UV and solar-based photocatalytic degradation of organic pollutants by nano-sized TiO2 grown on carbon nanotubes

Anew photocatalyst based on nano-sized TiO2 supported on single wall carbon nanotubes (SWCNTs) with tailored photocatalytic properties upon irradiation by both UV and solar simulated light was successfully employed for the degradation of a mixture of 22 organic pollutants in both ultrapure water and real secondary wastewater effluent. First-order degradation rates showed that under UV irradiation nanosized TiO2 supported on SWCNTs is much more effective than conventional Degussa P25 for degradation of iopamidol, iopromide, diatrizoic acid, diclofenac, triclosan and sulfamethoxazole in ultrapure water. For the remaining organics the degradation rates were comparable being in most of the cases Degussa P25 slightly more effective than nano-sized TiO2 supported on SWCNTs. Reactions performed in real secondary wastewater effluent showed a general reduction of degradation rates. Specifically, such a reduction was in the range 9-87% and 9-96% for the Degussa P25 and the nano-sized TiO2 supported on SWCNTs, respectively. Overall, the nano-sized TiO2 supported on SWCNTs under UV irradiation displayed comparable degradation rates with respect to convention Degussa P25. Under simulated solar irradiation the new prepared photocatalyst showed lower efficiency than Degussa P25 in ultrapure water. Such a gap was greatly reduced when the reactions were carried out in real secondary wastewater effluent. The nano-sized TiO2 supported on SWCNTs demonstrated to have the addition benefit to be easily removed from the aqueous solution by a mild centrifugation or a filtration step and, consequently, can be reused for a further photocatalytic treatment batch. Therefore, the obtained results showed that new photocatalyst based on nano-sized TiO2 supported on SWCNTs has proved to be a promising candidate to be used in a photocatalytic based-AOP and to be integrated with a biological step for the effective removal of emerging organic pollutants

Flow Index: a novel, non-invasive, continuous, quantitative method to evaluate patient inspiratory effort during pressure support ventilation

Background: The evaluation of patient effort is pivotal during pressure support ventilation, but a non-invasive, continuous, quantitative method to assess patient inspiratory effort is still lacking. We hypothesized that the concavity of the inspiratory flow-time waveform could be useful to estimate patient’s inspiratory effort. The purpose of this study was to assess whether the shape of the inspiratory flow, as quantified by a numeric indicator, could be associated with inspiratory effort during pressure support ventilation. Methods: Twenty-four patients in pressure support ventilation were enrolled. A mathematical relationship describing the decay pattern of the inspiratory flow profile was developed. The parameter hypothesized to estimate effort was named Flow Index. Esophageal pressure, airway pressure, airflow, and volume waveforms were recorded at three support levels (maximum, minimum and baseline). The association between Flow Index and reference measures of patient effort (pressure time product and pressure generated by respiratory muscles) was evaluated using linear mixed effects models adjusted for tidal volume, respiratory rate and respiratory rate/tidal volume. Results: Flow Index was different at the three pressure support levels and all group comparisons were statistically significant. In all tested models, Flow Index was independently associated with patient effort (p < 0.001). Flow Index prediction of inspiratory effort agreed with esophageal pressure-based methods. Conclusions: Flow Index is associated with patient inspiratory effort during pressure support ventilation, and may provide potentially useful information for setting inspiratory support and monitoring patient-ventilator interactions

Microbiological and chemical assessment of wastewater discharged by infiltration trenches in fractured and karstified limestone (Sca.re.s. project 2019–2020)

This study investigated the environmental contamination of groundwater as a consequence of the discharge of treated wastewater into the soil. The investigation focused on a wastewater treatment plant located in an area fractured by karst in the Salento peninsula (Apulia, Italy). Water samples were collected at four sites (raw wastewater, treated wastewater, infiltration trench, and monitoring well), monthly from May to December 2019 (with the exception of August), and were tested for (1) panel of bacteria; (2) enteric viruses; and (3) chemical substances. A gradual reduction in the concentration of bacteria, viruses and contaminants of emerging concern was observed across the profile of soil fissured by karst. All monitored bacteria were absent from the monitoring well, except for Pseudomonas aeruginosa. Pepper mild mottle virus and adenovirus were detected at all sampling sites. Personal care products and X-ray contrast media showed the greatest decrease in concentration from infiltration trench to the monitoring well, while the highest residual concentrations in the monitoring well were found for anticonvulsants (78.5%), antimicrobials (41.3%), and antipsychotic drugs (38.6%). Our results show that parameters provided by current law may not always be sufficient to evaluate the sanitary risk relating to the discharge of treated wastewater to the soil

