Application of an innovative model for the risk management of covid-19 in a multinational manufacturing company

The COVID-19 incidence in 61 manufacturing plants in Europe (EU), North America (NA) and Latin-America (LATAM) was compared with the incidence observed in the countries where the plants are located in order to evaluate the application of an innovative model for COVID-19 risk management. Firstly, a network of local and global teams was created, including an external university occupational physician team for scientific support. In July 2020, global prevention guidelines for the homogenous management of the pandemic were applied, replacing different site or regional procedures. A tool for COVID-19 monitoring was implemented to investigate the relationship between the incidence rates inside and outside the plants. In the period of May–November 2020, 565 confirmed cases (EU 330, NA 141, LATAM 94) were observed among 20,646 workers with different jobs and tasks, and in the last two months 85% EU and 70% NA cases were recorded. Only in 10% of cases was a possible internal origin of the contagion not excluded. In the EU and NA, unlike LATAM, the COVID-19 incidence rates inside the sites punctually followed the rising trend outside. In conclusion, the model, combining a global approach with the local application of the measures, maintains the sustainability in the manufacturing industry

Stratosphere-troposphere coupling at inter-decadal time scales: Implications for the North Atlantic Ocean

Evidence of stratosphere-troposphere coupling at inter-decadal time scales is searched for in a 260-year simulation performed with a climate model including a state-of-the-art stratosphere. The boundary conditions of the simulation are specified according to preindustrial conditions and are kept constant from year to year. It is shown that long lasting (∼20 years) positive and negative anomalies of the northern winter stratospheric polar vortex exist in the simulation. Given that there are no externally imposed low frequency time variations, these persistent variations are due to internal dynamical processes of the modeled coupled atmosphere ocean system. By composite analysis, it is shown that the long lasting stratospheric vortex anomalies are connected through the troposphere to mean sea level pressure, surface temperature and sea ice cover anomalies. These connections are reminiscent of intra-seasonal stratosphere-troposphere coupling. Over the ocean, the surface temperature and sea ice cover anomalies are indicative of the delayed Atlantic meridional overturning circulation response to atmospheric forcing. The latter is indeed found to be anomalously strong/weak during the long lasting positive/negative stratospheric vortex anomalies, providing evidence for a potential role of the stratosphere in decadal prediction. Copyright 2012 by the American Geophysical Union

Impact of an improved radiation scheme in the MAECHAM5 General Circulation Model

In order to improve the representation of the shortwave radiative transfer in the MAECHAM5 general circulation model, the spectral resolution of the shortwave radiation parameterization used in the model has been increased and extended in the UV-B and UV-C bands. The upgraded shortwave parameterization is first validated offline with a 4 stream discrete-ordinate line-by-line model. Thereafter, two 20-years simulations with the MAECHAM5 middle atmosphere general circulation model are performed to evaluate the temperature changes and the dynamical feedbacks arising from the newly introduced parameterization. The offline clear-sky comparison of the standard and upgraded parameterizations with the discrete ordinate model shows considerable improvement for the upgraded parameterization in terms of shortwave fluxes and heating rates. In the simulation with the upgraded ratiation parameterization, we report a significant warming of almost the entire atmosphere, largest at 1 hPa at the stratopause, and stronger zonal mean zonal winds in the middle atmosphere. The warming at the summer stratopause alleviates the cold bias present in the model when the standard radiation scheme is used. The stronger zonal mean zonal winds induce a dynamical feedback that results in a dynamical warming (cooling) of the polar winter (summer) mesosphere, caused by an increased downward (upward)circulation in the winter (summer) hemisphere. In the troposphere, the changes in the spectral resolution and the associated changes in the cloud optical parameters introduce a relatively small warming and, consistenly, a moisteneing. The warming occurs mostly in the upper troposphere and can contribute to a possible improvement of the model temperature climatology

Airways oxidative stress, lung function and cognitive impairment in aging.

Abstract BACKGROUND: An altered balance of oxidants/antioxidants is one of the pathological mechanisms of many age-dependent disorders. We aimed to investigate the age-related airways oxidative stress, using non invasive, safe and repeatable techniques; to evaluate the correspondence between systemic and local oxidative stress in healthy subjects of different age ranges; to analyse the correlation between systemic and local oxidative stress with lung function and with cognitive impairment. METHODS: Thirty consecutive healthy high school graduated subjects (8 M, 22 F), divided in three ranges of age ( 60 years) were enrolled. All subjects underwent oxygen free radicals and exhaled nitric oxide measurement (by the diacron reactive oxygen metabolites test and by a rapid-response chemiluminescence nitric oxide analyzer), lung function tests, and cognitive impairment scales (Mini Mental State Examination and Geriatric Depression Scale). RESULTS: A significant increase of oxygen free radicals, exhaled nitric oxide, and Geriatric Depression Scale score and a significant decrease of forced expiratory volume in 1 second and forced expiratory vital capacity from younger to older subjects were identified. Moreover, the significant positive correlation between oxygen free radicals and exhaled nitric oxide, and between oxygen free radicals and exhaled nitric oxide with Geriatric Depression Scale score were found. The significant negative correlation between forced expiratory volume in 1 second and oxygen free radicals or exhaled nitric oxide was also demonstrated. CONCLUSIONS: Our data supports the role of progressive local oxidative stress in damaging the lung function and in inducing depression symptoms

