The Role of POCUS to Face COVID-19: A Narrative Review.

COVID-19 has been a challenging outbreak to face, with millions of deaths among the globe. Acute respiratory failure due to interstitial pneumonia was the leading cause of death other than prothrombotic activation and complications. Lung ultrasound (LUS) and point-of-care ultrasound (POCUS) are widely used not only to triage, to identify, and to monitor lungs involvement but also to assess hemodynamic status and thrombotic and hemorrhagic complications, mainly in critically ill patients. POCUS has gained growing consideration due to its bedside utilization, reliability, and reproducibility even in emergency settings especially in unstable patients. In this narrative review, we aim to describe LUS and POCUS utilization in COVID-19 infection based on the literature found on this topic. We reported the LUS patterns of COVID-19 pulmonary infection, the diagnostic accuracy with respect to CT lung scan, its prognostic value, the variety of scores and protocols proposed, and the utilization of POCUS to investigate the extra-lung complications.

The Role of Pocus in Acute Respiratory Failure: A Narrative Review on Airway and Breathing Assessment.

Acute respiratory failure (ARF) is a challenging condition that clinicians, especially in emergency settings, have to face frequently. Especially in emergency settings, many underlying diseases can lead to ARF and life-threatening conditions have to be promptly assessed and correctly treated to avoid unfavorable outcomes. In recent years, point-of-care ultrasound (POCUS) gained growing consideration due to its bedside utilization, reliability and reproducibility even in emergency settings especially in unstable patients. Research on POCUS application to assess ARF has been largely reported mainly with observational studies showing heterogeneous results from many different applications. This narrative review describes the wide potentiality of POCUS to face airways and breathing life-threatening conditions such as upper airway management, pulmonary and pleural pathologies and diaphragm impairment. We conducted extensive research of the literature to report from major studies to case reports deemed useful in practical clinical utilization of POCUS in ARF. Due to the huge amount of the literature found, we focused on airways and breathing assessment trying to systematize the evidence according to clinical care of ARF in emergency settings. Further studies, possibly trials, should determine how POCUS is crucial in clinical practice in terms of standard of care improvements, patient safety and cost-benefit analysis.

Hemodynamic effects of a dielectric elastomer augmented aorta on aortic wave intensity: An in-vivo study.

Dielectric elastomer actuator augmented aorta (DEA) represents a novel approach with high potential for assisting a failing heart. The soft tubular device replaces a section of the aorta and increases its diameter when activated. The hemodynamic interaction between the DEA and the left ventricle (LV) has not been investigated with wave intensity (WI) analysis before. The objective of this study is to investigate the hemodynamic effects of the DEA on the aortic WI pattern. WI was calculated from aortic pressure and flow measured in-vivo in the descending aorta of two pigs implanted with DEAs. The DEAs were tested for different actuation phase shifts (PS). The DEA generated two decompression waves (traveling upstream and downstream of the device) at activation followed by two compression waves at deactivation. Depending on the PS, the end-diastolic pressure (EDP) decreased by 7% (or increased by 5-6%). The average early diastolic pressure augmentation (Pdia¯) increased by 2% (or decreased by 2-3%). The hydraulic work (WH) measured in the aorta decreased by 2% (or increased by 5%). The DEA-generated waves interfered with the LV-generated waves, and the timing of the waves affected the hemodynamic effect of the device. For the best actuation timing the upstream decompression wave arrived just before aortic valve opening and the upstream compression wave arrived just before aortic valve closure leading to a decreased EDP, an increased Pdia¯ and a reduced.WH.

Postoperative pulmonary complications and mortality after major abdominal surgery. An observational multicenter prospective study.

BACKGROUND: Postoperative pulmonary complications (PPCs) significantly contribute to postoperative morbidity and mortality. We conducted a study to determine the incidence of PPCs after major elective abdominal surgery and their association with early and 1-year mortality in patient without pre-existing respiratory disease. METHODS: We conducted a multicenter observational prospective clinical study in 40 Italian centers. 1542 patients undergoing elective major abdominal surgery were recruited in a time period of 14 days and clinically managed according to local protocol. The primary outcome was to determine the incidence of PPCs. Further, we aimed to identify independent predictors for PPCs and examine the association between PPCs and mortality. RESULTS: PPCs occurred in 12.6% (95% CI 11.1-14.4%) of patients with significant differences among general (18.3%, 95% CI 15.7-21.0%), gynecological (3.7%, 95% CI 2.1-6.0%) and urological surgery (9.0%, 95% CI 6.0-12.8%). PPCs development was associated with known pre- and intraoperative risk factors. Patients who developed PPCs had longer length of hospital stay, higher risk of 30-days hospital readmission, and increased in-hospital and one-year mortality (OR 3.078, 95% CI 1.825-5.191; P<0.001). CONCLUSIONS: The incidence of PPCs in patients without pre-existing respiratory disease undergoing elective abdominal surgery is high and associated with worse clinical outcome at one year after surgery. General surgery is associated with higher incidence of PPCs and mortality compared to gynecological and urological surgery.

