Demonstrating Agreement between Radio and Fluorescence Measurements of the Depth of Maximum of Extensive Air Showers at the Pierre Auger Observatory

We show, for the first time, radio measurements of the depth of shower maximum (X_{max}) of air showers induced by cosmic rays that are compared to measurements of the established fluorescence method at the same location. Using measurements at the Pierre Auger Observatory we show full compatibility between our radio and the previously published fluorescence dataset, and between a subset of air showers observed simultaneously with both radio and fluorescence techniques, a measurement setup unique to the Pierre Auger Observatory. Furthermore, we show radio X_{max} resolution as a function of energy and demonstrate the ability to make competitive high-resolution X_{max} measurements with even a sparse radio array. With this, we show that the radio technique is capable of cosmic-ray mass composition studies, both at Auger and at other experiments.

Apoptotic volume decrease (AVD) in A549 cells exposed to water-soluble fraction of particulate matter (PM10)

Exposure to atmospheric particulate matter (PM) is recognized as a human health risk factor of great concern. The present work aimed to study the cellular mechanisms underlying cytotoxic effects of airborne particulate matter <10 µm in size (PM₁₀), sampled in an urban background site from January to May 2020, on A549 cells. In particular, the study addressed if PM₁₀ exposure can be a main factor in the induction of the Apoptotic Volume Decrease (AVD), which is one of the first events of apoptosis, and if the generation of intracellular oxidative stress can be involved in the PM₁₀ induction of apoptosis in A549 cells. The cytotoxicity of PM₁₀ samples was measured by MTT test on cells exposed for 24 h to the PM₁₀ aqueous extracts, cell volume changes were monitored by morphometric analysis of the cells, apoptosis appearance was detected by annexin V and the induction of intracellular oxidative stress was evaluated by the ROS sensitive CM-H₂DCFDA fluorescent probe. The results showed cytotoxic effects ascribable to apoptotic death in A549 cells exposed for 24 h to aqueous extracts of airborne winter PM₁₀ samples characterized by high PM₁₀ value and organic carbon content. The detected reduced cell viability in winter samples ranged from 55% to 100%. Normotonic cell volume reduction (ranging from about 60% to 30% cell volume decrease) after PM₁₀ exposure was already detectable after the first 30 min clearly indicating the ability of PM₁₀, mainly arising from biomass burning, to induce Apoptotic Volume Decrease (AVD) in A549 cells. AVD was prevented by the pre-treatment with 0.5 mM SITS indicating the activation of Cl^- efflux presumably through the activation of VRAC channels. The exposure of A549 cells to PM₁₀ aqueous extracts was able to induce intracellular oxidative stress detected by using the ROS-sensitive probe CM-H₂DCFDA. The PM₁₀-induced oxidative stress was statistically significantly correlated with cell viability inhibition and with apoptotic cell shrinkage. It was already evident after 15 min exposure representing one of the first cellular effects caused by PM exposure. This result suggests the role of oxidative stress in the PM₁₀ induction of AVD as one of the first steps in cytotoxicity.

Characterisation of the correlations between oxidative potential and in vitro biological effects of PM10 at three sites in the central Mediterranean

Atmospheric particulate matter (PM) is one of the major risks for global health. The exact mechanisms of toxicity are still not completely understood leading to contrasting results when different toxicity metrics are compared. In this work, PM₁₀ was collected at three sites for the determination of acellular oxidative potential (OP), intracellular oxidative stress (OSGC), cytotoxicity (MTT assay), and genotoxicity (Comet assay). The in vitro tests were done on the A549 cell line. The objective was to investigate the correlations among acellular and intracellular toxicity indicators, the variability among the sites, and how these correlations were influenced by the main sources by using PMF receptor model coupled with MLR. The OP^DTT_V, OSGC_V, and cytotoxicity were strongly influenced by combustion sources. Advection of African dust led to lower-than-average intrinsic toxicity indicators. OP^DTT_V and OSGC_V showed site-dependent correlations suggesting that acellular OP may not be fully representative of the intracellular oxidative stress at all sites and conditions. Cytotoxicity correlated with both OP^DTT_V and OSGC_V at two sites out of three and the strength of the correlation was larger with OSGC_V. Genotoxicity was correlated with cytotoxicity at all sites and correlated with both, OP^DTT_V and OSGC_V, at two sites out of three. Results suggest that several toxicity indicators are useful to gain a global picture of the potential health effects of PM.

Concentration and size distribution of atmospheric particles in southern Italy during COVID-19 lockdown period

Many countries imposed lockdown (LD) to limit the spread of COVID-19, which led to a reduction in the emission of anthropogenic atmospheric pollutants. Several studies have investigated the effects of LD on air quality, mostly in urban settings and criteria pollutants. However, less information is available on background sites, and virtually no information is available on particle number size distribution (PNSD). This study investigated the effect of LD on air quality at an urban background site representing a near coast area in the central Mediterranean. The analysis focused on equivalent black carbon (eBC), particle mass concentrations in different size fractions: PM_2.5 (aerodynamic diameter D_a < 2.5 μm), PM₁₀ (D_a < 10 μm), PM_10-2.5 (2.5 < D_a < 10 μm); and PNSD in a wide range of diameters (0.01-10 μm). Measurements in 2020 during the national LD in Italy and period immediately after LD (POST-LD period) were compared with those in the corresponding periods from 2015 to 2019. The results showed that LD reduced the frequency and intensity of high-pollution events. Reductions were more relevant during POST-LD than during LD period for all variables, except quasi-ultrafine particles and PM_10-2.5. Two events of long-range transport of dust were observed, which need to be identified and removed to determine the effect of LD. The decreases in the quasi-ultrafine particles and eBC concentrations were 20%, and 15-22%, respectively. PM_2.5 concentration was reduced by 13-44% whereas PM_10-2.5 concentration was unaffected. The concentration of accumulation mode particles followed the behaviour of PM_2.5, with reductions of 19-57%. The results obtained could be relevant for future strategies aimed at improving air quality and understanding the processes that influence the number and mass particle size distributions.

