A Cross-Sectional Survey on Burnout Prevalence and Profile in the Sicilian Population of Ambulance Driver-Rescuers

Introduction: Burnout is present at a high rate in emergency medicine. The ambulance driver-rescuers, who furnish first aid to the victims, are the non-medical part of the Italian 118-service staff. There is a lack of research on burnout risk in Italian Emergency Medical Services and, particularly, for this category of workers. The two Italian studies, including a little group of ambulance driver-rescuers, reported inconsistent findings. Hypothesis: This survey investigated for the first time the prevalence and exact profile of burnout in a large sample of Italian driver-rescuers. As a secondary aim, the study described how the items of the Italian version of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) cluster in components in this sample. Methods: This cross-sectional census survey was conducted from June 2015 through May 2016 and involved all the driver-rescuers operating in Sicily, the biggest and most southern region of Italy. The subjects received a classification according to different profiles of burnout by using the Italian version of the MBI-HSS (burnout, engagement, disengagement, over-extension, and work-inefficacy). In order to explore the existence of independent factors, a Principal Component Analysis (PCA) was conducted on the survey to obtain eigenvalues >one for each component in the data. Results: The final sample comprised 2,361 responders (96.6% of the initial sample). Of them, 29.8% were in burnout (95% confidence interval [CI], 27.8% to 31.8%) and 1.7% presented a severe form (95% CI, 1.1% to 2.3%); 30.0% were engaged in their work (95% CI, 21.0% to 34.8%), 24.7% of responders were disengaged (95% CI, 22.9% to 26.5%), 1.2% presented an over-extension profile (95% CI, 0.8% to 1.7%), and 12.6% felt work-inefficacy (95% CI, 11.3% to 14.1%). The factors loaded into a five-factor solution at PCA, explaining 48.1% of the variance and partially replicating the three-factor structure. The Emotional Exhaustion (EE) component was confirmed. New dimensions from Personal Accomplishment (PA) and Depersonalization (DP) sub-scales described empathy and disengagement with patients, respectively, and were responsible for the increased risk of burnout. Conclusions: These results endorse the importance of screening and psychological interventions for this population of emergency workers, where burnout could manifest itself more insidiously. It is also possible to speculate that sub-optimal empathy skills could be related to the disengagement and work-inefficacy feelings registered

Dependence of the Ce(III)/Ce(IV) ratio on intracellular localization in ceria nanoparticles internalized by human cells

CeO2 nanoparticles (CNPs) have been investigated as promising antioxidant agents with significant activity in the therapy of diseases involving free radicals or oxidative stress. However, the exact mechanism responsible for CNP activity has not been completely elucidated. In particular, in situ evidence of modification of the oxidative state of CNPs in human cells and their evolution during cell internalization and subsequent intracellular distribution has never been presented. In this study we investigated modification of the Ce(iii)/Ce(iv) ratio following internalization in human cells by X-ray absorption near edge spectroscopy (XANES). From this analysis on cell pellets, we observed that CNPs incubated for 24 h showed a significant increase in Ce(iii). By coupling on individual cells synchrotron micro-X-ray fluorescence (μXRF) with micro-XANES (μXANES) we demonstrated that the Ce(iii)/Ce(iv) ratio is also dependent on CNP intracellular localization. The regions with the highest CNP concentrations, suggested to be endolysosomes by transmission electron microscopy, were characterized by Ce atoms in the Ce(iv) oxidation state, while a higher Ce(iii) content was observed in regions surrounding these areas. These observations suggest that the interaction of CNPs with cells involves a complex mechanism in which different cellular areas play different roles

MRI pattern characterization of cerebral cardioembolic lesions following atrial fibrillation ablation

BackgroundRecognizing etiology is essential for treatment and secondary prevention of cerebral ischemic events. A magnetic resonance imaging (MRI) pattern suggestive of an embolic etiology has been described but, to date, there are no uniformly accepted criteria.AimThe purpose of the study is to describe MRI features of ischemic cerebral lesions occurring after transcatheter ablation of atrial fibrillation (AF).MethodsA systematic review and meta-analysis of studies performing brain imaging investigations before and after AF transcatheter ablation was performed. The incidence of cerebral ischemic lesions after AF transcatheter ablation was the primary endpoint. The co-primary endpoints were the prevalence of the different neuroimaging features regarding the embolic cerebral ischemic lesions.ResultsA total of 25 studies, encompassing 3,304 patients, were included in the final analysis. The incidence of ischemic cerebral lesions following AF transcatheter ablation was 17.2% [95% confidence interval (CI) 12.2%–23.8%], of which a minimal fraction was symptomatic [0.60% (95% CI 0.09%–3.9%)]. Only 1.6% of the lesions (95% CI 0.9%–3.0%) had a diameter >10 mm, and in 20.5% of the cases the lesions were multiple (95% CI 17.1%–24.4%). Brain lesions were equally distributed across the two hemispheres and the different lobes; cortical location was more frequent [64.0% (95% CI 42.9%–80.8%)] while the middle cerebral artery territory was the most involved 37.0% (95% CI 27.3–48.0).ConclusionsThe prevailing MRI pattern comprises a predominance of small (<10 mm) cortical lesions, more prevalent in the territory of the middle cerebral artery

