Feasibility and Acceptability of a Real-Time Telerehabilitation Intervention for Children and Young Adults with Acquired Brain Injury During the COVID-19 Pandemic: An Experience Report

This study examined the feasibility and acceptability of a telerehabilitation intervention during the COVID-19 pandemic in a sample of children and young adults with Acquired Brain Injury (ABI). Thirteen patients and/or their families agreed to participate in the speech and neuropsychological telerehabilitation sessions. The treatment was synchronous, patient centered and aimed at improving specific abilities. Sessions were held twice a week over a 10-week period. Two questionnaires were completed both by parents and therapists to assess feasibility and acceptability. Neither technical issues nor clinical obstacles were found. The quality of the therapeutic relationship played a key role in the intervention. Synchronous telerehabilitation provided several advantages both for patients and therapists. Moreover, the patient centered intervention eased the burden of the caregivers at a time of high stress. The real-time telerehabilitation treatments were deemed suitable for children and young adults with ABI. Further studies are needed to support the use of telerehabilitation as an integral part of their standard care

I disturbi visuo-cognitivi. Kit. Con CD-ROM

Il libro, basato sulle più aggiornate conoscenze in ambito neuroscientifico e neuropsicologico, consente allo specialista, anche attraverso l’illustrazione di casi clinici, un percorso di valutazione e di definizione del profilo di funzionamento per impostare un programma di potenziamento o di riabilitazione individualizzato e centrato sul bisogno del bambino

How are mineral and organic phases regulating burning-induced soil water repellency? Unravelling the crucial dynamics occurring in the Alps even at moderate fire intensities.

Wildfires play the role of ecosystem shapers in the majority of terrestrial biomes, altering canopy and litter cover and imposing strong modifications on soils. Organic matter (OM) content and composition, mineralogy, pH, aggregate stability and water repellency (WR) are among the main edaphic properties to be affected by heat. Various studies dealt with occurrence, extent and persistence of burning-induced soil WR, but the dynamics at the basis of its formation (and loss) are still widely unclear. In addition, the vast majority of research on this topic has been carried out in the Mediterranean, even if alpine environments are far from being untouched by fires. Our aims were therefore to provide insight into the key mechanisms regulating WR thermal alterations in a relatively understudied environment. Our sampling design aimed at collecting soils representative of the Western Italian Alps. Charring was simulated in the lab, at increasing temperatures (up to 300° C), on a set of A soil horizons developed under pine and beech forest covers. Water drop penetration time (WDPT) was employed to test WR persistence. Soils were analyzed in terms of organic carbon (OC) and nitrogen contents, pH, texture and iron (Fe) oxides composition (Fe-DCB and Fe-pyrophosphate extracted). Fe-speciation and OM composition of some selected samples were further characterized using Fe K-edge extended X-ray absorption fine structure (EXAFS) spectroscopy and Fourier transform-infra red (FT-IR) spectroscopy, respectively. WR was found to be extremely variable, event at room temperature. For samples exhibiting an increase in WR upon burning intensity, maximum repellency was observed at 200° C. OC abundance (%) and coarse texture were found to be the main drivers of hydrophobicity in soil. WR was drastically lost when samples were exposed to temperatures higher than 200°C. Above this threshold, pH systematically increased and OC (%) sharply decreased. The increasingly negative charge of mineral surfaces, mirrored by pH increase, seems to result in a significant C volatilization by OM desorption, eventually leading to a super-hydrophilic behavior in soil. Fe EXAFS allowed to evaluate different thermal-dictated pathways of Fe-speciation. The formation of more crystalline Fe-forms (e.g. hematite, meghemite) was observed above 200° C. Even though a reduction in surface area should be expected when observing an increase in crystallization degree (potentially giving rise to greater WR), OM adhesion to mineral surfaces seems to be inhibited by the change induced in their charge. A reduction in the OM-bound Fe pool (pyrophosphate extracted) above 200° C could be appreciated, supporting the interpretation of oxy-hydroxides transformations and OC (%) loss. The current investigation has been carried out to capture an in-depth picture of wildfire impacts on alpine soils, targeting factors responsible for WR enhancement and shred. Identifying the mechanisms regulating wildfire-related WR is a key issue, as the formation of hydrophobic layers in soil highly favors its erosion. Addressing such matters is crucial to tackle the issue of ecosystems recovery, considering that climate-change-related alterations in wildfires regimes are already causing the occurrence of more frequent and disruptive fires

Heating response patterns of Alpine soils: from a plot-scale to lab experiments.

