Reduction of cognitive fatigue and improved performance at a VR-based driving simulator using tRNS

: Cognitive fatigue (CF) increases accident risk reducing performance, especially during complex tasks such as driving. We evaluated whether transcranial random noise stimulation (tRNS) could mitigate CF and improve driving performance. In a double-blind study, thirty participants performed a virtual reality truck driving task during real (n = 15) or sham (n = 15) tRNS applied bilaterally on the "anti-fatigue network". They completed two 30-min driving sessions while their driving performances were constantly monitored; heart rate was also monitored to evaluate arousal (Root-Mean-Square of successive R-R difference). tRNS was applied only during the first driving session to evaluate both online and offline stimulation effects. The primary outcome was CF reduction and performance improvement in the second (non-stimulated) driving session. Real tRNS significantly improved driving performances in the second driving session and reduced perceived CF. These results might also lead to the use of tRNS in those neurological disorders characterized by fatigue

Is the Salmonella contamination of swine carcasses at slaughter related to the Salmonella load in caecum?

The aim of this study was to examine the relationship between the load of Salmonella spp. in caeca and the carcass contamination in an Italian slaughterhouse. The sampling scheme was designed to be representative of the pigs slaughtered in a day and to estimate a 12% prevalence of pigs highly contaminated by Salmonella spp. (HCP, cecal load ≥3log). Environmental swabs were taken before slaughter. Cecal contents and carcass swabs were collected from the same pig. Salmonella MPN were estimated according to ISO6579- 2:2012/A1 and ISO7218:2007/E. The overall Salmonella prevalence were 34.64% and 7.19% for ceca and carcasses respectively, with S. Derby and S. 4,[5],12:i:- being the prevalent serotypes. The HCP prevalence was 11.44%. 7/59 environmental swabs tested positive; when the same serotype was isolated from the environment and from carcasses, the samples were excluded from further analysis. Statistical analysis was performed to investigate the relationship between Salmonella spp. loads in the cecum and contamination of the carcass of the same pig and the prevalence of HCP and the contamination of carcasses on the same day. For this purpose, the days were classified as “high prevalence days” depending on the proportion of caeca resulted positive (≥36%) and as “high load” days depending on the prevalence of HCP (≥10%). A correlation between the contamination of carcasses and the cecal Salmonella loads of the same animal was found (Spearman’s correlation coefficient: 0.2254; p-value=0.0001). No correlation was found between the contamination of carcasses and the categorization of the day of sampling as “high prevalence day”. Conversely, a correlation was found between the contamination of carcasses and the “high load” category of the sampling day (Wilcoxon test, p=0.0011). Notably, not the prevalence of pigs carrying Salmonella spp. but the prevalence of highly contaminated pigs was shown to be related to the contamination of carcasses

Parenting the Parents: The Ethics of Parent-Targeted Paternalism in the Context of Anti-poverty Policies

Governments often aim to improve children’s wellbeing by targeting the decision-making of their parents. In this paper, I explore this phenomenon, providing an ethical evaluation of the ways in which governments target parental decision-making in the context of anti-poverty policies. I first introduce and motivate the concept of parent-targeted paternalism to categorize such policies. I then investigate whether parent-targeted paternalism is ever pro tanto wrong, arguing that it is when directed at parents who meet a threshold of parental competency. I next explore the factors that affect the degree of pro tanto wrongness of paternalistic anti-poverty policies targeting parents, and provide an account of the conditions under which such policies are on balance permissible, and when they are not. Finally, I illustrate the plausibility and usefulness of my framework by considering a case

The economic impact of moderate stage Alzheimer's disease in Italy: Evidence from the UP-TECH randomized trial

