The SARS-CoV-2 pandemic as a source of unprecedented bioethical and biolaw issues: lessons for intensivists.

The following article presents the relevant and unprecedented bioethical and biolaw issues posed by the SARS-COV-2 pandemic and summarizes the initiatives adopted by the Italian Society of Anesthesia and Resuscitation (SIAARTI) as well as by the Veneto Region ICU Network. Since the initial phase of the pandemic, in March 2020, there has been a strong appeal from both SIAARTI and the Veneto Region ICU Network to consider "the appropriate intensive treatment." During the pandemic, the principle of proportionality must be applied, in compliance with the main principle in bioethics.

Continuous vs Intermittent Meropenem Administration in Critically Ill Patients With Sepsis: The MERCY Randomized Clinical Trial.

Importance: Meropenem is a widely prescribed β-lactam antibiotic. Meropenem exhibits maximum pharmacodynamic efficacy when given by continuous infusion to deliver constant drug levels above the minimal inhibitory concentration. Compared with intermittent administration, continuous administration of meropenem may improve clinical outcomes.

The PROVENT-C19 registry: A study protocol for international multicenter SIAARTI registry on the use of prone positioning in mechanically ventilated patients with COVID-19 ARDS.

Background: The worldwide use of prone position (PP) for invasively ventilated patients with COVID-19 is progressively increasing from the first pandemic wave in everyday clinical practice. Among the suggested treatments for the management of ARDS patients, PP was recommended in the Surviving Sepsis Campaign COVID-19 guidelines as an adjuvant therapy for improving ventilation. In patients with severe classical ARDS, some authors reported that early application of prolonged PP sessions significantly decreases 28-day and 90-day mortality.

COVID-19 ICU mortality prediction: a machine learning approach using SuperLearner algorithm.

Background: Since the beginning of coronavirus disease 2019 (COVID-19), the development of predictive models has sparked relevant interest due to the initial lack of knowledge about diagnosis, treatment, and prognosis. The present study aimed at developing a model, through a machine learning approach, to predict intensive care unit (ICU) mortality in COVID-19 patients based on predefined clinical parameters.

Results: Observational multicenter cohort study.

Static compliance and driving pressure are associated with ICU mortality in intubated COVID-19 ARDS.

Background: Pathophysiological features of coronavirus disease 2019-associated acute respiratory distress syndrome (COVID-19 ARDS) were indicated to be somewhat different from those described in nonCOVID-19 ARDS, because of relatively preserved compliance of the respiratory system despite marked hypoxemia. We aim ascertaining whether respiratory system static compliance (Crs), driving pressure (DP), and tidal volume normalized for ideal body weight (VT/kg IBW) at the 1st day of controlled mechanical ventilation are associated with intensive care unit (ICU) mortality in COVID-19 ARDS.

Methods: Observational multicenter cohort study.

Evaluating the Impact of Two Generalist Predators on the Leafhopper Population Density.

Outbreaks of the Nearctic leafhopper represent a threat to vinegrowers in Southern Europe, in particular in North-eastern Italy. The pest outbreaks are frequent in organic vineyards because insecticides labeled for organic viticulture show limited effectiveness towards leafhoppers. On the other hand, the naturally occurring predators and parasitoids of in vineyards are often not able to keep leafhopper densities at acceptable levels for vine-growers.

Continuous infusion versus intermittent administration of meropenem in critically ill patients (MERCY): A multicenter randomized double-blind trial. Rationale and design.

Objective: Meropenem is a β-lactam, carbapenem antibacterial agent with antimicrobial activity against gram-negative, gram-positive and anaerobic micro-organisms and is important in the empirical treatment of serious infections in Intensive Care Unit (ICU) patients. Multi-drug resistant gram-negative organisms, coupled with scarcity of new antibiotic classes, forced healthcare community to optimize the therapeutic potential of available antibiotics. Our aim is to investigate the effect of continuous infusion of meropenem against bolus administration, as indicated by a composite outcome of reducing death and emergence of extensive or pan drug-resistant pathogens in a population of ICU patients.

Global MHD modeling of resonant ULF waves: Simulations with and without a plasmasphere.