Physiologic Range of Myocardial Mechano-Energetic Efficiency among Healthy Subjects: Impact of Gender and Age

BACKGROUND

Myocardial mechano-energetic efficiency (MEE) is the capability of the left ventricle (LV) to convert the chemical energy obtained from the cardiac oxidative metabolism into mechanical work. The aim of present study was to establish normal non-invasive MEE and MEEi reference values.

METHODS

In total, 1168 healthy subjects underwent physical examinations, clinical assessment, and standardized transthoracic echocardiographic (TTE) examination. MEE was obtained by TTE as the ratio between stroke volume (SV) and heart rate (HR): MEE = SV/HR [HR expressed in seconds (HR/60)]. Because MEE is highly related to left ventricular mass (LVM), MEE was then divided by LVM with the purpose of obtaining an estimate of energetic expenditure per unit of myocardial mass (i.e., indexed MEE, MEEi, mL/s/g).

RESULTS

The mean values of MEE and MEEi in the overall population were 61.09 ± 18.19 mL/s; 0.45 ± 0.14, respectively. In a multivariable analysis, gender, body surface area (BSA), diastolic blood pressure, left atrial volume indexed to BSA, E/e' and tricuspid annular plane systolic excursion (TAPSE) were the independent variables associated with MEE, while age, gender, BSA and TAPSE were the independent variables associated with MEEi.

CONCLUSIONS

The knowledge of age- and gender-based MEE and MEEi normal values may improve the global assessment of LV cardiac mechanics and serve as a reference to identify phenotypes at high risk of cardiovascular events.

P346 HEALTH LITERACY ASSESSMENT AND HOSPITAL LENGTH OF STAY: A RETROSPECTIVE STUDY

Background

Cardiovascular diseases (CDs) were the leading cause of death worldwide in 2020. The risk of increasing CD is related to low Health Literacy (HL). HL can be defined as the individual’s ability to understand and process health information. Low HL has a risk ratio of 1.90 on mortality and 1.35 on readmission. A low level of HL was related to poorer use of health care services. Several inconsistencies were found about the relationship between HL and Length of stay (LOS). Although CDs are increasing because of the aging population, HL is often underestimated in the hospital setting. For this reason, HL assessment is important to identify patients at risk of poor HL. Therefore, this study aimed to describe the HL level in inpatients with CDs and to analyze the relationship between HL and LOS

Method

A retrospective design was used to randomly select 134 patients with CDs in eight cardiovascular and internal medicine units of an Italian hospital from 10 January to 10 May 2021. Clinical data were collected using a nursing information system (NIS) and the hospital discharge register. Single Item Literacy Screener (SILS) was used to measure HL and was systematically reported on NIS.

Results

The mean age of the sample was 71.28 (SD 13.19); 59% were male. HL‘s mean score was 2.43 (SD 1.2). A statistically significant linear association (Spearman’s correlation coefficient) was observed between the HL score and LOS. Patients with inadequate HL were 50.7% and had a longer LOS than patients with adequate HL (mean 9.1 ± 7.1 Vs 7.2 ± 5.9 days respectively, p = 0.05).

Conclusion

HL is poor and has been shown to be associated with LOS. These results should be confirmed after considering other variables through multivariate analyses. These findings suggest that the adverse effects of low HL may extend into the inpatient cardiovascular setting

P345 HEALTH LITERACY AS A MEASURE OF NURSING COMPLEXITY OF CARE IN A DEPARTMENT OF CARDIOVASCULAR MEDICINE

Background

HL plays a fundamental role in patients’ healthcare. According to the American Medical Association, HL can be viewed as a stronger predictor of a person’s health status than age, education level, and race. HL concept has many implications for nursing; they are responsible for identifying the patient’s barriers to their health information’s comprehension and providing specific nursing interventions in minimizing barriers. Moreover, HL assessment is necessary to plan tailored interventions, improve their efficacy through patient–centered communication. As a part of the nursing process, the nursing diagnosis (ND) classifies patients according to their level of nursing dependency and can be predictive for the nursing workload. No studies have been conducted on the relationship between NDs and HL. We aimed to describe the prevalence and distribution of NDs on admission in patients with CDs and to analyze the relationship between HL and NDs.

Method

A retrospective design was used to randomly select 134 patients with CDs in eight cardiovascular and internal medicine units of an Italian hospital from 10 January to 10 May 2021. NDs were collected using a nursing information system (NIS). Single Item Literacy Screener (SILS) was used to measure HL and was systematically reported on NIS.

Results

A mean of 3.5 ± 2.3 nursing diagnosis per patient was identified. A statistically significant linear association (Spearman’s correlation coefficient) was observed between HL score and the number of NDs.

Conclusion

HL was associated with the number of NDs.

A review on measurements of SARS-CoV-2 genetic material in air in outdoor and indoor environments: Implication for airborne transmission

Airborne transmission of SARS-CoV-2 has been object of debate in the scientific community since the beginning of COVID-19 pandemic. This mechanism of transmission could arise from virus-laden aerosol released by infected individuals and it is influenced by several factors. Among these, the concentration and size distribution of virus-laden particles play an important role. The knowledge regarding aerosol transmission increases as new evidence is collected in different studies, even if it is not yet available a standard protocol regarding air sampling and analysis, which can create difficulties in the interpretation and application of results. This work reports a systematic review of current knowledge gained by 73 published papers on experimental determination of SARS-CoV-2 RNA in air comparing different environments: outdoors, indoor hospitals and healthcare settings, and public community indoors. Selected papers furnished 77 datasets: outdoor studies (9/77, 11.7%) and indoor studies (68/77. 88.3%). The indoor datasets in hospitals were the vast majority (58/68, 85.3%), and the remaining (10/68, 14.7%) were classified as community indoors. The fraction of studies having positive samples, as well as positivity rates (i.e. ratios between positive and total samples) are significantly larger in hospitals compared to the other typologies of sites. Contamination of surfaces was more frequent (in indoor datasets) compared to contamination of air samples; however, the average positivity rate was lower compared to that of air. Concentrations of SARS-CoV-2 RNA in air were highly variables and, on average, lower in outdoors compared to indoors. Among indoors, concentrations in community indoors appear to be lower than those in hospitals and healthcare settings.

