The Abdominal Circulatory Pump

Blood in the splanchnic vasculature can be transferred to the extremities. We quantified such blood shifts in normal subjects by measuring trunk volume by optoelectronic plethysmography, simultaneously with changes in body volume by whole body plethysmography during contractions of the diaphragm and abdominal muscles. Trunk volume changes with blood shifts, but body volume does not so that the blood volume shifted between trunk and extremities (Vbs) is the difference between changes in trunk and body volume. This is so because both trunk and body volume change identically with breathing and gas expansion or compression. During tidal breathing Vbs was 50–75 ml with an ejection fraction of 4–6% and an output of 750–1500 ml/min. Step increases in abdominal pressure resulted in rapid emptying presumably from the liver with a time constant of 0.61±0.1SE sec. followed by slower flow from non-hepatic viscera. The filling time constant was 0.57±0.09SE sec. Splanchnic emptying shifted up to 650 ml blood. With emptying, the increased hepatic vein flow increases the blood pressure at its entry into the inferior vena cava (IVC) and abolishes the pressure gradient producing flow between the femoral vein and the IVC inducing blood pooling in the legs. The findings are important for exercise because the larger the Vbs the greater the perfusion of locomotor muscles. During asystolic cardiac arrest we calculate that appropriate timing of abdominal compression could produce an output of 6 L/min. so that the abdominal circulatory pump might act as an auxiliary heart

Communication and visiting policies in Italian intensive care units during the first COVID-19 pandemic wave and lockdown: a nationwide survey

Background: During the first coronavirus disease 2019 (COVID-19) pandemic wave, an unprecedented number of patients with respiratory failure due to a new, highly contagious virus needed hospitalization and intensive care unit (ICU) admission. The aim of the present study was to describe the communication and visiting policies of Italian intensive care units (ICUs) during the first COVID-19 pandemic wave and national lockdown and compare these data with prepandemic conditions. Methods: A national web-based survey was conducted among 290 Italian hospitals. Each ICU (active between February 24 and May 31, 2020) was encouraged to complete an individual questionnaire inquiring the hospital/ICU structure/organization, communication/visiting habits and the role of clinical psychology prior to, and during the first COVID-19 pandemic wave. Results: Two hundred and nine ICUs from 154 hospitals (53% of the contacted hospitals) completed the survey (202 adult and 7 pediatric ICUs). Among adult ICUs, 60% were dedicated to COVID-19 patients, 21% were dedicated to patients without COVID-19 and 19% were dedicated to both categories (Mixed). A total of 11,102 adult patients were admitted to the participating ICUs during the study period and only approximately 6% of patients received at least one visit. Communication with family members was guaranteed daily through an increased use of electronic devices and was preferentially addressed to the same family member. Compared to the prepandemic period, clinical psychologists supported physicians more often regarding communication with family members. Fewer patients received at least one visit from family members in COVID and mixed-ICUs than in non-COVID ICUs, l (0 [0–6]%, 0 [0–4]% and 11 [2–25]%, respectively, p < 0.001). Habits of pediatric ICUs were less affected by the pandemic. Conclusions: Visiting policies of Italian ICUs dedicated to adult patients were markedly altered during the first COVID-19 wave. Remote communication was widely adopted as a surrogate for family meetings. New strategies to favor a family-centered approach during the current and future pandemics are warranted

The PROVENT-C19 registry: A study protocol for international multicenter SIAARTI registry on the use of prone positioning in mechanically ventilated patients with COVID-19 ARDS

Background The worldwide use of prone position (PP) for invasively ventilated patients with COVID-19 is progressively increasing from the first pandemic wave in everyday clinical practice. Among the suggested treatments for the management of ARDS patients, PP was recommended in the Surviving Sepsis Campaign COVID-19 guidelines as an adjuvant therapy for improving ventilation. In patients with severe classical ARDS, some authors reported that early application of prolonged PP sessions significantly decreases 28-day and 90-day mortality. Methods and analysis Since January 2021, the COVID19 Veneto ICU Network research group has developed and implemented nationally and internationally the "PROVENT-C19 Registry", endorsed by the Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care. . .'(SIAARTI). The PROVENT-C19 Registry wishes to describe 1. The real clinical practice on the use of PP in COVID-19 patients during the pandemic at a National and International level; and 2. Potential baseline and clinical characteristics that identify subpopulations of invasively ventilated patients with COVID-19 that may improve daily from PP therapy. This web-based registry will provide relevant information on how the database research tools may improve our daily clinical practice. Conclusions This multicenter, prospective registry is the first to identify and characterize the role of PP on clinical outcome in COVID-19 patients. In recent years, data emerging from large registries have been increasingly used to provide real-world evidence on the effectiveness, quality, and safety of a clinical intervention. Indeed observation-based registries could be effective tools aimed at identifying specific clusters of patients within a large study population with widely heterogeneous clinical characteristics. Copyright

