Towards risk-targeted seismic hazard models for Europe.

Standards and Codes of Practice for designing new constructions and for assessing and strengthening existing ones are usually based on uniform hazard maps, where different Limit States (LSs) are associated with different hazard-exceedance probabilities. This approach yields non-homogeneous LS-exceedance probabilities across a territory, thus failing to achieve the goal of uniform risk throughout a territory. Such lack of uniformity stems from estimating the probability of failure using capacity and demand models. If the capacity of new constructions-or the capacity increase of strengthened existing constructions-are designed based on a prescribed hazard-exceedance probability, then the seismic risk depends on both the structure (depending on the design philosophy and corresponding design objectives), through the capacity model, and the location, through the hazard model. The aim of this study is threefold. First, it provides a seismic probability assessment formulation and a risk-targeted intensity measure based on a linear model in log-log coordinates of the hazard, under the assumption of log-normal capacity and demand. The proposed framework introduces a factor that multiplies the code hazard-based demand to account either for intentional (from design) over-capacity or for undesired (e.g., in existing constructions) under-capacity. Second, this paper shows an application to peak ground accelerations in Europe considering parameters taken from Standards and Codes of Practice. The developed framework is used to determine the risk-target levels of peak ground acceleration used for design in Europe, for both new and existing constructions. Third, the obtained target risk levels are used to determine a risk-based intensity modification factor and a risk-based mean return period modification factor, which can be readily implemented in current Standards to achieve risk-targeted design actions, with equal LS-exceedance probability across the territory. The framework is independent of the chosen hazard-based intensity measure, be it the commonly used peak ground acceleration or any other measure. The results highlight that in large areas of Europe the design peak ground acceleration should be increased to achieve the proposed seismic risk target and that this is particularly significant for existing constructions, given their larger uncertainties and typical low capacity with respect to the code hazard-based demand.

Culture-based antibiotic susceptibility testing for Helicobacter pylori infection: a systematic review.

Background: Primary antibiotic resistance in Helicobacter pylori (H. pylori) strains is increasing worldwide, affecting therapy success. The use of therapies tailored on susceptibility pre-testing at culture has been proposed, but data are still conflicting. Method: We performed a systematic review to evaluate the role of a culture-based therapeutic approach for H. pylori treatment, taking into account the sensitivity of culture and the success rates achieved with tailored therapies in different therapeutic steps. Results: We analyzed data from 51 studies. Overall, H. pylori strains were isolated in 80.7% of 7889 patients, the success rates being 78.1%, 77.5%, 86.3% and 86.6%, before first-, second-, third-line or more therapies, respectively. In comparative studies, the infection was cured in 89.9% of 2052 patients treated with tailored therapies, and in 77.6% of 2516 patients receiving empiric therapy (P<0.001). However, in the subanalysis, the tailored approach achieved optimal eradication rates (>90%) only when it was applied before first- and second-line therapies, but not before third-line or more attempts (<80%). Moreover, no significant difference emerged between the 2 approaches when data from only the most recent (last 5 years) studies were considered, as well as in those performed in Western populations. Conclusions: The attempt to achieve antibiotic susceptibility testing before treatment failed in 20% of infected patients managed in dedicated laboratories. Culture-tailored therapies administered after 2 or more therapies achieved suboptimal eradication rates. The role of bacterial culture in patients whose therapeutic management failed to eradicate H. pylori probably needs to be corroborated by further data.

Sickle Cell Trait and SARS-CoV-2-Induced Rhabdomyolysis: A Case Report.

