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Although immune-based therapies have revolutionized the management of cancer, novel approaches are urgently needed to improve their outcome. We investigated the role of endogenous steroids in the resistance to cancer immunotherapy, as these have strong immunomodulatory functions. Using a publicly available database, we found that the intratumoral expression of 11 beta-hydroxysteroid dehydrogenase type 1 (HSD11B1), which regenerates inactive glucocorticoids into active glucocorticoids, was associated with poor clinical outcome and correlated with immunosuppressive gene signatures in patients with renal cell carcinoma (RCC). HSD11B1 was mainly expressed in tumor-infiltrating immune myeloid cells as seen by immunohistochemistry in RCC patient samples. Using peripheral blood mononuclear cells from healthy donors or immune cells isolated from the tumor of RCC patients, we showed that the pharmacological inhibition of HSD11B1 improved the response to the immune checkpoint inhibitor anti-PD-1. In a subcutaneous mouse model of renal cancer, the combination of an HSD11B1 inhibitor with anti-PD-1 treatment increased the proportion of tumor-infiltrating dendritic cells. In an intrarenal mouse tumor model, HSD11B1 inhibition increased the survival of mice treated with anti-PD-1. In addition, inhibition of HSD11B1 sensitized renal tumors in mice to immunotherapy with resiquimod, a Toll-like receptor 7 agonist. Mechanistically, we demonstrated that HSD11B1 inhibition combined with resiquimod increased T cell-mediated cytotoxicity to tumor cells by stimulating the antigen-presenting capacity of dendritic cells. In conclusion, these results support the use of HSD11B1 inhibitors to improve the outcome of immunotherapy in renal cancer and highlight the role of the endogenous glucocorticoid metabolism in the efficacy of immunotherapy. [ABSTRACT FROM AUTHOR]

Since 2008, the European Union (EU) witnessed a growing tension between the social and economic dimensions of integration as a consequence of the 'polycrisis'. The increasing politicisation of EU issues in national political arenas that led to the rise of Eurosceptic parties mostly revolved around the issue of European solidarity. Against this background, this study investigates the congruence between voters and incumbent members of national parliaments on the highly contentious aspects of EU solidarity. First, the article maps the extent to which national political elites share similar views on EU solidarity with their voters. Secondly, we assess members of parliaments (MPs)-voters' congruence at the party level. Employing original data from an elite and a mass survey conducted in six EU countries between 2017 and 2018, we find that both voters and MPs expressed a high level of support for policies strengthening European solidarity in the Eurozone periphery. Instead, voters in Northern and Eastern EU member states shared more positive preferences than their national representatives. Furthermore, the party-voter distance was higher for radical-right Eurosceptic MPs, especially in Northern Europe, than for other parties. [ABSTRACT FROM AUTHOR]

Studies on the severity in multisystem inflammatory syndrome in children (MIS-C) show heterogeneous results and may not reflect a global perspective. This systematic review aims to estimate the frequency of in-hospital unfavorable outcomes in patients with MIS-C over the 3 years since the onset of the SARS-CoV-2 pandemic. A systematic search was conducted in Medline, Scopus, Embase, Cochrane, Web of Science, Scielo, and preprint repositories until December 15, 2022. Study selection and data extraction were evaluated independently. The primary outcomes were intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), and death. Additionally, we evaluated cardiovascular-related outcomes. We performed a random-effects model meta-analysis and assessed the certainty of the evidence. Fifty-seven studies (n = 13 254) were included. The frequency of ICU admission was 44.7% (95% CI 38.8–50.7), 11.9% for IMV (95% CI 9.6–14.4), and 2.0% for death (95% CI 1.3–3.0). The requirement of vasoactive/inotropic drugs was 40.1% (95% CI 35.9–44.4), 7.9% for coronary aneurysm (95% CI 4.1–12.7), 30.7% for decreased left ventricle ejection fraction (LVEF) (95% CI 26.3–35.4), and 29.7% for myocarditis (95% CI 18.4–42.4). We assess the included evidence as being of very low certainty. Finally, excess COVID-19 mortality by country and the diagnostic criteria for MIS-C (CDC compared to WHO) were associated with a higher frequency of ICU admissions. The year of study conduction (2022 compared to 2020) was associated with a lower frequency of IMV. Conclusion: The frequency of in-hospital unfavorable outcomes in patients with MIS-C was high. Well-designed studies are needed to explore other heterogeneity sources. Protocol registration: CRD42021284878. What is Known: • Multisystem inflammatory syndrome in children (MIS-C) is a serious post-infectious condition linked to SARS-CoV-2. Studies on the severity of MIS-C show heterogeneous results. These findings may not be representative of the reality in other regions, making it challenging to draw generalizable conclusions. What is New: • Over the 3 years since the onset of the SARS-CoV-2 pandemic, our systematic review has shown that the frequency of in-hospital unfavorable outcomes in patients with MIS-C is high, with a very low certainty of the evidence. Our results reflect the reality from a global perspective, across different countries with varying income levels. • The main sources of heterogeneity in the frequency of severe outcomes could be explained by the excess mortality due to COVID-19 in each country, the type of diagnostic criteria for MIS-C, and the year the study was conducted. [ABSTRACT FROM AUTHOR]

Objectives Disease-modifying antirheumatic drugs (DMARDs) are a first-line treatment in rheumatoid arthritis (RA). Treatment response to DMARDs is patient-specific, dose efficacy is difficult to predict and long-term results are variable. The gut microbiota are known to play a pivotal role in prodromal and early-disease RA, manifested by Prevotella spp. enrichment. The clinical response to therapy may be mediated by microbiota, and large-scale studies assessing the microbiome are few. This study assessed whether microbiome signals were associated with, and predictive of, patient response to DMARD treatment. Accurate early identification of those who will respond poorly to DMARD therapy would allow selection of alternative treatment (e.g. biologic therapy) and potentially improve patient outcome. Methods A multicentre, longitudinal, observational study of stool- and saliva microbiome was performed in DMARD-naive, newly diagnosed RA patients during introduction of DMARD treatment. Clinical data and samples were collected at baseline (n  = 144) in DMARD-naive patients and at six weeks (n  = 117) and 12 weeks (n  = 95) into DMARD therapy. Samples collected (n  = 365 stool, n  = 365 saliva) underwent shotgun sequencing. Disease activity measures were collected at each timepoint and minimal clinically important improvement determined. Results In total, 26 stool microbes were found to decrease in those manifesting a minimal clinically important improvement. Prevotella spp. and Streptococcus spp. were the predominant taxa to decline following six weeks and 12 weeks of DMARDs, respectively. Furthermore, baseline microbiota of DMARD-naive patients were indicative of future response. Conclusion DMARDs appear to restore a perturbed microbiome to a eubiotic state. Moreover, microbiome status can be used to predict likelihood of patient response to DMARD. [ABSTRACT FROM AUTHOR]

