Specific Guidelines Research Articles

Knowledge, Perception, and Attitudes during the COVID-19 Pandemic in the Peruvian Population.

Latin American countries have been profoundly affected by COVID-19. Due to the alarming incidence of identified cases, we intended to explore which psychosocial elements may influence poor adherence to the mandatory control measures among the population. We aimed to assess Peruvians' knowledge, attitudes, and vulnerability perception during the coronavirus outbreak. We collected data from 225 self-selected participants using a web-based cross-sectional survey. The overall respondents were between 18 and 29 years old (56.8%), female (59.5%), belonged to educated groups, and graduated professionals (69.3%), most of them. Logistic regression showed that Knowledge is highly associated with education (p = 0.031), occupation (p = 0.002), and age (p = 0.016). Our study identified that, although people reported adequate Knowledge by identifying expected symptoms and virus transmission ways in COVID-19 disease. There is a significant perceived susceptibility to contracting the mentioned virus, displaying stigmatized behavior (59.1%) and fear of contracting the virus from others (70.2%). Additionally, it is reported to lack people's confidence in national health authorities regarding sanitary responses (62.7%), preparedness for the disease (76.9%), and the lack of adequate measures to deal with it (51.1%). We found that age, education, and occupation modulate Knowledge. At the same time, only age affected Perception and Attitude. Public policies should consider specific guidelines on knowledge translation and risk communication strategies for both containing psychological responses promptly and ensuring compliance with general control measures by the population.

Encountering deception in virtual spaces: guidelines for virtual ethnography.

This Perspective Essay draws from an experience of deception in virtual fieldwork and considers implications for those designing methodologies for virtual ethnographies. As qualitative field work increasingly takes place within virtual spaces and through virtual means, researchers are faced with critical dilemmas in the processes of data gathering and verification. One of these dilemmas concerns ensuring data validity and facticity if encountered with research subjects who are deceptive about their identity, experiences, or relationship to the field of research. This Perspective Essay offers specific guidelines concerning articulating the nature and possibilities of deception in virtual spaces, identifying deceptive data, and what to do with deceptive data in order to maintain data validity and transparency.

A-324 Incorporating the Screening for Congenital Cytomegalovirus into a Newborn Genetic Testing Performed on Saliva Swab: An Intersection between Human Genetics and Infectious Diseases

Abstract Background Newborn genetic testing is a powerful tool for improving the future healthcare of infants because of its potential to screening for a wide range of disorders with a single test. The assay can be performed in non-invasive sample such as saliva swabs. Hundreds of genes associated to disorders with significant morbidity and mortality (if undiagnosed) are analyzed. Despite the knowledge that infectious disorders such as congenital cytomegalovirus virus (cCMV) infection also has potential to cause serious illness to newborns (10–15% of apparently asymptomatic infants with cCMV may develop hearing loss) most of the newborn genetic testing does not test the saliva for cCMV. This validation aims to compare two laboratory-developed PCR-based CMV tests in saliva samples to add the cCMV screening into our newborn genetic testing. Methods Saliva swabs (OCR-100, DNA Genotek) from infants of our NGS-based newborn genetic testing were enrolled (n = 171). Parent signed informed consent agreeing with the used of the left-over specimens. Infants age ranged from 0 to 10 years. Saliva DNA was extracted by using QIAsymphony and DSP DNA mini kit (Qiagen). CMV was tested by two independent qPCR assays performed on LightCycler 480II using LightCycler Multiplex DNA Master (Roche). Each assays target two separated regions of the CMV genome (UL55 + UL123 and UL34 + UL80.5). A third assay targeting human CPOX gene was used as process control. The assays limits of detection were calculated by applying probit regression to the qualitative results returned from a serial dilution (1:10) of a positive pool (2 310 000 UI/mL) into a negative pool of samples. The accuracies for CMV detection were estimated by the total, positive and negative agreement between the compared sets of assays. The assay with lower limit of detection were chosen and its precision was evaluated by testing a subset of 26 saliva swabs (6 positives and 20 negatives) during 3 distinct days. For accuracy and precision experiments, Cq values >35 (∼750 UI/mL) was considered as not detected. Results The limits of detections were 40.7 UI/mL (95% CI:19.2–62.27 UI/mL) for UL55 + UL123 and 184 UI/mL (95% CI:64–304 UI/mL) for UL34 + UL80.5. CMV was detected in 8 and not detected in 163 saliva swabs by either UL55 + UL123 and UL34 + UL80.5 resulting in total, positive and negative agreements of 100% (95% CI:97–100%), 100% (95% CI:67–100%) and 100% (95% CI:97–100%), respectively. The median (min-max) Cq values for UL55 + UL123 were 30.75 (21.39–34.42) and for UL34 + UL80.5 were 30.81 (20.53–34.1). In the assay precision evaluation, UL55 + UL123 returned the expected result in 26/26, 26/26 and 25/26 samples on day 1, 2 and 3, respectively. The exception was a borderline positive sample that reach the Cq cut-off value (>35) on day 3 evaluation. Conclusion The UL55 + UL123 assay had lower limit of detection for CMV compared UL34 + UL80.5 and was chosen to be used in our cCMV screening. Both assays showed complete agreement when applied to saliva swabs samples. UL55 + UL123 presented acceptable precisions for positive and negative results. The cCMV screening by qPCR is now performed in parallel to NGS in our newborn genetic testing. cCMV test is only performed for newborns with less than 21 days of life, as recommend by specific guidelines.

