The Traveller's Risk Perception (TRiP) questionnaire: pre-travel assessment and post-travel changes.

BACKGROUND: Travellers' risk perception is a key component of travel risk assessment because it influences the adequate implementation of safety precautions. The aims of this study are to validate a tool to analyse travellers' risk perception to identify which factors can influence it and how it changes upon return. METHODS: The Traveller's Risk Perception (TRiP) questionnaire was developed and administered to outpatients before and after travel in three travel clinics. A principal component analysis (PCA) was performed to validate the questionnaire and multivariate regression analysis was used to evaluate the effect of travellers' characteristics on the risk scores. RESULTS: A total of 1020 travellers completed the questionnaire. PCA identified two latent factors: 'generic-disseminated risks' and 'specific-circumstantial risks'. Cronbach's α was acceptable (0.76 and 0.70, respectively). The 'generic-disseminated risks' dimension scored higher than the 'specific-circumstantial risks' (p<0.001). The items with the highest scores were insect bites, gastrointestinal disorders and malaria. The mean scores were significantly lower after the travel for all items but one. CONCLUSIONS: The TRiP questionnaire is a valid and reliable tool for rating travellers' perceptions. Staff in travel clinics should be trained to systematically assess travellers' risk perception in order to tailor the consultation according to specific information needs.

Apparent metabolisable energy and amino acid digestibility of microalgae Spirulina platensis as an ingredient in broiler chicken diets.

1. This work investigates the apparent metabolisable energy (AME), its nitrogen-corrected form (AMEn) and amino acid (AA) digestibility coefficients of the microalgae Spirulina platensis as an ingredient in broiler chicken diets. 2. One group of birds was fed with a basal control diet (BD), and another was fed with a test diet composed of the BD with the addition of the microalgae at a proportion of 200 g/kg. AME and AMEn were assessed by total excreta collection and indigestibility analysis using acid-insoluble ash (AIA) as a marker. 3. The microalgae comprised 888.0 g/kg dry matter (DM), 18.42 MJ/kg gross energy, 514.7 g/kg crude protein, 9.9 g/kg ether extract, 10.6 g/kg crude fibre, 94.4 g/kg ash, 3.1 g/kg Ca and 11.0 g/kg P. 4. The values obtained for AME (13.48 MJ/kg DM) and AMEn (11.72 MJ/kg DM) were higher (p < 0.01) than those obtained using the AIA method (9.39-8.29 MJ/kg DM). The microalgae ileal digestibility coefficients were 0.80 ± 0.04 and 0.78 ± 0.04 for essential and non-essential AA, respectively. 5. Overall, the metabolisable energy content and digestibility of AA for S. platensis indicated that the microalgae are potentially an alternative nutrient source for broilers. The AIA method underestimated AME and AMEn in comparison to the total excreta collection method.

Effects of omalizumab in severe asthmatics across ages: A real life Italian experience.

BACKGROUND: This retrospective study aimed at evaluating long-term effects of Omalizumab in elderly asthmatics in a real-life setting. METHODS: 105 consecutive severe asthmatics (GINA step 4-5; mean FEV1% predicted:66 ± 15.7) treated with Omalizumab for at least 1 year (treatment mean duration 35.1 ± 21.7 months) were divided into 3 groups according to their age at Omalizumab treatment onset: 18-39, 40-64 and ≥ 65 years. RESULTS: Comorbidities, number of overweight/obese subjects and patients with late-onset asthma were more frequent among older people. A similar reduction of inhaled corticosteroids dosage and SABA on-demand therapy was observed in all groups during Omalizumab treatment; a similar FEV1 increased was also observed. Asthma Control Test (ACT) improved significantly (p < 0.001) in the three groups, increasing from 15 [IQR:12-18] to 24 [IQR:22-25] in younger subjects, from 14 [IQR:10-16] to 21 [IQR:20-23] in the 40-64-year-group and from 15 [IQR:12-16] to 20 [IQR:18-22] in elderly patients where improvement was lower (p = 0.039) compared to younger people. Asthma exacerbations decreased significantly after Omalizumab but the percentage of exacerbation-free patients was higher in younger people (76.9%) compared to middle aged patients (49.2%) and the elderly (29%) (p = 0.049). After Omalizumab treatment, the risk for exacerbations was lower in subjects aged 40-64 (OR = 0.284 [CI95% = 0.098-0.826], p = 0.021) and 18-39 (OR = 0.133 [CI95% = 0.026-0.678], p = 0.015), compared to elderly asthmatics. Also, a significantly reduced ACT improvement (ß = -1.070; p = 0.046) passing from each age class was observed. CONCLUSION: Omalizumab improves all asthma outcomes independently of age, although the magnitude of the effects observed in the elderly seems to be lower than in the other age groups.

