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A redescription of Corydoras undulatus Regan, 1912 is presented. The original description of C. undulatus is very succinct, as is its diagnosis, which is based only on external morphology. Additional information in the scientific literature on this species is scarce. Specimens from the distribution area of this species were analyzed; Paraná and Paraguay river basins in Argentina, Uruguay river basin in Argentina, Brazil and Uruguay, and the Laguna dos Patos system in Brazil. Morphological analysis, principal component analysis (PCA), meristic comparison and osteological description were performed. Corydoras undulatus can be distinguished from its congeners mainly by having the following combination of characters: mesethmoid short, with anterior tip short, smaller than 50% of the entire bone length; posterior margin of the pectoral-fin spine with nearly all serrations directed towards origin of spine; pectoral-fin spine with conical serrations; and its peculiar color pattern. The analysis of the material from the different basins did not indicate relevant morphological differences, suggesting that the species presents a wide distribution in La Plata and Laguna dos Patos drainages. The shared geographic distribution between these two systems is also present in other fish species. The current work presents data about the type locality, taxonomy, osteology, distribution and ontogenetic variation of color pattern in C. undulatus. Comments on the identity of a very similar congener, Corydoras latus, will also be provided.

This study has explored the valence of sibship that may empower the self-esteem of children with asthma at the interpersonal, environmental control competence, emotionality management, and body-image levels. It has been assumed that the relationship between siblings may have a moderating effect on the negative impact that asthma has on child’s development. Seventy children suffering from chronic asthma have been involved: 40 children with siblings (experimental group) and 30 sibling-free children (control group). The children with asthma have exhibited higher levels of self-esteem in comparison with the sibling-free children. The results of the study, at the clinical significance level, highlight how meaningful could be the involvement of healthy siblings to support the development, and to ease the compliance of children suffering from asthma. The outcomes have confirmed the supportive valence of sibship for the self-esteem of the children with asthma.

Crude palm oil extraction is one of the sources of livelihood in Ghana's Central Region. However, the water use and wastewater generation associated with the industry have not been given adequate attention. This study assessed the water consumption and wastewater generation by small-scale crude palm oil extraction mills in the region. Twenty-five (25) mills were selected from four palm oil-processing local government areas in the region. An interview guide was used to obtain information about the operations of the mills and corroborated through structured observations. Water consumption and wastewater generation were measured using a graduated plastic bucket. Water for processing was found to be sourced from hand-dug wells (56%), treated piped water (20%), boreholes with handpumps (16%) and rivers (8%). Water was bought at US$1.93 (boreholes) and US$2.89 (piped water) per cubic metre. The recurrent cost of water was the same as that paid for domestic use. For a litre of palm oil produced, 0.760-2.391 litres of water were consumed and 68-82% returned as wastewater. Sixty-eight percent of the water was used for boiling. The distance to water source influenced the consumption, with higher water consumption recorded for mills with on-plot water sources. Higher recurrent costs of water did not necessarily lead to lower water consumption. There was no significant difference in the water consumption and wastewater production between the wet and dry processing methods. The small-scale palm oil processing industry requires attention to manage a potential competition between commercial and domestic water use in rural and small towns. HIGHLIGHTS 1 L of crude palm oil produced could consume more than twice that volume of water.; Wastewater return factor is 62–89%.; Boiling of fruits consumes 68% of the water and generates 62% of the wastewater.; 10 L of palm oil produced consumes the equivalent of one person's water demand in rural Ghana.; Higher recurrent costs of water did not necessarily lead to lower water consumption.;

Water scarcity is a global issue confronting the present generation, particularly acute in arid regions such as Palestine. Treated wastewater reuse is recognized as a strategic solution. The challenge in obtaining effluent quality that meets the reuse requirements of the area is how to select the best treatment technology. A multi-criteria decision-making method is necessary for assessing the sustainability of different wastewater treatment technologies. This study selected the most sustainable secondary treatment technology that could produce quality effluent for agricultural reuse at the Rafah wastewater treatment plant in the Gaza Strip. The Evidential Reasoning method was applied to evaluate the sustainability of sand filters, constructed wetlands, activated sludge, and bio-tower technologies. The evaluation was based on four sustainability dimensions and thirty-five indicators. The dimensions and indicators were obtained from a review of related literature and validated by experts. Using a questionnaire, the judgment of local experts (professionals working on the project, selected university professors, and members of the agricultural NGOs) was used to evaluate the dimensions and indicators qualitatively. Data analysis was done using the Intelligent Decision System and Expert Choice software tools. The utility interval-based evidential reasoning ranking technique was used to rank the wastewater treatment options with and without ignorance as follows: constructed wetlands > sand filters > bio-towers > activated sludge. Constructed wetlands ranked as the most sustainable alternative, with a minimum utility of 0.7345. The environmental dimension, with a relative weighting of 60.4%, was the dimension with the greatest influence on ranking the secondary wastewater treatment alternatives.

La economía circular y la bioeconomía han resultado ser una alternativa a nivel mundial a los modelos de producción lineales y basados en combustibles fósiles y materias primas muchas veces no–renovables. Aunque en Centroamérica existen iniciativas de este tipo, principalmente en el sector bioenergético, se debe impulsar la aplicación de estos principios en sectores más amplios como la bio emediación, la fabricación de bio–fertilizantes e incluso de materiales de más alto valor como bio–polímeros y bio–cosméticos. De igual manera, la preservación de la biodiversidad debe ser un objetivo común centroamericano, aunado a esto, se debe añadir el efecto sinérgico entre los países centroamericanos, en donde el SICA puede jugar un rol institucional neutro, más no pasivo, de coordinación y articulación entre los países. La migración hacia una economía bio–basada y circular con enfoque ambientalmente sostenible es viable en la región considerando las tecnologías actuales y el potencial de biodiversidad de Centroamérica.

With a term now entered into common language, the historical period we are experiencing is defined as "Anthropocene", to underline the serious responsibility of human activities for the global impacts produced and for the quality of life on our planet. At the same time, we are in an era of transition, characterized by a necessary transformation of society, which, starting from the current economic model, based on the logic of consumption of resources, production of waste and pollution and energy dependence from fossil fuels, we are moving towards a new, more sustainable future characterized by the search for solutions to multiple environmental criticalities and strategies for adapting to their now irreversible effects. Numerous examples of responsible citizenship and bottom up initiatives, such as student living labs, demonstrate the importance of active participation, a more aware knowledge of sustainability issues that lead to the adoption of effective initiatives on a local scale for the health of our cities.

