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The genetic causes of epilepsies and developmental and epileptic encephalopathies (DEE) with onset in early childhood are increasingly recognized. Their outcomes vary from benign to severe disability. In this paper, we wished to retrospectively review the clinical, genetic, EEG, neuroimaging, and outcome data of patients experiencing the onset of epilepsy in the first three years of life, diagnosed and followed up in four Italian epilepsy centres (Epilepsy Centre of San Paolo University Hospital in Milan, Child Neurology and Psychiatry Unit of AUSL-IRCCS di Reggio Emilia, Pediatric Neurology Unit of Vittore Buzzi Children's Hospital, Milan, and Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia). We included 168 patients (104 with monogenic conditions, 45 with copy number variations (CNVs) or chromosomal abnormalities, and 19 with variants of unknown significance), who had been followed up for a mean of 14.75 years. We found a high occurrence of generalized seizures at onset, drug resistance, abnormal neurological examination, global developmental delay and intellectual disability, and behavioural and psychiatric comorbidities. We also documented differing presentations between monogenic issues versus CNVs and chromosomal conditions, as well as atypical/rare phenotypes. Genetic early-childhood-onset epilepsies and DEE show a very wide phenotypic and genotypic spectrum, with a high risk of complex neurological and neuropsychiatric phenotypes. [ABSTRACT FROM AUTHOR]

Cities are facing the greatest challenge of their whole lifecycle: choosing their own destiny. Cities are the main contributors to climate change, as much of the excess carbon dioxide in the atmosphere comes from them. Understanding how cities can transform into "circular cities" is key to fostering change. However, empirical studies in this direction are still scant. In this paper, we address this research gap by answering the following research question: how are current "cities of waste" transitioning to "circular cities"? We do so by means of an empirical study involving several stakeholders located in the town of Pavia (Northern Italy). We find that some actors have implemented virtuous circular economy (CE) practices; however, the transition to CE is overall conducted in a fragmented manner, with a lack of orchestration and planning among private actors as well as a lack of synergies between private and public actors. We conclude our study by advancing future avenues of research, highlighting our theoretical and managerial contributions, and advancing policy implications. [ABSTRACT FROM AUTHOR]

This paper presents the partitioning of the closed water distribution network (WDN) serving the city of Pavia, Italy. As a thus far poorly explored aspect in the scientific literature, clustering for the definition of size and extension of district metered areas (DMAs) and of inter-DMA boundary pipes is performed by ensuring that the DMAs respect the altimetric areas of the WDN by leaning on a modified formulation of modularity. To define the boundary pipes to be closed or alternatively fitted with a flow meter for the monitoring of DMA consumption, the dividing is performed with an innovative heuristic algorithm. This technique operates by sequentially implementing the boundary closures that do not cause significant head losses, to obtain an approximation of the Pareto front in the trade-off between number of flow meters installed and WDN reliability. In the last part of the work, the pumps present in the network are assumed to be equipped with the variable speed drive, and their hourly settings are optimized to regulate service pressure. Overall, WDN partitioning and pump setting optimization are proven to mitigate the service pressure and energy consumption of the WDN, offering evident and attractive benefits up to about 50% for water utilities. [ABSTRACT FROM AUTHOR]

This paper presents a comparative analysis of two hydrological models in the Storm Water Management Model (SWMM) software, namely, the non-linear reservoir (N-LR) and the unit hydrograph (UH), on the urban catchment of Cascina Scala, Pavia in Italy. The two models were applied for the simulation of the rainfall-runoff transformation in the 42 sub-catchments in Cascina Scala, while flow routing in the underground channels was simulated by means of the De Saint-Venant equations. A dataset of rainfall and runoff for 14 events from 2000 to 2003 was adopted for the calibration and validation of the models. The calibration was performed on 7 out of the 14 events by maximizing the fit of modeled-to-measured hydrographs in the final channel of the system. Prediction performance was assessed through different indices. Results from both models fit measured data well in terms of the total hydrograph. Whereas the time to peak was reliably predicted by both models, the N-LR was found to slightly outperform the UH in terms of total volume and peak flow prediction, though it requires a more detailed knowledge of the system for its implementation. Accordingly, the UH must be preferred in the case of a scarcity of data. [ABSTRACT FROM AUTHOR]

