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Two new paramagnetic supramolecular helicates with the formula (X@[Ni2L3])3+ (X = Cl, or Br; L = a bis-pyrazolylpyridine ligand) have been prepared and are described. Helicates of this metal are very rare with virtually no prior examples of them acting as hosts of anionic species. The persistence of the new assemblies in solution has been demonstrated unambiguously by mass spectrometry and paramagnetic 1H NMR. This has allowed us to establish the preference of the coordination [Ni2] host for Cl− over Br−, in agreement with DFT calculations. These results show the promise of the use of metallohelicates as suitable systems for the selective encapsulation of specific anions in solution. [ABSTRACT FROM AUTHOR]

The Internet has revolutionized communication, enabling interactions between individuals from diverse cultures. This is especially true for social media which encourages participation in millions of online communities on a wide range of topics, such as Reddit. Research has largely neglected the intricate relationship between new media and intercultural issues. This study aims to address this gap by exploring the use experience of bicultural and multicultural individuals on Reddit and investigating the impact of identity‐level (identity categorization, compartmentalization, and integration) and contextual‐level (identification with the online network, online intergroup contact frequency and quality) factors on intercultural sensitivity. A sample of 241 bicultural (n = 90) and multicultural (n = 151) Reddit users (females = 100, 41.49%) participated in the study. Hierarchical regression results showed that both identity‐level and contextual‐level factors significantly contributed to intercultural sensitivity. Specifically, on the identity‐level, integration was positively related to intercultural sensitivity, while compartmentalization was negatively associated with it. Additionally, on the contextual‐level, identification with the online network and high‐quality online intergroup contact were associated with greater intercultural sensitivity. This research highlights the importance of understanding how intercultural dynamics unfold within social media platforms and provides insights for fostering intercultural sensitivity in online communities. [ABSTRACT FROM AUTHOR]

Immune-checkpoint inhibitors have profoundly changed cancer treatment, improving the prognosis of many oncologic patients. However, despite the good efficacy of these drugs, their mechanism of action, which involves the activation of the immune system, can lead to immune-related adverse events, which may affect almost all organs. Pulmonary adverse events are relatively common, and potentially life-threatening complications may occur. The diagnosis is challenging due to the wide and non-specific spectrum of clinical and radiological manifestations. The role of the radiologist is to recognize and diagnose pulmonary immune-related adverse events, possibly even in the early stages, to estimate their extent and guide patients' management. [ABSTRACT FROM AUTHOR]

A positive relationship between user–avatar bond (UAB; i.e., avatar identification and avatar idealization) and problematic gaming (PG) has been well established among Massive Multiplayer Role-Playing Games (MMORPG) players. However, no study has examined how players' personal identity relates both to UAB and PG. Based on the Motivated Identity Construction Theory, the current study examined the relationships between actual levels of identity motives (self-efficacy, continuity, uniqueness, self-esteem, and belonging), UAB, and PG in a sample of 675 MMORPG players. Results showed that perceiving oneself as the same person over time (continuity) and feeling included and accepted (belonging) directly protect MMORPG players from PG, while perceiving oneself as highly unique (uniqueness) and having low confidence in one's own capacity to reach specific goals (self-efficacy) are indirect risk factors for PG as they strengthen UAB. The reasons explaining these links will be discussed. [ABSTRACT FROM AUTHOR]

Literature highlighted that problematic social network site use might have relevant detrimental consequences on users' well-being, particularly in adolescence. However, it is still not clear which variables could be considered protective or risk factors for such problematic use. The present study aimed to fill this gap, examining the relationship between reflective functioning and adolescents' identity development, while taking problematic SNS use into account. A sample of 354 students (age range = 13–19; Mage = 16.18, SD = 1.58; 19.9% males) from two Italians high schools participated in the study. Results from structural equation modeling showed that adolescents with high levels of reflective functioning reported lower levels of problematic SNS use. Furthermore, problematic SNS use mediated the relationship between reflective functioning and identity development, by disfavouring identity in-depth exploration and favouring reconsideration of commitment. We discussed clinical and research implications. [ABSTRACT FROM AUTHOR]

Background: The clinical presentation of acute myocarditis (AM) is widely variable, ranging from a subclinical disease to an infarct-like syndrome. Cardiac magnetic resonance (CMR) has become the reference non-invasive diagnostic tool for suspected AM, allowing the identification of the various hallmarks of myocardial inflammation (edema, fibrosis, and hyperemia). The aim of the study was to investigate any differences in morphological, functional, and tissue characterization CMR parameters between infarct-like AM in patients with unobstructed coronary arteries and non-infarct-like AM, diagnosed according to the original Lake-Louise Criteria (LLC); Methods: We retrospectively selected 39 patients diagnosed with AM according to LLC, divided into 2 groups according to the clinical presentation: infarct-like in group 1 patients and non-infarct-like in group 2 patients. CMR morphologic, functional, and tissue characterization parameters were analyzed and compared. Results: In group 1, CMR tissue characterization parameters were mainly altereda in septal location with mesocardial myocardial involvement; in group 2, CMR tissue characterization parameters were mainly altered in a lateral location with subepicardial myocardial involvement mainly at the mid-cavity. No significant differences in morphological or functional parameters were observed between the two study groups. Conclusions: Our results showed differences in the localization and distribution of myocardial tissue damage assessed by CMR among forms of AM accompanied by an infarct-like clinical presentation compared with non-infarct-like presentations of AM. The mechanisms underlying the different preferential sites of damage observed in our study are not known, and we do not exclude the possibility of their prognostic implications. [ABSTRACT FROM AUTHOR]

New York City's fiscal crisis of 1975 was the result of many years of deficit spending to support a variety of expanded services and generous union contracts. These deficits were covered for years by the issuance of city short-term notes and long-term bonds. Eventually, the city's mounting debt of $14 billion led to its inability to sell its notes and bonds. In order to deal with the possibility of the city's financial collapse, the governor of New York State and the state legislature created the Emergency Financial Control Board (EFCB), whose purpose was to manage the city's budget and cost reduction plans. They also created the Municipal Assistance Corporation (MAC) responsible for fiscal oversight and the sale of specially issued bonds. Both agencies eventually played major roles in preventing the city's financial collapse. In an effort to address the costly 5,000 excess acute care hospital beds in the city, the governor and his advisors proposed the creation of a Health Czar (HC). The purpose of this position was to shift responsibility for hospital closures and downsizing from the state government to a para-governmental individual. While there was early support for this proposal by some print media, opposition soon arose because of the flawed structure of the proposal. Also, many initially opposed it because it included the city's public health agency, the New York City Department of Health (NYCDOH), which did not have any responsibility for hospitals. The HC proposal eventually lost broad support because it bypassed legally established processes for the oversight of hospitals. It also almost uniquely focused on the public hospital system, and in so doing gave a pass to the voluntary hospitals and their excess bed capacities. The proposal eventually lost the support of the then mayor when the governor publicly supported a rival candidate in an upcoming election. The election success of yet a third candidate opposed to the proposal resulted in its eventual abandonment by the governor. [ABSTRACT FROM AUTHOR]

Due to the unpredictability of the COVID-19 pandemic situation, individuals felt uncertain and insecure. As a consequence, conspiracy theories flourished and quickly spread. In the current study, we examine the relationship between general and COVID-19-related conspiracy theories, cognitive reflection, psychopathological symptoms, and defense styles in a sample of Italian adults. A total of 450 participants (50.2% male; mean age = 40.89 years, SD = 12.15) took part in an online survey. Two linear regression models on the general (explained variance 22.6%) and COVID-19-related (explained variance 33.0%) conspiracy theories have been tested. Among the predictive factors, older age, mania symptoms, and immature defenses facilitate adherence to conspiracy theories; on the opposite side, higher education, cognitive reflection, and mature defenses protected from adherence to conspiracy theories. The study provides some novel findings about factors that are significantly associated with general and COVID-19-related conspiracy theories, and highlights the pivotal role of individuals' psychological defenses in conspiracy theories. [ABSTRACT FROM AUTHOR]

