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Agrivoltaics is presented as a possible solution to the need for new sources of renewable energies, also responding to the increasing demand for feed/food and energy in a strongly efficient and sustainable manner. To this aim, agrivoltaics proposes to combine agricultural and renewable energy production on the same land using photovoltaic technology. The performance of this new production model strongly depends on the interaction between the two systems, agricultural and photovoltaic. In that sense, one of the most important aspects to consider are the effects of the shadows of the photovoltaic panels on the crop land. Overall, the experiment clearly indicated that a fourth cycle of escarole is possible under the PVs of agrivoltaics. Both fresh weight and size of the salad bowls were significantly increased by the shade provided by the PVs. Escarole appeared to be very tolerant to the shade and commercial yields were boosted, compared to full sun treatments, even under extended shade conditions. Such an effect can be likely explained by an overall amelioration of the water status in shaded plots. Therefore, a further study of the behavior of escarole under agrivoltaic conditions will be desirable.

In recent years, the scope of participatory design has broadened to encompass perspectives and approaches beyond the human realm. This expansion requires considering multiple aspects to fully capture ‘more-than-humans’ diversity and concerns. One approach to tackle this multifaceted challenge is by examining it through the lens of time. However, the temporal dynamics of more-than-human entities remain relatively unexplored within participatory design. This paper investigates the potential of visual mapping to aid stakeholders engaged in participatory design processes that incorporate more-than-human perspectives in navigating the complex dimensions of more-than-human time. The findings demonstrate how visual mapping can facilitate thinking beyond linearity, developing awareness of workshop-related temporality, making time concrete, understanding the ‘far lense’ through the ‘near lense’, comprehending time’s relationality, unfolding time and considering multiple timespans simultaneously. Based on these findings, the paper suggests that visual mapping can help understand more-than-human temporalities in participatory design by thinking through them as a reflective practice.

We report the case of a young male patient who presented to our emergency department complaining of a transient headache and a feeling of motor impairment in his right lower limb, both of which completely resolved spontaneously. After a few minutes of his arrival, he developed a locked-in sensation with anxiety and agitation, followed by a rapid onset of left facio-brachio-crural hemisyndrome. Contrast-enhanced CT of the brain and neck showed the occlusion of the proximal-intermediate basilar artery. Acute basilar artery occlusion (BAO) is a rare life-threatening stroke that requires prompt diagnosis and appropriate treatment to avoid rapid fatal complications (coma and death). The prognosis is poor, with long-lasting sequelae in the survivors. The diagnosis is often difficult since BAO accounts for only 1% of all strokes, and the prodromal symptoms are often very mild, transient, and non-specific, such as nausea, dizziness, headache, confusion, and vertigo. In the presence of convulsion-like symptoms or an unexplained altered level of consciousness, emergency physicians should always consider BAO in the differential diagnosis.

We report on a 4-year-old boy affected by Gaucher disease (GD) type 3, who presented with splenomegaly and a history of oculomotor apraxia. GD is a rare lysosomal storage disorder caused by glucocerebrosidase deficiency with multi-organ involvement. Besides common clinical features such as hepatosplenomegaly and skeletal involvement, less frequent neurological symptoms, such as oculomotor apraxia, are indicative of neuronopathic forms of the disease, namely GD type 3, to be confirmed both by enzyme activity and genetic testing. Overall, GD management requires a multidisciplinary approach involving metabolic pediatricians, neurologists, psychologists, and geneticists, and currently relies on early enzyme replacement therapy. Although enzyme replacement therapy has proved to be effective in improving systemic signs and symptoms, it is unable to alleviate neurological complications once these have occurred, as it does not pass across the blood–brain barrier. Neurological improvements may occur through indirect mechanisms. Thus, our case report aims to highlight the importance of considering GD in the differential diagnosis of pediatric patients presenting with splenomegaly associated with neurological manifestations, as early intervention may significantly modify the disease progression and prevent further irreversible complications.

In Italy, the use of chainsaws for field operations such as Felling (FE), Delimbing (DE), and Bucking (BU) is widespread due to the topography, the medium–small size of farms, and the predominant presence of broad-leaved forests managed through coppicing. However, this has led to an increase in injuries and illnesses due to exposure to physical factors (e.g., noise, dust, and vibrations) and chemical agents (e.g., various volatile compounds). Occupational health and safety legislation in Italy has undergone several phases, including the approval of U.T. 81/2008. The present study aims to evaluate the noise generated by chainsaws and the concentration of pollutants (CO, VOC, and C6H6) present in chainsaw exhaust gases during interventions in a chestnut coppice in relation to the limits set by current legislation. The analysis of the noise generated by chainsaws during chestnut cutting operations showed that it exceeded the legal noise limits during all chainsaw activities, with peak levels of about 110 dB. The detected noise could cause important critical issues in relation to the health and safety of specialized operators. Furthermore, the correlation between the specific work (FE, DE, and BU) and the ratio between maximum and average values of CO and VOC emissions was evaluated. Notably, comparable levels of maximum VOC emissions were observed during the FE and BU phases. However, the average emission values during these phases exhibited significant differences, suggesting higher VOC production when the engine was running but not actively engaged in cutting. The highest emissions were recorded during the FE phase (CO = 135 ppm, VOC = 17.28 ppm, and C6H6 = 2.13 ppm).