Can we modulate asthma maintenance treatment level with disease seasonal variations?

Asthma can have clinical seasonal fluctuations due to different exposure factors. The analysis of our data and literature confirm a seasonal trend of asthma severity. In this brief review, authors discuss the possibility to adapt maintenance therapy level to clinical seasonal fluctuations, by increasing treatment in some seasons to prevent exacerbations and by decreasing it in others, when symptoms are low, in order to minimize costs and maximize safety. Literature and our data (concerning studies carried out in areas with a temperate climate) indicate that asthma severity is reduced in summer while it tends to increase in the other seasons. Authors conclude that a preventive increasing maintenance treatment level during the season when we know that patients worsen (starting some weeks before symptom worsening) may reduce asthma exacerbation risks. On the contrary, a summer treatment reduction, in patients that improve during this period, may be considered only in asthma phenotypes with a benign disease course in time.

The addition of entropy-based regularity parameters improves sleep stage classification based on heart rate variability.

The work considers automatic sleep stage classification, based on heart rate variability (HRV) analysis, with a focus on the distinction of wakefulness (WAKE) from sleep and rapid eye movement (REM) from non-REM (NREM) sleep. A set of 20 automatically annotated one-night polysomnographic recordings was considered, and artificial neural networks were selected for classification. For each inter-heartbeat (RR) series, beside features previously presented in literature, we introduced a set of four parameters related to signal regularity. RR series of three different lengths were considered (corresponding to 2, 6, and 10 successive epochs, 30 s each, in the same sleep stage). Two sets of only four features captured 99 % of the data variance in each classification problem, and both of them contained one of the new regularity features proposed. The accuracy of classification for REM versus NREM (68.4 %, 2 epochs; 83.8 %, 10 epochs) was higher than when distinguishing WAKE versus SLEEP (67.6 %, 2 epochs; 71.3 %, 10 epochs). Also, the reliability parameter (Cohens's Kappa) was higher (0.68 and 0.45, respectively). Sleep staging classification based on HRV was still less precise than other staging methods, employing a larger variety of signals collected during polysomnographic studies. However, cheap and unobtrusive HRV-only sleep classification proved sufficiently precise for a wide range of applications.

Can home-monitoring of sleep predict depressive episodes in bipolar patients?

The aim of this study is the evaluation of the autonomic regulations during depressive stages in bipolar patients in order to test new quantitative and objective measures to detect such events. A sensorized T-shirt was used to record ECG signal and body movements during the night, from which HRV data and sleep macrostructure were estimated and analyzed. 9 out of 20 features extracted resulted to be significant (p<;0.05) in discriminating among depressive and non-depressive states. Such features are representation of HRV dynamics in both linear and non-linear domain and parameters linked to sleep modulations.

Monitoring nocturnal heart rate with bed sensor.

INTRODUCTION: This article is part of the Focus Theme of Methods of Information in Medicine on "Biosignal Interpretation: Advanced Methods for Studying Cardiovascular and Respiratory Systems". OBJECTIVES: The aim of this study is to assess the reliability of the estimated Nocturnal Heart Rate (HR), recorded through a bed sensor, compared with the one obtained from standard electrocardiography (ECG). METHODS: Twenty-eight sleep deprived patients were recorded for one night each through matrix of piezoelectric sensors, integrated into the mattress, through polysomnography (PSG) simultaneously. The two recording methods have been compared in terms of signal quality and differences in heart beat detection. RESULTS: On average, coverage of 92.7% of the total sleep time was obtained for the bed sensor, testifying the good quality of the recordings. The average beat-to-beat error of the inter-beat intervals was 1.06%. These results suggest a good overall signal quality, however, considering fast heart rates (HR > 100 bpm), performances were worse: in fact, the sensitivity in the heart beat detection was 28.4% while the false positive rate was 3.8% which means that a large amount of fast beats were not detected. CONCLUSIONS: The accuracy of the measurements made using the bed sensor has less than 10% of failure rate especially in periods with HR lower than 70 bpm. For fast heart beats the uncertainty increases. This can be explained by the change in morphology of the bed sensor signal in correspondence of a higher HR.

