Application of average volume assured pressure support (AVAPS) and ultrasound assessment in COVID-19 infection: real-life observation.

BACKGROUND: ARDS in COVID-19 patients admitted to Emergency Departments (ED) is characterized by reduced diaphragm motility and increased work of breathing (WOB) by accessory respiratory muscles. Reduced perfusion of compliant lungs as consequence of vascular abnormalities has been highlighted as possible explanation of typical hypoxemia. Non-invasive mechanical ventilation (NIMV) has been proposed to treat ARDS. AVAPS is a hybrid modality of NIMV combining features of pressure and volume ventilation. METHODS: we enrolled 38 patients with COVID-19 ARDS to whom we applied NIMV with AVAPS modality. We assessed Tidal Volume (TV), diaphragm excursion (DE) and PaO2/FiO2 before starting NIMV and after three (T3) and six hours (T6) of ventilation. RESULTS: Admissions to ICU were avoided in 68% of our patients. TV (627±147.6 vs. 747.1±226 mL, P<0.00005) and DE (21.8±5.4 vs. 17.9±6.1 mm, P<0.00005) already improved after three hours of AVAPS. TV (521.5±120 mL, P<0.00005), DE (25.8±6.9 mm, P<0.00005) and PaO2/FiO2 (197.3±75.3 vs. 158±67.7, P<0.005) significantly improved in our cohort of patients after six hours. CONCLUSIONS: NIMV with AVAPS modality can be confidently used in the clinical management of COVID-19 patients with ARDS, since AVAPS has positive effects on ventilation-perfusion matching and WOB. We recommend low PEEP value and ultrasound assessment of diaphragm motility and lung characteristics, although further studies are needed to individuate clinical features of NIMV best-responder patients

Aedes albopictus bionomics data collection by citizen participation on procida island, a promising mediterranean site for the assessment of innovative and community-based integrated pest management methods

In the last decades, the colonization of Mediterranean Europe and of other temperate regions by Aedes albopictus created an unprecedented nuisance problem in highly infested areas and new public health threats due to the vector competence of the species. The Sterile Insect Technique (SIT) and the Incompatible Insect Technique (IIT) are insecticide-free mosquito-control methods, relying on mass release of irradiated/manipulated males, able to complement existing and only partially effective control tools. The validation of these approaches in the field requires appropriate experimental settings, possibly isolated to avoid mosquito immigration from other infested areas, and preliminary ecological and entomological data. We carried out a 4-year study in the island of Procida (Gulf of Naples, Italy) in strict collaboration with local administrators and citizens to estimate the temporal dynamics, spatial distribution, and population size of Ae. albopictus and the dispersal and survival of irradiated males. We applied ovitrap monitoring, geo-spatial analyses, mark-release-recapture technique, and a citizen-science approach. Results allow to predict the seasonal (from April to October, with peaks of 928-9,757 males/ha) and spatial distribution of the species, highlighting the capacity of Ae. albopictus population of Procida to colonize and maintain high frequencies in urban as well as in sylvatic inhabited environments. Irradiated males shown limited ability to disperse (mean daily distance travelled <60m) and daily survival estimates ranging between 0.80 and 0.95. Overall, the ecological characteristics of the island, the acquired knowledge on Ae. albopictus spatial and temporal distribution, the high human and Ae. albopictus densities and the positive attitude of the resident population in being active parts in innovative mosquito control projects provide the ground for evidence-based planning of the interventions and for the assessment of their effectiveness. In addition, the results highlight the value of creating synergies between research groups, local administrators, and citizens for affordable monitoring (and, in the future, control) of mosquito populations

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

On the interharmonics compnents generated by adjustable speed drives

The interharmonic generation process is addressed with reference to high power adjustable speed drives based on double stage conversion systems using line commutated or pulse width modulated inverters. Reference is made to ideal supply conditions. Formulas to forecast the interharmonic frequencies due to the interaction between the rectifier and the inverter are developed and a proper symbolism is proposed to recognize the interharmonic origins. Comprehensive analyses are performed for both the considered adjustable speed drives in a wide range of output frequencies and with reference to supply system side, output side, and dc link