Airborne concentrations of SARS-CoV-2 in indoor community environments in Italy

COVID-19 pandemic raised a debate regarding the role of airborne transmission. Information regarding virus-laden aerosol concentrations is still scarce in community indoors and what are the risks for general public and the efficiency of restriction policies. This work investigates, for the first time in Italy, the presence of SARS-CoV-2 RNA in air samples collected in different community indoors (one train station, two food markets, one canteen, one shopping centre, one hair salon, and one pharmacy) in three Italian cities: metropolitan city of Venice (NE of Italy), Bologna (central Italy), and Lecce (SE of Italy). Air samples were collected during the maximum spread of the second wave of pandemic in Italy (November and December 2020). All collected samples tested negative for the presence of SARS-CoV-2, using both real-time RT-PCR and ddPCR, and no significant differences were observed comparing samples taken with and without customers. Modelling average concentrations, using influx of customers' data and local epidemiological information, indicated low values (i.e. < 0.8 copies m-3 when cotton facemasks are used and even lower for surgical facemasks). The results, even if with some limitations, suggest that the restrictive policies enforced could effectively reduce the risk of airborne transmissions in the community indoor investigated, providing that physical distance is respected.

Efficacy and safety of methylphenidate on attention deficit hyperactivity disorder in children with Down syndrome

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is a common co-morbidity that affects up to 44% of children with Down syndrome (DS). There is a need for reliable, good quality research on the use of methylphenidate within this population. The objective of this study is to report our experience regarding the management of ADHD in these children using methylphenidate.

METHODS

This study is a retrospective observation of 21 children with DS, followed at Jérôme Lejeune Institute between 2000 and 2018. The diagnosis of ADHD was made using the Diagnostic and Statistical Manual of Mental Disorders criteria. Efficacy was measured as response or non-response on two main symptoms: attention/concentration and hyperactivity/impulsivity. Safety was evaluated by the presence or absence of side effects.

RESULTS

Sixteen out of the 21 children (76%) showed improvement with methylphenidate. The average age of treatment onset in responding children was 8 years and 10 months versus 6 years and 3 months in non-responders (P = 0.05). Average dose/weight was significantly different in responders and non-responders (0.82 vs. 0.54 mg/kg/day, respectively; P = 0.03). Twelve children out of 21 (57%) experienced side effects; only three experienced side effects severe enough to require treatment interruption. Most common side effects were loss of appetite and difficulties in falling asleep.

CONCLUSION

Methylphenidate was effective and safe in treating ADHD in 76% of cases in children with DS, with few serious side effects to report. Early diagnosis of ADHD is important to improve the quality of life, learning, inclusion and socialisation of children with DS.

The acoustical properties of tetraethyl orthosilicate based granular silica aerogels

Available data suggests that granulated aerogels can be of interest in terms of their sound absorption performance in the audio frequency range. However, there is still no thorough understanding of the complex physical phenomena which are responsible for their observed acoustical properties. This work is an attempt to address this gap through advanced material characterization methods and mathematical modelling. Aerogel samples are produced through a two-step, acid-base sol-gel process, with sol silica concentration and density being the main variables. Their pore structure is carefully characterized by nitrogen sorption analysis and scanning electron microscopy. The acoustical properties of hard-backed granular silica aerogels are measured in an impedance tube and the results predicted accurately with the adopted theoretical model. Although silica aerogels have over 90% of open interconnected pores, this was neither reflected in the measured acoustical properties nor the parameter values predicted with the model. Novel results show that only a proportion of the micro and mesopores in the direct vicinity of the grain surface influenced the acoustical properties of aerogels. Further work in the hierarchical pore structure of aerogels is required to better understand the roles of different pore scales on the measured acoustical properties of a granulated aerogel.

Characterization of airborne particulate fractions from the port city of Rijeka, Croatia

The aim of this work was characterization of airborne particulates in the port city of Rijeka in order to evaluate impact of ship emissions on air quality. Samples of airborne particulates were collected with a ten stages cascade impactor during two campaigns: autumn and spring. A total of 16 weekly samples were analyzed on mass concentration, ions, metals and carbonaceous species (EC, OC, WSOC). Distribution of airborne fractions showed a bimodal distribution, with two maxima: one in coarse, and other in fine fraction. Source apportionment using PMF receptor model identified six sources of airborne particulates in Rijeka: crustal, biomass burning, sea salt, traffic/metal industry, combustion/SIA and HFO burning, i.e., ship emission (contribution 3%). The contribution of ship traffic to primary emission of particulate matter, using vanadium as tracer, indicated a twofold increase for PM₁₀ and PM_2.5 relative to 2012-14. An unusual desert dust event was registered in autumn campaign.

Evaluation and predictive value of IgE responses toward a comprehensive panel of house dust mite allergens using a new multiplex assay: a real-life experience on an Italian population

Summary

Background. House dust mites (HDM) are among the most important allergen sources worldwide, representing a major cause of perennial allergic rhinitis and asthma. Aim. To evaluate the prevalence of IgE responses towards a comprehensive panel of HDM allergens and to evaluate the implications of molecular sensitization profiles on respiratory symptoms. Methods. 155 consecutive HDM-allergic patients (mean age: 27.5 years; range: 1-62; female: 63), 86 affected by rhinitis and 68 by asthma, were enrolled. Specific IgE reactivity to Der f 1, Der p 1, Der f 2, Der p 2, Der p 5, Der p 7, Der p 10, Der p 11, Der p 20, Der p 21 and Der p 23 was tested in patients' sera using the last version of the multiparametric assay Allergy Explorer (ALEX). Results. In all, major and minor allergens were positive, respectively, in 96.8% and 50.9% of the patients. Prevalence and IgE levels of Der f 1, Der f 2, Der p 1 and Der p 20 were significantly higher in asthmatic patients (p less than 0.05), whereas subjects negative for minor allergens resulted more frequently suffering from rhinitis (p = 0.0001). Asthmatic patients had IgE reactivity to a larger number of HDM allergens (mean 5.4; SD ± 2.3) than patients with only rhinitis (mean 4.2; SD ± 2.5) (p = 0.003), whereas no differences in the number of HDM positive molecules and in the specific IgE levels were found among different ages. Conclusions. This study confirms that the assessment of IgE to a comprehensive panel of HDM allergens defines different serological reactivity profiles that seem associated with different clinical presentations.