Identification and assay of carbohydrates in olive drupes by cesium attachment electrospray tandem mass spectrometry (ESI-MS/MS).

Identification and assay of sugars in olive drupes during their ripening phase is evaluated by tandem mass spectrometry. Recent achievements have shown that the quality of an extra virgin olive oil can be directly correlated to the ripening degree of the drupes that is likely linked to their saccharides content. An innovation in this peculiar food chain is now proposed that considers a high throughput assessment of the carbohydrate content by a recently introduced protocol based on the gas-phase chemistry of sugar-cesium adducts by ESI-MS/MS.

Flexible flatfoot treatment in children with mechanical sound vibration therapy.

UNLABELLED: The flat foot can be defined as a syndrome with multiple etiopathogenesis, characterized by an altered structure of the longitudinal arch of the plantar vault with its reduction in height. The plantar arch collapse can be counteracted by strengthening the muscles involved; for many years, specific physical exercises have been proposed with this purpose in physical and rehabilitation medicine. The aim of our work was to improve the plantar arch muscles' tone using high focal vibration therapy (300Hz) METHODS: 10 children with a 4th degree flat foot (age: 8,7±2,2; height: 132±15cm; weight: 35,2±12,3Kg) underwent 10 sessions, 2 days/wk, of 30 min of focused high vibratory therapy at a frequency of 300 Hz (Vissman, Italy). Before and after treatment stabilometry (StT), static and dynamic baropodometry tests were performed. RESULTS: Evaluation of StT showed an improvement of stability, a decrease of sway area and ellipse area. Baropodometry tests showed a decrease in foot surface. Also dynamic tests showed a decrease in both foot surfaces. DISCUSSION: The results lead us to consider this method as a method of first choice to a conservative approach in the rehabilitation of flat foot syndrome also for the 4th grade in children.

Influenza A H1N1 and severe asthma exacerbation.

The pandemic influenza A H1N1 will affect millions of subjects. This influenza can cause respiratory complications with possible death. We have described two case reports of acute severe asthma exacerbation combined to influenza A H1N1, caracterized by severe respiratory failure. The diagnosis of influenza A H1N1 was confirmed with the multiplex reverse transcription-polymerase chain reaction (RT-PCR) assay. These patients, apart from asthma, do not have other diseases; but they did not take adequate therapy. In addition to conventional therapy (corticosteroids, bronchodilator and antibiotics) oseltamivir 75 mg bid was immediately added. After few days the patients improved and therefore in a short time they were discharged. During this period, in the case of severe asthma exacerbations, one must always think of influenza A H1N1 as the possible cause. It is necessary to use oseltamivir precociously to avoid severe complications. All asthmatic patients must regularly take their therapy especially during pandemic influenza A H1N1.

Euclidean geometry explains why lengths allow precise body mass estimates in terrestrial invertebrates: the case of oribatid mites.

Indirect measures of soil invertebrate body mass M based on equations relating the latter to body length (l) are becoming increasingly used due to the required painstaking laboratory work and the technical difficulties involved in obtaining some thousands of reliable weight estimates for animals that can be very small. The implicit assumption of such equations is that dM/dV=delta, where V is body volume and delta is a constant density value. Classical Euclidean scaling implies that V is proportional to l(3) proportional to M. One may thus derive M from l when the latter can provide a good estimate of V and the assumption of a constant delta is respected. In invertebrates, equations relating weight to length indicate that the power model always provides the best fit. However, authors only focused on the empirical estimation of slopes linking the body mass to the length measure variables, sometimes fitting exponential and linear models that are not theoretically grounded. This paper explicates how power laws derive from fundamental Euclidean scaling and describes the expected allometric exponents under the above assumptions. Based on the classical Euclidean scaling theory, an equivalent sphere is defined as a theoretical sphere with a volume equal to that of the organism whose body mass must be estimated. The illustrated application to a data set on soil oribatid mites helps clarify all these issues. Lastly, a general procedure for more precise estimation of M from V and delta is suggested.

Localisation of heavy metals in the midgut epithelial cells of Xenillus tegeocranus (Hermann, 1804) (Acari: Oribatida).

