Humidification during Invasive and Non-Invasive Ventilation: A Starting Tool Kit for Correct Setting.

The humidification process of medical gases plays a crucial role in both invasive and non-invasive ventilation, aiming to mitigate the complications arising from bronchial dryness. While passive humidification systems (HME) and active humidification systems are prevalent in routine clinical practice, there is a pressing need for further evaluation of their significance. Additionally, there is often an incomplete understanding of the operational mechanisms of these devices. The current review explores the historical evolution of gas conditioning in clinical practice, from early prototypes to contemporary active and passive humidification systems. It also discusses the physiological principles underlying humidity regulation and provides practical guidance for optimizing humidification parameters in both invasive and non-invasive ventilation modalities. The aim of this review is to elucidate the intricate interplay between temperature, humidity, and patient comfort, emphasizing the importance of individualized approaches to gas conditioning.

Action Observation Treatment for Upper Limb Rehabilitation in Patients With Stroke: Protocol for a Multicenter Randomized Controlled Trial.

BACKGROUND: In the last few years, new noninvasive strategies have emerged as rehabilitative treatments for patients with stroke. Action observation treatment (AOT) is a rehabilitation approach based on the properties of the mirror neuron system with a positive impact on modifying cortical activation patterns and improving the upper limb kinematics. AOT involves the dynamic process of observing purposeful actions with the intention of imitating and then practicing those actions. In recent years, several clinical studies suggested the effectiveness of AOT in patients with stroke to improve motor recovery and autonomy in activities of daily living. However, a deeper knowledge of the behavior of the sensorimotor cortex during AOT seems to be essential. OBJECTIVE: The aim of this clinical trial, conducted in 2 neurorehabilitation centers and in patients' homes, is to investigate the effectiveness of AOT in patients with stroke, confirming the translational power of a tailored treatment. Particular emphasis will be placed on the predictive value of neurophysiological biomarkers. In addition, the feasibility and impact of a home-based AOT program will be investigated. METHODS: A 3-arm, assessor-blinded, randomized controlled trial will be performed by enrolling patients with stroke in the chronic stage. A total of 60 participants will be randomly allocated to receive 15 sessions of AOT with different protocols (AOT at the hospital, AOT at home, and sham AOT), 3 sessions per week. The primary outcome will be assessed using the Fugl-Meyer Assessment-Upper Extremity scores. Secondary outcomes will be clinical, biomechanical, and neurophysiological assessment. RESULTS: The study protocol is part of a project (project code GR-2016-02361678) approved and funded by the Italian Ministry of Health. The study began with the recruitment phase in January 2022, and enrollment was expected to end in October 2022. Recruitment is now closed (December 2022). The results of this study are expected to be published in spring 2023. Upon completion of the analyses, we will examine the preliminary effectiveness of the intervention and neurophysiological outcomes. CONCLUSIONS: This study will be used to evaluate the effectiveness of 2 different AOT scenarios (ie, AOT at the hospital and AOT at home) in patients with chronic stroke and to assess the predictive value of neurophysiological biomarkers. Specifically, we will attempt to induce the functional modification of the cortical components by exploiting the features of the mirror neuron system, demonstrating relevant clinical, kinematic, and neurophysiological changes after AOT. With our study, we also want to provide, for the first time in Italy, the AOT home-based program while assessing its feasibility and impact. TRIAL REGISTRATION: ClinicalTrials.gov NCT04047134; https://clinicaltrials.gov/ct2/show/NCT04047134. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/42094.

Bioeconomy perception by future stakeholders: Hearing from European forestry students.

This article provides useful information for universities offering forestry programs and facing the growing demand for bioeconomy education. An explorative survey on bioeconomy perception among 1400 students enrolled in 29 universities across nine European countries offering forestry programs was performed. The data have been elaborated via descriptive statistics and cluster analysis. Around 70% of respondents have heard about the bioeconomy, mainly through university courses. Students perceive forestry as the most important sector for bioeconomy; however, the extent of perceived importance of forestry varies between countries, most significantly across groups of countries along a North-South European axis. Although differences across bachelor and master programs are less pronounced, they shed light on how bioeconomy is addressed by university programs and the level of student satisfaction with this. These differences and particularities are relevant for potential development routes towards comprehensive bioeconomy curricula at European forestry universities with a forestry focus.

Structural social capital and local-level forest governance: Do they inter-relate? A mushroom permit case in Catalonia.