On the concentration of SARS-CoV-2 in outdoor air and the interaction with pre-existing atmospheric particles

The spread of SARS-CoV-2 by contact (direct or indirect) is widely accepted, but the relative importance of airborne transmission is still controversial. Probability of outdoor airborne transmission depends on several parameters, still rather uncertain: virus-laden aerosol concentrations, viability and lifetime, minimum dose necessary to transmit the disease. In this work, an estimate of outdoor concentrations in northern Italy (region Lombardia) was performed using a simple box model approach, based on an estimate of respiratory emissions, with a specific focus for the cities of Milan and Bergamo (Italy). In addition, the probability of interaction of virus-laden aerosol with pre-existing particles of different sizes was investigated. Results indicate very low (<1 RNA copy/m3) average outdoor concentrations in public area, excluding crowded zones, even in the worst case scenario and assuming a number of infects up to 25% of population. On average, assuming a number of infects equal to 10% of the population, the time necessary to inspire a quantum (i.e. the dose of airborne droplet nuclei required to cause infection in 63% of susceptible persons) would be 31.5 days in Milan (range 2.7-91 days) and 51.2 days in Bergamo (range 4.4-149 days). Therefore, the probability of airborne transmission due to respiratory aerosol is very low in outdoor conditions, even if it could be more relevant for community indoor environments, in which further studies are necessary to investigate the potential risks. We theoretically examined if atmospheric particles can scavenge virus aerosol, through inertial impact, interception, and Brownian diffusion. The probability was very low. In addition, the probability of coagulation of virus-laden aerosol with pre-existing atmospheric particles resulted negligible for accumulation and coarse mode particles, but virus-laden aerosol could act as sink of ultrafine particles (around 0.01 μm in diameter). However, this will not change significantly the dynamics behaviour of the virus particle or its permanence time in atmosphere.

SARS-CoV-2 concentrations and virus-laden aerosol size distributions in outdoor air in north and south of Italy

The COVID-19 disease spread at different rates in the different countries and in different regions of the same country, as happened in Italy. Transmission by contact or at close range due to large respiratory droplets is widely accepted, however, the role of airborne transmission due to small respiratory droplets emitted by infected individuals (also asymptomatic) is controversial. It was suggested that outdoor airborne transmission could play a role in determining the differences observed in the spread rate. Concentrations of virus-laden aerosol are still poorly known and contrasting results are reported, especially for outdoor environments. Here we investigated outdoor concentrations and size distributions of virus-laden aerosol simultaneously collected during the pandemic, in May 2020, in northern (Veneto) and southern (Apulia) regions of Italy. The two regions exhibited significantly different prevalence of COVID-19. Genetic material of SARS-CoV-2 (RNA) was determined, using both real time RT-PCR and ddPCR, in air samples collected using PM₁₀ samplers and cascade impactors able to separate 12 size ranges from nanoparticles (diameter D < 0.056 µm) up to coarse particles (D > 18 µm). Air samples tested negative for the presence of SARS-CoV-2 at both sites, viral particles concentrations were <0.8 copies m^-3 in PM₁₀ and <0.4 copies m^-3 in each size range investigated. Outdoor air in residential and urban areas was generally not infectious and safe for the public in both northern and southern Italy, with the possible exclusion of very crowded sites. Therefore, it is likely that outdoor airborne transmission does not explain the difference in the spread of COVID-19 observed in the two Italian regions.

Impact of epicardial adipose tissue increase after ST elevation Myocardial Infarction (STEMI) on IL-13 and left ventricular remodelling

Background

The role of epicardial adipose tissue (EAT) in myocardial diseases is well established, and several evidence suggest that EAT may negatively affect left ventricular (LV) remodelling through an imbalanced production and secretion of pro and anti-inflammatory cytokines. Of these, the IL-13 it is known to play a positive activity on cardiac remodelling. Nowadays, the crosstalk between EAT and the myocardium is still poorly understood and the effects of myocardial ischemia on morphological and functional properties of EAT are almost unknown.

Purpose

In the present study we explored whether an increase of EAT thickness after STEMI might be associated with unfavourable LV remodelling at 3 months (T1). We also evaluated the relationship between changes (Δ) of EAT thickness and systemic levels of Interleukin (IL)-13 which is known to play a favourable activity on LV remodelling after STEMI.

Methods

We enrolled 66 patients with first STEMI, undergoing primary percutaneous angioplasty. At baseline and at 3 months we performed a complete echocardiogram, including EAT maximal thickness assessment, and determined circulating levels of IL-13.

Results

At 3 months after STEMI, the population was stratified into two groups according to different EAT remodelling after cardiac event: Group 1, patients with an increased EAT thickness (Δ EAT&gt;1; 30 patients) and Group 2, patients with unchanged or decreased EAT thickness (Δ EAT&lt;1). The two groups did not differ for age, gender and atherosclerotic risk factors. Group 1 had a worse LV remodelling at 3 months with higher LV diastolic and systolic volumes, lower LV ejection fraction (p=0.003; p=0.013; p=0.013 respectively) and worse diastolic function (E/e'; p=0.011). Of interest, EAT thickness increase was paralleled by circulating IL-13 reduction (p=0.022).