Background: Ultrasound (US) imaging is useful for identifying functional lymphatic vessels and suitable veins for lymphovenous anastomosis (LVA). However, its accuracy depends on the experience of the examiner. The aim of this study was to assess the learning curve for preoperative planning of LVA using ultrahigh frequency US (UHFUS). Methods: Plastic surgeons from our department were asked to perform for the first time an US examination for preoperative planning of LVA (month 0). Data of the following US examinations were also periodically collected for two years (months 1, 3, 6, 12 and 24) and statistically analyzed. The results were also compared with the examinations of 3 experts in UHFUS. Results: At least one vein was accurately identified in all US examinations and with the highest level of confidence since the beginning (p 0.001). The lymphatic vessels correctly identified per incision progressively increased during the follow up: 33.3%, 41.7%, 83.3%, 100%, 100%, respectively (p 0.004). Conclusion: From month 3 onwards, the efficiency of the US examination increased, and after 6 months, the time decreased. Suitable veins for LVA can be located since the first US examinations, so even for a beginner, it is useful to incorporate US into preoperative planning. The assessment of the lymphatic vessels required more time: after 3 to 6 months, they can be accurately identified, and after 1 year, they were found in more complex cases, with complete confidence and the examinations began to be comparable with the experts. Level of evidence: Level III, Diagnostic Study. [ABSTRACT FROM AUTHOR]

We investigated the design and characterization of a Lab-On-a-Chip (LoC) cell detection system primarily designed to support immunotherapy in cancer treatment. Immunotherapy uses Chimeric Antigen Receptors (CARs) and T Cell Receptors (TCRs) to fight cancer, engineering the response of the immune system. In recent years, it has emerged as a promising strategy for personalized cancer treatment. However, it requires bioreactor-based cell culture expansion and manual quality control (QC) of the modified cells, which is time-consuming, labour-intensive, and prone to errors. The miniaturized LoC device for automated QC demonstrated here is simple, has a low cost, and is reliable. Its final target is to become one of the building blocks of an LoC for immunotherapy, which would take the place of present labs and manual procedures to the benefit of throughput and affordability. The core of the system is a commercial, on-chip-integrated capacitive sensor managed by a microcontroller capable of sensing cells as accurately measured charge variations. The hardware is based on standardized components, which makes it suitable for mass manufacturing. Moreover, unlike in other cell detection solutions, no external AC source is required. The device has been characterized with a cell line model selectively labelled with gold nanoparticles to simulate its future use in bioreactors in which labelling can apply to successfully engineered CAR-T-cells. Experiments were run both in the air—free drop with no microfluidics—and in the channel, where the fluid volume was considerably lower than in the drop. The device showed good sensitivity even with a low number of cells—around 120, compared with the 107 to 108 needed per kilogram of body weight—which is desirable for a good outcome of the expansion process. Since cell detection is needed in several contexts other than immunotherapy, the usefulness of this LoC goes potentially beyond the scope considered here. [ABSTRACT FROM AUTHOR]

The Internet of Things (IoT) has radically changed the industrial world, enabling the integration of numerous systems and devices into the industrial ecosystem. There are many areas of the manufacturing industry in which IoT has contributed, including plants' remote monitoring and control, energy efficiency, more efficient resources management, and cost reduction, paving the way for smart manufacturing in the framework of Industry 4.0. This review article provides an up-to-date overview of IoT systems and machine learning (ML) algorithms applied to smart manufacturing (SM), analyzing four main application fields: security, predictive maintenance, process control, and additive manufacturing. In addition, the paper presents a descriptive and comparative overview of ML algorithms mainly used in smart manufacturing. Furthermore, for each discussed topic, a deep comparative analysis of the recent IoT solutions reported in the scientific literature is introduced, dwelling on the architectural aspects, sensing solutions, implemented data analysis strategies, communication tools, performance, and other characteristic parameters. This comparison highlights the strengths and weaknesses of each discussed solution. Finally, the presented work outlines the features and functionalities of future IoT-based systems for smart industry applications. [ABSTRACT FROM AUTHOR]

The article opens with a summary of the historical evolution of Italian cultural heritage law to facilitate a better understanding of the reasons underlying its eminently protectionist attitude. It then briefly discusses the factors giving rise to a recent – albeit fairly moderate – shift towards a more solidaristic approach to regulating cultural property, together with the remaining, and significant, legal obstacles to the restitution of objects unlawfully, or at any rate unethically, appropriated during times of colonial occupation. To this effect, two particularly significant cases (the Aksum stele and the Venus of Cyrene) are also briefly analysed. The paper concludes with a discussion of the road still ahead in comparison with the approach taken by other countries. [ABSTRACT FROM AUTHOR]

This article investigates the association between individual-level transnationalism, interactions and cultural skills cutting across European Union (EU) member states, and voting behaviour in the 2019 European elections. The process of EU integration has expanded significantly virtual and physical forms of cross-border mobility in the last decades. Previous works have shown that transnational social exchange furthers Europhile attitudes and dilutes fears for immigrants. Against this backdrop, it is argued that people with high levels of transnationalism have the incentive to vote for parties with pro-EU integration and pro-immigration platforms. Empirical analyses conducted on original public opinion data show that transnational traits significantly affected vote choices in the 2019 European elections. Individual transnationalism is relevant per se in increasing the probability of voting for green and radical-left parties, instead, its negative association with voting for radical right parties runs through EU and immigration attitudes. [ABSTRACT FROM AUTHOR]

Background: Non-communicable diseases (NCDs) represent a global health challenge, accounting for 74% of deaths worldwide. One of the recommended interventions to reduce the risk of NCDs is the implementation of warning labels (WLs) on food products to alert consumers about high levels of undesirable nutrients, such as sugar or saturated fats. We aimed to conduct a bibliometric analysis of scientific literature related to WL policies in food and beverages to evaluate global trends and collaborations. Methods: A bibliometric analysis was performed using the Web of Science Core Collection (WoSCC). Articles published between 1998 and 2023 were retrieved using the search terms "warning labels" AND "food" OR "beverage". Bibliometric indicators, including publication counts, citations, collaborations, and thematic trends, were analyzed using the Bibliometrix package in R and VOSviewer. Results: We included 255 articles on WLs. Scientific production increased markedly from 2018 onwards, with over 30 articles published annually from 2018 to 2023. The most cited article, by Taillie et al., focused on the impact of Chile's WL policies. The United States had the largest scientific production, followed by Brazil and Chile. Nutrients was the journal with the most publications on this topic. Conclusions: The growth in WL-related research, particularly in Latin America, reflects the increasing implementation of these policies. These results underscore key collaborations and evolving research themes, from food labeling to broader public health impacts, emphasizing the need for continued evaluation of WL effectiveness. [ABSTRACT FROM AUTHOR]