Even though in the last few years we have witnessed a general rediscovery of female artists, the same has not happened for female Italian art historians whom have contributed in the art history making of the XX century. On the occasion of this conference I meant to remember Maria Luisa Ferrari, born in Cremona in 1929. No mention of her even in the endless internet world, no page passing on her biography and most important studies, starting from her dissertation thesis, discussed in Pavia with Edoardo Arslan in 1954, on the painter Giovan Pietro da Cemmo, published in Milan two years later. I hereby present some unpublished excerpts part of the correspondence with her first mentor, from which power games and "religion wars" among different art history schools of thought strongly emerge. My paper is dedicated to the human and professional events of the scholar and to the fundamental importance of her work for the period and in future perspective. [ABSTRACT FROM AUTHOR]

Background: Parkinson's disease (PD) is a neurodegenerative disorder characterized by a combination of motor and non-motor dysfunction. Dysphagia is a common symptom in PD, though it is still too frequently underdiagnosed. Consensus is lacking on screening, diagnosis, and prognosis of dysphagia in PD. Objective: To systematically review the literature and to define consensus statements on the screening and the diagnosis of dysphagia in PD, as well as on the impact of dysphagia on the prognosis and quality of life (QoL) of PD patients. Methods: A multinational group of experts in the field of neurogenic dysphagia and/or PD conducted a systematic revision of the literature published since January 1990 to February 2021 and reported the results according to PRISMA guidelines. The output of the research was then analyzed and discussed in a consensus conference convened in Pavia, Italy, where the consensus statements were drafted. The final version of statements was subsequently achieved by e-mail consensus. Results: Eighty-five papers were used to inform the Panel's statements even though most of them were of Class IV quality. The statements tackled four main areas: (1) screening of dysphagia: timing and tools; (2) diagnosis of dysphagia: clinical and instrumental detection, severity assessment; (3) dysphagia and QoL: impact and assessment; (4) prognostic value of dysphagia; impact on the outcome and role of associated conditions. Conclusions: The statements elaborated by the Consensus Panel provide a framework to guide the neurologist in the timely detection and accurate diagnosis of dysphagia in PD. [ABSTRACT FROM AUTHOR]

Introduction: Recent studies have highlighted the prognostic value of easily accessible inflammatory markers, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) for predicting severe outcomes in patients affected by Coronavirus disease 2019 (COVID-19). Our study validates NLR and PLR cut-off values from a prior cohort at IRCCS Policlinico San Matteo (OSM) of Pavia, Italy, across two new cohorts from different hospitals. This aims to enhance the generalizability of these prognostic indicators. Methods: In this retrospective cohort study, conducted at Milan's Ospedale Luigi Sacco (OLS) and IRCCS Ospedale Maggiore Policlinico (OMP) hospitals, we assess the predictive capacity of NLR and PLR for three main outcomes—non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP) usage, invasive ventilation (IV), and death—in patients with COVID-19 at admission. For each outcome, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were computed separately for male and female cohorts. Distinct NLR and PLR cut-off values were used for men (7.00, 7.29, 7.00 for NLR; 239.22, 248.00, 250.39 for PLR) and women (6.36, 7.00, 6.28 for NLR; 233.00, 246.45, 241.54 for PLR), retrieved from the first cohort at OSM. Results: A total of 3599 patients were included in our study, 1842 from OLS and 1757 from OMP. OLS and OMP sensitivity values for both NLR and PLR (NLR: 24–67%, PLR: 40–64%) were inferior to specificity values (NLR: 64–76%, PLR: 55–72%). Additionally, PPVs generally remained lower (< 63%), while NPVs consistently surpassed 68% for PLR and 72% for NLR. Finally, both PLR and NLR exhibited consistently higher NPVs for more severe outcomes (> 82%) compared to NPVs for CPAP/NIV. Conclusions: Consistent findings across diverse patient populations validate the reliability and applicability of NLR and PLR cut-off values. High NPVs emphasize their role in identifying individuals less likely to experience severe outcomes. These markers not only aid in risk stratification but also guide resource allocation in emergencies or limited-resource situations. [ABSTRACT FROM AUTHOR]

