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Subsurface storage changes (Δ S) represent a key modulator of drought propagation through the hydrological cycle, but their contribution to the annual water balance, and to drought propagation and recovery has rarely been explicitly assessed across catchments and climates. To expand on previous work on this matter, here we performed a large-sample analysis of precipitation, discharge, actual evapotranspiration (ET), and Δ S for 10 hydrological years and 102 catchments across various hydro-climatological regimes in Italy. We found that Δ S cannot be neglected in the annual water balance. Storage depletion leads to the attenuation of hydrological drought compared to meteorological drought, meaning that subsurface storage actively supports discharge during drought. We also found that storage generally recovers from precipitation deficits over time scales similar to the discharge recovery time, while recovery times for ET are longer. These findings show that subsurface storage drives drought propagation and recovery, regardless of climatic and catchment characteristics, and are thus relevant to properly inform water managers about surface- and ground-water availability in a changing climate. • Large-sample analysis of water balance components to study drought propagation and recovery. • Subsurface storage changes account on average for the 11% of long-term mean annual precipitation across the catchments. • Subsurface storage depletion sustains discharge during drought and the following recovery period. • A water balance approach is needed to better understand drought propagation and recovery. [ABSTRACT FROM AUTHOR]

An automated tool for pre-operational mapping of floods and inland waters using Sentinel-1 data is presented. The acronym AUTOWADE (AUTOmatic Water Areas DEtector) is used to denote it. The tool provides the end user (Italian Department of Civil Protection) with a continuous, near real-time (NRT) monitoring of the extent of inland water surfaces (floodwater and permanent water). It implements the following operations: downloading of Sentinel-1 products; preprocessing of the products and storage of the resulting geocoded and calibrated data; generation of the intermediate products, such as the exclusion mask; application of a floodwater/permanent water mapping algorithm; generation of the output layer, i.e., a map of floodwater/permanent water; delivery of the output layer to the end user. The open floodwater/permanent water mapping algorithm implemented in AUTOWADE is based on a new approach, denoted as buffer-from-edge (BFE), which combines different techniques, such as clustering, edge filtering, automatic thresholding and region growing. AUTOWADE copes also with the typical presence of gaps in the flood maps caused by undetected flooded vegetation. An attempt to partially fill these gaps by analyzing vegetated areas adjacent to open water is performed by another algorithm implemented in the tool, based on the fuzzy logic. The BFE approach has been validated offline using maps produced by the Copernicus Emergency Management Service. Validation has given good results with a F1-score larger than 0.87 and a kappa coefficient larger than 0.80. The algorithm to detect flooded vegetation has been visually compared with optical data and aerial photos; its capability to fill some of the gaps present in flood maps has been confirmed. [ABSTRACT FROM AUTHOR]

A fully automated processing chain for near real-time mapping of burned forest areas using Sentinel-2 multispectral data is presented. The acronym AUTOBAM (AUTOmatic Burned Areas Mapper) is used to denote it. AUTOBAM is conceived to work daily at a national scale for the Italian territory to support the Italian Civil Protection Department in the management of one of the major natural hazards, which affects the territory. The processing chain includes a Sentinel-2 data procurement component, an image processing algorithm, and the delivery of the map to the end-user. The data procurement component searches every day for the most updated products into different archives. The image processing part represents the core of AUTOBAM and implements an algorithm for burned forest areas mapping that uses, as fundamental parameters, the relativized form of the delta normalized burn ratio and the normalized difference vegetation index. The minimum mapping unit is 1 ha. The algorithm implemented in the image processing block is validated off-line using maps of burned areas produced by the Copernicus Emergency Management Service. The results of the validation shows an overall accuracy (considering the classes of burned and unburned areas) larger than 95% and a kappa coefficient larger than 80%. For what concerns the class of burned areas, the commission error is around 1%−3%, except for one case where it reaches 25%, while the omission error ranges between 6% and 25%. [ABSTRACT FROM AUTHOR]