The use of Virtual Reality (VR) in education is getting more and more common, especially when hands-on learning experiences have to be delivered. With VR it becomes possible, e.g., to simulate dangerous or costly procedures that could hardly be implemented in real settings. However, engaging large classes in immersive laboratory activities may be difficult, since VR kits are still rather expensive for quantity purchases and may require powerful PCs as well as proper spaces to work. A possible way to deal with these issues could be to combine VR with so-called asymmetric Collaborative Learning (CL). CL is a particularly interesting pedagogical approach, as it make learners work in team to achieve a common educational goal, promoting critical thinking and active learning. In asymmetric CL, in particular, learners use different technologies to interact. When combined with VR, asymmetric CL could be used, e.g., to let some learners get immersed in a virtual environment, while some others actively participate in the experience using a desktop interface. This configuration could allow, in principle, to involve more learners in the same amount of time and with the same number of VR kits, while also letting them benefit of the advantages of CL. Based on these considerations, this paper investigates the impact of CL on VR-based education by leveraging an immersive virtual environment designed to support a laboratory experience in a Chemistry course. A user study was conducted by involving 46 university students enrolled in the course. Objective and subjective metrics were used to compare two education methods, i.e. one in which the students experienced the VR environment in isolation, another one in which pairs of students collaborated with an asymmetric approach. Students' knowledge acquisition was assessed by means of theoretical quizzes, whereas practical performance was automatically measured during the VR experience. The experimental results showed that trading off VR-based, individual learning for CL may have positive effects on the acquisition of theoretical knowledge, but may be detrimental to the achievement of practical abilities if sufficient exposure to technology cannot be guaranteed. [ABSTRACT FROM AUTHOR]

The use of Virtual Reality (VR) in education is getting more and more common, especially when hands-on learning experiences have to be delivered. With VR it becomes possible, e.g., to simulate dangerous or costly procedures that could hardly be implemented in real settings. However, engaging large classes in immersive laboratory activities may be difficult, since VR kits are still rather expensive for quantity purchases and may require powerful PCs as well as proper spaces to work. A possible way to deal with these issues could be to combine VR with so-called asymmetric Collaborative Learning (CL). CL is a particularly interesting pedagogical approach, as it make learners work in team to achieve a common educational goal, promoting critical thinking and active learning. In asymmetric CL, in particular, learners use different technologies to interact. When combined with VR, asymmetric CL could be used, e.g., to let some learners get immersed in a virtual environment, while some others actively participate in the experience using a desktop interface. This configuration could allow, in principle, to involve more learners in the same amount of time and with the same number of VR kits, while also letting them benefit of the advantages of CL. Based on these considerations, this paper investigates the impact of CL on VR-based education by leveraging an immersive virtual environment designed to support a laboratory experience in a Chemistry course. A user study was conducted by involving 46 university students enrolled in the course. Objective and subjective metrics were used to compare two education methods, i.e. one in which the students experienced the VR environment in isolation, another one in which pairs of students collaborated with an asymmetric approach. Students' knowledge acquisition was assessed by means of theoretical quizzes, whereas practical performance was automatically measured during the VR experience. The experimental results showed that trading off VR-based, individual learning for CL may have positive effects on the acquisition of theoretical knowledge, but may be detrimental to the achievement of practical abilities if sufficient exposure to technology cannot be guaranteed. [ABSTRACT FROM AUTHOR]

Background: Periodontal disease is an inflammatory, chronic, and multifactorial disease. The objective of this study is to analyze the association between periodontal disease and some disorders such as papillomas (benign lesions), lichen planus (a chronic immune-mediated disorder), leukoplakia (potentially malignant lesions), and oral cancer (malignant lesions). Methods: For this study, 42 patients were recruited whose supragingival and subgingival plaque was qualitatively analyzed using a phase-contrast microscope, which allowed for the detection of compatible bacterial flora (immobile and composed mainly of cocci) indicative of periodontal health and incompatible bacterial flora (mobile and composed mainly of spirochetes) indicative of periodontal pathology. Patients with incompatible bacterial flora were then subjected to a laser-assisted periodontal treatment with irrigation with hydrogen peroxide within the periodontal pockets (a non-surgical laser-assisted periodontal protocol which is referred to as dye-free photodynamic therapy). Results: Based on the 42 patients recruited, there was no association between oral cavity lesions and periodontal pathogenic bacteria. Four of them were found to have incompatible bacterial flora. Indeed, it was found that almost all the patients had been previously instructed in the proper techniques of home oral hygiene, and more than half of them reported that they carried out periodic check-ups by a dental hygienist. Of the four patients with signs and symptoms of periodontitis, two stated a willingness to undergo the non-surgical laser-assisted periodontal protocol and showed improvements in periodontal indices such as CAL, PPD, and BoP. Conclusions: hygienists and dentists are determining factors in the prevention of periodontal disease and for the maintenance of good oral health. [ABSTRACT FROM AUTHOR]

Background: Alzheimer's disease is a slowly progressing neurodegenerative illness and the most common form of dementia. This pathology leads to an increase in cognitive decline and is responsible, in patients, for several difficulties in performing various activities of daily living, such as oral hygiene. Several experimental studies have shown that oral health in patients with Alzheimer's disease worsens in direct proportion to the progression of the disease due to the appearance of gingivitis and periodontitis. Methods: This clinical literature review aims to evaluate a possible correlation between periodontal disease and Alzheimer's disease, trying to understand if the periopathogens can contribute to the onset or the progression of Alzheimer's disease (AD). The study was conducted on the database PubMed (MEDLINE) of full-text systematic reviews in English on humans and animals that were published in the last five years, from 2018 to 2023. This returned 50 publications, which, once the eligibility criteria were applied, resulted in the 10 publications examined in this review. The selected articles were organized through the construction of tables, analyzed, and compared through Judith Garrard's Matrix method to arrive at the review results. Results: Infection by periopathogens can increase the risk of developing Alzheimer's disease, but also the onset of the latter can make it more difficult to maintain proper oral hygiene, favoring the onset of periodontal disease: it is possible to affirm the existence of a correlation between periodontitis and AD. It was found that patients exposed to chronic periodontitis have a greater risk of developing a cognitive decline or AD and that oral pathogens can be responsible for neuropathologies and increasing systemic inflammation. Conclusions: Periodontitis and periodontal pathogens represent a real risk factor for the onset or worsening of AD; however, the pathogenetic mechanism is still not completely clear. [ABSTRACT FROM AUTHOR]

Background: The blunt and penetrating abdominal trauma follow-up relies on contrast CT scan to detect solid organ injuries. CEUS is not widely used worldwide, despite its accuracy and feasibility in identifying parenchymal and vascular lesions. This survey aims to define the current use of CEUS in Trauma Centers and the expectations of Emergency Surgeons regarding its role. Methods: We sent an online questionnaire composed of 10 questions to trauma physicians worldwide during the period of September 2022 to March 2023. Results: 59 participants from 53 different centers answered the questionnaire. 76.2% of the enrolled participants have CEUS available at their Institution, and 49.2% think that it can replace CT scan. Contrast-CT scan remains the preferred option in the follow-up of blunt liver (69.5%), spleen (72.9%) and kidney (76.3%) injuries, followed by CEUS which is used in 18.6% for liver, 20.3% for spleen and 15.3% for kidney injuries. The results are similar for penetrating abdominal trauma, with contrast CT scan being the first-line imaging technique (91.5% for liver, 91.5% for spleen and 88.1% for kidney injuries), followed by CEUS (5.1% for liver, 5.1% for spleen and 6.8% for kidney injuries). Conclusions: Our survey shows that CEUS is still underutilized in the follow-up of abdominal trauma, even though many emergency surgeons consider it as a valid alternative to contrast CT scan. [ABSTRACT FROM AUTHOR]