The frequency and the accumulation of medium–small flood events can cause severe impacts. In a climate change context, real-time monitoring and a fast risk assessment are needed to support the post-disaster phases. The present work presents a novel methodology that leverages the potential of earth observation data to produce a proof-of-concept for flood vulnerability assessment, serving as the basis for a Map Operational Service for the Lombardy region. The proof-of-concept is related to both flood hazard estimation and vulnerability assessment, considering the evaluation of the potentialities of the synthetic aperture radar data when used to feed a downstream service. Using the city of Pavia (Italy), which was affected by a flood event in November 2019, as a case study, we present an integrated flood impact approach that includes a combination of social and physical parameters. The results contribute to a processing chain designed as a pre-operational service where each data analytic retrieves thematic products to support the exposure and damage estimates based on earth observation-derived hazard products for emergency and recovery responses. Three different satellites covered more than 40 h of the flood's evolution, supporting the great potential of the multi-sensor approach. Therefore, different sensor configurations in terms of spectral bands (X and C bands) and resolutions (from 10 to 1 m) provide a near real-time view of the event. Comparing the results obtained through the three hazard scenarios, a final social and physical Integrated Impact Index is obtained. The added value information leads to the determination of hotspots with which to prioritize effective interventions during emergency and recovery phases, crucial for capturing inherent conditions that allow communities to absorb impacts and cope with a damaging flood event. [ABSTRACT FROM AUTHOR]

Handly and easy-to-use optical instrumentation is very important for food safety monitoring, as it provides the possibility to assess law and health compliances at every stage of the food chain. In particular, the Surface-enhanced Raman Scattering (SERS) method appears highly promising because the intrinsic drawback of Raman spectroscopy, i.e., the natural weakness of the effect and, in turn, of the signal, is overcome thanks to the peculiar interaction between laser light and plasmonic excitations at the SERS substrate. This fact paved the way for the widespread use of SERS sensing not only for food safety but also for biomedicine, pharmaceutical process analysis, forensic science, cultural heritage and more. However, the current technological maturity of the SERS technique does not find a counterpart in the recognition of SERS as a routine method in compliance protocols. This is mainly due to the very scattered landscape of SERS substrates designed and tailored specifically for the targeted analyte. In fact, a very large variety of SERS substrates were proposed for molecular sensing in different environments and matrices. This review presents the advantages and perspectives of SERS sensing in food safety. The focus of the survey is limited to specific analytes of interest for producers, consumers and stakeholders in Oltrepò Pavese, a definite regional area that is located within the district of Pavia in the northern part of Italy. Our attention has been addressed to (i) glyphosate in rice fields, (ii) histamine in a world-famous local product (wine), (iii) tetracycline, an antibiotic often detected in waste sludges that can be dangerous, for instance in maize crops and (iv) Sudan dyes—used as adulterants—in the production of saffron and other spices, which represent niche crops for Oltrepò. The review aims to highlight the SERS performance for each analyte, with a discussion of the different methods used to prepare SERS substrates and the different reported limits of detection. [ABSTRACT FROM AUTHOR]

Purpose: The commitment of multidisciplinary teams in antimicrobial stewardship programs (ASPs) is often inadequately considered, especially in surgical wards. We wanted to evaluate clinical, microbiological, and pharmacological outcomes before and after the implementation of an ASP in the Vascular Surgery ward of Fondazione IRCCS Policlinico San Matteo, a tertiary care hospital in Pavia, Italy. Methods: This was a quasi-experimental quality-improvement study. The antimicrobial stewardship activity was conducted twice a week for 12 months and consisted of both prospective audit and feedback of all the ongoing antimicrobial prescriptions by the infectious diseases' consultants and educational meetings for the healthcare workers of the Vascular Surgery ward. For comparison between the study periods, Student t test (Mann–Whitney test for skewed distributions) was used for quantitative variables (ANOVA or Kruskall-Wallis for > 2 groups respectively), and Pearson's chi-squared test (Fisher exact test where appropriate) for categorical variables. 2-tailed tests were used. P-value significance cut-off was 0.05. Results: During the 12-month intervention period, among a total number of 698 patients, 186 prescriptions were revised, mostly leading to de-escalating an ongoing antimicrobial therapy (39, 20.97%). A statistically significant reduction in isolates of carbapenem-resistant Pseudomonas aeruginosa (p-value 0.003) and the absence of Clostridioides difficile infections were reported. No statistically significant changes were observed in terms of length of stay and all-cause in-hospital mortality. A significant decrease in the administration of carbapenems (p-value 0.01), daptomycin (p-value < 0.01) and linezolid (p-value 0.43) was registered. A significant reduction in antimicrobial costs was also observed. Conclusions: The implementation of a 12-month ASP brought significant clinical and economic results, highlighting the benefits of a multidisciplinary teamwork. [ABSTRACT FROM AUTHOR]