In response to the important environmental impacts produced by the road transport network during all its life cycle stages, a set of measurements to include sustainable principles have been identified between 1997–2021, analysed and mapped by applying SciMAT and VOSviewer. The results have shown the predominance of issues which analyse the life cycle assessment of road infrastructures in its both environmental and economic dimension as a way to mitigate their effects on climate change, including the reduction of resources and energy consumption, or of energy consumption and greenhouse gases emissions during the construction and operation stages, respectively. However, the incorporation of the social life cycle assessment dimension, their adaptation to climate change, and the use of smart roads are still in an early stage. Therefore, efforts to include these issues are necessary to address their design according to the resilience concept and ensuring a cleaner and more competitive and climate-neutral Europe.

Malignant pleural mesothelioma is an aggressive malignancy with poor prognosis. Unilateral pleural effusion is frequently the initial clinical sign requiring therapeutic thoracentesis, which also offers a diagnostic opportunity. Detection of soluble biomarkers can support diagnosis, but few show good diagnostic accuracy. Here, we studied the expression levels and discriminative power of two putative biomarkers, prosaposin and extracellular sulfatase SULF-1, identified by proteomic and transcriptomic analysis, respectively. Pleural effusions from a total of 44 patients (23 with mesothelioma, 8 with lung cancer, and 13 with non-malignant disease) were analyzed for prosaposin and SULF-1 by enzyme-linked immunosorbent assay. Pleural effusions from mesothelioma patients had significantly higher levels of prosaposin and SULF-1 than those from non-malignant disease patients. Receiver-operating characteristic (ROC) analysis showed that both biomarkers have good discriminating power as pointed out by an AUC value of 0.853 (p = 0.0005) and 0.898 (p < 0.0001) for prosaposin and SULF-1, respectively. Combining data ensued a model predicting improvement of the diagnostic performance (AUC = 0.916, p < 0.0001). In contrast, prosaposin couldn’t discriminate mesothelioma patients from lung cancer patients while ROC analysis of SULF-1 data produced an AUC value of 0.821 (p = 0.0077) but with low sensitivity. In conclusion, prosaposin and SULF-1 levels determined in pleural effusion may be promising biomarkers for differential diagnosis between mesothelioma and non-malignant pleural disease. Instead, more patients need to be enrolled before granting the possible usefulness of these soluble proteins in differentiating mesothelioma pleural effusions from those linked to lung cancer.

A study on water/energy balances at the household scale is performed using Life Cycle Assessment (LCA) to estimate Greenhouse Gas (GHG) emissions and impacts resulting from multiple scenarios incorporating various options for: (i) component sizing, (ii) energy usage, and (iii) water reuse. Sustainability indicators are evaluated to select feasible options, while reducing whole life cycle GHG emissions. Water reuse schemes using rainwater are strongly dependent on rainfall availability and require significant tank volumes. Schemes using only gray water are more compact but more energy for treatment is needed before usage. Schemes obtained by combining both options perform better in terms of reliability and sustainability.

RESUMO: Trata-se de uma revisão integrativa da literatura, em que foi realizada uma vasta pesquisa nos bancos de dados do The Scientific Electronic Library Online - SciELO e na Biblioteca Digital Brasileira de Teses e Dissertações, com objetivo geral de analisar as produções que abordam ou correlacionam a inserção de pessoas com deficiência visual (PCDV) no mercado de trabalho brasileiro, publicados no período de 2002 a 2018. A partir dos critérios estabelecidos, foram selecionados 15 (quinze) pesquisas para a amostra final entre artigos, tese e dissertações que contribuíram de forma expressiva, atendendo ao objetivo principal desta revisão integrativa. A partir dos resultados, as discussões foram organizadas em discutir o conceito de deficiência, caracterização da deficiência visual, acesso ao mercado de trabalho, lei de cotas e centros de reabilitação. Os resultados analisados revelam expressivamente que é significativa a falta de inclusão de pessoas com deficiência visual no mercado de trabalho nos últimos 16 anos, apontando as dificuldades e oportunidades dos últimos anos, seja por falta de estudo, capacitação, adaptação ao novo ambiente laboral ou inclusão por lei de cotas. PALAVRAS-CHAVE: Inclusão, Deficiência Visual, Mercado de Trabalho.

The level of One Health (OH), or “One Health-ness,” of health interventions has been defined as the capacity to operate according to six dimensions concerning OH operations and OH infrastructures, respectively (thinking, planning, and working; and information sharing, reciprocal learning, and systemic organization). Although health initiatives and research increasingly claim their orientation toward OH, such a capacity is rarely assessed. The objective of this study is to evaluate the One Health-ness of the academic team of the University of Bologna (UNIBO Team) working in the “ELEPHANT” project (Empowering universities' Learning and rEsearch caPacities in the one Health Approach for the maNagement of animals at the wildlife, livestock and human interface in SouTh Africa). This project involves universities, six from South Africa and two from Europe, and aims at embedding OH in research and learning to enable the control of diseases at the human, animal, and environmental interface, and to emphasize the interests of local African communities with wildlife conservation. The methodology adopts the NEOH method, developed in 2018 by the EU-COST Action, “Network for the Evaluation of One Health.” The approach is based on questionnaires delivered to participants, which focus on the six OH dimensions, and then translate answers into quantitative metrics through the OH Index (OHI) and the OH Ratio (OHR). The following two evaluation levels are foreseen: the whole project and the single partner institutions. The evaluations are carried on in parallel, with preliminary, mid-term, and final assessments, to monitor the efficacy of the project actions. The preliminary evaluation of the UNIBO Team resulted in the OHI of 0.23 and the OHR of 1.69 which indicate a low degree of OH-ness and an imbalance between OH operation and OH infrastructure. The UNIBO case study will be the baseline for the evaluation of the other partner institutions involved in the ELEPHANT project. This type of evaluation can support the implementation of OH practices inside a project and underpin the strategies that allow to achieving more effective results. Any improvement in the OH-ness of each single academic team can be also considered as a result of the ELEPHANT project, thus showing its multiplier effect in the context.