A-021 Comparing the Time Between the 1st and 2nd Troponin in Male and Female Patients in Singapore and Calgary, Alberta: Evidence of Extended Pre-preanalytical Time in Females with Low ACS Risk

Abstract Background At the 2022 AACC national meeting, in our assessment of reference change values (RCV) in troponins ordered in Calgary and Singapore, we postulated that there were gender differences in troponin-ordering between the two cities. Methods Singapore Changi Hospital ED patients [July 2018–July 2020] and Calgary patients [December 2017–December 2021] had hsTnT measured with the Roche Elecsys assay on multiple, local Cobas e801’s. The first two troponins of each patient were selected if they were ordered within 12 h. The troponin pairs were grouped by city, patient sex and whether the troponin pairs fulfilled the criteria of low likelihood of Acute Coronary Syndrome (ACS) according to city specific guidelines. Results The figure compares the average time difference between the first and second troponin test of females and males stratified by the initial troponin value. The paired t-test conducted shows that in Singapore there was no significant difference in the time for females and males to receive a second troponin test while in Calgary the time for females to receive a second troponin test was significantly longer (P < 0.0001) than males. Conclusion The significant difference between Calgary females and males in average time between the first and second troponin tests supports the idea that there may be gender specific differences in troponin ordering timing and patterns. 62%–68% of all laboratory errors originate from pre-pre-analytical processes of which timing is a factor. The well documented atypical presentation of myocardial infarction in females may contribute to the delayed second test in women. This timing difference may be a contributor to the RCV variance observed in our previous study which identified gender differences in the assessment of RCV in troponins ordered in Calgary and Singapore.

The use and abuse of keystone plant species in restoration practices of terrestrial ecosystems

Keystone plant species are commonly used for restoring degraded terrestrial sites because, despite being encountered in low abundances in natural communities, they interact with multiple species across multiple niche dimensions. Nevertheless, the demographic characteristics of these “great interactors” are often disregarded in restoration planning, which may bring unintended consequences for restoration trajectories once the outcome of species relationships interplays between positive and negative effects depending on the density of interacting species. Therefore, while replanting keystone species at their characteristically low densities may re‐entangle food webs and allow novel plant and animal recruitment, restoring them at high densities can assemble asymmetrical relationships strong enough to affect sympatric plant species establishment, survival, and reproduction. Here, we explore the negative consequences of overusing keystone plant species in sites undergoing restoration and provide specific guidelines for practitioners to maximize the benefits of keystone plants in restoration initiatives.