Background: Among clinicians and researchers, it is common knowledge that, in ALS, cognitive and behavioral involvement within the spectrum of frontotemporal degenerations (FTDs) begun to be regarded as a fact in the late 1990s of the twentieth century. By contrast, a considerable body of evidence on cognitive/behavioral changes in ALS can be traced in the literature dating from the late nineteenth century.Methods: Worldwide reports on cognitive/behavioral involvement in ALS dating from 1886 to 1981 were retrieved thanks to Biblioteca di Area Medica "Adolfo Ferrate," Sistema Bibliotecario di Ateneo, University of Pavia, Pavia, Italy and qualitatively synthetized.Results: One-hundred and seventy-four cases of ALS with co-occurring FTD-like cognitive/behavioral changes, described in Europe, America, and Asia, were detected. Neuropsychological phenotypes were consistent with the revised Strong et al.'s consensus criteria. Clinical observations were not infrequently supported by histopathological, post-mortem verifications of extra-motor, cortical/sub-cortical alterations, as well as by in vivo instrumental exams-i.e., assessments of brain morphology/physiology and psychometric testing. In this regard, as earlier as 1907, the notion of motor and cognitive/behavioral features in ALS yielding from the same underlying pathology was acknowledged. Hereditary occurrences of ALS with cognitive/behavioral dysfunctions were reported, as well as familial associations with ALS-unrelated brain disorders. Neuropsychological symptoms often occurred before motor ones. Bulbar involvement was at times acknowledged as a risk factor for cognitive/behavioral changes in ALS.Discussion: Historical observations herewith delivered can be regarded as the antecedents of current knowledge on cognitive/behavioral impairment in the ALS-FTD spectrum. [ABSTRACT FROM AUTHOR]

Featured Application: Beam monitor for high intensity beams in particle therapy. This work presents the tests of a multi-gap detector (MGD), composed of three parallel-plate ionization chambers (ICs) with different gap widths, assembled to prove the capability of correcting for charge volume recombination which is expected to occur when high fluence rates are delivered. Such beam conditions occur with a compact accelerator for charged particle therapy developed to reduce the costs, to accomplish faster treatments and to exploit different beam delivery techniques and dose rates as needed, for example, for range modulation and FLASH irradiations, respectively. The MGD was tested with carbon ions at the Centro Nazionale di Adroterapia Oncologica (CNAO Pavia, Italy), and with protons in two different beam lines: at Bern University Hospital with continuous beams and at the Laboratori Nazionale del Sud (Catania, Italy) of the Italian National Center of Nuclear Physics (INFN) with pulsed beams. For each accelerator, we took measurements with different beam intensities (up to the maximum rate of ionization achievable) and changed the detector bias voltage (V) in order to study the charge collection efficiency. Charge recombination models were used to evaluate the expected collected charge and to measure the linearity of the rate of ionization with the beam fluence rate. A phenomenological approach was used to determine the collection efficiency (f1) of the chamber with thinnest gap from the relative efficiencies, f1/f2 and f1/f3, exploiting the condition that, for each measurement, the three chambers were exposed to the same rate of ionization. Results prove that two calibration curves can be determined and used to correct the online measurements for the charge losses in the ICs for recombination. [ABSTRACT FROM AUTHOR]

In the last century, the increase in traffic, human activities and industrial production have led to a diffuse presence of air pollution, which causes an increase of risk of several health conditions such as respiratory diseases. In Europe, air pollution is a serious concern that affects several areas, one of the worst ones being northern Italy, and in particular the Po Valley, an area characterized by low air quality due to a combination of high population density, industrial activity, geographical factors and weather conditions. Public health authorities and local administrations are aware of this problem, and periodically intervene with temporary traffic limitations and other regulations, often insufficient to solve the problem. In February 2020, this area was the first in Europe to be severely hit by the SARS-CoV-2 virus causing the COVID-19 disease, to which the Italian government reacted with the establishment of a drastic lockdown. This situation created the condition to study how significant is the impact of car traffic and industrial activity on the pollution in the area, as these factors were strongly reduced during the lockdown. Differently from some areas in the world, a drastic decrease in pollution measured in terms of particulate matter (PM) was not observed in the Po Valley during the lockdown, suggesting that several external factors can play a role in determining the severity of pollution. In this study, we report the case study of the city of Pavia, where data coming from 23 air quality sensors were analyzed to compare the levels measured during the lockdown with the ones coming from the same period in 2019. Our results show that, on a global scale, there was a statistically significant reduction in terms of PM levels taking into account meteorological variables that can influence pollution such as wind, temperature, humidity, rain and solar radiation. Differences can be noticed analyzing daily pollution trends too, as—compared to the study period in 2019—during the study period in 2020 pollution was higher in the morning and lower in the remaining hours. [ABSTRACT FROM AUTHOR]