Introduction: Following an outbreak of meningococcal epidemic in 2015 and 2016 in Tuscany, we registered a higher demand for antimeningococcal vaccination (anti-Men ACWY) by Healthcare Workers of the University Hospital of Pisa [Azienda Ospedaliero Universitaria Pisana (AOUP)]. The purpose of this work is to analyze and discuss data on vaccination coverage resulting from this vaccination campaign.Materials and Methods: We conducted a monocentric study about anti-Men vaccination in the healthcare workers of the AOUP following the outbreak of meningococcal meningitis that occurred mainly in the population of the Tuscan provinces of Pisa, Pistoia, Prato, and Florence. The variables under examination were age, sex, educational qualification, and job profile. Department healthcare workers were vaccinated with two types of conjugated tetravalent vaccines for the A, C, Y, and W135 strains. Data were analyzed using the SPSS software.Results: The total population of the workers in AOUP was 7,188 subjects; the population considered in the study was 5,889. Between 2015 and 2017, a total of 2,423 subjects (41.1%) underwent anti-Men vaccination. Women, older HCWs, those with a lower educational qualification, doctors, and the HCWs of the maternal and child department, and imaging department recorded a statistically significant better vaccine compliance.Discussion: The AOUP, implementing the program of the Tuscany Region of vaccination against Neisseria meningitidis, has contributed to reduce the incidence of invasive meningococcal disease. Some critical issues remain in the compliance of some sections of the population, despite the high level of adherence recorded in this case, probably also due to the great media coverage of the event.

The concept of sustainability in the road construction sector is a complex issue because of the various steps that contribute to the production and release of greenhouse gas (GHG) emissions. Addressing this issue, the European Commission has put various policy initiatives in place to encourage the construction industry to adopt circular economy (CE) and industrial symbiosis (IS) principles e.g., the use of recycled materials. Cooperativa Trasporti Imola (CTI), a company located in the Emilia-Romagna region (Italy), has been chosen for the current case study to examine practices, management, and the industrial symbiosis network among various companies in the road construction and rehabilitation sector. In this regard, the use of steel slags, obtained by an electric arc furnace (EAF), and reclaimed asphalt pavement (RAP), obtained by the deconstruction and milling of old asphalt pavement have been investigated. Two mixtures of recycled hot Mix Asphalt (HMA) i) were prepared incorporating different recycled material percentages for the wearing and binder course, respectively, ii) were characterized in terms of size distribution, strength modulus and volumetric properties, iii) and finally were compared to the performances of two mixtures entirely designed by virgin materials for the wearing and binder course, respectively. Therefore, the Life Cycle Assessment (LCA) tool was chosen to evaluate the environmental impacts that affect the designed road life cycle. The results show that recycling RAP and EAF slags in a CTI batch plant provides benefits by reducing the consumption of virgin bitumen and aggregates and by reducing CO2eq emissions. Finally, practical implications on the use of recycled materials in new asphalt mixtures from a life cycle and industrial symbiosis perspective are provided.

In this study, empty palm fruit bunch fibre was used for solids-liquid separation of palm oil mill wastewater and the sludge was sun-dried for potential uses as soil conditioner or solid fuel. The fibre was manually compressed into a wooden mould to obtain a fibre bulk density of 70 ​kg/m3. A composite wastewater sample was poured evenly over the surface of the fibre. The wet solids were sun-dried for 14 days to achieve a moisture content of 99% solids and up to 65% COD removal. Analysis of the dried sludge showed nutrients content (% of dry weight) of 0.84 for total nitrogen, 0.15 for phosphorus and 0.49 for potassium. The mean calorific value of the dried sludge was 17.1 ​MJ/kg. The results show the potential of sun-dried palm oil mill wastewater sludge for use as sustainable soil conditioner or solid fuel. The effluent from the solids-liquid separation must be given additional treatment as it may still contain harmful constituents.

Soluble mesothelin-related peptide (SMRP) is a promising biomarker for malignant pleural mesothelioma (MPM), but several confounding factors can reduce SMRP-based test’s accuracy. The identification of these confounders could improve the diagnostic performance of SMRP. In this study, we evaluated the sequence of 1,000 base pairs encompassing the minimal promoter region of the MSLN gene to identify expression quantitative trait loci (eQTL) that can affect SMRP. We assessed the association between four MSLN promoter variants and SMRP levels in a cohort of 72 MPM and 677 non-MPM subjects, and we carried out in vitro assays to investigate their functional role. Our results show that rs2235503 is an eQTL for MSLN associated with increased levels of SMRP in non-MPM subjects. Furthermore, we show that this polymorphic site affects the accuracy of SMRP, highlighting the importance of evaluating the individual’s genetic background and giving novel insights to refine SMRP specificity as a diagnostic biomarker.

Malignant pleural mesothelioma (MPM) is a cancer mainly caused by asbestos fiber inhalation, characterized by an extremely long latency and poor prognosis. Recently, researchers have focused on testing the diagnostic ability of several biomarkers. Gamma-Glutamyltransferase (GGT) has been demonstrated to be the sum of several GGT sub-fractions activity, classified based on their molecular weight in big-GGT, medium-GGT, small-GGT, and free-GGT. This work aims to evaluate whether specific GGT fractional enzymatic activity patterns could be helpful in MPM diagnosis. We analyzed blood samples from 175 workers previously exposed to asbestos, 157 non-exposed healthy subjects, and 37 MPM patients through a molecular exclusion chromatographic method. We found a specific profile of GGT fractions activity, significantly associated with MPM, resulting in an increase in b-, m- activity, along with an evident, yet not significant, decrease in f-activity. Receiver-operating characteristic (ROC) analysis showed that the best Area Under Curve (AUC) value resulted from the combined index b/f (0.679, 95% CI: 0.582–0.777). Combining the b-/f-GGT activity with the levels of serum mesothelin-related protein (SMRP; another promising MPM biomarker) improved the diagnostic accuracy, increasing the AUC value to 0.875 (95% CI: 0.807–0.943, p =

