLUSION

This study represents the first attempt in Italy to define shared and objective appropriateness criteria for admission to intensive rehabilitation. Out of the total number of experts invited to participate (31), only 16 completed the entire survey. This poor participation rate unfortunately demonstrates the lack of awareness among Italian rehabilitation professionals, which is a further sign of both the scarcity of scientific evidence in this area and the need to reach consensus on admission criteria.

Dynamical charge density fluctuations pervading the phase diagram of a Cu-based high-T c superconductor

Charge density modulations have been observed in all families of high-critical temperature (T _c) superconducting cuprates. Although they are consistently found in the underdoped region of the phase diagram and at relatively low temperatures, it is still unclear to what extent they influence the unusual properties of these systems. Using resonant x-ray scattering, we carefully determined the temperature dependence of charge density modulations in YBa₂Cu₃O_7-δ and Nd_{1+ x} Ba_{2- x} Cu₃O_7-δ for several doping levels. We isolated short-range dynamical charge density fluctuations in addition to the previously known quasi-critical charge density waves. They persist up to well above the pseudogap temperature T*, are characterized by energies of a few milli-electron volts, and pervade a large area of the phase diagram.

P978 Acute myocardial infarction in young women without atherosclerotic disease

CONCLUSION

A high proportion of subjects presented with atypical challenging symptoms, while 30% were complicated with ventricular arrhythmias. This might be related to the high prevalence of proximal LAD dissection and anterior AMI in our subjects. An equal distribution of risk factors was recorded. No mortality events and no SCAD-recurrence were documented during follow up.

Abstract P978 Figure. Image 1

P1265 A home for two: a case of a twin pregnancy complicated by twin-to-twin transfusion in a woman with a repaired total anomalous pulmonary venous connection

BACKGROUND

Total anomalous pulmonary venous connection (TAPVC) is a rare correctable congenital heart lesion. According to the modified World Health Organization classification (mWHO) of maternal cardiovascular risk, pregnant patients with successfully repaired TAPVC are at low cardiovascular risk (mWHO class I), but the risk rises to mWHO class III if left ventricular (LV) impairment and ventricular arrhythmias are present.

CASE SUMMARY

A 34 years old woman with corrected supracardiac TAPVC, pregnant with a spontaneous monochorionic diamniotic twin pregnancy (TP) complicated by twin-to-twin transfusion syndrome (TTTS) was referred to the cardiologist in preparation for fetoscopic laser coagulation (FLC). She was born with a TAPVC to the innominate vein associated with an atrial septal defect (ASD), repaired at the age of 3 months by anastomosing the PVC to the posterolateral wall of the left atrium and closure of the ASD with a pericardial patch. At follow up a few years later she developed asymptomatic mild LV dysfunction and alternating brady and tachyarrhythmias including non-sustained ventricular tachycardias (NSVT). At 17th weeks of gestation she presented mild dyspnoea (NYHA functional class II) and an alternance of sinus bradycardia, atrial fibrillation and NSVT. 2D echocardiography showed moderate LV dilatation and dysfunction (LVEF 47%). She was treated with loop-diuretics, but refused antiarrhythmic and anticoagulant therapy. At 19th weeks, TTTS was diagnosed and successful FLC of placental anastomoses was carried out. Symptomatic worsening of LV function and functional class developed in the ensuing weeks (NYHA III, LVEF 40%). Induction of foetal lung maturity with maternal administration of steroids was carried out at 28 weeks but stopped because of spontaneous preterm labour. After delivery, the arrhythmic burden increased to the point of requiring admission to the intensive care unit (ICU) where pacemaker implant was indicated, but refused by the patient. Diuretics and ACE-inhibitors were titrated, but no beta-blockers nor other antiarrhythmics could be started due to intermittent av block. At discharge, the patient was asymptomatic at rest and there were no clinical signs of heart failure. At 17 months of follow-up, she was still asymptomatic, though LV function remained poor. The 2 newborns were discharged after a stormy 4 months in the neonatal ICU and are still being treated for bronchopulmonary dysplasia and the sequels of intraventricular haemorrages.

