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Marcella Nebbioso,1,* Antonietta Moramarco,1,* Alessandro Lambiase,1 Sandra Giustini,2 Marco Marenco,1 Emanuele Miraglia,2 Pasquale Fino,2 Chiara Iacovino,2 Ludovico Alisi1 1Department of Sense Organs, Sapienza University of Rome, Rome, Italy; 2Department of Dermatology, Sapienza University of Rome, Rome, Italy*These authors contributed equally to this workCorrespondence: Alessandro LambiaseDepartment of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, ItalyTel +390649975357Fax +390649975425Email alessandro.lambiase@uniroma1.itIntroduction: Neurofibromatosis type 1 (NF1) is a multisystemic disease caused by the mutation of Nf1 gene located on chromosome 17q11.2. The mutation determines the loss of function of the protein neurofibromin with consequent uncontrolled cellular proliferation. Patients are characterized by a wide range of dermatological, neurological, and ophthalmological symptoms.Purpose: The aim of the study was to evaluate, through pattern visual evoked potentials (p-VEPs) and frequency doubling technology (FDT) Matrix perimetry, the objective and psychophysical functionality of the optic pathways in a group of NF1 patient.Methods: The study group consisted of 26 patients affected by NF1 and 17 healthy controls. Each patient underwent a complete ophthalmological examination, p-VEPs with the evaluation of amplitude and latency of the P100 wave, and FDT perimetry, with the evaluation of central sensitivity (CS), mean deviation (MD), pattern standard deviation (PSD) and glaucoma hemifield test (GHT).Results: NF1 patients showed a statistically significant alteration in the transmission of visual impulse. P-VEPs results highlighted a reduced amplitude and an increased latency of the P100 wave, suggesting an involvement of the visual pathway. Visual field analysis showed a significant reduction in all the observed parameters as well (CS, MD, PSD, and GHT).Conclusion: The present study showed, in NF1 patients, a qualitative and quantitative alteration in the conduction of stimuli through the visual pathways. The observed alterations are present, although, only at a subclinical level. None of the patients included in the study showed any manifest visual deficit nor had any concomitant pathology that might have affected the outcome of the study. In conclusion, electrophysiological exams and computer perimetry may take part, alongside a wider array of exams, in the differential diagnosis and later monitoring of NF1.Keywords: electrophysiologic testing, frequency doubling technology Matrix perimetry, FDT, neurofibromatosis type 1, optic glioma, pattern visual evoked potentials

Thermoplastic poly(phenylene oxide) (PPO)-matrix composites were prepared and characterized in order to evaluate the effect of different ceramic fillers on the thermal and combustion behavior of the matrix. In particular, ceramic particles having three different shapes were exploited as fillers, particles showing a platelet-like, a needle-like or an equiaxial morphology. The composite materials were produced through a melt blending method, which yielded a homogeneous distribution of the ceramic particles in the organic matrix. It was demonstrated that the presence of the inorganic particles influenced the temperature range in which the degradation processes of the polymer occurred. In addition, the three fillers modified the thermal behavior of PPO differently in terms of enthalpy. Finally, the presence of the filler induced a change in combustion behavior of the polymeric matrix; in particular, sepiolite was able to increase the charring ability of the PPO/polystyrene blend with the development of a visible carbonaceous layer.

Abstract Atopic dermatitis (AD) is a highly heterogeneous chronic inflammatory skin disorder that is frequently associated with a plethora of comorbidities. AD is, therefore, considered a systemic disease impacted by a considerable burden and leading to poor quality of life, especially in patients with moderate-to-severe disease. Since atopic and non-atopic comorbidities can further worsen the disease course, accurate establishment of the patient’s individual intrinsic risk profile and needs is crucial and may help in guiding the selection of the best treatment option. Better quality of care for patients with AD can be delivered through a multidisciplinary team led by a dermatologist, for comprehensive patient management. The implementation of a multidisciplinary approach for AD could enhance the delivery of optimised and safe treatments, improve the standard of care and patient outcomes in the short and long term, and prevent or delay the lifelong impact of uncontrolled AD. Understanding the unmet needs, assessing correctly the patient risk profile and enhancing the shared patient–physician decision-making process can lead to disease control and quality-of-life improvement, especially in the context of the introduction of newer treatment for AD. This narrative review is a call for more data to establish standardised patient profiles and multidisciplinary strategies in AD management. In view on the fast-evolving treatments for AD, this review aims at highlighting the importance of a multidisciplinary approach to a comprehensive assessment and holistic care in patients with moderate-to-severe AD.

