Early Neurological ASsessment with pupillometrY during Cardiac Arrest REsuscitation (EASY-CARE): protocol for an observational multicentre prospective study

IntroductionOut-of-hospital cardiac arrest is burdened with a high rate of ineffective resuscitation and poor neurological outcome among survivors. To date, there are few perfusion assessment tools during cardiopulmonary resuscitation and none of them provide reliable data. Despite the lack of information, physicians must decide whether to extend or terminate resuscitation efforts.Method and analysisThis is a multicentre prospective, observational cohort study, involving adult patients, victims of unexpected out-of-hospital cardiac arrest. Early Neurological ASsessment with pupillometrY during Cardiac Arrest Resuscitation aims to primarily describe the reliability of quantitative pupillometry through use of the Neurological Pupillary Index (NPi) during the manoeuvre of cardiopulmonary resuscitation, as a predictor of the return of spontaneous circulation. The second objective is to seek and describe the association between the NPi and neurological outcome in the surviving cohort. Patients will be excluded if they are less than 18 years of age, have sustained traumatic brain injury, cerebrovascular emergencies, direct injury to the eyes or have pupil anomalies. Neurological outcome will be collected at intensive care unit discharge, at 30 days, 6 months and at 1 year. The Glasgow Coma Scale (GCS) will be used in the emergency department; modified Rankin Score will be adopted for neurological assessment; biomarkers and neurophysiology exams will be collected as well.Ethics and disseminationThe study has been approved by Ethics Committee of Milano. Local committee acceptance is required for each of the centres involved in the clinical and follow-up data collection. Data will be disseminated to the scientific community through original articles submitted to peer-reviewed journals and abstracts to conferences.Trial registration numberNCT05192772

On the Use of Biobased Waxes to Tune Thermal and Mechanical Properties of Polyhydroxyalkanoates–Bran Biocomposites

In this work, processability and mechanical performances of bio-composites based on poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) containing 5, 10, and 15 wt % of bran fibers, untreated and treated with natural carnauba and bee waxes were evaluated. Wheat bran, the main byproduct of flour milling, was used as filler to reduce the final cost of the PHBV-based composites and, in the same time, to find a potential valorization to this agro-food by-product, widely available at low cost. The results showed that the wheat bran powder did not act as reinforcement, but as filler for PHBV, due to an unfavorable aspect ratio of the particles and poor adhesion with the polymeric matrix, with consequent moderate loss in mechanical properties (tensile strength and elongation at break). The surface treatment of the wheat bran particles with waxes, and in particular with beeswax, was found to improve the mechanical performance in terms of tensile properties and impact resistance of the composites, enhancing the adhesion between the PHBV-based polymeric matrix and the bran fibers, as confirmed by predictive analytic models and dynamic mechanical analysis results

Is prolonged infusion of piperacillin/tazobactam and meropenem in critically ill patients associated with improved pharmacokinetic/pharmacodynamic and patient outcomes? An observation from the Defining Antibiotic Levels in Intensive care unit patients (DALI) cohort

Objectives:We utilized the database of the Defining Antibiotic Levels in Intensive care unit patients (DALI) study to statistically compare the pharmacokinetic/pharmacodynamic and clinical outcomes between prolonged-infusion and intermittent-bolus dosing of piperacillin/tazobactam and meropenem in critically ill patients using inclusion criteria similar to those used in previous prospective studies.Methods: This was a post hoc analysis of a prospective, multicentre pharmacokinetic point-prevalence study (DALI), which recruited a large cohort of critically ill patients from 68 ICUs across 10 countries.Results: Of the 211 patients receiving piperacillin/tazobactam and meropenem in the DALI study, 182 met inclusion criteria. Overall, 89.0% (162/182) of patients achieved the most conservative target of 50% fT(> MIC) (time over which unbound or free drug concentration remains above the MIC). Decreasing creatinine clearance and the use of prolonged infusion significantly increased the PTA for most pharmacokinetic/pharmacodynamic targets. In the subgroup of patients who had respiratory infection, patients receiving beta-lactams via prolonged infusion demonstrated significantly better 30 day survival when compared with intermittent-bolus patients [86.2% (25/29) versus 56.7% (17/30); P=0.012]. Additionally, in patients with a SOFA score of >= 9, administration by prolonged infusion compared with intermittent-bolus dosing demonstrated significantly better clinical cure [73.3% (11/15) versus 35.0% (7/20); P=0.035] and survival rates [73.3% (11/15) versus 25.0% (5/20); P=0.025].Conclusions: Analysis of this large dataset has provided additional data on the niche benefits of administration of piperacillin/tazobactam and meropenem by prolonged infusion in critically ill patients, particularly for patients with respiratory infections

Innovative Biotic Symbiosis for Plastic Biodegradation to Solve their End-of-Life Challenges in the Agriculture and Food Industries

