Treatment of allergic rhinitis during and outside the pollen season using mobile technology. A MASK study.

BACKGROUND: The analysis of mobile health (mHealth) data has generated innovative insights into improving allergic rhinitis control, but additive information is needed. A cross-sectional real-world observational study was undertaken in 17 European countries during and outside the estimated pollen season. The aim was to collect novel information including the phenotypic characteristics of the users. METHODS: The Allergy Diary-MASK-air-mobile phone app, freely available via Google Play and App, was used to collect the data of daily visual analogue scales (VASs) for overall allergic symptoms and medication use. Fluticasone Furoate (FF), Mometasone Furoate (MF), Azelastine Fluticasone Proprionate combination (MPAzeFlu) and eight oral H1-antihistamines were studied. Phenotypic characteristics were recorded at entry. The ARIA severity score was derived from entry data. This was an a priori planned analysis. RESULTS: 9037 users filled in 70,286 days of VAS in 2016, 2017 and 2018. The ARIA severity score was lower outside than during the pollen season. Severity was similar for all treatment groups during the pollen season, and lower in the MPAzeFlu group outside the pollen season. Days with MPAzeFlu had lower VAS levels and a higher frequency of monotherapy than the other treatments during the season. Outside the season, days with MPAzeFlu also had a higher frequency of monotherapy. The number of reported days was significantly higher with MPAzeFlu during and outside the season than with MF, FF or oral H1-antihistamines. CONCLUSIONS: This study shows that the overall efficacy of treatments is similar during and outside the pollen season and indicates that medications are similarly effective during the year.

Guidance to 2018 good practice: ARIA digitally-enabled, integrated, person-centred care for rhinitis and asthma.

AIMS: Mobile Airways Sentinel NetworK (MASK) belongs to the Fondation Partenariale MACVIA-LR of Montpellier, France and aims to provide an active and healthy life to rhinitis sufferers and to those with asthma multimorbidity across the life cycle, whatever their gender or socio-economic status, in order to reduce health and social inequities incurred by the disease and to improve the digital transformation of health and care. The ultimate goal is to change the management strategy in chronic diseases. METHODS: MASK implements ICT technologies for individualized and predictive medicine to develop novel care pathways by a multi-disciplinary group centred around the patients. STAKEHOLDERS: Include patients, health care professionals (pharmacists and physicians), authorities, patient's associations, private and public sectors. RESULTS: MASK is deployed in 23 countries and 17 languages. 26,000 users have registered. EU GRANTS 2018: MASK is participating in EU projects (POLLAR: impact of air POLLution in Asthma and Rhinitis, EIT Health, DigitalHealthEurope, Euriphi and Vigour). LESSONS LEARNT: (i) Adherence to treatment is the major problem of allergic disease, (ii) Self-management strategies should be considerably expanded (behavioural), (iii) Change management is essential in allergic diseases, (iv) Education strategies should be reconsidered using a patient-centred approach and (v) Lessons learnt for allergic diseases can be expanded to chronic diseases.

Improving the efficacy of municipal solid waste collection with a communicative approach based on easily understandable indicators.

The main aim of the study was to propose a useful methodological approach to define easily understandable indicators to use in communication campaigns organized to improve the efficacy of municipal solid waste collection. For this purpose, six economic-environmental indicators were defined, combining life cycle thinking and environmental communication. The indicators make it possible to obtain several combinations that can follow a variety of communication channels. Three indicators (quantity of recyclable materials recoverable from unsorted residual waste; total potential economic saving; number of jobs for young people as communicators) are expressed in absolute value and therefore refer to the whole community even if they are also good for single-targeted messages. The other three indicators (potential economic saving for each citizen; per capita saving of carbon dioxide equivalent; per capita saving of Disability Adjusted Life Years) are normalized with respect to the number of inhabitants and therefore refer to the individual citizen, but can also be used for global messages. As a case example, the methodology was applied to the collection of paper and cardboard in twelve Southern Italy cities obtaining very promising results. For example, the maximum quantity of paper and cardboard recoverable from unsorted waste would allow Naples and Palermo to recover more than €15 million. The maximum potential economic saving for each citizen was 25 €/capita. The economic saving obtained for Naples and Palermo could be translated in more than one thousand positions as young environmental communicators. Catania was the city with both the highest per capita potential saving of carbon dioxide (>60 kg CO2eq./capita) and maximum hypothetical per capita 'life-time recovery' (almost an hour). The innovative communication method used ('Greenopoli') assumed that school is the starting point to obtain a change of mindset because speaking with students (all potential communicators) means indirectly communicating with all other targets.