Digital discrimination against sexual minorities is becoming prevalent. It increasingly spreads through discriminatory content that mixes text and images (e.g., memes), thus, making online discrimination more difficult to detect. The present survey study focused on digital content that is discriminatory towards sexual minorities, aiming to analyze whether a sample of heterosexual social network users (65.2% female; Mage = 27.13) perceived different forms of discriminatory content (i.e., memes, news, and posts) as equally offensive and to what extent such different forms elicited the same online behavioral reactions. Furthermore, we considered how individuals' online network heterogeneity could influence their perception of digital discrimination. Results showed that individuals perceived memes as less offensive when compared to both news and posts. Accordingly, we also found that individuals took less time to react to posts when compared to the other forms of content. In addition, those who declared that they had a heterogenous online network perceived memes as more offensive than those who did not. Finally, regarding reacting behaviors, overall results showed that memes elicited few proactive behaviors and more acquiescent and ignoring behaviors than news and posts. The theoretical and practical implications of these results are discussed. [ABSTRACT FROM AUTHOR]

Brain abscess is a focal infection occurring within the brain parenchyma consisting of a pus collection surrounded by a vascularized capsule and a fibrinous-caseous layer between the pus and capsule. Surgery is indicated for lesions with a diameter >25 mm. Different surgical approaches have been described, including puncturing of the abscess (under neuronavigation, stereotactic or echographic guidance) with aspiration of the purulent fluid through a catheter and craniotomy with microsurgical removal of the purulent material and surrounding capsule. In recent years, the endoscopic approach has become more frequently used to treat brain abscesses. The theoretical advantages are visual awareness of the completeness of pus removal and the possibility of also removing the more solid fibrinoid component, which could be the source of recurrence. Craniotomy is likewise avoided. We present the case of an 11-year-old boy affected by a parieto-occipital brain abscess and initial ventriculitis who underwent endoscopic surgery. An ultrasonic aspirator was used to wash and suck the purulent material and fragment and remove the more solid fibrinoid component. The occipital horn of the lateral ventricle was also entered, and pus was removed. At the end of the procedure, a ventricular drainage tube was left in the surgical cavity. It was removed 1 day later, because the cavity had completely collapsed. The key surgical steps are presented in Video 1. 1-9 The procedure was uneventful, with very good clinical and radiological results. The endoscopic technique has been shown to be a safe and effective treatment option for intracranial abscess. In the case of large superficial lesions, the surgical risks appear similar to those of simple drainage through catheters, with a possible reduction of the 20% reported recurrence rate. The use of an ultrasonic aspirator could facilitate complete and faster pus removal, increasing the efficacy of the procedure. The patient and his parents consented to the procedure and the report of the patient's case details and imaging studies. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. [ABSTRACT FROM AUTHOR]

Purpose: To investigate clinical management of primary open-angle glaucoma (POAG) in the United States using real-world evidence and to examine healthcare resource utilization (HCRU), medication adherence/persistence, and procedure use. Design: A cross-sectional, retrospective analysis of Optum's de-identified Market Clarity Dataset (July 1, 2013–December 31, 2019). Patients and Methods: Patients ≥ 18 years with POAG diagnosis and continuous enrollment for 1-year pre- and post-index were eligible and categorized into four mutually exclusive cohorts: CH1, treated with antiglaucoma medication(s) only; CH2, underwent glaucoma procedure(s) only; CH3, treated with antiglaucoma medication(s) and underwent procedure(s); and CH4, received no treatment for POAG. Adherence and persistence with antiglaucoma medications, and disease-specific HCRU were analyzed. Pairwise two-sample comparisons and multivariate regressions were conducted. Results: Examined 232,572 eligible patients (CH1=60,895; CH2=4330; CH3=6027; CH4=161,320). Prostaglandin analogs were most prescribed antiglaucoma medications (CH1: 69.7%; CH3: 62.7%), of which latanoprost was most common (CH1: 51.3%; CH3: 46.1%). Disease-specific office visits occurred in 26.3%, 78.2%, 75.0%, 23.8%, and surgical services visits occurred in 3.8%, 36.3%, 42.5%, 3.3%, in CH1-CH4, respectively. Adherence was higher (medication possession ratio: 47.1% vs 39.4%; P< 0.0001), and more patients remained persistent across 1-year post-index period in CH1 vs CH3 (25.4% vs 16.1%; P< 0.0001). Positive predictors of medication persistence included being female, ≥ 55 years, and history of dyslipidemia or thyroid disease (all P≤ 0.0003). Conclusion: Overall, 70% POAG patients might not have received antiglaucoma treatment. Since POAG is a slowly progressive blinding disease, the lack of antiglaucoma treatment and suboptimal adherence/persistence with medications are of major concerns. Targeted screening and educational approaches are needed to improve POAG management. [ABSTRACT FROM AUTHOR]

Based on the Identity Process Theory, this study wondered whether COVID-19 risk representation threatened relational identity and health perception. A sample of 976 Italian university students (Mage = 24.2; females: 73.8%) and a sample of 204 university staff members (Mage = 50.86; females: 57.4%) completed an online survey during the 1st phase of COVID-19. The results confirmed that in both samples the COVID-19 risk representation has been related to participants' identity, both activating identity protection strategies and threatening their relational identity, i.e., the identity they derived from family and friendship relationships. Furthermore, identity protection mediated the relation between risk representation and health perception, suggesting that to feel even more part of their family and friend groups can protect participants from feeling unhealthy. [ABSTRACT FROM AUTHOR]

The study aims to evaluate the usefulness and effectiveness of digital communication tools implemented by an Italian NGO during the coronavirus disease 2019 (COVID-19) emergency period, considering their relations with perception of health-related risk, sense of belonging to host community, psychological distress, and wellbeing of the refugees taken in charge by the association. The study was conducted through an anonymous questionnaire proposed to a group of 102 refugees. The results confirmed that by increasing the sense of belonging to the Italian community, the time refugees spent on digital communication negatively associated with their psychological distress and positively associated with their wellbeing. Refugees' access to digital communication also increased their health-related risk perception that in turn raised their psychological distress. It specifically occurred when digital communication has been perceived as less affordable, i.e. as less clear, easy and reassuring. The results will be used to improve digital communication for health, educational, and proximity services dedicated to refugees. [ABSTRACT FROM AUTHOR]

Plants can ‘catch’ and mitigate airborne pollutants and are assisted by fungi inhabiting their leaves. The structure and function of the fungal communities inhabiting the phyllosphere of hornbeam trees growing in two chronically polluted areas, the oilfield of Bóbrka and the city center of Warsaw, were compared to the ones growing in one nature reserve, the Białowieża National Park. Fungi were isolated and characterized both phylogenetically and functionally for their potential role in air pollution mitigation. Both culture-dependent (e.g., enzyme assays and tolerance tests) and culture-independent methods (e.g., ITS and shotgun sequencings) were used. Furthermore, the degradation potential of the fungi was assessed by gas chromatography mass spectrometry (GC-MS). Shotgun sequencing showed that the phyllosphere fungal communities were dominated by fungi belonging to the phylum Ascomycota. Aureobasidium was the only genus detected at the three locations with a relative abundance ≥ 1.0%. Among the cultivated epiphytic fungi from Bóbrka, Fusarium sporotrichioides AT11, Phoma herbarum AT15, and Lophiostoma sp. AT37 showed in vitro aromatic hydrocarbon degradation potential with laccase activities of 1.24, 3.62, and 7.2 μU L-1, respectively, and peroxidase enzymes with activities of 3.46, 2.28, and 7.49 μU L-1, respectively. Furthermore, Fusarium sporotrichioides AT11 and Phoma herbarum AT15 tolerated exposure to airborne naphthalene and benzene. Lophiostoma sp. AT37 was the most tolerant to exposure to these pollutants, in line with being the best potential aromatic hydrocarbon degrader isolated in this study. [ABSTRACT FROM AUTHOR]