A novel soft cardiac assist device based on a dielectric elastomer augmented aorta: An in vivo study.

Although heart transplant is the preferred solution for patients suffering from heart failures, cardiac assist devices remain key substitute therapies. Among them, aortic augmentation using dielectric elastomer actuators (DEAs) might be an alternative technological application for the future. The electrically driven actuator does not require bulky pneumatic elements (such as conventional intra-aortic balloon pumps) and conforms tightly to the aorta thanks to the manufacturing method presented here. In this study, the proposed DEA-based device replaces a section of the aorta and acts as a counterpulsation device. The feasibility and validation of in vivo implantation of the device into the descending aorta in a porcine model, and the level of support provided to the heart are investigated. Additionally, the influence of the activation profile and delay compared to the start of systole is studied. We demonstrate that an activation of the DEA just before the start of systole (30 ms at 100 bpm) and deactivation just after the start of diastole (0-30 ms) leads to an optimal assistance of the heart with a maximum energy provided by the DEA. The end-diastolic and left ventricular pressures were lowered by up to 5% and 1%, respectively, compared to baseline. The early diastolic pressure was augmented in average by up to 2%.

Soil Organic Matter and Nutrient Levels in Outdoor Runs in Organic Laying Farms.

To evaluate the nutrient load due to the grazing of laying hens in outdoor runs, monitoring of soil characteristics was conducted in three Italian organic farms. For each farm, soil samples were taken from three increasing distances from the hen house and two depths, and different chemical parameters were evaluated. The comparison among the results from the different distances shows that N-NO3 and Olsen P are the most affected parameters by hen feces: both present high values with a statistically significant difference in the area close to the poultry house and for the most superficial layer. Even TKN and TOC show significant differences between the concentrations of the first layer (more concentrated) and those of the second layer (less concentrated). In general, the surface soil layer closest to the chicken house is the portion of the outdoor run most affected by chicken droppings and represents the most critical point in terms of potential environmental impact. Therefore, it is necessary to intensify the management of the outdoor run with tools that can facilitate the grazing of animals and with vegetation that can absorb nutrients by limiting leaching and runoff.

The effects of COVID-19 lockdown on fairness and cooperation: Evidence from a lablike experiment.

We run an experiment to study the effects of Covid-19 lockdown in Italy on preferences for fairness and cooperation. Given the impossibility of having participants in the lab during the lockdown, we adopted an online methodology based on a multi-platform architecture that brings experimental subjects in a "Lab on the Web". Results from standard Ultimatum and linear Public Good games show that the circumstances in which participants lived the lockdown significantly affect their behavior in the two games. In particular, participants are more selfish in the ultimatum bargaining and contribute more to the public good when social isolation is stronger. However, cooperation decreases when lockdown is longer. We interpret these results as evidence of "social embeddedness" to compensate for "social distancing".

Effect of Different Percentage of Camelina sativa Cake in Laying Hens Diet: Performance, Welfare, and Eggshell Quality.

Although camelina [Camelina sativa (L.) Crantz] is a good source of protein, antioxidants, and polyunsaturated fatty acids, its antinutritional compounds limit its use in animal feeding. The aim of this study was to verify the effect of feeding laying hens with up to 20% of camelina cake from a breeding line containing a low level of glucosinolates on performance, welfare, and eggshell quality. Two hundred and forty Hy-Line® hens from 18 to 51 weeks of age were divided into three treatments: control (C), camelina cake 10% (CAM10), and camelina cake 20% (CAM20). Egg number was recorded daily, while egg weight, feed consumption, and mortality were recorded weekly. At 24 and 43 weeks of hen age, shell resistance to fracture was measured. Our results demonstrate no detrimental effects for CAM10 and CAM20 diets on feed intake, growth performance, and welfare. No difference in egg production was detected among the diets. The significant (p < 0.05) interaction of diet and age factors suggest that the addition of camelina cake, up to 20%, likely protects the eggshell of older hens. Our findings confirm that camelina cake might be an alternative and sustainable protein source for hens.