Conclusion

Myocardial injury can result in EAT increase which is associated to worse LV remodelling probably through the loss of the protective role of IL-13.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): This research has been funded by the University of Naples “Federico II” and “Compagnia di San Paolo e l'Istituto Banco di Napoli” within the competitive grant STAR 2018; Valentina Parisi is the principal investigator

Comparison of the impact of ships to size-segregated particle concentrations in two harbour cities of northern Adriatic Sea

Detailed information on in-harbour shipping contribution to size segregated particles in coastal cities are scarce, especially in the busy Mediterranean basin. This poses issues for human exposure and air quality in urban harbour agglomerates, where only criteria pollutants (i.e. PM₁₀ and/or PM_2.5) are usually monitored. In this work, particle number and mass size distributions, in a large size range (0.01-31 μm), were obtained in two coastal cities of northern Adriatic Sea: Venice (Italy) and Rijeka (Croatia). Three size ranges were investigated: nanoparticles (diameter D < 0.25 μm); fine particles (0.25<D < 1 μm), and coarse particles (D > 1 μm). Absolute concentrations were larger in Venice for all size ranges showing, using analysis of daily trends, a large influence of local meteorology and boundary-layer dynamics. Contribution of road transport was larger (in relative terms) in Rijeka compared to Venice. The highest contributions of shipping were in Venice, mainly because of the larger ship traffic. Maximum impact was on nanoparticles 7.4% (Venice) and 1.8% (Rijeka), the minimum was on fine range 1.9% (Venice) and <0.2% (Rijeka) and intermediate values were found in the coarse fraction 1.8% (Venice) and 0.5% (Rijeka). Contribution of shipping to mass concentration was not distinguishable from uncertainty in Rijeka (<0.2% for PM₁, PM_2.5, and PM₁₀) and was about 2% in Venice. Relative contributions as function of particles size show remarkable similitudes: a maximum for nanoparticles, a quick decrease and a successive secondary maximum (2-3 times lower than the first) in the fine range. For larger diameters, the relative contributions reach a minimum at 1-1.5 μm and there is a successive increase in the coarse range. Size distributions showed a not negligible contribution of harbour emissions to nanoparticle and fine particle number concentrations, compared to PM_2.5 or PM₁₀, indicating them as a better metric to monitor shipping impacts compared to mass concentrations (PM_2.5 or PM₁₀).

Exploring Relative Preferences for HIV Service Features Using Discrete Choice Experiments: a Synthetic Review

PURPOSE OF REVIEW

Aligning HIV treatment services with patient preferences can promote long-term engagement. A rising number of studies solicit such preferences using discrete choice experiments, but have not been systematically reviewed to seek generalizable insights. Using a systematic search, we identified eleven choice experiments evaluating preferences for HIV treatment services published between 2004 and 2020.

RECENT FINDINGS

Across settings, the strongest preference was for nice, patient-centered providers, for which participants were willing to trade considerable amounts of time, money, and travel distance. In low- and middle-income countries, participants also preferred collecting antiretroviral therapy (ART) less frequently than 1 monthly, but showed no strong preference for 3-compared with 6-month refill frequency. Facility waiting times and travel distances were also important but were frequently outranked by stronger preferences. Health facility-based services were preferred to community- or home-based services, but this preference varied by setting. In high-income countries, the availability of unscheduled appointments was highly valued. Stigma was rarely explored and costs were a ubiquitous driver of preferences. While present improvement efforts have focused on designs to enhance access (reduced waiting time, travel distance, and ART refill frequency), few initiatives focus on the patient-provider interaction, which represents a promising critical area for inquiry and investment. If HIV programs hope to truly deliver patient-centered care, they will need to incorporate patient preferences into service delivery strategies. Discrete choice experiments can not only inform such strategies but also contribute to prioritization efforts for policy-making decisions.

Size-resolved particle emission factors of vehicular traffic derived from urban eddy covariance measurements

Road traffic is one of the major sources of atmospheric particles in urban areas. Modelling the contribution of this source to urban pollution requires reliable estimates of emission factors possibly resolved in size. In this work, size-resolved particle emission factors (EFs) of the mixed vehicle fleet were measured in the urban area of Lecce (south-eastern Italy). The approach used is based on vertical fluxes measured with eddy-covariance, counting of vehicles, and estimation of footprints. Results show that the average EF in number (range 0.009-3 μm) was 2.2*10¹⁴ #/Veh km, being dominated by ultrafine particles (D_p < 0.25 μm) due to exhaust emissions. EF number size distribution decreases with particle size. A reduction of more than four orders of magnitude was observed at D_p ≅ 0.9 μm. EF mass size distribution reaches a maximum around D_p ≅ 0.3 μm then decreases until D_p ≅ 0.9 μm. For larger particles EF in mass increases for the influence of non-exhaust emissions. Average emission factor of PM₁ was 56 mg/Veh Km and that of PM_2.5 was 63 mg/Veh Km. A comparison of measurements taken in 2010 and 2015 in the same area shows a decreasing trend of the average total EF in number of about 56%, likely as a consequence of the increased use of new generation vehicles following more restrictive limits for particle emissions.

Right Ventricular Functional Reserve in Early-Stage Idiopathic Pulmonary Fibrosis: An Exercise Two-Dimensional Speckle Tracking Doppler Echocardiography Study

BACKGROUND

The most important determinant of long-term survival in patients with idiopathic pulmonary fibrosis is the right ventricular (RV) adaptation to the increased pulmonary vascular resistance. Our aim was to explore RV contractile reserve during stress echocardiography in early-stage IPF.

METHODS

Fifty early-stage patients with IPF and 50 healthy control patients underwent rest and stress echocardiography, including RV two-dimensional speckle tracking echocardiography. At peak exertion, blood gas analysis and spirometry were also assessed.

