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Rationale & Objective In the general population, cognitive impairment is associated with increased mortality, and higher levels of education are associated with lower risks for cognitive impairment and mortality. These associations are not well studied in patients receiving long-term hemodialysis and were the focus of the current investigation. Study Design Prospective cohort study. Setting & Participants Adult hemodialysis patients treated in 20 Italian dialysis clinics. Exposures Patients’ cognitive function across 5 domains (memory, attention, executive function, language, and perceptual-motor function), measured using a neuropsychological assessment comprising 10 tests; and patients’ self-reported years of education. Outcome All-cause mortality. Analytical Approach Nested multivariable Cox regression models were used to examine associations of cognition (any domain impaired, number of domains impaired, and global function score from principal components analysis of unadjusted test scores) and education with mortality and whether there were interactions between them. Results 676 (70.6%) patients participated, with a median age of 70.9 years and including 38.8% women. Cognitive impairment was present in 79.4% (527/664; 95% CI, 76.3%-82.5%). During a median follow-up of 3.3 years (1,874 person-years), 206 deaths occurred. Compared to no cognitive impairment, adjusted HRs for mortality were 1.77 (95% CI, 1.07-2.93) for any impairment, 1.48 (95% CI, 0.82-2.68) for 1 domain impaired, 1.88 (95% CI, 1.01-3.53) for 2 domains, and 2.01 (95% CI, 1.14-3.55) for 3 to 5 domains. The adjusted HR was 0.68 (95% CI, 0.51-0.92) per standard deviation increase in global cognitive function score. Compared with primary or lower education, adjusted HRs were 0.79 (95% CI, 0.53-1.20) for lower secondary and 1.13 (95% CI, 0.80-1.59) for upper secondary or higher. The cognition-by-education interaction was not significant (P = 0.7). Limitations Potential selection bias from nonparticipation and missing data; no data for cognitive decline; associations with education were not adjusted for other socioeconomic factors. Conclusions Cognitive impairment is associated with premature mortality in hemodialysis patients. Education does not appear to be associated with mortality.

Rationale & Objective Clinical practice guidelines for dietary intake in hemodialysis focus on individual nutrients. Little is known about associations of dietary patterns with survival. We evaluated the associations of dietary patterns with cardiovascular and all-cause mortality among adults treated by hemodialysis. Study Design Prospective cohort study. Setting & Participants 8,110 of 9,757 consecutive adults on hemodialysis (January 2014 to June 2017) treated in a multinational private dialysis network and with analyzable dietary data. Exposures Data-driven dietary patterns based on the GA2LEN food frequency questionnaire. Participants received a score for each identified pattern, with higher scores indicating closer resemblance of their diet to the identified pattern. Quartiles of standardized pattern scores were used as primary exposures. Outcomes Cardiovascular and all-cause mortality. Analytical Approach Principal components analysis with varimax rotation to identify common dietary patterns. Adjusted proportional hazards regression analyses with country as a random effect to estimate the associations between dietary pattern scores and mortality. Associations were expressed as adjusted HRs with 95% CIs, using the lowest quartile score as reference. Results During a median follow-up of 2.7 years (18,666 person-years), there were 2,087 deaths (958 cardiovascular). 2 dietary patterns, “fruit and vegetable” and “Western,” were identified. For the fruit and vegetable dietary pattern score, adjusted HRs, in ascending quartiles, were 0.94 (95% CI, 0.76-1.15), 0.83 (95% CI, 0.66-1.06), and 0.91 (95% CI, 0.69-1.21) for cardiovascular mortality and 0.95 (95% CI, 0.83-1.09), 0.84 (95% CI, 0.71-0.99), and 0.87 (95% CI, 0.72-1.05) for all-cause mortality. For the Western dietary pattern score, the corresponding estimates were 1.10 (95% CI, 0.90-1.35), 1.11 (95% CI, 0.87-1.41), and 1.09 (95% CI, 0.80-1.49) for cardiovascular mortality and 1.01 (95% CI, 0.88-1.16), 1.00 (95% CI, 0.85-1.18), and 1.14 (95% CI, 0.93-1.41) for all-cause mortality. Limitations Self-reported food frequency questionnaire, data-driven approach. Conclusions These findings did not confirm an association between mortality among patients receiving long-term hemodialysis and the extent to which dietary patterns were either high in fruit and vegetables or consistent with a Western diet.

