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This study explores how young activists in Italy responded to the first wave of the Covid-19 pandemic using sixteen longitudinal qualitative interviews conducted in 2018 and 2020. Our fieldwork suggests that the Covid-19 crisis did not resonate with any significant shift in the trajectory of participation. At the same time, three major empirical observations with regard to time reappropriation, care practices, and digital activism were made, all of which worked in different ways according to the interviewees’ trajectories of participation. This research extends beyond the Covid-19 crisis and contributes to the literature on political participation by providing a way of investigating how activists respond to critical events in different ways depending on their trajectories of participation.

This review has been prepared by the Early Career Members and Chairs of the European Respiratory Society (ERS) Assembly 7: Paediatrics. We here summarise the highlights of the advances in paediatric respiratory research presented at the ERS International Congress 2022. The eight scientific groups of this Assembly cover a wide range of research areas, including respiratory physiology and sleep, asthma and allergy, cystic fibrosis (CF), respiratory infection and immunology, neonatology and intensive care, respiratory epidemiology, bronchology, and lung and airway developmental biology. Specifically, we report on abstracts presented at the congress on the effect of high altitude on sleep, sleep disorders, the hypoxic challenge test, and measurements of ventilation inhomogeneity. We discuss prevention of preschool wheeze and asthma, and new asthma medications. In children with CF, we describe how to monitor the effect of CF transmembrane conductance regulator modulator therapy. We present respiratory manifestations and chronic lung disease associated with common variable immunodeficiency. Furthermore, we discuss how to monitor respiratory function in neonatal and paediatric intensive care units. In respiratory epidemiology, we present the latest news from population-based and clinical cohort studies. We also focus on innovative and interventional procedures for the paediatric airway, such as cryotherapy. Finally, we stress the importance of better understanding the molecular mechanisms underlying normal and abnormal lung development.

Introduction: We evaluate the accuracy of postnatal biochemical and lung function tests performed within 3 h from birth for predicting surfactant need in preterm infants ≤34 weeks’ gestation receiving noninvasive respiratory support for respiratory distress syndrome (RDS). Methods: We systematically searched MEDLINE, Embase, The Cochrane Library, PROSPERO, and clinicaltrials.gov databases for studies published from 2000 to November 10, 2021, cross-referencing relevant literature and contacting experts. We included diagnostic accuracy studies and systematic reviews of biochemical or lung function tests identifying the need for surfactant in preterm neonates ≤34 weeks’ with RDS not intubated at birth. The authors individually assessed the risk of bias following a tailored QUADAS-2 tool. Results: Eight studies, including 810 infants, met the inclusion criteria. Four tests were included: the click test, the stable microbubble test, the lamellar body count on gastric aspirates, and the forced oscillation technique. The reference standards were transparent criteria for distinguishing the infants according to oxygen requirement, which reflected the current criteria for surfactant therapy. The risk of bias was judged high because of the population selection and exclusion of participants from the analysis. There were no serious concerns regarding blinding and applicability. The individual study sensitivity and specificity range from 0.60 to 1 and from 0.51 to 0.91, respectively. It was not appropriate to combine the accuracy estimates in a meta-analysis because of the heterogeneity of the study characteristics. Conclusions: Current evidence is insufficient to recommend biochemical and lung function tests for tailoring surfactant therapy.

This paper draws on a study of the life course of 40 young people (aged 18–35) in Bologna (Italy), who are active in eight different political organizations. It explores whether the political organization, given that the city’s political context is the same for all participants, affects the variation of their pathways. It does so by answering the following question: which phases in the lives of young participants are interconnected with the political organizations they are engaged in? To evaluate the impact of the organizational context on young participants, we will take into consideration three dimensions: the degree of bureaucratization, forms of action, and political orientation. Situated at the intersection of youth and social movement studies, this paper aims to advance our understanding of the connections between primary and political socialization processes in shaping young participants’ mobilization and sustained participation within different political organizations. Our empirical findings show that, if the degree of bureaucratization was constantly salient in the two phases, on the other hand political orientation was more salient during participants’ mobilization and the forms of action during participants’ sustained participation. In the conclusion, the paper critically discusses the empirical findings of our analysis of the respondents’ narratives.

The "t\bar{t}HH" production at colliders contains rich information on the nature of the Higgs boson and of its interactions with other particles. This project is an analysis of such process focusing on the final state where one of the Higgs bosons decays to a pair of bottom quarks and the other to a pair of photons, resulting in a clean but rather rare signature. The analysis uses data from proton-proton collisions at a center-of-mass energy of "\sqrt{s} =" 13 TeV recorded between 2016 and 2018 with the CMS detector at the LHC, corresponding to an integrated luminosity of 137.6 "fb^{-1}". The analysis was mainly carried out by means of a cut-based strategy, aimed at the identification of a signal-enriched region of the phase space. A data-driven estimation of the backgrounds is obtained by fitting simultaneously the signal mass window near 125 GeV and the sideband regions of the di-photon invariant mass peak. We also present a preliminary study on the use of machine learning techniques aimed at improving the sensitivity of the analysis.