Abstract Purpose Blue sclera is a characteristic and common clinical sign of Osteogenesis Imperfecta (OI). However, there is currently no widely accepted, objective method for assessing and grading blue sclera in individuals with OI. To address this medical need, this study is aimed to design and validate a new method called ‘BLUES’ (BLUe Eye Sclera) to objectively identify and quantify the blue color in the sclera of patients affected by OI. Methods Sixty-two patients affected by OI and 35 healthy controls were enrolled in the present prospective study, for a total of 194 eyes analyzed. In the 'BLUES' procedure, eye images from patients with OI and control subjects were analyzed to assess and grade the blue level of the sclera using Adobe Photoshop Software. The validation process then involved comparing the results obtained with the ‘BLUES’ procedure to the judgement of experienced ophthalmologists (JEO). A receiver-operating characteristic (ROC) curve analysis was used to examine the overall discriminatory power. The sensitivity and specificity levels and the Cohen's Kappa (K) indexes of ‘BLUES’ and ‘JEO’ were estimated versus the standard OI diagnosis. The K indexes of ‘BLUES’ versus ‘JEO’ were also evaluated. Results The optimal cut-off point of the scleral blue peak was calculated at 17%. Our findings demonstrated a sensitivity of 89% (CI95%: 0.835–0.945) and specificity of 87% (CI95%: 0.791–0.949) for the ‘BLUES’ procedure with an agreement versus the diagnosis of OI of 0.747. In comparison, the sensitivity and specificity of ‘JEO’ ranged from 89 to 94% and 77% to 100%, respectively, with an agreement ranging from 0.663 to 0.871 with the diagnosis of OI. The agreement between ‘BLUES ‘and ‘JEO’ evaluations ranged from 0.613 to 0.734. Conclusions Our findings demonstrated an 89% sensitivity and an impressive 87% specificity of our method to analyze the blue sclera in OI. The results indicated high agreement with disease diagnosis and were consistent with evaluations by experienced ophthalmologists. The ‘BLUES’ procedure appears to be a simple, reliable and objective method for effectively identify and quantify the blue color of the sclera in OI.

We previously established a thermodynamical model to calculate the specific frequencies of extremely low frequency-electromagnetic field (ELF-EMF) able to arrest the growth of cancer cells. In the present study, for the first time, we investigated the efficacy of this technology on osteosarcoma, and we applied a precise frequency of the electromagnetic field on three human osteosarcoma cell lines, grown as adherent cells and spheroids. We evaluated the antitumour efficacy of irradiation in terms of response to chemotherapeutic treatments, which is usually poor in this type of cancer. Importantly, the results of this novel combinatorial approach revealed that the specific exposure can potentiate the efficacy of several chemotherapeutic drugs, both on bidimensional and tridimensional cancer models. The effectiveness of cisplatinum, methotrexate, ifosfamide and doxorubicin was greatly increased by the concomitant application of the specific ELF-EMF. Moreover, our experiments confirmed that ELF-EMF inhibited the proliferation and modulated the mitochondrial metabolism of all cancer models tested, whereas mesenchymal cells were not affected. The latter finding is extremely valuable, given the importance of preserving the cell reservoir necessary for tissue regeneration after chemotherapy. Altogether, this novel evidence opens new avenues to the clinical applications of ELF-EMF in oncology.

