A novel approach to assess temporal baseline levels of trace metal contamination in the mussel M. galloprovincialis in the Mediterranean, Marmara and Black Seas.

This study reports, for the first time, the baseline levels for fifteen trace metals in M. galloprovincialis tissue from around the Mediterranean, Marmara and Black Seas. The environmental quality in the surrounding seawater was assessed i.e., a mussel farm was investigated by using CF and DC indices, and the water quality was qualified as good for the aquacultural activities. A strong Cu-regulation in the transplanted mussels was observed and it ranged between 3.20 and 3.60 µg/g d.w. The highest bioavailability and bioconcentration of the particulate Fe fraction could present a health risk to consumers with a low risk level (1 < THQ < 9.9). Cr is considered the limiting metal for mussel consumption (< 2 kg/day). The metal contamination gradient was assessed using TEPI and TESVI indices that identified seven reference stations on the large scale and revealed that Cd is the most investigated metal in the literature databases, and found that Pb was the most bioavailable contaminant in the areas examined.

Self-Monitoring and Self-Efficacy in Patients with Chronic Kidney Disease During Low-Sodium Diet Self-Management Interventions: Secondary Analysis of the ESMO and SUBLIME Trials.

BACKGROUND: Patients with chronic kidney disease are often requested to engage in self-monitoring sodium (i.e. salt) intake, but it is currently unknown how self-monitoring would empower them. This study aims to assess: (1) how frequent self-monitoring tools are being used during low-sodium diet self-management interventions; (2) whether self-efficacy (i.e. trust in own capability to manage the chronic disease) is associated with self-monitoring frequency; and (3) whether higher self-monitoring frequency is associated with an improvement in self-efficacy over time. METHOD: Data from two multicenter randomized controlled trials (ESMO [n = 151] and SUBLIME [n = 99]) among adult Dutch patients with chronic kidney disease (eGFR ≥ 20-25 mL/min/1.73 m2) were used. In both studies, routine care was compared to a 3-month low-sodium diet self-management intervention with several self-monitoring tools (online food diary, home blood pressure monitor, and urinary sodium measurement device [only ESMO]). Data was collected on usage frequency of self-monitoring tools. Frequencies during the interventions were compared between low and high baseline self-efficacy groups using the Mann-Whitney U test and T-test and associated with changes in self-efficacy during the interventions using Spearman correlation coefficients. RESULTS: Large variations in self-monitoring frequency were observed. In both interventions, usage of self-monitoring tools was highest during the first month with sharp drops thereafter. The online food diary was the most frequently used tool. In the ESMO intervention, low baseline self-efficacy was associated with a higher usage frequency of self-monitoring tools. This finding was not confirmed in the SUBLIME intervention. No significant associations were found between usage frequency of self-monitoring tools and changes in self-efficacy over time. CONCLUSION: Patients with low self-efficacy might benefit most from frequent usage of self-monitoring tools when sufficient guidance and support is provided.

Towards a Better Use of Antimicrobials on Farms: Insights from a Participatory Approach in the French Pig and Poultry Sectors.

Despite the strong decrease in antimicrobial use in the French poultry and pig sectors over the last decade, room for improvement remains. A participatory approach was set up in France, involving representatives of veterinarians, the pig and poultry industries, technical institutes, the French Ministry of Agriculture, and researchers, to further improve how antimicrobials are used on farms. By successively defining a shared, long-term vision of future antimicrobial use on farms, identifying lock-in mechanisms impeding this future vision from being realized, and articulating practical questions on how to move in the desired direction, the group rapidly reached a consensus. The results highlight the need for consensual standardized monitoring tools that would allow farmers and veterinarians to jointly monitor the health, welfare, antimicrobial resistance, and antimicrobial use on farms. Other results relate to better communication and training for citizens regarding animal health, animal welfare, and proper antimicrobial use; some benefits but also counterproductive effects of antibiotic-free labels that imperil animal health and welfare; the economic competitiveness of farms on international markets; and the economic sustainability of farm animal veterinary practices. These results call for a concerted way to produce tools for farmers and veterinarians and the broader involvement of other food sector actors.