An Overview of Long COVID Support Services in Australia and International Clinical Guidelines, With a Proposed Care Model in a Global Context.

Objective: To identify gaps among Australian Long COVID support services and guidelines alongside recommendations for future health programs. Methods: Electronic databases and seven government health websites were searched for Long COVID-specific programs or clinics available in Australia as well as international and Australian management guidelines. Results: Five Long COVID specific guidelines and sixteen Australian services were reviewed. The majority of Australian services provided multidisciplinary rehabilitation programs with service models generally consistent with international and national guidelines. Most services included physiotherapists and psychologists. While early investigation at week 4 after contraction of COVID-19 is recommended by the Australian, UK and US guidelines, this was not consistently implemented. Conclusion: Besides Long COVID clinics, future solutions should focus on early identification that can be delivered by General Practitioners and all credentialed allied health professions. Study findings highlight an urgent need for innovative care models that address individual patient needs at an affordable cost. We propose a model that focuses on patient-led self-care with further enhancement via multi-disciplinary care tools.

Zinc Deficiency and Therapeutic Value of Zinc Supplementation in Pediatric Gastrointestinal Diseases.

The benefits of zinc in treating certain gastrointestinal (GI) diseases have been recognized for over two decades. This review aims to explore zinc deficiency (ZD) and the potential therapeutic value and safety of zinc supplementation in pediatric GI diseases. A systematic review of published articles on ZD and zinc as adjuvant treatments for GI diseases was conducted using various databases. Children with inflammatory bowel disease (IBD), celiac disease, and those receiving long-term proton pump inhibitor treatments are particularly susceptible to ZD. ZD in children with celiac disease and IBD is attributed to insufficient intake, reduced absorption, and increased intestinal loss as a result of the inflammatory process. Zinc plays a crucial role in maintaining the integrity of the gastric mucosa and exerts a gastroprotective action against gastric lesions. Although considerable evidence supports the use of zinc as adjuvant therapy for certain GI diseases in adults, its use is unspecified in children except for infectious diarrhea. Current evidence suggests that zinc supplementation with well-documented dosages helps reduce the duration of diarrhea in children with acute or persistent diarrhea, while there are no specific guidelines for zinc supplementation in children with IBD and celiac disease. Zinc supplementation appears to be beneficial in peptic ulcer disease or gastroesophageal reflux disease. The available evidence highlights the need for intervention programs to enhance zinc status and reduce the morbidity of certain GI diseases in children.

The impact of COVID-19 on professional development for physiotherapists in Lagos, Nigeria.

Continuous professional development is important to maintain standards of care in the healthcare sector. However, in Lagos, Nigeria, the additional burden of COVID-19 and limited resources may provide separate challenges for physiotherapists' continuous professional development (CPD). To examine the availability and perceived quality of continuous professional development opportunities for physiotherapists working before and during the pandemic in Lagos, Nigeria. A qualitative study was conducted with 10 conveniently sampled physiotherapists, recruited via email. Interviews took place via Zoom, and the video function was utilised. Data were collected via semi-structured interviews using a pilot tested interview, and was transcribed and analysed thematically. The main method of workplace teaching pre-COVID-19 and during COVID-19 was bedside teaching (BT), which most participants received. Pre-COVID-19, the main barrier to receiving teaching was a lack of national guidelines providing specific details on CPD. During COVID-19, the main barrier was the difficulty of increased online teaching instead of teaching on real life patients. The main barriers for non-workplace CPD pre-COVID-19 were a lack of availability of learning opportunities and monetary cost of conferences. This was partially combatted by the increasing trend of online learning events during the pandemic, which increased access to non-workplace learning opportunities. Because of COVID-19, most CPD learning opportunities for physiotherapists in Lagos, Nigeria, were online, increasing overall accessibility. Adequate training to improve utilising online learning resources as well as specific guidelines for workplace physiotherapists CPD in Nigeria should be implemented and promoted to improve confidence and quality of care. Key insight into the CPD experiences of physiotherapists currently working in Lagos, Nigeria, which can guide policies and improve clinical outcomes.