Wildfires play the role of ecosystem shapers in the majority of terrestrial biomes. Nowadays, their regimes are changing as a consequence of land abandonment and climate change. After-fire dynamics are widely studied in North America and Mediterranean environments. However, soils developed in different biomes might not unequivocally respond to fire-induced heating, and forests of the Western Italian Alps are not unfamiliar to fire occurrence. For these reasons, we conducted several experiments (at plot and lab scale) at environmentally realistic conditions to systematically assess the impacts of fire on the physico-chemical properties of soils belonging to the Italian Alpine ecological region. A homogenous pine forest (Pinus sylvestris L.) located in a mountain region near Torino experienced the passage of a severe and large wildfire in fall 2017. The field survey carried out in 2020 revealed that lower organic carbon (OC) contents and higher bulk density (BD) values were associated to a greater fire severity. Abundance of pyrogenic carbon was related to the steepness degree, as a consequence of erosion. In the superficial horizons, the naturally high WR expected from soils developed under a conifer stand was not present. To elucidate mechanisms regulating WR occurrence and evolution, the thermal transformations borne by Alpine soils were investigated at controlled laboratory conditions. Topsoil samples displayed extremely different wettable behaviors upon increasing temperatures (Ts), with or without WR build-up. This occurred mainly in relation to content and composition of organic matter (OM), particle size distribution and abundance of iron (Fe) oxides. Notwithstanding the initial sample hydrophobicity, WR was dramatically lost above 200 °C due to increasing pH values, inducing OM de-sorption from the negatively charged mineral surfaces. In the same T range, the thermal transformation of soil Fe oxides were found to be primarily directed towards oxidative processes (hematite formation). Ts up to 300 °C could have potentially promoted the stabilization of the remaining (non-combusted) OM, with the synthesis of defect-rich Fe oxides and enrichment in condensed and aromatic compounds, and yet OM was highly dispersible at the high pH values resulting from the thermal treatment, such that OC might be weakly retained on mineral phases in an after-fire scenario

Tocilizumab for patients with COVID-19 pneumonia. The single-arm TOCIVID-19 prospective trial

BackgroundTocilizumab blocks pro-inflammatory activity of interleukin-6 (IL-6), involved in pathogenesis of pneumonia the most frequent cause of death in COVID-19 patients.MethodsA multicenter, single-arm, hypothesis-driven trial was planned, according to a phase 2 design, to study the effect of tocilizumab on lethality rates at 14 and 30 days (co-primary endpoints, a priori expected rates being 20 and 35%, respectively). A further prospective cohort of patients, consecutively enrolled after the first cohort was accomplished, was used as a secondary validation dataset. The two cohorts were evaluated jointly in an exploratory multivariable logistic regression model to assess prognostic variables on survival.ResultsIn the primary intention-to-treat (ITT) phase 2 population, 180/301 (59.8%) subjects received tocilizumab, and 67 deaths were observed overall. Lethality rates were equal to 18.4% (97.5% CI: 13.6-24.0, P=0.52) and 22.4% (97.5% CI: 17.2-28.3, P<0.001) at 14 and 30 days, respectively. Lethality rates were lower in the validation dataset, that included 920 patients. No signal of specific drug toxicity was reported. In the exploratory multivariable logistic regression analysis, older age and lower PaO2/FiO2 ratio negatively affected survival, while the concurrent use of steroids was associated with greater survival. A statistically significant interaction was found between tocilizumab and respiratory support, suggesting that tocilizumab might be more effective in patients not requiring mechanical respiratory support at baseline.ConclusionsTocilizumab reduced lethality rate at 30 days compared with null hypothesis, without significant toxicity. Possibly, this effect could be limited to patients not requiring mechanical respiratory support at baseline.Registration EudraCT (2020-001110-38); clinicaltrials.gov (NCT04317092)