Background: There is consensus that dementia is the most burdensome disease for modern societies. Few cost-of-illness studies examined the complexity of Alzheimer's disease (AD) burden, considering at the same time health and social care, cash allowances, informal care, and out-of-pocket expenditure by families. Methods: This is a comprehensive cost-of-illness study based on the baseline data from a randomized controlled trial (UP-TECH) enrolling 438 patients with moderate AD and their primary caregiver living in the community. Results: The societal burden of AD, composed of public, patient, and informal care costs, was about �20,000/yr. Out of this, the cost borne by the public sector was �4,534/yr. The main driver of public cost was the national cash-for-care allowance (�2,324/yr), followed by drug prescriptions (�1,402/yr). Out-of-pocket expenditure predominantly concerned the cost of private care workers. The value of informal care peaked at �13,590/yr. Socioeconomic factors do not influence AD public cost, but do affect the level of out-of-pocket expenditure. Conclusion: The burden of AD reflects the structure of Italian welfare. The families predominantly manage AD patients. The public expenditure is mostly for drugs and cash-for-care benefits. From a State perspective in the short term, the advantage of these care arrangements is clear, compared to the cost of residential care. However, if caregivers are not adequately supported, savings may be soon offset by higher risk of caregiver morbidity and mortality produced by high burden and stress. The study has been registered on the website www.clinicaltrials.org (Trial Registration number: NCT01700556). Copyright � International Psychogeriatric Association 2015

Impact of chronic obstructive pulmonary disease on short-term outcome in patients with ST-elevation myocardial infarction during COVID-19 pandemic: insights from the international multicenter ISACS-STEMI registry

Background: Chronic obstructive pulmonary disease (COPD) is projected to become the third cause of mortality worldwide. COPD shares several pathophysiological mechanisms with cardiovascular disease, especially atherosclerosis. However, no definite answers are available on the prognostic role of COPD in the setting of ST elevation myocardial infarction (STEMI), especially during COVID-19 pandemic, among patients undergoing primary angioplasty, that is therefore the aim of the current study. Methods: In the ISACS-STEMI COVID-19 registry we included retrospectively patients with STEMI treated with primary percutaneous coronary intervention (PCI) between March and June of 2019 and 2020 from 109 high-volume primary PCI centers in 4 continents. Results: A total of 15,686 patients were included in this analysis. Of them, 810 (5.2%) subjects had a COPD diagnosis. They were more often elderly and with a more pronounced cardiovascular risk profile. No preminent procedural dissimilarities were noticed except for a lower proportion of dual antiplatelet therapy at discharge among COPD patients (98.9% vs. 98.1%, P = 0.038). With regards to short-term fatal outcomes, both in-hospital and 30-days mortality occurred more frequently among COPD patients, similarly in pre-COVID-19 and COVID-19 era. However, after adjustment for main baseline differences, COPD did not result as independent predictor for in-hospital death (adjusted OR [95% CI] = 0.913[0.658–1.266], P = 0.585) nor for 30-days mortality (adjusted OR [95% CI] = 0.850 [0.620–1.164], P = 0.310). No significant differences were detected in terms of SARS-CoV-2 positivity between the two groups. Conclusion: This is one of the largest studies investigating characteristics and outcome of COPD patients with STEMI undergoing primary angioplasty, especially during COVID pandemic. COPD was associated with significantly higher rates of in-hospital and 30-days mortality. However, this association disappeared after adjustment for baseline characteristics. Furthermore, COPD did not significantly affect SARS-CoV-2 positivity. Trial registration number: NCT 04412655 (2nd June 2020)

Gender Difference in the Effects of COVID-19 Pandemic on Mechanical Reperfusion and 30-Day Mortality for STEMI: Results of the ISACS-STEMI COVID-19 Registry

Background. Several reports have demonstrated the impact of the COVID-19 pandemic on the management and outcome of patients with ST-segment elevation myocardial infarction (STEMI). The aim of the current analysis is to investigate the potential gender difference in the effects of the COVID-19 pandemic on mechanical reperfusion and 30-day mortality for STEMI patients within the ISACS-STEMI COVID-19 Registry. Methods. This retrospective multicenter registry was performed in high-volume primary percutaneous coronary intervention (PPCI) centers on four continents and included STEMI patients undergoing PPCIs in March–June 2019 and 2020. Patients were divided according to gender. The main outcomes were the incidence and timing of the PPCI, (ischemia time ≥ 12 h and door-to-balloon ≥ 30 min) and in-hospital or 30-day mortality. Results. We included 16683 STEMI patients undergoing PPCIs in 109 centers. In 2020 during the pandemic, there was a significant reduction in PPCIs compared to 2019 (IRR 0.843 (95% CI: 0.825–0.861, p < 0.0001). We did not find a significant gender difference in the effects of the COVID-19 pandemic on the numbers of STEMI patients, which were similarly reduced from 2019 to 2020 in both groups, or in the mortality rates. Compared to prepandemia, 30-day mortality was significantly higher during the pandemic period among female (12.1% vs. 8.7%; adjusted HR [95% CI] = 1.66 [1.31–2.11], p < 0.001) but not male patients (5.8% vs. 6.7%; adjusted HR [95% CI] = 1.14 [0.96–1.34], p = 0.12). Conclusions. The COVID-19 pandemic had a significant impact on the treatment of patients with STEMI, with a 16% reduction in PPCI procedures similarly observed in both genders. Furthermore, we observed significantly increased in-hospital and 30-day mortality rates during the pandemic only among females. Trial registration number: NCT 04412655