Since the beginning of the pandemic, while progressive movements have mainly focused on social inequalities exacerbated by the sanitary emergency, a number of protests emerged and quickly became visible that initially targeted the policies taken to reduce contagion and subsequently focused on the vaccine and vaccination. In the attempt to account for the rapid development of these protests, social scientists have mostly turned to classical approaches used in the analysis of far-right organizations and sects, looking at broad transformations in society or at fear and a sense of insecurity at the individual level. In this article, we build upon a social movement approach to look at the main characteristics of the protests against anti-contagion measures. From a theoretical point of view, we point to the importance of disentangling the specific waves happening within broader protest cycles. Empirically, focusing on the Italian case, we present a novel development in protest event analysis looking at the specific forms of action, the actors involved, and their claims in two waves of contention during the pandemic in Italy, between 2020 and 2021.

To evaluate the impact of human milk and different neonatal variables on tidal breathing flow-volume loop (TBFVL) parameters within three months' corrected age (CA) in infants born ≤32 wks or weighing1500 g.We retrospectively studied 121 infants with gestational age (GA) ≤ 32 weeks or birth weight (BW) 1500 gr who had lung function assessment within three months' CA by TBFVL analysis between June 2009 and April 2018. We investigated the impact of GA, gender, being Small for GA (SGA), sepsis, days of mechanical ventilation (MV) and human milk feeding (HMF) on later respiratory function, both in the entire group and according to BW ( ≤1000 g and1000 g).The mean(SD) z-score for tidal volume (Vt) and time to peak expiratory flow to expiratory time (tPTEF/tE) were respectively -4.3 (2.5) and -0.8 (2.0) for the overall population with no significant differences between infants1000 g or ≥1000 g. The mean(SD) Vt standardized for body weight was 6.2(2.0) ml/kg. Being female was associated with better Vt/Kg, whereas longer MV or being born SGA were associated with worst tPTEF/tE. For infants with BW 1000 gr, tPTEF/tE was positively associated with HMF.An early TBFVL assessment within three months' CA already reveals lung function alteration in preterm infants. Being female is associated with better Vt/Kg, while longer duration of MV or being born SGA negatively affect tPTEF/tE. The positive association between HMF and better tPTEF/tE in infants with BW1000 g has emerged, which deserves further investigation.

Prompt and stable control of hyperthyroidism is fundamental to avoid the detrimental effects of thyroid hormone excess, and antithyroid drugs, mainly methimazole (MMI), represent the first-line treatment for Graves’ disease (GD) hyperthyroidism. Decreased serum concentrations of selenium (Se) and calcifediol (25(OH)D, VitD) have been reported in newly diagnosed GD patients in observational studies. Low Se levels might exacerbate oxidative stress by compromising the antioxidant machinery’s response to reactive oxygen species, and low VitD levels might hamper the anti-inflammatory immune response. We performed a randomized controlled clinical trial (EudraCT 2017-00505011) to investigate whether Se and cholecalciferol (VitD) addition to MMI is associated with a prompter control of hyperthyroidism. Forty-two consecutive patients with newly-onset GD and marginal/insufficient Se and VitD levels were randomly assigned to treatment with either MMI monotherapy or MMI combined with Se and VitD. Se treatment was withdrawn after 180 days, while the other treatments were continued. Combination therapy resulted in a significantly greater reduction in serum FT4 concentration at 45 days (-37.9 pg/ml, CI 95%, -43.7 to -32.2 pg/ml) and 180 days (-36.5 pg/ml, CI 95%, -42 to -30.9 pg/ml) compared to MMI monotherapy (respectively: -25.7 pg/ml, CI 95%, -31.6 to -19.7 pg/ml and -22.9 pg/ml, CI 95%, -28 to -17.3 pg/ml, p 0.002). Data at 270 days confirmed this trend (-37.8 pg/ml, CI 95%, -43.6 to -32.1 pg/ml vs -24.4 pg/ml, CI 95%, -30.3 to -18.4 pg/ml). The quality of life (QoL) score was investigated by the validated “Thyroid-related Patient-Reported Outcome” questionnaire (ThyPRO). ThyPRO composite score showed a greater improvement in the intervention group at 45 days (-14.6, CI 95%, -18.8 to -10.4), 180 (-9, CI 95%, -13.9 to -4.2) and 270 days (-14.3, CI 95%, -19.5 to -9.1) compared to MMI group (respectively, -5.2, CI 95%, -9.5 to -1; -5.4, CI 95%, -10.6 to -0.2 and -3.5, CI 95%, -9 to -2.1, p 0-6 months and 6-9 months

