Experimental support of the scaling rule for demographic stochasticity

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73613/1/j.1461-0248.2006.00903.x.pd

Severe asthma: One disease and multiple definitions

Introduction: There is, so far, no universal definition of severe asthma. This definition usually relies on: number of exacerbations, inhaled therapy, need for oral corticosteroids, and respiratory function. The use of such parameters varies in the different definitions used. Thus, according to the parameters chosen, each patient may result in having severe asthma or not. The aim of this study was to evaluate how the choice of a specific definition of severe asthma can change the allocation of patients. Methods: Data collected from the Severe Asthma Network Italy (SANI) registry were analyzed. All the patients included were then reclassified according to the definitions of U-BIOPRED, NICE, WHO, ATS/ERS, GINA, ENFUMOSA, and TENOR. Results: 540 patients, were extracted from the SANI database. We observed that 462 (86%) met the ATS/ERS criteria as well as the GINA criteria, 259 (48%) the U-Biopred, 222 (41%) the NICE, 125 (23%) the WHO, 313 (58%) the Enfumosa, and 251 (46%) the TENOR criteria. The mean eosinophil value were similar in the ATS/ERS, U-Biopred, and Enfumosa (528, 532 and 516 cells/mcl), higher in WHO and Tenor (567 and 570 cells/mcl) and much higher in the NICE classification (624 cells/mcl). Lung function tests resulted similarly in all groups, with WHO (67%) and ATS/ERS-GINA (73%), respectively, showing the lower and upper mean FEV1 values. Conclusions: The present observations clearly evidence the heterogeneity in the distribution of patients when different definitions of severe asthma are used. However, the recent definition of severe asthma, provided by the GINA document, is similar to that indicated in 2014 by ATS/ERS, allowing mirror reclassification of the patients examined. This lack of homogeneity could complicate the access to biological therapies. The definition provided by the GINA document, which reflects what suggested by ATS/ERS, could partially overcome the problem

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Severe asthma: One disease and multiple definitions