The nutritional status of 926 patients (51.4% female) at an acute tertiary private hospital with a length of stay ≥14 days was assessed using Subjective Global Assessment. The prevalence of malnutrition was 42.5% (37.2% length of stay of 14-27 days, 51.6% ≥28 days). From logistic regression analysis, length of stay and age were independent predictors of malnutrition. It is important that the nutritional status of longer stay patients is monitored and appropriate nutrition support is commenced.

Background Dental disease is more extensive in adults with chronic kidney disease, but whether dental health and behaviors are associated with survival in the setting of hemodialysis is unknown. Study Design Prospective multinational cohort. Setting & Participants 4,205 adults treated with long-term hemodialysis, 2010 to 2012 (Oral Diseases in Hemodialysis [ORAL-D] Study). Predictors Dental health as assessed by a standardized dental examination using World Health Organization guidelines and personal oral care, including edentulousness; decayed, missing, and filled teeth index; teeth brushing and flossing; and dental health consultation. Outcomes All-cause and cardiovascular mortality at 12 months after dental assessment. Measurements Multivariable-adjusted Cox proportional hazards regression models fitted with shared frailty to account for clustering of mortality risk within countries. Results During a mean follow-up of 22.1 months, 942 deaths occurred, including 477 cardiovascular deaths. Edentulousness (adjusted HR, 1.29; 95% CI, 1.10-1.51) and decayed, missing, or filled teeth score ≥ 14 (adjusted HR, 1.70; 95% CI, 1.33-2.17) were associated with early all-cause mortality, while dental flossing, using mouthwash, brushing teeth daily, spending at least 2 minutes on oral hygiene daily, changing a toothbrush at least every 3 months, and visiting a dentist within the past 6 months (adjusted HRs of 0.52 [95% CI, 0.32-0.85], 0.79 [95% CI, 0.64-0.97], 0.76 [95% CI, 0.58-0.99], 0.84 [95% CI, 0.71-0.99], 0.79 [95% CI, 0.65-0.95], and 0.79 [95% CI, 0.65-0.96], respectively) were associated with better survival. Results for cardiovascular mortality were similar. Limitations Convenience sample of clinics. Conclusions In adults treated with hemodialysis, poorer dental health was associated with early death, whereas preventive dental health practices were associated with longer survival.

The latest EU policies focus on the issue of food safety with a view to assuring adequate and standard quality levels for the food produced and/or consumed within the EC. To that purpose, the environment where agricultural products are manufactured and processed plays a crucial role in achieving food hygiene. As a consequence, it is of the utmost importance to adopt proper building solutions which meet health and hygiene requirements and to use suitable tools to measure the levels achieved. Similarly, it is necessary to verify and evaluate the level of safety and welfare of the workers in their working environment. The safety of the workers has not only an ethical and social value but also an economic implication, since possible accidents or environmental stressors are the major causes of the lower efficiency and productivity of workers. However, the technical solutions adopted in the manufacturing facilities in order to achieve adequate levels of safety and welfare of the workers are not always consistent with the solutions aimed at achieving adequate levels of food hygiene, even if both of them comply with sectoral rules which are often unconnected with each other. Therefore, it is fundamental to design suitable models of analysis that allow assessing buildings as a whole, taking into account both health and hygiene safety as well as the safety and welfare of workers. Hence, this paper proposes an evaluation model that, based on an established study protocol and on the application of a fuzzy logic procedure, allows evaluating the global safety level of a building. The proposed model allows to obtain a synthetic and global value of the building performance in terms of food hygiene and safety and welfare of the workers as well as to highlight possible weaknesses. Though the model may be applied in either the design or the operational phase of a building, this paper focuses on its application to certain buildings already operational in a specific productive context.

The nutritional status of 926 patients (51.4% female) at an acute tertiary private hospital with a length of stay ≥14 days was assessed using Subjective Global Assessment. The prevalence of malnutrition was 42.5% (37.2% length of stay of 14-27 days, 51.6% ≥28 days). From logistic regression analysis, length of stay and age were independent predictors of malnutrition. It is important that the nutritional status of longer stay patients is monitored and appropriate nutrition support is commenced.

In the past seven years the Service for Prevention and Safety in Workplaces of the Health Local Agency of Rome C set out some activities towards the occupational physicians (so-called "competent physicians") of three different kinds: control and surveillance, institutional activities on demand and activities for quality improvement. In the first ambit we conducted some investigations on the procedures of the workers' medical surveillance and the role of competent physicians in the risk evaluation inside three different intervention projects (monitoring the enforcement of the D.Lgs. 626/94; intervention on the chemical risk, intervention in the car repair shops). In the second ambit we analysed 92 notifications of occupational diseases and we dealt with 27 appeals against the judgement of the fitness to work. In the third ambit we made 19 meetings on various subjects: correct procedures in medical surveillance, quality in diagnostic examinations, the enforcement of new regulations. We report the results of these interventions which let us identify the most common criticalities in the activity of the competent physicians, but also to face them with a new approach based more on peer review instead of control and surveillance.

