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The first step in reintroducing plastic waste into the recycling cycle is to use material recovery facilities (MRFs). However, while the composition and types of plastic waste are changing over time, the layout of MRFs does not always adapt to this change. In this paper, an existing MRF in Southern Italy was chosen as a reference to evaluate its current performance and to estimate possible improvements in sorting through a specific upgrade. First, an analysis of the amount, composition, and sources (in terms of type of waste and distance from the MRF) of the input waste was conducted. The composition of the input waste was then compared with the amount of selected output waste streams in order to calculate the current sorting efficiency of each stream and compare it with the values obtained from the upgrade. Lastly, the current performance of the plant was compared with a previous assessment of the same MRF in order to highlight possible variation. Results showed how the incoming waste was mainly composed of packaging plastic waste, and that some plastic waste not yet selected by the plant ended up in specific output streams. Therefore, the current performance of the MRF resulted high for PET and PE bottles (80.2% and 92.8%, respectively), in contrast to mixed or flexible packaging, where the efficiency achieved lower values (55–50%). These values were caused by a weakness in the 2D flow sorting line, which the upgrade mostly addressed. The upgraded configuration increased the production of recyclable waste from 34.32% to 50.39%, especially due to the recovery of small flexible packaging films in PE and biopolymers. [ABSTRACT FROM AUTHOR]

In 2014, UNAIDS launched renewed global targets for HIV control to achieve by 2025, known as "the three 95": 95% of people living with HIV (PWH) diagnosed, of which 95% are receiving treatment, of which 95% are on sustained virological suppression. In Italy, new HIV diagnoses have been steadily decreasing since 2012. However, in 2020, 41% of new diagnoses presented with less than 200 CD4+ cells/µL and 60% with less than 350 CD4+ cells/µL. Implementing testing and early treatment is a key strategy to prevent AIDS, late presentation, and HIV transmission. We selected non-Infectious Diseases Units based on the European project HIDES and engaged colleagues in a condition-guided HIV screening strategy. We enrolled 300 patients, of which 202 were males (67.3%) and 98 were females (32.7%). Most of the screening was performed in Infectious Diseases (ID) and Hematologic wards. In total, we diagnosed eleven new HIV infections with a hospital prevalence in the study population of 3.7%. Five (45.4%) had a CD4 count <100/mm3, one (9.1%) <200/mm3, and one (9.1%) <300/mm3. Regarding risk factors, 81.8% declared having had unprotected sexual intercourse and 54.5% were heterosexual. All patients promptly started a combination antiretroviral regimen and 10 (90.9%) obtained an undetectable HIV-RNA status. Eight of the eleven (72.7%) patients are currently on follow-up in our outpatient clinic. A proactive indicator disease-guided screening can help avoid missed opportunities to diagnose HIV infection in a hospital setting. Implementing this kind of intervention could favor early diagnosis and access to treatment. [ABSTRACT FROM AUTHOR]

This paper proposes an energy management system based on an Artificial Neural Network (ANN) to be integrated with the standard ISO 50001 and aims to describe the definition and the enhancement of the energy baselines by means of artificial intelligence techniques applied and tested on the real electrical absorption data of the auxiliary units of different thermal power plants in Italy. Power plant optimized operations are important both for cost and energy performance reasons with related effects on the environment in the next future energy transition scenario. The improvement of the energy baselines consists in determining more accurate consumption monitoring models that are able to track inefficiencies and absorption drifts through data analytics and Artificial Intelligence. Starting from the analysis of the energy vectors at the production site level, we performed a multi-scale analysis to define the consumption at macro areas level and finally find the most relevant consumption units within the plants. A comparison of different ANNs applied to several real power plant data was performed to model complex plant architecture and optimize energy savings with respect to pre-set thresholds according to the ISO 50001 standard procedure. The energy baselines are determined through the analysis of the data available in the power plants' Distributed Control System (DCS), and we can identify the consumption derived from the unit's proper operation. Based on the reported numerical simulations, improved baselines have been reached up to a 5% threshold for different plant sub-units, thus representing a relevant overall saving in terms of alert threshold definition and related control efficiency: a potential saving of about 140 MWh throughout the considered three-year dataset was obtained taking into account a cooling tower sub-unit, representing a considerable economic benefit. The results obtained highlight the neural technique efficiency in defining more accurate energy baselines and represents a valuable tool for large energy plant asset management to face relevant energy drifts observed in the last years of plant operation. [ABSTRACT FROM AUTHOR]

