Evaluation of blue light exposure, illuminance level and the associations with sleep/wake patterns in two populations living with sensory impairment

Exposure to sufficient light during the daytime is fundamental for the regulation of the sleep/wake cycle, with the blue part of the spectrum most influential. This thesis explores exposure to environmental blue light and level of illuminance in two populations that experience circadian disruption i.e. older people and young people with autism spectrum disorder (ASD). The aim was to examine associations between blue light exposure, illuminance level and sleep/wake and physical activity patterns. Firstly, an exploratory study was conducted in adolescents with ASD living in a residential school setting aged 13-17 years (n=8). Secondly, a cross-sectional study carried out in two seasons (summer and winter) with a comparative study between seasons of varying light exposure and sleep/wake and physical activity outcomes was conducted in older people aged 72-99 years (n=20). In both studies quantitative measures were used to examine personal light exposure and sleep/wake patterns by use of novel equipment known as an actiwatch. This research demonstrated that objective measures of sleep/wake and light monitoring could be successfully administered in two populations with complex sensory issues. Preliminary findings from the exploratory study in adolescents with ASD indicated that exposure to blue light prior to bedtime was associated with a delay in sleep onset. The methodology developed for participant recruitment and engagement in a study using body sensors proved to be successful. Results for the study in older people suggested that between seasons daytime physical activity, blue light exposure and illuminance levels were significantly higher in summer. Correlated component regression (CCR) was used to investigate predictors of sleep parameters, suggesting morning blue light exposure (a predictor of total night-time sleep), daytime activity level (a predictor of sleep efficiency) and visual function (a predictor of minutes awake during the night) may contribute to sleep quality. The findings from these studies suggested that light exposure and health outcomes, such as physical activity and visual function could be responsible for sleep quality. This has important implications for design and health interventions promoting health and wellbeing, i.e. morning light exposure and time outdoors are important for circadian entrainment and building design and routine should reflect a diurnal light pattern light

The Waiver of Patent Protections for COVID-19 Vaccines During the Ongoing Pandemic and the Conspiracy Theories: Lights and Shadows of an Issue on the Ground

Vaccines against the coronavirus disease 2019 (COVID-19) currently constitute the main hope for the fight against the ongoing pandemic. Mass immunization against the severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) should be considered as a global battle in which no country can be left behind, in particular the low-income countries. This last aspect may, in fact, favor the uncontrolled replication of the virus with the insurge of new variants. One of the possible solutions to limit this problem is the waiver of patent protections for COVID-19 vaccines. On 2 October 2020, India and South Africa asked the World Trade Organization (WTO) to allow all countries to choose to neither grant nor enforce patents and other intellectual property (IP) related to COVID-19 drugs, vaccines, diagnostics and other technologies for the duration of the pandemic, until global herd immunity is achieved. On 5 May 2021, the United States (US) administration announced the willingness to liberalize intellectual property concerning the COVID-19 vaccines (1, 2). Although this issue is very interesting, its feasibility is particularly complex and intricate. Accordingly, there are discordant opinions among scholars and physicians on the real usefulness of patent liberalization (3–6). It has been suggested that an exception be made to the agreements establishing the World Trade Organization, in particular The Agreement on Trade Related Aspects of Intellectual Property Rights. This request would be based on the theory according to which the vaccines against the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) during a pandemic should be considered as a “common good”, similarly to water, or air. According to the Economic Theory of the Commons, which is supported by Elinor Ostrom, winner of the 2009 Nobel prize in Economics, the aforementioned terms should be considered in the Roman category of “res communes omnium”, meaning not appropriable and precluded from legal trade (7, 8). From a practical point of view, the suspension of patent protections would limit the business models for the legitimate producers of COVID-19 vaccines. Among the potential strategies to encourage the waiver of patent protections it is possible to include: the direct donation of vaccines from the high-income countries, the reduction of the costs of the production lines, the shortening of the duration of patent protections, and a series of preferential patent waivers to countries that manufacture a large fraction of the global vaccines (e.g., India). One of the further possible solutions is represented by the solidarity by several governments or other agencies. This strategy is pursued, for example, by the program for COVID-19 Vaccines Global Access (COVAX). The latter is supported by Global Alliance for Vaccines and Immunization (GAVI), Coalition for Epidemic Preparedness Innovations (CEPI), and the World Health Organization (WHO) (9, 10)

A metabolomic approach to animal vitreous humor topographical composition: A pilot study