A lower global lung ultrasound score is associated with higher likelihood of successful extubation in invasively ventilated COVID-19 patients

Lung ultrasound (LUS) can be used to assess loss of aeration, which is associated with outcome in patients with coronavirus disease 2019 (COVID-19) presenting to the emergency department. We hypothesized that LUS scores are associated with outcome in critically ill COVID-19 patients receiving invasive ventilation. This retrospective international multicenter study evaluated patients with COVID-19-related acute respiratory distress syndrome (ARDS) with at least one LUS study within 5 days after invasive mechanical ventilation initiation. The global LUS score was calculated by summing the 12 regional scores (range 0-36). Pleural line abnormalities and subpleural consolidations were also scored. The outcomes were successful liberation from the ventilator and intensive care mortality within 28 days, analyzed with multistate, competing risk proportional hazard models. One hundred thirty-seven patients with COVID-19-related ARDS were included in our study. The global LUS score was associated with successful liberation from mechanical ventilation (hazard ratio [HR]: 0.91 95% confidence interval [CI] 0.87-0.96; P = 0.0007) independently of the ARDS severity, but not with 28 days mortality (HR: 1.03; 95% CI 0.97-1.08; P = 0.36). Subpleural consolidation and pleural line abnormalities did not add to the prognostic value of the global LUS score. Examinations within 24 hours of intubation showed no prognostic value. To conclude, a lower global LUS score 24 hours after invasive ventilation initiation is associated with increased probability of liberation from the mechanical ventilator COVID-19 ARDS patients, independently of the ARDS severity.Pathogenesis and treatment of chronic pulmonary disease

ECMO for COVID-19 patients in Europe and Israel

Since March 15th, 2020, 177 centres from Europe and Israel have joined the study, routinely reporting on the ECMO support they provide to COVID-19 patients. The mean annual number of cases treated with ECMO in the participating centres before the pandemic (2019) was 55. The number of COVID-19 patients has increased rapidly each week reaching 1531 treated patients as of September 14th. The greatest number of cases has been reported from France (n = 385), UK (n = 193), Germany (n = 176), Spain (n = 166), and Italy (n = 136) .The mean age of treated patients was 52.6 years (range 16–80), 79% were male. The ECMO configuration used was VV in 91% of cases, VA in 5% and other in 4%. The mean PaO2 before ECMO implantation was 65 mmHg. The mean duration of ECMO support thus far has been 18 days and the mean ICU length of stay of these patients was 33 days. As of the 14th September, overall 841 patients have been weaned from ECMO support, 601 died during ECMO support, 71 died after withdrawal of ECMO, 79 are still receiving ECMO support and for 10 patients status n.a. . Our preliminary data suggest that patients placed on ECMO with severe refractory respiratory or cardiac failure secondary to COVID-19 have a reasonable (55%) chance of survival. Further extensive data analysis is expected to provide invaluable information on the demographics, severity of illness, indications and different ECMO management strategies in these patients

Physiological effects of two driving pressure-based methods to set positive end-expiratory pressure during one lung ventilation

During one-lung ventilation (OLV), titrating the positive end-expiratory pressure (PEEP) to target a low driving pressure (∆P) could reduce postoperative pulmonary complications. However, it is unclear how to conduct PEEP titration: by stepwise increase starting from zero PEEP (PEEPINCREMENTAL) or by stepwise decrease after a lung recruiting manoeuvre (PEEPDECREMENTAL). In this randomized trial, we compared the physiological effects of these two PEEP titration strategies on respiratory mechanics, ventilation/perfusion mismatch and gas exchange. Patients undergoing video-assisted thoracoscopic surgery in OLV were randomly assigned to a PEEPINCREMENTAL or PEEPDECREMENTAL strategy to match the lowest ∆P. In the PEEPINCREMENTAL group, PEEP was stepwise titrated from ZEEP up to 16 cm H2O, whereas in the PEEPDECREMENTAL group PEEP was decrementally titrated, starting from 16 cm H2O, immediately after a lung recruiting manoeuvre. Respiratory mechanics, ventilation/perfusion mismatch and blood gas analyses were recorded at baseline, after PEEP titration and at the end of surgery. Sixty patients were included in the study. After PEEP titration, shunt decreased similarly in both groups, from 50 [39–55]% to 35 [28–42]% in the PEEPINCREMENTAL and from 45 [37–58]% to 33 [25–45]% in the PEEPDECREMENTAL group (both p &lt; 0.001 vs baseline). The resulting ∆P, however, was lower in the PEEPDECREMENTAL than in the PEEPINCREMENTAL group (8 [7–11] vs 10 [9–11] cm H2O; p = 0.03). In the PEEPDECREMENTAL group the PaO2/ FIO2 ratio increased significantly after intervention (from 140 [99–176] to 186 [152–243], p &lt; 0.001). Both the PEEPINCREMENTAL and the PEEPDECREMENTAL strategies were able to decrease intraoperative shunt, but only PEEPDECREMENTAL improved oxygenation and lowered intraoperative ΔP. Clinical trial number NCT03635281; August 2018; “retrospectively registered”