Magnetic, gravimetric and seismic reflection data were obtained in the area between Genoa and Pontremoli northwards from the Ligurian coast to the Lombardy South-Alpine sector. Data and interpretation provide evidence on geometry, depth and nature of the subsurface down to the magnetic basement (superficial crust). From these factors we attempt a structural outline of the southern Alps-Po Basin-northern Apennine system. By filtering the Bouguer anomalies, the gravimetric data reveal residual anomalies relative to the “Milan High” and a band of translated structures on the southern Alpine and northern Apennine rims. Magnetic data indicate the presence of a substratum with high susceptibility and magnetic bodies having various natures and origins. These bodies can be ascribed to ophiolites, volcanites and tectonically disrupted basement slabs beneath the southern Alps and northern Apennines. Seismic reflection data provide structural evidence of the sedimentary sequence. By integrating seismic interpretations with borehole and surface geological data, we depicted the structural geometries as well as the chronological evolution of the area. The study area consists of a rigid zone acting as a foreland and two orogenic zones, having Tertiary compressive structures, which overthrust the central zone to the north and south. The central zone was affected by Permian extensional tectonics coupled with volcanism, uplifted in the Triassic-Lias and dislocated by synsedimentary faults during the Mesozoic. Beginning in the Tertiary the area was subjected to gradual sinking. The fault zones are characterized by large-scale Paleogene-Neogene overthrusting involving the pre-Mesozoic basement. On the Apennine side, the panorama is complicated by the presence of localized thick ophiolitic bodies.

Pair-housed, water-deprived rats were trained to run in a two-way shuttle box, using water reinforcement. Animals were tested either singly or in pairs; in the paired condition, the animals were required to shuttle in close physical proximity. Paired performance, but not single performance was severely disrupted by single housing for 3-7 weeks. Performance of singly-housed animals could be restored either by re-housing in pairs (30 days) or by chronic (30 day) treatment with the antidepressants imipramine or fluoxetine. Chronic imipramine was also prophylactically active in preventing the deterioration in performance of singly-housed animals. The superior paired performance of pair-housed animals and of imipramine-treated singly-housed animals, was abolished by the 5-HT antagonist metergoline. Metergoline had relatively little effect on single running: the DA antagonist pimozide disrupted paired and single running equally. The results suggest a role for 5-HT in cooperative performance and in the action of antidepressant drugs in this paradigm.

A comparison of the results obtained from the geophysical interpretation with the available information regarding the Italian geological situation permitted us to establish our so-called “geo-magnetic provinces”. The relationship between the magnetic characteristics and the tectonic evolution permitted the identification of each of the four following “provinces” that exist inside the global tectonic confines: 1. (1) The “Sardo-Corso” block , which represents the eastern boundary of stable Europe. This province is characterized by medium-wavelength low-amplitude anomalies that originate in an outcropping basement (Hercynian granites s.l.). 2. (2) The “Orogenic belt” , which constitutes the double Alps-Apennines system. From a magnetic standpoint, this system is characterized by short-wavelength, low-amplitude anomalies that are due to a Paleozoic outcropping and/or buried, acid, crystalline basement. These anomalies are found to overlie long-wavelength, medium-amplitude regional anomalies that are related to a deep, Apenninic basement (central-northern Apennines). 3. (3) The “Foreland area” , which occurs from Sicily (Hyblean Plateau) and Apulia northwards to Ancona and the Po Plain. This area is characterized by a crystalline basement which is typically “differentiated” from the standpoint of basicity. 4. (4) The “Rifting zone” , which is represented by the part of the Tyrrhenian Sea lying south of the “41st-Parallel discontinuity”, the Ionian Abyssal Plain and the Pantelleria and Linosa troughs in the Sicily Channel. The main characteristic of this province is its extreme basicity differentiation in the crystalline basement, which is induced by the geochemical processes connected with the deep, geodynamic events. These phenomena do not permit the correlation of the semioceanic basement of the Rifting zone with the continental basement. By means of interactive modeling, a structural-tectonic picture of the basement of the various Italian “geo-magnetic provinces” has been obtained. The main result was found to be that the Orogenic belt basement is undergoing intense tectonic compression and overlies the structural highs of the Foreland area, which mainly show tensive events.

