Automated Morphometric Analysis of in-vivo Human Corneal Endothelium

In-vivo specular and confocal microscopy provide information on the corneal endothelium health state. The reliable estimation of the clinical parameters requires the accurate detection of cell contours. We propose a method for the automatic segmentation of cell contour. The centers of the cells are detected by convolving the original image with Laplacian of Gaussian kernels, whose scales are set according to the cell size preliminary estimated through a frequency analysis. A structure made by connected vertices is derived from the centers, and it is fine-tuned by combining information about the typical regularity of endothelial cells shape with the pixels intensity of the actual image. Ground truth values for the clinical parameters were obtained from manually drawn cell contours. An accurate automatic estimation is achieved on 30 images: for each clinical parameter, the mean difference between its manual estimation and the automated one is always less than 7%

Levels of burn-out among healthcare workers during the COVID-19 pandemic and their associated factors: a cross-sectional study in a tertiary hospital of a highly burdened area of north-east Italy

Objective: To determine burn-out levels and associated factors among healthcare personnel working in a tertiary hospital of a highly burdened area of north-east Italy during the COVID-19 pandemic. Design: Observational study conducted from 21 April to 6 May 2020 using a web-based questionnaire. Setting: Research conducted in the Verona University Hospital (Veneto, Italy). Participants: Out of 2195 eligible participants, 1961 healthcare workers with the full range of professional profiles (89.3%) completed the survey. Primary outcome measure: Levels of burn-out, assessed by the Maslach Burnout Inventory-General Survey (MBI-GS). Multivariable logistic regression analysis was performed to identify factors associated with burn-out in each MBI-GS dimension (emotional exhaustion, EX; professional efficacy, EF; cynicism, CY). Results: Overall, 38.3% displayed high EX, 46.5% low EF and 26.5% high CY. Burn-out was frequent among staff working in intensive care units (EX 57.0%; EF 47.8%; CY 40.1%), and among residents (EX 34.9%; EF 63.9%; CY 33.4%) and nurses (EX 49.2%; EF 46.9%; CY 29.7%). Being a resident increased the risk of burn-out (by nearly 2.5 times) in all the three MBI subscales and being a nurse increased the risk of burn-out in the EX dimension in comparison to physicians. Healthcare staff directly engaged with patients with COVID-19 showed more EX and CY than those working in non-COVID wards. Finally, the risk of burn-out was higher in staff showing pre-existing psychological problems, in those having experienced a COVID-related traumatic event and in those having experienced interpersonal avoidance in the workplace and personal life. Conclusions: Burn-out represents a great concern for healthcare staff working in a large tertiary hospital during the COVID-19 pandemic and its impact is more burdensome for front-line junior physicians. This study underlines the need to carefully address psychological well-being of healthcare workers to prevent the increase of burn-out in the event of a new COVID-19 healthcare emergency

Repurposing Tempeh Fermentation: a Promising Protein Source Using Food Residues and Edible Filamentous Fungi

Brewers' spent grains (BSG) are the main by-product of the brewery industry, accounting for more than 80 % of total produced by-products. Although this matrix is primarily composed of hemicellulose, cellulose, protein and lignin, the current end-of-life scenario for BSG is as livestock feed. In the present study, a valorisation approach for BSG that uses an edible fungus (Rhizopus oligosporus) in solid state fermentations (SSF) is proposed. First, a microbiological characterization is performed, to shed light on the indigenous microorganisms that are present in the BSG matrix. Then, an appropriate technology approach is used for the SSF that can be conducted both at laboratory and household levels. In the SSF experiments, different temperature (30-35 °C), mass of BSG substrate, inoculum ratio (10 and 15 % v/m) and drilling patters for the aeration of the systems are investigated. The fermentation products were characterized by preparing homogenized samples; it was registered an increase in protein content (5-64%), a slight acidification (ΔpH=0.1-1.2), a decrease of °Brix and the loss of organic matter (and water). The formation of the tempeh cakes was variable, and the differences are analyzed in terms of the operational parameters of each studied batch

Supported employment for people with severe mental illness: a pilot study of an Italian social enterprise with a special ingredient