AbstractIn recent years, design in the public sector has gained popularity amongst policymakers as well as among scholars. Design is perceived as a promising way to create more successful policies and public services. Despite growing popularity, a critical reflection on benefits and challenges, as well as about different understandings of design practices in the public sector, are still lacking. Therefore, this paper aims to investigate different ways public organizations engage and introduce design approach. In this paper we present 3 municipalities in Denmark and the way design is understood and implemented in organizational work practices. Our contribution to theory is twofold. First, our research responds to the recent call of different researchers to investigate how design is operationalized and drawn upon in practice by different organizations in the public sector. Second, our research contributes to the design field, by showing barriers of implementations, different benefits and challenges connected with design in organizations with no prior experience in design.

Spinal cord injury without radiographic abnormality (SCIWORA) is a rare post-traumatic myelopathy, more frequently seen in paediatric population and elderly. Clinical manifestation can range from transient isolated paraesthesia to quadriplegia. Due to its rarity in adults and the broad spectrum of neurological manifestations, SCIWORA actually represents a challenge for emergency physicians. Early diagnosis and timely intervention are crucial for the patient’s prognosis avoiding permanent neurological deficits. Magnetic resonance imaging (MRI) plays a pivotal role in the diagnosis, management and prognosis of SCIWORA, being the golden standard technique to identify spinal cord injuries. To highlight the importance of in-depth neurological examination and early diagnosis of SCIWORA, we describe the case of a 53-year-old woman who presented to our emergency department following a forward fall down the stairs with a minor head injury.

The COVID-19 pandemic poses an ongoing global challenge, and several risk factors make people with multiple sclerosis (pwMS) particularly susceptible to running a severe disease course. Although the literature does report numerous articles on the risk factors for severe COVID-19 and vaccination response in pwMS, there is a scarcity of reviews integrating both these aspects into strategies aimed at minimizing risks. The aim of this review is to describe the risk of vulnerable pwMS exposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the issues related to the SARS-CoV-2 vaccine and to evidence possible future strategies in the clinical management of pwMS. The authors searched for papers on severe COVID-19 risk factors, SARS-CoV-2 vaccination and people with multiple sclerosis in support of this narrative literature review. We propose a multilevel strategy aimed at: the evaluation of risk factors for severe COVID-19 in people with multiple sclerosis, identifying the most appropriate vaccination schedule that is safe for people on disease-modifying drugs (DMDs) and a strict follow-up of high-risk people with multiple sclerosis to allow for the prompt administration of monoclonal antibodies to manage COVID-19 risks in this patient population.

Background: to test the association with overall survival (OS) of low attenuation areas (LAAs) quantified by staging computed tomography (CT) of patients who underwent radical surgery for nonsmall-cell lung cancer (NSCLC). Methods: patients who underwent radical surgery for NSCLC at our institution between 1 January 2017 and 30 November 2021 were retrospectively evaluated. Patients who performed staging or follow-up CTs in other institutions, who received lung radiotherapy or chemotherapy, and who underwent previous lung surgery were excluded. At staging and 12-months follow-up CT, LAAs defined as voxels p = 0.038), staging CT %LAAs ≥ 5% (HR, 7.27; 95%CI, 1.60–32.96; p = 0.010), and staging CT %LAA lobe ratio > 10% (HR, 0.24; 95%CI 0.05–0.94; p = 0.046). Conclusions: in patients with NSCLC who underwent radical surgery, a %LAAs ≥ 5% and a %LAA lobe ratio > 10% at staging CT are predictors, respectively, of shorter and longer OS. The LAA ratio to the whole lung at staging CT could be a critical factor to predict the overall survival of the NSCLC patients treated by surgery.

Regeneration of existing buildings and abandoned areas is a governmental and European key objective. This research focuses on Poveglia: an abandoned island in the Venetian lagoon, Italy. The underpinning idea concerns the upgrade of Poveglia to a zero energy Cognitive University Campus, connected to other educational institutions in the lagoon. The vision aims at reusing abandoned islands combining architecture, learning environments and digital networks, to demonstrate the potential of new technologies for the transformation of abandoned areas. The case study demonstrates the effectiveness of employing improved and revised systems and tools, developed in eLUX lab at the University of Brescia, for the regeneration of the island. The inclusion of the island in a smart campus network results in triggering positive synergies both enhancing energy efficiency and the learning environment. A further development concerns the setup of strategies for historical preservation, energy efficiency and renewable energy production.

We report the case of a 32-year-old Italian man admitted to our emergency room for visual disturbances with blurred vision, anisocoria and temporal headache suddenly occurred in absence of other neurological symptoms. A diagnosis of Datura stramoniuminduced anticholinergic toxicity was done. With our work, we want to highlight the importance of a meticulous clinical examination, including papillary diameter and reflexes, combined with a detailed history of the patient in the emergency room. Anticholinergic toxicity is a medical emergency. The diagnosis is always clinical, and it can represent a challenge for the emergency clinicians because it can mimic several neurological diseases, including acute stroke and seizures, but early diagnosis is crucial to avoid severe complications and management errors.