Background: Over the latest 15 years, breast augmentation with implant has been progressively refined technically and artistically. However, little attention is usually given to the intermammary space. The aim of this article is to report author's experience and technique in the safe reduction of the intermammary space in breast augmentation with implants without fat grafting. Patients and Methods: From July 2019 to July 2021, 62 consecutive patients undergoing cosmetic breast enhancement with implant and requesting a reduction of the intermammary space were retrospectively evaluated. Preoperatively, breast features were registered for all patients. Preoperative intermammary distance ranged from 2.3 to 7 cm (5.4 ± 0.74). Results: The average follow-up time was 20 months (range 12 to 36 months). All implants were anatomical silicon-gel filled implants with micropolyurethane foam shell. No major early and late complications were experienced. The outcomes were graded as excellent in 45 breasts (72.6 %), very good in 15 (24.2%), good in the two cases (3.2%) with minor delayed wound healing (less than 1 cm) which solved conservatively within 1 month. Patients' satisfaction was high to very high. Postoperative intermammary distance was reduced in all cases and ranged from 1 to 4.5 (mean 2.6 ± 0.52 cm) Conclusion: The intermammary distance can be safely reduced with implant only in all cases who seek it, both via submuscular and via subfascial approach by a precise medial pocket dissection and implantation of micropolyurethane foam-coated implant, which guarantee device's stability during the healing process avoiding malposition. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Human services educators continually seek ways to make outreach programming more engaging and effective. This study evaluated an ongoing relationship education program funded by the United States Department of Health and Human Services (Administration of Children and Families) to determine the effectiveness of the Before You Tie the Knot (BYTK) premarital education program. A self-reported, quantitative, retrospective-pretest-then-post-test evaluation was utilized to assess key objectives in the sample (n = 1285). Clearly- evident effect sizes were found for perceived behavior changes in the participants' implementation of skills related to relationship quality (i.e., positive interaction, negative interaction, positive bonds, happiness/satisfaction, commitment, and not feeling trapped) covered in the training over a five-week period. Implications for how the BYTK program can facilitate change and learning in educational settings, as well as inform relationship education outreach programming, are discussed. [ABSTRACT FROM AUTHOR]

This study sought to determine whether chiropractic faculty were extrinsically, introjectedly, or intrinsically motivated to pursue scholarship; if satisfaction of a faculty member's work-related needs of autonomy, competence, and relatedness correlated with intrinsic motivation to pursue scholarly activities; and to identify barriers to faculty participation in scholarship. An anonymous online survey was administered to full-time faculty at 2 chiropractic institutions in the United States. Survey items assessed whether faculty perceived their work-related needs as met, which motivation type they displayed, and perceived barriers to performing scholarly work. Pearson correlation was used to measure the relationships between satisfaction of the work-related needs and intrinsic motivation. Content analysis was used to analyze faculty responses regarding perceived barriers. On average, survey items indicating extrinsic motivation received 52.2% of positive responses, those indicating intrinsic motivation received 47.8% of positive responses, and those indicating introjected motivation received 26.7%. Intrinsic motivation was positively correlated with each of the work-related needs (autonomy: r =.34, p =.067; competence: r =.52, p =.004; relatedness: r = 0.34, p =.063). Four categories of barriers were reported: time constraints, lack of knowledge, lack of support, and lack of interest. In this sample, chiropractic faculty most frequently identified with survey items indicating extrinsic motivation. Satisfaction of each of the 3 work-related needs was positively correlated with intrinsic motivation; however, competence showed a significant correlation indicating as competence is satisfied faculty are more likely to be intrinsically motivated to pursue scholarship. Perceived lack of time, knowledge, and support were reported barriers to the pursuit of scholarship. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of ductus venosus agenesis (ADV) in singleton pregnancies ranges from 0.04% to 0.15%, while its prevalence in twins remains largely unknown. To our knowledge, in the literature, there is only a single case report of a monochorionic diamniotic (MCDA) pregnancy complicated by ADV. Fetuses with ADV are at increased risk for congenital cardiac disease, heart failure, and fetal growth restriction (FGR). Consequently, these pregnancies have a heightened risk of experiencing an adverse outcome, like stillbirth and neonatal or infant death. Closer antenatal monitoring is warranted when ADV is suspected. Currently, there are no guidelines regarding the standard of care in cases of ADV and no recommendations for the timing of delivery in either singleton or twin pregnancies. Cases: This study aims to provide a comprehensive overview of the management of twin pregnancies complicated by ADV, featuring two cases of MC twins with concurrent sFGR and ADV in one twin. Discussion: These pregnancies experienced completely different outcomes, underscoring the necessity for personalized management tailored to the specific risk factors present in each pregnancy. Typically, in MCDA pregnancies with severe sFGR (type II and III), delivery represents the most reasonable option when venous Doppler abnormalities are identified. However, the absence of the DV complicates the management and the process of decision-making regarding the timing of delivery in cases of sFGR and ADV. We emphasize that effective decision-making should be guided by the presence of additional risk factors, including velamentous insertion, significant estimated fetal weight discordance, and progressive deterioration of the Doppler over time. Conclusions: Our experience suggests that these factors are strongly correlated with poorer outcomes. Given this context, could it be acceptable, in the case of MC pregnancy complicated by severe sFGR and ADV, with worsening findings and additional risk factors (e.g., velamentous insertion, severe birth weight discrepancy), to anticipate the time of delivery starting from 30 weeks of gestational age? [ABSTRACT FROM AUTHOR]

Vicarious stigma shows how indirect stigmatizing experiences can lead people living with HIV (PLWH) to feel discriminated against. We enrolled 350 PLWH, who were administered a 17-item questionnaire to investigate a subjective experience of stigma experienced in the hospital care setting. We found that at least once 215 PLWH (61.4%) did not want the HIV exemption indicated on the prescription for a specialist medical visit, 232 PLWH (66.3%) never used their HIV-related exemption to make a specialist medical visit, 230 PLWH (65.7%) avoided undergoing a medical assessment outside the infectious disease clinics and 241 patients (68.9%) felt unwelcome during a specialist medical visit. Moreover, 241 patients (61.1%) had heard at least once stories of health workers who did not want to touch PLWH, 213 patients (60.9%) had heard stories at least once of PLWH who had been mistreated by hospital staff, 180 patients (51.4%) had at least once heard stories about PLWH being refused treatment and services and 257 patients (73.4%) had at least once heard stories about health workers talking publicly about PLWH. This is a little explored area, especially regarding the vicarious stigma faced by PLWH. Our findings indicate the importance of combating HIV-related stigma for the wellbeing of PLWH. [ABSTRACT FROM AUTHOR]

At CRYPTO ’94, Cramer, Damgård, and Schoenmakers introduced a general technique for constructing honest-verifier zero-knowledge proofs of partial knowledge (PPK), where a prover Alice wants to prove to a verifier Bob she knows τ witnesses for τ claims out of k claims without revealing the indices of those τ claims. Their solution starts from a base honest-verifier zero-knowledge proof of knowledge Σ and requires to run in parallel k execution of the base protocol, giving a complexity of O (k γ (Σ)) , where γ (Σ) is the communication complexity of the base protocol. However, modern practical scenarios require communication-efficient zero-knowledge proofs tailored to handle partial knowledge in specific application-dependent formats. In this paper, we propose a technique to compose a large class of Σ -protocols for atomic statements into Σ -protocols for PPK over formulae in conjunctive normal form (CNF) that overlap, in the sense that there is a common subset of literals among all clauses of the formula. In such formulae, the statement is expressed as a conjunction of m clauses, each of which consists of a disjunction of k literals (i.e., each literal is an atomic statement) and ℓ literals are shared among clauses. The prover, for a threshold parameter τ ≤ k , proves knowledge of at least τ witnesses for τ distinct literals in each clause. At the core of our protocol, there is a new technique to compose Σ -protocols for regular CNF relations (i.e., when τ = 1 ) that exploits the overlap among clauses and that we then generalize to formulae where τ > 1 providing improvements over state-of-the-art constructions. [ABSTRACT FROM AUTHOR]

