Using different epilithic-diatom assemblage metrics for an ecological characterization of the shores of Lake Garda

It has been proved that littoral diatoms provide a useful marker for detecting localised changes resulting from neve anthropogenic disturbances or intermittent releases of sewage along the shorelines of lakes. This study tested the spatial resolution at which this general observation occurs, by selecting areas with different anthropogenic pressures (urbanization) along a latitudinal gradient in Lake Garda, a deep and wide peri-Alpine lake. The sampling design aimed to detect differences in diatom distribution in terms of species diversity, quality indices, proportion of Red List taxa, assemblages, and individual species. Because the extent to which diatom assemblages respond to these gradients was unknown, we used assemblage metrics of different sensitivities. Results showed that the most important environmental factor was the latitudinal gradient, which was revealed by almost all the assemblage metrics. This dominant trend was explained by two co-occurring environmental gradients: concentration of nutrients and thermal gradient. The importance of different levels of urbanization was unevenly partitioned among locations and latitudes because of the different intensities of urbanization pressure. Only the species Brachysira neglectissima, the quality index (Trophic Index), and to a lesser extent, the metric at assemblage level revealed significant effects. Overall, this study comes to two main conclusions: (1) different metrics are needed to detect the multifaceted effects of anthropogenic disturbances, which by their very nature are unevenly distributed and of different intensities, and therefore affect assemblages to different degrees; (2) for any monitoring program in this lake to be effective, the various gradients revealed in this work should be taken into account. Failing to include these sources of variability might lessen the benefits of monitorin

Nutrition in Patients with Idiopathic Pulmonary Fibrosis: Critical Issues Analysis and Future Research Directions

In idiopathic pulmonary fibrosis (IPF), several factors may have a negative impact on the nutritional status, including an increased respiratory muscles load, release of inflammation mediators, the coexistence of hypoxemia, and physical inactivity. Nutritional abnormalities also have an impact on IPF clinical outcomes. Given the relevance of nutritional status in IPF patients, we sought to focus on some critical issues, highlighting what is known and what should be further learned about these issues. We revised scientific literature published between 1995 and August 2019 by searching on Medline/PubMed and EMBASE databases including observational and interventional studies. We conducted a narrative review on nutritional assessment in IPF, underlining the importance of nutritional evaluation not only in the diagnostic process, but also during follow-up. We also highlighted the need to keep a high level of attention on cardiovascular comorbidities. We also focused on current clinical treatment in IPF with Nintedanib and Pirfenidone and management of gastrointestinal adverse events, such as diarrhea, induced by these antifibrotic drugs. Finally, we concentrated on the importance of pulmonary rehabilitation program, including nutritional assessment, education and behavioral change, and psychological support among its essential components. More attention should be devoted to the assessment of the undernutrition and overnutrition, as well as of muscle strength and physical performance in IPF patients, taking also into account that an adequate clinical management of gastrointestinal complications makes IPF drug treatments more feasible

Parental presence in Italian pediatric intensive care units: a reappraisal of current visiting policies

Parental presence in Italian pediatric intensive care units: a reappraisal of current visiting policie