MASK 2017: ARIA digitally-enabled, integrated, person-centred care for rhinitis and asthma multimorbidity using real-world-evidence.

mHealth, such as apps running on consumer smart devices is becoming increasingly popular and has the potential to profoundly affect healthcare and health outcomes. However, it may be disruptive and results achieved are not always reaching the goals. Allergic Rhinitis and its Impact on Asthma (ARIA) has evolved from a guideline using the best evidence-based approach to care pathways suited to real-life using mobile technology in allergic rhinitis (AR) and asthma multimorbidity. Patients largely use over-the-counter medications dispensed in pharmacies. Shared decision making centered around the patient and based on self-management should be the norm. Mobile Airways Sentinel networK (MASK), the Phase 3 ARIA initiative, is based on the freely available MASK app (the Allergy Diary, Android and iOS platforms). MASK is available in 16 languages and deployed in 23 countries. The present paper provides an overview of the methods used in MASK and the key results obtained to date. These include a novel phenotypic characterization of the patients, confirmation of the impact of allergic rhinitis on work productivity and treatment patterns in real life. Most patients appear to self-medicate, are often non-adherent and do not follow guidelines. Moreover, the Allergy Diary is able to distinguish between AR medications. The potential usefulness of MASK will be further explored by POLLAR (Impact of Air Pollution on Asthma and Rhinitis), a new Horizon 2020 project using the Allergy Diary.

Investigation of the environmental impacts of municipal wastewater treatment plants through a Life Cycle Assessment software tool.

This paper investigates the total and per capita environmental impacts of municipal wastewater treatment in the function of the population equivalent (PE) with a Life Cycle Assessment (LCA) approach using the processes of the Ecoinvent 2.2 database available in the software tool SimaPro v.7.3. Besides the wastewater treatment plant (WWTP), the study also considers the sewerage system. The obtained results confirm that there is a 'scale factor' for the wastewater collection and treatment even in environmental terms, in addition to the well-known scale factor in terms of management costs. Thus, the more the treatment plant size is, the less the per capita environmental impacts are. However, the Ecoinvent 2.2 database does not contain information about treatment systems with a capacity lower than 30 PE. Nevertheless, worldwide there are many sparsely populated areas, where it is not convenient to realize a unique centralized WWTP. Therefore, it would be very important to conduct an LCA study in order to compare alternative on-site small-scale systems with treatment capacity of few PE.

Life cycle assessment and economic analysis of a low concentrating photovoltaic system.

Many new photovoltaic (PV) applications, such as the concentrating PV (CPV) systems, are appearing on the market. The main characteristic of CPV systems is to concentrate sunlight on a receiver by means of optical devices and to decrease the solar cells area required. A low CPV (LCPV) system allows optimizing the PV effect with high increase of generated electric power as well as decrease of active surface area. In this paper, an economic analysis and a life cycle assessment (LCA) study of a particular LCPV scheme is presented and its environmental impacts are compared with those of a PV traditional system. The LCA study was performed with the software tool SimaPro 8.0.2, using the Econinvent 3.1 database. A functional unit of 1 kWh of electricity produced was chosen. Carbon Footprint, Ecological Footprint and ReCiPe 2008 were the methods used to assess the environmental impacts of the LCPV plant compared with a corresponding traditional system. All the methods demonstrated the environmental convenience of the LCPV system. The innovative system allowed saving 16.9% of CO2 equivalent in comparison with the traditional PV plant. The environmental impacts saving was 17% in terms of Ecological Footprint, and, finally, 15.8% with the ReCiPe method.