Abstract In Italy the fertility rate is very low, and an increasing number of patients are infertile and require treatments. The Italian Law concerning the safety of patient care, and the professional liability of health professionals, indicates that health professionals must comply with the recommendations set out in the guidelines developed by public and private bodies and institutions, as well as scientific societies and technical-scientific associations of the health professions, except for specific cases. Unfortunately, no guideline for the diagnosis and the management of infertility is currently available in Italy. In 2019, the Italian Society of Human Reproduction pointed out the need to produce Italian guidelines and subsequently approved the establishment of a multidisciplinary and multiprofessional working group (MMWG) to develop such a guideline. The MMWG was representative of 5 scientific societies, one national federation of professional orders, 3 citizens' and patients' associations, 5 professions (including lawyer, biologist, doctor, midwife, and psychologist), and 3 medical specialties (including medical genetics, obstetrics and gynecology, and urology). The MMWG chose to adapt a high-quality guideline to the Italian context instead of developing one from scratch. Using the Italian version of the Appraisal of Guidelines for Research and Evaluation II scoring system, the National Institute of Clinical Excellence guidelines were selected and adapted to the Italian context. The document was improved upon by incorporating comments and suggestions where needed. This study presents the process of adaptation and discusses the pros and cons of the often-neglected choice of adapting rather than developing new guidelines.

ABSTRACTThis current study investigates the effect of Direct Energy Deposition (DED) process conditions on the properties and microstructure of M300 maraging steel samples. The investigation centers on two key factors: laser power and deposition environment. The microstructure of this tool steel is analyzed by computing the Primary Cellular Arm Spacing. The findings revealed a significant influence of both inert atmosphere and laser power on cooling conditions. These different cooling rates influence the phase content as demonstrated by X-Ray Diffraction and Electron Backscatter Diffraction measurements. It was demonstrated the presence of different content of residual austenite at cell boundaries. These distinct microstructural features caused variations in the hardness values of the printed samples. Furthermore, a direct aging heat treatment was implemented, that was chosen from Differential Scanning Calorimetry measurements results. This heat treatment proves effective in achieving consistent hardness increases and eliminated the differences among samples built in different process conditions. This outcome suggests the possibility of selecting the most economically viable DED parameters for optimal results.

Mutations in the human PURA gene cause the neurodevelopmental PURA syndrome. In contrast to several other monogenetic disorders, almost all reported mutations in this nucleic acid-binding protein result in the full disease penetrance. In this study, we observed that patient mutations across PURA impair its previously reported co-localization with processing bodies. These mutations either destroyed the folding integrity, RNA binding, or dimerization of PURA. We also solved the crystal structures of the N- and C-terminal PUR domains of human PURA and combined them with molecular dynamics simulations and nuclear magnetic resonance measurements. The observed unusually high dynamics and structural promiscuity of PURA indicated that this protein is particularly susceptible to mutations impairing its structural integrity. It offers an explanation why even conservative mutations across PURA result in the full penetrance of symptoms in patients with PURA syndrome.

In this article, we consider the Cauchy problem for a semi-linear wave equation with time-dependent damping and memory nonlinearity. Conditions for global existence are presented in the energy space H1(Rn)×L2(Rn){H}^{1}\left({{\mathbb{R}}}^{n})\times {L}^{2}\left({{\mathbb{R}}}^{n}), n≥1n\ge 1.

In recent years, advanced digital technologies have driven an outstanding paradigm shift in the field of architectural heritage, particularly for building modelling, historical documentation and touristic promotion. Nonetheless, they show great potentialities in the field of assessment and control of the state of conservation of heritage buildings. In particular, close-range and aerial photogrammetry have increasingly relied on low-cost and user-friendly tools and procedures, with a high degree of automation that makes them accessible to specialists who are foremost involved in architectural diagnosis and conservation, rather than in remote sensing sciences. In this framework, this paper provides a scoping review of 117 publications, based on the PRISMA protocol, from Scopus and Web of Science databases, related to the employment of photogrammetric models and methods, with specific focus on the targets and purposes of the diagnostic process, including decay mapping, structural monitoring and modelling, non-destructive investigation and multi-source documentation. In detail, the results point out that current studies mainly support robust processing of large amounts of information from direct observation of surface alterations, systematic correlation between materials, construction characteristics, visible anomalies and experimental measurements, as well as multi-disciplinary collaborative workflows through remote inspection and harmonized data management. Further improvements were identified, including standardization of acquisition procedures, automatization of elaboration pipelines, integration of real-time data, validation of diagnosis decision-making support tools and scalability to networks of assets.

