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In recent decades, many concrete bridges, built in the 60s and 70s of the 20th Century with a Gerber-girder scheme, show severe damage of the saddles due to concrete degradation and reinforcement corrosion. On the basis of the recent Ministerial Guidelines for the assessment of existing bridges, it is necessary to evaluate the state of the Gerber saddles in a large number of bridges on both main and secondary roads. To do this, it is necessary to apply flexible assessment procedures that can be adapted to several situations and that allow a speedy assessment of the intervention priorities. The methodologies of intervention represent the crucial point for a rapid rehabilitation of these infrastructures. In this paper, on the basis of some case-studies, assessment and strengthen-ing methodologies are proposed that can be applied to different real cases, in consideration of the budget available, with the aim of drafting an operative list of priorities and improving as many bridges as possible, currently in service

Many existing reinforced concrete bridges exhibit behaviour at the Service Limit State and the Ultimate Limit State which can be considered unsatisfactory with respect to the current provisions of Codes, but which are actually deficiencies deriving from obsolete calculation methods, structure age, material degradation, diffuse or localized corrosion and increased loads. Among these, cantilever bridges with half-joints may present a decrease in global safety coefficients for the most stressed current sections of the deck or in the local ones, that affect the performance of elements sensitive to degradation, such as Gerber saddles. In these cases, simple strengthening interventions through external prestressing that reduce the tensile stress in concrete areas subject to cracking, as well as the deformability of the points that have accumulated displacements over time (due to creep or degradation), can often be implemented without the need to recourse to interventions of greater impact, obtaining an improvement in the structural behaviour or a variation of the static scheme that improves the overall performance. This is the case of a concrete Niagara-type cantilever bridge with half-joints, designed and built in the 60s in southern Italy by Riccardo Morandi, presented here as a case-study, which does not show a very high or widespread state of decay but rather a slight insufficiency of some elements, in particular related to the cantilever bridge behaviour. A methodology is proposed for the safety assessment of these bridges and a solution for improving performance through minimal rehabilitation interventions with the introduction of external prestressing. The results of the analysis in the present state, the deficiencies found as well as the possible level of increase in the safety coefficients at ULS with the proposed intervention are presented.

The performance of cantilever reinforced concrete bridges is fundamental topic in assessment and retrofit of Italian infrastructures, because the static scheme of the so-called “Gerber bridges” was very popular between 50’s and 70’s of XX Century. Many of them present severe damage due to the drainage of the deck waters inside the joint and to the consequent degradation of Gerber saddles. Furthermore, the state of corrosion of the reinforcements together with the actual degree of freedom of internal constraints, often partially blocked due to degradation and subsequent maintenance over time, modify the structural behaviour and the performance both in terms of service and ultimate limit states. This paper presents a case study of a reinforced concrete bridge with a three-span cantilever scheme, designed in southern Italy by Riccardo Morandi, in which this problem led to a difficult assessment of the actual performance of the bridge. The on-site static and dynamic investigations and the bridge modelling in its current condition, taking into account the effects of degradation in the Gerber saddles, made it possible to evaluate the state of the bridge after more than 60 years from construction