The Global Alliance for Infections in Surgery : defining a model for antimicrobial stewardship-results from an international cross-sectional survey

Background: Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world. Methods: A cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery. Results: The response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4-6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p <0.05) compared to community teaching (83.3%) and community hospitals (66.7%). Protocols for pre-operative prophylaxis and for antimicrobial treatment of surgical infections were respectively implemented in 96.2 and 82.3% of the hospitals. The majority of the surgical departments implemented both persuasive and restrictive interventions (72.8%). The most common types of interventions in surgical departments were dissemination of educational materials (62.5%), expert approval (61.0%), audit and feedback (55.1%), educational outreach (53.7%), and compulsory order forms (51.5%). Conclusion: The survey showed a heterogeneous organization of ASPs worldwide, demonstrating the necessity of a multidisciplinary and collaborative approach in the battle against antimicrobial resistance in surgical infections, and the importance of educational efforts towards this goal.Peer reviewe

Understanding similarities and differences in land use visions for Scotland

The successful transition towards a global society that can live within planetary boundaries is one of the greatest challenges for the twenty-first century. Sustainable land use and land management will be essential to ensure the continued delivery of the ecosystem goods and services needed to support a rapidly growing global population. To support the transition towards sustainable development, decision-makers need to better understand how land use change affects people and the environment. However, these insights are of limited use without societal agreement on future land uses. Understanding synergies and differences between land use visions forms a first step in assessing and comparing alternative pathways towards a sustainable future. This thesis uses a range of methods to understand visions of future land use amongst professional land use stakeholders, society at large, and young people in Scotland. Twenty semi-structured interviews were held with policy experts from the Scottish land use sectors. A nationwide statistically representative web-based survey provided insight into the visions of the Scottish population. And finally, a novel visual interview methodology was used to interview 26 pupils from two high schools in Perthshire. Inductive content analysis and descriptive statistics were used to analyse the results and understand and compare the land use visions of these different groups. As expected, different groups had different visions of future land use. There was, however, general agreement on certain themes, in particular the desire for a more sustainable lifestyle and the importance of a healthy environment. The sectoral stakeholders would like to see more partnerships, dialogue and collaboration; a society that is more engaged and aware about land use; resilient local economies; and short-, medium-, and long-term policies that help to achieve these goals. One of the key challenges for these groups will be how to translate abstract concepts such as ‘healthy ecosystem’ and ‘dialogue and partnerships’ into practice. This clearly requires a shared understanding of what a ‘healthy ecosystem’ means to different stakeholders, as well as appreciation of what true dialogue means and how this can be used to co-create solutions – potentially a radical change from the traditional top-down approaches. The research also identified divisions in Scottish society between those who want to continue a ‘status quo’ lifestyle, and those – in particular younger people (who spent time in the natural environment, through either school or home life) and those from a higher socio-economic background – who want a more sustainable lifestyle and to be more connected with the natural environment. These results are important, as policy makers need to be able to identify the factors that have successfully engaged certain groups and to promote these factors. Programmes that provide access to the natural environment (such as the Duke of Edinburgh’s Award) need to ensure equal opportunities by targeting disadvantaged groups. Simultaneously, it needs to be explored how to encourage those who would like to continue a ‘status quo’ lifestyle into a more sustainable one. Past research has shown how preferences can be influenced and how changes can be initiated by incentives and restrictions in order to promote desired behaviours. The power of the media should be leveraged: programmes such as BBC’s ‘Blue Planet’ highlight how our lifestyle choices impact on the natural environment and can provide the motivation for change. The current issues surrounding Brexit and Climate Change require a national conversation; using methods such as those presented in the thesis to elicit land use visions can help identify the commonalties and differences between stakeholders’ views. This can provide a starting point for dialogue and critical reflection on current instruments and objectives, and how they might be adapted to better reflect Scottish preferences and conditions