In this paper, we study optimality conditions for a class of control problems driven by a cylindrical Wiener process, resulting in a stochastic maximum principle in differential form. The control acts on both the drift and volatility, potentially as unbounded operators, allowing for SPDEs with boundary control and/or noise. Through the factorization method, we establish a regularity property for the state equation, which, by duality, extends to the backward costate equation, understood in the transposition sense. Finally, we show that the cost functional is Gâteaux differentiable, with its derivative represented by the costate. The optimality condition is derived using results from set-valued analysis. [ABSTRACT FROM AUTHOR]

This research explores the application of wireless sensor networks for the non-invasive monitoring of sleep quality and vital signs in elderly individuals, addressing significant challenges faced by the aging population. The study implemented and evaluated WSNs in home environments, focusing on variables such as breathing frequency, deep sleep, snoring, heart rate, heart rate variability (HRV), oxygen saturation, Rapid Eye Movement (REM sleep), and temperature. The results demonstrated substantial improvements in key metrics: 68% in breathing frequency, 68% in deep sleep, 70% in snoring reduction, 91% in HRV, and 85% in REM sleep. Additionally, temperature control was identified as a critical factor, with higher temperatures negatively impacting sleep quality. By integrating AI with WSN data, this study provided personalized health recommendations, enhancing sleep quality and overall health. This approach also offered significant support to caregivers, reducing their burden. This research highlights the cost-effectiveness and scalability of WSN technology, suggesting its feasibility for widespread adoption. The findings represent a significant advancement in geriatric health monitoring, paving the way for more comprehensive and integrated care solutions. [ABSTRACT FROM AUTHOR]

Copper is an essential element in the diet of mammals, including humans. It plays an important role in the physiological regulation of various enzymes and is consequently involved in several biological processes such as angiogenesis, oxidative stress regulation, neuromodulation, and erythropoiesis. Copper is essential for facilitating the transfer of iron from cells to the bloodstream, which is necessary for proper absorption of dietary iron and the distribution of iron throughout the body. In particular, patients with end-stage renal failure who require renal replacement therapy are at increased risk for disorders of copper metabolism. Many studies on hemodialysis, peritoneal dialysis, and kidney transplant patients have focused on serum copper levels. Some reported mild deficiency, while others reported elevated levels or even toxicity. In some cases, it has been reported that alterations in copper metabolism lead to an increased risk of cardiovascular disease, malnutrition, anemia, or mielopathy. The aim of this review is to evaluate the role of copper in patients undergoing hemodialysis and its potential clinical implications. [ABSTRACT FROM AUTHOR]

Within an industrial plant, the handling of randomly arranged objects is becoming increasingly popular. The technology industry has introduced ever more powerful devices to the market, but they are often unable to meet the demands of the industry in terms of processing times. Using a multi-component feeder, which facilitates the automatic picking of objects arranged in bulk, is the ideal element to speed up the identification of objects by the vision system. The innovative designed feeder eliminates the dead time of the vision system since the feeder has two working surfaces, thus making the viewing time hidden in relation to the total handling cycle time. In addition, the step feeder integrated into the feeder structure allows for control over the number of objects that fall onto the work surface, optimizing the material flow. The feeder was designed to palletize aluminum hinge fins but can also handle other products with different shapes and sizes. A two-dimensional (2D) vision system is integrated into the robotic cell to identify the components to be palletized, obtaining a reduced cycle time. The innovative feeder is fully adaptable to industrial applications and allows for easy integration into the robotic cell in which it is installed; by testing its operation with different aluminum fins, male and female, significant results were obtained in terms of cycle times ranging from 1.44 s to 1.68 s per piece, with an average productivity level (PL) of 1175 pcs every 30 min. [ABSTRACT FROM AUTHOR]

Background and aims: The aim of this study was to investigate the possible preanalytical effect of incomplete filling of blood tubes on molecular biology assays. Materials and methods: The study population consisted of 13 healthy volunteers from whom 11 mL of whole blood was collected and then distributed in different volumes (1.5, 3.0, and 6.0 mL, respectively) into three 6.0 mL spray-dried and evacuated K2EDTA blood tubes. Automated RNA extraction was performed using the Maxwell® CSC RNA Blood Kit. DNA was extracted with a MagCorePlusII, with concomitant measurement of glyceralde-hyde-3-phosphate dehydrogenase (GAPDH) gene expression. The nucleic acid concentration was calculated using the NanoDrop 1000 spectrophotometer, and purity was assessed using A260/280 and A260/230 absorbance ratios. Results: The RNA concentration was higher in the tubes filled with 1.5 and 3.0 mL of blood than in the reference 6 mL filled tube. The RNA 260/280 and RNA 260/230 ratios did not differ significantly between the differently filled blood tubes. The DNA concentration remained constant in the differently filled tubes. Compared to the 6.0 mL reference filled tube, the 1.5 mL and 3.0 mL filled blood tubes displayed a lower DNA 260/280 nm ratio. The DNA 260/230 ratio did not differ significantly in any of the variously filled tubes. Compared to the 6.0 mL reference filled blood tube, the 1.5 mL and 3.0 mL filled blood tubes showed a significant increase in the GAPDHcycle threshold. Conclusions: Our results suggest that underfilling of K2EDTA blood tubes may be a modest but analytically significant source of bias in molecular biology testing. [ABSTRACT FROM AUTHOR]

The number of children eligible for Paediatric Palliative Care has dramatically increased over the years, with few tools that can help with early identification. The Paediatric Palliative Screening Scale is a dedicated German, English, and Portuguese screening tool. We aimed to translate and perform a cultural adaptation to the Italian setting of the Paediatric Palliative Screening Scale. This paper was a descriptive observational cross-sectional study. We carried it out in two consecutive steps: (1) translation and back translation and (2) cultural adaptation through a Delphi process. Twenty Paediatric Palliative Care national experts were invited to judge the content and structure of the translated scale and to assess the appropriateness and clarity of each question. Consensus was defined as 70% or more of experts agreeing with each item's appropriateness and clarity. The Italian version of the Paediatric Palliative Screening Scale was obtained after two rounds of Delphi. After the second round of consultation, a substantial increase in experts' consensus was found, especially for questions 1.1, 3.2 and 3.3 (from 56.3 to 93.8%), and reaching more than 83% for all the revised items. Conclusions: The Paediatric Palliative Screening Scale is a reliable tool that can assist in timely evaluating children who qualify for Paediatric Palliative Care. The tool can be used in Italian healthcare settings with its cultural adaptation. What is Known: • Despite the lack of early diagnosis techniques, there is a significant increase in the number of children entitled to Paediatric Palliative Care. • A specific screening tool called the Paediatric Palliative Screening Scale determines a child's suitability for paediatric palliative treatment. What is New: • The Paediatric Palliative Screening Scale is necessary to assess the psychosocial needs of patients eligible for Paediatric Palliative Care. The Italian scale has good content and face validity ensuring equivalence between the original and target populations. [ABSTRACT FROM AUTHOR]