RESULTS

At rest, RV diameters were mildly increased in IPF; however, although RV conventional systolic function indexes were similar between the IPF and control groups, RV global longitudinal strain and RV lateral wall longitudinal strain (LWLS) were significantly reduced in the IPF cohort. During physical exercise, patients with IPF showed a reduced exercise tolerance with lower maximal workload (P < .01), level of oxygen saturation (P < .001), and peak heart rate (P < .01). Systolic and diastolic BP values were similar in both groups. Systolic pulmonary artery pressure (PAPs) increase (ΔPAPs) during exertion was higher in IPF vs healthy subjects (P < .0001); RV LWLS increase (ΔRV LWLS) during exercise was lower in patients with IPF vs control patients (P < .00001). By multivariable analysis, RV LWLS at rest and ΔRV LWLS were directly related to peak exertion capacity, PAPs, and blood oxygen saturation level (Spo₂; P < .0001). Δ RV LWLS was directly related to diffusion lung carbon monoxide (P < .0001).

CONCLUSIONS

RV myocardial dysfunction is already present at rest in early-stage IPF and worsens during exertion as detected by two-dimensional speckle-tracking echocardiography. The RV altered contractile reserve appears to be related to reduced exercise tolerability and impaired pulmonary hemodynamic.

Characterisation of particle size distributions and corresponding size-segregated turbulent fluxes simultaneously with CO2 exchange in an urban area

Number and mass particle concentrations and fluxes were measured, simultaneously with CO₂ concentration and flux, in the urban area of Lecce (Italy). The measurements of the turbulent exchanges of atmospheric particles and gas were performed with an eddy-covariance station located near the busiest road of the town. For the smaller particles, the diurnal evolution of the particle number concentrations and fluxes shows a clear correlation with human activities, in particular vehicular traffic, which is the obvious candidate as the source of the two clear peaks in the CPC concentration in the morning and in the evening. The fluxes were upward for all the measurement period, even though small net deposition was observed for larger particles and during weekend. For the CPC, the correlation with the traffic daily pattern is extremely strong. The city is a continuous particle source. The data analysis seems also to suggest the presence of local urban nucleation events. CO₂ and particle concentrations were larger at low wind velocity, instead, fluxes were larger at high wind velocity. This opposite behaviour suggests that the influence of local urban emissions is larger on fluxes with respect to concentrations. The average daily patterns of CO₂ concentration show an overlap between biogenic cycle and urban emissions. Again, traffic appears to be the dominant source for fluxes and the urban area is a net source of CO₂.

Hypercoagulable State in Patients with Advanced Gastrointestinal Cancer: Evidence for an Acquired Resistance to Activated Protein C

Aims and background

Thromboembolic complications are common in patients with cancer and represent the second cause of death in patients with overt malignant disease. The aim of this study was to investigate the activated protein C pathway in cancer.

Methods

We studied the coagulation cascade, natural clotting inhibitors, fibrinolytic proteins and resistance to activated protein C in 20 patients with advanced gastrointestinal cancer and 84 volunteers by measuring PT, APTT, fibrinogen, AT III, PC, PS, APC resistance, fibrinolytic system (PLG, ANPL, PAI-1 and t-PA) and activation peptides (D-Dimers, prothrombin 0 fragment 1+2/F1+2).

Results

Laboratory tests confirmed coagulation abnormalities in cancer patients. Fibrinogen, D-Dimers and F1+2 were increased, while t-PA activity was significantly lower than that of controls. APC resistance was higher in cancer patients compared to the control group (55% vs 2%; P < 0.0001). Excess thrombin generation was manifested by increased F1+2 plasma levels in APC-resistant cancer patients. Genetic analyses showed that only one patient with a poor response to APC carried a factor V R506Q mutation in exon 10.

Conclusions

Our findings show a high prevalence of APC resistance in cancer, compatible with an acquired defect in the APC pathway.

Reference Ranges and Physiologic Variations of Left E/e' Ratio in Healthy Adults: Clinical and Echocardiographic Correlates

Background:

Transthoracic Doppler echocardiographic examination is commonly performed to define the diastolic ventricular function since it is widely available, noninvasive, and inexpensive with respect to other diagnostic imaging modalities. However, data regarding age- and gender-matched reference values are scanty and sometimes conflicting. This study aims to explore the physiologic variations of left ventricular (LV) E/e' ratio as assessed in a large cohort of healthy adults and to investigate clinical and echocardiographic correlates.

Methods:

From June 2007 to February 2014, 1168 healthy Caucasian adults (mean age 45.1 ± 15.6 years) performed standard echocardiographic examination (transthoracic echocardiogram).

Results:

E/e' constantly increases across all the age classes (P < 0.0001, analyses of variance both for males and females) with a strong statistically significant linear positive correlation with age. Stepwise multiple linear regression analysis identified age (P < 0.0001), LV mass (P < 0.001), LV end-diastolic volume (P < 0.01), and left atrial volume (P < 0.001) as the only independent determinants of E/e' ratio (model R² = 0.54, P < 0.0001).

Conclusions:

In healthy subjects, transmitral E velocity to e' ratio changes in relation to the age: it increased with a statistically significant correlation in individuals older than 60 years. Hence, differences related to demographic and anthropometric measurements may potentially develop a misclassification of otherwise normal individuals when established on dichotomically suggested normal reference values. Our study can demonstrate that it is indispensable to apply specific cutoff related to the age and gender to properly assess LV diastolic function.

Malignant ovarian germ cell tumors in pediatric patients: The AIEOP (Associazione Italiana Ematologia Oncologia Pediatrica) study

OBJECTIVE

Malignant ovarian germ cell tumors (MOGCT) carry an excellent prognosis, and the treatment aims to achieve results with the least possible treatment-related morbidity. The aim of this study was to assess the outcomes of pediatric patients with MOGCT.

METHODS

Patients were treated according to their stage: surgery and surveillance for stage I; a modified bleomycin-etoposide-cisplatin (BEP) regimen for stages II (three cycles), III, and IV (three cycles) with surgery on residual disease.