Nasal delivery is a non-invasive strategy for effective drug delivery. Nevertheless, in order to promote drug uptake by the nasal mucosa, it is fundamental to increase its residence time in the administration site. To this aim, nano-sized drug delivery systems are widely exploited. Within this context, the commercially available nanoemulsion for parenteral nutrition is a biocompatible, safe and clinically approved vehicle for drug delivery. Furthermore, the nanodroplet surface can be modified via a well-established protocol to graft Concavalin A, a lectin capable of improving the mucosal adhesion, by binding to the α-mannose and α-glucose residues of the mucosal glycocalyx. The obtained targeted formulation is able to induce haemagglutination, as opposite to non-modified nanoemulsion. Furthermore, the ConA grafting maintains the physicochemical properties of the nanodroplets (size~230 nm, Z < -35 mV) and does not interfere with the loading of the Rose Bengal fluorescent probe. Fluorescently labelled ConA grafted nanodroplets showed enhanced permeation and accumulation in ex vivo bovine nasal mucosa. This study is a proof of concept that Concanavalin A can be used to decorate the surface of nanodroplets, acting as a permeation promoter.

Data regarding double switching from originator infliximab (IFX) to IFX biosimilars in inflammatory bowel diseases (IBDs) are lacking. The purpose of this study was to evaluate the safety and efficacy of switching from originator IFX to CT-P13 and subsequently to SB2 (double switch) in patients with IBD. Patients undergoing IFX-double switch in eight Centers in Lombardy (Italy) from November 2018 to May 2019 were retrospectively analyzed. The IFX discontinuation rate, incidence and type of adverse events (AEs), and clinical remission rate were recorded. A comparison with a control group of patients with IBD single-switched from originator IFX to CT-P13 was performed, before and after an inverse probability of treatment weighting (IPTW)-based propensity score analysis. Fifty-two double-switched patients with IBD were enrolled. The 24- and 52-week proportions of patients continuing on IFX therapy following the second switch (CTP13 → SB2) were 98% (95% confidence interval [CI] 94%-100%) and 90% (95% CI 81%-99%), respectively. Four patients experienced a total of five AEs, all graded 1-3 according to Common Terminology Criteria for Adverse Events (CTCAE). No infusion reactions were observed. The 24-week and follow-up end clinical remission rates following the second switch were 94% and 88%, respectively. No differences were observed in the safety and efficacy outcomes by comparing the double-switch group with a single-switch group of 66 patients with IBD; all these results were confirmed by IPTW-adjusted analysis. The study suggests both the safety and efficacy of the double switch from originator IFX to CT-P13 and SB2 in patients with IBD is maintained. This strategy may be associated with potential cost implications., (© 2021 The Authors. Clinical and Translational Science published by Wiley Periodicals LLC on behalf of American Society for Clinical Pharmacology and Therapeutics.)

During the past 50 years, the aim to reduce the eddy current losses in magnetic cores to a minimum led to the formulation of new materials starting from electrically insulated iron powders, today called Soft Magnetic Composites (SMC). Nowadays, this promising branch of materials is still held back by the mandatory tradeoff between energetic, electrical, magnetic, and mechanical performances. In most cases, the research activity focuses on the deposition of an insulating/binding layer, being one of the critical points in optimizing the final composite. This insulation usually is achieved by either inorganic or organic layer constituents. The main difference is the temperature limit since most inorganic materials typically withstand higher treatment temperatures. As a result, the literature shows many materials and process approaches, each one designed to meet a specific application. The present work summarizes the recent advances in state of the art, analyzing the relationship among material compositions and magnetic and mechanical properties. Each coating shows its own processing sets, which vary from simple mechanical mixing to advanced chemical methods to metallurgical treatments. From state of the art, Aluminum coatings are characterized by higher current losses and low mechanical properties. In contrast, higher mechanical properties are obtained by adopting Silicon coatings. The phosphates coatings show the best-balanced overall properties. Each coating type was thoroughly investigated and then compared with the literature background highlighting. The present paper thus represents a critical overview of the topic that could serve as a starting point for the design and development of new and high-performing coating solutions for SMCs. However, global research activity continuously refines the recipes, introducing new layer materials. The following steps and advances will determine whetherthese materials breakthrough in the market.