The integration of Artificial Intelligence (AI) in the FinTech industry has significantly reshaped operational workflows, product innovation, and risk management, all of which are pivotal to company valuation. This study investigates the impact of AI-enhanced multilayer networks on FinTech valuation, introducing a novel, scalable multilayer network model with AI-driven Copula Nodes that serve as connectors across operational layers. By incorporating AI, the research unveils a dynamic and interconnected approach to FinTech valuation, revealing new pathways for value co-creation through real-time adjustments and predictive capabilities. The research reveals that while operational efficiency is a major driver of market value, a balanced integration of AI across risk management, product innovation, and market perception is essential for maximizing value. Additionally, the findings highlight the importance of managing AI-driven risks such as algorithmic bias and regulatory challenges. This comprehensive framework offers critical insights for FinTechs, investors, and regulators seeking to understand the complex role of AI in enhancing valuation within the evolving financial services landscape. [ABSTRACT FROM AUTHOR]

Digital signatures are widely deployed to authenticate the source of incoming information, or to certify data integrity. Common signature verification procedures return a decision (accept/reject) only at the very end of the execution. If interrupted prematurely, however, the verification process cannot infer any meaningful information about the validity of the given signature. This limitation is due to the algorithm design solely, and it is not inherent to signature verification. In this work, we provide a formal framework to extract information from prematurely interrupted signature verification, independently of why the process halts: we propose a generic verification procedure that progressively builds confidence on the final decision. Our transformation builds on a simple but powerful intuition and applies to a wide range of existing schemes considered to be post-quantum secure, including some lattice-based and multivariate equations based constructions. We demonstrate the feasibility of our approach through an implementation on off-the-shelf resource-constrained devices. In particular, an intensive testing activity has been conducted measuring the increase of performance on three IoT boards—i.e., Arduino, Raspberry, and Espressif—and a consumer-grade laptop. While the primary motivation of progressive verification is to mitigate unexpected interruptions, we show that verifiers can leverage it in two innovative ways. First, progressive verification can be used to intentionally adjust the soundness of the verification process. Second, our transformation splits verification into a computationally intensive offline set-up (run once), and an efficient online verification that is faster than the original algorithm. We conclude showing how to tweak our compiler for progressive verification to work on a wide range of signatures with properties, on three real-life use cases, and in combination with efficient verification. [ABSTRACT FROM AUTHOR]

Ecosystem restoration is inherently a complex activity with inevitable tradeoffs in environmental and societal outcomes. These tradeoffs can potentially be large when policies and practices are focused on single outcomes versus joint achievement of multiple outcomes. Few studies have assessed the tradeoffs in Nature's Contributions to People (NCP) and the distributional equity of NCP from forest restoration strategies. Here, we optimized a defined forest restoration area across India with systematic conservation planning to assess the tradeoffs between three NCP: i) climate change mitigation NCP, ii) biodiversity value NCP (habitat created for forest-dependent mammals), and iii) societal NCP (human direct use of restored forests for livelihoods, housing construction material, and energy). We show that restoration plans aimed at a single-NCP tend not to deliver other NCP outcomes efficiently. In contrast, integrated spatial forest restoration plans aimed at achievement of multiple outcomes deliver on average 83.3% (43.2 to 100%) of climate change mitigation NCP, 89.9% (63.8 to 100%) of biodiversity value NCP, and 93.9% (64.5 to 100%) of societal NCP delivered by single-objective plans. Integrated plans deliver NCP more evenly across the restoration area when compared to other plans that identify certain regions such as the Western Ghats and north-eastern India. Last, 38 to 41% of the people impacted by integrated spatial plans belong to socioeconomically disadvantaged groups, greater than their overall representation in India's population. Moving ahead, effective policy design and evaluation integrating ecosystem protection and restoration strategies can benefit from the blueprint we provide in this study for India. [ABSTRACT FROM AUTHOR]

Background: Immunoglobulin (Ig) glycosylation modulates the immune response and plays a critical role in ageing and diseases. Studies have mainly focused on IgG glycosylation, and little is known about the genetics and epidemiology of IgA glycosylation. Methods: We generated, using a novel liquid chromatography-mass spectrometry method, the first large-scale IgA glycomics dataset in serum from 2423 twins, encompassing 71 N- and O-glycan species. Results: We showed that, despite the lack of a direct genetic template, glycosylation is highly heritable, and that glycopeptide structures are sex-specific, and undergo substantial changes with ageing. We observe extensive correlations between the IgA and IgG glycomes, and, exploiting the twin design, show that they are predominantly influenced by shared genetic factors. A genome-wide association study identified eight loci associated with both the IgA and IgG glycomes (ST6GAL1, ELL2, B4GALT1, ABCF2, TMEM121, SLC38A10, SMARCB1, and MGAT3) and two novel loci specifically modulating IgA O-glycosylation (C1GALT1 and ST3GAL1). Validation of our findings in an independent cohort of 320 individuals from Qatar showed that the underlying genetic architecture is conserved across ancestries. Conclusions: Our study delineates the genetic landscape of IgA glycosylation and provides novel potential functional links with the aetiology of complex immune diseases, including genetic factors involved in IgA nephropathy risk. [ABSTRACT FROM AUTHOR]

Background: Vitamin A is essential for physiological processes like vision and immunity. Vitamin A's effect on gut microbiome composition, which affects absorption and metabolism of other vitamins, is still unknown. Here we examined the relationship between gut metagenome composition and six vitamin A-related metabolites (two retinoid: -retinol, 4 oxoretinoic acid (oxoRA) and four carotenoid metabolites, including beta-cryptoxanthin and three carotene diols). Methods: We included 1053 individuals from the TwinsUK cohort with vitamin A-related metabolites measured in serum and faeces, diet history, and gut microbiome composition assessed by shotgun metagenome sequencing. Results were replicated in 327 women from the ZOE PREDICT-1 study. Results: Five vitamin A-related serum metabolites were positively correlated with microbiome alpha diversity (r = 0.15 to r = 0.20, p < 4 × 10−6). Carotenoid compounds were positively correlated with the short-chain fatty-acid-producing bacteria Faecalibacterium prausnitzii and Coprococcus eutactus. Retinol was not associated with any microbial species. We found that gut microbiome composition could predict circulating levels of carotenoids and oxoretinoic acid with AUCs ranging from 0.66 to 0.74 using random forest models, but not retinol (AUC = 0.52). The healthy eating index (HEI) was strongly associated with gut microbiome diversity and with all carotenoid compounds, but not retinoids. We investigated the mediating role of carotenoid compounds on the effect of a healthy diet (HEI) on gut microbiome diversity, finding that carotenoids significantly mediated between 18 and 25% of the effect of HEI on gut microbiome alpha diversity. Conclusions: Our results show strong links between circulating carotene compounds and gut microbiome composition and potential links to a healthy diet pattern. [ABSTRACT FROM AUTHOR]