At present just about 30% of the waste plastic collected is efficiently recycled, while the rest is incinerated, disposed in landfills, or can end up in compost and be released in the environment, inducing a very negative effect on safety and health of flora and fauna. Sustainable management of hardly recyclable plastic waste generated by light weight single use packaging and agricultural films can be improved by applying biotechnological approaches, combining microorganisms, new enzymes, earthworms, and insects to work collaboratively, not only to promote the degradation of these plastics but also to obtain, by-products of the biodegradation process to be valorized as fertilizers, functional polysaccharides, etc. In order to develop a feasible process, mapping and characterization of the most diffused agri-food waste plastic were conducted isolating the main types of plastic involved. Plastic waste in agriculture is mainly constituted by polyethylene (PE) both linear low density (LLDPE) and high density (HDPE), polypropylene (PP) and polystyrene (PS), whereas in food packaging polyethylene is still present together with a large presence of polypropylene, polystyrene and polyethylene terephthalate (PET). Combining plastic presence and availability of organisms for their degradability, representative samples of plastics (PE, PET, PS) were selected for analysis of deterioration and potential subsequent biodegradation by enzymes and organisms. To monitor the plastic degradability by enzymes, and larvae, methods for the plastic analysis were set, outlining some differences in virgin and post consumer plastic in particular after use in agriculture, assessing the possibility to monitor the degradability of plastic with time and different treatments, in particular, some evidence of polyethylene degradability from larvae of Tenebrio molitor was observed

Overview of Agro-Food Waste and by Products Valorization for Polymer Synthesis, and Modification for Bio-Composite Production.

The world economy growth and global population rising push for a more efficient management of the Earth’s natural resources. The combined plastic and food sector form an important part of the EU economy, accounting for 15 million jobs. Unlocking the innovation potential in the field of packaging, and cosmetics will significantly contribute to job creation and competitiveness. Sus-tainable synthesis of polyhydroxyalkanaotes from agro-food by-products as well as synthesis of lactic acid co-polymers constitute a pathway to performing and sustainable polymeric matrices. Natural fibers as well as polysaccharides (starch, cellulose, chitin, chitosan), cutin and protein rich by-products are abundantly available from the agrofood industry. Natural fibres may be modified chemically, with enzymes or treating their surface with natural waxes with a significant im-provement in adhesion and impact resistance. An overview on the availability, collection, treat-ment and approach to valorization of largely available agro-food waste biomass for both polymers and biocomposites production, is hereby reported with exampled of case studies and product de-veloped in our research units, such as sustainable pots, rigid containers, active films, non-woven tissue

(Table 2) Salinity, pH, alkalinity and major ion concentrations in ANDRILL core AND-2A pore water

The compositional record of the AND-2A drillcore is examined using petrological, sedimentological, volcanological and geochemical analysis of clasts, sediments and pore waters. Preliminary investigations of basement clasts (granitoids and metasediments) indicate both local and distal sources corresponding to variable ice-volume and ice-flow directions. Low abundance of sedimentary clasts (e.g., arkose, litharenite) suggests reduced contributions from sedimentary covers while intraclasts (e.g., diamictite, conglomerate) attest to intrabasinal reworking. Volcanic material includes pyroclasts (e.g., pumice, scoria), sediments and lava. Primary and reworked tephra layers occur within the Early Miocene interval (1093 to 640 metres below sea floor mbsf). The compositions of volcanic clasts reveal a diversity of alkaline types derived from the McMurdo Volcanic Group. Finer-grained sediments (e.g., sandstone, siltstone) show increases in biogenic silica and volcanic glass from 230 to 780 mbsf and higher proportions of terrigenous material c. 350 to 750 mbsf and below 970 mbsf. Basement clast assemblages suggest a dominant provenance from the Skelton Glacier - Darwin Glacier area and from the Ferrar Glacier - Koettlitz Glacier area. Provenance of sand grains is consistent with clast sources. Thirteen Geochemical Units are established based on compositional trends derived from continuous XRF scanning. High values of Fe and Ti indicate terrigenous and volcanic sources, whereas high Ca values signify either biogenic or diagenic sources. Highly alkaline and saline pore waters were produced by chemical exchange with glass at moderately elevated temperatures

Negative symptoms in children and adolescents with early-onset psychosis and at clinical high-risk for psychosis: systematic review and meta-analysis

Early-onset psychosis (EOP) refers to the development of a first episode of psychosis before 18 years of age. Individuals at clinical high risk for psychosis (CHR-P) include adolescents and young adults, although most evidence has focused on adults. Negative symptoms are important prognostic indicators in psychosis. However, research focusing on children and adolescents is limited. To provide meta-analytical evidence and a comprehensive review of the status and advances in the diagnosis, prognosis and treatment of negative symptoms in children and adolescents with EOP and at CHR-P. PRISMA/MOOSE-compliant systematic review (PROSPERO: CRD42022360925) from inception to 18 August 2022, in any language, to identify individual studies conducted in EOP/CHR-P children and adolescents (mean age <18 years) providing findings on negative symptoms. Findings were systematically appraised. Random-effects meta-analyses were performed on the prevalence of negative symptoms, carrying out sensitivity analyses, heterogeneity analyses, publication bias assessment and quality assessment using the Newcastle-Ottawa Scale. Of 3289 articles, 133 were included (n = 6776 EOP, mean age 15.3 years (s.d. = 1.6), males = 56.1%; n = 2138 CHR-P, mean age 16.1 years (s.d. = 1.0), males = 48.6%). There were negative symptoms in 60.8% (95% CI 46.4%-75.2%) of the children and adolescents with EOP and 79.6% (95% CI 66.3-92.9%) of those at CHR-P. Prevalence and severity of negative symptoms were associated with poor clinical, functional and intervention outcomes in both groups. Different interventions were piloted, with variable results requiring further replication. Negative symptoms are common in children and adolescents at early stages of psychosis, particularly in those at CHR-P, and are associated with poor outcomes. Future intervention research is required so that evidence-based treatments will become available