Between 1100 A.D. and 1700 A.D., terracotta statues were created in the Interior Delta of the Niger River in what is now the Republic of Mali. They are known as Djenné-Jeno terracottas because of their geographic proximity to an ancient town of that name. Some of these statues possess surface excrescences that have long perplexed archaeologists, art historians, curators, and others. This study of these surface excrescences employed clinical, diagnostic, and epidemiological methodologies to elucidate their possible meanings. It has not been possible to ascribe these excrescences to a single cause. However, examination of all the evidence permitted consideration of several possibilities. These include diseases such as smallpox, onchocerciasis, and the secondary stage of venereal syphilis. On certain statues, the anatomic placement of excrescences possibly symbolizes intentional cicatrization that resulted in keloid formation which may have been a form of beautification. [ABSTRACT FROM AUTHOR]

Background: Desmoplastic infantile astrocytomas and gangliogliomas (DIA/DIG) usually present with a large size, large cystic component, large dural implant, encasement of big vessels, clinical presentation within 18 months of life, high incidence of seizures and overall good prognosis, even if tumour surgery can be very challenging at first procedure. Methods: We retrospectively reviewed clinical and radiological data of patients diagnosed with desmoplastic infantile tumours who were surgically treated between 2008 and 2019. Results: The series included 12 patients. The median age at surgery was 91 days. The average tumour volume was 212 cm3. Cystic components were predominant ranging from 0 to 295 cm3. Active hydrocephalus was pre-operatively evident in 5 cases. Eight patients (66.6%) received total or subtotal removal, three of them (25%) underwent partial removal, and one patient (8.3%) received a biopsy. One patient died within 24 h after surgery due to severe hypotension, as a consequence of significant intraoperative blood loss. Overall, seven (58.3%) patients were reoperated on the tumour after the first procedure: 4 patients were operated twice; 3 patients were operated 3 times. Two patients presented remote localizations and underwent chemotherapy. At last follow-up, 7 patients were tumour-free, 2 are alive with stable disease, and 2 are alive with progressive disease (leptomeningeal seeding). Conclusion: Desmoplastic infantile tumours are rare giant neonatal tumours. Total removal is the goal of treatment, but prognosis remains good even if total removal is not achieved. In case of tumour progression or epilepsy from residual tumour, reoperation is the first option, with chemotherapy reserved to unresectable or disseminated cases with mixed results, while, to date, radiotherapy still plays no role. [ABSTRACT FROM AUTHOR]

Background: Endoscopic aqueductoplasty with aqueductal stenting is an effective surgical procedure for the treatment of isolated fourth ventricle (IFV). Due to the rarity of the underlying pathology, it can be considered a rare procedure that can be performed with different surgical techniques and approaches. Objectives: To assess long-term functioning of permanent aqueductal stents implanted in children affected by hydrocephalus and IFV and to describe some variations of the same procedure. Methods: We reviewed retrospectively all the patients presenting at our institution in the years 1999–2019 for symptoms of isolated fourth ventricle who underwent a surgical procedure of endoscopic aqueductoplasty and/or aqueductal stent. Surgical reports, radiological images, and surgical videos were retrospectively analyzed. Results: Thirty-three patients with symptomatic isolated fourth ventricle (IFV) underwent fifty (50) neuroendoscopic procedures in the period observed. The median age of the patients at the time of first surgery was 7 months, with 22 premature babies. In twenty-nine patients (87.8%), a precoronal approach was performed, while four patients received a suboccipital burr hole. Ten patients were never reoperated since. Twenty-three patients underwent further surgeries: a new aqueductoplasty with aqueductal stent was performed in 13 cases. The remaining 10 patients required a combination of other procedures for management of hydrocephalus. Long-term follow-up showed a permanent stent functioning rate of 87% at 2 years and 73% at 4 years, remaining stable afterwards at very long term (20 years). Conclusion: Endoscopic aqueductoplasty and stenting is a reliable procedure in the long-term management of isolated fourth ventricle. [ABSTRACT FROM AUTHOR]

The article reviews the exhibition "Sahel: Art and Empires on the Shores of the Sahara" curated by Alisa LaGamma, assisted by Yaëlle Biro and Hakimah Abdul-Fattah at the Metropolitan Museum of Art from January 30 to October 26, 2020.

In this study, we sought to compose consortia of plant growth-promoting (PGP) and trace element tolerant bacteria, to improve plant growth and inhibit uptake and translocation of trace elements, eventually allowing the cultivation of profitmaking crops on trace elements polluted soils, reducing the risks of entrance of these elements into the food chain. Sunflower (Helianthus annuus L.) was grown on two polluted military soils (MS1 and MS2) in greenhouse microcosms and inoculated with three different bacterial consortia (C1, C2, C3). Growth and physiological status of the plants were unaffected during the experiment with the inoculation. After 2 months, plants were harvested. Consortium C2 and C3 decreased Pb shoot bioaccumulation by respectively 80–85% when plants were grown in the MS1 and even to concentrations below detection limit in plants grown in MS2. Differences in uptake and (sub)cellular localization of Pb and Cd in selected bacterial isolates were investigated in vitro by TEM-EDX. Pb absorption was observed by Bacillus wiedmanni ST29 and Bacillus paramycoides ST9 cultures. While adsorption at the bacterial cell wall was observed by Bacillus paramycoides ST9 and retention in the extracellular matrix by Cellulosimicrobium cellulans ST54. [ABSTRACT FROM AUTHOR]

A method to determine T-2 and HT-2 toxins, both in feed and food, is described. The method is based on sample clean-up by immunoaffinity columns, followed by triple quadrupole LC-MS/MS determination. It was in-house validated in compliance with the European Union legislation, in the concentration range 5.0–750 µg kg−1 and accredited according to the ISO/IEC 17025 standard, for the scope of official control of feed and food. The method was applied to monitor the contamination levels of T-2 and HT-2 toxins in 105 feed samples, both raw materials and compound feed and 17 cereals and derived products for human consumption, collected in Southern Italy between 2015 and 2019. T-2 toxin was quantified in 32 feed (30.5%) and in 2 food samples (11.8%). HT-2 toxin was quantified in 65 feed (61.9%) and in 3 food (17.6%) samples. [ABSTRACT FROM AUTHOR]

• West Nile virus is a widespread mosquito-borne human and animal pathogenic virus of increasing importance. • In 1% of cases, WNV infection leads to a severe illness affecting the central nervous system (CNS). • The detection of anti-E IgM and IgG antibodies is widely used in serology to diagnose these infections. West Nile virus is a widespread mosquito-borne human and animal pathogenic virus of increasing importance. The E protein of the viral envelope is critical for attachment and entry into the host cell and has been the target for vaccine design and small molecule inhibitors. Furthermore, the detection of anti-E IgM and IgG antibodies is widely used in serology to diagnose these infections. Here we describe a strategy for the production of recombinant antibodies against the E protein of West Nile virus for research and immunodiagnostic purposes. Initially the fast and easy protocol previously developed for the similar Tick-borne encephalitis virus has been adapted to West Nile virus E antigen production and purification. A human naïve scFv phage library has been selected on the produced antigen, identifying a panel of highly specific anti-E protein antibodies. Once produced as scFv-Fc recombinant proteins, the selected antibodies have been characterized by mapping their binding sites and by defining their affinity for the target. The impact on neutralizing virus attachment and entry has been also evaluated. The obtained results demonstrate the potential of the produced reagents for research and diagnostic applications. [ABSTRACT FROM AUTHOR]