The interplay between chronic hepatitis B and diabetes mellitus: A narrative and concise review.

Type 2 diabetes mellitus (T2DM) is a prevalent metabolic disorder among individuals with chronic hepatitis B (CHB), contributing to additional adverse impacts on both hepatic and extrahepatic systems. Existing evidence suggests a potential positive association between CHB and the development of insulin resistance and T2DM. The presence of T2DM in CHB patients is associated with an increased risk of liver fibrosis, cirrhosis, decompensation, and hepatocellular carcinoma (HCC) occurrence. Moreover, it elevates the risk of non-liver cancers and all-cause mortality in this population. T2DM also serves as the key element in metabolic dysfunction-associated steatotic liver disease, which is prevalent in the CHB population. Although specific guidelines for managing T2DM in CHB patients have not been proposed, some studies indicated that intensive glycemic control may benefit the prognosis of these patients. Additionally, specific antidiabetic agents, such as metformin and thiazolidinediones, promise to reduce HCC risk. However, unresolved questions, including the optimal glycemic control target and the selection of antidiabetic agents for CHB patients, remain and thus warrant further investigations through well-designed prospective trials. Implementing a standardized protocol encompassing regular monitoring, risk stratification, and early intervention using a multidisciplinary framework may improve the outcomes of diabetic CHB patients.

Solid pseudopapillary neoplasms of the pancreas in childhood and adolescence—an analysis of the German Registry for Rare Pediatric Tumors (STEP)

Solid pseudopapillary neoplasms (SPNs) are the most common entity among pediatric pancreatic tumors. Still, these are rare tumors with an annual incidence of 0.1–0.2/1,000,000, and little is known about their optimal treatment. This analysis aimed to increase knowledge about the occurrence and treatment strategies of SPN in childhood. Data regarding diagnostics, treatment, and outcome of children aged 0–18 years with SPN recorded in the German Registry for Rare Pediatric Tumors (STEP) were analyzed. Thirty-eight patients were identified with a median age of 14.5 years at diagnosis (range: 8–18) and a female preponderance (81.6%). The most frequent location of the tumor was the pancreatic tail. In histopathological and immunohistochemical examination, pseudopapillary, solid, and cystic lesions as well as expression of beta-catenin, progesterone receptors, and cyclin D1 were the most common findings. All patients underwent surgical resection. Most patients underwent open resection, predominantly tail resection for tumors in the tail region and pylorus-preserving pancreaticoduodenectomy for tumors in the head region. The main postoperative sequela was exogenous pancreatic insufficiency (23.7%), especially with SPN in the pancreatic head. No recurrence occurred during follow-up, although two patients underwent resection with microscopic residue.Conclusion: SPN of the pancreas in childhood are low-grade malignancies with usually favorable treatment outcomes. However, therapy can lead to relevant long-term sequelae. To prevent recurrence, complete surgical resection is recommended, sparing as much healthy pancreatic tissue as possible. Interdisciplinary collaboration between specialists is essential to optimize treatment. Molecular genetic analysis of these tumors could improve understanding of their genesis.What is Known:• Solid pseudopapillary neoplasms (SPNs) of the pancreas are very rare tumors in childhood.• Little is known about tumorigenesis, and there are no specific guidelines for treatment and follow-up in pediatric patients.What is New:• Characteristics, treatment, and outcome were comprehensively assessed in a large cohort of pediatric patients with SPN.• We propose recommendations for diagnosis, treatment, and follow-up of children with SPN, based on our analysis and considering published experience.

Suboptimal gestational weight gain and neonatal outcomes in low and middle income countries: individual participant data meta-analysis

ObjectiveTo estimate the associations between gestational weight gain (GWG) during pregnancy and neonatal outcomes in low and middle income countries.DesignIndividual participant data meta-analysis.SettingProspective pregnancy studies from 24 low and middle...