This is a final study report with the following objectives Primary objectives To monitor and estimate the incidence rates of adverse events of special interest (AESI) in vaccinated and non-vaccinated persons by data source over the period January 1st 2020-October 31st 2021 by brand and dose of vaccine and age of the population. To monitor and estimate the incidence rates of diagnosed COVID-19 in vaccinated and non-vaccinated persons by data source over the period January 1st 2020-October 31st 2021 by brand and dose of vaccine as well as age. To monitor exposure and coverage to COVID-19 vaccines by brand and dose of vaccine as well as age. Secondary objectives To compare the incidence rates of AESIs in the risk window of 28 days after vaccination with dose 1 and/or dose 2 with the incidence rates of AESIs in 2020. To monitor and estimate vaccine exposure, incidence rates of adverse events of special interest. (AESI) and of COVID-19 in vaccinated and non-vaccinated persons over the period January 1st 2020-October 31st 2021 in the at-risk population for developing severe COVID-19 by data source, brand and dose of vaccine as well as age. Methods We used a retrospective cohort design, in 4 electronic health care databases, with periodic updates of the data during the study period (January 2020 -September 2021). Persons entered the cohort on 1/1/2020 and exit upon latest data extraction, death, moving out or the specific events of interest. Person-time after cohort entry was divided in non-exposed person-time, and person-time following vaccination by specific brands, labelled by dose and distance since last vaccination (-1, -2, -3 weeks etc). The source population included all individuals observed in one of the participating data sources for at least one day during the study period (01 January 2020 - last data availability) and who have at least 1 year of data availability before cohort entry, except for individuals with data available since birth. Per event, for calculation of incidence, individuals were followed from cohort entry and contribute to person-time in month (prior to vaccination) and in weeks after vaccination plus specific vaccine exposure (brand & dose) category. Follow-up was censored upon the earliest of date of the event (except for recurrent events), death, exiting the data source, or last data draw-down. For comparison of post-vaccination rates follow-up ended 28 days after each of the vaccine doses, if they had a 2nd dose the intervals post-dose stopped at the date of vaccination with the second. Incidence rates were calculated for 2020 (non-exposed), and after vaccination by vaccine brand, dose and data source. Incidence rates were standardised directly to the Eurostat population and standardised rate differences were calculated using R. Following results of the interim analysis in July 2021, Poisson regression was added to the amended protocol to adjust for measured covariates that were related to the chance of exposure to certain vaccines (age, sex, risk factors for severe covid and prior covid-19). We did not design to adjust for covariates related to the specific outcomes and this study was not designed for causal inference but for monitoring safety. This means that residual confounding may remain, which is why we pre-stated that we classify an association as ‘disproportional’ if the IRR was above 2. Results This study comprised a total of 25,720,158 subjects. We count only the largest population for BIFAP for the total, as the regions with hospital linkage are a subset of the primary care populations. The largest population included was from CPRD with more than 14 million participants. Data locks differed per site: June 30, 2021 in Tuscany, August 31st for BIFAP, August 1st 2021 for PHARMO and May 2021 for CPRD Aurum. At the start of the study 1/1/2020, 34% of the Tuscany population had one or more risk factors for severe COVID-19 disease, and this was around 25% in each of the other data sources (table 2). Median age was highest in Tuscany region (49) and BIFAP-HOSP regions (49). Overall, 12,117,458 persons received a first dose of a Covid-19 vaccine (47.1%) (excluding unknown vaccines manufacturers). Percentage was highest in BIFAP (68.7%). In BIFAP the majority of persons also had received a second dose for each of the vaccine brands. Percentage of full primary regimen of 2-dose primary regimens were lower in other data sources, in particular for AstraZeneca in CPRD, as this vaccine also had the highest distance between dose 1 and 2 in each data source. mRNA vaccines had a short distance between dose 1 and 2 in all sites except for