The relationship between corruption and chronic diseases: evidence from Europeans aged 50 years and older.

OBJECTIVES: Do people living in more corrupted countries report worse health? We answer this question by investigating the relationship between country-level corruption and the number of chronic diseases for a sample of Europeans aged above 50. METHODS: We link a rich panel dataset on individual health and socio-demographic characteristics with two country-level corruption indices, analyse the overall relationship with pooled ordinary least squares and fixed-effect models, explore heterogeneous effects driven by country and individual factors, and disentangle the effect across different public sectors. RESULTS: Individuals living in more corrupted countries suffer from a higher number of chronic diseases. The heterogeneity analysis shows that (1) health outcomes are worsened especially for respondents living in relatively low-income countries; (2) the health of females and people with poor socio-economic status is more affected by corruption; (3) the corruption-health negative link mainly occurs for cardiovascular diseases and ulcers; (4) only corrupted sectors linked with healthcare are associated with poorer health. CONCLUSIONS: We inform the policy debate with novel results in establishing a nexus between corruption and morbidity indicators.

Text Mining Analysis to Evaluate Stakeholders' Perception Regarding Welfare of Equines, Small Ruminants, and Turkeys.

Welfare of animals significantly depends on how stakeholders perceive their needs and behave in a way to favor production systems that promote better welfare outcomes. This study aimed at investigating stakeholders' perception of the welfare of equines, small ruminants, and turkeys using text mining analysis. A survey composed by open-ended questions referring to different aspects of animal welfare was carried out. Text mining analysis was performed. A total of 270 surveys were filled out (horses = 122, sheep = 81, goats = 36, turkeys = 18, donkeys = 13). The respondents (41% veterinarians) came from 32 different countries. To describe welfare requirements, the words "feeding" and "water" were the most frequently used in all the species, meaning that respondents considered the welfare principle "good feeding" as the most relevant. The word "environment" was considered particularly important for turkeys, as well as the word "dry", never mentioned for other species. Horses stakeholders also considered "exercise" and "proper training" important. Goat stakeholders' concerns are often expressed by the word "space", probably because goats are often intensively managed in industrialized countries. Although the sample was too small to be representative, text mining analysis seems to be a promising method to investigate stakeholders' perception of animal welfare, as it emphasizes their real perception, without the constraints deriving by close-ended questions.

Differences in prevalence of welfare indicators in male and female turkey flocks (Meleagris gallopavo).

Previous research has shown that the transect walks (TW) method provide a practical and effective approach to welfare assessment in broiler and turkey farms. This method for turkey welfare assessment is reasonable in terms of time demands within minimal costs. Furthermore, TW approach resembles the routine checks used by farmers. The overall aim of this study was to verify the feasibility of the TW method as potential practical tool for on-farm welfare assessment in turkeys during the fattening period. A total of 14 commercial turkey farms (8 male and 6 female flocks) of the same genetic strain (British United Turkeys [B.U.T.] - Big 6) with similar management standard procedures were evaluated. Bird ages at evaluation ranged from 122 to 138 D and 90 to 103 D old, for males and females, respectively. Two independent assessors walked slowly on randomized longitudinal paths (transects) within each house, while recording the prevalence of birds showing any of the 12 welfare and health indicators considered: immobility, lameness, wounds, small size, featherless, dirtiness, sick, terminally ill, dead, and behavioral indicators, such as, aggression towards mate, interaction with humans and mating. The effect of assessor, gender, and interaction assessor by gender was evaluated by using ANOVA. Reliability of the method was noted by the effect of gender (P < 0.001) for immobility, lameness, wounds, and dirtiness indicators. Male flocks showed higher prevalence of immobility (0.035±0.004% vs. 0.004±0.001%), lameness (2.269±0.108% vs. 1.253±0.051%), wounds (0.288±0.014% vs. 0.127±0.009%), and dirtiness (0.050±0.004% vs. 0.022±0.004%) as compared to female flocks. Differences among assessors were relatively minor, with differences detected only for back and tail wounds, dirtiness, aggression towards mate, and interaction with humans. This study reports advantages and limitations of this method for welfare assessment on-commercial turkey flocks and it is the first description of the Italian welfare profile of turkey's commercial flocks.

Experimental Demonstration of Hyperbolic Metamaterial Assisted Illumination Nanoscopy.