Abstract This study aims to analyze virtual self-discrepancy (VSD), avatar identification, and gaming addiction in Massively Multiplayer Online Role-Playing Games (MMORPGs). Two studies were conducted to test the relations between VSDs (i.e., idealized vs utopian avatar), avatar identification, and gaming addiction. In the cross-sectional survey (Study 1; 770 MMORPGs players) we assumed that higher MMORPG addiction was directly predicted by the construction of an idealized avatar (vs. utopian avatar) and by the avatar identification, which also mediated the relationship between the VSDs and gaming addiction. In the 2 × 2 experimental study (Study 2; 100 participants), manipulating VSD and avatar identification, we assumed that MMORPG addiction risk was higher in the idealized avatar-high identification condition than in the utopian avatar-low identification condition. Results confirmed that the more idealized the avatar was, the more the users increased their avatar identification (Study 1), that in turn was associated with gaming addiction (Study 1 and Study 2), and that only an idealized avatar (vs. utopian avatar) directly affected gaming addiction (Study 1). Furthermore, results showed that MMORPG addiction risk was higher in participants who customized an idealized avatar and identified with it (vs. utopian avatar-low identification) (Study 2). Highlights • Avatar identification increases addiction risk more than avatar customization. • Creating an idealized avatar increases identification with it. • Using an idealized avatar is riskier than using a utopian avatar. • The risk of addiction can be avoided by keeping a low identification with the avatar. [ABSTRACT FROM AUTHOR]

The second world cholera pandemic in Europe (1829-1849) was significant because of its geographic extent and the enormous numbers of people who fell ill or died. It was also singularly important because it demonstrated the profound levels of ignorance in both Europe and North America concerning the cause, modes of transmission, and treatment of cholera. This paper discusses the pandemic in the Kingdom of the Two Sicilies in great detail. Even though medical and public health authorities in this kingdom had several years to prepare for cholera's eventual arrival in 1836-1837, their elaborate preventive and therapeutic measures proved no more successful than elsewhere. Despite their efforts, it was estimated that there were 32,145 cases of cholera in the city of Naples by July 1837. Some 19,470 people were estimated to have died among the city's then 357,283 population. This amounted to a cholera-specific mortality rate of 54.5/1000 population. Sicily was also severely affected by the epidemic. It was estimated that 69,000 people died of cholera in Sicily, 24,000 of them in the city of Palermo. Two rural towns in the kingdom, San Prisco and Forio d'Ischia, were selected for in-depth epidemiologic study. The former had a population of 3700 in 1836-1837, while the latter had a population of 5500. The economic basis of both towns was agriculture. However, because Forio is located on an island, fishing and sea transport were then also important industries. Cholera appeared in San Prisco in July 1837 and quickly swept through the population. By August, the epidemic was essentially over. It is estimated that some 109 people died from cholera in San Prisco for a disease-specific mortality rate of 29.5/1000 population. The age range of those who died from cholera was 1 to 90 years. The majority of deaths (60.6 %) were among women. The first cases of cholera appeared in Forio d'Ischia in June 1837. The epidemic then peaked in July. It is estimated that approximately 316 people died from cholera in Forio out of a population of 5500. This resulted in a cholera-specific mortality rate of 57.5/1000 population. Among the first 42 fatal cases in whom the disease was documented on their death certificates, ages ranged from 15 to 88 years. The mean age was 52.4 years. The majority of deaths (57.1 %) were among women. We reached beyond the statistics of this epidemic by presenting an in-depth study of the first person to die from cholera in Forio d'Ischia, Nicola Antonio Insante. By focusing on him, we were able to develop a broad account of the social and economic consequences of his death on his family. At the same time, our research demonstrated the resiliency of his immediate and distant descendants. Similarly, we discuss the D'Ambra and Scola families of Forio d'Ischia, and the Caruso and Valenziano families of San Prisco, among whom a number died from cholera in 1837. [ABSTRACT FROM AUTHOR]

The new emission legislation for sea-going vessels issued by the International Maritime Organization (IMO) requires drastic reduction in exhaust gas nitrogen oxides (NOx), and the combination of different primary methods can be an interesting solution without increasing remarkably the machinery. In this paper, the Miller cycle and the dilution with exhaust gas in the combustion chamber were tested to reach the Tier III limits for a four-stroke marine engine. In particular, the Miller cycle is used to reduce the in-cylinder temperature, and lower oxygen content in the combustion chamber is realized with cooled exhaust gas recirculation (EGR). Despite a remarkable reduction in NOx, the main drawback was a significant increase in fuel consumption. Split injection is combined with the abovementioned methods, in order to improve the engine efficiency. The novelty of this study consists in the simultaneous use of a split fuel injection, the Miller cycle and EGR in a marine-size application. Along this study, combining Miller timing with a relatively low EGR rate reduces NOx emissions by 90%. On the other hand, split injection does not bring significant advantages in fuel economy, although the results with very early pilot injection suggest further studies to be realized. [ABSTRACT FROM AUTHOR]

Waardenburg syndrome (WS) is a genetic disorder of which there are four distinct types. These four types are differentiated by the physical defects which they produce. Presented here is the case of a 13-year-old boy with WS Type I who was observed and physically assessed in Mali, West Africa in 1969. His physical findings included a bright blue coloring to the irises of the eyes, profound sensorineural deafness, mutism, dystopia canthorum (lateral displacement of the inner canthi of the eyes), broad nasal root, bushy eyebrows, and scaphoid deformities of the supraorbital portions of the frontal bone. Because family members were not available for interviews or physical examinations, it was not possible to determine if this patient was suffering from a congenital form of the disorder or from a spontaneous mutation. Given the patient's then location in a remote rural area of Mali where electricity was absent, it was not possible to perform additional diagnostic tests. The patient described here is the first with WS in Mali, West Africa to have been medically observed and evaluated and later documented in the medical literature. A second case of the syndrome in Mali was described in the medical literature in 2011 in an 18-month-old infant who did not have sensorineural hearing loss, but who did have a bilateral cleft lip. An historical overview of WS is presented along with details concerning the characteristics of the four types of the disorder. [ABSTRACT FROM AUTHOR]

Smallpox inoculation (variolation) was widely reported in sub-Sahara Africa before, during, and after the colonial era. The infective smallpox materials and techniques used, as well as the anatomical sites for inoculation, varied widely among different ethnic groups. The practice among the Boran and Gabra pastoralists of northern Kenya resembled that which was prevalent in a number of areas of Ethiopia. This is not surprising as the Boran also live in southern Ethiopia, and Gabra herdsmen frequently cross the border into this region. The Boran and Gabra technique for smallpox inoculation consisted of taking infective material from the vesicles or pustules of those with active smallpox, and scraping it into the skin on the dorsum of the lower forearm. Although the intent was to cause a local reaction and at most a mild form of smallpox, severe cases of the disease not infrequently resulted. Also, variolated individuals were capable of infecting others with smallpox, thereby augmenting outbreaks and sustaining them. The limited known reports of smallpox inoculation among the Boran and Gabra are presented in this communication. The expansion of vaccination with effective heat stable vaccines, the development of medical and public health infrastructures, and educational programs all contributed to the eventual disappearance of the practice among the Boran and Gabra. [ABSTRACT FROM AUTHOR]

Dr Morris Greenberg was an eminent American epidemiologist who served with the New York City Department of Health for a 40 year period, from 1920 until his passing in 1960. In 1946, he became Director of the department's Bureau of Preventable Diseases. In this role, he set very high standards for outbreak and epidemic investigations joined with a commitment to scholarly research and collaboration with the city's medical centers. He received his medical degree from Columbia University College of Physicians and Surgeons and then interned at Bellevue Hospital in New York City. He later trained in pediatrics in Vienna, Austria and received a Master of Science in Public Health degree from Columbia University School of Public Health. In 1942, he became a member of the teaching staff at the School of Public Health. During his years with the New York City Department of Health he led efforts to control outbreaks of smallpox and rickettsialpox, and initiated important studies of poliomyelitis, hepatitis, trichinosis, congenital cardiac anomalies in children, and the embryopathic effects of rubella in pregnancy. Dr. Greenberg's outbreak and epidemic investigations were popularized by The New Yorker writer, Berton Roueché, whose most widely read book remains, Eleven Blue Men and other Narratives of Medical Detection. The book's title is based on Greenberg's investigation of accidental sodium nitrite poisoning among eleven elderly men in Manhattan who as a result, became cyanotic. A pioneer in epidemiology and the prevention and control of communicable disease, Greenberg established very high performance standards for the discipline before there was a Center for Disease Control and Prevention and an Epidemic Intelligence Service in the United States. [ABSTRACT FROM AUTHOR]