Impact of an improved shortwave radiation scheme in the MAECHAM5 General Circulation Model

International audienceIn order to improve the representation of ozone absorption in the stratosphere of the MAECHAM5 general circulation model, the spectral resolution of the shortwave radiation parameterization used in the model has been increased from 4 to 6 bands. Two 20-years simulations with the general circulation model have been performed, one with the standard and the other with the newly introduced parameterization respectively, to evaluate the temperature and dynamical changes arising from the two different representations of the shortwave radiative transfer. In the simulation with the increased spectral resolution in the radiation parameterization, a significant warming of almost the entire model domain is reported. At the summer stratopause the temperature increase is about 6 K and alleviates the cold bias present in the model when the standard radiation scheme is used. These general circulation model results are consistent both with previous validation of the radiation scheme and with the offline clear-sky comparison performed in the current work with a discrete ordinate 4 stream scattering line by line radiative transfer model. The offline validation shows a substantial reduction of the daily averaged shortwave heating rate bias (1?2 K/day cooling) that occurs for the standard radiation parameterization in the upper stratosphere, present under a range of atmospheric conditions. Therefore, the 6 band shortwave radiation parameterization is considered to be better suited for the representation of the ozone absorption in the stratosphere than the 4 band parameterization. Concerning the dynamical response in the general circulation model, it is found that the reported warming at the summer stratopause induces stronger zonal mean zonal winds in the middle atmosphere. These stronger zonal mean zonal winds thereafter appear to produce a dynamical feedback that results in a dynamical warming (cooling) of the polar winter (summer) mesosphere, caused by an increased downward (upward) circulation in the winter (summer) hemisphere. In addition, the comparison of the two simulations performed with the general circulation model shows that the increase in the spectral resolution of the shortwave radiation and the associated changes in the cloud optical properties result in a warming (0.5?1 K) and moistening (3%?12%) of the upper tropical troposphere. By comparing these modeled differences with previous works, it appears that the reported changes in the solar radiation scheme contribute to improve the model mean temperature also in the troposphere

Comparison of prasugrel and clopidogrel used as antiplatelet medication for endovascular treatment of unruptured intracranial aneurysms: A meta-analysis

BACKGROUND: Clopidogrel is routinely used to decrease ischemic complications during neurointerventional procedures. However, the efficacy may be limited by antiplatelet resistance. PURPOSE: Our aim was to analyze the efficacy of prasugrel compared with clopidogrel in the cerebrovascular field. DATA SOURCES: A systematic search of 2 large databases was performed for studies published from 2000 to 2018. STUDY SELECTION: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we included studies reporting treatment-related outcomes of patients undergoing neurointerventional procedures under prasugrel, and studies comparing prasugrel and clopidogrel. DATA ANALYSIS: Random-effects meta-analysis was used to pool the overall rate of complications, ischemic and hemorrhagic events, and influence of the dose of prasugrel. DATA SYNTHESIS: In the 7 included studies, 682 and 672 unruptured intracranial aneurysms were treated under prasugrel (cases) and clopidogrel (controls), respectively. Low-dose (20 mg/5 mg; loading and maintenance doses) prasugrel compared with the standard dose of clopidogrel (300 mg/75 mg) showed a significant reduction in the complication rate (OR 0.36; 95% CI, 0.17–74, P .006; I2 0%). Overall, the ischemic complication rate was significantly higher in the clopidogrel group (40/672 6%; 95% CI, 3%–13%; I2 83% versus 16/682 2%; 95% CI, 1%–5%; I2 73%; P .03). Low and high loading doses of prasugrel were associated with 0.6% (5/535; 95% CI, 0.1%–1.6%; I2 0%) and 9.3% (13/147; 95% CI, 0.2%–18%; I2 60%) intraperiprocedural hemorrhages, respectively (P .001), whereas low and high maintenance doses of prasugrel were associated with 0% (0/433) and 0.9% (2/249; 95% CI, 0.3%–2%; I2 0%) delayed hemorrhagic events, respectively (P .001). LIMITATIONS: Retrospective series and heterogeneous endovascular treatments were limitations. CONCLUSIONS: In our study, low-dose prasugrel compared with clopidogrel premedication was associated with an effective reduction of the ischemic events with an acceptable rate of hemorrhagic complications

