L’APP Mind Inclusion: la tecnologia assistiva per promuovere l’inclusione sociale delle persone con disabilità intelletive nella loro comunità

Information and Communication Technologies have been widely used to enhance evidencebased interventions in the education and training of individuals with intellectual disabilities. The use of Information and Communication Technologies for these purposes is called Assistive Technology. Assistive technology is able to support persons with intellectual disabilities to live fuller and richer lives in their communities, supporting more successful functioning across multiple domains: independent living and inclusion in community.This study has the aim to present and explain the development of an assistive technology tool for persons with intellectual disabilities, the Mind Inclusion APP which can allow persons with intellectual disabilities to search and reach for a location or an activity in their community. The APP was co-created through the support of a participatory design and a person centred approach.A sample of 48 people, including persons with disabilities, caregivers, educators and business owners, was involved at all stages of the project. This study has shown that persons with disabilities can interact better, be part of their society more easily, and learn new skills reducing the impact of disability on daily functioning by using the Mind Inclusion APP

Accesible co-creation tools for people with intellectual disabilities: working for and with end-users

[EN] In a world defined by rapid change, the search for solutions to societal challenges has become more complex calling for new paradigms of innovation focused on collaborations with the community and users. Cocreation approaches in the design and production of a service or product can bring low-cost innovation and unique and personalized customer experiences leading to user acceptance of a product or service. Under a co-creation perspective, the participatory approach developed in the MINDInclusion project aims to improve the inclusion of people with intellectual disabilities into public places and society by using a co-created online tool based on personal experiences of people with disabilities. Paying special attention to the Design thinking method, the main goal of this experience was to co-create cognitive accessible design tools that guide the collection of users and other stakeholders experiences in the process of defining problems and solutions. To this end, 14 researchers and educators worked defining together a set of guiding exercises and design thinking methods for the 4 co-design cycles. As a result two tools were developed to gather information to recreate as a final output “personas scenarios”, an “empathy map” and expected “use scenarios”. The former was an adapted game board about public places based on the traditional monopoly game and the latter a diary with a set of activities that will facilitate the collection of contextual information. Previous experiences have shown that co-design process can promote greater social cohesion, acceptance and empowerment. Working with people with intellectual disability presents several challenges since the co-creation process needs to be cognitive accessible. However, the tools created under this experience can be extrapolated to other contextsAlmeida, R.; Losada Durán, R.; Cid Bartolomé, T.; Giaretta, A.; Segalina, A.; Bessegato, A.; Visentin, S.... (2020). Accesible co-creation tools for people with intellectual disabilities: working for and with end-users. Editorial Universitat Politècnica de València. 53-61. https://doi.org/10.4995/INN2019.2019.10086OCS536

Sigh in patients with acute hypoxemic respiratory failure and acute respiratory distress syndrome: the PROTECTION pilot randomized clinical trial

Background: Sigh is a cyclic brief recruitment manoeuvre: previous physiological studies showed that its use could be an interesting addition to pressure support ventilation to improve lung elastance, decrease regional heterogeneity and increase release of surfactant. Research question: Is the clinical application of sigh during pressure support ventilation (PSV) feasible? Study design and methods: We conducted a multi-center non-inferiority randomized clinical trial on adult intubated patients with acute hypoxemic respiratory failure or acute respiratory distress syndrome undergoing PSV. Patients were randomized to the No Sigh group and treated by PSV alone, or to the Sigh group, treated by PSV plus sigh (increase of airway pressure to 30 cmH2Ofor 3 seconds once per minute) until day 28 or death or successful spontaneous breathing trial. The primary endpoint of the study was feasibility, assessed as non-inferiority (5% tolerance) in the proportion of patients failing assisted ventilation. Secondary outcomes included safety, physiological parameters in the first week from randomization, 28-day mortality and ventilator-free days. Results: Two-hundred fifty-eight patients (31% women; median age 65 [54-75] years) were enrolled. In the Sigh group, 23% of patients failed to remain on assisted ventilation vs. 30% in the No Sigh group (absolute difference -7%, 95%CI -18% to 4%; p=0.015 for non-inferiority). Adverse events occurred in 12% vs. 13% in Sigh vs. No Sigh (p=0.852). Oxygenation was improved while tidal volume, respiratory rate and corrected minute ventilation were lower over the first 7 days from randomization in Sigh vs. No Sigh. There was no significant difference in terms of mortality (16% vs. 21%, p=0.342) and ventilator-free days (22 [7-26] vs. 22 [3-25] days, p=0.300) for Sigh vs. No Sigh. Interpretation: Among hypoxemic intubated ICU patients, application of sigh was feasible and without increased risk

A preliminary study of low-dose angiotensin 1-7 plus the pineal hormone melatonin in the treatment of human systemic diseases other than cancer and autoimmune pathologies