Background: Since the beginning of the SARS-CoV-2 pandemic, the ability to predict the trajectory of the disease has represented a major challenge for clinicians. There is recent evidence that complete blood cell count (CBC)-derived inflammation indexes have predictive value in COVID-19. We aimed to describe any changes in the clinical features, CBC-derived ratios, and outcomes of patients admitted to our hospital across two temporally distinct waves. Methods: We retrospectively assessed and compared the clinical characteristics and blood cell count values of patients hospitalized during the second and fourth waves of COVID-19, and explored any outcome differences in terms of the level of respiratory support required and transfer to intensive care. Results: We observed that fourth-wave patients were older, less male-predominant, and carried more comorbidities compared to the second-wave patients but, nevertheless, experienced more favorable outcomes. A strong internal correlation was documented for both waves between outcomes and CBC-derived ratios, with the fourth-wave cases displaying lower admission values of the neutrophil-to-lymphocyte ratio (NLR), derived NLR (dNLR), platelet-to-lymphocyte ratio (PLR), and systemic inflammation index (SII). No significant differences were found for lymphocyte-to-monocyte ratio (LMR), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI). Conclusions: We observed that both admission values of CBC-derived indexes and adverse respiratory outcomes decreased from the second to the fourth wave of COVID-19. These data represent a contribution to the existing knowledge on the role of CBC-derived indexes as a potential tool to help clinicians to quickly differentiate in-hospital patients at increased risk of serious illness and death. [ABSTRACT FROM AUTHOR]

Population ageing and improved healthcare may lead to an increase in the prevalence of stroke. The aim of this study is to investigate the prevalence of stroke and stroke-related disability in a population sample resident in Aosta, Italy. The information was collect using a simple questionnaire for first ever stroke in the past combined with the analysis of the patients’ medical records and integrated with the information reported by six general practitioners. 102 cases of stroke were identified in the study population of 6,930 subjects, for an overall prevalence per 1,000 inhabitants of 1.4 (95% CI 0.81–1.99), which increased to 4.79 (95% CI 3.29–6.29) in subjects aged ≥65 years. Fifty-nine percent of the cases were completely or partially dependent (Rankin scores of 2–5). At the time of interview, 72% were living at home. Our data do not reveal any increase in the prevalence of stroke, possibly because of a reduced incidence of the disease. [ABSTRACT FROM AUTHOR]

Background Asthma considerably impairs patients' quality of life and increases healthcare costs. Severity, morbidity, and degree of disease control are the major drivers of its clinical and economic impact. National scientific societies are required to monitor the application of international guidelines and to adopt strategies to improve disease control and better allocate resources. Aim to provide a detailed picture of the characteristics of asthma patients and modalities of asthma management by specialists in Italy and to develop recommendations for the daily management of asthma in a specialist setting. Method: A quantitative research program was implemented. Data were collected using an ad hoc questionnaire developed by a group of specialists selected by the Italian Pneumology Society/Italian Respiratory Society. Results The records of 557 patients were analyzed. In the next few years, specialists are expected to focus their activity patients with more severe disease and will be responsible for selection of patients for personalized biological therapy; however, only 20% of patients attending Italian specialist surgery can be considered severe. In 84.4% of cases, the visit was a follow-up visit requested in 82.2% of cases by the specialist him/herself. The Asthma Control Test is used only in 65% of patients. When available, a significant association has been observed between the test score and asthma control as judged by the physician, although concordance was only moderate (κ = 0.68). Asthma was considered uncontrolled by the specialist managing the case in 29.1% of patients; nevertheless, treatment was not stepped up in uncontrolled or partly controlled patients (modified in only 37.2% of patients). Conclusions The results of this survey support re-evaluation of asthma management by Italian specialists. More resources should be made available for the initial visit and for more severely ill patients. In addition, more extensive use should be made of validated tools, and available drugs should be used more appropriately. [ABSTRACT FROM AUTHOR]