Objective To evaluate COVID-19 pandemic preparedness, available resources, and guidelines for neonatal care delivery among neonatal health care providers in low- and middle-income countries (LMICs) across all continents. Study design Cross-sectional, web-based survey administered between May and June, 2020. Results Of 189 invited participants in 69 LMICs, we received 145 (77%) responses from 58 (84%) countries. The pandemic provides significant challenges to neonatal care, particularly in low-income countries. Respondents noted exacerbations of preexisting shortages in staffing, equipment, and isolation capabilities. In Sub-Saharan Africa, 9/35 (26%) respondents noted increased mortality in non-COVID-19-infected infants. Clinical practices on cord clamping, isolation, and breastfeeding varied widely, often not in line with World Health Organization guidelines. Most respondents noted family access restrictions, and limited shared decision-making. Conclusions Many LMICs face an exacerbation of preexisting resource challenges for neonatal care during the pandemic. Variable approaches to care delivery and deviations from guidelines provide opportunities for international collaborative improvement.

Supplemental material, sj-pdf-1-soc-10.1177_00380385221129945 for Urban Rebels? A Gendered Approach to Domicile and Protest Participation in Nine European Countries by Anna Lavizzari and Martín Portos in Sociology

Supplemental material, sj-pdf-1-soc-10.1177_00380385221129945 for Urban Rebels? A Gendered Approach to Domicile and Protest Participation in Nine European Countries by Anna Lavizzari and Martín Portos in Sociology

Monitoring infants' breathing activity is crucial in research and clinical applications but remains a challenge. This study aims to develop a contactless method to monitor breathing patterns and thoracoabdominal asynchronies in infants inside the incubator, using depth cameras.We proposed an algorithm to extract the 3D displacements of the ribcage and abdomen from the analysis of depth images. We evaluated the accuracy of the systemThe developed system proved accurateThe proposed method has value for evaluating infants' breathing patterns in research applications and, after further development, may represent a simple monitoring tool for infants' respiratory activity inside the incubator.

The extent of lung hypoplasia impacts the survival and severity of morbidities associated with congenital diaphragmatic hernia (CDH). The alveoli of CDH infants and in experimental models of CDH have thickened septa with fewer type II pneumocytes and capillaries. Fetal treatments of CDH-risk preterm birth. Therefore, treatments must aim to balance the need for increased gas exchange surface area with the restoration of pulmonary epithelial type II cells and the long-term respiratory and neurodevelopmental consequences of prematurity. Achievement of sufficient lung development in utero for successful postnatal transition requires adequate intra-thoracic space for lung growth, maintenance of sufficient volume and appropriate composition of fetal lung fluid, regular fetal breathing movements, appropriate gas exchange area, and ample surfactant production. The review aims to examine the rationale for current and future therapeutic strategies to improve postnatal outcomes of infants with CDH.

Background Current criteria for surfactant administration assume that hypoxia is a direct marker of lung-volume de-recruitment. We first introduced an early, non-invasive assessment of lung mechanics by the Forced Oscillation Technique (FOT) and evaluated its role in predicting the need for surfactant therapy. Objectives To evaluate whether lung reactance (Xrs) assessment by FOT within 2 h of birth identifies infants who would need surfactant within 24 h; to eventually determine Xrs performance and a cut-off value for early detection of infants requiring surfactant. Methods We conducted a prospective, observational, non-randomized study in our tertiary NICU in Milan. Eligible infants were born between 27+0 and 34+6 weeks’ gestation, presenting respiratory distress after birth. Exclusion criteria: endotracheal intubation at birth, major malformations participation in other interventional trials, parental consent denied. We assessed Xrs during nasal CPAP at 5 cmH2O at 10 Hz within 2 h of life, recording flow and pressure tracing through a Fabian Ventilator for off-line analysis. Clinicians were blinded to FOT results. Results We enrolled 61 infants, with a median [IQR] gestational age of 31.9 [30.3; 32.9] weeks and birth weight 1490 [1230; 1816] g; 2 infants were excluded from the analysis for set-up malfunctioning. 14/59 infants received surfactant within 24 h. Xrs predicted surfactant need with a cut-off − 33.4 cmH2O*s/L and AUC-ROC = 0.86 (0.76–0.96), with sensitivity 0.85 and specificity 0.83. An Xrs cut-off value of − 23.3 cmH2O*s/L identified infants needing surfactant or respiratory support > 28 days with AUC-ROC = 0.89 (0.81–0.97), sensitivity 0.86 and specificity 0.77. Interestingly, 12 infants with Xrs 2O*s/L (i.e. de-recruited lungs) did not receive surfactant and subsequently required prolonged respiratory support. Conclusion Xrs assessed within 2 h of life predicts surfactant need and respiratory support duration in preterm infants. The possible role of Xrs in improving the individualization of respiratory management in preterm infants deserves further investigation.