Background & Aim: Although acute lower GI bleeding (LGIB) represents a significant healthcare burden, prospective real-life data on management and outcomes are scanty. Present multicentre, prospective cohort study was aimed at evaluating mortality and associated risk factors and at describing patient management., Methods: Adult outpatients acutely admitted for or developing LGIB during hospitalization were consecutively enrolled in 15 high-volume referral centers. Demographics, comorbidities, medications, interventions and outcomes were recorded., Results: Overall 1,198 patients (1060 new admissions;138 inpatients) were included. Most patients were elderly (mean-age 74±15 years), 31% had a Charlson-Comorbidity-Index ≥3, 58% were on antithrombotic therapy. In-hospital mortality (primary outcome) was 3.4% (95%CI 2.5-4.6). At logistic regression analysis, independent predictors of mortality were increasing age, comorbidity, inpatient status, hemodynamic instability at presentation, and ICU-admission. Colonoscopy had a 78.8% diagnostic yield, with significantly higher hemostasis rate when performed within 24-hours than later (21.3% vs.10.8%, p = 0.027). Endoscopic hemostasis was associated with neither in-hospital mortality nor rebleeding. A definite or presumptive source of bleeding was disclosed in 90.4% of investigated patients., Conclusion: Mortality in LGIB patients is mainly related to age and comorbidities. Although early colonoscopy has a relevant diagnostic yield and is associated with higher therapeutic intervention rate, endoscopic hemostasis is not associated with improved clinical outcomes [ClinicalTrial.gov number: NCT04364412]., Competing Interests: Conflict of Interest None declared., (Copyright © 2021 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

Background: Prospective studies about endoscopic retrograde cholangio-pancreatography (ERCP) in a community setting are rare., Aim: To assess success and complication rates of routinely-performed ERCP in a regional setting, and the priority quality indicators for ERCP practice., Methods: Prospective region wide observational study on consecutive patients undergoing ERCP during a 6-month period. A centralized online ERCP questionnaire was built and used for data storage. Primary quality indicators provided by the American Society of Gastrointestinal Endoscopy (ASGE) were considered., Results: 38 endoscopists from 18 centers performed a total of 2388 ERCP. The most common indication for ERCP was choledocholitiasis (54.8%) followed by malignant jaundice (22.6%). Cannulation of the desired duct was obtained in 2293 cases (96%) and ERCP was successful in 2176 cases (91.1%). Success and ERCP difficulty were significantly related to the experience of the operator (p = 0.001 and p < 0.001, respectively). ERCP difficulty was also significantly related to volume centers (p < 0.01). The overall complication rate was 8.4%: post-ERCP pancreatitis (PEP) occurred in 4.1% of procedures, bleeding in 2.9%, infection in 0.8%, perforation in 0.4%. Mortality rate was 0.4%. All the ASGE priority quality indicators for ERCP were confirmed., Conclusions: The procedural questionnaire proved to be an important tool to assess and verify the quality of routinely-performed ERCP performance in a community setting., (Copyright © 2019. Published by Elsevier Ltd.)

Flood risk mitigation usually requires a significant investment of public resources and cost-effectiveness should be ensured. The assessment of the benefits of hydraulic works requires the quantification of (i) flood risk in absence of measures, (ii) risk in presence of mitigation works, (iii) investments to achieve acceptable residual risk. In this work a building-scale is adopted to estimate direct tangible flood losses to several building classes (e.g. residential, industrial, commercial, etc.) and respective contents, exploiting various sources of public open data in a GIS environment. The impact simulations for assigned flood hazard scenarios are computed through the RASOR platform which allows for an extensive characterization of the properties and their vulnerability through libraries of stage-damage curves. Recovery and replacement costs are estimated based on insurance data, market values and socio-economic proxies. The methodology is applied to the case study of Florence (Italy) where a system of retention basins upstream of the city is under construction to reduce flood risk. Current flood risk in the study area (70 km 2 ) is about 170 Mio euros per year without accounting for people, infrastructures, cultural heritage and vehicles at risk. The monetary investment in the retention basins is paid off in about 5 years. However, the results show that although hydraulic works are cost-effective, a significant residual risk has to be managed and the achievement of the desired level of acceptable risk would require about 1 billion euros of investments., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background and Aims: Perception of quality of care is important in the management of patients with chronic diseases, particularly inflammatory bowel disease., Aims and Methods: This longitudinal study aimed to investigate variations of the Quality of Care through the Patients' Eyes (QUOTE-IBD) questionnaire scores one year after the basal evaluation in the Studio Osservazionale quaLità cUre malatTIe crOniche intestiNali (SOLUTION-1) study., Results: Of the cohort of 992 patients, 936 were evaluable. The QUOTE-IBD score overcame satisfactory levels of more than the 80%, overall and in all subdomains except for the "Continuity of Care" sub-dimension (mean, 8.3; standard deviation, 1.49), scored satisfactory only by 34% of the patients. No significant changes in satisfaction were recorded overall, or considering patients subgroups. Significant differences were found at the end of the follow-up between physicians' and patients' perceptions of quality of care, with the former over-rating their performance in "Continuity of Cares" and under-rating "Costs", "Competence", and "Accessibility" sub-domains of the score (p<0.05 for all)., Conclusion: Perceived quality of care in a large cohort of Italian patients with inflammatory bowel disease remains unchanged after one-year follow-up and was not significantly affected by disease activity or therapeutic interventions. Differences between physicians' and patients' perceptions of quality of care should be taken into account., (Copyright © 2017 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