Production and characterization of lightweight aggregates from municipal solid waste incineration fly-ash through single- and double-step pelletization process

The performance of a cold-bonding pelletization process was investigated for lightweight aggregates (LWAs) production from municipal solid waste incineration (MSWI) fly-ash (FA), by including multiple waste materials in the aggregate mixture. Before pelletization, FA was pre-treated by washing with water, which led to a reduction of chloride (66.79%) and sulphate (25.30%) content. This was further confirmed by XRF and XRD analyses, which showed a reduction of chloride elements and the content of chlorine crystalline phases. The pelletization process was carried out using both single- and double-step methods. For single-step pelletization, all the mixtures contained 80% FA, combined with various compositions of cement (5, 10, and 15%) and granulated blast furnace slag (GBFS) (5, 10, and 15%). For the double-step pelletization 30% of cement and 70% of marble sludge (MS) were added to each of the previous mixtures. The apparent density of all the aggregates varied between 1.60 and 1.87 g cm 3, suggesting their suitability to be classified as LWAs. Aggregates produced from double-step pelletization showed improved characteristics, with water absorption capacity and open porosity generally lower compared to the corresponding aggregates from the single-step pelletization. The best values of compressive (crushing) strength (almost 11 MPa) were observed for double-step pelletization aggregates with initial cement: GBFS mixture of 15%:5%. Results from leaching tests showed an overall significant release of chloride and sulphate. Nevertheless, leaching from double-step pelletization aggregates was reduced by 1.73- 4.02 times for chloride and 1.58-5.67 times for sulphate, further suggesting that better performances are achievable through the addition of an aggregate second layer

A New Approach to Model the Effect of Climate Change on the Building Sector: a Climate Models Data Fusion

Several climate models have been developed and used to forecast the effects of the climate changes, however the variability of results due to different models lead to a significant uncertainty on the estimation of the building energy use for the next century. In this context, the paper analyses this uncertainty and combines different climate models in order to improve the robustness of energy consumption predictions. The data of the climate models were then used to generate hourly weather files for the future period 2020-2099 and energy simulations for a case study located in Palermo (Italy) were performed. Results show a wide variability among all models (either alone or combined with our data-fusion method), with a mean variability of about 18% of the cooling energy requirements considering the RCP4.5 scenario. This reinforces the need for a more detailed validation and alternative climate change models for building simulation

Overestimation of nanoparticles-induced DNA damage determined by the comet assay

<p>The increasing use of engineered nanoparticles (NPs) in a wide range of commercial products raises concern about the possible risks that NPs pose to human health. Many aspects of the interaction between living cells and NPs are still unclear, and a reliable assessment of NP genotoxicity would be important. One of the most common tests used for genotoxicity is the comet assay, a sensitive method measuring DNA damage in individual cells. The assay was originally developed for soluble molecules, but it is also used in the assessment of genotoxicity of NPs. However, concerns have been raised recently about the reliability of this test in the case of NPs, but no conclusive results have been presented. Using nuclei isolated from human epithelial cells incubated with NPs, we obtained clear evidence of overestimation of NP genotoxicity by the comet assay in the case of CeO₂, TiO_2, SiO₂, and polystyrene NPs. Removal of the NPs in the cytoplasm was effective in eliminating this genotoxicity overestimation (<i>ex post</i> damage) and determining the actual damage produced by the NPs during incubation with the cells (<i>ex ante</i> damage). This method could improve significantly the determination of NP genotoxicity in eukaryotic cells.</p

The Phenotype of Mesenchymal Stromal Cell and Articular Chondrocyte Cocultures on Highly Porous Bilayer Poly-L-Lactic Acid Scaffolds Produced by Thermally Induced Phase Separation and Supplemented with Hydroxyapatite