Hidden inequalities amongst the international workforce

This chapter focuses on low status expatriates who have been largely ‘hidden’ from managerial scholarship. They are ‘hidden’ because they are ignored by the migrant literature which looks at people trying to remain in their new society and gain citizenship; and ignored by the expatriation literature which is mainly concerned with high-status ‘top’ talent. These hidden expatriates are typically maids, drivers, security guards, and construction workers - low status and low paid, unable to obtain citizenship, and liable to be sent home, unemployed, at the whim of their employer. If we, as scholars, are to contribute to the betterment of society by elevating the health and well-being of those who live in it, then we must recognise the existence of and address the management issues and concerns of those at the ‘bottom of the pyramid’. We use Organisational Justice theory and draw on examples from Turkey, Singapore and the Middle East to examine the position, the concerns, and the issues of such workers and their often-unequal place in the workforce

Aging drives Tet2+/- clonal hematopoiesis via IL-1 signaling

Clonal hematopoiesis of indeterminate potential (CHIP), also referred to as aging-related clonal hematopoiesis (ARCH), is defined as an asymptomatic clonal expansion of mutant mature hematopoietic cells over 4% of blood leukocytes. CHIP associates with advanced age and increased risk for hematological malignancy, cardiovascular disease and all-cause mortality. Loss-of-function somatic mutations in TET2 are frequent drivers of CHIP. However, the contribution of aging-associated cooperating cell-extrinsic drivers, like inflammation, remains under-explored. Using bone marrow (BM) transplantation and newly developed genetic mosaicism (HSC-SCL-Cre-ERT; Tet2+/flox; R26+/tm6(CAG-ZsGreen1)Hze) mouse models of Tet2+/--driven CHIP, we observed an association between increased Tet2+/- clonal expansion and higher BM levels of the inflammatory cytokine IL-1 upon aging. Administration of IL-1 to mice carrying CHIP led to an IL-1R1-dependent expansion of Tet2+/- hematopoietic stem and progenitor cells (HSPCs) and mature blood cells. This expansion was caused by increased Tet2+/- HSPC cell-cycle progression, increased multilineage differentiation and higher repopulation capacity compared to their WT counterparts. In agreement, IL-1α-treated Tet2+/- HSCs showed increased DNA replication and repair transcriptomic signatures and reduced susceptibility to IL-1α-mediated downregulation of self-renewal genes. Importantly, genetic deletion of IL-1R1 in Tet2+/- HPSC or pharmacological inhibition of IL-1 signaling impaired Tet2+/- clonal expansion, establishing the IL-1 pathway as a relevant and therapeutically targetable driver of Tet2+/- CHIP progression during aging

Young people experiencing work precariousness: risks and opportunities

The exclusion from labor market participation of young generations, stuck in precarious employment, in long-term unemployment, or even in inactivity, has come to represent one of the main concerns in Europe, a key threat to the European social model and its objective to keep together competitiveness and social cohesion. The social risks linked to work precariousness are unevenly distributed across countries. The current crisis exacerbates them, and may also deepen the distance among and within countries in terms of social vulnerability of the young and of how it is tackled by national and local welfare policies. Based on 120 interviews with young persons in twenty European cities, the chapter comparatively analyzes their experience in work precariousness and unemployment. Stemming from an investigation of both individual and social factors at the basis of their condition, the analysis focuses on the ambiguous character of precariousness that can bring about both opportunities and constraints for different, or even for the same persons. The agency of the young is examined, together with their access to various types of resources: public welfare, private services, third sector programs, primary and secondary network's help. Finally, the impact of work precariousness on the general living conditions of the young, and on their capacity to develop overall transversal strategies, is explored

Tolerance of arabica coffee cultivars for aluminum in nutritive solution

This work aimed to evaluate the Coffea arabica cultivars for aluminum toxicity tolerance, in modified Hoagland solution. A completely randomized design with five repetitions in a factorial 4 x 4 (cultivar x combinations of aluminum) was used. After 44 days of the sowing, were transferred ten seedlings each cultivar germinated in the absence of Al3+ to solution without Al3+, and ten for solution with Al3+; ten seedlings each cultivar germinated in presence of Al3+ to solution without Al3+, and ten for solution with Al3+. In the treatment with aluminum, the element was added to the nutritive solution in the concentration of 0.83 mmol L-1 as Al2(SO4)3.16H2O. The cultivars Catuaí Amarelo IAC 62 and Iapar 59 were tolerant to the aluminum; cultivar Oeiras presented intermediate tolerance, while cultivar Obatã IAC 1669-20 was sensitive. The tolerance of the coffee cultivars to the aluminum during the initial development of the seedlings did not depend on the presence of aluminum in the germination phase