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Introduction: Patients with pulmonary fibrosis experience early oxyhemoglobin desaturation under effort, which limits their ability to exercise and their quality of life. Recent studies have shown that in resting normoxaemic patients who become hypoxemic under exertion, administration of outpatient oxygen significantly improves stress dyspnoea and quality of life. It is unclear how this happens, since oxygen administration does not act directly on dyspnoea, and does not appear to have much effect on the heart rate and pulmonary artery pressure. We tested the hypothesis that correcting the hypoxaemia could reduce the increase in respiratory effort during the 6 min walking test, recording the breathing pattern during administration of oxygen or placebo. Methods: We evaluated 20 patients with fibrotic interstitial lung diseases (17 males and 3 females; mean age 72 ± 2 years; M ± SE) with a resting SpO2 ≥92 that fell to ≤88% during the 6 min walk test (6MWT). After first establishing the oxygen flow necessary to prevent desaturation, the patients underwent two further 6MWT, 15–20 min apart, one with administration of medical air and one with oxygen at the same flow, in randomized double-blind order. During the test, SpO2, heart rate, respiratory rate, tidal volume and minute ventilation (VE) were recorded, using a Spiropalm spirometer (Cosmed, Rome, Italy). Results: Oxygen saturation during the 6MWT decreased to a minimum value of 82.3% (95% CI 80.1–84.5%) during placebo and to 92% (90.3–93.7%) during oxygen with an average difference of 9.7% (7.8–11.6%, p < 0.0001). On the contrary, heart rate showed an increasing trend with walking time reaching a significantly higher maximum rate during placebo, with a difference of 5.4 bpm (2.9–8.7, p < 0.005) compared to oxygen. The distance walked was slightly but significantly greater after oxygen by 28 m (2–53, p < 0.05) and end of test dyspnoea after placebo by 0.6 points (0.1–1.1, p < 0.05). Respiratory rate increased over time, without differences between oxygen and placebo in the first minute of walking, then increasing significantly more during placebo (p < 0.0005). With placebo, tidal volume increased rapidly reaching a plateau at about 48% of FVC after 3 min, while with oxygen, the increase was slower, reaching a maximum of about 45% of FVC at the end of the test. Nevertheless, the difference was highly significant (p < 0.0005) at all the time points. Minute ventilation also increased significantly with walking time but remained at a highly significant lower level during oxygen than placebo at all the time points. Mean reduction in VE during the test with oxygen compared to placebo was 4.4 L/min (3.9–4.9, p < 0.0005). Conclusion: In our ILD patients, administration of outpatient oxygen during walking was related to a reduced increase in heart rate, respiratory rate, tidal volume and minute ventilation necessary to meet increased oxygen requirements, resulting in a lower workload on the cardiovascular system and on respiratory muscles and a consequent reduction in dyspnoea.

This research deals with the issue of the recovery of the historic urban fabric with a view towards ecological transition, nowadays considered the preferable direction of sustainability for the reform of the house–city–landscape system. The massive incentives provided by the Italian government for sustainable building, in view of the post-pandemic economic recovery, risk being reduced to mere support for the real estate sector, which turns the financial transfer from the public into an increase in asset value for the private sector. Such an incentive system could contradict the original function of the city, which is to be the privileged place for social communication and the creation of the identity of settled communities. A process of property development that disregards the distribution of income favors the most valuable property, thus increasing the socioeconomic distance between centrality and marginality. The latter is a condition that often characterizes the parts of the historic city affected by extensive phenomena of physical and functional obsolescence of the built heritage, and it is less capable of attracting public funding. The increase of building decay and social filtering-down accelerates the loss and involution of neighborhood identities; the latter constitutes the psycho-social energy that helps preserve the physical, functional and anthropological integrity of the city, due to the differences that make its parts recognizable. This study, with reference to a neighborhood in the historic city of Syracuse (Italy), proposes a model of analysis, evaluation and planning of interventions on the buildings’ roofs, aimed at defining the best strategy for ecological–environmental regeneration. The model presented allows one to generate a multiplicity of alternative strategies that combine different uses of roofs: from the most sustainable green roofs, but that are less cost-effective from the identity and landscape point of view; to the most efficient photovoltaic roofs from the energy–environmental point of view; and up to the most cost-effective ones, the vertical extensions with an increase in building volume. The proposed tool is an inter-scalar multidimensional valuation model that connects the multiple eco-socio-systemic attitudes of individual buildings to the landscape, identity, energy–environmental and economic overall dimensions of the urban fabric and allows one to define and compare multiple alternative recovery hypotheses, evaluating their potential impacts on the built environment. The model allows the formation of 100 different strategies, which are internally coherent and differently satisfy the above four perspectives, and it provides the preferable ones for each of the five approaches practiced. The best strategy characterizes most green roofs, 427 out of 1075 building units, 277 blue roofs, 121 green–blue roofs and 46 grey roofs.