Background: To test the agreement between postoperative pulmonary function tests 12 months after surgery (mpo-PFTs) for non-small cell lung cancer (NSCLC) and predicted lung function based on the quantification of well-aerated lung (WAL) at staging CT (sCT). Methods: We included patients with NSCLC who underwent lobectomy or segmentectomy without a history of thoracic radiotherapy or chemotherapy treatment with the availability of PFTs at 12 months follow-up. Postoperative predictive (ppo) lung function was calculated using the resected lobe WAL (the lung volume between −950 and −750 HU) at sCT. The Spearman correlation coefficient (rho) and intraclass correlation coefficient (ICC) were used to the test the agreement between WAL ppo-PFTs and mpo-PFTs. Results: the study included 40 patients (68 years-old, IQR 62–74 years-old; 26/40, 65% males). The WAL ppo-forced expiratory volume in 1 s (FEV1) and the ppo-diffusing capacity of the lung for carbon monoxide (%DLCO) were significantly correlated with corresponding mpo-PFTs (rho = 0.842 and 0.717 respectively; p < 0.001). The agreement with the corresponding mpo-PFTs of WAL ppo-FEV1 was excellent (ICC 0.904), while it was good (ICC 0.770) for WAL ppo-%DLCO. Conclusions: WAL ppo-FEV1 and WAL ppo-%DLCO at sCT showed, respectively, excellent and good agreement with corresponding mpo-PFTs measured 12 months after surgery for NSCLC. WAL is an easy parameter obtained by staging CT that can be used to estimate post-resection lung function for patients with borderline pulmonary function undergoing lung surgery.

Abstract Fabry disease (FD) is a systemic X-linked lysosomal disorder. A ‘peripheral nerve variant’ of FD has been hypothesized in subjects with neuropathy, without the early manifestations of the classic phenotype. A cohort of undiagnosed neuropathy patients with chronic polyneuropathy of undetermined aetiology and demyelinating neuropathy, unresponsive to immunomodulating treatment, were screened for FD. A total of 103 patients (64% males), were enrolled. No typical pathogenetic mutations for FD were identified. We are aware that the study sample was very small, but only a large, unfeasible theoretical sample size could demonstrate a statistically significant increased prevalence of FD in neuropathy patients, as peripheral neuropathy of undetermined cause is uncommon and there is a low prevalence of FD in the general population. Therefore, we are of the opinion that including tailored FD screening in the neuropathy diagnostic work-up, particularly when there are additional clinical characteristics, should be considered.

This paper investigates the opportunities of leveraging a hackathon format to empower citizens’ abilities of using open data to improve their neighbourhoods and communities. The presented discussion is grounded in five civic hackathon case studies organised in five european cities. The research revealed specialised learning and collaborative alignment as two mutually complementing aspects of the involved learning processes, which were achieved with the help of high-fidelity and low-fidelity prototypes, respectively. Consequently, the paper identifies and discusses three main factors required to sustain social learning ecosystems beyond hackathon events, and with the purpose of democratisation of smart city services. These factors include a) supporting individuals in obtaining specific expert knowledge and skills, b) nurturing data-literate activist communities of practice made up of citizens with complementary expert skillsets, and c) enabling members of these communities to generate varying fidelity prototypes of open-data services.

Buildings cannot perform without a proper planning, execution and monitoring of Facility Management services. Moreover, occupancy monitor procedures for cognitive buildings are gaining momentum in performance optimization through dynamic adaption of indoor conditions (e.g. temperature, humidity, shadings). In this article, the application of a similar approach for automated execution of maintenance contracts (e.g. cleaning services) is presented. This approach is allowed by monitoring occupancy, through an ultrasonic sensor network. The methodology has been validated on a case study, concerning an office building in Milan, Italy.

Introduction: Pediatric-onset multiple sclerosis (POMS) is characterized by high inflammatory disease activity. Our aim was to describe the treatment sequencing and report the impact highly effective disease-modifying treatment (HET) had on disease activity. Materials and Methods: Five consecutive patients with POMS were administered HET following lower efficacy drug or as initial therapy. Data on treatment sequencing, relapses and MRIs were collected during the follow-up. Results: Our patients had an average age of 13.8 years (range 9–17) at diagnosis and 13.4 years (range 9–16) at disease onset, and 2/5 (40%) POMS were female. The pre-treatment average annualized relapse rate was 1.6 (range 0.8–2.8), and the average follow-up length was 5 years (range 3–7). A total of 2/5 (40%) patients were stable on HET at initial therapy, and 3/5 (60%) required an escalation to more aggressive treatment, even if two of them had been put on HET as initial treatment. Four out of five patients (80%) had No Evidence of Disease Activity-3 status (NEDA-3) at an average follow-up of 3 years (range 2–5). Conclusion: It has been observed that in a recent time period all the cases had prompt diagnosis, early HET or escalation to HET with a good outcome in 80% of the cases.