OBJECTIVES: Despite an asbestos ban in the European Union, exposure to asbestos still represents an occupational risk. Biomarkers of DNA damage and genomic instability in groups exposed to asbestos may contribute to the identification of subgroups/subjects at higher risk. METHODS: A cross-sectional study was conducted on 468 male individuals (80 working in occupational settings with potential exposure to asbestos fibers, 202 retired workers with past exposure, and 186 non-exposed controls) to compare genomic instability, cell proliferation and differentiation level using the non-invasive micronucleus buccal cytome assay. Data on demographic variables, lifestyle, and occupational history were collected with a standardized questionnaire. Micronuclei (MN) and other biomarkers of DNA damage and genomic instability were scored in a minimum of 2000/1000 cells per individual, respectively. RESULTS: Univariate and multivariate analysis showed opposite associations of MN frequency with current and former exposure. Compared to unexposed controls, workers with current potential exposure to asbestos had 55% lower MN frequency [95% confidence interval (CI) 71–29%, P

Abstract Malignant pleural mesothelioma (MPM) is an aggressive human cancer and miRNAs can play a key role for this disease. In order to broaden the knowledge in this field, the miRNA expression was investigated in a large series of MPM to discover new pathways helpful in diagnosis, prognosis and therapy. We employed nanoString nCounter system for miRNA profiling on 105 MPM samples and 10 healthy pleura. The analysis was followed by the validation of the most significantly deregulated miRNAs by RT-qPCR in an independent sample set. We identified 63 miRNAs deregulated in a statistically significant way. MiR-185, miR-197, and miR-299 were confirmed differentially expressed, after validation study. In addition, the results of the microarray analysis corroborated previous findings concerning miR-15b-5p, miR-126-3p, and miR-145-5p. Kaplan-Meier curves were used to explore the association between miRNA expression and overall survival (OS) and identified a 2-miRNA prognostic signature (Let-7c-5p and miR-151a-5p) related to hypoxia and energy metabolism respectively. In silico analyses with DIANA-microT-CDS highlighted 5 putative targets in common between two miRNAs. With the present work we showed that the pattern of miRNAs expression is highly deregulated in MPM and that a 2-miRNA signature can be a new useful tool for prognosis in MPM.

Abstract Introduction Decreased plasma BDNF (pBDNF) levels have been proposed as a biomarker in illness phases of mood disorders. Serum cortisol (seC) levels are an index of energy mobilization and stress. The aim of this cross‐sectional study was to evaluate pBDNF and seC levels in workers exposed to occupational stress and suffering from Adjustment Disorders (AD) compared to healthy workers. Methods Plasma BDNF and seC levels were measured by means of specific immunoassays in 64 AD patients and 38 healthy controls. Perceived and occupational stress was evaluated in patients and controls using the Psychological Stress Measure (PSM) and the Job Content Questionnaire (JCQ). Psychopatological symptoms in patients were assessed using specific rating scales. Results Plasma BDNF levels resulted significantly higher in patients than in controls, whereas no significant differences were found for seC levels. In patients but not in controls pBDNF levels showed a significant positive correlation with seC levels. Perceived stress levels were positively correlated with all psychopatological rating scales scores. Conclusions BDNF could play a key role in the pathophysiology of stress‐related disorders and its peripheral levels elevation could contribute to protect neurons under stress. Further research is needed focusing on biomarkers for stress‐related disorders as a potential tool for the diagnosis and prevention of occupational diseases.

The trade-off between awareness and interruption is a crucial aspect in network fault notifiers: Low severity alarms should not distract operators from other primary tasks, however it might be crucial that operators promptly react to critical notifications. A notification system should hence determine when a particular interruption is appropriate and how it should be presented. In this direction, this paper presents a multistep design path beginning from the objective of designing a proof-of-concept for a glanceable alarm notification component for telecommunication network management systems based on a peripheral display approach. In particular the goal was a notifier guided by severity-based strategies and offering the information expressiveness of a one-notification-at-the-time perspective while enriching it with overview capabilities to guarantee (possibly subliminal) long-term local and global content comprehension and prompt reaction only when the interruption from the foreground task is dictated by the fault severity. A first design macro-phase led to the simple yet effective GLANCE (GLanceable Alarm Notification for a User Centered Experience) model, based on a visual coding technique oriented to comprehension and reaction, and a transition strategy oriented to interruptions and reaction. A second design macro-phase studied the application of GLANCE to a personal customizable multichannel notification tool and to a service-oriented fault monitor for digital terrestrial television broadcasting networks.

Malignant pleural mesothelioma (MPM) is a rare cancer originated from pleural mesothelial cells. MPM has been associated with long-term exposure to asbestos. In this work we performed a comparative proteomic analysis of biphasic pleural mesothelioma (B-PM). Tissue biopsies were obtained from 61 patients who were subjected to a diagnostic thoracoscopy. 2D/MS based approach was used for proteomic analysis. The 22 proteins found differentially expressed in B-PM, with respect to benign, were analyzed by Ingenuity Pathways Analysis and compared with those obtained for epitheliod pleural mesothelioma (E-PM). A different activation of transcription factors, proteins and cytokines were observed between two subtypes.

Asbestos fibers include a group of silicate minerals that occur in the environment and are widely employed in occupational settings. Asbestos exposure has been associated to various chronic diseases; such as pulmonary fibrosis; mesothelioma; and lung cancer; often characterized by a long period of latency. Underlying mechanisms that are behind the carcinogenic effect of asbestos have not been fully clarified. Therefore; we have conducted an epidemiological study to evaluate the relationship between 8-hydroxy-2′-deoxyguanosine (8-oxodG), one of the most reliable biomarkers of oxidative stress and oxidative DNA damage; and asbestos exposure in the peripheral blood of residents in Tuscany and Liguria regions; Italy; stratified by occupational exposure to this carcinogen. Levels of 8-oxodG were expressed such as relative adduct labeling (RAL); the frequency of 8-oxodG per 105 deoxyguanosine was significantly higher among exposed workers with respect to the controls; i.e., 3.0 ± 0.2 Standard Error (SE) in asbestos workers versus a value of 1.3 ± 0.1 (SE) in unexposed controls (p < 0.001). When the relationship with occupational history was investigated; significant higher levels of 8-oxodG were measured in current and former asbestos workers vs. healthy controls; 3.1 ± 0.3 (SE) and 2.9 ± 0.2 (SE), respectively. After stratification for occupational history; a significant 194% excess of adducts was found in workers with 10 or more years of past asbestos exposure (p < 0.001). 8-oxodG can be used for medical surveillance programs of cohorts of workers with past and recent exposures to carcinogens for the identification of subjects requiring a more intense clinical surveillance.