The main objective of the Youth Wiki's project is to support evidence-based European cooperation in the field of Youth and to help European Commission and the Member States in their decision-making, by providing information on reforms and initiatives. Within this framework, the chapter discusses Italian young people's involvement in global issues and the main youth policies sustaining and promoting this engagement, notably in the fields of sustainable development, the environment, and ecological transition as well as public diplomacy at an international level.

Recent scientific studies have reached the near-unanimous conclusion that the media produce a stereotypical representation of young people. However, research in this area has not often scrutinized whether there are any significant differences in the coverage of the subject matter. Notably, this article examines whether the political leaning of newspapers has any impact on the levels of plurality in the news coverage of youth. On the basis of political claim analyses of six newspapers from three countries (Greece, Italy, and Spain), we find that the coverage of youth in the public debate is very similar if we compare center-right to center-left newspapers. This suggests that the social construction of the concept of youth dominates in the adult world, regardless of any political differences. Nonetheless, differences emerge when young people are given the opportunity to speak for themselves; center-left newspapers are more likely to recognize the agency of, and give a voice to, young people. Recent scientific studies have reached the near-unanimous conclusion that the media produce a stereotypical representation of young people. However, research in this area has not often scrutinized whether there are any significant differences in the coverage of the subject matter. Notably, this article examines whether the political leaning of newspapers has any impact on the levels of plurality in the news coverage of youth. On the basis of political claim analyses of six newspapers from three countries (Greece, Italy, and Spain), we find that the coverage of youth in the public debate is very similar if we compare center-right to center-left newspapers. This suggests that the social construction of the concept of youth dominates in the adult world, regardless of any political differences. Nonetheless, differences emerge when young people are given the opportunity to speak for themselves; center-left newspapers are more likely to recognize the agency of, and give a voice to, young people.

Published online: 27 Sep 2019 Looking at the French approach to migration in four key political moments between 2014 and 2018, three main narratives can be seen as dominating the French debate on migration, namely the Westphalian, the humanitarian and the multilateral, each related to various justice claims. Surprisingly, a securitarian approach was not as dominant as expected. However, different justice claims were used to support various political interests, often in a clearly instrumental way. In France today, the politics of migration are still important for the country's foreign policy and are not just a domestic issue. European Union (EU)

The legal developments in scholarly publishing began back at the time of the Guttenberg press. The scholarly journal publishing industry evolved over the centuries. The 1960s through the launch of the internet saw the industry explode with growth. With the advent and development of the digital journal, open access, and other clandestine illegal databases, it is essential that the industry work to protect its interests. This chapter will provide a history, overview, and developments that will be required to ensure the ongoing concerns of the industry.

Background: Current criteria for surfactant administration assume that hypoxia is a direct marker of lung-volume de-recruitment. Objectives: To evaluate whether lung reactance (Xrs) assessment by FOT within 2h of birth identifies infants who would need surfactant within 24h; to eventually determine Xrs performance and a cut-off value for early detection of infants requiring surfactant. Methods: We conducted a prospective, observational, non-randomized study in our tertiary NICU in Milan. Eligible infants were born between 27+0 and 34+6 weeks' gestation presenting respiratory distress after birth. Exclusion criteria: endotracheal intubation at birth, major malformations. We assessed Xrs during nasal CPAP at 5cmH2O at 10Hz within 2h of life, recording flow and pressure tracing through a Fabian Ventilator for off-line analysis. Clinicians were blinded to FOT results. Results: We enrolled 61 infants, with a median[IQR] gestational age of 31.9[30.3; 32.9]weeks and birth weight 1490[1230; 1816]g. 14/59 infants received surfactant within 24h. Xrs predicted surfactant need with a cut-off -33.4 cmH2O*s/L and AUC-ROC=0.86 (0.76-0.96), with sensitivity 0.85 and specificity 0.83. An Xrs cut-off value of -23.3 cmH2O*s/L identified infants needing surfactant or respiratory support >28 days with AUC-ROC=0.89 (0.81-0.97), sensitivity 0.86 and specificity 0.77. Interestingly, 12 infants with Xrs