Challenges Associated with Effective Implementation of CT Dose Check Standards and Radiation Monitoring Index in Computed Tomography: Healthcare Sector Experience.

Computed tomography (CT) radiation dose management tools should be used whenever possible, particularly with the increasing demand for acquiring CT studies. Herein, we aim to assess the advantages and challenges faced with implementing two CT dose management tools. A second aim was to highlight CT examinations exceeding dose notification values (NVs) and define the common set of causes. A total of 13,037 CT examinations collected over a six-month period, were evaluated, using two independent CT dose management tools, a CT Dose Notification prospective-view tool (PVT) following CT Dose Check standards and a retrospective statistical-based view tool (RSVT). Dose NVs were set to twice the Local Diagnostic Reference Levels. There was a significant discrepancy between dose NV counts registered with prospective (4.15%) and retrospective (7.98%) tools using T-Test. A core difference is the dose configuration setup, with PVT and RSVT being dose per series and whole study, respectively. Both prospective and retrospective dose management tools were equally useful despite their technical difference. Configuring the CT prospective dose notification check tool using NVs that is based on DRLs has limitations, and one needs to establish dose NVs per series to overcome this technical hurdle. Technical challenges make the implementation of CT Dose Check standards puzzling.

Relationship between ATP Bioluminescence Measurements and Microbial Assessments in Studies Conducted in Food Establishments: A Systematic Literature Review and Meta-Analysis.

ABSTRACT: Adherence to proper environmental cleaning practices is critical in food establishments. To validate cleanliness, cleaning practices should be routinely monitored, preferably by a rapid, reliable, and cost-effective method. The aim of this study was to determine whether a correlation exists between ATP bioluminescence measurements and selected microbial assessments in studies conducted in food establishments. A systematic literature review and meta-analysis was conducted using the principles of preferred reporting items for systematic reviews and meta-analyses. Twelve online databases and search engines were selected for the review. Peer-reviewed articles published in English between January 2000 and July 2020 were included in the search. From a total of 19 eligible studies, 3 that included Pearson correlation coefficients (r) between ATP bioluminescence measurements and microbial assessments were used for the meta-analysis calculations. Only the fixed-effect model produced a strong correlation because one value dominated the estimates: r = 0.9339 (0.9278, 0.9399). In contrast, both the random effects model, 0.2978 (0.24, 0.3471), and the mixed effects model, r = 0.3162 (-0.0387, 0.6711), indicated a weak relationship between ATP bioluminescence and microbial assessments, with no evidence of a strong correlation. The meta-analysis results indicated no sufficient evidence of a strong correlation between ATP bioluminescence measurements and microbial assessments when applied within food establishments. This lack of evidence for a strong correlation between the results of these two monitoring tools suggests that food establishments cannot depend on only one method. Yet, with immediate feedback and quantification of organic soiling, ATP bioluminescence could be an effective monitoring tool to use in food establishments.

Targeting for nonpoint source pollution reduction: A synthesis of lessons learned, remaining challenges, and emerging opportunities.

The ability to identify, target, and treat critical pollution source areas on a landscape is an ongoing challenge for water quality programs that seek to address nonpoint source (NPS) pollution. In this article, we develop a conceptual framework for targeting program design, and review recent experience with the implementation of targeting programs that corresponds with a wide range of program characteristics. Through this review, we emphasize that the complex and locally dependent nature of NPS generation and transport makes it impossible to define a narrow set of rules to guide targeting programs everywhere. Instead, we evaluate key features of NPS targeting in several different contexts, highlighting lessons learned from recent experience. This synthesis of targeting program design and implementation points toward several areas of opportunity for improved NPS policy, however more research is needed to systematically document changes in behavior and pollutant loads. The lack of monitoring data at refined scales presents a major obstacle to targeting program success. This paper synthesizes new opportunities and ongoing challenges for the implementation of targeting in NPS water quality programs.

A review on integrated approaches for municipal solid waste for environmental and economical relevance: Monitoring tools, technologies, and strategic innovations.