Abstract: The recent advances of the psychoneuroimmunology have demonstrated the existence of a physiological anti-inflammatory antitumor neuroendocrine axis, mainly constituted by the pineal gland through its indole hormone melatonin (MLT) and the ACE2-angiotensin 1-7 (Ang 1-7) system. Moreover, most human systemic diseases, including cancer, autoimmunity, metabolic, cardiovascular, and neurodegenerative pathologies, have appeared to be characterized by an endogenous deficiency in the functionless of the pineal gland and ACEACE2 system. Therefore, the exogenous correction of MLT and Ang 1-7 deficiency could improve the clinical control of human systemic diseases. On these bases, a preliminary study of MLT plus Ang 1-7 was planned in patients suffering from systemic alterations other than cancer and autoimmunity. The study included 33 consecutive patients, whose pathologies were, as follows: cardiovascular pathologies: 9; pulmonary diseases: 7; metabolic syndrome: 7; neurodegenerative pathologies: 10. Both Ang 1-7 and MLT were given orally, at a dose of 0.5 mg/day in the morning for Ang 1-7, and at a dose of 10 mg/day in the evening for MLT. The treatment was well tolerated in all patients, and no-therapy related toxicity occurred. On the contrary, most patients experienced a relief of anxiety and asthenia, and an improvement in both mood and quality of sleep. Moreover, most patients referred an increased diuresis. Blood pressure values progressively became within the normal range in hypertensive patients. On the same way, glucose and cholesterol levels progressively decrease on therapy in diabetic and hypercholesterolemic patients, respectively. Patients with pulmonary disturbance referred an important enhancement in the expectoration, with a following improvement in the respiratory symptomatology. Finally, an apparent improvement in cognitive and motor functions was achieved in patients with neurodegenerative pathologies. These preliminary results would suggest a future medical possibility to treat the human systemicdiseases by simply correcting their endogenous neuroendocrine deficiencies, mainly those involving the functions of the pineal gland and ACE2-Ang1-7 system

Lung Transplant for ARDS after COVID-19: Long-Term Outcomes and Considerations about Detrimental Issues

During the first outbreak of COVID-19 in Italy, based on the only few cases reported from a Chinese centre at the time, we performed lung transplantation in two patients with irreversible acute respiratory distress syndrome (ARDS) after COVID-19 at our centre. After two years, we report the outcomes of these cases and some considerations. The first patient, an 18-year-old male, is in excellent conditions twenty-four months after surgery. The second patient was a 48-year-old man; his airways were colonized by carbapenemase-producing klebsiella pneumoniae at the time of lung transplantation, and he had previously suffered from delirium and hallucinations in the intensive care unit. His postoperative clinical course was complicated by dysexecutive behaviour and then septic shock; he died 62 days after surgery. The recently reported experience of different transplantation centres has led to the inclusion of irreversible acute respiratory distress syndrome (ARDS) after COVID-19 among the indications for lung transplantation in carefully selected patients. Our results confirm the feasibility and the good long-term outcomes of lung transplantation for COVID-19-associated ARDS. Nonetheless, our experience corroborates the need for careful recipient selection: special attention must be paid to the single-organ dysfunction principle, the evaluation of any neuro-psychiatric disorder, and MDR germs colonization, before listing

Ventricular Arrhythmias and Implantable Cardioverter-Defibrillator Therapy in Women: A Propensity Score-Matched Analysis

Background: Causes of sex differences in incidence of sustained ventricular arrhythmias (SVAs) are poorly understood. Objectives: This study aims to investigate sex-specific risk of SVAs and device therapies by balancing sex groups in relation to several baseline characteristics with the propensity score (PS). Methods: We used a large remote monitoring dataset from implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy defibrillators (CRT-Ds). Study endpoints were time to the first appropriate SVA, time to the first device therapy for SVA, and time to the first ICD shock. Results were compared between females and a PS-matched male subgroup. Results: In a cohort of 2,532 patients with an ICD or CRT-D (median age, 70 years), 488 patients (19.3%) were women. After selecting 488 men PS-matched for 19 variables relative to baseline demographics, implant indications, principal comorbidities, and concomitant therapy, yet the SVA rate at the 2.1-year median follow-up was significantly lower in women than in man (adjusted HR: 0.65; 95% CI: 0.51-0.81; P < 0.001). Women also showed a reduced risk of any device therapy (HR: 0.59; 95% CI: 0.45-0.76; P < 0.001) and shocks (HR: 0.66; 95% CI: 0.47-0.94; P = 0.021). Differences in sex-specific SVA risk profile were not confirmed in CRT-D patients (HR: 0.78; 95% CI: 0.55-1.09; P = 0.14) nor in those with an ejection fraction <30% (HR: 0.80; 95% CI: 0.52-1.23; P = 0.31). Conclusions: After matching demographics, indications, principal comorbidities, and concomitant therapy, women still exhibited a lower SVA risk profile than men, except in the subgroups of CRT-D or/and ejection fraction <30%