High-flow nasal cannula (HFNC) is a non-invasive respiratory support (NRS) modality to treat premature infants with respiratory distress syndrome (RDS). The delivery of nebulized surfactant during NRS would represent a truly non-invasive method of surfactant administration and could reduce NRS failure rates. However, the delivery efficiency of nebulized surfactant during HFNC has not been evaluated in vitro or in animal models of respiratory distress. We, therefore, performed first a benchmark study to compare the surfactant lung dose delivered by commercially available neonatal nasal cannulas (NCs) and HFNC circuits commonly used in neonatal intensive care units. Then, the pulmonary effect of nebulized surfactant delivered via HFNC was investigated in spontaneously breathing rabbits with induced respiratory distress. The benchmark study revealed the surfactant lung dose to be relatively low for both types of NCs tested (Westmed NCs 0.5 ± 0.45%; Fisher & Paykel NCs 1.8 ± 1.9% of a nominal dose of 200 mg/kg of Poractant alfa). The modest lung doses achieved in the benchmark study are compatible with the lack of the effect of nebulized surfactant in vivo (400 mg/kg), where arterial oxygenation and lung mechanics did not improve and were significantly worse than the intratracheal instillation of surfactant. The results from the present study indicate a relatively low lung surfactant dose and negligible effect on pulmonary function in terms of arterial oxygenation and lung mechanics. This negligible effect can, for the greater part, be explained by the high impaction of aerosol particles in the ventilation circuit and upper airways due to the high air flows used during HFNC.

Among Tidal Breathing Flow Volume (TBFV) parameters, tPTEF/tE is a reproducible marker of airway obstruction associated with infants’ wheezing. Few studies evaluated tPTEF/tE in preterm infants in association with respiratory outcomes post-discharge. Objectives: 1) characterise tPTEF/tE over the first 2yrs of life; 2) evaluate tPTEF/tE predictive value for hospitalisation for respiratory infections (HRI) in preterm infants ± Bronchopulmonary Dysplasia (BPD). We retrospectively analysed TBFV measurements performed at 0-6, 6-12 and 12-24months corrected age in 97 infants ≤32wks’ gestation. We assessed the association between tPTEF/tE z-score and subsequent HRI using uni- and multi-variable logistic regressions and compared nested models by likelyhood ratio test (LRT). tPTEF/tE was lower than normal at all time-points (Fig1), was significantly associated with HRI, particularly in infants without BPD (Fig2), and significantly added to BPD classifications alone in predicting HRI (LRT p < 0.001). Preterm infants present a persistent airway obstruction over the first 2yrs. tPTEF/tE predicts HRI and may be of particular interest for identifying infants at risk without BPD.

The coronavirus disease 2019 (COVID-19) pandemic has predominantly affected adults of higher age groups, and the effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on infants and neonates appears to be small. While we are gathering emerging evidence on the exact SARS-CoV-2 disease process, intrauterine or perinatal transmission of SARS-CoV-2 remains ambiguous and vertical transmission has yet to be proven although viral RNA by reverse transcription polymerase chain reaction has been found in placental membranes and breast milk. [...]

Background: The COVID-19 pandemic threatens global newborn health. We describe the current state of national and local protocols for managing neonates born to SARS-CoV-2-positive mothers. Methods: Care providers from neonatal intensive care units on six continents exchanged and compared protocols on the management of neonates born to SARS-CoV-2-positive mothers. Data collection was between March 14 and 21, 2020. We focused on central protocol components, including triaging, hygiene precautions, management at delivery, feeding protocols, and visiting policies. Results: Data from 20 countries were available. Disease burden varied between countries at the time of analysis. In most countries, asymptomatic infants were allowed to stay with the mother and breastfeed with hygiene precautions. We detected discrepancies between national guidance in particular regarding triaging, use of personal protection equipment, viral testing, and visitor policies. Local protocols deviated from national guidance. Conclusions: At the start of the pandemic, lack of evidence-based guidance on the management of neonates born to SARS-CoV-2-positive mothers has led to ad hoc creation of national and local guidance. Compliance between collaborators to share and discuss protocols was excellent and may lead to more consensus on management, but future guidance should be built on high-level evidence, rather than expert consensus. Impact: At the rapid onset of the COVID19 pandemic, all countries presented protocols in place for managing infants at risk of COVID19, with a certain degree of variations among regions.A detailed review of ad hoc guidelines is presented, similarities and differences are highlighted.We provide a broad overview of currently applied recommendations highlighting the need for international context-relevant coordination.

To investigate, in infants born preterm with or without bronchopulmonary dysplasia (BPD), the trajectory of tidal breathing flow-volume (TBFV) parameters in the first 2 years of life; the association between TBFV parameters and perinatal risk factors; and the predictive value of TBFV parameters for rehospitalizations due to respiratory infections and wheeze.We retrospectively analyzed TBFV measurements performed at 0-6, 6-12, and 12-24 months of corrected age in 97 infants32 weeks of gestation and1500 g. We assessed the association between TBFV parameters and perinatal risk-factors using linear regressions and the predictive capacity for subsequent respiratory morbidity using logistic regressions. We used the area under the curve and likelihood ratio test (LRT) to compare nested models.Time to peak tidal expiratory flow/expiratory time ratio (tPTEF/tE) was lower than normal for the first 2 years of corrected age. Longer duration of oxygen supplementation, intubation, and respiratory support were associated with reduced tPTEF/tE at all time points. For each z-score increase in tPTEF/tE, the OR for rehospitalizations decreased by 0.70. tPTEF/tE added significantly to BPD classifications alone in predicting rehospitalizations (area under the receiver operating characteristic curve = 0.81 vs 0.76, P value for LRT = .0012), and wheeze (area under the receiver operating characteristic curve = 0.76 vs 0.71, P value for LRT.001).Infants born preterm, with and without BPD, display persistent airway obstruction during the first 2 years of life. tPTEF/tE may identify infants at greater risk of severe respiratory morbidity.