Rapid population growth, combined with increased industrialization, has exacerbated the issue of solid waste management. Poor management of municipal solid waste (MSW) not only has detrimental environmental consequences but also puts public health at risk and introduces several other socioeconomic problems. Many developing countries are grappling with the problem of safe disposing of large amounts of produced municipal solid waste. Unmanaged municipal solid waste pollutes the environment, so its use as a potential renewable energy source would aid in meeting both increased energy needs and waste management. This review investigates emerging strategies and monitoring tools for municipal solid waste management. Waste monitoring using high-end technologies and energy recovery from MSW has been discussed. It comprehensively covers environmental and economic relevance of waste management technologies based on innovations achieved through the integration of approaches.

Ethics for integrating emerging technologies to contain COVID-19 in Zimbabwe.

Zimbabwe is among the countries affected with the coronavirus disease (COVID-19) and implemented several infection control and measures such as social distancing, contact tracing, regular temperature checking in strategic entry and exit points, face masking among others. The country also implemented recursive national lockdowns and curfews to reduce the virus transmission rate and its catastrophic impact. These large-scale measures are not easy to implement, adhere to and subsequently difficult to practice and maintain which lead to imperfect public compliance, especially if there is a significant impact on social and political norms, economy, and psychological wellbeing of the affected population. Also, emerging COVID-19 variants, porous borders, regular movement of informal traders and sale of fake vaccination certificates continue to threaten impressive progress made towards virus containment. Therefore, several emerging technologies have been adopted to strengthen the health system and health services delivery, improve compliance, adherence and maintain social distancing. These technologies use health data, symptoms monitoring, mobility, location and proximity data for contact tracing, self-isolation, and quarantine compliance. However, the use of emerging technologies has been debatable and contentious because of the potential violation of ethical values such as security and privacy, data format and management, synchronization, over-tracking, over-surveillance and lack of proper development and implementation guidelines which impact their efficacy, adoption and ultimately influence public trust. Therefore, the study proposes ethical framework for using emerging technologies to contain the COVID-19 pandemic. The framework is centered on ethical practices such as security, privacy, justice, human dignity, autonomy, solidarity, beneficence, and non-maleficence.

Refining Pheromone Lures for the Invasive Halyomorpha halys (Hemiptera: Pentatomidae) Through Collaborative Trials in the United States and Europe.

Brown marmorated stink bug, Halyomorpha halys, is native to Asia and has invaded North America and Europe inflicting serious agricultural damage to specialty and row crops. Tools to monitor the spread of H. halys include traps baited with the two-component aggregation pheromone (PHER), (3S,6S,7R,10S)-10,11-epoxy-1-bisabolen-3-ol and (3R,6S,7R,10S)-10,11-epoxy-1-bisabolen-3-ol, and pheromone synergist, methyl (2E,4E,6Z)-decatrienoate (MDT). Here, an international team of researchers conducted trials aimed at evaluating prototype commercial lures for H. halys to establish relative attractiveness of: 1) low and high loading rates of PHER and MDT for monitoring tools and attract and kill tactics; 2) polyethylene lure delivery substrates; and 3) the inclusion of ethyl (2E,4E,6Z)-decatrieonate (EDT), a compound that enhances captures when combined with PHER in lures. In general, PHER loading rate had a greater impact on overall trap captures compared with loading of MDT, but reductions in PHER loading and accompanying lower trap captures could be offset by increasing loading of MDT. As MDT is less expensive to produce, these findings enable reduced production costs. Traps baited with lures containing PHER and EDT resulted in numerically increased captures when EDT was loaded at a high rate, but captures were not significantly greater than those traps baited with lures containing standard PHER and MDT. Experimental polyethylene vial dispensers did not outperform standard lure dispensers; trap captures were significantly lower in most cases. Ultimately, these results will enable refinement of commercially available lures for H. halys to balance attraction and sensitivity with production cost.

Expert consensus on the monitoring of transthyretin amyloid cardiomyopathy.