In diffuse forest uses, like non-timber forest products' harvesting, the behavioural alignment of pickers is crucial for avoiding a "tragedy of the commons". Moreover, the introduction of policy tools such as a harvest permit system may help in keeping the activity under control. Besides the official enforcement, pickers' engagement may also derive from the perceived legitimate decision of forest managers and the community pressure to behave according to the shared values. Framed within the social capital theory, this paper examines three types of relations of rural communities in a protected area in Catalonia (Spain) where a system of mushroom picking permits was recently introduced. Through social network analysis, we explore structural changes in relations within the policy network across the policy conception, design and implementation phases. We then test whether social links of the pickers' community relate to influential members of the policy network. Lastly, we assess whether pickers' bonding and bridging structures affect the rate of permit uptake. Our results show that the high degree of acceptance could be explained by an adequate consideration of pickers' preferences within the decision-making group: local pickers show proximity to members of the policy network with medium-high influence during the three policy phases. The policy network also evolves, with some members emerging as key actors during certain phases. Significant differences are found in pickers' relations among and across the involved municipalities following an urban-rural gradient. A preliminary relation is found between social structures and differential pickers' engagement. These results illustrate a case of positive social capital backing policy design and, probably, also implementation. This calls for a meticulous design of forest policy networks with respect to communities of affected forest users.

[Level of sedation level and modifications of vital signs during hygienic care in patients admitted to an intensive care unit]. / Livello di sedazione e alterazioni dei parametri vitali durante le cure igieniche nei pazienti ricoverati in una terapia intensiva polivalente.

INTRODUCTION: Hygienic care practices may represent a source of stress for intensive care patients. AIM: To identify the hygienic care practices more involved in changes of vital signs and the association to the level of sedation. METHODS: Prospective observational study of eleven patients admitted to a general intensive care unit, observed for three consecutive hygiene care morning practices. A protocol for standardizing hygiene practices was adopted. Vital signs were recorded on an electronic database at the beginning of each of the following phase: before the start of hygiene, of mouth cleaning, of sponge bath, positioning of bedpan, first and second side rotation, change of position of endotracheal tube and replacement of tapes, and at the end of hygiene. RESULTS: 29 events of hygiene practices were observed in the 11 patients included in the study (the measurements of three events were discarded). Significant vital signs alterations were induced mainly by the rotation and change of position of the orotracheal tube. Significant correlations were observed between changes in Heart Rate and Bispectral Index (BIS) (coefficient of 0.345; P: 0.329), between BIS and systolic arterial blood pressure (0.774, P: 0.009), BIS and Tidal Volume (-0.569, P: 0.086), and BIS and Respiratory Rate (0.707, P: 0.022). CONCLUSIONS: The hygienic care in intensive care patients may negatively impact on vital signs. Some nursing manoeuvres cause variations of the vital signs also related to changes in the state of consciousness caused by possible defects or excesses of sedation. The sedation level, during hygienic care, should be constantly monitored.

[The comfort of patients ventilated with the Helmet Bundle]. / The Helmet Bundle: il comfort del paziente ventilato con CPAP con scafandro.

INTRODUCTION: Interventions aimed at increasing comfort of patients treated with Helmet Continuous Positive Airway Pressure (H-CPAP) increase its endurance and the duration of treatment. AIM: To assess the effect of nursing interventions on factors of discomfort for H-CPAP patients. METHODS: The fixing method of the helmet (5 subjects), the noise generated by the gas source and the level of humidity in the helmet were assessed. Fixing method: pain measured with Numeric rating scales (NRS) and Stress detector after the application of armpit straps or counterweights. Noise: level of noise (decibel measurement) in the helmet and the interventions to reduce it. Humidity: level of humidity with different models of active humidifiers. RESULTS: The armpit straps increase the pain measured with the stress detector of 0.206 microSiemens and of 4.8 points of the NRS after 5 minutes. The system with counterweights does not increase pain. The Heath and Moisture Exchangers (HME) Filters and tubes with smooth inner surface decrease the level of noise in the helmet from 70 to 48 decibel, with a gas flow of 30 l/min. The humidification and warming of gases (26 degrees C (-2 gradient) and warmed tubes) delivers a relative humidity of 33.9 +/- 1.9 mgH2O/l thus avoinding the steaming of the helmet. CONCLUSIONS: The use of counterweights, HME filters, tubes with smooth surface, ear plugs to reduce the noise level and active humidification and warming of gases reduce the discomfort associated to H-CPAP.