The authors, after having analyzed the clinical patterns and the causes producing cava syndrome, propose a sequential diagnostic approach to it, whose course makes use of radiological procedures more or less invasive, and of endoscopic and histobioptic techniques. Among radiological investigations pan-cavography has allowed the authors to formulate the diagnosis of limited venous return because of intrinsic causes, conferring so an aetiological connotation and a physiopathological correlation indispensable for a correct and rapid therapy of the uncommon "intrinsic cava syndrome" of two patients, suffering respectively from "idiopathic thrombosis of superior vena cava, concerning also the beginning of inferior vena cava" and from "Fiedler cardiomyopathy".

A mortal case of leptosprosis happened in a little agricultural community situated in a country town in the south Lazio Region, and in consequence of that the Local Health Unit originated a series of epidemiological investigation and preventive treatments. Serological tests were effectuated both on the residents of the interested area and on animals of the farm. These serological tests gave positive results for four inhabitants and eight animals. The agricultural community were subjected to a chemoprophylaxis. No new cases of disease have been found. The drinking water was analyzed because the water supplied came from unprotected wells. The tests gave unfavorable results for the presence of fecal streptococci. It wasn't possible to effect specific tests for the research of leptospira, because it was difficult to find suitably equipped laboratory. As a result of these tests it was decided to apply preventive treatments on a permanent basis on the farm in question. The fact that the serodiagnosis showed the same kind of leptospira in both men and animal, suggested once again the problem of transmission between animals and men and the need for adequate measures of profilaxis. Also the need to cover exposed agricultural work men with an adequate insurance. Great interest was shown in the correct intervention of the operators of Public Hygiene Service and Veterinary Services. It's essential to coordinate the activity of the two services for an effective intervention in these si milar cases, both during the phases of epidemiological research and prevention. Intention of this work is to furnish a possible operative procedure for situations of this kind.

In this paper a computer algorithm is presented in order to describe the flowdynamies of air in bioclimatic buildings, Such a procedure allows to “follow” the air flow path across the living space, accounting for pressure drops and mixing effects, The algorithm has been added to a computer code for the thermal transient analysis of buildings giving rise to a compact program architecture able to thoroughly describe the interaction in time and space between flowdynamies and thermodynamics of complex systems. Two cases were developped respectively dealing with open and closed circuits, such as Solar Chimney, Trombe wall and Barra-Costantini system in summer mode (open circuits), and Trombe wall. Barra-Costantini system and green-house in winter mode (closed circuits).

During the last decades the CFD computer modelling of fire has increased significantly. The CFD fire simulator has been purposely developed and optimized for fire protection; nowadays they have a high reliability and ample perspectives of further development. The main drawbacks of CFD fire simulators are mainly due to the complexity of its setting. They are not user friendly and require a good competence on fires and fair competence in computing. To be able to estimate how the simulation outcome is influenced by model assumptions and simplifications, the user has to evaluate the dominating physical processes and involved empirical parameter that has an essential influence on the specific fire scenario. In this paper the Thermo-gravimetric (TGA) and Cone-calorimetric tests will be used to show in which ranges the input parameters such as reference temperature (i.e. the temperature of the released mass rate peak), thermal conductivity, pyrolysis range, specific heat, in a fire simulation with the “Fire Dynamics Simulator”, will vary based on the measurement errors, measurement uncertainty, or misinterpretation of the user. Fire simulation validated on experimental tests are used to evaluate the impact of those variant input data on the simulation. A parametric analysis has been carried out and the results are evaluated and discussed.

A numerical analysis on a compact heat exchanger in aluminum foam is accomplished. The governing equations in two-dimensional steady state regime are written in local thermal non-equilibrium (LTNE). The physical domain under investigation is made up of a plate in aluminum foam with inside a single array of five circular tubes. The presence of the open-celled metal foam is modelled as a porous media by means of the Darcy-Brinkman-Forchheimer law. The metal foam is characterized by a porosity of 0.93 and different pores per inch (PPI), equal to 5, 10, 20 and 40 are analized. The LTNE assumption is considered to simulate the heat transfer between the fluid phase and the solid matrix of the foam. The compact heat exchanger at different air flow rates is studied with an assigned surface tube temperature. The results are shown in terms of heat and mechanical power ratio. Global parameters such as effectiveness and NTU, typical in compact heat exchangers, are showed. Furthermore, local air temperature and velocity profiles in the smaller cross section, between two consecutive tubes, as a function of Reynolds number are presented.