We investigate the plasmaspheric influence on the resonant mode coupling of magnetospheric ultralow frequency (ULF) waves using the Lyon-Fedder-Mobarry (LFM) global magnetohydrodynamic (MHD) model. We present results from two different versions of the model, both driven by the same solar wind conditions: one version that contains a plasmasphere (the LFM coupled to the Rice Convection Model, where the Gallagher plasmasphere model is also included) and another that does not (the stand-alone LFM). We find that the inclusion of a cold, dense plasmasphere has a significant impact on the nature of the simulated ULF waves.

Numerical calculation of interaction forces between paramagnetic colloids in two-dimensional systems.

Typically the force between paramagnetic particles in a uniform magnetic field is described using the dipolar model, which is inaccurate when particles are in close proximity to each other. Instead, the exact force between paramagnetic particles can be determined by solving a three-dimensional Laplace's equation for magnetostatics under specified boundary conditions and calculating the Maxwell stress tensor. The analytical solution to this multi-boundary-condition Laplace's equation can be obtained by using a solid harmonics expansion in conjunction with the Hobson formula.

Assessment of efficacy and safety of pandemic A/H1N1/2009 influenza vaccine in a group of health care workers.

Introduction: The development in an extremely short time of an efficacious and safe vaccine against the pandemi A/H1N1 virus was a challenge that involved the entire scientific community.

Aims: To assess the immunological and clinical efficacy of the new H1N1v monovalent influenza vaccine (Focetria Novartis Vaccines, Siena, Italy) in a group of health care workers (HCWs).

Methods: A total of 148 volunteer HCWs were enrolled between Mid-Novembre 2009 and December 2009.

Occupational diseases due to allergic and toxic chemicals in health care workers: fitness for work.

The purpose of this review is to suggest job fitness criteria for health care workers exposed to sensitizing or chemical agents. These recommendations are derived from a comparison between previous documents on prevention and management of allergic and chemical risks in health care settings and updated evidence; the job fitness criteria and the main documents on these topics are summarized in tables. Glove allergy, in particular latex allergy, is still a significant problem but we should remember that a wide choice of alternative materials is now easily available; many different alternative health products are also currently available when an allergy to disinfectants or detergents is diagnosed.

[Does the occupational physician training convey the knowledge of the positive effects of work on the human quality of life?].

Occupational Medicine has always been concerned with the negative aspects of work on human health. Much less frequently have the possible positive effects of work on health been studied and taught. In fact the cultural background of occupational medicine has for many years witnessed the development of a prevalently negative view of work, which is perceived as a deteriorating activity, as the inevitable cause of psychophysical deterioration, of illness and injury.

[Study of the olfactory function of a group of workers with significant lead exposure].

The aims of this study are to verify the potential lead damage on olfactory function and to identify early effects due to lead exposure. Our diagnostic evaluation included: (i) questionnaire to collect data about work and clinical history, (ii) olfactory evaluation: threshold test (Single-Starcaise) and identification/discrimination test (Wright). Lead exposure was evaluated by air sampling and biological monitoring (PbB, lead in blood).

[Hearing function and solvent exposure: study of a worker population exposed to styrene].

The aim of the study was to investigate the ototoxic effects of occupational styrene exposure, in absence of other risk factors. Pure-tone audiometric thresholds of 32 workers exposed to styrene, but not to noise, in fibreglass reinforced plastic boat manufacturing process were detected and compared to audiometric thresholds of a control unexposed group composed by 60 subjects. Exposure to styrene was measured by urinary mandelic + phenylglyoxylic acid (mean value 149 mg/g crea, SD 80 mg/g crea).

[Health surveillance on workers exposed to wood dust: usefulness of the assessment of the nasal mucosa].

The purpose of this paper is to evaluate alterations in the nasal mucosa in workers that for professional purpose, are exposed, for a long period of time, to wood dust (WD). The increased frequency in alterations could underline a mechanism for chronic damage that could lead to cancer This study took into account 50 cabinet workers (EW) who had been exposed to WD for an average of 33 years and were compared to 48 controls (CC). A questionnaire regarding nasal symptoms was submitted, the nasal mucosa was examined by fibroscopy, secretions were valuated, cytogram from a nasal swap was also done.