Literature on antiepileptic induced iatrogenic hypoglycemia is scanty. Due to its broad spectrum of activity and mechanisms of action, valproic acid (VPA), a fatty acid, is the most widely prescribed epilepsy treatment worldwide. Herein, we describe an adult epileptic patient, where persistent, otherwise unexplained hypoglycemia, was most likely induced by VPA, as suggested by the VPA time course and glucose blood levels. Indeed, no further hypoglycemic episodes occurred after VPA discontinuation and the diagnostic work-up ruled out other possible causes of hypoglycemia. This case supports the hypothesis that VPA may induce hypoglycemia, due to still not well-defined metabolic mechanisms of action. Moreover, it emphasizes the fact that an iatrogenic pathogenesis should be considered if an apparently unexplained hypoglycemia occurs in a patient on chronic therapy with antiepileptics, even at a therapeutical dosage.

Maintenance budget appraisal and allocation is a fundamental activity for the definition of an effective Facility Management (FM) strategy. Once the maintenance policy is set by the assets’ owner, facility managers are asked to compare different maintenance strategies (i.e. preventive vs. corrective) in order to provide a reliable and cost-effective maintenance budget. This can be hindered by unavailability of data for maintenance of building components. Nowadays, Building Information Modelling (BIM) provides plenty of data, but procedures are seldom focused on maintenance costs appraisal and this frequently leads to an intensive data re-elaboration. The objective of this research is to provide a precise maintenance budget appraisal according to different maintenance strategies through the Facility Condition Index (FCI), calculated starting from data stored into an Industry Foundation Classes (IFC) model. Data are stored in IfcAsset elements, using the related property sets. To overcome calculation needs, some additional attributes may be associated to elements and stored in custom property sets. The results of this research are a set of data, procedures and tools that allow the quantification and planning of maintenance expenditure, allowing a proper budget allocation. These procedures and tools answer the need of both designers during new constructions (to prepare the maintenance plan, as required by current Italian laws for public buildings) and asset managers during the digitisation of existing buildings (to store maintenance data and to rely on better appraisals). In this paper a demonstration is presented, with the purpose of showing the proposed methodology and tools. The demonstration has been carried out on some of the architectural and Mechanical, Electrical, Plumbing (MEP) components that mainly contribute to the annual maintenance expenditure.

Physical assets are, nowadays, more and more included in the digital environment, providing huge amount of data, and involving a complex network of stakeholders. Many Information Communication Technologies (ICTs) are employed in Architecture, Engineering, Construction and Operation (AECO), in order to tackle the digital transformation. Currently, one of the most acknowledged approaches for managing the new complexity of the built environment is Building Information Modelling (BIM). This article addresses the issue of the maturity of organisations, which adopt or are willing to adopt a BIM approach. Therefore, research aims at providing a critical review on BIM maturity of organisations operating in AECO. The BIM approach can be considered a step forward for supporting the development of digital processes able to foster the achievement of their business objectives. The scope of the research concerns the overall dynamics of the AECO sector concerning the digital revolution affecting management of the built environment processes along the life cycle of physical assets. Therefore, a literature review on Scopus databases has been carried out and most relevant dynamics in the literature production have been identified and investigated trough bibliometric, trend and cluster analyses carried out on the selected sample of articles. In summary it can be stated that the BIM maturity allow to evaluate organisations’ digitalisation potential enabling the reengineering of business processes. Moreover, the evaluation of organisations’ BIM compliant approaches can provide a sound assessment method during a bid process, contributing to the transparent and effective selection of the most virtuous firms.

Abstract Background Perinatal asphyxia (PA) occurs in about 2 to 10 per 1000 live full-term births. Although neonatal epileptic seizures are observed in up to 60% of cases, PA may mimic or subtend other conditions. Hypoxia related brain injury is particularly relevant, as it may have permanent effects on neuropsychomotor development. Antepartum obstetric conditions, may, in turn, lead to hypoxic-ischemic damage to the fetus and the newborn, often underlying PA. Herein, a case of PA that hid and triggered signs and symptoms of Glutaric Aciduria type I (GA-I), is reported. Case presentation R.F. was born at term after prolonged labour, by induced vaginal delivery with the Kristeller manoeuvre. He presented with severe asphyxia and asystoly. Immediate cardiopulmonary resuscitation promptly restored cardiorespiratory parameters, allowing for early extubation 30 min after. During the following hours, severe axial muscle hypotonia with an increased tone of the limb extensor muscles became evident. The absence of crying and archaic reflexes persisted and there was an onset of generalized tonic or clonic seizure. First level metabolic and inflammatory markers were within the normal range. An inherited metabolic disease was then suspected, due to the persistent clinical signs of severe neurological damage without any detectable septic parameter. GA-I was assessed and specific treatment started without any clinical improvement, although ensuring adequate growth and metabolic control. Thereafter, the baby developed a severe encephalopathy with drug resistant epileptic seizures. The progression of the neurological damage and a CVC-related sepsis led him to exitus at 2 years. Conclusions To the best of our knowledge, this is the first case of early post-natal onset of GA-I reported in literature to date, in the absence of expanded newborn screening (NBS) programme. As expanded NBS programmes for inborn errors of metabolism have not yet been internationally adopted, we are of the opinion that such diseases may well be hidden by misleading signs and symptoms imputable to other more frequent harmful clinical conditions. Moreover, it would be advisable that neonatologists be trained to include GA-I in the differential diagnosis of neurological damage secondary to PA.