A comparison of the efficacy of organic and mixed-organic polymers with polyaluminium chloride in chemically assisted primary sedimentation (CAPS).

CAPS is the acronym for chemically assisted primary sedimentation, which consists of adding chemicals to raw urban wastewater to increase the efficacy of coagulation, flocculation and sedimentation. The principal benefits of CAPS are: upgrading of urban wastewater treatment plants; increasing efficacy of primary sedimentation; and the major production of energy from the anaerobic digestion of primary sludge. Metal coagulants are usually used because they are both effective and cheap, but they can cause damage to the biological processes of anaerobic digestion. Generally, biodegradable compounds do not have these drawbacks, but they are comparatively more expensive. Both metal coagulants and biodegradable compounds have preferential and penalizing properties in terms of CAPS application. The problem can be solved by means of a multi-criteria analysis. For this purpose, a series of tests was performed in order to compare the efficacy of several organic and mixed-organic polymers with that of polyaluminium chloride (PACl) under specific conditions. The multi-criteria analysis was carried out coupling the simple additive weighting method with the paired comparison technique as a tool to evaluate the criteria priorities. Five criteria with the following priorities were used: chemical oxygen demand (COD) removal > turbidity, SV60 > coagulant dose, and coagulant cost. The PACl was the best alternative in 70% of the cases. The CAPS process using PACl made it possible to obtain an average COD removal of 68% compared with 38% obtained, on average, with natural sedimentation and 61% obtained, on average, with the best PACl alternatives (cationic polyacrylamide, natural cationic polymer, dicyandiamide resin).

A simple method to equalize the workload when operating several small wastewater treatment plants: a case study.

The aim of the present study is to define a simple (and easy to use) method to equalize the workload of personnel operating several small wastewater treatment plants (SWWTPs). The approach is illustrated through a case study which is the result of collaboration between researchers and a water and wastewater management company operating in Southern Italy. The topic is important since personnel have a significant impact on the operating costs of SWWTPs, and the approach outlined results in the minimum number of staff being required to assure the management of the service. Four kinds of work units are considered: plant managers, assistant plant managers, laboratory technicians and executives. In order to develop a practical, feasible and easy to use method, the workload was evaluated considering only the population equivalent (PE) and the number of plants managed. The core of the method is the evaluation of the percentage of time that the personnel units devote to the operation of SWWTPs of the municipality considered. The proposed procedure offers a useful tool to equalize the workload, both in terms of PE and the number of plants managed, the procedure being easily modifiable to introduce other evaluation criteria. By using familiar concepts such as PE and number of plants managed, the approach of the method can easily be understood by management. It can also be readily adapted to other similar situations.

Rescue of traumatized riders in world circuits: a comparison between skidboard vs scoop Exl65 and aluminium scoop stretchers.

We compared the following stretchers to identify the better and safer to immobilize a fallen rider on the track. The stretchers were: Northwall's Innovation Skidboard, Ferno's Scoop EXL65 and anonymous aluminium scoop stretcher. We performed tests on track with several repetitions on a 25 meters path including asphalt, curb, natural and synthetic grass, and gravel. The Dainese Company supplied a suit and a helmet with sensors equipped to receive data. Dainese engineers processed data too. We timed the performance made by teams of three operators, men and women in different roles. The Skidboard turned out to be the most innovative and secure spine board, because generates less energy than other stretchers and reduces, almost cancels, the harmful consequences of the patient's fall on the ground. Exl65 generates more spin and longitudinal stresses than Skidboard, especially the cervical spine. Skidboard is faster than other stretchers to complete the fallen rider's rescue on the track. It is the only spineboard that allows to tie the patient to the stretchers from head to toe, which does not happen with the aluminum scoop and only partially with the Exl65. Skidboard is better than others to rescue fallen and traumatized riders on the tracks quickly and safely. 

