Archivio Istituzionale della Ricerca- Università degli Studi di Foggia
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Recognizing malnutrition in adults with critical illness: Guidance statements from the Global Leadership Initiative on Malnutrition
No full textBackground: Patients with critical illness may present with disease-related malnutrition upon intensive care unit (ICU) admission. They are at risk of development and progression of malnutrition over the disease trajectory because of inflammation, dysregulated metabolism, and challenges with feeding. Methods: The Global Leadership Initiative on Malnutrition (GLIM) convened a panel of 36 clinical nutrition experts to develop consensus-based guidance statements addressing the diagnosis of malnutrition during critical illness using a modified Delphi approach with a requirement of ≥75% agreement. Results: (1) To identify pre-existing malnutrition, we suggest evaluation within 48 h of ICU admission when feasible (100% agreement) or within 4 days (94% agreement). (2) To identify the development and progression of malnutrition, we suggest re-evaluation of all patients every 7–10 days (97% agreement). (3) To identify progressive loss of muscle mass, we suggest evaluation of muscle mass as soon as feasible (92% agreement) and again after 7–10 days (89% agreement). (4) To identify the development and progression of malnutrition before and after ICU discharge, we suggest re-evaluating nutrition status before ICU discharge and during clinical visits that follow (100% agreement). Conclusion: Research using consistent etiologic and phenotypic variables offers great potential to assess the efficacy of nutrition interventions for critically ill patients with malnutrition. Assessment of these variables during and beyond the ICU stay will clarify the trajectory of malnutrition and enable exploration of impactful treatment modalities at each juncture. GLIM offers a diagnostic approach that can be used to identify malnutrition in critically ill patients
Targeting axial and peripheral psoriatic arthritis: a retrospective observational study on the clinical relevance of upadacitinib
No full textObjective: To evaluate upadacitinib (UPA) effectiveness on axial and peripheral manifestations of PsA by assessing the proportion of patients achieving low disease activity (LDA) and inactive disease (ID) status for axial involvement, and MDA and DAPSA-defined remission/LDA for peripheral domain. Methods: This retrospective study included PsA patients from 27 Italian rheumatology centres. Demographic, clinical and outcome data were collected at baseline, 6 and 12 months. Kaplan-Meier curves assessed treatment persistence. Multivariate models identified predictors of discontinuation and outcomes. Results: Among the 425 patients, 282 (66.4%) had peripheral PsA and 143 (33.6%) mixed (peripheral and axial) PsA. The 12-month UPA survival rate was 75.1%, higher in peripheral than mixed PsA (P = 0.039). Fibromyalgia was the strongest predictor of discontinuation (aHR 1.72; 95% CI: 1.08-2.75; P = 0.022). At 12 months, 38.2% of patients achieved ASDAS-LDA and 20.6% reached ASDAS-ID (LUNDEX-adjusted rates were 29.4% and 15.8%, respectively). The crude 12-month MDA rate was 59.9% (47.4% after LUNDEX adjustment). Enthesitis resolved in 80.2% of patients (P < 0.001), and NSAIDs use decreased to 32.9% (P < 0.001). Overall, VAS pain decreased significantly from 71.4 to 40 (mean change -31.4; 95% CI: -42.5 to -33.6; P < 0.0001), with a 44% reduction, well above the minimal clinically important improvement. No major cardiovascular events were reported; most adverse events were mild, including gastrointestinal intolerance (19%), infections (9.5%) and elevated liver enzymes (14.2%). Conclusion: Our study confirms UPA effectiveness across PsA domains, with clinically meaningful improvements in axial involvement and pain
A cross sectional study of multisensory learning socioemotional skills and behavioral outcomes in schools
No full textEmotion recognition ability (ERA) is a core component of social cognition and behavioral regulation. While previous studies have focused on individuals with neuroanatomical impairments, little is known about multisensory emotion misperception in typically developing children with behavioral difficulties. This study explored the relationship between multisensory emotional confusion and behavioral problems in early childhood, using the Diagnostic Analysis of Nonverbal Accuracy – Second Edition, Revised Version (DANVA-2-RV) and the Strengths and Difficulties Questionnaire – Teacher Version (SDQ-TV). Data were collected from three first-grade classes in two public elementary schools in Southern Italy. Both institutions are inclusive, but only typically developing children were included in the normative sample. Forty children (mean age = 6.1 years; 21 males) completed the DANVA-2-RV to assess recognition of basic emotional expressions, while their main teachers completed the SDQ-TV to evaluate behavioral functioning. Results showed that multisensory emotional confusion was consistently associated with behavioral maladjustment. Moreover, the emotional confusion index emerged as a significant predictor of behavioral difficulties, highlighting its potential as an early indicator of socio-emotional vulnerability. These findings support the inclusion of confusion metrics in assessments and emphasize the importance of early interventions to strengthen children’s socio-emotional skills
La promozione del benessere attraverso una tecnica di ricerca-azione: il pattern language
No full textSUSTAINABLE TOURISM CAPACITY IN MARINE RESERVES: THE CASE OF THE TREMITI ISLANDS, ITALY