Idiopathic pulmonary fibrosis (IPF) is a rare lung disease that quickly leads to death. This paper addressed the issue of whether the levels of trace elements in sputum samples are suitable biomarkers for IPF disease. The sputum Cd, Cr, Cu, Fe, Mn, Ni, Pb and Zn concentrations were measured by sector field inductively coupled plasma mass spectrometry in populations sampled in Sardinia Island (Italy) including 31 patients with IPF, 31 patients with other lung-related diseases and 30 age- and gender-matched healthy controls. Risk factors in the disease as gender, age, severity and duration of the disease were assessed. Results showed that IPF patients had significantly increased sputum levels of Cd, Cr, Cu and Pb respect to controls. In males, but not in females, sputum levels of Cd, Cr and Cu were significantly higher in IPF cases respect to controls. In addition, Cr and Pb were increased in male patients with IPF compared to male patients with other lung diseases. Regarding Zn, it was found higher with the more serious stage of disease. Moreover, the ratios Cu/Zn, Fe/Mn and Cu/Mn were significantly increased in IPF patients and in non-IPF patients than in control subjects. These data showed clear increases in the concentration of some trace elements in sputum from patients with IPF and patients with other lung-related diseases that may contribute to the injury. The non-invasiveness of the sputum analysis is beneficial for its use as biomarker of trace element status in diseased patients for both the researcher and the clinic., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Introduction: The early identification of factors that predict the length of hospital stay (HS) in patients affected by coronavirus desease (COVID-19) might assist therapeutic decisions and patient flow management., Methodology: We collected, at the time of admission, routine clinical, laboratory, and imaging parameters of hypoxia, lung damage, inflammation, and organ dysfunction in a consecutive series of 50 COVID-19 patients admitted to the Respiratory Disease and Infectious Disease Units of the University Hospital of Sassari (North-Sardinia, Italy) and alive on discharge., Results: Prolonged HS (PHS, >21 days) patients had significantly lower PaO2/FiO2 ratio and lymphocytes, and significantly higher Chest CT severity score, C-reactive protein (CRP) and lactic dehydrogenase (LDH) when compared to non-PHS patients. In univariate logistic regression, Chest CT severity score (OR = 1.1891, p = 0.007), intensity of care (OR = 2.1350, p = 0.022), PaO2/FiO2 ratio (OR = 0.9802, p = 0.007), CRP (OR = 1.0952, p = 0.042) and platelet to lymphocyte ratio (OR = 1.0039, p = 0.036) were significantly associated with PHS. However, in multivariate logistic regression, only the PaO2/FiO2 ratio remained significantly correlated with PHS (OR = 0.9164; 95% CI 0.8479-0.9904, p = 0.0275). In ROC curve analysis, using a threshold of 248, the PaO2/FiO2 ratio predicted PHS with sensitivity and specificity of 60% and 91%, respectively (AUC = 0.780, 95% CI 0.637-0.886 p = 0.002)., Conclusions: The PaO2/FiO2 ratio on admission is independently associated with PHS in COVID-19 patients. Larger prospective studies are needed to confirm this finding., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2021 Angelo Zinellu, Andrea De Vito, Valentina Scano, Panagiotis Paliogiannis, Vito Fiore, Giordano Madeddu, Ivana Maida, Elisabetta Zinellu, Arduino Aleksander Mangoni, Luigi Benedetto Arru, Ciriaco Carru, Sergio Babudieri, Pietro Pirina, Alessandro Giuseppe Fois.)

Background: Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease that may have a negative impact on both patients' quality of life and survival. Patients with COPD frequently suffer from heart failure (HF), likely owing to several shared risk factors., Aim: To evaluate the differences in treatment of COPD with and without HF comorbidity according to COPD severity in the general practitioner setting., Methods: We conducted an observational, retrospective study using data obtained from the Italian Health Search Database, which collects information generated by the routine activity of general practitioners. The study sample included 225 patients with COPD, alone or combined with HF., Findings: It has been found that the prevalence of some comorbidities such as diabetes and HF significantly increases with the severity of COPD. Regarding pharmacological treatment, a reduction in the prescription of individually administered long-acting β 2-agonists (LABAs) and long-acting anticholinergics (LAMAs) has been observed with increasing severity of the disease. Moreover, an increase in the prescription of both the combination of the two bronchodilators (LABA + LAMA) and their association with inhaled corticosteroids has been observed with increasing severity of COPD. The prescription of β-blockers in patients with COPD suffering from HF comorbidity decreases from 100% in stage I to less than 50% in the other stages of COPD. This study shows that general practitioners do not follow the guidelines recommendations for the management of patients with COPD in the different stages of the disease, with and without HF comorbidity, as well as in the management of HF. Further efforts must be made to ensure adequate treatment for these patients.

Background: The first European case series are detecting a very high frequency of chemosensitive disorders in COVID-19 patients, ranging between 19.4% and 88%., Methods: Olfactory and gustatory function was objectively tested in 72 COVID-19 patients treated at University Hospital of Sassari., Results: Overall, 73.6% of the patients reported having or having had chemosensitive disorders. Olfactory assessment showed variable degree hyposmia in 60 cases and anosmia in two patients. Gustatory assessment revealed hypogeusia in 33 cases and complete ageusia in one patient. Statistically significant differences in chemosensitive recovery were detected based on age and distance from the onset of clinical manifestations., Conclusion: Olfactory and gustatory dysfunctions represent common clinical findings in COVID-19 patients. Otolaryngologists and head-neck surgeons must by now keep this diagnostic option in mind when evaluating cases of ageusia and nonspecific anosmia that arose suddenly and are not associated with rhinitis symptoms., (© 2020 Wiley Periodicals, Inc.)