BACKGROUND Rhabdomyolysis is a syndrome characterized by muscle necrosis and the subsequent release of intracellular muscle constituents into the bloodstream. Although the specific cause is frequently evident from the history or from the immediate events, such as a trauma, extraordinary physical exertion, or a recent infection, sometimes there are hidden risk factors that have to be identified. For instance, individuals with sickle cell trait (SCT) have been reported to be at increased risk for rare conditions, including rhabdomyolysis. Moreover, there have been a few case reports of SARS-CoV-2 infection-related rhabdomyolysis. CASE REPORT We present a case of a patient affected by unknown SCT and admitted with SARS-CoV-2 pneumonia, who suffered non-traumatic non-exertional rhabdomyolysis leading to acute kidney injury (AKI), requiring acute hemodialysis (HD). The patients underwent 13 dialysis session, of which 12 were carried out using an HFR-Supra H dialyzer. He underwent kidney biopsy, where rhabdomyolysis injury was ascertained. No viral traces were found on kidney biopsy samples. The muscle biopsy showed the presence of an "open nucleolus" in the muscle cell, which was consistent with virus-infected cells. After 40 days in the hospital, his serum creatinine was 1.62 mg/dL and CPK and Myoglobin were 188 U/L and 168 ng/mL, respectively; therefore, the patient was discharged. CONCLUSIONS SARS-CoV-2 infection resulted in severe rhabdomyolysis with AKI requiring acute HD. Since SARS-CoV-2 infection can trigger sickle-related complications like rhabdomyolysis, the presence of SCT needs to be ascertained in African patients.

[Consensus document and recommendations for the prevention of cardiovascular disease in Italy - 2018]. / Documento di consenso e raccomandazioni per la prevenzione cardiovascolare in Italia 2018.

Cardiovascular prevention represents a cornerstone of modern strategies to reduce the burden of cardiovascular disease. It is of key importance to prevent cardiovascular diseases and associated events, not only to reduce morbidity and mortality, but also to increase the years of wellness in the aging population and to make the growing socio-economic burden imposed by cardiovascular events more sustainable.The current approach to prevention is based on an integrated use of effective lifestyle measures and, whenever appropriate, of antihypertensive and antidiabetic drugs, lipid-lowering agents and antiplatelet drugs.Given that population characteristics, in terms of ethnicity, demography and lifestyle habits, and healthcare system organizations differ among countries, international guidelines are not always applicable to specific countries and, often, are difficult to translate into daily clinical practice.In order to afford the specific features of Italy, 10 Scientific Societies and Research Institutions, mostly involved in preventive strategies, contributed to the present Italian consensus document, which includes brief, practical recommendations to support the preventive actions within the physician community and the general practice setting.

Algorithms for the diagnosis and treatment of restless legs syndrome in primary care.

BACKGROUND: Restless legs syndrome (RLS) is a neurological disorder with a lifetime prevalence of 3-10%. in European studies. However, the diagnosis of RLS in primary care remains low and mistreatment is common. METHODS: The current article reports on the considerations of RLS diagnosis and management that were made during a European Restless Legs Syndrome Study Group (EURLSSG)-sponsored task force consisting of experts and primary care practitioners. The task force sought to develop a better understanding of barriers to diagnosis in primary care practice and overcome these barriers with diagnostic and treatment algorithms. RESULTS: The barriers to diagnosis identified by the task force include the presentation of symptoms, the language used to describe them, the actual term "restless legs syndrome" and difficulties in the differential diagnosis of RLS. CONCLUSION: The EURLSSG task force reached a consensus and agreed on the diagnostic and treatment algorithms published here.

Effects of multi-support excitation on isolated bridges

Multi-support seismic excitation can affect the response of isolated bridges, and particularly the perfomance of the isolating devices, which are generally designed for synchronous action. Three phenomena are of major interest for bridge structures, denoted as: a) incoherence, b)wave-passage, c)site-response, of which the former two, grouped under the term 'nonsynchronism', have been object of an extensive parametric study in the past. Here, the third phenomenon is addressed, which is due to spatially varying local soil profiles, and its effects on the bridge response are evaluated. The technique adopted is that of a random vibration analysis of linear systems, equivalent to the examined bridges equipped with hysteretic-type isolating devices, whose response is represented through linear elements of equivalent stiffness and damping.(AU)