Transthyretin amyloid cardiomyopathy (ATTR-CM) is a life-threatening condition with a heterogeneous clinical presentation. The recent availability of treatment for ATTR-CM has stimulated increased awareness of the disease and patient identification. Stratification of patients with ATTR-CM is critical for optimal management and treatment; however, monitoring disease progression is challenging and currently lacks best-practice guidance. In this report, experts with experience in treating amyloidosis and ATTR-CM developed consensus recommendations for monitoring the course of patients with ATTR-CM and proposed meaningful thresholds and frequency for specific parameters. A set of 11 measurable features across three separate domains were evaluated: (i) clinical and functional endpoints, (ii) biomarkers and laboratory markers, and (iii) imaging and electrocardiographic parameters. Experts recommended that one marker from each of the three domains provides the minimum requirements for assessing disease progression. Assessment of cardiac disease status should be part of a multiparametric evaluation in which progression, stability or improvement of other involved systems in transthyretin amyloidosis should also be considered. Additional data from placebo arms of clinical trials and future studies assessing ATTR-CM will help to elucidate, refine and define these and other measurements.

Systematic Review: Patient Perceptions of Monitoring Tools in Inflammatory Bowel Disease.

BACKGROUND AND AIMS: Inflammatory bowel disease (IBD) is a lifelong disease requiring frequent assessment to guide treatment and prevent flares or progression. Multiple tools are available for clinicians to monitor disease activity; however, there are a paucity of data to inform which monitoring tools are most acceptable to patients. The review aims to describe the available evidence for patient preference, satisfaction, tolerance and/or acceptability of the available monitoring tools in adults with IBD. METHODS: Embase, Medline, Cochrane Central and Clinical Trials.gov were searched from January 1980 to April 2019 for all study types reporting on the perspectives of adults with confirmed IBD on monitoring tools, where two or more tools were compared. Outcome measures with summary and descriptive data were presented. RESULTS: In 10 studies evaluating 1846 participants, monitoring tools included venipuncture, stool collection, gastrointestinal ultrasound, computed tomography, magnetic resonance imaging, wireless capsule endoscopy, barium follow-through and endoscopy. Outcome domains were patient satisfaction, acceptability of monitoring tool and patient preference. Noninvasive investigations were preferable to endoscopy in nine studies. When assessed, gastrointestinal ultrasound was consistently associated with greater acceptability and satisfaction compared with endoscopy or other imaging modalities. CONCLUSIONS: Adults with IBD preferred noninvasive investigations, in particular gastrointestinal ultrasound, as compared to endoscopy for monitoring disease activity. When assessing disease activity, patient perceptions should be considered in the selection of monitoring tools. Further research should address whether adpoting monitoring approaches considered more acceptable to patients results in greater satisfaction, adherence and ultimately more beneficial clinical outcomes.

COVID-19 Crisis Creates Opportunity towards Global Monitoring & Surveillance.

The spectrum of emerging new diseases as well as re-emerging old diseases is broadening as infectious agents evolve, adapt, and spread at enormous speeds in response to changing ecosystems. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a recent phenomenon and may take a while to understand its transmission routes from less traveled territories, ranging from fomite exposure routes to wastewater transmission. The critical challenge is how to negotiate with such catastrophic pandemics in high-income countries (HICs ~20% of the global population) and low-and middle-income countries (LMICs ~ 80% of the global population) with a total global population size of approximately eight billion, where practical mass testing and tracing is only a remote possibility, particularly in low-and middle-income countries (LMICs). Keeping in mind the population distribution disparities of high-income countries (HICs) and LMICs and urbanisation trends over recent years, traditional wastewater-based surveillance such as that used to combat polio may help in addressing this challenge. The COVID-19 era differs from any previous pandemics or global health challenges in the sense that there is a great deal of curiosity within the global community to find out everything about this virus, ranging from diagnostics, potential vaccines/therapeutics, and possible routes of transmission. In this regard, the fact that the gut is the common niche for both poliovirus and SARS-CoV-2, and due to the shedding of the virus through faecal material into sewerage systems, the need for long-term wastewater surveillance and developing early warning systems for better preparedness at local and global levels is increasingly apparent. This paper aims to provide an insight into the ongoing COVID-19 crisis, how it can be managed, and what measures are required to deal with a current global international public health concern. Additionally, it shed light on the importance of using wastewater surveillance strategy as an early warning practical tool suitable for massive passive screening, as well as the urgent need for microfluidic technology as a rapid and cost-effective approach tracking SARS-CoV-2 in wastewater.