Objective We aimed to measure lung mechanics at birth by the forced oscillation technique (FOT) for assessment of the initial degree of lung aeration and the short-term aeration changes after applying different respiratory support strategies. Methods Eighteen preterm infants (gestational age = 29-36 week) were randomized to receive either continuous positive airway pressure (CPAP) at 5 cmH2 O only or combined with a sustained inflation (SI; 15 seconds at 25 cmH2 O after 5 seconds of CPAP) at birth. We assessed the respiratory system reactance at 5 Hz (X5; increases with lung volume recruitment at a given distending pressure) at 2, 40, and 150 seconds after initiation of CPAP. k-Means clustering of the initial X5 value (X5,i ) stratified newborn into either infants with lower (lowerX5,i ; X5 -240 cmH2 O*s/L) initial degree of lung volume recruitment. Results Initial values were highly heterogeneous. In the LowerX5,i group, X5 increased with time, with SI-patients showing significantly higher values at 150 seconds than the non-SI group (X5 = -89 ± 27 cmH2 O vs -274 ± 58 cmH2 O). In the higherX5,i group, X5 did not improve with time, regardless of the respiratory strategy, suggesting a lack of lung recruitment. Moreover, 75% of infants receiving SI in the higherX5,i group experienced a transient loss of aeration after the maneuver. Conclusions Preterm newborns present initially with highly heterogeneous lung aeration at birth that significantly impacts the effectiveness of the subsequent lung volume recruitment strategy. FOT may represent a valuable tool for individualizing a respiratory resuscitation at birth as it is noninvasive and may be applied simultaneously to respiratory support.

Objective Despite technical specifications of neonatal mechanical ventilators (MVs) guarantee clinically irrelevant discrepancies between the set and the delivered values of ventilation parameters, previous studies reported large deviations. Most studies characterized performances of a given model/brand by studying a single device, disregarding possible intramodel differences, and leaving the accuracy of the ventilation parameters effectively delivered in clinical settings unknown. The aim of this study was to evaluate the real-life accuracy of pressure and volume parameters delivered by neonatal ventilators ready to be used on patients in neonatal intensive care units (NICUs). Study design In vitro study. Subjects selection Neonatal ventilators (n = 33 of 8 different models) available in four European NICUs. Methodology The MVs were connected to a test lung (resistance = 50 cmH2 O*s/L, compliance = 0.35 mL/cmH2 O) provided with pressure and flow sensors. MVs were tested over two different ventilation modes randomly: (a) pressure controlled (PC) with a peak inspiratory pressure (PIP) of 22 cmH2 O, and (b) PC with volume targeted ventilation (VTV) with a tidal volume (VT ) of 6 mL. In all tests, positive end-expiratory pressure (PEEP) was set to 6 cmH2 O, respiratory rate to 45 breaths/min, inspiratory time to 0.33 seconds, and oxygen fraction to 0.3. Results During PC the median (min-max) values delivered were: PEEP = 5.84(4.95-6.48) cmH2 O, PIP = 21.63(20.04-22.62) cmH2 O. During VTV, VT was 5.94(4.63-8.01) mL. VT was considerably variable, ranging from -22% to +33% of the set and displayed values. Differences in accuracy among devices of the same model were comparable to those found among different models. Conclusions Our findings suggest that loss of accuracy in ventilation variables is likely related to daily use of the devices rather than weakness in the design or manufacturing process, urging the improvement of maintenance and quality control procedures to preserve the performances of neonatal MVs during their entire lifespan.