123noopenIntroduction: There is, so far, no universal definition of severe asthma. This definition usually relies on: number of exacerbations, inhaled therapy, need for oral corticosteroids, and respiratory function. The use of such parameters varies in the different definitions used. Thus, according to the parameters chosen, each patient may result in having severe asthma or not. The aim of this study was to evaluate how the choice of a specific definition of severe asthma can change the allocation of patients. Methods: Data collected from the Severe Asthma Network Italy (SANI) registry were analyzed. All the patients included were then reclassified according to the definitions of U-BIOPRED, NICE, WHO, ATS/ERS, GINA, ENFUMOSA, and TENOR. Results: 540 patients, were extracted from the SANI database. We observed that 462 (86%) met the ATS/ERS criteria as well as the GINA criteria, 259 (48%) the U-Biopred, 222 (41%) the NICE, 125 (23%) the WHO, 313 (58%) the Enfumosa, and 251 (46%) the TENOR criteria. The mean eosinophil value were similar in the ATS/ERS, U-Biopred, and Enfumosa (528, 532 and 516 cells/mcl), higher in WHO and Tenor (567 and 570 cells/mcl) and much higher in the NICE classification (624 cells/mcl). Lung function tests resulted similarly in all groups, with WHO (67%) and ATS/ERS-GINA (73%), respectively, showing the lower and upper mean FEV1 values. Conclusions: The present observations clearly evidence the heterogeneity in the distribution of patients when different definitions of severe asthma are used. However, the recent definition of severe asthma, provided by the GINA document, is similar to that indicated in 2014 by ATS/ERS, allowing mirror reclassification of the patients examined. This lack of homogeneity could complicate the access to biological therapies. The definition provided by the GINA document, which reflects what suggested by ATS/ERS, could partially overcome the problem.restrictedopenBagnasco D.; Paggiaro P.; Latorre M.; Folli C.; Testino E.; Bassi A.; Milanese M.; Heffler E.; Manfredi A.; Riccio A.M.; De Ferrari L.; Blasi F.; Canevari R.F.; Canonica G.W.; Passalacqua G.; Guarnieri G.; Patella V.; Maria Pia F.B.; Carpagnano G.E.; Colle A.D.; Scioscia G.; Gerolamo P.; Puggioni F.; Racca F.; Favero E.; Iannacone S.; Savi E.; Montagni M.; Camiciottoli G.; Allegrini C.; Lombardi C.; Spadaro G.; Detoraki C.; Menzella F.; Galeone C.; Ruggiero P.; Yacoub M.R.; Berti A.; Scichilone N.; Durante C.; Costantino M.T.; Roncallo C.; Braschi M.; D'Adda A.; Ridolo E.; Triggiani M.; Parente R.; Maria D.A.; Verrillo M.V.; Rolla G.; Brussino L.; Frazzetto A.V.; Cristina Z.M.; Lilli M.; Crimi N.; Bonavia M.; Corsico A.G.; Grosso A.; Del Giacco S.; Deidda M.; Ricciardi L.; Isola S.; Cicero F.; Amato G.; Vita F.; Spanevello A.; Pignatti P.; Cherubino F.; Visca D.; Massimo Ricciardolo F.L.; Anna Carriero V.M.; Bertolini F.; Santus P.; Barlassina R.; Airoldi A.; Guida G.; Eleonora N.; Aruanno A.; Rizzi A.; Caruso C.; Colantuono S.; Senna G.; Caminati M.; Arcolaci A.; Vianello A.; Bianchi F.C.; Marchi M.R.; Centanni S.; Luraschi S.; Ruggeri S.; Rinaldo R.; Parazzini E.; Calabrese C.; Flora M.; Cosmi L.; Di Pietro L.; Maggi E.; Pini L.; Macchia L.; Di Bona D.; Richeldi L.; Condoluci C.; Fuso L.; Bonini M.; Farsi A.; Carli G.; Montuschi P.; Santini G.; Conte M.E.; Turchet E.; Barbetta C.; Mazza F.; D'Alo S.; Pucci S.; Caiaffa M.F.; Minenna E.; D'Elia L.; Pasculli C.; Viviano V.; Tarsia P.; Rolo J.; Di Proietto M.; Lo Cicero S.Bagnasco, D.; Paggiaro, P.; Latorre, M.; Folli, C.; Testino, E.; Bassi, A.; Milanese, M.; Heffler, E.; Manfredi, A.; Riccio, A. M.; De Ferrari, L.; Blasi, F.; Canevari, R. F.; Canonica, G. W.; Passalacqua, G.; Guarnieri, G.; Patella, V.; Maria Pia, F. B.; Carpagnano, G. E.; Colle, A. D.; Scioscia, G.; Gerolamo, P.; Puggioni, F.; Racca, F.; Favero, E.; Iannacone, S.; Savi, E.; Montagni, M.; Camiciottoli, G.; Allegrini, C.; Lombardi, C.; Spadaro, G.; Detoraki, C.; Menzella, F.; Galeone, C.; Ruggiero, P.; Yacoub, M. R.; Berti, A.; Scichilone, N.; Durante, C.; Costantino, M. T.; Roncallo, C.; Braschi, M.; D'Adda, A.; Ridolo, E.; Triggiani, M.; Parente, R.; Maria, D. A.; Verrillo, M. V.; Rolla, G.; Brussino, L.; Frazzetto, A. V.; Cristina, Z. M.; Lilli, M.; Crimi, N.; Bonavia, M.; Corsico, A. G.; Grosso, A.; Del Giacco, S.; Deidda, M.; Ricciardi, L.; Isola, S.; Cicero, F.; Amato, G.; Vita, F.; Spanevello, A.; Pignatti, P.; Cherubino, F.; Visca, D.; Massimo Ricciardolo, F. L.; Anna Carriero, V. M.; Bertolini, F.; Santus, P.; Barlassina, R.; Airoldi, A.; Guida, G.; Eleonora, N.; Aruanno, A.; Rizzi, A.; Caruso, C.; Colantuono, S.; Senna, G.; Caminati, M.; Arcolaci, A.; Vianello, A.; Bianchi, F. C.; Marchi, M. R.; Centanni, S.; Luraschi, S.; Ruggeri, S.; Rinaldo, R.; Parazzini, E.; Calabrese, C.; Flora, M.; Cosmi, L.; Di Pietro, L.; Maggi, E.; Pini, L.; Macchia, L.; Di Bona, D.; Richeldi, L.; Condoluci, C.; Fuso, L.; Bonini, M.; Farsi, A.; Carli, G.; Montuschi, P.; Santini, G.; Conte, M. E.; Turchet, E.; Barbetta, C.; Mazza, F.; D'Alo, S.; Pucci, S.; Caiaffa, M. F.; Minenna, E.; D'Elia, L.; Pasculli, C.; Viviano, V.; Tarsia, P.; Rolo, J.; Di Proietto, M.; Lo Cicero, S

Intranasal midazolam: pharmacokinetics and pharmacodynamics assessed by quantitative EEG in healthy volunteers

The pharmacokinetics and pharmacodynamics of a highly concentrated cyclodextrin-based intranasal (i.n.) midazolam formulation containing the absorption-enhancer chitosan were studied in 12 healthy volunteers and compared with intravenous (i.v.) midazolam. The pharmacodynamic (PD) effects were assessed using quantitative electroencephalography (EEG). Maximal plasma concentrations of 63 and 110 ng/ml were reached at 8.4 and 7.6 min after 3 and 6 mg i.n. midazolam, respectively. After 5 mg i.v. and 6 and 3 mg i.n. midazolam, the times to onset of significant EEG effects in the β2 band (18-25 Hz) were 1.2, 5.5, and 6.9 min, respectively, and the times to loss of response to auditory stimuli were 3.0, 8.0, and 15.0 min, respectively. A sigmoid maximum-effect (E(max)) model indicated disequilibrium between plasma and effect-site concentrations, with equilibration half-lives of 2.1-4.8 min. The observed pharmacokinetic-PD (PK-PD) properties suggest that i.n. midazolam deserves to be evaluated as an easy and noninvasive method of administering a first benzodiazepine dose, e.g., in out-of-hospital emergency settings with no immediate i.v. access