Assessment of chlorinated ethenes degradation after field scale injection of activated carbon and bioamendments: Application of isotopic and microbial analyses.

Over the last decade, activated carbon amendments have successfully been applied to retain chlorinated ethene subsurface contamination. The concept of this remediation technology is that activated carbon and bioamendments are injected into aquifer systems to enhance biodegradation. While the scientific basis of the technology is established, there is a need for methods to characterise and quantify the biodegradation at field scale. In this study, an integrated approach was applied to assess in situ biodegradation after the establishment of a cross sectional treatment zone in a TCE plume. The amendments were liquid activated carbon, hydrogen release donors and a Dehalococcoides containing culture. The integrated approach included spatial and temporal evaluations on flow and transport, redox conditions, contaminant concentrations, biomarker abundance and compound-specific stable isotopes. This is the first study applying isotopic and microbial techniques to assess field scale biodegradation enhanced by liquid activated carbon and bioamendments. The injection enhanced biodegradation from TCE to primarily cis-DCE. The Dehalococcoides abundances facilitated characterisation of critical zones with insufficient degradation and possible explanations. A conceptual model of isotopic data together with distribution and transport information improved process understanding; the degradation of TCE was insufficient to counteract the contaminant input by inflow into the treatment zone and desorption from the sediment. The integrated approach could be used to document and characterise the in situ degradation, and the isotopic and microbial data provided process understanding that could not have been gathered from conventional monitoring tools. However, quantification of degradation through isotope data was restricted for TCE due to isotope masking effects. The combination of various monitoring tools, applied frequently at high-resolution, with system understanding, was essential for the assessment of biodegradation in the complex, non-stationary system. Furthermore, the investigations revealed prospects for future research, which should focus on monitoring contaminant fate and microbial distribution on the sediment and the activated carbon.

The new simplified MARIA score applies beyond clinical trials: A suitable clinical practice tool for Crohn's disease that parallels a simple endoscopic index and fecal calprotectin.

BACKGROUND: A simplified magnetic resonance enterography (MRe) index (sMARIA) for Crohn's disease (CD) was recently developed and validated. OBJECTIVE: Our aims were (a) to assess sMARIA's accuracy in a sample other than the validation cohort; (b) to evaluate its correlation with a simpler endoscopy index (SES-CD) and fecal calprotectin (FC); and (c) to assess the need of an expert radiologist to reliably use sMARIA. METHODS: Patients with CD who underwent MRe, ileocolonoscopy and FC within 2-4 weeks had their MRe retrospectively reviewed by two blinded raters. Disease activity was evaluated through sMARIA, SES-CD and FC. sMARIA's accuracy, indices correlation, and interrater reliability were assessed. RESULTS: In total, 84 patients were included, comprising 420 intestinal segments evaluations. sMARIA ≥1 accurately identified segments with active disease (90% sensitivity, 98% specificity; area under the curve 0.94, 95% confidence interval (CI) 0.91-0.97; p < 0.01). sMARIA correlated with endoscopy, both for ileal and colonic segments (R = 0.94 and R = 0.82; p < 0.01). Per patient, there was a strong correlation between sMARIA, endoscopy (R = 0.95; p < 0.01) and FC (R = 0.91; p < 0.01). Interrater agreement was excellent (intraclass correlation coefficient 0.95; 95% CI 0.94-0.96; p < 0.01). CONCLUSION: sMARIA accurately measured CD activity using SES-CD as standard of reference, and exhibited high correlation with a simple endoscopic index and a biomarker. The interrater reliability between a radiology resident and an expert was excellent.

Catch me if you can: the influence of refuge / trap design, previous feeding experience, and semiochemical lures on vine weevil (Coleoptera: Curculionidae) monitoring success.