Background The risk of COVID‐19 is expected to be higher among solid organ transplant. The aim of the present study was to evaluate the incidence of COVID‐19 and the impact of the SARS‐CoV‐2 outbreak on the personal hygiene and expectations in heart and lung transplant recipients. Methods A telephone survey of heart (n = 69) and lung (n = 41) transplant patients and a group of controls (n = 41) was conducted concerning personal hygiene before and after the outbreak; the impact on subjective expectations regarding graft outcome; symptoms possibly associated with SARS‐CoV‐2 infection; and diagnosis of COVID‐19. Results Seventy nine percent of the patients declared they increased the use of face masks and handwash. Behavior at home regarding self‐isolation did not change. About half the patients said they were afraid of the virus. A higher percentage of Lung transplant (LTX) were convinced that SARS‐CoV‐2 could have a negative impact on the outcome of their graft. 28% declared that they were afraid to come to the hospital for routine examinations and asked to postpone. Nine LTX and five Heart transplant (HTX) patients experienced symptoms that could have been associated with SARS‐CoV‐2 infection, but none of them underwent a nasopharyngeal swab. Only one LTX was diagnosed with the infection. Conclusions In our study, we observed a low incidence of COVID‐19 in heart and lung transplant patients (0.9%), similar to that of the general population of our Region. Isolation measures were already observed before the pandemic and were further strengthened in most cases. Particular attention should also be paid to new psychological and physical complications indirectly linked to the COVID‐19 pandemic.

Vulnerability is a big issue for small inland urban centres, which are exposed to the risk of depopulation. In the climate of the centre-northern part of Italy, and in the context of the recent concentration of a high number of earthquakes in that area, seismic vulnerability can become the determinant cause of the final abandonment of a small town. In some Italian regions, as well as in Emilia Romagna, municipalities are implementing seismic vulnerability reduction policies based on the Emergency Limit Condition, which has become a basic point of reference for ordinary land planning. This study proposes an approach to seismic vulnerability reduction based on valuation planning for implementation within the general planning framework of the Faentina Union, a group of five small towns located in the southwestern part of the Province of Ravenna, Italy. This approach consists of three main stages: knowledge&mdash, the typological, constructive, and technological descriptions of the buildings, specifically concerning their degree of vulnerability, interpretation&mdash, analysis with the aim of outlining a range of hypotheses with respect to damage in case of a prospective earthquake, and planning&mdash, the identification of the courses of action intended to meaningfully reduce the vulnerability of buildings. This stage includes a cost modelling tool aimed at defining the trade-off between the extension and the intensity of the vulnerability reduction works, given the budget.

This contribution deals with the energy-environmental interventions to be encouraged and subsidized over the implementation of the Detailed Renovation Program of Ragusa Superiore, Italy. It proposes a global economic-evaluative strategic planning pattern supporting decision-making in developing a specific energy-environmental equalization program. Starting from the huge database of the GIS describing the Architectural Units forming the old town’s urban fabric, the pattern features each of them with several architectural and energy attributes, so that each of them can be sorted among the different Categories of Intervention, ranging from the conservative to the transformative ones. Furthermore, the energy characteristics of all the AUs of the sample have been modelled in order to calculate the energy performance to be improved. The combination of architectural and energy characteristics provides the profile of each AU according to which the pattern associates to it the appropriate CI and calculates the related cost and real estate market price surplus to be used for the equalization. By releasing the constraint according to which an AU is sorted to a specific CI, the pattern is able to design several global strategies that can be ranked by performing a MAVT model.