John P. Craig (1923-2016) was an eminent physician-scientist, gifted educator, and greatly valued mentor. Born in West Liberty, Ohio on 29 November 1923, he attended Oberlin College, and received his medical degree from Case Western Reserve University, School of Medicine. This was followed by an internship at Yale University Medical Center, and then service in the U.S. Army during the Korean War. He was a battalion surgeon, preventive medicine officer, and epidemiologist. While in Korea, he conducted important investigations of hemorrhagic fever among American troops. His observations led to the recognition of hemorrhagic fever with renal syndrome, now called Korean hemorrhagic fever. He also identified a new Hanta virus. Craig received his Master of Public Health degree magna cum laude from the Harvard School of Public Health. He then worked with Nobel Laureate, Max Theiler, at the Rockefeller Foundation. Soon afterwards, he joined the faculty of the Department of Microbiology and Immunology at the State University of New York, Downstate Medical Center, where he established a new research laboratory. Over the years, his research focused on diphtheria infections and cholera. He became internationally respected for his work on cholera, and specifically on cholera toxin and its relationship to vascular permeability. He served for over 6 years as the Chair of the Cholera Panel of the U.S.-Japan Cooperative Program, and in this position set the direction for future research. The author of over 100 articles published in the peer-reviewed scientific literature, he also gave numerous presentations at national and international scientific meetings on a wide range of microbial diseases. Craig was highly regarded by colleagues and students as a superb teacher. He was a leader in initiating patient-oriented problem-solving (POPS) exercises for medical students. He also led curricular reform in the medical school in the 1990s whose purpose was to reduce lecture hours and expand time for small-group interactive sessions. Craig was designated Distinguished Teaching Professor by the State University of New York, and inducted as an Honorary Alumnus of the College of Medicine. The John P. Craig Award for Excellence in Microbiology and Immunology was established in 1993, and is annually presented to a graduating medical student. Following retirement to Tucson, Arizona, Craig devoted time to planning and teaching a tropical medicine course in Costa Rica that was co-sponsored by the University of Costa Rica Medical School and Louisiana State University. He was a member of the Board of Managers of the Wright Nature Center in Trinidad, and an active volunteer in the Herpetology Department of the Arizona-Sonora Desert Museum in Tucson, Arizona. He also had a great interest in ornithology. John P. Craig passed away in Tucson, Arizona on 27 September 2016 in his ninety-third year. He was an eminent success as a research scientist as well as an outstanding educator and mentor. As a result, he had a lasting influence on the lives and careers of both students and colleagues. [ABSTRACT FROM AUTHOR]

Charles William Lacaillade (1904-1978) was an eminent biologist in the middle decades of the twentieth century. He was born in Lawrence, Massachusetts of parents whose ancestors were French Canadians. His father, also named Charles William Lacaillade, was a dentist who graduated from Tufts University School of Dentistry in 1898. His mother, Elodia Eno, came from a family of very successful businessmen. Lacaillade was the third of six children. His two older brothers, Harold Carleton and Hector Eno, both graduated from the University of Louisville, School of Dentistry, while his younger brother, Lawrence, became a businessman. His sister, Luemma, married Dr. Henry Steadman, a veterinarian, while his youngest sister, Gloria, married a U.S. Army officer, Lieutenant Colonel Victor Anido. Lacaillade received his MS and PhD degrees in biology and zoology from Harvard University. He then became a fellow at The Rockefeller Institute for Medical Research. At both institutions, he studied under some of the most eminent biological scientists of the time. These included Rudolf W. Glaser, George Howard Parker, Theobald Smith, Carl TenBroeck, and William Morton Wheeler. At the Rockefeller Institute, he co-discovered the vector and mode of transmission of Eastern Equine Encephalomyelitis. This discovery, and the research he conducted with Rudolf W. Glaser, quickly established him as an outstanding biological researcher. However, a change in leadership at the Rockefeller Institute resulted in research priorities being given to the disciplines of general physiology, physical chemistry, and nutrition. This shift in the research agenda away from the biological sciences precluded career advancement at the Rockefeller Institute for post-doctoral fellows like Lacaillade. It was the height of the Great Depression, and even biologists with terminal doctoral degrees found it difficult to find positions. In 1935, Lacaillade accepted a position as an assistant in biology at St. John's College in Brooklyn, New York. Although a small single-gender college for men, the Department of Biology there under Dr. Andrew I. Dawson had an impressive record of research achievements. Lacaillade remained at this institution for the remainder of his career until his retirement in 1970. He eventually became Distinguished Professor of Biology, Chair of the Department of Biology, and the recipient of numerous awards and recognitions. Lacaillade quickly developed a reputation as an outstanding teacher, mentor, and scientist. He taught introductory courses in biology as well as advanced ones in parasitology and entomology. He preceptored graduate students and guided their dissertation research. Above all else, he was a superb mentor who provided sage advice to pre-professional students planning careers in medicine and dentistry. Lacaillade effortlessly adapted to the transformation of St. John's College, with an annual enrollment of some 600, to St. John's University, with an average annual student census of 20,000. He also oversaw the geographic relocation of his department from Brooklyn to the then new campus in Jamaica, New York in 1955. He proved to be a stabilizing presence during the faculty strike of 1966 and its aftermath which included a reorganization of the university. Throughout his life, Lacaillade was admired as a man of letters. His interests spanned art, literature, opera, and the theater. He had a passionate interest in English literature, about which he wrote, and was proud of his collection of first editions of English writers. Charles William Lacaillade was an eminent success as a research biologist early in his career. However, his greater successes came later as an outstanding educator and mentor. As such, he had a positive and lasting influence on the lives and careers of many students and colleagues. He passed away on 17 September 1978 in Danvers, Massachusetts. [ABSTRACT FROM AUTHOR]

In the late nineteenth and early twentieth centuries, a number of European expeditions traveled to the region of Lake Rudolf, now largely in northern Kenya. Although diverse in intent, many of these were undertaken in the interests of furthering colonial territorial claims. In 1900-1901, Major Herbert Henry Austin led a British expedition down to the lake from Khartoum in the north. Of the 62 African, Arab, and European members of this expedition, only 18 (29 %) arrived at its final destination at Lake Baringo in Kenya. Because of a confluence of adverse climatic, social, and political conditions, the expedition ran short of food supplies when it arrived at the northern end of the lake in April 1901. For the next 4 months, the members of the expedition struggled down the west side of the lake and beyond. The greatest mortality (91 %) occurred among the 32 African transport drivers who were the most marginally nourished at the outset of the trip. The lowest mortality among the Africans on the expedition (15 %) occurred among the members of the Tenth Sudanese Rifles Battalion, who had an excellent nutritional status at the start of the expedition. Major Austin himself suffered from severe scurvy with retinal hemorrhages which left him partially blind in his right eye. An analysis of the mortality rates among the groups that participated in this expedition was undertaken. This revealed that poor nutritional status at the start of the trip was predictive of death from starvation. [ABSTRACT FROM AUTHOR]