BACKGROUND: Vine weevil, Otiorhynchus sulcatus F. (Coleoptera: Curculionidae), is one of the most economically important pest species of berry and ornamental crops globally. Monitoring this nocturnal pest can be difficult and time consuming and the efficacy of current tools is uncertain. Without effective monitoring tools, implementation of integrated pest management strategies is challenging. This study tests the relative efficacy of a range of vine weevil monitoring tools. Whether host-plant volatiles and weevil feeding experience influence vine weevil capture is also tested. RESULTS: Monitoring tool efficacy differed overall between the six monitoring tool designs tested and ranged from catches of 0.4% to 26.7% under semi-field conditions. Previous feeding experience influenced vine weevil behavior. In yew conditioned populations, 39% of the weevils responded to and were retained in the trap baited with yew foliage while 37% of weevils from Euonymus fortunei conditioned populations responded to and were retained in the trap baited with E. forunei foliage. A simple synthetic lure consisting of (Z)-2-pentenol + methyl eugenol also increased vine weevil catches compared with an unbaited trap. CONCLUSION: Demonstrating differences in the efficacy of different monitoring tool designs is an important first step for developing improved methods for monitoring vine weevil populations within crops. This study presents the first direct comparison of vine weevil monitoring tool designs and indicates that trap efficacy can be improved by baiting with host-plant material or a synthetic lure based on host-plant volatiles. © 2019 Society of Chemical Industry.

Biofilms in Food Processing Environments: Challenges and Opportunities.

This review examines the impact of microbial communities colonizing food processing environments in the form of biofilms on food safety and food quality. The focus is both on biofilms formed by pathogenic and spoilage microorganisms and on those formed by harmless or beneficial microbes, which are of particular relevance in the processing of fermented foods. Information is presented on intraspecies variability in biofilm formation, interspecies relationships of cooperativism or competition within biofilms, the factors influencing biofilm ecology and architecture, and how these factors may influence removal. The effect on the biofilm formation ability of particular food components and different environmental conditions that commonly prevail during food processing is discussed. Available tools for the in situ monitoring and characterization of wild microbial biofilms in food processing facilities are explored. Finally, research on novel agents or strategies for the control of biofilm formation or removal is summarized.

Validation of Arxula Yeast Estrogen Screen assay for detection of estrogenic activity in water samples: Results of an international interlaboratory study.

Endocrine-active substances can adversely impact the aquatic ecosystems. A special emphasis is laid, among others, on the effects of estrogens and estrogen mimicking compounds. Effect-based screening methods like in vitro bioassays are suitable tools to detect and quantify endocrine activities of known and unknown mixtures. This study describes the validation of the Arxula-Yeast Estrogen Screen (A-YES®) assay, an effect-based method for the detection of the estrogenic potential of water and waste water. This reporter gene assay, provided in ready to use format, is based on the activation of the human estrogen receptor alpha. The user-friendly A-YES® enables inexperienced operators to rapidly become competent with the assay. Fourteen laboratories from four countries with different training levels analyzed 17ß-estradiol equivalent concentrations (EEQ) in spiked and unspiked waste water effluent and surface water samples, in waste water influent and spiked salt water samples and in a mixture of three bisphenols. The limit of detection (LOD) for untreated samples was 1.8ng/L 17ß-estradiol (E2). Relative repeatability and reproducibility standard deviation for samples with EEQ above the LOD (mean EEQ values between 6.3 and 20.4ng/L) ranged from 7.5 to 21.4% and 16.6 to 28.0%, respectively. Precision results are comparable to other frequently used analytical methods for estrogens. The A-YES® has been demonstrated to be an accurate, precise and robust bioassay. The results have been included in the ISO draft standard. The assay was shown to be applicable for testing of typical waste water influent, effluent and saline water. Other studies have shown that the assay can be used with enriched samples, which lower the LOD to the pg/L range. The validation of the A-YES® and the development of a corresponding international standard constitute a step further towards harmonized and reliable bioassays for the effect-based analysis of estrogens and estrogen-like compounds in water samples.

Asthma management among allergists in Italy: results from a survey.