An optical metamaterial is capable of manipulating light in nanometer scale that goes beyond what is possible with conventional materials. Taking advantage of this special property, metamaterial-assisted illumination nanoscopy (MAIN) possesses tremendous potential to extend the resolution far beyond conventional structured illumination microscopy. Among the available MAIN designs, hyperstructured illumination that utilizes strong dispersion of a hyperbolic metamaterial (HMM) is one of the most promising and practical approaches, but it is only theoretically studied. In this paper, we experimentally demonstrate the concept of hyperstructured illumination. A ∼80 nm resolution has been achieved in a well-known Ag/SiO2 multilayer HMM system by using a low numerical aperture objective (NA = 0.5), representing a 6-fold resolution enhancement of the diffraction limit. The resolution can be significantly improved by further material optimization.

Hyperbolic metamaterials for dispersion-assisted directional light emission.

A novel method is presented to outcouple high spatial frequency (large-k) waves from hyperbolic metamaterials (HMMs) without the use of a grating. This approach relies exclusively on dispersion engineering, and enables preferential power extraction from the top or from the side of a HMM. Multilayer (ML) HMMs are shown to be better suited for lateral outcoupling, while nanowire HMMs are the most convenient choice for top outcoupling. A 6-fold increase in laterally extracted power is predicted for a dipole-HMM system with a Ag/Si ML operating at λ = 530 nm, when metallic filling ratio is changed from an unoptimized to the optimized one. This new design concept supports the cost-effective mass production of high-speed HMM optical transmitters.

Experimental Demonstration of Localized Plasmonic Structured Illumination Microscopy.

Super-resolution imaging methods such as structured illumination microscopy and others have offered various compromises between resolution, imaging speed, and biocompatibility. Here we experimentally demonstrate a physical mechanism for super-resolution that offers advantages over existing technologies. Using finely structured, resonant, and controllable near-field excitation from localized surface plasmons in a planar nanoantenna array, we achieve wide-field surface imaging with resolution down to 75 nm while maintaining reasonable speed and compatibility with biological specimens.

Optical Observation of Plasmonic Nonlocal Effects in a 2D Superlattice of Ultrasmall Gold Nanoparticles.

The advances in recent nanofabrication techniques have facilitated explorations of metal structures into nanometer scales, where the traditional local-response Drude model with hard-wall boundary conditions fails to accurately describe their optical responses. The emerging nonlocal effects in single ultrasmall silver nanoparticles have been experimentally observed in single-particle spectroscopy enabled by the unprecedented high spatial resolution of electron energy loss spectroscopy (EELS). However, the unambiguous optical observation of such new effects in gold nanoparticles has yet not been reported, due to the extremely weak scattering and the obscuring fingerprint of strong interband transitions. Here we present a nanosystem, a superlattice monolayer formed by sub-10 nm gold nanoparticles. Plasmon resonances are spectrally well-separated from interband transitions, while exhibiting clearly distinguishable blueshifts compared to predictions by the classical local-response model. Our far-field spectroscopy was performed by a standard optical transmission and reflection setup, and the results agreed excellently with the hydrodynamic nonlocal model, opening a simple and widely accessible way for addressing quantum effects in nanoplasmonic systems.

The impact of obsessive dimension on symptoms and functioning in schizophrenia.

Obsessive Compulsive Symptoms (OCS) and Disorder (OCD) occur frequently in patients with schizophrenia. Nevertheless the impact of OCS/OCD on clinical characteristics and outcome of schizophrenia remains controversial. The aim of the present study is to examine the effect of obsessive-compulsive dimension on symptom expression and functioning in schizophrenia. Sixty patients affected by schizophrenia completed the SCID-IV, the Positive and Negative Syndrome Scale, the Yale-Brown Obsessive-Compulsive Scale, the Social and Occupational Functioning Assessment Scale and the Strauss and Carpenter Level of Functioning Rating Scale. Obsessive-compulsive dimension was associated neither with positive or disorganization symptoms nor with negative symptoms. By contrast, it adversely affected levels of functioning, with a major impact exerted by compulsions rather than obsessions. Obsessive-compulsive dimension appears to be independent from negative and positive symptoms of schizophrenia and independently decreases social functioning.

Enhanced spontaneous emission inside hyperbolic metamaterials.

Hyperbolic metamaterials can enhance spontaneous emission, but the radiation-matter coupling is not optimized if the light source is placed outside such media. We demonstrate a 3-fold improvement of the Purcell factor over its outer value and a significant enlargement in bandwidth by including the emitter within a Si/Ag periodic multilayer metamaterial. To extract the plasmonic modes of the structure into the far field we implement two types of 1D grating with triangular and rectangular profile, obtaining a 10-fold radiative enhancement at visible frequencies.