Subacute bacterial endocarditis (SBE) was invariably a fatal disease in the pre-penicillin era. The availability of sulfonamide antibiotics beginning in the mid-1930s raised hopes that they would be effective in SBE. Unfortunately, except in rare instances, they were not. This paper reviews the clinical experience with sulfonamides in the pre-penicillin period in treating patients with SBE. It presents in detail the case of Pasquale Imperato, who died from the disease at the age of 72 years on 30 November 1942. In so doing, it focuses on the medical management measures then available to treat patients with SBE and on the inevitable course of the illness once it began. Also discussed is the relationship of acute rheumatic fever and its sequela, rheumatic heart disease, to predisposing people to SBE and possible genetic factors. The well-known case of Alfred S. Reinhart, a Harvard Medical School student who died from SBE in 1931 and who kept a detailed chronicle of his disease, is also discussed and contrasted with Pasquale Imperato's case. [ABSTRACT FROM AUTHOR]

Part 2 presents detailed genealogic information on Josephine Imperato's paternal and maternal lineages extending from four to seven generations into the nineteenth and eighteenth centuries. Among these lineages are some where early adult death over successive generations is perhaps indicative of type 2 diabetes mellitus (type 2 DM). These lineages, all in the town of San Prisco in Italy, include both paternal and maternal ones with the following surnames: Casaccia, Casertano, Cipriano, de Angelis, de Paulis, Peccerillo, Foniciello, di Monaco, Vaccarella, Valenziano, Ventriglia, and Zibella. Genealogic studies of eighteenth and nineteenth century vital records in this area of Italy cannot definitively establish type 2 diabetes mellitus as either an immediate or contributory cause of death. This is because causes of death were not recorded and because disease diagnostic capabilities were largely absent. Genealogic studies of those who lived in Italy in the eighteenth and nineteenth centuries can at best provide data on approximate age at time of death. Early adult death in this era was not uncommon. However, its presence over several successive generations in a lineage raises the possibility of inherited diseases prominent among which is type 2 DM. [ABSTRACT FROM AUTHOR]

Part 2 presents detailed genealogic information on Josephine Imperato’s paternal and maternal lineages extending from four to seven generations into the nineteenth and eighteenth centuries. Among these lineages are some where early adult death over successive generations is perhaps indicative of type 2 diabetes mellitus (type 2 DM). These lineages, all in the town of San Prisco in Italy, include both paternal and maternal ones with the following surnames: Casaccia, Casertano, Cipriano, de Angelis, de Paulis, Peccerillo, Foniciello, di Monaco, Vaccarella, Valenziano, Ventriglia, and Zibella. Genealogic studies of eighteenth and nineteenth century vital records in this area of Italy cannot definitively establish type 2 diabetes mellitus as either an immediate or contributory cause of death. This is because causes of death were not recorded and because disease diagnostic capabilities were largely absent. Genealogic studies of those who lived in Italy in the eighteenth and nineteenth centuries can at best provide data on approximate age at time of death. Early adult death in this era was not uncommon. However, its presence over several successive generations in a lineage raises the possibility of inherited diseases prominent among which is type 2 DM. [ABSTRACT FROM AUTHOR]

Establishing the role of heredity in type 2 diabetes mellitus (type 2 DM) is challenging. While type 2 DM frequently displays a pattern of familial aggregation, many other risk factors are responsible for the clinical expression of the disease. This paper reviews a number of the early twentieth-century studies of inheritance patterns for type 2 DM and presents in detail the history of Josephine Foniciello Imperato (Maria Giuseppa Foniciello) who died from the disease in New York City at the age of 52 years on 14 November 1921, ten months before commercial insulin became available. [ABSTRACT FROM AUTHOR]

The medical inspection of immigrants arriving in the United States in the late nineteenth and early twentieth centuries was framed by a need to rapidly process large numbers of people. Scientific medicine, such as it was then, was subordinate to the existing immigration laws which reflected the influences of the powerful anti-immigration forces of eugenics and nativism. The line, or single-file queues in which immigrants were arranged, facilitated rapid processing. The split-second medical gaze was hailed by the then leadership of the U.S. Public Health Service as scientifically sound, based as it was on the alleged exceptional disease detection skills of examining public health physicians. In reality, this system was seriously flawed, led to numerous diagnostic errors, and was free of any form of public outcomes assessment or accountability. In time, trachoma became the principal focus of line physicians because of the belief that it could be easily detected, and those diagnosed with it summarily deported. However, the diagnosis of the early stages of this disease is far more complex since it must be differentiated from other forms of benign conjunctivitis. Described here is the case of Cristina Imparato, a 46-year-old immigrant who arrived in New York from Italy on September 27, 1910, and who was given a diagnosis of trachoma which resulted in her summary deportation three days later on September 30, 1910. Her case serves to illustrate the complex forces at work at that time around the issue of immigration. These included a need to meet the labor needs of expanding industries while responding to the immigration restriction demands of eugenics supporters and nativists and the call to protect the country from imported disease threats. [ABSTRACT FROM AUTHOR]

The article focuses on the perception of twins in the African country of Mali. It explores the Bamana (also called Bambara) and Maninka cultures and explains that in their belief systems, hermaphrodites, pseudo-hermaphrodites, and albinos are all regarded as twins. The creation mythology of the peoples is explored and the treatment of twins, such as the gifts they receive, the rituals they undergo as infants, and the marriage ceremony traditions, is described. It explains that hermaphrodites and albinos do not receive the same elevated social treatment as twins. The representation of twins in sculptures is also analyzed.

The Bamana and Maninka of Mali greatly value twins, and have elaborated a range of cultural beliefs and practices to assure their survival. Rates of twinning among these two ethnic groups average from 15.2/1000 to 17.9/1000 births compared to 10.5/1000 births (without assisted reproduction) in the United States and Great Britain. Twins (flaniw) are regarded as extraordinary beings with unusual powers, and as a gift from the supreme deity. A small altar (sinzin) is maintained in the home of twins, and periodic sacrifices of chicken blood, kola nuts, millet paste and millet beer regularly made to assure their protection. Albinos (yéjeguéw) and true and pseudo-hermaphrodites (tyétémousotéw) are also considered twin beings. However, they are believed to be the result of aberrant parental social behavior. The Bamana and Maninka believe that all four groups (twins, albinos, hermaphrodites, and pseudo-harmaphrodites) are closely linked to Faro, an androgynous supernatural being who provides equilibrium in the world. Faro is the original albino and hermaphrodite who gave birth to the first pair of twins after self-impregnation. Whenever a twin dies, a small wooden statue is sculpted called a flanitokélé (twin that remains). This commemorative figure is kept close to the surviving twin, reflecting a belief in the inseparability of twins. Eventually, the surviving twin takes responsibility for the figure. When a surviving twin marries, another figure is often sculpted in the opposite sex from the deceased twin, and placed with the original sculpture. Such commemorative sculptures are not created upon the death of those who are albinos, hermaphrodites, or pseudo-hermaphrodites. In recent years, transformational belief patterns have evolved as increasing numbers of Bamana and Maninka embrace Islam. Traditional beliefs are often given Islamic myths of origin. However, even in this Islamic context, many practices that assure twin survival are maintained. [ABSTRACT FROM AUTHOR]

The article presents a commentary about avian influenza viruses. The avian influenza virus or H5N1 is a common cause of diseases in the bird species. It has caused epidemics in the domestic poultry of some countries starting in Hong Kong. From Hong Kong, it spread to other parts of Asia and it eventually landed in Europe. Its ability to be transmitted from domestic poultry to humans is causing concerns to many people. It can also be transmitted through the importation of exotic birds from infected areas. Wild aquatic birds are seen as the main carriers of the virus.