Vulnerability is the big issue of the small inland urban centers exposed to the risk of depopulation. In the climate and in the context of an increasing seismic risk in the center-northern part of Italy, seismic vulnerability can become the determinant cause of the final abandonment of a small town. In some Italian regions, as well as Emilia Romagna, municipalities are implementing seismic vulnerability reduction policies based on the Emergency Limit Condition that has become a basic reference for ordinary land planning. This study proposes a valuation planning approach to the seismic vulnerability reduction carried out within the general planning framework concerning the Faentina Union, a group of five small towns located in the south-western part of the Province of Ravenna, Italy. The approach consists of three main stages: knowledge – the typological, constructive and technological description of the buildings specifically concerning their vulnerability degree; interpretation – the analyses aimed to outline a range of hypotheses about the damages in case of seism; planning – identifying the works intended to definitely reduce the vulnerability of the buildings. This stage includes a cost modelling tools aimed at outlining the trade-off between the extension and the intensity of the vulnerability reduction works, given the budget.

An analysis of the costs for the rehabilitation of the urban fabric of the old town of Ragusa Superiore was carried out in order to provide useful guidance to the development plan and the possible incentives. The analysis is based on a range of different strategies, from conservative to transformative, formed by associating to each architectural unit a different Intervention Category depending on the degree of achievement of the different – and sometimes conflicting – objectives of the plan. The analysis was carried out on a sample of 1700 architectural units grouped into 22 types taking into account size, spatial distribution, exposure, building features. For each category of intervention a cost range was calculated basing on the single works that for each type have been supposed. The results provide a wide range of information about the correlation between the maintenance condition – as reported by the Detailed Plan, the one we reported and the costs calculated. The comparison of the results with the objectives of the Plan allows the planners and the decision makers to identify the strategy that maximizes the ratio benefits/costs and defines the limits and the conditions for the incentives.

The old town of Ragusa is getting through a process of progressive enhancement in some different directions. Its differently valued parts need to be comprised in a whole valorization strategy connecting the decision making process with functional and symbolic values. In such a multi-layered urban sub-system, the architectural unit can play the role of main information/value units which the valuation/decision making pattern starts from. The pattern works as an impact assessment tool, which generates a great number of intervention strategies in order to maximize different and conflicting objectives and provides for each of them an axiological profile aimed at defining a trade-off scheme between them. Some GIS tools and a WebGIS interface allow the real-time control of the different scenarios envisaged in the decision making process.

The old town of Ragusa is undertaking a regeneration process in some different directions. Its differently valued areas need to be comprised in a whole valorisation strategy, connecting the decision making process with functional and symbolic values. In such a multi-layered urban sub-system, the architectural unit can play the role of one of the main information/value units which the valuation/decision making pattern starts from. The pattern works as an impact assessment tool, that generates a great number of intervention strategies in order to maximize different and conflicting objectives, and provides for each of them an axiological profile aimed at defining a trade-off scheme between them. Some GIS tools and a WebGIS interface allow the real-time control of the different scenarios envisaged in the decision making process.

Only recently seismic prevention has come up in urban planning and considered as a significant part of the social capital of the urban heritage. Among the planning tools for reducing the vulnerability of urban fabrics, the Emergency Limit Condition (ELC) defines the fields which require widespread strengthening interventions in the buildings involved in resilient town units. The extent and intensity of such interventions can be graded so as to find an optimal ELC measure, taking the needs of the urban and human capital into account. In case of the old town centre of Ragusa, a model for analysing the seismic vulnerability of the built-up areas has been integrated with a model for a cost-revenue estimation in order to identify the conditions of the ELC dimensioning and to develop the relevant incentive system.