Background: Not much is known about errors and near misses in digestive endoscopy., Aims: To verify whether an incident report, with certain facilitating features, gives useful information about unintended events, only excluding errors in medical diagnosis., Method: Nine endoscopy units took part in this cross sectional, prospective, multicentre study which lasted for two weeks. Members of the staff were required to report any unintended, potentially dangerous event observed during the daily work. A form was provided with a list of "reminders" and facilitators were appointed to help. The main outcome measurements were type of event, causes, corrective interventions, stage of occurrence in the workflow and qualification of the reporters., Results: A total of 232 errors were reported (two were not related to endoscopy). The remaining 230 amount to 10.3% of 2239 procedures; 66 (29%) were considered errors with consequences, 164 (71%) "near misses". There were 150 pre-operative errors (65%), 22 operative (10%) and 58 post-operative (25%). Corrective interventions were provided for 60 cases of errors and 119 near misses. Most of the events were reported by the nurses (106 out of 232, 46%)., Conclusions: Short-term incident reporting focusing on near misses, using forms with lists of "reminders", and the help of a facilitator, can give useful information on errors and near misses in digestive endoscopy., (Copyright © 2012 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

Endoscopic palliation is the most suitable approach to improve quality of life in patients with esophageal cancer since diagnosis is often made at an advanced stage, when radical treatment is unfeasible. Endoscopy offers several techniques to palliate dysphagia either by stenting the stenosis or by reducing the tumor mass with thermoablation. A small number of randomized controlled trials is available to compare the efficacy of different techniques and the ideal palliation has not been defined as yet. Recently, the development of self-expandable covered metal stents has rapidly gained ground in the endoscopy units throughout the world as a simple, single step procedure for palliation of dysphagia.

Background/aims: Measurement of health related quality of life (HRQoL) is a new tool to evaluate patients with inflammatory bowel disease (IBD). The aims of this study were to verify reliability and responsiveness of a disease-specific questionnaire [Italian Questionnaire on Quality of Life (IQQoL)], and to assess the relationship between clinical and demographic variables and HRQoL in IBD patients., Methodology: The IQQoL was submitted to all IBD patients consecutively seen at eight participating Hospitals, and re-administered at follow-up visits. The IQQoL covers intestinal and systemic symptoms, emotional and social function. The higher the score, the worse the HRQoL., Results: 249 patients were enrolled, 106 with Crohn's disease (CD) and 143 with ulcerative colitis (UC). IQQoL was re-administered to 134 patients: 98 with unchanged, 17 with worsened and 19 with improved disease activity. The IQQoL was stable over time in patients with stable clinical conditions, and very responsive to change both in patients with improved and worsened disease activity. HRQoL was inversely correlated with disease activity, both in CD and UC. Perception of HRQoL was significantly worse in women than in men., Conclusions: The IQQoL is a reliable and responsive instrument to assess HRQoL in IBD patients. Active disease is related to poor HRQoL perception. In CD, women, mainly if young, have a worse HRQoL perception than men.