Designing and implementing an OMMID midwifery professional competence mixed test: A multimethod, multiphasic study

The assessment of professional competence is essential to ensure the achievement of competence standards. The goal of this study is to design and implement a professional competence test model to make the test unified, comprehensive, and fair. This research was a multimethod, multiphasic study. The first qualitative phase of the nominal group technique was conducted to design the test model with specific guidelines. The second phase was a mixed-method parallel field trial conducted on 161 senior midwifery bachelor students in universities of Iran. The test was conducted following the traditional method in the control group and OMMID model in the intervention group. This model consists of three parts: the MCQs (multiple choice questions), OSCE (objective structured clinical examination), and clinically-oriented tests, which included Mini-CEX (mini-clinical evaluation exercise) and DOPS (direct observation of procedural skills). Data were collected using questionnaires and interviews, and the results were assessed qualitatively and quantitatively. The OMMID model and the associated guideline were designed. Qualitative data analysis resulted in six main themes, including organizing, structure, tension due to change, fairness, unification, and outcome. The OMMID model did not increase students' anxiety and stress and did not decrease their satisfaction. The merits of this model include having a centralized guideline, using multiple evaluation methods, comprehensive evaluation of necessary skills, promotion of fairness, and increased student satisfaction.

Screening and management of osteoporosis: a survey of knowledge, attitude, and practice among healthcare professionals in Egypt—a study by the Egyptian Academy of Bone Health

SummarySecondary-level healthcare professionals, mainly rheumatologists and orthopedic surgeons, were invited to participate in an online survey questionnaire to assess knowledge and compliance with osteoporosis management guidelines and strategies, as well as self-reported quality of care. About 51% of the participants admit that they do not implement specific guidelines for the management of osteoporosis in their standard practice and depend on their experience and their clinical judgments. Moreover, although a good percentage (58%) had satisfactory knowledge levels in domains on the risk of osteoporotic fractures and investigations of osteoporosis, 47.5% of the participants did not score satisfactorily in questions on pharmacotherapy, especially for those patients at high risk for fractures.IntroductionA recently published study demonstrated a treatment gap among those eligible for osteoporosis therapy in Egypt of about 82.1% in postmenopausal women and 100% in men. The current survey aimed to address some of the factors that may contribute to this wide gap.MethodsThis was a cross-sectional study of secondary care healthcare professionals (both physicians and orthopedic surgeons) who were invited to complete an online questionnaire, which gathered information about physicians’ socio-demographic data, knowledge, and compliance with osteoporosis management guidelines and strategies, as well as self-reported quality of care. Additionally, a knowledge score was calculated for all the participants.ResultsA good percentage (58%) had a satisfactory knowledge level in domains on the risk of osteoporotic fractures and investigations of osteoporosis; however, 47.5% did not score satisfactorily in questions on pharmacotherapy, especially for those patients at high risk for fractures.ConclusionsThis work has identified some of the barriers to implementing guidelines for osteoporosis and fragility fracture management. In the meantime, it highlights the urgency of intensifying efforts to develop the knowledge and attitude of the healthcare professionals dealing with this condition in Egypt.

Risk Issues in Esports Events: A Proposal for a Research Framework

Online gaming or esports has become extremely popular nowadays. As esports popularity increases, the trend of esports events has also been increasing around the world and all major esports stakeholders such as players, organizers, sponsors, teams and broadcasters are taking this opportunity to step up and shine. People participated and watched esports as a form of entertainment until it is now one of the most popular sports in the world. Players are now fighting to be professional players while event organizers take the opportunity to organize more esports events. However, with no specific policy or guideline regarding esports, many issues and risks could arise especially among the major esports stakeholders. Without proper planning on risk management, not only players but all major stakeholders in esports events could be at great risk. To address the gap, this research will explore major esports event stakeholders and identify risks associated with esports events from the stakeholders’ perspective. The proposed research will first need to explore the esports stakeholders in its preliminary stage and continue with addressing the risks and issues for all major stakeholders at the secondary stage. Methodically, this exploratory research will apply focus study interviews and case studies as its main method of investigation. The framework can later help all esports events stakeholders enhance their planning process through a proper risk management plan. It will also benefit the government in the development of policy regarding esports events.