Technical, economic and environmental analysis of a MSW kerbside separate collection system applied to small communities.

The main aim of this study was to evaluate the costs and environmental impacts induced by a fixed model of MSW kerbside separate collection system for communities up to 10,000 inhabitants, in order to evaluate the convenience for the smaller municipalities to unite and form more economically and environmentally sound systems. This topic is important not only due to the large number of small municipalities (e.g. in Italy 72% of the municipalities has less than 5000 inhabitants) but also to the fact that separate collection systems are typically designed to take into account only the technical and economic aspects, which is a practice but not acceptable in the light of the sustainable development paradigm. In economic terms, between 1000 and 4000 inhabitants, the annual per capita cost for vehicles and personnel decreased, with a maximum at approximately 180€/inhabitants/year; while, from 5000 up to 10,000 inhabitants, the annual per capita cost was practically constant and equal to about 80€/inhabitants/year. For the municipalities of less than 5000 inhabitants, from an economic point of view the aggregation is always advantageous. The environmental impacts were calculated by means of the Life Cycle Assessment tool SimaPro 7.1, while the economic-environmental convenience was evaluated by combining in a simple multicriteria analysis, the annual total per capita cost (€/inhabitants/year) and the annual total per capita environmental impact (kEco-indicator point/inhabitants/year), giving the same importance to each criteria. The analysis was performed by means of the Paired Comparison Technique using the Simple Additive Weighting method. The economic and environmental convenience of the aggregation diminishes with the size of the municipalities: for less than 4000 inhabitants, the aggregation was almost always advantageous (91.7%); while, for more than or equal to 5000 inhabitants, the aggregation was convenient only in 33.3% of the cases. On the whole, out of 45 cases examined, for the municipalities from 1000 to 9000 inhabitants, the aggregation was both economically and environmentally convenient in 60.0% of the cases.

Bone effect of adjuvant tamoxifen, letrozole or letrozole plus zoledronic acid in early-stage breast cancer: the randomized phase 3 HOBOE study.

BACKGROUND: To measure bone mineral density (BMD) reduction produced by letrozole as compared with tamoxifen and the benefit of the addition of zoledronic acid. PATIENTS AND METHODS: A phase 3 trial comparing tamoxifen, letrozole or letrozole+zoledronic acid in patients with hormone receptor-positive early breast cancer was conducted; triptorelin was given to premenopausal patients. Two comparisons were planned: letrozole versus tamoxifen and letrozole+zoledronic acid versus letrozole. Primary end point was the difference in 1-year change of T-score at lumbar spine (LTS) measured by dual energy X-ray absorptiometry scan. RESULTS: Out of 483 patients enrolled, 459 were available for primary analyses. Median age was 50 (range 28-80). The estimated mean difference (95% confidence interval [CI]) in 1-year change of LTS was equal to -0.30 (95% CI -0.44 to -0.17) in the letrozole versus tamoxifen comparison (P<0.0001) and to +0.60 (95% CI +0.46 to +0.77) in the letrozole+zoledronic acid versus letrozole comparison (P<0.0001). Bone damage by letrozole decreased with increasing baseline body mass index in premenopausal, but not postmenopausal, patients (interaction test P=0.004 and 0.47, respectively). CONCLUSIONS: In the HOBOE (HOrmonal BOne Effects) trial, the positive effect of zoledronic acid on BMD largely counteracts damage produced by letrozole as compared with tamoxifen. Letrozole effect is lower among overweight/obese premenopausal patients.

Groundwater recharge in an endoreic basin with reclaimed municipal wastewater.