Background Cystic echinococcosis (CE) is a chronic, complex and neglected infection that may cause serious disease in humans. Given its peculiar epidemiologic and clinical features, collection of clinical data is challenging. Notification systems, when available, fail to record important clinical features, available data are mostly retrospectively collected and no prospectively enrolled uniform surveillance systems exist. The European Register of Cystic Echinococcosis database (ERCE) is the first systematic attempt to address these issues. Methods Here, we describe the demographics and clinical characteristics of 436 patients who accessed the CE clinic at the University of Pavia–San Matteo Hospital Foundation, in Pavia, Italy, from March 2012 to February 2020. Results Overall, 436 patients, consisting of 204 (46.8%) males and 232 (53.2%) females were enrolled; the mean age at enrollment was 50 (range 4–88) y. Of the 436 patients, 248 (56.9%) were born in Italy while 188 (43.1%) were foreign-born. In total, 638 CE cysts were counted, most of them in the CE4 (230; 36.1%) and CE3b (131; 20.5%) stages. Conclusions This is the largest cohort of CE patients with detailed clinical and demographic data published to date. We strongly encourage colleagues caring for CE patients in the European Union to join the ERCE. [ABSTRACT FROM AUTHOR]

Dysphagia is common in Parkinson's disease (PD). The effects of antiparkinsonian drugs on dysphagia are controversial. Several treatments for dysphagia are available but there is no consensus on their efficacy in PD. To conduct a systematic review of the literature and to define consensus statements on the treatment of dysphagia in PD and related nutritional management. A multinational group of experts in the field of neurogenic dysphagia and/or Parkinson's disease conducted a systematic evaluation of the literature and reported the results according to PRISMA guidelines. The evidence from the retrieved studies was analyzed and discussed in a consensus conference organized in Pavia, Italy, and the consensus statements were drafted. The final version of statements was subsequently achieved by e-mail consensus. The literature review retrieved 64 papers on treatment and nutrition of patients with PD and dysphagia, mainly of Class IV quality. Based on the literature and expert opinion in cases where the evidence was limited or lacking, 26 statements were developed. The statements developed by the Consensus panel provide a guidance for a multi-disciplinary treatment of dysphagia in patients with PD, involving neurologists, otorhinolaryngologists, gastroenterologists, phoniatricians, speech-language pathologists, dieticians, and clinical nutritionists. • PD treatments should be optimized to minimize the impact on swallowing function • Treatment of dysphagia should be guided by an instrumental assessment of swallowing • There is insufficient evidence to support the use of neuromodulation techniques • Botulinum toxin is an option for isolated upper esophageal sphincter impairment • PEG feeding must be considered on an individual basis, but not in case of dementia [ABSTRACT FROM AUTHOR]

The interaction between geomorphological processes and anthropogenic activities produces an impressive association of geomorphological and archaeological heritage in urban contexts. We analyzed the urban geomorphology and the geo- and cultural heritage in the town of Pavia (N Italy). The city is located in a strategic position, on a series of fluvial terraces where the Romans founded a colony, probably in the place of an Iron Age Gaul settlement. In Medieval Times and the Modern Era, Pavia sprawled outside the Roman walls, creating new urban areas and modifying the landscape. Geomorphological and GIS-spatial analyses integrated with anthropic landform surveying, archaeological data and historical cartography were performed. This multi-disciplinary approach allowed an investigation into how urban development was firstly adapted and then superimposed onto fluvial landforms. As a result, a flexible geocultural itinerary is proposed for linking geoheritage with cultural heritage, and for disseminating urban geomorphology key-concepts. [ABSTRACT FROM AUTHOR]