O objetivo deste estudo foi analisar o processo de formação de terapeutas ocupacionais de uma Universidade pública da região Nordeste do Brasil, na perspectiva da educação inclusiva. Para tanto, utilizou-se uma abordagem qualitativa de pesquisa. O instrumento utilizado para coletar os dados foi o roteiro de entrevista, que permitiu entrevistar de forma reflexiva 14 terapeutas ocupacionais. A análise de dados empregada foi a de conteúdo, especificamente, a temática. Os resultados indicaram que os(as) terapeutas ocupacionais são favoráveis à educação inclusiva, porém suas formações profissionais estavam direcionadas para uma dimensão clínica-terapêutica. Mediante essa situação, foram sugeridas mudanças: incentivar a interface entre as áreas da saúde e educação; analisar/reformular a matriz curricular do curso; associar o conteúdo da Terapia Ocupacional no campo da educação inclusiva com os eixos do ensino, pesquisa e extensão. Diante disso, é necessário que a Universidade pesquisada programe e execute ações que contribuam para formação profissional do(a) terapeuta ocupacional na perspectiva da educação inclusiva.

[This corrects the article DOI: 10.1371/journal.pone.0085935.].

European Commission is strongly committed into issues related to plastic materials production and plastic waste management. While the Circular Economy Package has set targets generally referred to recycling rates, the European Strategy for plastics in a circular economy (and related action plan), fosters sustainability along the entire plastic value chain: from primary producers to converters, brand owners and retailers to waste collectors and recyclers. The Directive on the reduction of the impact of certain plastic products on the environment (more commonly known as Directive on Single-Use-Plastics, waiting for publication in the Official Journal of the European Union) rules targets on ten plastic products most often found as littering on global beaches, directly affecting plastic industry and, consequently, market. Policy makers and industrial stakeholders are called upon to collaborate. The article aims to illustrate interactions between European Commission and all plastic value chain stakeholders on implementing measures to reach ambitious targets pursued by the recent European policy. The study shows how European Commission has robustly worked to regulate production and consumption patterns on plastic carrier bags and packaging (including food packaging) thus facilitating the achievement of specific targets provided by the recent Directive. However, additional provisions concerning market restriction have been introduced; industrial stakeholders carried on a prompt response by promoting the creation of alliances, join venture and association, as well as a more integrated plastic value chain. On the base of this purpose, a virtuous example of a closed supply chain is presented.

O objetivo deste estudo foi analisar o processo de formação de terapeutas ocupacionais de uma universidade pública da Região Nordeste do Brasil, na perspectiva da educação inclusiva. Para tanto, utilizou-se uma abordagem qualitativa de pesquisa. O instrumento utilizado para coletar os dados foi o roteiro de entrevista, que permitiu entrevistar de forma relexiva 14 terapeutas ocupacionais. A análise de dados empregada foi a de conteúdo, especiicamente a temática. Os resultados indicaram que os(as) terapeutas ocupacionais são favoráveis à educação inclusiva, porém suas formações proissionais estavam direcionadas para uma dimensão clínica-terapêutica. Mediante essa situação, os(as) terapeutas ocupacionais sugerem algumas mudanças: incentivar a interface entre as áreas da saúde e educação; analisar/reformular a matriz curricular do curso; associar o conteúdo da Terapia Ocupacional no campo da educação inclusiva com os eixos do ensino, pesquisa e extensão. Diante disso, é necessário que a Universidade pesquisada programe e execute ações que contribuam para formação proissional do(a) terapeuta ocupacional na perspectiva da educação inclusiva.

Indoor air quality (IAQ) management in public spaces is assuming a remarkable importance. Busy environments, like airport terminals, are currently regarded as possible hotspots and IAQ is a crucial element for passengers and staff protection, as well as a key aspect of airport passenger experience. A one-month monitoring period has been performed on IAQ in the airport of Bologna (Italy), as prototypal example of large regional airport. Four strategic areas within the airport have been equipped with electronic monitoring platforms, including different contaminants and two microclimatic sensors. Data suggest that daily variation in IAQ parameters typically follow the activity pattern of the different environments under study (i.e., passengers’ flows) for gaseous contaminants, where particulate matter counts oscillate in a definite range, with a significant role played by ventilation system. Gaseous contaminants show a correlation between indoor and outdoor concentrations, mainly due to airside activities. Micro-climatic comfort parameters have been tested to match with standards for commercial environments. As results appears in line with typical households IAQ values, the current air ventilation system appears to be adequate. Nevertheless, an integrated air management system, based on real-time monitoring, would lead to optimization and improvement in environmental and economical sustainability.