Background: People with mental disorders are far more likely to be unemployed than the general population. Two internationally recognized, evidence-based models of interventions for employment for people with severe mental health problems are Individual Placement Support and the Clubhouse. In Italy, a common model is the 'social enterprise' (SE), which is a programme run by non-profit organisations that help individuals with disabilities to be employed. Despite SEs spread and relevance in Italy, there are no studies about Italian samples. This paper reports on a pilot evaluation of psychosocial and work outcomes of a SE based in Verona, Italy. The study aims to investigate if people with SMI involved in SE job placements may achieve personal recovery and better outcomes over time, and in comparison with a comparable group of users. Methods: This is a pilot descriptive study with three components. A longitudinal design that comprised a functioning description of 33 SE members with a psychiatric disability in two time-points (when they joined the SE-on average 5 years before the study recruitment, and at the study recruitment-year 2018); and a repeated collection of job details of the 33 members in three time points: 2 years before the recruitment,-year 2016; 1 year before the recruitment - year 2017; and at the recruitment-year 2018. An assessment at the recruitment time-year 2018, of SE users' satisfaction with the job placement, symptoms, functioning, and quality of life (QoL). A cross-sectional study that compared the 33 SE members at the recruitment time-year 2018, with a matched group of people with the following criteria: living in local supported accommodations, being unemployed and not SE members. The two groups were compared on ratings of psychopathology, functioning, and QoL. Descriptive analyses were done. Results: At the recruitment time - year 2018, all SE participants showed a significant better functioning (p < 0.001) than when they joined the SE-when they had been employed for an average of 5 years. In comparison to the matched group, SE members had significantly better functioning (p = 0.001), psychopathology (p = 0.007), and QoL (p = 0.034). According to their SE membership status, participants comprised trainees (21.2%) and employee members (78.8%). Trainees compared to employees had lower autonomies, functioning, QoL and more severe psychopathology. Over the two years prior to study recruitment, trainees showed stable poor autonomies, while employee members showed a variation from average autonomies in the 2 years before the recruitment time - year 2016, to good ones at the recruitment time - year 2018. Over the two years, all SE members set increasing numbers of objectives in all three domains. All SE participants reported high levels of satisfaction with all aspects of the job placement. Conclusions: SE that provides tailored support to assist people to gain employment skills may be an effective component in helping recovery from SMI

Measurements of Protein Content in Aqueous and Alkaline Extracts from Brewer's Spent Grains (bsg): Insights Into the Extraction Kinetics and Energy Consumption

The brewers’ spent grain (BSG) is a rich biomass matrix containing several compounds of interest that require urgent and suitable valorisation strategies, due to its high production volume in the brewing industry. Among the most widespread approaches is the preparation of extracts, targeting particular compounds or soluble and/or insoluble fractions, after operating pre-treatment processes. In the present study, extraction experiments are carried out with fresh untreated BSG, under very gentle extraction conditions (room temperature and moderate agitation, in the 0-5 h interval), and using different solvents: deionized water, 0.1 M NaOH and 0.5 M NaOH in a 1:5 m/v solid-to-solvent ratio. The extraction dynamics were followed by monitoring the dry matter (DM) content obtained in the extracts after a centrifugation step. The protein content is estimated in each case by means of two different methods: direct measurements of absorbance at 280 nm (using bovine serum albumin, BSA, and commercial whey protein isolate as standards) as well as using the Bradford colorimetric method and BSA standard; the consistency of these measurements is contrasted against the DM values. The apparent extraction kinetics were studied, using a saturation model; the coefficients and their range of uncertainty were obtained. Extraction efficiencies in the range 14.24%-53.60% gDM ext/gDM BSG are achieved, which correspond to extraction yields of 38.88-150.09 gDM ext/kg fresh BSG. In addition, the energy footprint of the process is estimated at laboratory scale

Tourists’ Preferences for Alpine Pastures Maintenance

Traditional extensive agriculture is the main factor of landscape management in the mountains: a large part of the Alps is modelled by agriculture. Interpreted as a multifunctional activity, including landscape modelling and maintenance, agriculture generates the conditions under which mountain pasture landscape is an economic resource potentially exploitable by tourism. The aim of this work is to draw the profiles of tourists of mountain pastures and to estimate their Willingness to Pay (WTP)for landscape pastures resilience. The innovation of this work lies in the use of a multivariate approach using Contingent Valuation Method (CVM), Multiple Correspondence Analysis (MCA) and Hierarchical Cluster Analysis (HCA). The analysis obtained three clusters that identify different tourists’ profiles. The main result is the existence of a positive WTP for the permanence of pasture systems with an agricultural management. Policy guidelines have been proposed to institutions owning pastures and huts to manage these assets

Exploring gender impact on collaborative care planning: insights from a community mental health service study in Italy