Bilayer scaffolds could provide a suitable topology for osteochondral defect repair mimicking cartilage and subchondral bone architecture. Hence, they could facilitate the chondro- and osteogenic lineage commitment of multipotent mesenchymal stromal cells (MSCs) with hydroxyapatite, the major inorganic component of bone, stimulating osteogenesis. Highly porous poly-L-lactic acid (PLLA) scaffolds with two layers of different pore sizes (100 and 250 mu m) and hydroxyapatite (HA) supplementation were established by thermally induced phase separation (TIPS) to study growth and osteogenesis of human (h) MSCs. The topology of the scaffold prepared via TIPS was characterized using scanning electron microscopy (SEM), a microCT scan, pycnometry and gravimetric analysis. HMSCs and porcine articular chondrocytes (pACs) were seeded on the PLLA scaffolds without/with 5% HA for 1 and 7 days, and the cell attachment, survival, morphology, proliferation and gene expression of cartilage- and bone-related markers as well as sulfated glycosaminoglycan (sGAG) synthesis were monitored. All scaffold variants were cytocompatible, and hMSCs survived for the whole culture period. Cross-sections revealed living cells that also colonized inner scaffold areas, producing an extracellular matrix (ECM) containing sGAGs. The gene expression of cartilage and bone markers could be detected. HA represents a cytocompatible supplement in PLLA composite scaffolds intended for osteochondral defects

Datasheet1_MRI pattern characterization of cerebral cardioembolic lesions following atrial fibrillation ablation.docx

BackgroundRecognizing etiology is essential for treatment and secondary prevention of cerebral ischemic events. A magnetic resonance imaging (MRI) pattern suggestive of an embolic etiology has been described but, to date, there are no uniformly accepted criteria.AimThe purpose of the study is to describe MRI features of ischemic cerebral lesions occurring after transcatheter ablation of atrial fibrillation (AF).MethodsA systematic review and meta-analysis of studies performing brain imaging investigations before and after AF transcatheter ablation was performed. The incidence of cerebral ischemic lesions after AF transcatheter ablation was the primary endpoint. The co-primary endpoints were the prevalence of the different neuroimaging features regarding the embolic cerebral ischemic lesions.ResultsA total of 25 studies, encompassing 3,304 patients, were included in the final analysis. The incidence of ischemic cerebral lesions following AF transcatheter ablation was 17.2% [95% confidence interval (CI) 12.2%–23.8%], of which a minimal fraction was symptomatic [0.60% (95% CI 0.09%–3.9%)]. Only 1.6% of the lesions (95% CI 0.9%–3.0%) had a diameter >10 mm, and in 20.5% of the cases the lesions were multiple (95% CI 17.1%–24.4%). Brain lesions were equally distributed across the two hemispheres and the different lobes; cortical location was more frequent [64.0% (95% CI 42.9%–80.8%)] while the middle cerebral artery territory was the most involved 37.0% (95% CI 27.3–48.0).ConclusionsThe prevailing MRI pattern comprises a predominance of small (<10 mm) cortical lesions, more prevalent in the territory of the middle cerebral artery.</p

Meta-Analysis Comparing Complete or Culprit Only Revascularization in Patients With Multivessel Disease Presenting With Cardiogenic Shock

The optimal strategy for patients with an acute myocardial infarction (MI) and multivessel (MV) coronary artery disease complicated by cardiogenic shock (CS) remains unknown. We conducted a meta-analysis of all randomized controlled trials and observational studies that reported adjusted effect measures to evaluate the association of MV-PCI (percutaneous coronary intervention), compared with culprit only (C)-PCI, with cardiovascular events in patients admitted for CS and MV disease. We identified 12 studies (n = 1 randomized controlled trials, n = 11 observational) that included 7,417 patients (n = 1,809 treated with MV-PCI and n = 5,608 with C-PCI). When compared with C-PCI, MV-PCI was not associated with an increased risk of short-term death (odds ratio [OR] 1.14, 95% confidence interval [CI] 0.87 to 1.48, p = 0.35 and adjusted OR [ORadj] 1.00, 95% CI 0.70 to 1.43, p = 1.00). In-hospital and/or short-term mortality tended to be higher with MV-PCI, when compared with C-PCI, for CS patients needing dialysis (ß 0.12, 95% CI from 0.049 to 0.198; p= 0.001), whereas MV-PCI was associated with lower in-hospital and/or short-term mortality in patients with an anterior MI (ß −0.022, 95% CI −0.03 to −0.01; p <0.001). MV-PCI strategy was associated with a more frequent need for dialysis or contrast-induced nephropathy after revascularization (OR 1.36, 95% CI 1.06 to 1.75, p = 0.02). In conclusion, MV-PCI seems not to increase risk of death during short- or long-term follow-up when compared with C-PCI in patients admitted for MV coronary artery disease and MI complicated by CS. Furthermore, it appears a more favorable strategy in patients with anterior MI, whereas the increased risk for AKI and its negative prognostic impact should be considered in decision-making process. Further studies are needed to confirm our hypothesis on in these subpopulations of CS patients