BACKGROUND: In Europe more than 50% of asthmatic treated patients have not well-controlled asthma. Asthma affects about 2.5 million of patients in Italy. AIMS AND OBJECTIVES: The present survey aims at investigating how Italian allergists approach asthmatic patients, in order to highlight pitfalls and unmet needs concerning real-life asthma management. METHODS: An anonymous 16 item web questionnaire was available (April-October 2015) to all allergists who visited the web site of SIAAIC (Società Italiana di Allergologia, Asma Immunologia Clinica). Those who wished to give their contribution had the opportunity to answer about epidemiology, risk factors, treatment approaches, and adherence to therapy. RESULTS: One hundred and seventy four allergists answered the survey. 54% of them reported up to 10 patient visits per week and 35.3% between 10 and 30. The most frequent reasons of follow up visits are routine check-up (56.5% of allergists), and worsening of symptoms (41% of allergists). Nocturnal apnoeas, gastro-esophageal reflux and obesity are the most important comorbidities/risk factors of poorly controlled asthma. Bronchial hyper-responsiveness, increased NO levels and reduced exercise tolerance are the most important indicators of asthma severity. Concerning therapy, ICS combined with LABA is the treatment of choice suitable for the majority of patients. A rapid onset of action and a flexible ICS dosage are indicated as the optimal characteristics for achieving the therapeutic goals. Poor adherence to therapy is an important reason for symptom worsening for the majority of allergists. Complex dosage regimens and economic aspects are considered the most important factors impacting on adherence. CONCLUSIONS: Allergists are involved in the management of asthma, regularly seeing their patients. Co-morbidities are frequent in asthmatic patients and may impact negatively on disease control, thus identifying patients who need a more careful and strict monitoring. Airway hyper-responsiveness to methacholine challenge test and nitric oxide are considered important indicators of asthma severity. The combination of LABA and inhaled steroids is considered the treatment of choice for most asthmatic patients, in keeping with broad evidence indicating that the combination therapy is more effective and rapid in gaining asthma control than inhaled corticosteroids alone. Adherence to medication regimens is considered of essence to achieve the therapeutic goals.

Monitoring human tick-borne disease risk and tick bite exposure in Europe: available tools and promising future methods.

Ticks are the main vector for infectious disease pathogens in both humans and animals, and tick-borne diseases are currently spreading throughout Europe. Various surveillance methods have been developed to estimate the burden and risk of tick-borne diseases and host exposure to tick bites. The ultimate aims of these approaches are to determine the risk level of a tick-borne disease in a given area, determine its health priority, identify the at-risk population and propose specific countermeasures or complementary studies as needed. The purpose of this review is to present the current methods for monitoring the circulation of tick-borne diseases and to highlight the use of salivary antigens as original and recently developed serological tools that could be useful for tick bite risk assessment and could improve the current surveillance methods.

Asthma management among different specialists: results from a national Italian survey.

In Europe more than 50% of asthmatic treated patients have a not well-controlled asthma. The present survey aims at investigating how different specialists approach asthmatic patients. A web anonymous questionnaire was randomly administered to 604 General Practitioners (GPs), 241 Pneumologists and 131 Allergists. It concerned: epidemiology, diagnostic workup, follow-up and risk factors, treatment and future risk. A general agreement emerges about asthma diagnostic work-up. All categories are aware of the impact of comorbidities on asthma. LABA/inhaled steroids combination is considered the first choice treatment. Surprisingly, depot steroids and long-acting beta2 agonists (LABA) alone are still prescribed by GPs. Concerning monitoring tools, Allergists rely on inflammation biomarkers, whereas reduction of rescue medication is more relevant for GPs. Asthma Control Test (ACT) is considered time consuming by more than 50% of all physicians and is not known by most of GPs. Adherence is considered a crucial problem in asthma management. All categories seem to have a good knowledge about asthma. The cultural background may account for mild differences in asthma control tools and treatment options. GPs have a pivotal role in discriminating patients who need specific assessment by specialists. It is thus important that GPs and specialists share common tools for recognizing and managing those patients.