The 1977 New York City blackout began at 9:36 p.m. on 13 July and lasted some 25 h until 10:39 p.m. on 14 July. The New York City Department of Health rapidly set up a Blackout Contingency Plan, established priorities, and mobilized its staff to address remedial interventions. Top priorities included water supplies, sewage disposal, perishable food supplies, hospital and emergency room services, solid waste disposal, beach contamination with untreated sewage , and assisting those on electrically powered home life support systems. The 1977 blackout occurred during an extended heat wave. An analysis of total deaths and deaths due to pulmonary and cardiovascular/renal diseases by day correlated with temperatures. However, there was no direct correlation with the blackout itself, in part perhaps because of the confounding influence of high temperatures. The increase of deaths on very hot days outside of the blackout period lends strong support to the relationship between increased deaths and high ambient temperatures. The 1977 New York City blackout was distinguished from those of 1965 and 2003 by violence, arson, and looting that occurred in several areas. These acts resulted in 204 civilian injuries, 436 police injuries, 80 firefighter injuries, and 1037 fires. The violence, arson, and looting caused extensive long-term physical and functional damage to certain areas of two boroughs of the city, Brooklyn and the Bronx. Although the New York City Department of Health had not previously established a disaster preparedness plan, its professionals quickly rose to the occasion because they were able to draw upon vast public health practice experience and ingenuity. [ABSTRACT FROM AUTHOR]

The Zika virus was first identified in 1947 in the Zika Forest of Uganda. It was discovered in a rhesus monkey that had been placed in a cage on a sentinel platform in the forest by the Virus Research Institute. When this writer visited the institute and the Zika Forest in 1961, work was underway to identify mosquito species at various levels of the tree canopy. This was done through the placement of traps at various levels of a 120-foot-high steel tower which this writer climbed. At that time, researchers isolated 12 strains of Zika virus from traps on the tower. Over the next six decades, the virus spread slowly to other parts of Africa, and eventually appeared in Southeast Asia, transmitted by Aedes aegypti and other Aedes mosquito species. By 1981, only 14 cases of illness had been reported as due to the Zika virus. Since most infections with this virus are either mild or asymptomatic, its true geographic spread was not fully appreciated. The current globalization of the Zika epidemic began on the Pacific island of Yap in the Federated States of Polynesia in 2007. This was the first known presence of the Zika virus outside of Africa and Southeast Asia. It was estimated that 73 % of the island's population had been infected. In 2013, the virus spread to French Polynesia where an estimated 28,000 cases occurred in a population of 270,000. During that year and afterwards, microcephaly and other congenital abnormalities were observed in the infants of women who were pregnant when they contracted the virus. It is currently not known if cases of microcephaly have resulted from infection of pregnant women or from infection plus some other co-factor. The epidemic rapidly spread to the Cook Islands and Easter Island. In 2015, Zika virus infection was diagnosed in Brazil where it was associated with microcephaly in the infants of some women who were pregnant when they contracted the disease. Cases of the Guillain-Barré syndrome were also found to be associated with Zika virus infection. How the disease entered Brazil is a matter of conjecture. However, the strain responsible for the epidemic in Brazil and elsewhere in South and Central America is phylogenetically identical to that which caused the epidemic in French Polynesia. The wide distribution of Aedes aegypti, a principal vector of the virus, and other Aedes species has greatly facilitated the spread of the disease. Aedes aegypti is an invasive species of mosquito in the Western Hemisphere that has adapted well to densely-populated urban environments. In addition, male-to-female human sexual transmission has increasingly been demonstrated in the US and elsewhere. In February 2016, the World Health Organization (WHO) declared the current Zika outbreak a Public Health Emergency of international concern. On the recommendation of its Emergency Committee on Zika Virus and Observed Increase in Neurological Disorders and Neonatal Malformations, WHO issued a group of recommendations to contain the epidemic. The globalization of the Zika virus was made possible by the widespread presence in various parts of the world of Aedes vectors and increased human travel that facilitated geographic spread. This globalization of Zika follows upon that of West Nile, Ebola, Dengue, and Chikungunya. Its ultimate spread is difficult to predict, but will hopefully be restricted through vigorous preventive measures. [ABSTRACT FROM AUTHOR]

Global health electives based in resource-poor countries have become extremely popular with medical students from resource rich ones. As the number of such programs and participants increase, so too do the absolute health and safety risks. It is clear from a number of published reports that many institutions provide little or no meaningful preparedness for students and do little to ensure their health and safety. These deficiencies together can affect students, their foreign hosts, and sponsoring institutions. The School of Public Health at the State University of New York, Downstate Medical Center, and its predecessor, the Department of Preventive Medicine and Community Health, have sponsored a 6-8 week global health elective for fourth year medical students since 1980. The purposes of this elective are to provide students with an opportunity to observe the health care and public health systems in resource-poor countries, provide medical service, and have a cross-cultural experience. Over the course of the past 35 years, 386 students have participated in this global health elective in more than 41 resource-poor countries. Recent annual applications for this elective have been as high as 44 out of a class of 200 students. Over the past 10 years, annual acceptance rates have varied, ranging from a low of 32 % in 2007-2008 to a high of 74 % in 2010-2011 and 2013-2014. Careful screening, including a written application, review of academic records and personal interviews, has resulted in the selection of highly mature, adaptable, and dedicated students who have performed well at overseas sites. Appropriately preparing students for an overseas global health experience in resource-poor countries requires the investment of much professional and staff time and effort. At the SUNY Downstate School of Public Health, these resources have underpinned our Global Health in Developing Countries elective for many years. As a result, the elective is characterized by meticulous organization, extensive preparedness measures for students, and continuous monitoring of site and country safety. The health of students is ensured by one-on-one assessment of immunization needs, anti-malarials, and the provision of a five-day supply of post-exposure HIV prophylaxis. Students sign agreements regarding the legal issues, immunizations, and anti-malarials recommended as well as HIV post-exposure prophylaxis. They are also required to obtain medical evacuation insurance provided by the university, and medical care insurance valid overseas. Student travel plans are also approved as is in-country lodging. The focus of our 6-8 week global health elective is not clinical medicine. Rather, it is to enable students to learn about the health care and public health systems in a resource-poor country. Through that focus, they also come to understand the causes of health and health care disparities that exist in the country to which they are assigned. Our students are greatly advantaged with regard to cross-cultural understanding since our school is located in New York City's Borough of Brooklyn, where 40 % of the population was born outside of the U.S. Our comprehensive effort at risk management for this global health elective includes a thorough debriefing for each student upon his/her return. Special attention is given to ascertaining illness or injury while overseas, and, when necessary, immediate referral is made to an appropriate university clinical department where a student can be appropriately case managed. Meticulous oversight, careful selection of safe overseas sites, and attention to preparing students have resulted in significant risk reduction and successful experiences for the majority of our 386 students. This article describes the model we have developed for ensuring the health, safety, and preparedness of students participating in our global health elective. [ABSTRACT FROM AUTHOR]

The upcoming emission legislation for sea-going vessels issued by the international marine organization requires drastic reduction in nitric oxides. A well-known approach for meeting these requirements is to reduce the in-cylinder temperature prior to combustion by using the so-called Miller cycle. However, the mere use of this technique presents the actual limits due to long ignition delay, which occurs when the compression temperature is very low. As a consequence, premixed combustion develops quickly, increasing the local temperature in the combustion chamber and favoring NOx formation. Splitting the fuel injection into a small pilot and a main injection can reduce the magnitude of the premixed combustion and the local in-cylinder temperatures. The work presented here is divided in two parts and is novel by being the first systematic study of split injection combined with Miller cycle in large-bore engines. In its first stage, an extensive study of the injection dwell with two intake valve closings and three timings of the main injection are analyzed. In the second stage, both injection events are shifted later in the power stroke with fixed injection dwell. Overall, the pilot injection reduced the ignition delay but dropped the peak of the premixed combustion only with the most advanced intake valve closing. This improved fuel economy, but provided no advantages as far as emissions are concerned. In addition, while increasing injection dwell reduced NOx emissions, it also increased fuel consumption. The highest achieved NOx reduction was close to 60%, with a small drawback in fuel economy. [ABSTRACT FROM AUTHOR]