Sign Language Translation in a Healthcare Setting

Communication between healthcare professionals and deaf patients is challenging, and the current COVID-19 pandemic makes this issue even more acute. Sign language interpreters can often not enter hospitals and face masks make lipreading impossible. To address this urgent problem, we developed a system which allows healthcare professionals to translate sentences that are frequently used in the diagnosis and treatment of COVID-19 into Sign Language of the Netherlands (NGT). Translations are displayed by means of videos and avatar animations. The architecture of the system is such that it could be extended to other applications and other sign languages in a relatively straightforward way

Sign Language Translation in a Healthcare Setting

Communication between healthcare professionals and deaf patients is challenging, and the current COVID-19 pandemic makes this issue even more acute. Sign language interpreters can often not enter hospitals and face masks make lipreading impossible. To address this urgent problem, we developed a system which allows healthcare professionals to translate sentences that are frequently used in the diagnosis and treatment of COVID-19 into Sign Language of the Netherlands (NGT). Translations are displayed by means of videos and avatar animations. The architecture of the system is such that it could be extended to other applications and other sign languages in a relatively straightforward way

Continuous assessment of neuro-ventilatory drive during 12 h of pressure support ventilation in critically ill patients

none11noIntroduction: Pressure support ventilation (PSV) should allow spontaneous breathing with a “normal” neuro-ventilatory drive. Low neuro-ventilatory drive puts the patient at risk of diaphragmatic atrophy while high neuro-ventilatory drive may causes dyspnea and patient self-inflicted lung injury. We continuously assessed for 12&nbsp;h the electrical activity of the diaphragm (EAdi), a close surrogate of neuro-ventilatory drive, during PSV. Our aim was to document the EAdi trend and the occurrence of periods of “Low” and/or “High” neuro-ventilatory drive during clinical application of PSV. Method: In 16 critically ill patients ventilated in the PSV mode for clinical reasons, inspiratory peak EAdi peak (EAdiPEAK), pressure time product of the trans-diaphragmatic pressure per breath and per minute (PTPDI/b and PTPDI/min, respectively), breathing pattern and major asynchronies were continuously monitored for 12&nbsp;h (from 8 a.m. to 8 p.m.). We identified breaths with “Normal” (EAdiPEAK 5–15&nbsp;μV), “Low” (EAdiPEAK &lt; 5&nbsp;μV) and “High” (EAdiPEAK &gt; 15&nbsp;μV) neuro-ventilatory drive. Results: Within all the analyzed breaths (177.117), the neuro-ventilatory drive, as expressed by the EAdiPEAK, was “Low” in 50.116 breath (28%), “Normal” in 88.419 breaths (50%) and “High” in 38.582 breaths (22%). The average times spent in “Low”, “Normal” and “High” class were 1.37, 3.67 and 0.55&nbsp;h, respectively (p &lt; 0.0001), with wide variations among patients. Eleven patients remained in the “Low” neuro-ventilatory drive class for more than 1&nbsp;h, median 6.1 [3.9–8.5]&nbsp;h and 6 in the “High” neuro-ventilatory drive class, median 3.4 [2.2–7.8]&nbsp;h. The asynchrony index was significantly higher in the “Low” neuro-ventilatory class, mainly because of a higher number of missed efforts. Conclusions: We observed wide variations in EAdi amplitude and unevenly distributed “Low” and “High” neuro ventilatory drive periods during 12&nbsp;h of PSV in critically ill patients. Further studies are needed to assess the possible clinical implications of our physiological findings.openDi mussi R.; Spadaro S.; Volta C.A.; Bartolomeo N.; Trerotoli P.; Staffieri F.; Pisani L.; Iannuzziello R.; Dalfino L.; Murgolo F.; Grasso S.Di mussi, R.; Spadaro, S.; Volta, C. A.; Bartolomeo, N.; Trerotoli, P.; Staffieri, F.; Pisani, L.; Iannuzziello, R.; Dalfino, L.; Murgolo, F.; Grasso, S