Novel biomarkers are advocated to manage carotid plaques. Therefore, we aimed to test the association between textural features of carotid plaque at computed tomography angiography (CTA) and unfavorable outcome after carotid artery stenting (CAS). Between January 2010 and January 2021, were selected 172 patients (median age, 77 years; 112/172, 65% men) who underwent CAS with CTA of the supra-aortic vessels performed within prior 6 months. Standard descriptors of the density histogram were derived by open-source software automated analysis obtained by CTA plaque segmentation. Multiple logistic regression analysis, receiver operating characteristic (ROC) curve analysis and the area under the ROC (AUC) were used to identify potential prognostic variables and to assess the model performance for predicting unfavorable outcome (periprocedural death or myocardial infarction and any ipsilateral acute neurological event). Unfavorable outcome occurred in 17/172 (10%) patients (median age, 79 years; 12/17, 70% men). Kurtosis was an independent predictor of unfavorable outcome (odds ratio, 0.79; confidence interval, 0.65–0.97; p = 0.029). The predictive model for unfavorable outcome including CTA textural features outperformed the model without textural features (AUC 0.789 vs. 0.695, p = 0.004). In patients with stenotic carotid plaque, kurtosis derived by CTA density histogram analysis is an independent predictor of unfavorable outcome after CAS.

Citizens in dense built environments are susceptible to the simultaneous occurrence of Slow Onset Disaster (SLOD) events, being particularly prone to increasing temperatures and air pollution. Previous research works have assessed these events’ arousal separately and have identified when their intensity is critical. However, few have integrated their analysis, possibly limited by the quality and granularity of available data, the accessibility and distribution of sensors, and measurements not emulating the surroundings of a pedestrian. Thus, this work performed an outdoor meso-scale multi-hazard-based risk analysis to study the aggregated effects of the SLODs mentioned above. The study was carried out to narrow down the time-frames within 2019 in which these two events could have affected citizens’ health the most. A weighted fuzzy logic was applied to superimpose climatic (temperature, humidity, wind speed, and solar irradiance) and air quality (particulate matter, ozone, and ammonium) distress (true risk) on an hourly basis, allocated using set healthy and comfortable ranges for a specific dense urban climate context within Milan (Italy), processing data from Milano via Juvara station. The findings show that sensitive groups were at risk of high temperature and pollution separately during 26% and 29% of summer and mid-season hours, respectively; while multi-hazard risk would arise during 10.93% of summer and mid-season hours, concentrated mainly between 14:00 and 20:00.

Digital Twins (DT) are powerful tools to support asset managers in the operation and maintenance of cognitive buildings. Building Information Models (BIM) are critical for Asset Management (AM), especially when used in conjunction with Internet of Things (IoT) and other asset data collected throughout a building’s lifecycle. However, information contained within BIM models is usually outdated, inaccurate, and incomplete as a result of unclear geometric and semantic data modelling procedures during the building life cycle. The aim of this paper is to develop an openBIM methodology to support dynamic AM applications with limited as-built information availability. The workflow is based on the use of the IfcSharedFacilitiesElements schema for processing the geometric and semantic information of both existing and newly created Industry Foundation Classes (IFC) objects, supporting real-time data integration. The methodology is validated using the West Cambridge DT Research Facility data, demonstrating good potential in supporting an asset anomaly detection application. The proposed workflow increases the automation of the digital AM processes, thanks to the adoption of BIM-IoT integration tools and methods within the context of the development of a building DT.

Measurement of performances in asset management is an enabling factor to define an effective strategy. The scope of this research concerns the investigation on the Facility Condition Index (FCI): one of the most common metrics related to the built environment. The research aims at providing a critical review concerning the FCI and its use. The research methodology has been developed according to three steps: bibliographic research, bibliometric analysis and critical review. Most of the sources agree that FCI provides a reliable economic measurement of maintenance needs, though it must be tied to a strong condition assessment methodology. Moreover, different methodologies for computation of the deferred maintenance and the current replacement value can be found in literature and many researchers emphasised the limits of FCI when dealing with components characterised by a considerable difference in replacement costs. In conclusion, FCI is included in the wider framework of asset management business process.