[Interactions between alcohol and work exposure to chemical substances].

Background And Objectives: The quite diffused habit of a significant assumption of alcohol drinks, can interfere with the professional exposure to chemical substances. The interaction may result in increasing their toxicity and/or modifying the parameters of the biological monitoring. It may also act as a confounding factor, not only in epidemiologic researches but also at individual level when the assessment of the occupational exposure and/or the diagnosis of an occupational diseases, is under consideration.

[The presence of asbestos bodies in induced sputum as an indicator of asbestos exposure].

Background: Very few references on the usability of presence of asbestos bodies (AB) in induced sputum as an indicator of asbestos exposure are to be found in the scientific literature.

Objectives: The purpose of this study was to prove whether the presence of AB in induced sputum is a valid assessor of asbestos exposure.

Method: This was achieved by comparing the above-mentioned method with the search for AB in bronchoalveolar lavage (BAL) fluid and repeating the trials over time in order to study the reproducibility of the results.

[Efficacy in occupational medicine: proposals of the regional sections of SIMLII of Lombardy and Emilia Romagna].

The efficacy in Occupational Medicine is based on the degree of attainment of workers health and safety care. The Occupational Physician activity, attending on business parts, gives a contribution to the mission of the firm leading to the workers health/safety. The Occupational Physician actions are conditioned by workers features and by the other members of prevention system.

[Research and formal demonstration of evidence of efficiency in occupational medicine].

There is an increasing pressure on occupational health professionals to ensure that their practice is based on a quality standard and an evidence of appropriateness. The efficacy-effectiveness of their activity strictly depends on their intellectual and professional integrity, their technical and legal competence, but also on the quality of the relations with the company organisation they are able to establish. We asked to some occupational physician when they considered their interventions in the workplace to be efficacious.

[Characterisation of an HBsAg mutant of hepatitis B virus (HBV) isolated from a dialysed patient involved in an occupational accident].

Background: Mutants of the hepatitis B virus (HBV) following vaccination (escape mutants) have been isolated over the course of the last decade. They consist most commonly of an aminoacid change from glycine to arginine at position 145 of the highly antigenic a determinant of the surface antigen (HBsAg).

Objective: Description of an escape mutant of HBV identified in the course of the post-exposure follow-up of a percutaneous exposure.

[Determination of interleukin-8 in induced sputum of workers exposed to low concentrations of asbestos].

The concentration of interleukin-8 (IL-8) in the induced sputum of 17 workers exposed to low airborne asbestos levels and of 10 controls was determined. IL-8 levels were statistically significantly increased in the asbestos exposed group compared to controls. This finding underlines the usefulness of the study of proinflammatory mediators as possible predictors of alveolar damage.

Olfactory function in workers exposed to moderate airborne cadmium levels.

Objective: The present study investigated the olfactory function in workers exposed to moderate airborne cadmium (Cd) levels, with the purpose of identifying possible early adverse effects of the metal, not demonstrable with the traditional diagnostic methods.

Methods: The exposed group consisted of 33 men employed in cadmium fusion, sintering and alloys lamination. Two reference groups were considered: the first consisted of 39 subjects assigned to manual workings, but not exposed to harmful substances for olfaction (drivers, warehousemen); the second was characterized by 23 subjects exposed to iron and steel welding fumes (iron base alloys), non-specific irritants on the respiratory tract.

[Health surveillance: from risk presumption to risk assessment].

A working group of the Occupational Medicine and Industrial Hygiene Association of Lombardy, the National Association of Occupational Health Physicians the National Society of Prevention Operators made a paper in order to rationalize the sanitary surveillance, observing the laws in force and following the European Directives. The authors, thinking that everyday experience not very useful health examinations are carried out and that the sanitary surveillance should be planned according to the real working risks, give methodological directives about the way to make the mandatory clinical examinations less frequent, to the firms, to the occupational health physician and to the public occupational health operators of the local health units that must supervise the sanitary surveillance.