The aim of this paper was to evaluate the groundwater pollution in an endoreic basin in southern Italy. The aquifer circulation was carried out on two different levels: a shallow groundwater, with a water table of about 10 m, and a deep groundwater in a karst aquifer, with a water table of 140-190 m. Reclaimed municipal wastewater and superficial water collected in the catchment area were both drained in a swallow hole linked with the deep groundwater. The agricultural practice conducted in the endoreic basin produced an excess of nitrate in the soil. Nitrate was subsequently washed out and displaced in the groundwater. With regard to the EU Drinking Water Directive (98/83/EC), the research activity conducted during 2003 showed the absence of pollution in the deep groundwater used for drinking water supply. The shallow groundwater, instead, was strongly influenced by agricultural and pasture activities, with detectable levels of nitrates and bacteria. In order to reduce the load of pollution entering the swallow hole and then in the deep groundwater, the realisation of a constructed wetland plant was proposed to improve the quality of reclaimed wastewater, as well as to pursue the wastewater reuse in agriculture.

Treatment of high strength wastewater with vertical flow constructed wetland filters.

The aim of the present study was to evaluate the behaviour of vertical flow constructed wetlands to treat high strength wastewater. Influents were obtained mixing tap water with different percentages of MSW landfill leachate (5%, 10% and 20%). Phragmites australis seedlings were used as macrophytes. The reeds were nurtured during three spring months, before the start of the experimental period. Three and four days of detention time were adopted. Influent concentrations of 510-2,050 mg L(-1), 180-740 mg L(-1) and 65-260 mg L(-1) were obtained for COD, N-NH4(+) and N-NO3(-), respectively. The environmental temperature averaged around 31.0 +/- 1.4 degrees C. During the experimental period, all parameters showed an increasing removal efficiency trend. Best results in terms of COD removal were obtained for mixtures at lowest rate of landfill leachate; while, denitrification process showed an opposite behaviour; finally, the removal of ammonia nitrogen appeared to be independent upon influent concentrations. Analysis carried out on the reed tissues showed a theoretic maximum storage of TKN in the leaves of about 55 mg/g dry weight. A leachate percentage of about 35% was derived to be able to fully inhibit the growth of macrophytes.

Energy from gasification of solid wastes.

Gasification technology is by no means new: in the 1850s, most of the city of London was illuminated by "town gas" produced from the gasification of coal. Nowadays, gasification is the main technology for biomass conversion to energy and an attractive alternative for the thermal treatment of solid waste. The number of different uses of gas shows the flexibility of gasification and therefore allows it to be integrated with several industrial processes, as well as power generation systems. The use of a waste-biomass energy production system in a rural community is very interesting too. This paper describes the current state of gasification technology, energy recovery systems, pre-treatments and prospective in syngas use with particular attention to the different process cycles and environmental impacts of solid wastes gasification.

Effect of oral contraceptives on lacrimal fluid peroxidase activity in women.

Lacrimal fluid peroxidase has been supposed to be involved in the protection against oxidative damage to the ocular surface. Our recent findings showed the existence of significant cyclic variations in lacrimal fluid peroxidase activity that were positively correlated with those of 17beta-estradiol plasma levels throughout the menstrual cycle of fertile women. In the present study lacrimal fluid peroxidase activity of 8 healthy normocyclic women using low-dose oral contraceptives during the monthly cycle was determined. Data showed that low-dose oral contraceptives caused a decrease in lacrimal fluid peroxidase activity and a lack of its cyclic pattern with respect to the enzyme activity of 8 untreated age-matched women. Moreover, this result suggests that lacrimal fluid peroxidase activity could be regulated by estrogen.

Variations of lacrimal fluid peroxidase activity in female and male rats.

Previous research from this laboratory showed that human lacrimal fluid peroxidase has cyclic variations during the menstrual cycle, correlated with plasma levels of 17beta-oestradiol. In the present investigation, variations of enzyme activity and total protein content during the oestrous cycle of young adult female rats are analysed. Effects from circadian rhythm and a gender-related influence are also examined. In female rats, as in women, lacrimal fluid peroxidase activity shows cyclic variations; in fact, it significantly (p < 0.05) changes during the different phases of the oestrous cycle. In contrast, in males such variations do not occur. Thus, we suggest that gender seems to exert a significant influence on the secretion of this specific tear protein, probably by a direct effect of oestrogens.