No full textThe Marine Reserve of the Tremiti Islands - Southern Italy, Apulia - covers 1466 hectares and is managed by the Gargano National Park Authority. The Reserve is characterized by natural features such as Posidonia oceanica meadows. During the summer months, particularly in August, the flow of tourists increases exponentially. This study describes an evolution of the method to determine the Tourist Carrying Capacity (TCC) of the Tremiti Islands to ensure the sustainability of the marine reserve. The approach is an extension of the carrying capacity model used by Pazienza (2001) for three important municipalities in the Gargano National Park. Among other strategies to ensure the sustainability of the Tremiti Islands, Ranieri et al. determined an environmental contribution for each activity authorized in the MPA: 0.70 €/capita for bathing; 0.27€/capita for diving; 1.34 €/capita for boat rental; 1.10 €/capita for boating
Enhanced Justice. La provocazione tecnologica nella cultura e nell'esperienza giuridiche
No full textOral anticoagulation in patients with atrial fibrillation and heart valve prosthesis: A substudy from the Left Atrial Appendage Occlusion Study (LAAOS) III trial
No full textObjective: Societal guidelines recommend vitamin K antagonists (VKAs) for patients with atrial fibrillation with recent biological valve implantation, but the safety and efficacy of direct oral anticoagulants (DOACs) in this setting remain uncertain, especially in the early postoperative period. This substudy of the Left Atrial Appendage Occlusion Study (LAAOS) III trial aimed to compare thromboembolic and bleeding outcomes in patients discharged on VKAs versus DOACs after bioprosthesis implantation or mitral valve repair. Methods: A total of 2645 patients were included, with 461 discharged on DOACs and 2184 on VKAs. Patients with mechanical valves or isolated coronary surgery were excluded. The primary end point was stroke or systemic thromboembolism. Major bleeding was a secondary end point. Cox proportional hazard models adjusted for time-dependent covariates and clinical factors (eg, age, previous stroke, left atrial appendage occlusion) were applied to assess outcomes. Results: Patients discharged on DOACs were older, mostly male, and had lower rates of rheumatic heart disease than those on VKAs. During follow-up, no significant differences were observed in thromboembolic (hazard ratio, 0.754; 95% confidence interval, 0.496-1.145; P = .185) or major bleeding events (hazard ratio, 0.760; 95% confidence interval, 0.601-1.153; P = .197) between groups. A nonsignificant trend toward worse outcomes was noted for patients who discontinued or switched anticoagulation. Conclusions: In this large cohort of patients after mitral and/or aortic bioprosthesis implantation or mitral valve repair within the LAAOS III, DOACs showed similar thromboembolic and bleeding risks as VKAs, suggesting they may be a safe alternative
Shotgun Aanalysis of fennel protein extracts using Fourier Transform Ion Cyclotron Resonance Mass Spectrometry
No full textA rapid shotgun method using Fourier Transform Ion Cyclotron Resonance Mass Spectrometry (FT-ICR-MS) was developed for the characterization of fennel proteins. Following enzymatic digestion with trypsin, small volumes of the extract were analyzed via direct infusion in positive ion mode. For the molecular identification, a dedicated bioinformatic strategy was implemented, starting from the publicly available NCBI protein database. From the 231 entries originally listed under the Foeniculum vulgare organism, only the unique, non-redundant protein sequences were retained, eliminating partial or duplicate entries that appear in the database under different identifiers. This refinement produced a curated dataset of 92 specific fennel proteins. In consideration of possible allergenic cross-reactivity—especially relevant to individuals with spice-mugwort-allergy syndrome—this protein list was expanded by adding 10 known allergenic proteins from botanically related species such as celery, parsley, carrot, birch, and mugwort. Thus, a final database of 102 protein sequences was constructed. All proteins were then in-silico digested to simulate tryptic peptide fragmentation, producing a theoretical list of m/z values. These predicted values were compared to the experimental mass spectra acquired from FT-ICR-MS using a custom-developed MATLAB algorithm, designed to match signals with high accuracy. Finally, database searching in Peptide Mass Fingerprint mode was performed by using the matched m/z values as input data. A total of 70 proteins were successfully identified in the fennel extract, including 61 specific to fennel and 9 allergenic proteins from the additional reference sources. This method proves to be both time-efficient and robust for complex plant protein analysis
The PLS-PM approach to analyze the quality of health services over time
No full textThe study of the quality of services provided in the health sector plays a fundamental role in applied statistical studies. The work focuses on using Structural Equation Modeling Path Modeling as a valuable way to analyze longitudinal data relating to the level of the satisfaction expressed with respect to a selection of public and private operators. The aim of the study is to develop an experimental model to measure the level of satisfaction with the services provided by an external organization over time. In the work, the data used result from a survey on the services offered by Sanita' Service s.r.l. at the ASL (local health organization) agencies in Foggia