Sites of intracellular metal deposition in the midgut ventriculus and in the proventricular glands of Xenillus tegeocranus (Hermann, 1804) (Acari: Oribatida) were studied by TEM. The study aimed to obtain new information on the ultrastructural features of heavy metal compartmentalisation and elimination mechanisms in oribatid mites. Specimens of X. tegeocranus were collected from an abandoned mining and smelting area and from an unpolluted site. A large number of electron-dense granules (EDGs) were detected: concentric spherocrystals were observed mainly in the epithelium of the midgut ventriculus, while homogeneous dark granules were found exclusively in proventricular gland cells. The elemental composition of EDGs, studied by X-ray microanalysis, showed that midgut cells of X. tegeocranus can store metals (Fe, Mn, Zn, Ni, and Cu) in granules. The chemical composition of EDGs seems to be influenced by the presence and bioavailability of heavy metals in soil, with different kinds of metals accumulating in different types of granules.

Fine structure of the midgut and Malpighian papillae in Campodea (Monocampa) quilisi Silvestri, 1932 (Hexapoda, Diplura) with special reference to the metal composition and physiological significance of midgut intracellular electron-dense granules.

The fine structure of the midgut and the Malpighian papillae in Campodea (Monocampa) quilisi Silvestri, 1932 (Hexapoda, Diplura) specimens was described. We observed the presence of electron-dense granules (EDGs) in the midgut epithelial cells, similar in genesis, structure and aspect to the type A spherocrystals described in the midgut epithelium of Collembola and Diplopoda. Energy-dispersive X-ray microanalysis was used to detect the chemical composition of the granules and to relate it to the concentrations of some potential toxic heavy metals (Pb, Cu, Zn) in soil and litter. Chemical composition of the granules seems strongly influenced by the presence and bioavailability of heavy metals in the external environment. Specimens from a contaminated abandoned mining and smelting area (Colline Metallifere, southern Tuscany) were able to accumulate Fe, Mn, Zn, Pb and Cu in their midgut EDGs. In addition, we observed that C. (M.) quilisi was able to excrete the metal-containing granules into the external medium by the moulting of the intestinal epithelium. This confirms that the process of ionic retention of midgut cells is particularly significant in animals lacking Malpighian tubules.

Type I collagen contains at least 14 cryptic fibronectin binding sites of similar affinity.

There is uncertainty in the literature regarding the number and location of fibronectin binding sites on denatured collagen. Although most attention has focused on a single site near the collagenase-sensitive region of each alpha chain, there is evidence for additional sites in other regions. We treated bovine type I collagen with cyanogen bromide, labeled the resulting mixture with fluorescein, and separated the peptides by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Fluorescent bands were excised from the gel and dialyzed exhaustively to remove detergent. Titration of eight distinct fluorescent-labeled fragments with the 42-kDa gelatin-binding fragment of fibronectin caused increases in anisotropy that were fully reversible with unlabeled gelatin. By fitting the dose responses it was possible to calculate apparent K(d)'s whose values ranged between 1 and 4 microM. The largest fragment, alpha(2)-CB3,5, composing about 2/3 of the alpha(2) chain, when further digested with endoproteinase Lys-C, yielded at least three additional subfragments that also bound with similar affinities. Thus, there appear to be at least 14 distinct fibronectin binding sites of similar affinity in bovine type I collagen, five on each of the alpha(1) chains and four on the alpha(2) chain. Experiments with several synthetic peptides failed to reveal the exact nature of the binding site.

Recognition of alpha 2-macroglobulin by the low density lipoprotein receptor-related protein requires the cooperation of two ligand binding cluster regions.

The low density lipoprotein receptor-related protein (LRP) is a scavenger receptor that binds several ligands including the activated form of the pan-proteinase inhibitor alpha(2)-macroglobulin (alpha(2)M*) and amyloid precursor protein, two ligands genetically linked to Alzheimer's disease. To delineate the contribution of LRP to this disease, it will be necessary to identify the sites on this receptor which are responsible for recognizing these and other ligands to assist in the development of specific inhibitors. Structurally, LRP contains four clusters of cysteine-rich repeats, yet studies thus far suggest that only two of these clusters (clusters II and IV) bind ligands. Identifying binding sites within LRP for certain ligands, such as alpha(2)M*, has proven to be difficult. To accomplish this, we mapped the binding site on LRP for two inhibitors of alpha(2)M* uptake, monoclonal antibody 8G1 and an amino-terminal fragment of receptor-associated protein (RAP D1D2). Surprisingly, the inhibitors recognized different clusters of ligand binding repeats: 8G1 bound to repeats within cluster I, whereas the RAP fragment bound to repeats within cluster II. A recombinant LRP mini-receptor containing the repeats from cluster I along with three ligand binding repeats from cluster II was effective in mediating the internalization of (125)I-labeled alpha(2)M*. Together, these studies indicate that ligand binding repeats from both cluster I and II cooperate to generate a high affinity binding site for alpha(2)M*, and they suggest a strategy for developing specific inhibitors to block alpha(2)M* binding to LRP by identifying molecules capable of binding repeats in cluster I.