Flow-Diversion Treatment of Unruptured Saccular Anterior Communicating Artery Aneurysms: A Systematic Review and Meta-Analysis

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Down Syndrome: how to communicate the diagnosis

Communicating the diagnosis of Down Syndrome to a couple of parents is never easy, whether before or after birth. As doctors, we must certainly rely on our own relational skills, but it is also necessary to be confident in some general indications, which are often overlooked in the strict hospital routine. This article is intended as a summary of the main articles published on this subject in the international literature, collecting and summarising the most important indications that have emerged in years of medical practice all over the world as well as in our personal experience. The diffusion of these guidelines is essential to help the doctor in this difficult task, on which there is often little training, and above all to guarantee to the parents the least traumatic communication possible

Treatment of Intracranial Aneurysms with Self-Expandable Braided Stents: A Systematic Review and Meta-Analysis

International audience; BACKGROUND:The safety and efficacy of treatment with self-expandable braided stents (LEO and LVIS) required further investigation.PURPOSE:Our aim was to analyze the outcomes after treatment with braided stents.DATA SOURCES:A systematic search of 3 databases was performed for studies published from 2006 to 2017.STUDY SELECTION:According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we included studies reporting patients treated with LEO or LVIS stents.DATA ANALYSIS:Random-effects meta-analysis was used to pool the following: aneurysm occlusion rate, complications, and neurologic outcomes.DATA SYNTHESIS:Thirty-five studies evaluating 1426 patients treated with braided stents were included in this meta-analysis. Successful stent delivery and complete aneurysm occlusion were 97% (1041/1095; 95% CI, 95%-98%) (I2 = 44%) and 88.3% (1097/1256; 95% CI, 85%-91%) (I2 = 72%), respectively. Overall, treatment-related complications were 7.4% (107/1317; 95% CI, 5%-9%) (I2 = 44%). Ischemic/thromboembolic events (48/1324 = 2.4%; 95% CI, 1.5%-3.4%) (I2 = 27%) and in-stent thrombosis (35/1324 = 1.5%; 95% CI, 0.6%-1.7%) (I2 = 0%) were the most common complications. Treatment-related morbidity was 1.5% (30/1324; 95% CI, 0.9%-2%) and was comparable between the LEO and LVIS groups. Complication rates between the anterior (29/322 = 8.8%; 95% CI, 3.4%-12%) (I2 = 41%) versus posterior circulation (10/84 = 10.5%; 95% CI, 4%-16%) (I2 = 0%) and distal (30/303 = 8%; 95% CI, 4.5%-12%) (I2 = 48%) versus proximal aneurysms (14/153 = 9%; 95% CI, 3%-13%) (I2 = 46%) were comparable (P > .05).LIMITATIONS:Limitations were selection and publication biases.CONCLUSIONS:In this analysis, treatment with the LEO and LVIS stents was relatively safe and effective. The most common complications were periprocedural thromboembolisms and in-stent thrombosis. The rate of complications was comparable among anterior and posterior circulation aneurysms, as well as for proximal and distally located lesions

Kaluza-Klein gauge and minimal integrable extension of OSp(4|6)/(SO(1,3) x U(3)) sigma-model

Basing upon experience from performing double-dimensional reduction of the D=11 supermembrane on AdS_4 x S^7 background to Type IIA superstring on AdS_4 x CP^3 we introduce Kaluza-Klein (partial) kappa-symmetry gauge as a vanishing condition of the contribution to the D=11 supervielbein components tangent to D=10 space-time proportional to the differential of the coordinate parametrizing compact 11-th space-time dimension, that is identified with the supermembrane world-volume compact dimension. For AdS_4 x S^7 supermembrane Kaluza-Klein gauge removes half Grassmann coordinates associated with 8 space-time supersymmetries, broken by the AdS_4 x CP^3 superbackground, by imposing D=3 (anti-)Majorana condition on them. The consideration relies on the realization of osp(4|8) isometry superalgebra of the AdS_4 x S^7 superbackground as D=3 N=8 superconformal algebra. Requiring further vanishing of the D=10 dilaton leaves in the sector of broken supersymmetries just two Grassmann coordinates organized into D=3 (anti-)Majorana spinor that defines minimal SL(2,R)-covariant extension of the OSp(4|6)/(SO(1,3)x U(3)) sigma-model. Among 4 possibilities of such a minimal extension we consider in detail one, that corresponds to picking out D=3 Majorana coordinate related to broken Poincare supersymmetry, and show that the AdS_4 x CP^3 superstring equations of motion in this partial kappa-symmetry gauge are integrable. Also the relation between the OSp(4|6)/(SO(1,3) x U(3)) sigma-model and the AdS_4 x CP^3 superstring is revisited.Comment: LaTeX, 22 pages; v2: minor improvements in the text, typos corrected, references adde