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Objectives: To determine the short-term tolerance, efficacy, and lung deposition of supraglottic atomized surfactant in spontaneously breathing lambs receiving continuous positive airway pressure. Design: Prospective, randomized animal study. Setting: Animal research laboratory. Subjects: Twenty-two preterm lambs on continuous positive airway pressure (132 +/- 1 d gestational age). Interventions: Animals receiving continuous positive airway pressure via binasal prongs at 8 cm H 2 O were randomized to receive atomized surfactant at approximately 60-minute of life (atom; n = 15) or not (control; n = 7). The atom group received 200 mg/kg of poractant alfa (Curosurf; Chiesi Farmaceutici SpA, Parma, Italy) over 45 minutes via a novel atomizer located in the upper pharynx that synchronized surfactant delivery with the inspiratory phase. Measurements and Main Results: Arterial blood gas, regional distribution of tidal ventilation (electrical impedance tomography), and carotid blood flow were recorded every 15 minutes until 90 minutes after stabilizing on continuous positive airway pressure. Gas exchange, respiratory rate, and hemodynamic variables, including carotid blood flow, remained stable during surfactant treatment. There was a significant improvement in arterial alveolar ratio after surfactant delivery in the atom group (p < 0.05; Sidak posttests), while there was no difference in Paco 2. Electrical impedance tomography data showed a more uniform pattern of ventilation in the atom group. In the atom group, the median (interquartile range) deposition of surfactant in the lung was 32% (22-43%) of the delivered dose, with an even distribution between the right and the left lungs. Conclusions: In our model of spontaneously breathing lambs receiving CPAP, supraglottic atomization of Curosurf via a novel device was safe, improved oxygenation and ventilation homogeneity compared with CPAP only, and provided a relatively large lung deposition suggesting clinical utility.

Surfactant improves lung mechanics and the success of non-invasive respiratory support in preterm infants. The lack of non-invasive bedside tools for monitoring lung mechanics makes current guidelines for surfactant therapy based on O2 requirements, which may be not specific for this application. Objective: To assess feasibility and role of early, non-invasive evaluation of respiratory mechanics by FOT in non-intubated preterm infants for stratifying the severity of respiratory disease. Eligibility: 28-34wk gestation, no need of early intubation after birth. FOT at 10Hz was applied by a modified ventilator (Fabian, Acutronic) and a face-mask during CPAP=5cmH2O. Measurements were performed at 2 and 24h of life. FiO2 was titrated and surfactant given as in Sweet (2016). 4 groups (n=45) were considered: Patients not requiring respiratory support (SB); receiving CPAP for less than (CPAP-S) or more than 28d (CPAP-L) but who never received surfactant and patients who received surfactant (Surf). Xrs in Surf and CPAP-L was significantly lower at 2h compared to SB and CPAP-S (fig 1). After receiving surfactant patients improved, leaving CPAP-L only showing significantly lower Xrs at 24h. Xrs stratifies patients according to the degree of respiratory disease. CPAP-L infants presented poor Xrs at 2h, did not match clinical criteria for surfactant but had a long respiratory support dependence.

OBJECTIVE: To provide a non-invasive approach to monitoring lung function in spontaneously breathing lambs, from birth to five months of life, by the forced oscillation technique (FOT). This report describes the experimental set-up, data processing, and identification of normal predicted values of resistance (Rrs) and reactance (Xrs) of the respiratory system, along with normal bronchodilator response for bronchial reversibility testing. APPROACH: Rrs and Xrs at 5, 11, and 19 Hz were measured monthly for five months in 20 normal term lambs that breathed spontaneously. In seven lambs, repeated measurements also were made within the first month of life (at 3, 7, 14, and 21 d of life). We determined the repeatability and reproducibility of the measurements and characterized the relationship between lung mechanics and age, sex, and body dimensions, using regression analysis, and measured changes in lung mechanics in response to inhaled bronchodilator. MAIN RESULTS: The measurements provided repeatable and reproducible data. Rrs decreased, whereas Xrs increased, with growth from birth through the first two months of life, after which no statistically significant differences were detected. We identified normal value equations for Rrs and Xrs and for each of the measured anthropometric variables. Respiratory system mechanics were not affected by the bronchodilator. SIGNIFICANCE: The FOT provides reliable non-invasive measurement of respiratory system mechanics in spontaneously breathing term lambs from birth to five months of age. The methods and normal reference values defined in this study will facilitate testing of the pathophysiological consequences of preterm birth and prolonged respiratory support on respiratory system mechanics.

Between 2013 and 2016, a broad range of Catholic groups following pro-life and pro-family agendas has conducted a large anti-gender campaign, whose main result was the definition of a Catholic anti...

A vertical ferroelectric HfO 2 field effect transistor based on 3-D macaroni NAND architecture is reported for the first time. Up to 2 V memory window was obtained after the application of 100 ns program/erase pulses. Flash-like endurance of 104 cycles is reported and first reliability assessments were performed.

Une reflexion autour du modele d’un groupe psycho-educatif pour adolescents qui a debute il y a dix ans au sein du Service medico-psychologique de Lugano. Le groupe peut devenir un agent potentiel de transformation pour les jeunes qui ne se pretent pas au jeu symbolique de la psychotherapie, mais qui peuvent beneficier de la relation psycho-educative qui se propose comme territoire intermediaire, transitionnel entre le concret et la pensee.

CMOS image sensors can suffer from background noise in absence of any light. In order to suppress this it is important to keep this noise, referred to as dark-current low. This implies that the internal generation current should be very low. Trace metal impurities have been reported to increase the generation current. In this study the trap-assisted generation current contributions due to 7 different metal impurities have been calculated. It was concluded that Cu and Mn impurities yield the highest generation current contribution.

