Organización y desincronización de los ritmos circadianos en enfermeras y matronas italianas: actividades sociales y laborales

INTRODUCTION: Biological rhythms are present in all living organisms. The circadian rhythm (from the latin circa dies), with a duration of approximately 24 hours, is the most commonly studied in human beings. Biological rhythms are characterized by multiple molecular mechanisms aiming at synchronization and adaptation of organism to the temporal variations of environment. The circadian individual preference (chronotype) represents the phenotypic manifestation of such a complex mechanism, in many behavioral and daily living aspects. As far the late 70’s of the last century, Horne and Ostberg identified individual differences in circadian attitudes and defined different chronotypes by means of a self-assessed questionnaires with a defined score. Belonging to a defined chronotype seems to have an impact on everydays activities including working. On the other hand, the biological circadian rhythms could be disrupted by everydays activities leading to desynchronization. It has been reported two main types of desynchronization: fast (jet lag) and slow (shift work). Recently, also tlso the change due to Daylight Saving Time (DST) has been identified as a desynchronizing condition with possible negative impact on health. Thus, the starting hypothesis of this doctoral thesis is that social and working activities and chronotype may be closely related, and desynchronization, eg, shift work and DST, should be taken into consideration in Italian midwives. OBJECTIVES: General To determine the effect of chronotype and desynchronization of circadian rhythms (shift work and DST) on social and working activities in Italian midwives. Specific - To assess individual circadian preferences, effects on sleep, and quality of life perceived by midwives. - To determine the effect of the chronotype on social and working activities. - To evaluate the association between the biannual DST and labor activity. - To determine the effect of shift work and the time change on social and work activities. MATERIAL AND METHODS: Two approaches were used: a) Observational study: by the use of validated questionnaires administered through social networks, registered midwives belonging to the Italian Board of Nursing of Midwifery were investigated during 2019. The variables evaluated were individual circadian preference, work shift, working experience, fear of medication errors and sociodemographic, such as age and educational level. A cluster analysis was carried out to know the association between variables. b) Retrospective case-control study using administrative databases: the certificates of attendance at birth generated during the period 2016-2018 in the Region of Emilia-Romagna of Italy were considered. The number of spontaneous deliveries two weeks before (control) and after DST (cases) were analyzed. Further variables, such as gestational age, type of delivery, delivery time, newborn’s weight, Apgar test 5 minutes after delivery, and the use of analgesia during delivery, were evaluated. Univariate and multivariate analyses (logistic regression analysis) were carried out. RESULTS: In the first part of the work, 401 midwives (98.8% women) were enrolled. The mean age was 38.5 }10.1 years and the most common chronotypes were intermediate (50.3%) and moderately morning (39%). Nearly fifty percent of cases self-perceived risk of medication error “at least once”. Perception of risk of medication error was associated with midwifes aged between 31-35 years, undergoing shift work, with a working experience between 6-10 years, and having an intermediate chronotype. In the second study, 7415 spontaneous deliveries were evaluated, the mean age of the women was 31.4 } 10.1 years, and gestational age 39.3 } 1.4 weeks. No significant differences were found between the number of deliveries before and after DST. There were no significant differences for the mode of delivery, gestational age and the number of spontaneous deliveries. Gestational time, newborn weight, Apgar test 5 minutes after delivery, and use of analgesia did not show statistical significance as well. Mother’s age was the only variable found to be independently associated with delivery during the two weeks after DST. CONCLUSIONS The chronotype and shift work in Italian midwives influence professional self-perception, specifically the perception of risk of medication error. Younger midwives, with lower working experience, engaged in shift work and belonging to an Intermediate chronotype, seem to be at higher risk of potential medication error. Morning hours seem to represent highest risk frame for female healthcare workers and shift work is not always aligned with individual circadian preference. Thus, some suggested practical applications could include, for example, assessment of individual chronotype and sleep attitude in healthcare personnel, specific training programs, and intervention strategies, such as time-scheduled naps during night-shifts. As for the potential rhythm disruption operated by DST, the present study did not find any differences in the number of deliveries in the weeks following time shifts. This finding is in agreement with previous data obtained at quite different conditions of latitude, climate, and light exposure. It is possible that the multihormonal etiology of labor may explain this phenomenon. Further studies extended to different latitudes and ethnicities, could be very useful to verify the possibility of a generalization.INTRODUCCIÓN: Los ritmos biológicos están presentes en todos los organismos vivos. El ritmo circadiano (del latín circa dies), con una duración aproximada de 24 horas, es el más estudiado en