CPRD, where Pfizer also had a mean of 76 days between dose 1 and 2, but only 28 days for Moderna vaccine. In this data instance heterologous schedules were very rare. Vaccination coverage data reflected well the regional/national data for ARS and BIFAP, but were lower for CPRD and PHARMO, probably due to delays in automated feedback on vaccination from immunization registers. We studied the 2020 rates of different AESI. Most AESI were very rare, only the coagulation disorders were more common. We monitored the occurrence of AESI using cumulative weekly rates, and by censoring at 28-day intervals after each dose. The latter was used to compare against background, which was done using age standardized incidence rate differences, and subsequent Poisson analysis adjusting (where possible for age, sex, prior covid-19 and any risk factors for COVID). The table below shows the key results. For most AESI no excess risk was observed following vaccination, 30 event/vaccine/dose combinations showed excess age standardized rate differences and associations in the Poisson analyses (see table below), however after adjustment for factors associated with vaccine roll out, only 10 significant associations of pooled incidence rate ratios remained based on dose 1 and 2 combined. These comprised anaphylaxis after AstraZeneca, TTS after both AstraZeneca and Janssen vaccine, erythema multiforme after Moderna, GBS after Janssen vaccine, SOCV after Janssen vaccine, thrombocytopenia after Janssen and Moderna vaccine and venous thromboembolism after Moderna and Pfizer vaccines. The risk was more than two-fold increased for TTS, SOCV and thrombocytopenia. Conclusions This study has provided many lessons It showed that we could monitor a large number of AESI and COVID-19 across 4 data sources in four countries based on the ConcePTION common data model, and common analytics pipeline, and that semantic harmonization was possible across the different disease terminologies Monitoring could start very early in the vaccination campaign, and repeated updates were possible The same population and data sources were used both to compute background rates, and to retrieve observed events after vaccination. This design avoids a limitation of using, on the one hand, real-world data to assess background rates, and, on the other, spontaneous reporting to assess observed cases: underestimation, if any, is more likely to affect the two periods is a uniform way, thus improving the validity of comparison. Underestimation of an AESI can be discussed, based on the characteristics of the data source in relation with the AESI. For example, ICPC codes do not allow for studying the majority for rare AESI, which affected the ability of PHARMO of monitoring such AESI; or, events that do not require hospitalisation or access to emergency room cannot be studied in the ARS data source. COVID-19 vaccines had very different user patterns across the countries in terms of type, distance between dose 1 and 2 and the populations targeted. We observed strong channelling of the different vaccines that differed across countries AESI incidence rates were mostly very low, especially for neurological, immunological and haematological events. Coagulations disorders and cardiac disorders were more frequent, at the same time such events were those with stronger confounding For several AESI we observed disproportionalities between post-vaccination observed and expected rates. Most of these events had been the topic of regulatory discussions, based on public records such as the haematological events, neurological events and erythema multiforme. In spite of the large numbers of vaccinees, power is limited for the events that are very rare, The research leading to these results was conducted as part of the activities of the EU PE&PV (Pharmacoepidemiology and Pharmacovigilance) Research Network (led by Utrecht University) with collaboration from the Vaccine Monitoring Collaboration for Europe network (VAC4EU). Scientific work for this project was coordinated by the University Medical Center Utrecht. The project has received support from the European Medicines Agency under the Framework service contract nr EMA/2018/28/PE. This document expresses the opinion of the authors, and may not be understood or quoted as being made on behalf of or reflecting the position of the European Medicines Agency or one of its committees or working parties. The authors from BIFAP would like to acknowledge the excellent collaboration of the primary care practitioners and pediatricians, and also the support of the regional authorities participating in the database.