The construction of tunnels excavated by the conventional method in densely populated urban environments requires an adequate characterization of the loads acting on the primary lining during the excavation process, to ensure that the ground is deformed and stresses around the tunnel are relieved, simultaneously complying with the failure and serviceability limits of international standards while minimizing damage to nearby structures. In this paper, common lining design criteria are revisited, through the numerical simulation of an instrumented tunnel section which is part of a 4.5 km long metro line currently under construction in Mexico City. Key needs for improvement in current design approaches are identified. The tunnel was instrumented with load cells, extensometers, and topographical references for convergences and divergences. A three-dimensional finite difference model of the instrumented section was developed, and the load transfer mechanisms between the excavated soil and the primary lining were analyzed. Then, the numerical simulation of the contribution of the secondary lining in the overall stability for sustained load was established, along with the expected ground settlements, which can significantly affect nearby structures. Results gathered from this research are key for updating lining design criteria for urban tunnels built in stiff brittle soils.

Gamification, the integration of game design elements into non-game contexts, has gained prominence in the software engineering education and training realm. By incorporating elements such as points, badges, quests, and challenges, gamification aims to motivate and engage learners, potentially transforming traditional educational methods. This paper addresses the gap in systematic evaluations of gamification’s effectiveness in software engineering education and training by conducting a comprehensive literature review of 68 primary studies. This review explores the advantages of gamification, including active learning, individualized pacing, and enhanced collaboration, as well as the psychological drawbacks such as increased stress and responsibility for students. Despite the promising results, this study highlights that gamification should be considered a supplementary tool rather than a replacement for traditional teaching methods. Our findings reveal significant interest in integrating gamification in educational settings, driven by the growing need for digital content to improve learning.

In recent years, additive manufacturing (AM) has played a significant role in various fashion industries, especially the textile and jewelry manufacturing sectors. This review article delves deeply into the wide range of methods and materials used to make intricately designed jewelry fabrication using the additive manufacturing (AM) process. The Laser Powder Bed Fusion (L-PBF) process is examined for its suitability in achieving complex design and structural integrity in jewelry fabrication even with respect to powder metallurgy methods. Moreover, the review explores the use of precious materials, such as gold, silver, copper, platinum, and their alloys in additive manufacturing. Processing precious materials is challenging due to their high reflectivity and thermal conductivity, which results in poor densification and mechanical properties. To address this issue, the review article proposes three different strategies: (i) adding alloying elements, (ii) coating powder particles, and (iii) using low-wavelength lasers (green or blue). Finally, this review examines crucial post-processing techniques to improve surface quality, robustness, and attractiveness. To conclude, this review emphasizes the potential of combining additive manufacturing (AM) with traditional craftsmanship for creating jewelry, exploring the potential future directions and developments in the field of additive manufacturing (AM) for jewelry fabrication.

Eosinophilic gastroenteritis (EGE) is a rare disease which mainly consists of an abnormal eosinophile infiltration of the gastrointestinal tract. It’s classified according to its location: eosinophilic esophagitis, eosinophilic gastritis, eosinophilic enteritis (including duodenum, jejunum and/or ileum) and eosinophilic colitis and degree of infiltration (mucosal, muscular, serosal). Depending on eosinophile concentration, type of EGE and the patient’s condition it may manifest with different clinical presentations such as functional dyspepsia, abdominal pain, irritability, hypoproteinemia, diarrhea, anemia, among others. Few research has been done on such an uncommon pathology to the extent that treatment evidence is mostly limited to small case series. This case study reports an infrequent presentation of EGE in the small and large intestine as an undifferentiated gastrointestinal disease and successful corticoid management given to the patient in order to further broaden knowledge on this subject and facilitate an established clinical conduct for the treating physician.