Introduction: Personal recovery is associated with socio-demographic and clinical factors, and gender seems to influence the recovery process. This study aimed to investigate: i) differences in the recovery goals of men and women users of a community mental health service in Italy; ii) any differences by gender in recovery over six months using the Mental Health Recovery Star (MHRS). Methods: Service users and staff completed the MHRS together at recruitment and six months later to agree the recovery goals they wished to focus on. Socio-demographic and clinical characteristics and ratings of symptoms (BPRS), needs (CAN), functioning (FPS), and functional autonomy (MPR) were collected at recruitment and six months follow-up. Comparisons between men and women were made using t-tests. Results: Ten women and 15 men completed the MHRS with 19 mental health professionals. Other than gender, men and women had similar socio-demographic, and clinical characteristics at recruitment. Women tended to choose recovery goals that focused on relationships whereas men tended to focus on work related goals. At follow-up, both men and women showed improvement in their recovery (MHRS) and women were less likely to focus on relationship related goals, perhaps because some had found romantic partners. There were also gains for both men and women in engagement with work related activities. Ratings of functional autonomy (MPR) improved for both men and women, and men also showed improvement in symptoms (BPRS) and functioning (FPS). Conclusions: Our findings suggest that collaborative care planning tools such as the MHRS can assist in identifying individualized recovery goals for men and women with severe mental health problems as part of their rehabilitation

Development and validation of a new standardized measure for assessing experiences of discrimination within mental health services. A participatory research project

Aims: People with mental disorders frequently report experiences of discrimination within mental health services, which can have significant detrimental effects on individuals' well-being and recovery. This study aimed to develop and validate a new standardized measure aiming to assess experiences of stigmatization among people with mental disorders within mental health services. Methods: The scale was developed in Italian and tested for ease of use, comprehension, acceptability, relevance of items and response options within focus group session. A cross-sectional validation survey was conducted among mental health service users in Italy. Exploratory factor analysis with Promax oblique rotation, the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy and the Bartlett's test of sphericity were used to assess the suitability of the sample for factor analysis. Reliability was assessed as internal consistency using Cronbach's alpha and as test-retest reliability using weighted kappa and intraclass correlation coefficient (ICC). Precision was examined by Kendall's tau-b coefficient. Results: Overall, 240 people with mental disorders participated in the study; 56 also completed the retest evaluation after 2 weeks. The 18 items of the scale converged over a two-factor solution ('Dignity violation and personhood devaluation' and 'Perceived life restrictions and social exclusion'), accounting for 56.4% of the variance (KMO 0.903; Bartlett's test p < 0.001). Cronbach's alpha for the total score was 0.934. The scale showed one item with kappa above 0.81, four items between 0.61 and 0.80, ten items between 0.41 and 0.60, two items between 0.21 and 0.40 and only one item below 0.20. ICC was 0.928 (95% CI 0.877-0.958). Kendall's tau-b ranged from 0.450 to 0.617 (p < 0.001). Conclusions: The newly developed scale represents a valid and reliable measure for assessing experiences of stigma among patients receiving care within mental health services. The scale has provided initial evidence of being specifically tailored for individuals with psychotic and bipolar disorders. However, the factorial structure of the scale should be replicated through a confirmatory factor analysis on a larger sample of individuals with these conditions

Childhood and adulthood severe stressful experiences and biomarkers related to glucose metabolism: a possible association?

Background: No study investigated the association between stress exposure in different stages of life and metabolic dysfunction.Aim: We explore the association between stress exposure and several biomarkers related to glucose metabolism (insulin, c-peptide, GIP, GLP-1, glucagon) in a group of 72 healthy individuals.Method: We used the Childhood Experience of Care and Abuse-Questionnaire (CECA-Q) and a modified version of the Life Events Scale to define exposure to stress, according to four categories: no exposure to childhood trauma (CT) nor to stressful life events (SLEs) (46%), only to CT (25%), only to SLEs (21%), to both (8%).Results: We found that c-peptide (p = 0.006) and insulin (p = 0.002) levels differed among the four categories: 0.77 ng/ml (SD 0.27) and 0.21 ng/ml (SD 0.06) for none, 0.77 (SD 0.37) and 0.20 (SD 0.08) for only SLEs, 0.88 (SD 0.39) and 0.27 (SD 0.12) for only CT, 1.33 (SD 0.57) and 0.40 (SD 0.28) for both, respectively. The highest levels of biomarkers were found in subjects exposed to both CT and SLEs.Conclusion: Our preliminary results seem to suggest that CT might be specifically associated with a dysfunction of glucose metabolism, which might increase the risk of poorer health outcomes in adulthood. This association seems to be even stronger in individuals additionally exposed to SLEs in adulthood. In conclusion, if confirmed in other studies, subjects exposed to both CT and SLEs appear the most vulnerable individuals, for whom preventative interventions, such as healthy lifestyle education programs, might ameliorate the risk of developing metabolic abnormalities