DISCUSSION

We are not aware of other described twin pregnancies in repaired TAPVC with residual LV dysfunction and arrhythmia. As the haemodynamic load of twin pregnancy is more severe and the twin pregnancy itself at high risk both for prematurity and maternal cardiac deterioration, evaluation by a Specialist Multidisciplinary referral Unit should occur before conception especially in mNYHA class III and higher, as per current guidelines.

Abstract P1265 Figure. Image 1

Light Dark Matter Search with Ionization Signals in XENON1T

We report constraints on light dark matter (DM) models using ionization signals in the XENON1T experiment. We mitigate backgrounds with strong event selections, rather than requiring a scintillation signal, leaving an effective exposure of (22±3) tonne day. Above ∼0.4  keV_{ee}, we observe <1  event/(tonne day keV_{ee}), which is more than 1000 times lower than in similar searches with other detectors. Despite observing a higher rate at lower energies, no DM or CEvNS detection may be claimed because we cannot model all of our backgrounds. We thus exclude new regions in the parameter spaces for DM-nucleus scattering for DM masses m_{χ} within 3-6  GeV/c^{2}, DM-electron scattering for m_{χ}>30  MeV/c^{2}, and absorption of dark photons and axionlike particles for m_{χ} within 0.186-1  keV/c^{2}.

Search for Light Dark Matter Interactions Enhanced by the Migdal Effect or Bremsstrahlung in XENON1T

Direct dark matter detection experiments based on a liquid xenon target are leading the search for dark matter particles with masses above ∼5  GeV/c^{2}, but have limited sensitivity to lighter masses because of the small momentum transfer in dark matter-nucleus elastic scattering. However, there is an irreducible contribution from inelastic processes accompanying the elastic scattering, which leads to the excitation and ionization of the recoiling atom (the Migdal effect) or the emission of a bremsstrahlung photon. In this Letter, we report on a probe of low-mass dark matter with masses down to about 85  MeV/c^{2} by looking for electronic recoils induced by the Migdal effect and bremsstrahlung using data from the XENON1T experiment. Besides the approach of detecting both scintillation and ionization signals, we exploit an approach that uses ionization signals only, which allows for a lower detection threshold. This analysis significantly enhances the sensitivity of XENON1T to light dark matter previously beyond its reach.

Low temperature hidden Fermi-liquid charge transport in under doped La x Sr1-x CuO2 infinite layer electron-doped thin films

We have studied the low temperature electrical transport properties of La _x Sr_1-x CuO₂ thin films grown by oxide molecular beam epitaxy on (1 1 0) GdScO₃ and TbScO₃ substrates. The transmission electron microscopy measurements and the x-ray diffraction analysis confirmed the epitaxy of the obtained films and the study of their normal state transport properties, removing the ambiguity regarding the truly conducting layer, allowed to highlight the presence of a robust hidden Fermi liquid charge transport in the low temperature properties of infinite layer electron doped cuprate superconductors. These results are in agreement with recent observations performed in other p  and n doped cuprate materials and point toward a general description of the superconducting and normal state properties in these compounds.

P5355Evaluation of maternal heart rate during the first week postpartum with wearable device

Background

Throughout pregnancy and puerperium significant cardiovascular changes occur. Maternal heart rate (HR) increases from the first to the third trimester of pregnancy, with a further increase during labor. Changes in the postpartum period are less well defined, in particular, the phenomenon of postpartum maternal bradycardia (PMB).

Purpose

To describe the distribution of HR in the first week postpartum, the incidence of PMB and to investigate the relationship between PMB and other maternal factors such as age, BMI and type of delivery.