Microalgae biotechnology is hampered by the high production costs and the massive usage of water during large-volume cultivations. These drawbacks can be softened by the production of high-value compounds and by adopting metabolic engineering strategies to improve their performances and productivity. Today, the most sustainable approach is the exploitation of industrial wastewaters for microalgae cultivation, which couples valuable biomass production with water resource recovery. Among the food processing sectors, the dairy industry generates the largest volume of wastewaters through the manufacturing process. These effluents are typically rich in dissolved organic matter and nutrients, which make it a challenging and expensive waste stream for companies to manage. Nevertheless, these rich wastewaters represent an appealing resource for microalgal biotechnology. In this study, we propose a sustainable approach for high-value compound production from dairy wastewaters through cyanobacteria. This strategy is based on a metabolically engineered strain of the model cyanobacterium Synechococcus elongatus PCC 7942 (already published elsewhere) for 2-phenylethanol (2-PE). 2-PE is a high-value aromatic compound that is widely employed as a fragrance in the food and cosmetics industry thanks to its pleasant floral scent. First, we qualitatively assessed the impact of four dairy effluents on cyanobacterial growth to identify the most promising substrates. Both tank-washing water and the liquid effluent of exhausted sludge resulted as suitable nutrient sources. Thus, we created an ideal buffer system by combining the two wastewaters while simultaneously providing balanced nutrition and completely avoiding the need for fresh water. The combination of 75% liquid effluent of exhausted sludge and 25% tank-washing water with a fine-tuning ammonium supplementation yielded 180 mg L−1 of 2-PE and a biomass concentration of 0.6 gDW L-1 within 10 days. The mixture of 90% exhausted sludge and 10% washing water produced the highest yield of 2-PE (205 mg L−1) and biomass accumulation (0.7 gDW L−1), although in 16 days. Through these treatments, the phosphates were completely consumed, and nitrogen was removed in a range of 74%–77%. Overall, our approach significantly valorized water recycling and the exploitation of valuable wastewaters to circularly produce marketable compounds via microalgae biotechnology, laying a promising groundwork for subsequent implementation and scale-up.

A 81-year-old male patient presented macroscopic hematuria. Flexible cystoscopy didn't give any diagnosis and urinary citology was negative. Total body CT showed a bladder inguinal hernia with diffuse thickening of the bladder wall, while abdomen bladder was regular.Diagnosis was difficult because flexible cystoscope could not reach the lesion, preventing diagnosis and bladder resection. We decided to reduce inguinal hernia surgically and perform a partial cystectomy removing the suspect neoplastic part of the bladder. Histologic examination showed muscle invasive squamous cell carcinoma with negative margins. After two years follow up, patient was free from bladder cancer, without any significative LUTS.

A 65-year-old male patient presented a large mass of the left kidney and a concomitant saccular abdominal aortic aneurysm (AAA) of the infrarenal aorta. Due to the particular vascularization of the right kidney in order to allow an endovascular Aneurysm Repair (EVAR), a hybrid staged repair was planned. Through a median laparotomy, a left radical nephrectomy and an ilio-renal bypass were performed, thus creating the anatomical feasibility for subsequent EVAR. Two days later the AAA was excluded by positioning of an abdominal straight stent graft. This original surgical strategy showed to be effective and reduced invasiveness of traditional approach.