seres humanos. Los ritmos biológicos se caracterizan por múltiples mecanismos moleculares que se encargan de la sincronización y adaptación del organismo a las variaciones temporales del entorno. La preferencia individual circadiana (cronotipo) representa la manifestación fenotípica, de un mecanismo tan complejo, en muchos aspectos conductuales y de la vida diaria. Ya a finales de la década de los 70 del siglo pasado, Horne y Ostberg identificaron diferencias individuales en las actitudes circadianas y definieron diferentes cronotipos mediante cuestionarios autoevaluados con una puntuación definida. La pertenencia a un cronotipo definido parece tener un impacto en las actividades cotidianas, incluido el trabajo. Por otro lado, los ritmos circadianos biológicos podrían verse interrumpidos por las actividades cotidianas que conducen a la desincronización. Se ha informado de dos tipos principales de desincronización: rápida (jet lag) y lenta (trabajo por turnos). Recientemente, también se ha identificado el cambio debido al horario de verano o Daylight Saving Time (DST) como una condición desincronizante con posible impacto negativo en la salud. Por tanto, la hipótesis de partida de la presente tesis doctoral es que las actividades sociales y laborales y el cronotipo pueden estar estrechamente relacionados, y la desincronización, por ejemplo, el trabajo por turnos y el horario de verano, debe tenerse en cuenta en las matronas italianas. OBJETIVOS: General: Determinar el efecto del cronotipo y la desincronización de los ritmos circadianos (trabajo por turnos y DST) sobre las actividades sociales y laborales de las matronas italianas. Específicos: - Evaluar las preferencias circadianas individuales, los efectos sobre el sueño y la calidad de vida percibida por las parteras. - Determinar el efecto del cronotipo en las actividades sociales y laborales. - Evaluar la asociación entre DST y la actividad laboral. - Determinar el efecto del trabajo por turnos y DST en las actividades sociolaborales. MATERIAL Y MÉTODOS: Se emplearon dos enfoques: a) Estudio observacional empleando cuestionarios validados a través de redes sociales, durante el año 2019. Los sujetos de estudios fueron matronas colegiadas en la Italian Board of Nursing and Midwifery. Las variables estudiadas fueron la preferencia circadiana individual, así como datos laborales (turno de trabajo, experiencia laboral, presencia de errores de medicación) y sociodemográficos (edad, nivel de estudios, sexo). Se llevo a cabo un análisis por clúster para conocer la asociación entre variables. b) Estudio caso-control retrospectivo empleando bases de datos administrativas, concretamente los certificados de asistencia al parto generados durante el periodo 2016-2018 en la Región de Emilia- Romagna, Italia. Se analizo el número de partos espontáneos 2 semanas antes (control) y después del DST (casos). También se analizaron otras variables secundarias como la edad gestacional, tipo de parto, tiempo de parto, peso del recién nacido, test de Apgar a los 5 minutos del parto y el uso de analgesia durante el parto. Se llevo a cabo un análisis univariante y multivariante (análisis de regresión logística). RESULTADOS: En la primera parte del trabajo, participaron 401 matronas (98,8% mujeres), con una edad media de 38,5 }10,1 años y siendo los cronotipos más comunes los intermedios (50.3 %) y moderadamente matutinos (39%). El 48.1% de los casos auto percibían que habían tenido “al menos una vez” riesgo de error de medicación. La percepción de riesgo de error de medicación se asoció con profesionales con una edad entre 31-35 años, que trabajaban a turnos, con una experiencia laboral entre 6-10 años, y un cronotipo intermedio. Por otra parte, en el segundo enfoque, se evaluaron 7415 partos espontáneos, siendo la edad media de las mujeres de 31,4 }10,1 años, con una edad gestacinal de 39,3 }1,4 semanas y siendo el 64,7% italianas. No se encontraron diferencias significativas entre el número de partos antes y después del DST. No hubo diferencias significativas para el modo de parto, edad gestacional y el número de partos espontáneos. El tiempo gestacional, peso del recién nacido, test de Apgar a os 5 minutos del parto y uso de analgesia tampoco mostraron una significación estadística. La única variable que se asociaba independientemente con el parto durante las dos semanas posteriores al DST fue la edad de la madre. CONCLUSIONES: El cronotipo y el trabajo a turnos en las matronas italianas influyen en el ámbito laboral, concretamente en la percepción de riesgo de error de medicación. Las matronas más jóvenes, con menor experiencia laboral, que realizan trabajo por turnos y pertenecen a un cronotipo intermedio, parecen tener un mayor riesgo potencial de error de medicación. Las horas de la mañana parecen representar el periodo de mayor riesgo para las trabajadoras de la salud y el trabajo por turnos no siempre está alineado con la preferencia circadiana individual. Por tanto, algunas aplicaciones prácticas sugeridas podrían incluir, por ejemplo, la evaluación del cronotipo individual y patrón del sueño en el personal sanitario, programas de formación específicos y estrategias de intervención, como las siestas programadas durante los turnos de noche. En cuanto a la posible alteración del ritmo operada por DST, no se encontraron diferencias en el número de partos en las semanas posteriores al cambio de hora. Este hallazgo está de acuerdo con datos anteriores obtenidos en condiciones bastante diferentes de latitud, clima y exposición a la luz. Es posible que la etiología multihormonal del trabajo de parto pueda explicar este fenómeno. Otros estudios extendidos a diferentes latitudes y etnias podrían ser útiles para la generalización de los hallazgos encontrados