Purpose of Review: In the current review, we aim to highlight the evolving evidence on the diagnosis, prevention and treatment of critical illness weakness (CIW) and critical illness associated diaphragmatic weakness (CIDW)., Recent Findings: In the ICU, several risk factors can lead to CIW and CIDW. Recent evidence suggests that they have different pathophysiological mechanisms and impact on outcomes, although they share common risk factors and may overlap in several patients. Their diagnosis is challenging, because CIW diagnosis is primarily clinical and, therefore, difficult to obtain in the ICU population, and CIDW diagnosis is complex and not easily performed at the bedside. All of these issues lead to underdiagnosis of CIW and CIDW, which significantly increases the risk of complications and the impact on both short and long term outcomes. Moreover, recent studies have explored promising diagnostic techniques that are may be easily implemented in daily clinical practice. In addition, this review summarizes the latest research aimed at improving how to prevent and treat CIW and CIDW., Summary: This review aims to clarify some uncertain aspects and provide helpful information on developing monitoring techniques and therapeutic interventions for managing CIW and CIDW., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Acute Respiratory Distress Syndrome (ARDS) is an important global health issue with high in-hospital mortality. Importantly, the impact of ARDS extends beyond the acute phase, with increased mortality and disability for months to years after hospitalization. These findings underscore the importance of extended follow-up to assess and address the Post-Intensive Care Syndrome (PICS), characterized by persistent impairments in physical, cognitive, and/or mental health status that impair quality of life over the long-term. Persistent muscle weakness is a common physical problem for ARDS survivors, affecting mobility and activities of daily living. Critical illness and related interventions, including prolonged bed rest and overuse of sedatives and neuromuscular blocking agents during mechanical ventilation, are important risk factors for ICU-acquired weakness. Deep sedation also increases the risk of delirium in the ICU, and long-term cognitive impairment. Corticosteroids also may be used during management of ARDS, particularly in the setting of COVID-19. Corticosteroids can be associated with myopathy and muscle weakness, as well as prolonged delirium that increases the risk of long-term cognitive impairment. The optimal duration and dosage of corticosteroids remain uncertain, and there's limited long-term data on their effects on muscle weakness and cognition in ARDS survivors. In addition to physical and cognitive issues, mental health challenges, such as depression, anxiety, and post-traumatic stress disorder, are common in ARDS survivors. Strategies to address these complications emphasize the need for consistent implementation of the evidence-based ABCDEF bundle, which includes daily management of analgesia in concert with early cessation of sedatives, avoidance of benzodiazepines, daily delirium monitoring and management, early mobilization, and incorporation of family at the bedside. In conclusion, ARDS is a complex global health challenge with consequences extending beyond the acute phase. Understanding the links between critical care management and long-term consequences is vital for developing effective therapeutic strategies and improving the quality of life for ARDS survivors., (© 2024. The Author(s).)

Introduction: Long-term weakness is common in survivors of COVID-19-associated acute respiratory distress syndrome (CARDS). We longitudinally assessed the predictors of muscle weakness in patients evaluated 6 and 12 months after intensive care unit discharge with in-person visits., Methods: Muscle strength was measured by isometric maximal voluntary contraction (MVC) of the tibialis anterior muscle. Candidate predictors of muscle weakness were follow-up time, sex, age, mechanical ventilation duration, use of steroids in the intensive care unit, the compound muscle action potential of the tibialis anterior muscle (CMAP-TA-S100), a 6-min walk test, severe fatigue, depression and anxiety, post-traumatic stress disorder, cognitive assessment, and body mass index. We also compared the clinical tools currently available for the evaluation of muscle strength (handgrip strength and Medical Research Council sum score) and electrical neuromuscular function (simplified peroneal nerve test [PENT]) with more objective and robust measures of force (MVC) and electrophysiological evaluation of the neuromuscular function of the tibialis anterior muscle (CMAP-TA-S100) for their essential role in ankle control., Results: MVC improved at 12 months compared with 6 months. CMAP-TA-S100 ( P = 0.016) and the presence of severe fatigue ( P = 0.036) were independent predictors of MVC. MVC was strongly associated with handgrip strength, whereas CMAP-TA-S100 was strongly associated with PENT., Discussion: Electrical neuromuscular abnormalities and severe fatigue are independently associated with reduced MVC and can be used to predict the risk of long-term muscle weakness in CARDS survivors., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Benedini, Cogliati, Lulic-Kuryllo, Peli, Mombelli, Calza, Guarneri, Cudicio, Rizzardi, Bertoni, Gazzina, Renzi, Gitti, Rasulo, Goffi, Pozzi, Orizio, Negro, Latronico and Piva.)

Background: Severe weakness associated with critical illness (CIW) is common. This narrative review summarizes the latest scientific insights and proposes a guide for clinicians to optimize the diagnosis and management of the CIW during the various stages of the disease from the ICU to the community stage., Main Body: CIW arises as diffuse, symmetrical weakness after ICU admission, which is an important differentiating factor from other diseases causing non-symmetrical muscle weakness or paralysis. In patients with adequate cognitive function, CIW can be easily diagnosed at the bedside using manual muscle testing, which should be routinely conducted until ICU discharge. In patients with delirium or coma or those with prolonged, severe weakness, specific neurophysiological investigations and, in selected cases, muscle biopsy are recommended. With these exams, CIW can be differentiated into critical illness polyneuropathy or myopathy, which often coexist. On the general ward, CIW is seen in patients with prolonged previous ICU treatment, or in those developing a new sepsis. Respiratory muscle weakness can cause neuromuscular respiratory failure, which needs prompt recognition and rapid treatment to avoid life-threatening situations. Active rehabilitation should be reassessed and tailored to the new patient's condition to reduce the risk of disease progression. CIW is associated with long-term physical, cognitive and mental impairments, which emphasizes the need for a multidisciplinary model of care. Follow-up clinics for patients surviving critical illness may serve this purpose by providing direct clinical support to patients, managing referrals to other specialists and general practitioners, and serving as a platform for research to describe the natural history of post-intensive care syndrome and to identify new therapeutic interventions. This surveillance should include an assessment of the activities of daily living, mood, and functional mobility. Finally, nutritional status should be longitudinally assessed in all ICU survivors and incorporated into a patient-centered nutritional approach guided by a dietician., Conclusions: Early ICU mobilization combined with the best evidence-based ICU practices can effectively reduce short-term weakness. Multi-professional collaborations are needed to guarantee a multi-dimensional evaluation and unitary community care programs for survivors of critical illnesses., (© 2023. The Author(s).)