In accordance with European objectives, the Basilicata region intends to promote the use of energy systems and heat generators powered by lignocellulosic biomass, so the present study aimed to investigate the availability of logging residues and most suitable areas for the construction of bioenergy production plants. The life cycle assessment (LCA) methodology was employed to conduct an environmental impact assessment of the biomass distribution and its transport, and spatial LCA was used to evaluate the impact of regional transport. One cubic meter kilometer (m3 km−1) was used as the functional unit and a small lorry was considered for the transport. The results showed that the available harvesting residues amounted to 36,000 m3 and their loading environmental impact accounted for 349 mPt m−3. The impacts of transport (4.01 mPt m−3) ranged from 3.4 to 144,400 mPt km−1 forest parcel−1, mainly affecting human health (95%) and, second, the ecosystem quality (5%). Three possible sites for bioenergy plant location were identified considering the environmental impact distribution due to feedstock transport. Findings from this research show the importance of considering the LCA of biomass acquisition in site selection and can fill the knowledge gaps in the available literature about spatial LCA.

The current perspective about urban development expects 70% of energy consumption will be concentrated in the cities in 2050. In addition, a growing density of people in the urban context leads to the need for increased security and safety for citizens, which imply a better lighting infrastructure. Smart solutions are required to optimize the corresponding energy effort. In developing countries, the cities’ lighting is limited and the lighting world map is strongly significant about the urban density of the different areas. Nevertheless, in territories where the illumination level is particularly high, such as urban contexts, the conditions are not homogenous at the microscale level and the perceived security is affected by artificial urban lighting. As an example, 27.2% of the families living in the city of Milan, ombardy Region, Italy, consider critical the conditions of lighting in the city during the night, although the region has diffused infrastructure. The paper aims to provide a local illuminance geographic information system (GIS) mapping at the neighborhood level that can be extended to the urban context. Such an approach could unveil the need to increase lighting to enhance the perceived safety and security for the citizens and promote a higher quality of life in the smart city. Lighting mapping can be matched with car accident mapping of cities and could be extended to perceived security among pedestrians in urban roads and green areas, also related to degradation signs of the built environment. In addition, such an approach could open new scenarios to the adaptive street lighting control used to reduce the energy consumption in a smart city: the perceived security of an area could be used as an additional index to be considered during the modulation of the level of the luminosity of street lighting. An example of a measurement set-up is described and tested at the district level to define how to implement an extensive monitoring campaign based on an extended research schema.

Measuring and rating resilience of assets is a key enabler for asset and portfolio management. This paper presents a resilience rating system for buildings by utilising a Building Information Modelling approach. The assessment is carried out through a calculation following the Analytical Hierarchy Process. This methodology can be applied to different types of buildings, without a loss of precision or reliability. This resilience rating forms an integral part of more comprehensive array of Key Performance Indicators frameworks for asset and portfolio management, and therefore can significantly influence strategic investment choices for designers, engineers and building owners.

Background: Thrombolysis in the elderly is still a matter of debate. Recently, the Third International Stroke Trial (IST-3) suggested that recombinant tissue plasminogen activator (rt-PA) improves functional outcome, without a substantial absolute increase in symptomatic intracranial hemorrhage, even in older patients. The aim of the current prospective study is to describe safety and functional outcome in a cohort of patients treated by intravenous rt-PA in an Italian stroke unit “real world setting”. Methods: All the consecutive patients treated with rt-PA between 2006 and 2010 in an Italian province with 290,000 inhabitants were enrolled. Total and symptomatic (associated with a 4-point worsening on the National Institutes of Health Stroke Scale [NIHSS] score) hemorrhages were evaluated, as safety measures, along with disability (at 3-month modified Rankin scale) as effectiveness measure. Results: One hundred and eighty-seven patients were treated with rt-PA; 90 males (48.1%); average age 75.1 (±11.9) years; 79 (42.2%) patients aged ≥80 years. Patients aged ≥80 years had a higher NIHSS score at stroke onset (13.5 vs. 10.9). No significant difference was found between patients aged

Rating systems are assumed as instruments to endorse architectural quality, reliability, energy efficiency, economic convenience and finally expose a sustainability label. Moreover, these tools can be tied to a BIM model. The aim of this research is to set up a lean methodology to fulfil CESBA requirements through Construction to Operations Building information exchange – COBie in project on existing buildings adopting the BIM Bronze approach by UK Ministry of Justice - MoJ. This will allow to develop a semantic model and to extract sustainability reports in a post-construction phase, thereby minimising the cost of gathering information on existing buildings. An illustrated example regarding energy criteria of CESBA protocol will be presented to further the proposed approach.

Polyvinyl acetate (PVA) exhibits fine adhesion qualities when bonded to wood. However, when using thermo-treated wood, a number of different unstudied factors (such as the water stress condition) influence the wood bonding effectiveness. The main goal of this study was to evaluate how different treatments affect the shear bonding strength for three cases of thermo-vacuum treated woods. Wood from both Norway spruce (Picea abies Karst.) and common ash (Fraxinus excelsior L.) was thermo-treated at 190 °C for two hours under vacuum conditions (250 mbar). Turkey oak (Quercus cerris L.) logs were separately steamed at 110 °C for 24 h, then thermo-vacuum treated at 160 °C for three hours. The bonding shear strength between the PVA adhesive and treated wood was evaluated using water stress condition. The results were compared with the adhesive bond line properties of the untreated wood. The shear strength and wettability of the produced material were measured. Tests for the shear resistance, performed in accordance with the standard DIN EN 204, revealed dissimilar behavior as well as the influence of treatment schedules for the different wood species. Consequently, the tests performed allowed a detailed characterization of the effect of the thermo-vacuum process on the bonding quality of three common woods in different water stress conditions.