Kinematic and Spatiotemporal Analysis Between Sprint Drills and Maximal Sprinting

Purpose: To determine if any kinematic differences exist between two common sprint drills (A- and B-drills) and maximal sprinting. Methods: 12 collegiate sprinters (19.17±1.11 y/o) granted informed consent were filmed performing two 40-meter sprints, A-skips, and B-skips. Three-dimensional motion analysis tracked the coordinates of 24 reflective markers and resulting joint kinematics were computed. Results: Statistical analysis revealed that sprinting yielded a significantly lower maximum hip flexion (p=0.015) but a significantly higher minimum ankle angular velocity (p=0.012) and step rate (p=0.000) value than A-drills. When compared to B-drills, sprinting values were significantly lower in maximum hip flexion (p=0.047), minimum knee flexion (p=0.043), and maximum hip angular velocity (p=0.006), but significantly higher in minimum ankle angular velocity (p=0.018) and step rate (p=0.000). Experienced sprinters had a significantly greater maximum plantar-flexion in sprinting (p=0.031) and minimum knee flexion in A-drills (p=0.030) than inexperienced sprinters. Inexperienced sprinters had a significantly greater plantar-flexion in A-drills (p=0.026) and B-drills (p=0.046), B-drill maximum knee flexion (p=0.016), maximum ankle angular velocity (p=0.024), and minimum knee angular velocity (p=0.048) than experienced sprinters. Conclusion: Since several kinematic differences exist between two common sprint drills as compared to maximal sprinting, efficacy of their uses is questioned

Can wastewater treatment plants cope with future nanoparticle loading scenarios?

