Sleep History and Hypertension Burden in First-Generation Chinese Migrants Settled in Italy: The CHIinese in Prato Cross-Sectional Survey

Migration flows from China are largely directed towards the South of Europe, Chinese being now the third largest overseas-born population in Italy. The aim of the study was to investigate hypertension burden and self-reported sleep disorders among 1608 first-generation Chinese migrants aged 16 to 59 years settled in Prato and recruited in a cross-sectional survey. Hypertension was defined as systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg or self-reported antihypertensive treatment; potential impact of sleep disorders was analyzed by logistic regression adjusted for age, sex, marital status, education, health insurance, current smoking, parental hypertension, alcohol drinking, overweight or obesity, central obesity, diabetes, high total cholesterol, and high triglycerides. Among the 1608 participants, 21.7% were hypertensive (age-standardized prevalence 19.2%; 95% Cl: 18.5–20.0); 54% of hypertensive subjects were aware of their condition; 70% of aware hypertensive subjects received drugs, and 39% of treated subjects had blood pressure controlled. Self-reported snoring increased the risk of hypertension; when compared with no snoring, the age- and sex-adjusted OR for hypertension of snoring 3 to 6 d/week was 2.11 (95% Cl: 1.48–3.01) and 2.48 (95% Cl: 1.79–3.46) of snoring every day. When compared with a sleep duration ≤5 hours, subjects with sleep duration of 7 hours had reduced risk of high triglycerides (adjusted OR: 0.66; 95% Cl: 0.43–0.95). Despite a high level of awareness, low treatment rates for hypertension were observed among Chinese participants, independently of health insurance. Sleep history is to be considered in screening and prevention programs

Assessing the Impact of Ozone on Forest Trees in An Integrative Perspective: Are Foliar Visible Symptoms Suitable Predictors for Growth Reduction? A Critical Review

Plant growth reduction (GR) is the most widely accepted damage parameter to assess the sensitivity of trees to tropospheric ozone (O3) pollution since it integrates different physiological processes leading to loss of photosynthetic activity and distraction of metabolic resources from growth to defense, repair, and recovery pathways. Because of the intrinsic difficulty to assess the actual O3 risk assessment for forests in field conditions, foliar visible symptoms (FVS) induced by O3 have been proposed as a proxy to estimate possible GR in forest trees. The rationale for this assumption is that the onset of FVS implies a reduction of the photosynthetic capacity of plants. In this review, we show that GR and FVS can be the consequences of independent physiological pathways involving different response mechanisms that can cause both FVS without GR and GR without FVS. The onset of FVS may not lead necessarily to significant GR at plant level for several reasons, including the rise of compensatory photosynthesis, the time lag between growth processes and the accumulation of critical O3 dose, and the negligible effect of a modest amount of injured leaves. Plant GR, on the other hand, may be induced by different physiological mechanisms not necessarily related to FVS, such as stomatal closure (i.e., carbon starvation) to avoid or reduce O3 uptake, and the increase of respiratory processes for the production of metabolic defense compounds. Growth reduction and FVS can be interpreted as different strategies for the acclimation of plants to a stressful environment, and do not mean necessarily damage. Growth reduction (without FVS) seems to prevail in species adapted to limiting environmental conditions, that avoid loss and replacement of injured leaves because of the high metabolic cost of their production; conversely, FVS manifestation (without GR) and the replacement of injured leaves is more common in species adapted to environments with low-stress levels, since they can benefit from a rapid foliar turnover to compensate for the decreased rate of photosynthesis of the whole plant

Solvent Effects on the Actinic Step of Donor-Acceptor Stenhouse Adduct Photoswitching

Donor-acceptor Stenhouse adducts (DASAs) are negative photochromes that switch with visible light and are highly promising for applications ranging from smart materials to biological systems. However, the strong solvent dependence of the photoswitching kinetics limits their application. The nature of the photoswitching mechanism in different solvents is key for addressing the solvatochromism of DASAs, but as yet has remained elusive. Here, we employ spectroscopic analyses and TD-DFT calculations to reveal changing solvatochromic shifts and energies of the species involved in DASA photoswitching. Time-resolved visible pump-probe spectroscopy suggests that the primary photochemical step remains the same, irrespective of the polarity and protic nature of the solvent. Disentangling the different factors determining the solvent-dependence of DASA photoswitching, presented here, is crucial for the rational development of applications in a wide range of different media

The impact of Nursing Homes staff education on end-of-life care in residents with advanced dementia: a quality improvement study

Context. End-of-life care in nursing homes (NHs) needs improvement. We carried out a study in 29 NHs in the Lombardy Region (Italy).Objectives. The objective of this study was to compare end-of-life care in NH residents with advanced dementia before and after an educational intervention aimed to improving palliative care.Methods. The intervention consisted of a seven-hour lecture, followed by two 3-hour meetings consisting of case discussions. The intervention was held in each NH and well attended by NH staff. This multicenter, comparative, observational study included up to 20 residents with advanced dementia from each NH: the last 10 who died before the intervention (preintervention group, 245 residents) and the first 10 who died at least three months after the intervention (postintervention group, 237 residents). Data for these residents were collected from records for 60 days and seven days before death.Results. The use of "comfort hydration" (< 1000 mL/day subcutaneously) tended to increase from 16.9% to 26.8% in the postintervention group. The number of residents receiving a palliative approach for nutrition and hydration increased, though not significantly, from 24% preintervention to 31.5% postintervention. On the other hand, the proportion of tube-fed residents and residents receiving intravenous hydration decreased from 15.5% to 10.5%, and from 52% to 42%, respectively. Cardiopulmonary resuscitations decreased also from 52/245 (21%) to 18/237 (7.6%) cases (P = 0.002).Conclusion. The short educational intervention modified some practices relevant to the quality of end-of-life care of advanced dementia patients in NHs, possibly raising and reinforcing beliefs and attitudes already largely present. (C) 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved

The last week of life of nursing home residents with advanced dementia: a retrospective study

Background Barriers to palliative care still exist in long-term care settings for older people, which can mean that people with advanced dementia may not receive of adequate palliative care in the last days of their life; instead, they may be exposed to aggressive and/or inappropriate treatments. The aim of this multicentre study was to assess the clinical interventions and care at end of life in a cohort of nursing home (NH) residents with advanced dementia in a large Italian region. Methods This retrospective study included a convenience sample of 29 NHs in the Lombardy Region. Data were collected from the clinical records of 482 residents with advanced dementia, who had resided in the NH for at least 6 months before death, mainly focusing on the 7 days before death. Results Most residents (97.1%) died in the NH. In the 7 days before death, 20% were fed and hydrated by mouth, and 13.4% were tube fed. A median of five, often inappropriate, drugs were prescribed. Fifty-seven percent of residents had an acknowledgement of worsening condition recorded in their clinical records, a median of 4 days before death. Conclusions Full implementation of palliative care was not achieved in our study, possibly due to insufficient acknowledgement of the appropriateness of some drugs and interventions, and health professionals' lack of implementation of palliative interventions. Future studies should focus on how to improve care for NH residents

Forest ecosystem monitoring in Tuscany (Italy): past activities, present status and future perspectives

Since 1987 the Region of Tuscany has been actively monitoring crown status in its forests, in order to protect them from atmospheric pollution, biotic factors and environmental change. Over this period the Region has performed periodical inventories on crown condition in publicly-owned forests (Level I network) and established a network of permanent plots (MON.I.TO., Level II – III) to study long-term changes occurring in forest ecosystems. Some of these permanent plots were later included in the national programme CONECOFOR, managed by the Ministry for Policy in Agriculture and Forest. Currently a further development of MON.I.TO. is being implemented, called MONITO III – TOpModel, the aim of which is to broaden the information potential of the monitoring system to include carbon stocks and biodiversity evaluation. This paper provides an up-to-date report on the status of the various surveys and recommends a closer connection between MON.I.TO. and the other regional information systems, especially the Regional Forest Inventory, in order to produce information that may be useful in forest planning and in Sustainable Forest Management

Shedding Light on the Photoisomerization Pathway of Donor-Acceptor Stenhouse Adducts

Donor-acceptor Stenhouse adducts (DASAs) are negative photochromes that hold great promise for a variety of applications. Key to optimizing their switching properties is a detailed understanding of the photoswitching mechanism, which, as yet, is absent. Here we characterize the actinic step of DASA-photoswitching and its key intermediate, which was studied using a combination of ultrafast visible and IR pump-probe spectroscopies and TD-DFT calculations. Comparison of the time-resolved IR spectra with DFT computations allowed to unambiguously identify the structure of the intermediate, confirming that light absorption induces a sequential reaction path in which a Z-E photoisomerization of C-2-C-3 is followed by a rotation around C-3-C-4 and a subsequent thermal cyclization step. First and second-generation DASAs share a common photoisomerization mechanism in chlorinated solvents with notable differences in kinetics and lifetimes of the excited states. The photogenerated intermediate of the second-generation DASA was photo-accumulated at low temperature and probed with time-resolved spectroscopy, demonstrating the photoreversibility of the isomerization process. Taken together, these results provide a detailed picture of the DASA isomerization pathway on a molecular level

Carriers of ADAMTS13 Rare Variants Are at High Risk of Life-Threatening COVID-19

Thrombosis of small and large vessels is reported as a key player in COVID-19 severity. However, host genetic determinants of this susceptibility are still unclear. Congenital Thrombotic Thrombocytopenic Purpura is a severe autosomal recessive disorder characterized by uncleaved ultra-large vWF and thrombotic microangiopathy, frequently triggered by infections. Carriers are reported to be asymptomatic. Exome analysis of about 3000 SARS-CoV-2 infected subjects of different severities, belonging to the GEN-COVID cohort, revealed the specific role of vWF cleaving enzyme ADAMTS13 (A disintegrin-like and metalloprotease with thrombospondin type 1 motif, 13). We report here that ultra-rare variants in a heterozygous state lead to a rare form of COVID-19 characterized by hyper-inflammation signs, which segregates in families as an autosomal dominant disorder conditioned by SARS-CoV-2 infection, sex, and age. This has clinical relevance due to the availability of drugs such as Caplacizumab, which inhibits vWF-platelet interaction, and Crizanlizumab, which, by inhibiting P-selectin binding to its ligands, prevents leukocyte recruitment and platelet aggregation at the site of vascular damage