Problematic gaming is a topic of great clinical and social relevance, so it is particularly important to identify its protective and risk factors. Literature already showed that maladaptive personality favors problematic gaming. In the light of Kernberg's model of personality organization, the present cross-sectional study aimed to evaluate the mediational process through which low level of personality organization associates with problematic gaming, exploring the role of depressive and anxious symptoms and of motivations for playing. A sample of 1036 video gamers filled in an online survey regarding: level of personality organization; depressive and anxious symptoms; socializing, achievement, and immersion motivations for playing; problematic gaming. The path analysis showed that lower level of personality organization associated with greater problematic gaming and that depressive (but not anxious) symptoms, and socializing and achievement (but not immersion) motivations positively mediated this relationship. Furthermore, results showed that psychopathological symptoms and achievement motivations sequentially mediated the relationship between low level of personality organization and problematic gaming, highlighting that depressive symptoms secondary to a low level of personality organization could lead to a risky use of video games, i.e., they could push to use video games to self-enhance oneself, a dysfunctional strategy that exposes to problematic gaming. The study gives some indications on the variables that associate with problematic gaming and has some practical relevance, providing suggestions in the design of effective problematic gaming prevention and treatment interventions. [ABSTRACT FROM AUTHOR]

For many centuries, unwed mothers in southern Italy were forced to surrender their infants because of a number of social, religious, economic, and political pressures. This study focuses on the policies and practices that were in place in southern Italy regarding illegitimate infants in the late nineteenth century. A detailed analysis of the policies and practices present in the town of Forio d'Ischia during the 20-year period 1880-1899 is also presented. During these two decades, there were 37 illegitimate live births representing 0.70 % of the 5249 live births recorded in this town. Although small in number, these illegitimate births, referred to as spuri in Italian, from the Latin spurius, meaning bastard, were managed by standard predetermined procedures. These included anonymity for the parents, the transfer of such infants to an official town receiver of foundlings, and their transport to Naples' orphanage, the Real Casa Santa dell'Annunziata. This orphanage maintained fairly detailed records about the children who were delivered to it. After a few days at the orphanage, infants were often entrusted to the care of external wet nurses, preferably outside of Naples. This was done in the belief that infant survival was better assured in more rural environments. The case of an illegitimate infant, Antonino Spinalbese, is presented in detail. Born on 14 February 1882 in the town of Forio d'Ischia, he was brought to the orphanage 4 days later. Following a two-day stay at the orphanage, he was entrusted to an external wet nurse, Michele Mondella, and her husband, Ciro Fiscale di Felice, a mariner in the town of Torre del Greco. The available evidence indicates that Antonino Spinalbese became a mariner like his stepfather. As a crew member of the passenger ship, Vulcano, he made three trips from Naples to New York City in 1922 and 1923. [ABSTRACT FROM AUTHOR]

In 1947, a smallpox outbreak occurred in New York City with a total of twelve cases and two deaths. In order to contain this outbreak, the New York City Department of Health launched a mass immunization campaign that over a period of some 60 days vaccinated 6.35 million people. This article examines in detail the epidemiology of this outbreak and the measures employed to contain it. In 1976, a swine influenza strain was isolated among a few recruits at a US Army training camp at Fort Dix, New Jersey. It was concluded at the time that this virus possibly represented a re-appearance of the 1918 influenza pandemic influenza strain. As a result, a mass national immunization program was launched by the federal government. From its inception, the program encountered a myriad of challenges ranging from doubts that it was even necessary to the development of Guillain-Barré paralysis among some vaccine recipients. This paper examines the planning for and implementation of the swine flu immunization program in New York City. It also compares it to the smallpox vaccination program of 1947. Despite equivalent financial and personnel resources, leadership and organizational skills, the 1976 program only immunized approximately a tenth of the number of New York City residents vaccinated in 1947. The reasons for these marked differences in outcomes are discussed in detail. [ABSTRACT FROM AUTHOR]

The School of Public Health at the State University of New York, Downstate Medical Center has sponsored a 6-8 week global health elective for fourth year medical students since 1980. The purpose of this elective is to provide students with an opportunity to observe the health care and public health delivery systems in low-income countries, provide medical service and have a cross-cultural experience. Over the course of the past 35 years, 388 students have participated in this global health elective in more than 41 low-income countries. The most popular sites include the Dominican Republic, Guatemala, India, Kenya and Thailand. Overall, interest in this elective has persisted throughout the course of time, sometimes temporarily increasing or decreasing with outside factors, such as the events of 11 September 2001 and the outbreak of Severe Acute Respiratory Syndrome in Asia. Recent annual applications for this elective have been as high as 44 out of a class of 200 students. Over the past 10 years, annual acceptance rates have varied, ranging from a low of 32 % in 2007-2008 to a high of 74 % in 2010-2011 and 2013-2014. Careful screening, including a written application, review of academic records and personal interviews has resulted in the selection of highly mature, adaptable and dedicated students who have performed well at overseas sites. Student rated satisfaction levels with this elective are almost universally high, with most rating it the best experience of their medical school years. Students undergo extensive preparation prior to their travel overseas, including a review of individual health and safety issues, travel and lodging, and the nature of the host country culture, health care system and assignment site. Downstate medical students are especially experienced in cross-cultural understanding because of the unusual diversity of the patient population in Brooklyn, and the diversity of local hospital staff and the medical school class. The Alumni Fund of the College of Medicine has steadfastly supported this elective with both a philosophical commitment and financial grants to help defray costs since the very early years. The Dr. Michael and Lona B. Kennéy Endowment, the Joshua H. Weiner endowment, and the LSK Foundation have also provided financial support for this elective. Throughout the course of this elective, overseas preceptors have willingly given of their time and institutional resources to make these experiences available and meaningful for our students. [ABSTRACT FROM AUTHOR]

This study sought to determine whether medical students who participate in a global health elective in a low-income country select residencies in primary care at higher rates compared with their classmates and US medical graduates in general. Given the projected increase in demand for primary care physicians, particularly in underserved areas, understanding possible factors that encourage training in primary care or enhance interest in the care of underserved populations may identify opportunities in medical school training. The authors used data from the Office of Student Affairs, SUNY Downstate College of Medicine and the National Residency Matching Program to compare rates of primary care residency selection from 2004 to 2012. Residency selections for students who participated in the SUNY Downstate School of Public Health Global Health Elective were compared with those of their classmates and with residency match data for US seniors. In 7 of the 8 years reviewed, students who participated in the SUNY Downstate School of Public Health Global Health Elective selected primary care residencies at rates higher than their classmates. Across years, 57 % of the students who completed the elective matched to primary care residences, which was significantly higher than the 44 % for the remainder of Downstate's medical student class ( p = 0.0023). In 6 of the 8 years, Downstate students who participated in the Global Health Elective selected primary care residencies at rates higher than US medical school seniors in general; rates were the same for both Downstate Global Health Elective students and US medical school seniors in 2009. Students who participated in a global health experience in a low-income country selected primary care residencies at higher rates than their classmates and US medical school graduates in general. Understanding how these experiences correlate with residency selection requires further investigation; areas of future study are discussed. [ABSTRACT FROM AUTHOR]

A most interesting and intriguing male disorder of sexual differentiation is due to 5α-reductase-2 isoenzyme deficiency. These male infants are born with ambiguous external genitalia due to a deficiency in their ability to catalyze the conversion of T to dihydrotestosterone. Dihydrotestosterone is a potent androgen responsible for differentiation of the urogenital sinus and genital tubercle into the external genitalia, urethra, and prostate. Affected males are born with a clitoral-like phallus, bifid scrotum, hypospadias, blind shallow vaginal pouch from incomplete closure of the urogenital sinus, and a rudimentary prostate. At puberty, the surge in mainly T production prompts virilization, causing most boys to choose gender reassignment to male. Fertility is a challenge for affected men for several reasons. Uncorrected cryptorchidism is associated with low sperm production, and there is evidence of defective transformation of spermatogonia into spermatocytes. The underdeveloped prostate and consequent low semen volumes affect sperm transport. In addition, semen may not liquefy due to a lack of prostate-specific antigen. In the present review, we discuss the 5α-reductase-2 deficiency syndrome and its impact on human fertility. [ABSTRACT FROM AUTHOR]