The purpose of this study was to evaluate the feasibility of a 1H-NMR-based metabolomic approach to explore the metabolomic signature of different topographical areas of vitreous humor (VH) in an animal model. Five ocular globes were enucleated from five goats and immediately frozen at 280uC. Once frozen, three of them were sectioned, and four samples corresponding to four different VH areas were collected: the cortical, core, and basal, which was further divided into a superior and an inferior fraction. An additional two samples were collected that were representative of the whole vitreous body. 1H-NMR spectra were acquired for twenty-three goat vitreous samples with the aim of characterizing the metabolomic signature of this biofluid and identifying whether any site-specific patterns were present. Multivariate statistical analysis (MVA) of the spectral data were carried out, including Principal Component Analysis (PCA), Hierarchical Cluster Analysis (HCA), and Partial Least Squares Discriminant Analysis (PLS-DA). A unique metabolomic signature belonging to each area was observed. The cortical area was characterized by lactate, glutamine, choline, and its derivatives, N-acetyl groups, creatine, and glycerol; the core area was characterized by glucose, acetate, and scyllo-inositol; and the basal area was characterized by branched-chain amino acids (BCAA), betaine, alanine, ascorbate, lysine, and myo-inositol. We propose a speculative approach on the topographic role of these molecules that are mainly responsible for metabolic differences among the as-identified areas. 1H-NMR-based metabolomic analysis has shown to be an important tool for investigating the VH. In particular, this approach was able to assess in the samples here analyzed the presence of different functional areas on the basis of a different metabolite distribution.The purpose of this study was to evaluate the feasibility of a 1H-NMR-based metabolomic approach to explore the metabolomic signature of different topographical areas of vitreous humor (VH) in an animal model. Five ocular globes were enucleated from five goats and immediately frozen at -80°C. Once frozen, three of them were sectioned, and four samples corresponding to four different VH areas were collected: the cortical, core, and basal, which was further divided into a superior and an inferior fraction. An additional two samples were collected that were representative of the whole vitreous body. 1H-NMR spectra were acquired for twenty-three goat vitreous samples with the aim of characterizing the metabolomic signature of this biofluid and identifying whether any site-specific patterns were present. Multivariate statistical analysis (MVA) of the spectral data were carried out, including Principal Component Analysis (PCA), Hierarchical Cluster Analysis (HCA), and Partial Least Squares Discriminant Analysis (PLS-DA). A unique metabolomic signature belonging to each area was observed. The cortical area was characterized by lactate, glutamine, choline, and its derivatives, N-acetyl groups, creatine, and glycerol; the core area was characterized by glucose, acetate, and scyllo-inositol; and the basal area was characterized by branched-chain amino acids (BCAA), betaine, alanine, ascorbate, lysine, and myo-inositol. We propose a speculative approach on the topographic role of these molecules that are mainly responsible for metabolic differences among the as-identified areas. 1H-NMR-based metabolomic analysis has shown to be an important tool for investigating the VH. In particular, this approach was able to assess in the samples here analyzed the presence of different functional areas on the basis of a different metabolite distribution. © 2014 Locci et al

The “quarantine dry eye”: The lockdown for coronavirus disease 2019 and its implications for ocular surface health

The pandemic of coronavirus disease 2019 (COVID-19) has led many countries of the world to impose a series of containment measures such as lockdowns (mass quarantines), curfews or similar restrictions (eg, stay-at-home orders, or shelter-in-place orders). All these restrictions were established in order to limit spread of COVID-19. Thus, approximately 3.9 billion people worldwide were under lockdown by early April 2020. During this time (home confinement), some solutions have been proposed by experts to improve work and school productivity, including smart working and online school lessons. However, many of the restrictive measures are likely to act as predisposing factors for dry eye disease (DED), directly or related to sick building syndrome (SBS). Herein, we discuss the implications of quarantine measures on eye health, in particular on DED associated with SBS, and introduce some potential preventive strategies for lockdown-related ocular surface disorders. Several risk factors are implicated in their pathogenesis, including environmental changes (eg, air quality) and modifications in personal behaviors (eg, the abuse of digital devices, malnutrition, and sleep/psychiatric disorders). Considering a number of predisposing factors for DED, it is possible to state that patients under lockdown are at risk of ocular surface alterations. Accordingly, the COVID-19 pandemic era is expected to determine an increase in dry eye patients all around the world (a new phenomenon that we propose to name the “quarantine dry eye”) in the event that the restrictive measures will be recursively extended over time

Post-mortem corneal thickness measurements with a portable optical coherence tomography system: a reliability study