The increased production and utilization of nanomaterials has brought significant advantages and developments in many sectors. The application of nanoparticles (NPs), however, comes with the challenge of their growing release into wastewater streams which could eventually enter the natural environment. Exposure to NPs can lead to a wide range of chronic and acute toxic effects on living organisms. These may vary from DNA damages, impairment of metabolic functions, organ injuries and ultimately death. Furthermore, NPs can also interact with other chemical substances. This has the potential to affect their behaviour and, in some cases, increase the toxicity of the generated NPs – chemicals mixtures. The presence and toxicology of NPs in conventional wastewater treatment plants has received increasing attention, attempting to understand their transport through, and impact on, wastewater treatments systems. While these efforts have largely focused on single NP types and concentrations equal to or below the predicted environmental concentrations, few attempts have investigated NP mixture scenarios as well extremely high NP concentrations. Further investigation into high concentration scenarios are needed due to the likely increase in NP use and therefore release into wastewater in the future. Moreover, further examination of NP removal in mixed NP systems is needed as most wastewaters will contain a mixture of NPs. In addition, the time dependent removal profile of NPs in wastewater secondary treatments has largely been ignored, with most studies focussing on the single endpoint of NP bulk removal. These current gaps indicate that we are poorly prepared to deal with nanoparticle pollution. Extreme NP release events can occur in case of accidents, unregulated discharge, and these spike events are of great concern for water and wastewater companies. The main aim of this PhD was to assess whether conventional and emerging secondary biological treatments can remove single and NP mixtures from wastewater and hence prevent their release into receiving water bodies. Firstly, a range of protocols for processing and analysing NPs were examined to determine the most effective. From this, NP determination was achieved via development and validation of a single analytical method based on microwave assisted acid digestion followed by inductively coupled plasma optical emission spectroscopy (IPC-OES). The results demonstrated the robustness of the method to quantify single and, most importantly, NP mixtures in aqueous solutions. The removal of NPs was studied as a function of NP type, concentration, time and bacteria nature. Activated (aerobic) and granular (anaerobic) sludge microorganisms were used to treat wastewater spiked with nano sized copper oxide (CuO), titanium dioxide (TiO2) and zinc oxide (ZnO). NPs – bacteria experiments prove that wastewater biological treatments can reduce NP release into the environment. Overall, activated sludge had greater efficiency than anaerobic granules. Activated sludge yielded NP removal greater than 90% in most of the experimental conditions tested within 180 minutes. However, the treatment efficacy was reduced at high NP mixture concentration. The presence of anaerobic granules could remove up to 70% of the NPs present in wastewater. However, these microorganisms did not seem to suffer reduction of removal performances in a NP concentration dependent manner. The effects of natural secondary wastewater liquor on NP behaviour were also assessed. Results show that primary treated wastewater liquor has the potential to stabilize NPs and hence reduce their removal due to aggregation driven sedimentation. The research presented here highlights the importance of the presence of biologically mediated secondary treatments to cope with the increasing occurrence of NPs in wastewater. The results indicate that microorganisms are an effective tool to remove NPs from sewage and therefore protect the natural aquatic environment. These findings hold implications for the fate and transport of nanoparticles through environmental systems and wastewater treatment plants.The increased production and utilization of nanomaterials has brought significant advantages and developments in many sectors. The application of nanoparticles (NPs), however, comes with the challenge of their growing release into wastewater streams which could eventually enter the natural environment. Exposure to NPs can lead to a wide range of chronic and acute toxic effects on living organisms. These may vary from DNA damages, impairment of metabolic functions, organ injuries and ultimately death. Furthermore, NPs can also interact with other chemical substances. This has the potential to affect their behaviour and, in some cases, increase the toxicity of the generated NPs – chemicals mixtures. The presence and toxicology of NPs in conventional wastewater treatment plants has received increasing attention, attempting to understand their transport through, and impact on, wastewater treatments systems. While these efforts have largely focused on single NP types and concentrations equal to or below the predicted environmental concentrations, few attempts have investigated NP mixture scenarios as well extremely high NP concentrations. Further investigation into high concentration scenarios are needed due to the likely increase in NP use and therefore release into wastewater in the future. Moreover, further examination of NP removal in mixed NP systems is needed as most wastewaters will contain a mixture of NPs. In addition, the time dependent removal profile of NPs in wastewater secondary treatments has largely been ignored, with most studies focussing on the single endpoint of NP bulk removal. These current gaps indicate that we are poorly prepared to deal with nanoparticle pollution. Extreme NP release events can occur in case of accidents, unregulated discharge, and these spike events are of great concern for water and wastewater companies. The main aim of this PhD was to assess whether conventional and emerging secondary biological treatments can remove single and NP mixtures from wastewater and hence prevent their release into receiving water bodies. Firstly, a range of protocols for processing and analysing NPs were examined to determine the most effective. From this, NP determination was achieved via development and validation of a single analytical method based on microwave assisted acid digestion followed by inductively coupled plasma optical emission spectroscopy (IPC-OES). The results demonstrated the robustness of the method to quantify single and, most importantly, NP mixtures in aqueous solutions. The removal of NPs was studied as a function of NP type, concentration, time and bacteria nature. Activated (aerobic) and granular (anaerobic) sludge microorganisms were used to treat wastewater spiked with nano sized copper oxide (CuO), titanium dioxide (TiO2) and zinc oxide (ZnO). NPs – bacteria experiments prove that wastewater biological treatments can reduce NP release into the environment. Overall, activated sludge had greater efficiency than anaerobic granules. Activated sludge yielded NP removal greater than 90% in most of the experimental conditions tested within 180 minutes. However, the treatment efficacy was reduced at high NP mixture concentration. The presence of anaerobic granules could remove up to 70% of the NPs present in wastewater. However, these microorganisms did not seem to suffer reduction of removal performances in a NP concentration dependent manner. The effects of natural secondary wastewater liquor on NP behaviour were also assessed. Results show that primary treated wastewater liquor has the potential to stabilize NPs and hence reduce their removal due to aggregation driven sedimentation. The research presented here highlights the importance of the presence of biologically mediated secondary treatments to cope with the increasing occurrence of NPs in wastewater. The results indicate that microorganisms are an effective tool to remove NPs from sewage and therefore protect the natural aquatic environment. These findings hold implications for the fate and transport of nanoparticles through environmental systems and wastewater treatment plants

Arbitration in the Settlement of Jurisdictional Disputes.