Pre-exposure prophylaxis (PrEP) is an effective tool for human immunodeficiency virus (HIV) prevention. The purpose of this study is to identify correlates of PrEP retention using patient data from an urban, publicly funded safety-net clinic in Washington, DC. Cox proportional hazards regression, logistical regression, and survival curves were used to assess the association of age, gender, race/ethnicity, insurance, number of partners, and sexually transmitted infection (STI) diagnosis at PrEP initiation with time on PrEP. From August 2016-December 2020, 1,126 people were prescribed PrEP - patients were mostly Black (44.8%) or Latinx (30.4%) and identified as cisgender men (84.6%). Half had no insurance (49.1%), with the remaining patients reporting private (28.9%) or public (21.5%) insurance. Age at PrEP prescription ranged from 15 to 66 with 80% being 20 to 39 years. For the 87.7% (n = 987) of patients who discontinued PrEP, mean PrEP time was 158 days and median was 28 days. The highest rates of discontinuation were observed within the first month with 44.3% discontinuing by day 30, 52.3% by 3 months, and 73.2% by 1 year. Cisgender women, transgender persons, and those younger than 30 years were more likely to discontinue PrEP. Latinx and patients with less than 3 male partners in the last 90 days were less likely to discontinue PrEP. We demonstrated a high level of PrEP uptake among populations disproportionally affected by HIV. Future analyses are needed to examine ways of reducing barriers to PrEP initiation and improving PrEP adherence. [ABSTRACT FROM AUTHOR]

Background: Toxoplasmosis is a parasitic infection caused by Toxoplasma gondii and is responsible for gestational and congenital infections worldwide. The current standard therapy is based on the administration of Spiramycin to prevent trans‐placental transmission. Other therapies are being studied to reduce the rates of foetal transmission and symptomatic congenital infection. Objectives: We report our long‐standing experience in maternal toxoplasmosis infection treatment using a combination of Spiramycin–Cotrimoxazole, assessing its effectiveness in preventing vertical transmission compared to the expected incidence of congenital infection. Methods: We retrospectively collected cases of pregnant women referred to our centre for suspected toxoplasmosis infection according to Lebech criteria, treated with Spiramycin–Cotrimoxazole. Results: Of 1364 women referred to our centre, postnatal follow‐up of primary toxoplasmosis was available in 562 cases (73.9%). The overall vertical transmission rate was 3.4% in women treated immediately with Spiramycin–Cotrimoxazole after the diagnosis of infection. In comparison, it was 7.7% in women undergoing the same therapy but late or with poor compliance. The foetal transmission rate was 71.4% in untreated cases. All the infected newborns of mother treated adequately with Spiramycin–Cotrimoxazole were asymptomatic afterbirth, while 6/21 infected infants of the inadequate Spiramycin–Cotrimoxazole therapy group had postnatal sequelae (28.5%). The incidence of transmission after appropriate Spiramycin–Cotrimoxazole therapy was significantly lower than the expected rate reported in literature. Conclusions: A combination of Spiramycin and Cotrimoxazole is safe and effective in preventing foetal congenital toxoplasmosis and reducing sequelae in case of in‐utero infection. The timing and adherence to the therapy are crucial to lowering the risk of congenital infection and neonatal morbidity. [ABSTRACT FROM AUTHOR]

Background: Acute mesenteric ischaemia (AMI) is a life-threatening disease where early diagnosis is critical to avoid morbidity and mortality from extensive irreversible bowel necrosis. Appropriate prediction of presence of bowel necrosis is currently not available but would help to choose the optimal method of treatment. The study aims to identify combinations of biomarkers that can reliably identify AMI and distinguish between potentially reversible and irreversible bowel ischaemia. Methods: This is a prospective multicentre study. Adult patients with clinical suspicion of AMI (n = 250) will be included. Blood will be sampled on admission, at and after interventions, or during the first 48 h of suspicion of AMI if no intervention undertaken. Samples will be collected and the following serum or plasma biomarkers measured at Tartu University Hospital laboratory: intestinal fatty acid-binding protein (I-FABP), alpha-glutathione S-transferase (Alpha- GST), interleukin 6 (IL-6), procalcitonin (PCT), ischaemia-modified albumin (IMA), D-lactate, D-dimer, signal peptide-CUB-EGF domain-containing protein 1 (SCUBE-1) and lipopolysaccharide-binding protein (LBP). Additionally, more common laboratory markers will be measured in routine clinical practice at study sites. Diagnosis of AMI will be confirmed by computed tomography angiography, surgery, endoscopy or autopsy. Student's t or Wilcoxon rank tests will be used for comparisons between transmural vs. suspected (but not confirmed) AMI (comparison A), confirmed AMI of any stage vs suspected AMI (comparison B) and non-transmural AMI vs transmural AMI (comparison C). Optimal cut-off values for each comparison will be identified based on the AUROC analysis and likelihood ratios calculated. Positive likelihood ratio > 10 (> 5) and negative likelihood ratio < 0.1 (< 0.2) indicate high (moderate) diagnostic accuracy, respectively. All biomarkers with at least moderate accuracy will be entered as binary covariates (using the best cutoffs) into the multivariable stepwise regression analysis to identify the best combination of biomarkers for all comparisons separately. The best models for each comparison will be used to construct a practical score to distinguish between no AMI, non-transmural AMI and transmural AMI. Discussion: As a result of this study, we aim to propose a score including set of biomarkers that can be used for diagnosis and decision-making in patients with suspected AMI. Trial registration: NCT06212921 (Registration Date 19–01-2024). [ABSTRACT FROM AUTHOR]

Do female public servants receive a stronger negative public reaction from being involved in corruption than their male counterparts? While there are good theoretical reasons to suggest they do, the empirical evidence on this question to date, which primarily focuses on elected officials, remains inconclusive. To shed new light on this matter, we investigate a larger but hitherto understudied group: street-level bureaucrats. Using a conjoint experiment conducted in Paraguay, one of the most corrupt countries in Latin America, we evaluate public preferences for corrupt versus non-corrupt bureaucrats. Contrary to existing theories of gender and corruption, our results suggest there is no significant difference in how citizens react to male and female corrupt bureaucrats. [ABSTRACT FROM AUTHOR]

The article describes a mother-infant dyadic therapy from the early stages of pregnancy through the first year of life of the baby. The historic context is the height of the Covid-19 pandemic, which forces the therapy to be remote, and the focus is on the dyad's search for a level of closeness that the mother can tolerate, as she battles feelings of anxiety and depletion, and that is nurturing for the baby. The therapist and mother's alliance in creating a virtual space for all to feel cared for is described, as the therapist gives voice to the mother's struggles and hopes, and lends her voice to the baby's needs and wishes. [ABSTRACT FROM AUTHOR]