The purpose of this study was to determine the repeatability and reproducibility of post-mortem central corneal thickness (CCT) measurements by using a real-time, portable optical coherence tomography (OCT) system on an animal model, and to prospectively evaluate the time-course of post-mortem changes in CCT. Forty-six ocular globes of sheep (Ovis aries) were analyzed with a portable spectral-domain OCT device by two operators at different postmortem intervals (PMIs) as follows: immediately (i.e. within 10 minutes), at the 30(th) minute, at the 1(st), 6(th), 12(th), 24(th) and 48(th) hour, and later (up to the 96(th) hour). The coefficient of repeatability ranged from 0.3% to 3.5%, and coefficients of reproducibility ranged from 0.2% to 3.7% in the central region of the cornea. The intraclass correlation coefficients were particularly high at different PMIs, thus confirming good measurement reliability with the portable OCT. The average CCT decreased immediately and then increased thereafter, with two peaks at 6 and 24 hours after death. Our results suggest that portable OCT is a reliable tool for monitoring CCT variations after death and may be useful in characterizing corneas before explantation, detecting quantitative variations during post-mortem corneal degeneration or assessing changes in CCT for forensic implications

The architecture of corneal stromal striae on optical coherence tomography and histology in an animal model and in humans

The purpose of this study was to use a portable optical coherence tomography (OCT) for characterization of corneal stromal striae (CSS) in an ovine animal model and human corneas with histological correlation, in order to evaluate their architectural pattern by image analysis. Forty-six eyes from female adult sheep (older than 2 years), and 12 human corneas, were included in our study. The eyes were examined in situ by a portable OCT, without enucleation. All OCT scans were performed immediately after death, and then the eyes were delivered to a qualified histology laboratory. In the ovine animal model, CSS were detected with OCT in 89.1% (41/46) of individual scans and in 93.4% (43/46) of histological slices. In human corneas, CSS were found in 58.3% (7/12) of cases. In both corneal types, CSS appeared as “V”- or “X”-shaped structures, with very similar angle values of 70.8° ± 4° on OCT images and 71° ± 4° on histological slices (p ≤ 0.01). Data analysis demonstrated an excellent degree of reproducibility and inter-rater reliability of measurements (p < 0.001). The present study demonstrated that by using a portable OCT device, CSS can be visualized in ovine and human corneas. This finding suggests their generalized presence in various mammals. The frequent observation, close to 60%, of such collagen texture in the corneal stroma, similar to a ‘truss bridge’ design, permits to presume that it plays an important structural role, aimed to distribute tensile and compressive forces in various directions, conferring resilience properties to the cornea

COVID-19 and Italian Healthcare Workers From the Initial Sacrifice to the mRNA Vaccine: Pandemic Chrono-History, Epidemiological Data, Ethical Dilemmas, and Future Challenges

On March 11, 2020, the World Health Organization (WHO) declared the coronavirus disease 2019 (COVID-19) outbreak a pandemic. Simultaneously, in Italy, in which the first case had occurred on February 18, the rigid phase of the lockdown began. The country has attracted worldwide attention, becoming at the same time a field of study both concerning the spread of the pandemic and advanced assessments of the effectiveness of political, public health, and therapeutic measures. The protagonists of the Italian crisis were the healthcare workers (HCWs) who were exposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) without having any perception of what they were facing, courageously contributing to the containment of the epidemic to be defined by the media as “heroes.” However, in the first phase of the pandemic (March–May 2020), the price that the Italian Public Health System had to pay both in terms of the number of positive virus cases and deaths among the HCWs was beyond and represented a peculiarity compared to what happened in other countries. In the current study, after a summary of the evolution of the pandemic in Italy, we offer an analysis of the statistical data concerning contagions and deaths among healthcare workers (physicians in particular). In conclusion, we describe the critical issues that still need to be resolved and the future challenges facing healthcare workers and the general population

A Fatal Case of Metastatic Pulmonary Calcification during the Puerperium

We present an unusual case of a fatal respiratory failure in a young woman developed two weeks after she gave birth at home. Circumstantial and clinical features of the case were strongly suggestive for a 'classical' septic origin of the respiratory symptoms. Autopsy, together with histopathological and immunohistochemical analyses allowed demonstrating a massive calcium redistribution consisting of an important osteolysis, especially from cranial bones and abnormal accumulation in lungs and other organs. Such physiopathology was driven by a primary hyperparathyroidism secondary to a parathyroid carcinoma as demonstrated by immunohistochemistry. This very rare case is furthermore characterised by a regular pregnancy course, ended with the birth of a healthy new-born. A complex interaction between pregnancy physiology and hyperparathyroidism might be hypothesised, determining the discrepancy between the relative long period of wellness and the tumultuous cascade occurred in the puerperium