Publication, JRP-TOXOSOURCES

On Italian roads, a lot of reinforced concrete bridges were built in the 1950’s and 1960’s for short spans, before the advent of prefabricated structures. Many of these bridges, sited on principal or secondary roadways, show the effects of corrosion of reinforcements and high levels of damage, leading to the likelihood of achievement of the Ultimate Limit State, below the required performances of serviceability, especially in the case of Gerber saddles having strongly corroded reinforcements. Different case studies of bridges sited in Southern Italy (Sicily) are shown, allowing engineers to classify the main effects of damage in corroded structures with the Gerber static scheme (cantilever girder bridges), for a first application of the new Italian Bridge Assessment and Maintenance Guidelines. The case studies are illustrated, and the structural implications are discussed, providing indications for treating the common cases of bridges with Gerber saddles

Background Nutritional profile, physical activity level and sedentary behaviours, in preteen age, are determinants able to influence both short and long-term state of health, therefore succeeding in health education campaigns addressed to this age group is critical for the interested population. Is currently underway the multiannual follow-up of the Italian “sCOOL FOOD - Per un Futuro di tutto Rispetto” project of Monte dei Paschi Foundation of Siena, Tuscany, which offers year-round cycles of classes and workshops about the themes listed above. Our objective was to assess whether this intervention could significantly influence over time healthy, and unhealthy, behaviours of the participants. Methods We structured the follow-up as a prospective cohort study with one-group pretest-posttest design. We used the CAWI technique, building a questionnaire based on the Italian “OKkio alla Salute” survey, and collected data from the whole population of students enrolled in the project (in the school year 2018-2019 they were 3787, aged from 7 to 12) before and after the intervention. Afterwards, we conducted paired data analysis on the frequencies of specific behaviours. Results We analysed paired data from 310 respondents. Improvements were gained in: afternoon TV watching (OR 0.54; 0.34 - 0.84; p < 0.01), consumption of sweet (OR 0.39; 0.16 - 0.88; p < 0.05) and salty (0.42; 0.18 - 0.90; p < 0.05) snacks, attitude to play outdoors after school (OR 2.6; 1.21 - 6.04; p < 0.01), sedentary behaviour in leisure time (OR 0.27; 0.16 - 0.44; p < 0.0001), mean weekly sport activity (+0.14 days; +0.02 - +0.27; p < 0.05). No variable has deteriorated. Conclusions The improved compliance with healthy behaviours in the participants at this project suggests its viability as a health promotion campaign. Further parallel surveys on control groups are pending, in order to control potential confounders such as the seasonality of some habits and the awareness of the participants on the addressed subjects. Key messages A coordinated and cross-disciplinary food and lifestyle year-round education campaign at school can affect health determinants of children. School can correct unfavourable eating and lifestyle behaviours determined by family habits.

Background Exposure to hypothermia is somehow unavoidable when a baby comes to life. This is the reason why any possible effort should be made by every caregiver involved during birth, from labour to transfer into the maternity ward, to reduce it. Hypothermia has widely shown to be related to several neonatal problems, and the risks are more relevant when the babies are born prematurely. Method An observational study was conducted in April 2016 to assess the current practises to avoid hypothermia at birth in 20 Italian neonatal units. Each unit introduced local improvements in clinical practice and the same observational study was repeated 1 year later. Results A total of 4722 babies were analysed. An overall increase in adherence to local and international recommendations emerged from our study. Significant differences between 2016 and 2017 were found in regard to neonatal temperature at nursery entry (36.3 °C vs 36.5 °C, respectively, p 60″ (48.1% vs 68.1%, respectively, p 60′ (56.3% vs 60.9, respectively, p = 0.03). Statistical correlations with the risk of hypothermia were found for delivery room (OR 0.88 (CI 95%0.83–0.94), p p Conclusion Periodical assessment of the delivery room practice has shown to be effective in improving adherence to the international recommendations. Relationship between neonatal hypothermia and several other variables including the delivery room and mother temperature underlines how neonatal thermoregulation starts immediately after birth. Hence, a multi-disciplinary approach is needed to provide the optimal environment for a safe birth.

Postoperative rehabilitation after simultaneous anterior cruciate ligament reconstruction and opening wedge high tibial osteotomy is a complex concept. Different osteotomy techniques, extremely selected patients, high expectations in returning to previous sport activities, and the different individual physical profile and performances make traditional chronological criteria impractical and unfeasible. This study presents a novel rehabilitation in which functional objective criteria are considered the key factors for standardizing a 4-step protocol. Each step is "individualized", based on the patient's response to the healing processes and to the different training phases, allowing for a safe return to sports competitions. This definitively implies a strict collaboration between patient, surgeon, physician and physiotherapists, as well as thorough and detailed patient education. Due to the high versatility of these new rehabilitation concepts, the application of the "individualized" steps described in this study may be broadened to include different sports medicine knee injuries that may benefit from a specific, detailed and carefully patient-centered rehabilitation project.

Periprosthetic osteolysis is still one of the major limitations of prosthetic joints longevity. The process of this "silent" iatrogenic disease involves both mechanical and biological factors that initiate a local immune response in the periprosthetic tissue that eventually lead to implant loosening and failure. There are many causes of the primary aseptic loosening inside the periprosthetic microenvironment, but the most important elements are the wear debris and the cell-particle interactions. Together with implant position, micromotion, bearings, joint fluid pressure, and increased load on the joints drive the pathogenesis of the disease. This narrative review aims to summarise recent studies describing the biological and mechanical factors in the pathogenesis of osteolysis and some of the current pharmacological attempts to "rescue" a failing implant.