Lacrimal fluid peroxidase activity during the menstrual cycle.

PURPOSE: The aim of this work was to investigate peroxidase activity in human tears during the various phases of the menstrual cycle. For comparative purposes saliva was also examined. METHODS: Tear fluids and saliva from 10 healthy volunteers 23-41 years of age (mean: 28.2 years), with regular menstrual cycles were sampled for the duration of at least two complete cycles. Menstrual cycles and ovulation periods were evaluated by measuring morning body temperature and hormone levels in plasma and urine. Unstimulated tears and unstimulated saliva were collected in the morning every two days. Peroxidase activity was monitored according to the 5,5'-dithiobis, 2-nitrobenzoic acid thiocyanate (Nbs-SCN) method and the protein content was determined by the Bradford method. RESULTS: Peroxidase activity in tears, expressed as U/mL, was significantly (p <.05) higher during the preovulatory and luteal phases with respect to the menses, whilst total protein content remained almost unchanged throughout all phases. A positive correlation was found between lacrimal fluid peroxidase activity and 17beta-estradiol plasma levels (p <.001). Salivary peroxidase activity did not show such estrogen-related changes. CONCLUSIONS: Our findings report cyclic variations in peroxidase activity in human tears during the menstrual cycle. Such cycling seems to reflect variations of 17 beta-estradiol plasma levels. These results suggest that a regulation of lacrimal fluid peroxidase by 17 beta-estradiol could be one possible cause for the female gender predilection in some ocular diseases, such as keratoconjunctivitis sicca.

Effect of different whole body hyperthermic sessions on the heat shock response in mice liver and brain.

We examined by Western blots the effect of variations of the heating sessions, such as duration and intensity on the following aspects: 70-kDa heat shock protein (HSP70) and HSP72 induction. Protein ubiquitination PLCgamma , PKCepsilon and PKCalpha levels in murine liver and brain were also studied. Results demonstrated that maximal induction of HSP72 was obtained after heat shock at 43.5 degrees C in both organs. Preconditioning at lower temperatures (either acclimation to 39 degrees C or induction of thermotolerance to 43.5 degrees C with a single exposure to 39 degrees C) attenuated the heat shock response. Hepatic HSP72 induction was elicited only as a consequence of hyperthermia since either fasting or restraint were unable to trigger its synthesis. On the contrary, a ubiquitination decrease of a 31 kDa protein was obtained both after hyperthermia and fasting This indicates that the latter is a more generic response of hepatic cells to noxious stimuli. Analysis of the above mentioned enzymes showed that in liver of naive mice PKCalpha is barely present while PKCepsilon is quite abundant. All hyperthermic treatments caused a general decrease of the latter, except for the heat shock at 43.5 degrees C that caused an increase. PLCgamma decreased after all heating sessions. It is known that hyperthermia in the range of 41-45 degrees C induces apoptotic death in many cell types. Therefore we analyzed the presence of the typical apoptotic DNA ladder. Our data strongly suggest that both hyperthermia and restraint induce necrosis in liver while apoptosis and necrosis become evident in brain. All these effects are still present 24 h from the last heating session: This indicates that in vivo, hyperthermia produces long term modifications of the hepatic cell.

Experimental ocular acute hypertension-induced chromatinic alterations in astrocytic cells in rat optic nerve.

The effects of ocular acute hypertension experimentally induced on the astrocyte cells of rat have been studied. Evaluation was made of the damage to the chromatin of those cells by means of cytochemical (haematoxylin-eosin) analysis and of the state of fragmentation of the DNA by means of the TUNEL technique as well as the protective effect of the peroxide scavenger, troxol, on those events.

Induced acute ocular hypertension: mode of retinal cell degeneration.

The effects of experimental hypertension on retinal cells were studied. Evaluation was made of IOP levels and degree of cell damage by cytochemical and DNA analysis, and degeneration modes: necrosis and apoptosis.