Abstract Forthcoming

Host–Guest Complex of β-Cyclodextrin and Disulfide Form of 4-Aminothiophenol

An inclusion complex of β-cyclodextrin and 4-aminothiophenol was assembled by hydrophobic interaction of the host (β-cyclodextrin) and guest (4-aminothiophenol). The complex was isolated as crystalline solid and studied by single crystal X-ray diffraction method along with NMR and IR spectroscopy. Two cyclodextrin rings each containing one disulfide form of 4-aminothiophenol were found to pair up by hydrogen bonding of the outer rim -OH groups. The phenyl disulfide moiety of 4-aminophenyl disulfide molecule was found in the core of β-cyclodextrin, while the amino functional groups were positioned to the exterior of the cyclodextrin ring. Phenyl rings of the guest molecule from each partner of the paired cyclodextrin complex were found parallel to each other, indicating possible π-π stacking interaction between them

Geothermal Power: Factors affecting the performance of Binary Plants

A meta-study is conducted investigating the effect of plant parameters on the power output and efficiency of geothermal binary cycle power plants. Production well depth, geofluid temperature and mass flow rate are the parameters considered. An increase in mass flow rate is shown to increase both power output and efficiency. It is shown that a distinction can be made between two basic types of binary plants based off of mass flow and performance data. The well depth is shown to have no effect on plant performance. In addition, condenser parameters were investigated and the highest efficiency condenser system is determined

Las imágenes en los procesos de enseñanza en el nivel superior

El uso de imágenes en los procesos de enseñanza nos convoca a analizar los propósitos pedagógico- didácticos en torno a su inclusión dentro de los procesos de alfabetización visual que el mundo contemporáneo resignifica permanentemente. Nos orientamos a focalizar sobre las demandas cognitivas que se inauguran desde la propuesta docente en torno a las imágenes dentro del nivel superior, concebidas como instrumento de mediación que contribuye a la construcción de saberes por parte de los/as estudiantes. Aspiramos a explicitar brevemente alguna de las hipótesis interpretativas preliminares en torno a las nuevas alfabetizaciones en la enseñanza de las ciencias sociales, tales conjeturas son construidas a partir de un proceso de investigación en curso que indaga el uso de los medios digitales en el nivel.Especialización en Docencia Universitari

Taking care of systemic sclerosis patients during COVID-19 pandemic : rethink the clinical activity

COVID-19 outbreak has quickly spread worldwide, causing a high pressure on the health-care system. In Italy, from March 8, 2020, all the deferrable clinical activities have been suspended to increase the health care offer for COVID-19 patients. The hospital organization has been modified also in order to assure non-COVID-19 patients assistance. The Scleroderma Unit of ASST Pini-CTO Hospital, in Milan, in the region mostly hit by SARS-CoV-2 in Italy, follows more than 600 patients affected by systemic sclerosis (SSc). Patients with SSc need a close follow-up with a regular screening of organ involvement and frequent intravenous treatments. All SSc patients have been educated about ministerial directives to limit COVID-19 spread. The organization of our Scleroderma Unit has been quickly rethought to assure SSc patients assistance in safety for them and for health-care workers during urgent visits or infusion therapies. Using electronic way of communication with frequent virtual contact and guarantying home deliveries of some therapies, we allowed a continuity of care also outside the Hospital

SARS-CoV-2 pandemic: An overview

By the end of May 2020, SARS-CoV-2 pandemic caused more than 350,000 deaths worldwide. In the first months, there have been uncertainties on almost any area: infection transmission route, virus origin and persistence in the environment, diagnostic tests, therapeutic approach, high-risk subjects, lethality, and containment policies. We provide an updated summary of the current knowledge on the pandemic, discussing the available evidence on the effectiveness of the adopted mitigation strategies