RESULTS

Seventy-seven patients were enrolled (median age 11.8 years), 26 with dysgerminoma (Dysg), 13 with immature teratoma and elevated serum alpha-fetoprotein levels (IT + AFP), and 38 with nondysgeminoma (Non-Dysg) staged as follows: 27 stage I, 13 stage II, 32 stage III, 5 stage IV. Among evaluable patients in stage I (5-year event-free survival [EFS] 72.1% [95% CI: 56.4-92.1%]; 5-year overall survival [OS] 100%), seven relapsed (three patients with Dysg and four patients with Non-Dysg) and were rescued with chemotherapy (plus surgery in three patients). Among the evaluable patients with stages II-IV, 48 (98%) achieved complete remission after chemotherapy ± surgery, one (IT + AFP, stage IV) had progressive disease. In the whole series (median follow-up 80 months), the 5-year OS and EFS were 98.5% (95% CI: 95.6-100%) and 84.5% (95% CI: 76.5-93.5%).

CONCLUSIONS

We confirm the excellent outcome for MOGCT. Robust data are lacking on surgical staging, surveillance for Non-Dysg with stage I, the management of IT + AFP, and the most appropriate BEP regimen. As pediatric oncologists, we support the role of surveillance after proper surgical staging providing cases are managed by experts at specialized pediatric centers.

Salvage total laryngectomy after conservation laryngeal surgery for recurrent laryngeal squamous cell carcinoma

The aim of the present study was to evaluate the oncological efficacy of salvage total laryngectomy in patients who had previously undergone supracricoid partial laryngectomy or transoral laser microsurgery for treatment of laryngeal squamous cell carcinoma. We retrospectively reviewed the medical, surgical and pathological records of 35 patients who underwent salvage total laryngectomy after recurrence of laryngeal cancer (following supracricoid partial laryngectomy or transoral laser microsurgery). Kaplan-Meier survival curves as well as univariate and multivariate analyses of prognostic factors were performed. No statistically significant differences were seen comparing the supracricoid partial laryngectomy group with the transoral laser microsurgery group for overall survival and disease-specific survival at 3 years (OS = 38% vs. 52%, p = 0.16; DSS = 40% vs. 61%, p = 0.057) or locoregional control at 2 years (LRC = 40% vs. 54%, p = 0.056). A trend indicating worse survival and locoregional control for supracricoid partial laryngectomy patients emerged. Preservation of the osteocartilaginous frame in transoral laser microsurgery could hypothetically result in better salvageability of anterior recurrences with extralaryngeal spread.

Patient selection for transcatheter aortic valve replacement: A combined clinical and multimodality imaging approach

Transcatheter aortic valve replacement (TAVR) has been validated as a new therapy for patients affected by severe symptomatic aortic stenosis who are not eligible for surgical intervention because of major contraindication or high operative risk. Patient selection for TAVR should be based not only on accurate assessment of aortic stenosis morphology, but also on several clinical and functional data. Multi-Imaging modalities should be preferred for assessing the anatomy and the dimensions of the aortic valve and annulus before TAVR. Ultrasounds represent the first line tool in evaluation of this patients giving detailed anatomic description of aortic valve complex and allowing estimating with enough reliability the hemodynamic entity of valvular stenosis. Angiography should be used to assess coronary involvement and plan a revascularization strategy before the implant. Multislice computed tomography play a central role as it can give anatomical details in order to choice the best fitting prosthesis, evaluate the morphology of the access path and detect other relevant comorbidities. Cardiovascular magnetic resonance and positron emission tomography are emergent modality helpful in aortic stenosis evaluation. The aim of this review is to give an overview on TAVR clinical and technical aspects essential for adequate selection.

A storage ring experiment to detect a proton electric dipole moment

A new experiment is described to detect a permanent electric dipole moment of the proton with a sensitivity of 10^-29 e ⋅ cm by using polarized "magic" momentum 0.7 GeV/c protons in an all-electric storage ring. Systematic errors relevant to the experiment are discussed and techniques to address them are presented. The measurement is sensitive to new physics beyond the standard model at the scale of 3000 TeV.

Application of PMF and CMB receptor models for the evaluation of the contribution of a large coal-fired power plant to PM10 concentrations

The evaluation of the contribution of coal-fired thermo-electrical power plants to particulate matter (PM) is important for environmental management, for evaluation of health risks, and for its potential influence on climate. The application of receptor models, based on chemical composition of PM, is not straightforward because the chemical profile of this source is loaded with Si and Al and it is collinear with the profile of crustal particles. In this work, a new methodology, based on Positive Matrix Factorization (PMF) receptor model and Si/Al diagnostic ratio, specifically developed to discriminate the coal-fired power plant contribution from the crustal contribution is discussed. The methodology was applied to daily PM10 samples collected in central Italy in proximity of a large coal-fired power plant. Samples were simultaneously collected at three sites between 2.8 and 5.8km from the power plant: an urban site, an urban background site, and a rural site. Chemical characterization included OC/EC concentrations, by thermo-optical method, ions concentrations (NH4(+), Ca(2+), Mg(2+), Na(+), K(+), Mg(2+), SO4(2-), NO3(-), Cl(-)), by high performances ion chromatography, and metals concentrations (Si, Al, Ti, V, Mn, Fe, Ni, Cu, Zn, Br), by Energy dispersive X-ray Fluorescence (ED-XRF). Results showed an average primary contribution of the power plant of 2% (±1%) in the area studied, with limited differences between the sites. Robustness of the methodology was tested inter-comparing the results with two independent evaluations: the first obtained using the Chemical Mass Balance (CMB) receptor model and the second correlating the Si-Al factor/source contribution of PMF with wind directions and Calpuff/Calmet dispersion model results. The contribution of the power plant to secondary ammonium sulphate was investigated using an approach that integrates dispersion model results and the receptor models (PMF and CMB), a sulphate contribution of 1.5% of PM10 (±0.3%) as average of the three sites was observed.