Phenolic compounds in virgin olive oil. 2. Reappraisal of the extraction, HPLC separation, and quantification procedures.

The extraction procedures (solid/liquid SPE and liquid/liquid LLE) and HPLC separation and quantification methods of polyphenolic compounds have been checked in virgin olive oils in order to explain the differences in content reported in the literature. The work has been carried out on oils prepared from one cultivar and produced under the same protocol. The extraction methods are practically equivalent, but the SPE technique is more favorable because it is faster and simpler. It has been proved that the chromatographic features and the method of chemical expression of the concentrations may greatly affect the final values. Thus, under the same analytical method, the total concentration values of polyphenols of the same oil show variations from 18% to 80%, according to the formality of expression as gallic acid, caffeic acid, or tyrosol equivalents. The role of the nature and spectrophotometric features of the phenols and of the internal standard is also discussed, and it was found to be an important source of reported variation. A gradient separation with an eluent mixture acetonitrile-sulfuric acid (0.1 mol/L), detection at 225 nm, and quantitative calculation of polyphenolic compounds in oils (expressed as tyrosol equivalents, THY(eq)) is proposed.

Domain organization of the 39-kDa receptor-associated protein.

The 39-kDa receptor-associated protein (RAP) is an endoplasmic reticulum resident protein that binds to the low density lipoprotein receptor-related protein (LRP) as well as certain members of the low density lipoprotein receptor superfamily and antagonizes ligand binding. In order to identify important functional regions of RAP, studies were performed to define the domain organization and domain boundaries of this molecule. Differential scanning calorimetry (DSC) experiments revealed that the process of thermal denaturation of RAP is highly reversible and occurs in a broad temperature range with two well resolved heat absorption peaks. A good fit of the endotherm was obtained with four two-state transitions suggesting these many cooperative domains in the molecule. A number of recombinant fragments of RAP were expressed in bacteria, and their domain composition and stability were characterized by DSC, circular dichroism, and fluorescence spectroscopy. The results confirmed that RAP is composed of four independently folded domains, D1, D2, D3, and D4, that encompass residues 1-92, 93-163, 164-216, and 217-323, respectively. The first and the fourth domains preserved their structure and stability when isolated, whereas the compact structure of the fragment corresponding to D2 seems to be altered when isolated from the parent molecule. Isolated D3 was partially degraded during isolation from bacterial lysates. The isolated D4 was capable of binding with high affinity to LRP whereas neither D1 nor D2 bound. At the same time a fragment containing both D1 and D2 exhibited high affinity binding to LRP. These facts combined with the thermodynamic analysis of the melting process of the fragments containing D1 and D2 indicate that these two domains interact with each other and that the proper folding of the second domain into a native-like active conformation requires presence of the first domain.

Cross-linking of fibronectin to C-terminal fragments of the fibrinogen alpha-chain by factor XIIIa.

Fibronectin binds specifically to fibrin and is covalently cross-linked to the fibrin alpha chain by activated factor XIII (XIIIa). This reaction is important for wound healing. Here we investigate XIIIa-catalyzed cross-linking of fibronectin and some of its fragments to a recombinant fragment representing the COOH-terminal 30 kDa of the fibrin alpha chain (alpha C30K:His 368-Val 610). Only fibronectin and those fragments containing an intact NH2-terminus were able to form cross-linked complexes. As many as 10 of the 17 lysines in alpha C30K can serve as amine donors in this reaction. Analysis of the rate of XIIIa-catalyzed cross-linking of fibronectin NH2-terminal peptides and fragments with alpha C30K revealed that the presence of the first type I "finger" module accelerates the cross-linking reaction; addition of fingers 2-5 had no further effect.