Unconjugated bilirubin plays an important role in cholesterol gallstone formation. Patients with symptomatic gallstone disease who have high bilirubin plasma levels and/or are homozygous for the rs6742078 TT variant of the bilirubin glucuronidating gene UGT1A1 should not undergo oral dissolution therapy with ursodeoxycholic acid. A large Danish study has shown that high bilirubin plasma levels and the genetic variant rs6742078 TT of the enzyme bilirubin glucuronidase UGT1A1 are associated with an increased risk of developing symptomatic gallstone disease. Recent reports regarding the significant association between bilirubin levels and symptomatic gallstone disease open a new chapter about the indication and exclusion criteria for oral dissolution therapy of symptomatic gallstone disease. A highly select subgroup of patients with small, single, radiolucent cholesterol gallstones who received oral dissolution therapy with ursodeoxycholic acid (UDCA) had a reported recurrence of symptomatic gallstone disease of 50% over five years. This is probably related to the persistence of other causal risk factors for gallstones in addition to that of cholesterol suprasaturation. A subgroup of patients with high plasma bilirubin levels and the UGT1A1 genetic variant rs6742078 have a greater risk of recurrence. In conclusion, oral dissolution therapy with UDCA might still be appropriate for patients that refuse laparoscopic cholecystectomy provided they have small (< 0.5 cm), radiolucent cholesterol gallstones and a functioning gallbladder, and have mean plasma bilirubin levels below 1.33 mg/dL and are not homozygous for the UGT1A1 rs6742078 TT genotype. [Arch Clin Exp Surg 2014; 3(3.000): 161-165]

Background. Echinococcosis is a zoonosis caused by the Echinococcus adult or larvae tapeworms. Surgery has been the mainstay for large cysts, those that are likely to rupture, or infected, or exerting an important mass effect, but it has been said to be impractical in patients with multiple cysts in several organs. The aim of this study is to report our strategy for the surgical resection or for the drainage of large (> 5 cm) and/or complicated liver and multi-organ hydatid cysts. Methods. From 1992 to 2012, 13 patients have been evaluated for open surgery or a minimally invasive approach for cystic echinococcosis. After Albendazole administration, liver cysts have been treated by pericystectomy in nine cases, partial pericystectomy in three cases, and in one case we preferred to consider the percutaneous drainage. In case of multiple extra-abdominal organ localization, we first treated the liver localizations. Results. There has not been operative or post-operative mortality. Follow-up has been done for 1 and ndash;10 years and has revealed no recurrence. Conclusion. Surgery could have satisfactory results among patients with single and multiple large (> 5 cm) cysts in multiple organs. In case of recurrence, adhesion to the inferior cava vein or when general conditions are poor, the percutaneous intracystic injection of 90% ethanol followed by the cyst drainage (PAIR) is strongly recommended. [Arch Clin Exp Surg 2014; 3(2.000): 102-106]

Operations and maintenance optimization are primary issues in Facility Management (FM). Moreover, the increased complexity of the digitized assets leads Facility Managers to the adoption of interdisciplinary metrics that are able to measure the peculiar dynamics of the asset-service system. The aim of this research concerns the development of a cross-domain Decision Support System (DSS) for maintenance optimization. The algorithm underpinning the DSS enables the maintenance optimization through a wiser allocation of economic resources. Therefore, the primary metric encompassed in the DSS is a revised version of the Facility Condition Index (FCI). This metric is combined with an index measuring the service life of the assets, one measuring the preference of the owner and another measuring the criticality of each component in the asset. The four indexes are combined to obtain a Maintenance Priority Index (MPI) that can be employed for maintenance budget allocation. The robustness of the DSS has been tested on an office building in Italy and provided good results. Despite the proposed algorithm could be included in a wider Asset Management system employing other metrics (e.g., financial), a good reliability in the measurement of cross-domain performance of buildings has been observed.

Urban areas can be considered the ground for the challenges related to the UN’s Sustainable Development Goals (SDGs). The objective of shaping cities as human settlement that will see a more inclusive, safe, resilient, and sustainable future is often argued in literature as an issue dependent on behavioral change of inhabitants in urban areas. In this paper, the authors question if experimental applications based on gamification can co-produce more sustainable neighborhoods through an impact evaluation method that departs from individual choices within the complex of urban mobility. This investigation is carried out within MUV (Mobility Urban Values), an EU research and innovation project, which aims to trigger more sustainable urban mobility in six pilot cities. This article describes the critical method of validation, an impact assessment of the MUV experimental gamification in the pilot cities, in order to represent a proof for future urban strategies. This methodological approach is based on an evaluation structured on indicators of both impact and process suitable for urban contexts. As based on six pilot cities, with possibilities for transferability to other contexts and scalability to other cities, the method represents a reference work for the evaluation of similar experimental applications.