Accurate prognosis and diagnosis are crucial for selecting and planning lung cancer treatments. As a result of the rapid development of medical imaging technology, the use of computed tomography (CT) scans in pathology is becoming standard practice. An intricate interplay of requirements and obstacles characterizes computer-assisted diagnosis, which relies on the precise and effective analysis of pathology images. In recent years, pathology image analysis tasks such as tumor region identification, prognosis prediction, tumor microenvironment characterization, and metastasis detection have witnessed the considerable potential of artificial intelligence, especially deep learning techniques. In this context, an artificial intelligence (AI)-based methodology for lung cancer diagnosis is proposed in this research work. As a first processing step, filtering using the Butterworth smooth filter algorithm was applied to the input images from the LUNA 16 lung cancer dataset to remove noise without significantly degrading the image quality. Next, we performed the bi-level feature selection step using the Chaotic Crow Search Algorithm and Random Forest (CCSA-RF) approach to select features such as diameter, margin, spiculation, lobulation, subtlety, and malignancy. Next, the Feature Extraction step was performed using the Multi-space Image Reconstruction (MIR) method with Grey Level Co-occurrence Matrix (GLCM). Next, the Lung Tumor Severity Classification (LTSC) was implemented by using the Sparse Convolutional Neural Network (SCNN) approach with a Probabilistic Neural Network (PNN). The developed method can detect benign, normal, and malignant lung cancer images using the PNN algorithm, which reduces complexity and efficiently provides classification results. Performance parameters, namely accuracy, precision, F-score, sensitivity, and specificity, were determined to evaluate the effectiveness of the implemented hybrid method and compare it with other solutions already present in the literature. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to evaluate the association between ethnic minority membership and their knowledge about their human health rights in Peru. Design/methodology/approach: A secondary analysis of the National Health User Satisfaction Survey 2015–2016 was conducted using an analytical cross-sectional design. Participants who spoke Quechua, Aymara, Awajun, Bora or a language other than Spanish aged 15 year were considered as a racial minority. The question "Do you know that by law you have health rights?" was applied to incorporate knowledge on health rights. Generalized linear models of the Poisson distribution were used to calculate crude prevalence ratio and adjusted prevalence ratio. A total of 3,721 responses were included in the analysis. Findings: The average age was 38.3 year, and 26.6% were males. The prevalence of belonging to an ethnic minority was 7.7%, and 27.6% of the participants did not know about their health rights. An association was found in the adjusted regression analysis between belonging to an ethnic minority and a greater probability of not knowing human health rights. Originality/value: The value of the works lies in one in four participants who did not know he had health rights by law. Belonging to an ethnic minority was associated with not knowing about having human health rights. [ABSTRACT FROM AUTHOR]

The phonocardiogram (PCG) can be used as an affordable way to monitor heart conditions. This study proposes the training and testing of several classifiers based on SVMs (support vector machines), k-NN (k-Nearest Neighbor), and NNs (neural networks) to perform binary ("Normal"/"Pathologic") and multiclass ("Normal", "CAD" (coronary artery disease), "MVP" (mitral valve prolapse), and "Benign" (benign murmurs)) classification of PCG signals, without heart sound segmentation algorithms. Two datasets of 482 and 826 PCG signals from the Physionet/CinC 2016 dataset are used to train the binary and multiclass classifiers, respectively. Each PCG signal is pre-processed, with spike removal, denoising, filtering, and normalization; afterward, it is divided into 5 s frames with a 1 s shift. Subsequently, a feature set is extracted from each frame to train and test the binary and multiclass classifiers. Concerning the binary classification, the trained classifiers yielded accuracies ranging from 92.4 to 98.7% on the test set, with memory occupations from 92.7 kB to 11.1 MB. Regarding the multiclass classification, the trained classifiers achieved accuracies spanning from 95.3 to 98.6% on the test set, occupying a memory portion from 233 kB to 14.1 MB. The NNs trained and tested in this work offer the best trade-off between performance and memory occupation, whereas the trained k-NN models obtained the best performance at the cost of large memory occupation (up to 14.1 MB). The classifiers' performance slightly depends on the signal quality, since a denoising step is performed during pre-processing. To this end, the signal-to-noise ratio (SNR) was acquired before and after the denoising, indicating an improvement between 15 and 30 dB. The trained and tested models occupy relatively little memory, enabling their implementation in resource-limited systems. [ABSTRACT FROM AUTHOR]

Objectives : Petrous bone cholesteatoma (PBC) is a rare condition of the petrous portion of the temporal bone. Treatment of choice consists of radical surgical removal, paying attention to protect the facial nerve and inner ear as far as possible. The aim of the present study was to evaluate the efficacy of modified translabyrinthine techniques in preserving hearing function and the use of the adjuvant endoscopic techniques in a group of PBC patients. Methods : This study comprised 16 cases of PBCs surgically treated in our Department. Pre- and post-operative hearing status was assessed with pure tone audiometry and speech discrimination and graded according to the Gardner- Robertson classification system. Facial function was based on the House Brackman (HB) classification. PBCs were grouped using Sanna's classification. The choice of surgical technique was based on the above findings together with preoperative evidence. Post-operative follow-up ranged from 1 to 10 years and also included Computed Tomography and Magnetic Resonance Imaging assessment. Results : PBCs were classified as follows: 37.5% infralabyrinthine; 43.75% supralabyrinthine; and 18.75% massive. Preservation of the bone conduction threshold was feasible in 62.5% of patients. For supralabyrinthine PBCs a subtotal petrosetomy was performed in all cases and hearing preservation was possible in 57% of them: an adjuvant endoscopic approach was performed in 43%. Infralabyrinthine PBCs were treated using a modified translabyrinthine approach with preservation of bone conduction in 83% of patients; an adjuvant endoscopic approach was performed in 50% cases. One patient with a massive cholesteatoma was treated by modified translabyrinthine approach, preserving a serviceable level of hearing. In all massive cases, an adjuvant endoscopic approach was performed. In 2 patients with preoperative palsy, facial nerve function showed an improvement. The follow-up period revealed evidence of limited recurrence at CT imaging in 2 patients. Conclusions : The introduction of modified surgical approaches, able to preserve the anatomical-functional structures, have shown an improvement of post-operative hearing outcomes. [ABSTRACT FROM AUTHOR]

Background Primary care clinicians play a critical role in diagnosis and treatment of migraine, yet barriers exist. This national survey assessed barriers to diagnosis and treatment of migraine, preferred approaches to receiving migraine education, and familiarity with recent therapeutic innovations. Methods The survey was created by the American Academy of Family Physicians (AAFP) and Eli Lilly and Company and distributed to a national sample through the AAFP National Research Network and affiliated PBRNs from mid-April through the end of May 2021. Initial analyses were descriptive statistics, ANOVAs, and Chi-Square tests. Individual and multivariate models were completed for: adult patients seen in a week; respondent years since residency; and adult patients with migraine seen in a week. Results Respondents who saw fewer patients were more likely to indicate unclear patient histories were a barrier to diagnosing. Respondents who saw more patients with migraine were more likely to indicate the priority of other comorbidities and insufficient time were barriers to diagnosing. Respondents who had been out of residency longer were more likely to change a treatment plan due to attack impact, quality of life, and medication cost. Respondents who had been out of residency shorter were more likely to prefer to learn from migraine/headache research scientists and use paper headache diaries. Conclusions Results demonstrate differences in familiarity with migraine diagnosis and treatment options based on patients seen and years since residency. To maximise appropriate diagnosis within primary care, targeted efforts to increase familiarity and decrease barriers to migraine care should be implemented. [ABSTRACT FROM AUTHOR]