Purpose: This work aimed to compare physical impairment in survivors of classic ARDS compared with COVID-19-associated ARDS (CARDS) survivors., Material and Methods: This is a prospective observational cohort study on 248 patients with CARDS and compared them with a historical cohort of 48 patients with classic ARDS. Physical performance was evaluated at 6 and 12 months after ICU discharge, using the Medical Research Council Scale (MRCss), 6-min walk test (6MWT), handgrip dynamometry (HGD), and fatigue severity score (FSS). We also assessed activities of daily living (ADLs) using the Barthel index., Results: At 6 months, patients with classic ARDS had lower HGD (estimated difference [ED]: 11.71 kg, p < 0.001; ED 31.9% of predicted value, p < 0.001), 6MWT distance (ED: 89.11 m, p < 0.001; ED 12.96% of predicted value, p = 0.032), and more frequent significant fatigue (OR 0.35, p = 0.046). At 12 months, patients with classic ARDS had lower HGD (ED: 9.08 kg, p = 0.0014; ED 25.9% of predicted value, p < 0.001) and no difference in terms of 6MWT and fatigue. At 12 months, patients with classic ARDS improved their MRCss (ED 2.50, p = 0.006) and HGD (ED: 4.13 kg, p = 0.002; ED 9.45% of predicted value, p = 0.005), while those with CARDS did not. Most patients in both groups regained independence in ADLs at 6 months. COVID-19 diagnosis was a significant independent predictor of better HGD (p < 0.0001) and 6MWT performance (p = 0.001), and lower prevalence of fatigue (p = 0.018)., Conclusions: Both classic ARDS and CARDS survivors experienced long-term impairments in physical functioning, confirming that post-intensive care syndrome remains a major legacy of critical illness. Surprisingly, however, persisting disability was more common in survivors of classic ARDS than in CARDS survivors. In fact, muscle strength measured with HGD was reduced in survivors of classic ARDS compared to CARDS patients at both 6 and 12 months. The 6MWT was reduced and fatigue was more common in classic ARDS compared to CARDS at 6 months but differences were no longer significant at 12 months. Most patients in both groups regained independent function in ADLs at 6 months., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: Patients admitted to the intensive care unit (ICU) following severe acute respiratory syndrome 2 (SARS-CoV-2) infection may have muscle weakness up to 1 year or more following ICU discharge. However, females show greater muscle weakness than males, indicating greater neuromuscular impairment. The objective of this work was to assess sex differences in longitudinal physical functioning following ICU discharge for SARS-CoV-2 infection., Methods: We performed longitudinal assessment of physical functioning in two groups: 14 participants (7 males, 7 females) in the 3-to-6 month and 28 participants (14 males, 14 females) in the 6-to-12 month group following ICU discharge and assessed differences between the sexes. We examined self-reported fatigue, physical functioning, compound muscle action potential (CMAP) amplitude, maximal strength, and the neural drive to the tibialis anterior muscle., Results: We found no sex differences in the assessed parameters in the 3-to-6-month follow-up, indicating significant weakness in both sexes.Sex differences emerged in the 6-to-12-month follow-up. Specifically, females exhibited greater impairments in physical functioning, including lower strength, walking lower distances, and high neural input even 1 year following ICU-discharge., Discussion: Females infected by SARS-CoV-2 display significant impairments in functional recovery up to 1 year following ICU discharge. The effects of sex should be considered in post-COVID neurorehabilitation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Lulic-Kuryllo, Benedini, Cogliati, Cudicio, Guarneri, Gazzina, Piva, Latronico, Orizio and Negro.)

Purpose of Review: Sepsis, defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, is a leading cause of hospital and ICU admission. The central and peripheral nervous system may be the first organ system to show signs of dysfunction, leading to clinical manifestations such as sepsis-associated encephalopathy (SAE) with delirium or coma and ICU-acquired weakness (ICUAW). In the current review, we want to highlight developing insights into the epidemiology, diagnosis, prognosis, and treatment of patients with SAE and ICUAW., Recent Findings: The diagnosis of neurological complications of sepsis remains clinical, although the use of electroencephalography and electromyography can support the diagnosis, especially in noncollaborative patients, and can help in defining disease severity. Moreover, recent studies suggest new insights into the long-term effects associated with SAE and ICUAW, highlighting the need for effective prevention and treatment., Summary: In this manuscript, we provide an overview of recent insights and developments in the prevention, diagnosis, and treatment of patients with SAE and ICUAW., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

The vital status of people with a destroyed brain is one of the most discussed topics in medical literature. According to the current legal narrative, people whose brain is destroyed are dead. Nevertheless, a clear biological rationale to support with certainty such a narrative is still lacking. The purported rationale of the "the brain as the central integrator of the body" has proven to be biologically untenable. Persons with a destroyed brain can be maintained viable for long periods of time, showing clear signs of good biological integration. This fact stirs up a continuous seething of heated discussions among scholars, and generates uncertainty among lay people, loss of trust towards the medical community, and highly controversial cases in the media. To try to settle this unresolved situation, we propose a moral narrative, according to which people whose brain is destroyed should be considered as dead. Defining those people as biologically dead is impossible. Their clinical condition is neither life nor death; it is something in between, an artifice created by modern medicine. Yet, we can well state that the irreversible loss of all brain functions is a clinically and scientifically useful point of no return in the process of dying which can guide sound decisions. Through a personal reinterpretation of the myth of Orpheus and Eurydice, we would like to show that the choice to consider people with a destroyed brain as dead is a sound moral decision and an act of love.

Adult and pediatric palliative care (PC) share common aims and ethical principles but differ in many organizational and practical aspects. The aim of this narrative review is to analyze these differences and focus on which key aspects of pediatric palliative care could integrate adult services for a better care of suffering patients.Interventions which are peculiar of pediatric PC respect to adult PC include: an earlier referral to the PC service to identify the needs and plan the interventions at an earlier stage of the disease; consequently, a more systematic cooperation with the disease-specific physicians to reduce the burden of treatments; a better integration with the community and the social surroundings of the patients, to prevent social isolation and preserve their social role; a more dynamic organization of the PC services, to give patients the chance of being stabilized at in-hospital or residential settings and subsequently discharged and cared at home whenever possible and desired; the implementation of respite care for adults, to help the families coping with the burden of the disease of their beloved and promote the home-based PC.This review underlines the relevance of some key-aspects of pediatric PC that can be beneficial also within PC of adults. Its findings give the chance for a more dynamic and modern organization of adult PC services and may serve as a basis of future research for new interventions., (© 2023. The Author(s).)

