Psychological needs and mental health in women aged ≥ 65 years after cardiac surgery: an exploratory study

Background. Recent developments in cardiac care have led to an increase survival even among elderly cardiac patients. Previous studies showed that women have worse health related outcomes compared with men. The main aims of this study are to assess psychological needs and factors promoting mental health among women aged ≥ 65 years following heart surgery. Methods. 74 consecutive women aged ≥ 65 years and referred to a cardiac rehabilitation unit in Northern Italy after heart surgery were enrolled in this exploratory study. Psychological questionnaires exploring cognitive functioning, psychological needs, anxiety, depression, physical and mental health status, self-esteem were administered by a psychologist to each patient using a face-to-face interview. Results. The main areas of psychological needs reported by patients were relational and emotional support, assistance and treatment, information about diagnosis and future conditions and information concerning economic-insurance issues. Multivariate linear regression analysis showed that factors significantly associated with patients’ mental health were anxiety (p = 0.01) and locus of control (p = 0.01). Conclusions. In order to improve older cardiac women’s mental health after cardiac surgery is important to offer tailored rehabilitative interventions able to meet their specific needs such as the management of anxiety symptoms and loss of control, the need to regain the family role, the need of more information concerning the diagnosis and prognosis and emotional support

Anemia in chronic heart failure patients: comparison between invasive and non-invasive prognostic markers

Background: The prognosis of chronic heart failure (CHF) remains poor despite advances in medical management. Several different variables determine prognosis. Recently anemia has emerged as an independent prognostic variable in the evaluation of CHF. It is therefore important to analyze the role of anemia in patients with mild to severe CHF already well characterized by hemodynamic, echo- Doppler, and cardiopulmonary exercise testing. Objective: We performed this study to evaluate, in a large general cohort of CHF patients, the frequency of anemia and its correlation with their clinical profile. We assessed the prognostic value of anemia in relation to other known prognostic variables. Methods: Two-dimensional echocardiography, right heart catheterization, cardiopulmonary tests and laboratory examinations were performed in a population of 980 consecutive patients with CHF (53±9.4 years, 85% male, LVEF 25±8%; 45% with NYHA class III-IV). A hemoglobin (Hb) concentration less than 12 g/dl was used to define anemic patients. The primary end point was cardiac death or urgent heart transplantation. Results: Nineteen percent of patients were anemic. These patients had a lower body mass index (24±3 vs. 25±4 Kg/m2 p <0.0004), a worse functional class (64% were in NYHA class III-IV vs 41% in the non-anemic group, p <0.0001), poorer exercise capacity (12.4 vs. 14.8 ml/kg/min peak VO2, p <0.0001) and increased right (7±5 vs. 5±4 mmHg, p <.0004) and left (21±9 vs. 19±10 p <0.007) ventricular filling pressures. During a 3-year follow-up cardiac deaths occurred in 236 (24%) and 52 (5%) of patients received an urgent heart transplant. On univariate regression analysis anemia was significantly correlated with these “hard” cardiac events (39% of anemic patients vs 27% of non-anemic patients). By multivariate logistic regression analysis different prognostic models were identified using non-invasive, with or without peak VO2, or invasive parameters. The prognostic model including anemia (AUCROC: 0.720) showed similar accuracy in predicting cardiac events to other prognostic models with peak VO2 (AUCROC: 0.719) or invasive variables (AUCROC: 0.719). Conclusions: The present study demonstrates that anemia in CHF patients is associated with prognosis, worse NYHA functional class, exercise capacity and hemodynamic profiles. The relationship between anemia and mortality is independent of other simple non-invasive prognostic factors. Prognostic models with more complex or invasive independent predictors did not increase the accuracy to predict cardiac mortality or the need for urgent transplantation

Analytical expressions for macrodispersion in three-dimensional Sub-Gaussian hydraulic conductivity fields

Subsurface flow and transport settings are typically characterized by spatial variability of the underlying hydro-geological attributes (e.g., permeability and porosity) and a high degree of uncertainty associated with data and model parameter estimates. In this context, we rely on a stochastic approach and analyse conservative solute transport taking place within three-dimensional, sub-Gaussian domains with isotropic, exponential correlation structure of the associated log-conductivity fields. The flow is uniform in the mean and driven by an imposed average head gradient. We present an analytical solution based on a small perturbation approach that allows assessing the temporal evolution of longitudinal and transverse macrodispersion. Similar to what is observed for Gaussian log-conductivity domains, these are seen to attain a (Fickian) asymptotic regime after the solute plume has travelled a sufficient number of conductivity correlation scales. We also derive closed-form analytical expressions for other statistical moments of interest (e.g., seepage velocity and particle displacement covariance) and benchmark these solutions against numerical Monte Carlo simulations for various degrees of domain heterogeneity. This enables us to assess the extent at which a small perturbation approximation can embed the key features of macrodispersion within three-dimensional sub-Gaussian conductivity fields of increasing heterogeneity levels. Our results suggest that, similar to what already observed for Gaussian fields, the analytical formulation fully captures the trend of longitudinal macrodispersion for values of log-conductivity variance smaller than the unity, the goodness of the results becoming worse as the variance increases. Our formulation also captures directional displacement and seepage velocity covariances, even though the degree of agreement with their numerical Monte Carlo counterparts rapidly deteriorates with increasing conductivity variance. Particularly refined numerical grids are required to capture the nugget effect exhibited by the analytical longitudinal velocity covariance, thus posing a challenge to assess the system behaviour at short distances