Acute confusional migraine (ACM) is recognized as a rare, but highly disabling migraine equivalent, mostly reported in children and adolescents. Herein we describe the case of a 12-year-old girl admitted to hospital for an acute confusional state and severe psychomotor agitation, associated with a pulsating headache and nausea, which turned out to be a manifestation of ACM. The girl was discharged on topiramate prophylaxis, titrated up to 75 mg/die; no recurrence of confusional and/or headache episodes has been reported over the last 14 months to date. Due to the rarity of this clinical entity, only anecdotal reports about acute and prophylactic treatment of ACM are available in the literature. The case reported herein suggests that topiramate seems to be effective in ACM prophylaxis, although a longer observation period in our patient and more cases are needed to confirm any long-term clinical benefit.

The aim of this work is comparing the two year performance (diameter, total height and mortality) of twenty tree and shrub species in a semi arid environment. The research also wants to supply recommendation on the agronomic cropping techniques in areas where rainfall is the main limiting factor and water use is strictly limited. Woody biomass is gaining increasing importance for energy production in Italy. During the last five years, roughly 5000 ha of Short Rotation Forestry (SRF) have been planted, mostly in northern Italy, especially using poplar clones. However, in Southern Italy, due to the poor rainfall and the lack of knowledge existing on the species to use, few groves have been established. The studied groves were set in December 2005 in a Mediterranean area where the total year rainfall is not higher than 600 mm (mostly in autumn and winter). Twenty species (Salix cinerea, Ulmus carpinifolia, Corylus avellana, Spartium junceum, Acer saccharinum, Morus alba, Saphora japonica, Eleagnus angustifolia, Fraxinus angustifolia (var oxicarpa), Sambucus nigra, Robinia pseudoacacia, Populus nigra, Albizia julibrissis, Populus alba, Salix alba, Ailanthus altissima, Alnus cordata, Ficus carica, Eucalyptus camaldulensis, Celtis australis) were planted in “collection” plots and set in singular plots on single rows (3 m X 0.5 m spacing). Six species (R. pseudoacacia, P. nigra, P. alba, S. nigra, E. camaldulensis, and A. altissima) were planted in eighteen random “experimental” split-plots, using single and twin rows (0.5 m spacing between plants). Plots had a rectangular plant spacing (3 m between singular and twin rows, 0.5 m on each row). Plant density was roughly 6670 cuttings ha-1 in “collection” plots with singular rows and 10950 cuttings ha-1 in “experimental” plots using single and twin rows. The expected harvest interval ranges from 2 to 5 years, depending on the first results. In the “collection” plots, the first results showed good performances in terms of diameter and total height of R. pseudoacacia, E. camaldulensis and E. angustifolia. The highest mortality percentage was recorded for S. nigra, P. nigra, P. alba both in “collection” and “experimental” plots. All other species showed mortality percentage lower than 20%.

We address the efficient realization of a filtered multitone (FMT) modulation system and its orthogonal design. FMT modulation can be viewed as a Discrete Fourier Transform (DFT) modulated filter bank (FB). It generalizes the popular orthogonal frequency division multiplexing (OFDM) scheme by deploying frequency confined subchannel pulses. We compare three realizations that have been described by Cvetković and Vetterli (1998), and Weiss and Stewart (2000), and Tonello (2006). A detailed derivation of them is performed in the time-domain via the exploitation of different FB polyphase decompositions. We then consider the design of an orthogonal FMT system and we exploit the third realization which allows simplifying the orthogonal FB design and obtaining a block diagonal system matrix with independent subblocks. A numerical method is then presented to obtain an orthogonal FB with well frequency confined subchannel pulses for arbitrarily large number of subchannels. Several examples of pulses with minimal length are reported and their performance is evaluated in typical multipath fading channels. Finally, we compare the orthogonal FMT system with a cyclically prefixed OFDM system in the IEEE 802.11 wireless LAN channel. In this scenario, FMT with minimal length pulses and single tap subchannel equalization outperforms the OFDM system in achievable rate.

Two-stage liver transplantation (LT) has been reported for cases of fulminant liver failure that can lead to toxic hepatic syndrome, or massive hemorrhages resulting in uncontrollable bleeding. Technically, the first stage of the procedure consists of a total hepatectomy with preservation of the recipient's inferior vena cava (IVC), followed by the creation of a temporary end-to-side porto-caval shunt (TPCS). The second stage consists of removing the TPCS and implanting a liver graft when one becomes available. We report a case of a two-stage total hepatectomy and LT in which a temporary end-to-end anastomosis between the portal vein and the middle hepatic vein (TPMHV) was performed as an alternative to the classic end-to-end TPCS. The creation of a TPMHV proved technically feasible and showed some advantages compared to the standard TPCS. In cases in which a two-stage LT with side-to-side caval reconstruction is utilized, TPMHV can be considered as a safe and effective alternative to standard TPCS.