Background: Sports-related concussion (SRC) is a subset of mild traumatic brain injuries occurring in contact sports. Most people recover spontaneously, but in retired professional players, the risk for neurodegenerative diseases is increased. A biomarker, such as neurofilament light chains (NfL), would help to address this issue and demonstrate sports' safety. Assessing NfL in professional soccer players may be the best way to investigate if repetitive head-impact exposure in the typical lower and asymptomatic range is harmful., Objective: To evaluate whether the NfL in serum is a sensitive biomarker to detect mild brain injury in professional soccer players., Methods: Thirty-six soccer players belonging to a professional Italian team underwent serum NfL assessment using ultrasensitive single-molecule array technology. Sixteen healthy nonathletic controls were also enrolled. Differences between groups and changes over time, considering pre-season vs. season, were considered., Results: Serum NfL concentrations were comparable in the soccer professional players (median [interquartile range], 6.44 pg/mL [4.60-8.27] and controls (6.50 pg/mL [5.26-7.04]), with a median difference of - 0.06 pg/mL (95% CI -1.36 to 1.18), p = 0.957. No significant differences according to players' role (goalkeeper, defender, midfielder or forward) or according to timing of sampling (pre-season vs. season) were found., Conclusions: These results suggest that professional soccer, even when played at the highest level of competition, may be considered safe. Future studies assessing serum NfL levels after soccer-related concussions should be carried out, to evaluate their usefulness as a return-to-play marker avoiding second impact syndrome., (© 2022. Fondazione Società Italiana di Neurologia.)

Survival has been considered the cornerstone for clinical outcome evaluation in critically ill patients admitted to intensive care unit (ICU). There is evidence that ICU survivors commonly show impairments in long-term outcomes such as quality of life (QoL) considering them as the most relevant ones. In the last years, the concept of patient-important outcomes has been introduced and increasingly reported in peer-reviewed publications. In the present systematic review, we evaluated how many randomized controlled trials (RCTs) were conducted on critically ill patients and reporting a benefit on survival reported also data on QoL. All RCTs investigating nonsurgical interventions that significantly reduced mortality in critically ill patients were searched on MEDLINE/PubMed, Scopus and Embase from inception until August 2021. In a second stage, for all the included studies, the outcome QoL was investigated. The primary outcome was to evaluate how many RCTs analyzing interventions reducing mortality reported also data on QoL. The secondary endpoint was to investigate if QoL resulted improved, worsened or not modified. Data on QoL were reported as evaluated outcome in 7 of the 239 studies (2.9%). The tools to evaluate QoL and QoL time points were heterogeneous. Four interventions showed a significant impact on QoL: Two interventions improved survival and QoL (pravastatin in subarachnoid hemorrhage, dexmedetomidine in elderly patients after noncardiac surgery), while two interventions reduced mortality but negatively influenced QoL (caloric restriction in patients with refeeding syndrome and systematic ICU admission in elderly patients). In conclusion, only a minority of RCTs in which an intervention demonstrated to affect mortality in critically ill patients reported also data on QoL. Future research in critical care should include patient-important outcomes like QoL besides mortality. Data on this topic should be collected in conformity with PROs statement and core outcome sets to guarantee quality and comparability of results., (© 2022. The Author(s).)

We report on the outcome of 114 COVID-19-associated acute respiratory distress syndrome (ARDS) survivors evaluated at 3, 6 and 12 months after intensive care unit discharge with assessment of physical, mental and cognitive impairments. Critical illness polyneuromyopathy was diagnosed in 23 patients (39%). Handgrip dynamometry was 70% predicted at 3 months and significantly improved over time, whereas the 6 min walk test (80% predicted) and severe fatigue (27% of patients) did not. Independence in activities of daily living (ADL) was achieved by 98% at 3 months. Cognitive impairment (28% at 3 months) improved over time, whereas depression, anxiety and post-traumatic stress disorder symptoms, present in 9%, 10% and 4% at 3 months, did not. Normalised health-related quality of life was good. COVID-19-associated ARDS leads to persisting impairment in performance-based measures of physical function, while ADL, cognitive and mental health status, and health-related quality of life may be less impaired. Trial registration number NCT04608994., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

The exact incidence of neurological and cognitive sequelae of COVID-19 in the long term is yet unknown. The aim of this research is to investigate the type of neurological and cognitive impairment in COVID-19 cases of different severity. Two hundred fifteen patients, who had developed COVID-19, were examined 4 months after the diagnosis by means of neurological exam and extensive cognitive evaluation, investigating general cognition, memory, verbal fluency, visuospatial abilities and executive functions. Fifty-two of them were treated in intensive care unit (ICU patients), whereas 163 were not hospitalized (non-ICU patients). Neurological deficits were found in 2/163 (1.2%) of non-ICU and in 7/52 (13.5%) of the ICU cases, all involving the peripheral nervous system. ICU patients performed significantly worse in all the neuropsychological tests and showed a worse age- and education-corrected cognitive impairment: Cognitive Impairment Index (CII) was higher in ICU than in non-ICU patients (median ICU 3 vs 2, p = .001). CII significantly correlated with age in both groups, was unrelated to length of follow- up, diabetes and hypertension and - only for ICU patients- to PaO 2 /FiO 2 at ICU admission. Obtained results support the greater susceptibility of COVID-19 patients, treated in ICU, to develop neurological deficits and cognitive impairment at a four-month follow up, as compared to cases with mild/moderate symptoms., (Copyright © 2021. Published by Elsevier B.V.)

Coronavirus disease 2019 (COVID-19) has caused more than 175 million persons infected and 3.8 million deaths so far and is having a devastating impact on both low and high-income countries, in particular on hospitals and Intensive Care Units (ICU). The ICU mortality during the first pandemic wave ranged from 40% to 85% during the busiest ICU period for admissions around the peak of the surge, and those surviving are frequently faced with impairments affecting physical, cognitive, and mental health status, complicating the postacute phase of COVID-19, which in the pre-COVID period, were defined collectively as postintensive care syndrome (PICS). Long COVID is defined as four weeks of persisting symptoms after the acute illness, and post-COVID syndrome and chronic COVID-19 are the proposed terms to describe continued symptomatology for more than 12 weeks. Overall, 50% of ICU survivors suffer from new physical, mental, and/or cognitive problems at 1 year after ICU discharge. The prevalence, severity, and duration of the various impairments in ICU survivors are poorly defined, with substantial variations among published series, and may reflect differences in the timing of assessment, the outcome measured, the instruments utilized, and thresholds adopted to establish the diagnosis, the qualification of personnel delivering the tests, the resource availability as well diversity in patients' case-mix. Future longitudinal studies of adequate sample size with repeated assessments of validated outcomes and comparison with non-COVID-19 ICU patients are needed to fully explore the long-term outcome of ICU patients with COVID-19. In this article, we focus on chronic COVID-19 in ICU survivors and present state-of-the-art data regarding long-term complications related to critical illness and the treatments and organ support received.