Custom-design of intrinsically antimicrobial polyurethane hydrogels as multifunctional injectable delivery systems for mini-invasive wound treatment

Effective management of hard-to-close skin wounds is a challenging issue due to several co-morbidities in affected patients. Particularly, infections represent a major obstacle in wound healing. The design of efficient wound treatments thus represents an urgent need. Injectable drug delivery hydrogels with intrinsic antimicrobial and antifungal properties were herein designed for perspective application in the mini-invasive treatment of hard-to-close wounds. First, an amphiphilic polyurethane was synthesized from Poloxamer® 407 macrodiol and N-Boc diethanolamine chain extender (DHP407, Mw =33 kDa). Chain-extension reaction step was optimized to maximize the formation of -NH groups along the polymer chains (4.5 × 10^20±1.8 × 10^19 –NH groups/gpolymer), after Boc-caging group removal (D-DHP407). DHP407 and D-DHP407 water-based solutions were thermosensitive with slightly different Critical Micellar Concentration (17.5 μg/mL vs. 19.7 μg/mL) and cluster hydrodynamic diameter (235.6 ± 19.9 nm vs. 260.1 ± 20.5 nm), and similar Critical Micellar Temperature (22.5 °C vs. 23.1 °C). A polyurethane solution concentration (15% w/V) was selected by tube-inverting test and rheological analysis showing injectability, as evidenced by sol-to-gel transition at 27.7 ± 0.6 °C for DHP407 and 29.7 ± 0.6 °C for D-DHP407, within few minutes, at similar gelation kinetics. DHP407 and D-DHP407 hydrogels showed controlled release of Bovine Serum Albumin (BSA) model protein (1 mg/mL), with no burst phenomena. BSA released from DHP407 and D-DHP407 hydrogels at 24 h was 33.7 ± 5.0% and 24.6 ± 1.2%, respectively. D-DHP407 hydrogel was biocompatible and able to support NIH-3T3 cell proliferation. Furthermore, D-DHP407 hydrogel showed intrinsic antifungal and antibacterial activity against C. albicans and Gram-positive S. aureus and Gram-negative E. coli bacteria, injectability and capability to retain shape post-injection, making it promising for future use in the management of hard-to-close skin wounds

On multi-model assessment of complex degradation paths: the fate of diclofenac and its transformation products

This is the peer reviewed version of the following article: [Ceresa, L., Guadagnini, A., Rodríguez-Escales, P., Riva, M., Sanchez-Vila, X., & Porta, G. M. (2023). On Multi-Model assessment of complex degradation paths: The fate of diclofenac and its transformation products. Water Resources Research, 59, e2022WR033183], which has been published in final form at https://doi.org/10.1029/2022WR033183. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.We present a methodology to quantify the impact of model structure and parametric uncertainty on formulations targeting biotransformation processes of Emerging Contaminants in subsurface water resources. The study is motivated by recognizing that modeling of bio-mediated reactions of recalcitrant compounds in soil and aquifers is plagued by uncertainty. At the same time, process-based models often require the parameterization of complex physico-chemical processes, a situation which is exacerbated by the paucity of direct observations. Thus, assessment and formulation of modeling tools capable to balance complexity and reliability is a key challenge. The modeling strategy proposed here aims at pairing and applying a suite of quantitative tools starting from a prior diagnosis of multiple uncertainty sources and leading to parameter estimation and model selection in the presence of a limited number of observations. The methodology is illustrated through application to a multi-step, reactive scenario involving biotransformation of the pharmaceutical diclofenac (DCF) in groundwater. Our framework includes four plausible models. These are obtained through successive simplifications of a recently developed highly complex model. Such simplifications are accomplished consistent with the results of a comprehensive Multi-Model Global Sensitivity Analysis. The latter allows ranking the levels of influence of system processes on model outputs by incorporating the effects of model formulation and parametric uncertainties. The kinetic of the loop-initiating process (DCF nitrosation, linked to the temporal evolution of N-cycle components) is documented as dominating in explaining the variability of model outputs of environmental interest. Model discrimination criteria suggest that a simplified counterpart of the reference model is favored to interpret available data. Our modeling approach can assist interpretation and prototyping of a wide range of contaminant biotransformation models. The latter is a key objective also for the purpose of developing credible (environmental) risk assessment tools and designing experimental sampling campaigns.Peer ReviewedPostprint (author's final draft

The use of blades and pointed tools during middle palaeolithic, the example of Riparo Tagliente (VR)

The aim of this study is to understand Neanderthals' techno-functional behavior at Riparo Tagliente (VR). To this purpose, the use-wear analysis on the lithic artefacts from the upper levels of the Mousterian sequences was carried out. In particular, two main features of the Mousterian lithic assemblage of Riparo Tagliente are considered: how the laminar component and the pointed tools were differently used. The use of blades in the Mousterian period represents a debated issue: many scholars interpret the Mousterian blades as specific tools used as butchering knives, while others underline their use as undifferentiated tools. The use of pointed tools is also an interesting topic: if different scholars stress their undifferentiated use, others propose their use as spear points. The use-wear analysis completed on the Riparo Tagliente's Mousterian lithic assemblage highlights a general opportunistic behavior in the use of knapping products. Concerning the relation between the artefacts' use and their typology, the data collected suggests a relation between blades and butchering activities and an undifferentiated use of pointed tools. Our study also underlines the identification of wear traces on flakes that are usually considered as waste products (i.e. management-flakes of Levallois cores and reshaping flakes), suggesting that we should reconsider the definition of waste products in the light of the use-wear analysis results