Transcranial Doppler ultrasonography: From methodology to major clinical applications

Non-invasive Doppler ultrasonographic study of cerebral arteries [transcranial Doppler (TCD)] has been extensively applied on both outpatient and inpatient settings. It is performed placing a low-frequency (≤ 2 MHz) transducer on the scalp of the patient over specific acoustic windows, in order to visualize the intracranial arterial vessels and to evaluate the cerebral blood flow velocity and its alteration in many different conditions. Nowadays the most widespread indication for TCD in outpatient setting is the research of right to left shunting, responsable of so called “paradoxical embolism”, most often due to patency of foramen ovale which is responsable of the majority of cryptogenic strokes occuring in patients younger than 55 years old. TCD also allows to classify the grade of severity of such shunts using the so called “microembolic signal grading score”. In addition TCD has found many useful applications in neurocritical care practice. It is useful on both adults and children for day-to-day bedside assessment of critical conditions including vasospasm in subarachnoidal haemorrhage (caused by aneurysm rupture or traumatic injury), traumatic brain injury, brain stem death. It is used also to evaluate cerebral hemodynamic changes after stroke. It also allows to investigate cerebral pressure autoregulation and for the clinical evaluation of cerebral autoregulatory reserve.

Acute and Chronic Effects of Noninvasive Ventilation on Left and Right Myocardial Function in Patients with Obstructive Sleep Apnea Syndrome: A Speckle Tracking Echocardiographic Study

BACKGROUND

In patients with obstructive sleep apnea syndrome (OSAS), repetitive hypoxia due to sleep-induced apnea adversely affects the interaction between myocardial oxygen demand and supply, resulting in the development of subclinical cardiac dysfunction. The purpose of the study was to analyze the different involvement of left and right heart myocardial function in patients with OSAS treated with noninvasive ventilation (NIV).

METHODS

Conventional Doppler echocardiography, Doppler myocardial imaging (DMI), and two-dimensional speckle tracking echocardiography (2DSTE) of left (LV) and right ventricular (RV) longitudinal and right atrial (RA) deformation were performed in 55 patients with OSAS undergoing NIV (M/F 38/17; mean age 67.8 ± 11.2 years). LV and RV global longitudinal strain (GLS) was calculated by averaging local strain along the entire right and left ventricle, before and during NIV, and after 6 months of nocturnal NIV therapy.

RESULTS

LV morphology was comparable before and during NIV, whereas LV ejection fraction and LV DMI early diastolic peak velocity were significantly improved in patients with OSAS during NIV, as was LV regional peak myocardial strain (P < 0.001). RV diameters were slightly increased in patients with OSAS during ventilation, whereas pulmonary artery systolic pressure (PASP), RV GLS, and regional peak myocardial RV strain were significantly reduced during ventilation (P < 0.0001). RA transverse diameters and RA area were also slightly increased during NIV, whereas RA lateral wall strain was reduced (P < 0.001). Acute RV myocardial impairment completely reversed at follow-up, with a decrease in PASP and subsequent increase in both RV and RA myocardial performance.

CONCLUSIONS

Conventional 2DSTE is a useful tool for assessing left and right heart morphology and myocardial deformation in patients with OSAS and for monitoring both acute and chronic effects of NIV.

Transcranial Doppler Ultrasound: Physical Principles and Principal Applications in Neurocritical Care Unit

Transcranial Doppler (TCD) ultrasonography is a noninvasive ultrasound study, which has been extensively applied on both outpatient and inpatient settings. It involves the use of a low-frequency (≤2 MHz) transducer, placed on the scalp, to insonate the basal cerebral arteries through relatively thin bone windows and to measure the cerebral blood flow velocity and its alteration in many different conditions. In neurointensive care setting, TCD is useful for both adults and children for day-to-day bedside assessment of critical conditions including vasospasm in subarachnoid hemorrhage, traumatic brain injury, acute ischemic stroke, and brain stem death. It also allows to investigate the cerebrovascular autoregulation in setting of carotid disease and syncope. In this review, we will describe physical principles underlying TCD, flow indices most frequently used in clinical practice and critical care applications in Neurocritical Unit care.

Transcranial Doppler Ultrasound: Incremental Diagnostic Role in Cryptogenic Stroke Part II

Transcranial Doppler (TCD) ultrasonography is a noninvasive ultrasound study, which has been extensively applied in both outpatient and inpatient settings. Its main use in current clinical practice is the research for “Paradoxical Embolism,” due to migration of thromboembolic material from systemic venous circulation to the left cardiac chambers and arterial circulation through cardiopulmonary shunts such as patent foramen ovale which represents an important cause of cryptogenic stroke, especially in patients under 55 years of age. In this review, we shall describe the incremental diagnostic role in cryptogenic stroke for this imaging modality. TCD not only can be used to detect right-left cardiopulmonary shunts but it also allows to classify the grade of severity of such shunts using the so-called “Microembolic Signals grading score.”

Self-Lubricity of WSex Nanocomposite Coatings

Transition metal chalcogenides with lamellar structure are known for their use in tribological applications although limited to vacuum due to their easy degradation in the presence of oxygen and/or moisture. Here we present a tailored WSex coating with low friction (0.07) and low wear rates (3×10(-7) mm3 Nm(-1)) even in ambient air. To understand the low friction behavior and lower chemical reactivity a tribological study is carried out in a high-vacuum tribometer under variable pressure (atmospheric pressure to 1×10(-8) mbar). A detailed investigation of the film nanostructure and composition by advanced transmission electron microscopy techniques with nanoscale resolution determined that the topmost layer is formed by nanocrystals of WSe2 embedded in an amorphous matrix richer in W, a-W(Se). After the friction test, an increased crystalline order and orientation of WSe2 lamellas along the sliding direction were observed in the interfacial region. On the basis of high angle annular dark field, scanning transmission electron microscopy, and energy dispersive X-ray analysis, the release of W atoms from the interstitial basal planes of the a-W(Se) phase is proposed. These W atoms reaching the surface, play a sacrificial role preventing the lubricant WSe2 phase from oxidation. The increase of the WSe2 crystalline order and the buffer effect of W capturing oxygen atoms would explain the enhanced chemical and tribological response of this designed nanocomposite material.