Methods

Women who gave their informed consent during a clinical evaluation in the third trimester of pregnancy, and delivered at our tertiary centre between 01/01/2018 and 30/09/2018, were included. Within 12 hours from delivery, a wrist-worn tracker with a light-emitting diode (FitBit Alta HR) was applied and then removed one week postpartum. Data were extracted as 5 minutes recordings, each showing a mean HR. Only day-time recordings were considered. PMB was defined as ratio between bradycardia recordings (mean HR<60 bpm) and all recordings >0.6. SPSS was used for statistical analysis.

Results

252 women were included (mean age 35.3±5 years, BMI 23.3±5 kg/m2). 63% of women underwent caesarean section. Mean HR of the total population on day 1 after delivery was 80.7±11 bpm and then progressively decreased, with a mean HR on day 7 of 76.5±12 bpm (figure 1). 24 women developed PMB, with an incidence of 9.5%. The trend of HR in bradycardic women was opposite to that of non-bradycardic women, with an increase from day 1 (55±7 bpm) to day 7 (60.5±9 bpm) (figure 2). Device recordings during the first two days were in agreement with periodic bedside HR measurements. No bradycardic woman experienced syncope or pre-syncope or required treatment. PMB showed a positive correlation with caesarean section vs. vaginal delivery (p<0.01) and maternal age (p<0.05). No correlation was found with BMI and postpartum haemoglobin.

Trend of HR in the first week postpartum

Conclusion

In our population the incidence of PMB identified with wearable device was 9.5% and was associated with caesarean section and maternal age. Considering that HR returned within normal limits 7 days after delivery and no woman was symptomatic, our study suggests that PMB might be considered a benign entity.

P5356NT-proBNP is a valuable diagnostic tool of heart failure even during post partum period

Background

Post-partum period is characterized by complex haemodynamic changes that may lead to heart failure (HF) in a minority of patients. B-type natriuretic peptides inactive amino terminal fragment (NT-proBNP) is an established biomarker in the management of HF. Patients presenting with dyspnea are considered at high risk of HF if NT-proBNP is above 125 pg/ml. Higher levels of NT-proBNP in the post natal period were reported to be associated with increased risk of cardiovascular events, but there is no defined cut-off value established for prediction of HF in this setting.

Purpose

We conducted this study to identify an adequate cut-off value which would predict haemodynamic overload among post-partum women.

Methods

All women who gave informed consent during an obstetric clinical evaluation at our tertiary centre between 01/01/2018 and 30/09/2018 were included in the study. NT-proBNP was measured within 24 hours from delivery. The primary endpoint of the study was the development of signs and symptoms of heart failure (with the need of intravenous diuretics or a cardiological evaluation) within 15 days after delivery. We therefore analyzed the ability of different cut-off of NT-proBNP values in predicting the primary outcome. Confidence intervals (CI) for sensitivity and specificity were calculated with the Wilson score method.

Results

252 women were included in the study. Eleven of them developed in the study timeframe signs and symptoms of HF (4.3%); all of them were treated with diuretics. Nine patients were evaluated with echocardiography and 3 of them required cardiological counseling. The cut-off value of 600 pg/mL was found to have the best sensitivity (73%, CI 95% 0.43–0.9), specificity (98%, CI 95% 0.95–0.98), positive likelihood ratio (29, CI 95% 12–69) and negative likelihood ratio (0.28, IC 95% 0.10–0.70). The diagnostic odds ratio was 104 (CI 95% 22–494, p<0.001). Mean NT-proBNP was 169±121 pg/mL (cutoff <600 pg/mL) versus 852±245 pg/mL.

Different cut-off evaluated NT-proBNP value (pg/mL) Specificity Sensibility Diagnostic Odds ratio 125 42 81 3.4 (95% CI 0.7–16, p=0.1) 300 85 72 14 (95% CI 4–62, p<0.01) 600 98 73 104 (95% CI 22–494, p<0.01) 700 98 66 65 (95% CI 12–341, p<0.01)

Conclusion

Our study suggests that NT-proBNP higher than 600 pg/mL is a high risk marker for developing HF in the post partum period. This value is slightly higher compared to the one adopted among the general population for diagnosis of HF and may reflect the peculiar haemodynamic changes of this setting.