Proposal of a Protocol for the Safe Removal of Post-Earthquake Provisional Shorings

The recent seismic events in Italy, including the earthquakes in L’Aquila in 2009 and central Italy in 2016, have significantly impacted the historical centers of small and medium-sized cities. These events directly affected their ancient masonry building heritage, resulting in severe damage. In order to minimize the risk of collapses and prevent further harm to people and structures until restoration efforts can be carried out, provisional post-seismic shorings have been extensively employed. These occurrences motivated several studies focused on the selection and assembly of post-seismic shorings, considering the various rigid failure mechanisms that may occur in a wall or section of an ancient masonry building. Yet, thus far, the critical considerations concerning the disassembly of these shorings, which significantly influence the repair process of a compromised structure from safety, organizational, and economic perspectives, have been overlooked. This research endeavors to establish a protocol for the dismantling of provisional shorings. To this end, a preliminary risk assessment tool has been devised, furnishing a safety index that correlates with the level of risk associated with shoring removal, along with corresponding risk categories. The study recommends preliminary interventions, categorized as mandatory or optional, to mitigate the risk prior to shoring removal. Furthermore, specific guidelines are provided based on the assessed risk level indicated by the safety index. To illustrate the application of this risk assessment tool, a case study involving an ancient masonry building in L’Aquila is presented.

Formula Feeding Is Associated with Rapid Weight Gain between 6 and 12 Months of Age: Highlighting the Importance of Developing Specific Recommendations to Prevent Overfeeding.

We examined differences in mean daily calorie intake and rapid weight gain risk among 6- to 12-month-old infants by milk feeding status: breastmilk only, breastmilk and formula (combined), or formula only. Another objective was to determine what frequency and amount of formula fed were associated with overfeeding among infants. Mother-infant dyads (n = 240) were recruited from a pediatric clinic mainly serving Medicaid recipients. At 6, 9, and 12 months of infants' age, 24 h feeding recalls were conducted using the multiple-pass method. Infant weight measurements were accessed from clinic records to estimate rapid weight gain between 6 and 12 months. Among the participants, 82% received WIC. More than half of the participants were either African American or Latino by race/ethnicity. Calorie intake among formula-only fed infants was higher than in the other two milk feeding groups. One-fourth of the infants were experiencing rapid weight gain, and the risk was 3-fold higher among formula-only fed infants. Exceeding daily calorie requirements or overfeeding was associated with both formula amount and the frequency of feeding (p < 0.01). Specific guidelines and education on formula feeding practices are critical to prevent accelerated growth among infants. Gaining further understanding on parenting style and formula feeding practices is also warranted.

Importance of microbiology in autopsy procedure

The importance of bacterial cultures in autopsy has been controversial since Filippo Pacini and Robert Koch's early investigation into the etiology of cholera. Death-war and / or post-mortem invasion by the patient's native flora poses a problem with respect to post-mortem intervals, selection of anatomical location of cultures containing blood, CSF, and number of specimens required to be bought and collected in Microbial Laboratory for processing. Additionally, importance of postmortem virus research is significant. An increasingly important aspect of occupational safety is involved in handling of patient samples by laboratory staff. During the AIDS epidemic, regulatory bodies were urged to reconsider the importance of postmortem microbiological tests. This editorial is used to determine the exact cause of death without sacrificing the logistical and human resources of the Institute of Microbiology Practical sampling guidelines. The American University of Pathologists (CAP) are known to have developed a general checklist item for performing autopsy, but there are no specific guidelines, recommendations, or checklist items to address performance criteria for postmortem microbial culture studies. This review provides a brief historical perspective on autopsy microbiology, including a discussion of concerns about the postmortem spread of microorganisms, followed by a description of how to sample.