To describe the interrelationship between antenatal steroids, exogenous surfactant, and two approaches to lung recruitment at birth on oxygenation and respiratory system compliance (Cdyn) in preterm lambs.Lambs (n = 63; gestational age 127 ± 1 d) received either surfactant at 10-min life (Surfactant), antenatal corticosteroids (Steroid), or neither (Control). Within each epoch lambs were randomly assigned to a 30-s 40 cmH2O sustained inflation (SI) or an initial stepwise positive end-expiratory pressure (PEEP) open lung ventilation (OLV) maneuver at birth. All lambs then received the same management for 60-min with alveolar-arterial oxygen difference (AaDO2) and Cdyn measured at regular time points.Overall, the OLV strategy improved Cdyn and AaDO2 (all epochs except Surfactant) compared to SI (all P0.05; two-way ANOVA). Irrespective of strategy, Cdyn was better in the Steroid group in the first 10 min (all P0.05). Thereafter, Cdyn was similar to Steroid epoch in the OLV + Surfactant, but not SI + Surfactant group. OLV influenced the effect of steroid and surfactant (P = 0.005) on AaDO2 more than SI (P = 0.235).The antenatal state of the lung influences the type and impact of a recruitment maneuver at birth. The effectiveness of surfactant maybe enhanced using PEEP-based time-dependent recruitment strategies rather than approaches solely aimed at initial lung liquid clearance.

BackgroundDespite the theoretical benefits of high-frequency oscillatory ventilation (HFOV) in preterm infants, systematic reviews of randomized clinical trials do not confirm improved outcomes. The authors hypothesized that oscillating a premature lung with multiple frequencies simultaneously would improve gas exchange compared with traditional single-frequency oscillatory ventilation (SFOV). The goal of this study was to develop a novel method for HFOV, termed “multifrequency oscillatory ventilation” (MFOV), which relies on a broadband flow waveform more suitable for the heterogeneous mechanics of the immature lung.MethodsThirteen intubated preterm lambs were randomly assigned to either SFOV or MFOV for 1 h, followed by crossover to the alternative regimen for 1 h. The SFOV waveform consisted of a pure sinusoidal flow at 5 Hz, whereas the customized MFOV waveform consisted of a 5-Hz fundamental with additional energy at 10 and 15 Hz. Per standardized protocol, mean pressure at airway opening () and inspired oxygen fraction were adjusted as needed, and root mean square of the delivered oscillatory volume waveform (Vrms) was adjusted at 15-min intervals. A ventilatory cost function for SFOV and MFOV was defined as , where Wt denotes body weight.ResultsAveraged over all time points, MFOV resulted in significantly lower VC (246.9 ± 6.0 vs. 363.5 ± 15.9 ml2 mmHg kg−1) and (12.8 ± 0.3 vs. 14.1 ± 0.5 cm H2O) compared with SFOV, suggesting more efficient gas exchange and enhanced lung recruitment at lower mean airway pressures.ConclusionOscillation with simultaneous multiple frequencies may be a more efficient ventilator modality in premature lungs compared with traditional single-frequency HFOV.

Respiratory management during extracorporeal membrane oxygenation (ECMO) is complex. Assessment of lung mechanics might support a patient-tailored ventilatory strategy. We report, for the first time, the use of the forced oscillation technique (FOT) to evaluate lung function during neonatal ECMO to improve the individualization of respiratory support. The patient was a formerly preterm infant at a corrected age of 40 weeks (gestational age 32 weeks) undergoing veno-arterial ECMO for refractory respiratory failure secondary to influenza A (H1N1) pneumonia. We used the FOT as a bedside non-invasive tool for daily monitoring of lung mechanics, from ECMO day 6 (E6) until decannulation. A small-amplitude, 5-Hz oscillatory pressure was overimposed on the ventilation waveform at the airway opening during positive end-expiratory pressure (PEEP) trials. From E6 to E9, lung mechanics changes with PEEP indicated a largely de-recruited and easily over-distendable lung that was not recruitable by applying lung-protective PEEP values. After surfactant and steroid administration, oscillatory reactance (Xrs) values began improving, suggesting a more recruited and pressure-recruitable lung. On E11, despite the lack of improvement in the radiographic appearance of the thorax, the FOT measurements showed a more recruited lung. Weaning from ECMO was started, and the patient was extubated within 48 h. The decannulation was successful, and the patient was extubated within 48 h after ECMO weaning. First-year respiratory and neurodevelopmental follow-up evaluation was unremarkable. This report suggests the potential usefulness of the FOT for monitoring the lung mechanics of ventilated newborns during ECMO to achieve individualized respiratory management. Such tailoring might improve neonatal outcomes and support clinicians with the establishment of a timely and safer weaning approach. These findings need to be verified on a larger population.