Risk of de novo aneurysm formation in patients previously diagnosed with a ruptured or unruptured aneurysm: 18-year follow-up

BackgroundData on de novo aneurysm formation after treatment for intracranial aneurysms remains scarce. We studied the incidence of de novo aneurysm formation in patients who had undergone aneurysm treatment more than 18 years prior to follow-up. As it is a disease affecting a younger patient population more specific guidelines are needed when planning a follow-up regime. MethodsThe rate of de novo aneurysm formation was assessed with Magnetic Resonance Angiography (MRA) follow-up >18 years after endovascular or microsurgical treatment for an intracranial aneurysm. Variables associated with de novo aneurysm formation were studied using logistic regression. Missing data were imputed using chained random forests. A data-driven model for the prediction of de novo aneurysm was created to calculate the relative variable importance of ten clinical features. ResultsDe novo aneurysms were identified in 11/81 (13.6 %) patients, of whom 1 was male, over a median follow-up of 20 years. Sex was the most important variable associated with de novo aneurysm formation. Regarding the development of de novo aneurysm, men displayed an odds ratio (OR) of 0.16 (0.01–0.97), compared with women. OR for mRS score 2 or more was 0.20 (95 % CI 0.01–1.34), and OR for smokers was 3.70 (0.54–31.18). Six out of 11 patients (54.5 %) needed treatment; 1 underwent endovascular treatment (EVT) and 5 underwent microsurgical treatment (MST). The overall annual de novo aneurysm formation rate was 0.92 %. ConclusionsThis study highlights the need for a longer follow-up imaging monitoring of patients that have previously undergone treatment for an intracranial aneurysm. These data are useful to take into consideration when planning a follow-up strategy.

Effect of type and aggregate gradation on the functional properties of porous asphalt (case study of Iran)

Porous asphalt mixtures are gaining popularity due to their ability to effectively drain surface water and mitigate traffic noise in regions with high rainfall. However, compared to conventional asphalt pavements, these types of pavements with high void content necessitate specific guidelines for achieving an optimal mix design. The performance characteristics of porous asphalt mixtures are notably influenced by the grading and composition of materials, especially with regards to their resistance to moisture damage. This study aimed to investigate the properties of porous asphalt mixtures using limestone and siliceous aggregates with varying gradations, while maintaining bitumen contents of 5% and 6%. In accordance with the regulations set forth by the National Center for Asphalt Technology, the findings indicate that siliceous-based aggregates exhibit improved void characteristics (increased by 3%) and permeability (increased by 11%). However, they also display reduced resistance to moisture-induced failures (decreased by 4%). On the other hand, adhering to the gradation recommendations provided by the National Asphalt Pavement Association guidelines, except for a slight decrease of 3% in moisture sensitivity, yields an overall enhancement of 25% in other performance characteristics. To analyze the data, statistical methods were employed, resulting in regression models with a minimum R2 value of 0.97. These models helped determine the optimal binder percentage for different aggregate types and gradations, providing valuable insights for practical implementation.

Physical activity and sport practice to improve balance control of visually impaired individuals: a narrative review with future perspectives.

Visual disability negatively impacts balance, everyday self-efficacy, and mobility and often leads affected subjects to perceive physical exercise as a burdensome challenge thus discouraging them from practicing. Despite the well-proven benefits of regular physical activity in visually impaired people, especially addressing postural control, there are no specific guidelines and most of the available literature seems to be flawed by critical issues. Given the wide heterogeneity and the multidimensional needs of this population, a more realistic and target-specific perspective is needed in order to properly investigate and promote exercise practice and adherence for balance improvement. On this basis, through a critical overview of the recent literature, the present article aimed to enrich the current knowledge about this topic by providing innovative suggestions, both practical and methodological, and specifically deepening the disability-related deficits and peculiarities of different age ranges. Moreover, since a multidisciplinary approach is advisable when designing and leading exercise protocols tailored to visually impaired individuals, such innovative hints also highlighted the central role of the adapted physical activity specialist, hence contributing to foster its official professional recognition and involvement in this field.