Spontaneous smiles in response to politicians can serve as an implicit barometer for gauging electorate preferences. However, it is unclear whether a subtle Duchenne smile-an authentic expression involving the coactivation of the zygomaticus major (ZM) and orbicularis oculi (OO) muscles-would be elicited while reading about a favored politician smiling, indicating a more positive disposition and political endorsement. From an embodied simulation perspective, we investigated whether written descriptions of a politician's smile would trigger morphologically different smiles in readers depending on shared or opposing political orientation. In a controlled reading task in the laboratory, participants were presented with subject-verb phrases describing left and right-wing politicians smiling or frowning. Concurrently, their facial muscular reactions were measured via electromyography (EMG) recording at three facial muscles: the ZM and OO, coactive during Duchenne smiles, and the corrugator supercilii (CS) involved in frowning. We found that participants responded with a Duchenne smile detected at the ZM and OO facial muscles when exposed to portrayals of smiling politicians of same political orientation and reported more positive emotions towards these latter. In contrast, when reading about outgroup politicians smiling, there was a weaker activation of the ZM muscle and no activation of the OO muscle, suggesting a weak non-Duchenne smile, while emotions reported towards outgroup politicians were significantly more negative. Also, a more enhanced frown response in the CS was found for ingroup compared to outgroup politicians' frown expressions. Present findings suggest that a politician's smile may go a long way to influence electorates through both non-verbal and verbal pathways. They add another layer to our understanding of how language and social information shape embodied effects in a highly nuanced manner. Implications for verbal communication in the political context are discussed.

We examined the antibiotic prescribing rate for respiratory diagnoses (AXR) before and after onset of the COVID-19 pandemic in urgent care clinics. At the onset, AXR declined substantially due to changes in case mix. Using AXR as a stewardship metric requires monitoring of changes in case mix.

Providing employees with proper work conditions should be one of the main concerns of any employer. Even so, in many cases, work shifts chronically expose the workers to a wide range of potentially harmful compounds, such as ammonia. Ammonia has been present in the composition of products commonly used in a wide range of industries, namely production in lines, and also laboratories, schools, hospitals, and others. Chronic exposure to ammonia can yield several diseases, such as irritation and pruritus, as well as inflammation of ocular, cutaneous, and respiratory tissues. In more extreme cases, exposure to ammonia is also related to dyspnea, progressive cyanosis, and pulmonary edema. As such, the use of ammonia needs to be properly regulated and monitored to ensure safer work environments. The Occupational Safety and Health Administration and the European Agency for Safety and Health at Work have already commissioned regulations on the acceptable limits of exposure to ammonia. Nevertheless, the monitoring of ammonia gas is still not normalized because appropriate sensors can be difficult to find as commercially available products. To help promote promising methods of developing ammonia sensors, this work will compile and compare the results published so far.

Several clinical laboratories assess sperm DNA fragmentation (sDF) in addition to semen analysis in male infertility diagnosis. Among tests evaluating sDF, TUNEL (Terminal deoxynucleotidyl transferase dUTP nick end labeling) and SCD (Sperm Chromatin Dispersion) are widely used. Our lab developed a modified version of TUNEL (TUNEL/PI) able to distinguish two sperm populations (PI Brighter and PI Dimmer) differently associated with sperm viability and reproductive outcomes. The aim of this study was to compare sDF levels detected by SCD and TUNEL/PI in the semen samples from 71 male subjects attending our Andrology Laboratory. Our results demonstrate that SCD is less sensitive in determining sDF compared to TUNEL/PI. The statistically significant positive correlation found between sDF evaluated by SCD and PI Dimmer (consisting of all dead spermatozoa) suggests that SCD mainly detects sDF in unviable spermatozoa. We confirmed that most spermatozoa detected by SCD are unviable by performing SCD after incubation in hypo-osmotic medium to discriminate viable and unviable cells in 52 samples. Such results might explain the lower ability of this test in discriminating couples having successful ART outcomes demonstrated in published metanalyses. Overall, our results indicate that SCD is less sensitive in evaluating sDF for diagnostic purposes.

The contribution fits into the framework of Digital Heritage, within the diagnostic process, leading up to restoration. Control and monitoring of architectural heritage are still open topics, with respect to requirements as simplicity, non-invasiveness and cost-effectiveness of both procedures and equipment. A peculiar gap concerns the accessibility to the artefact, which could be compromised by bad state of preservation, poor hygienic/sanitary conditions, or unsafe post-emergency circumstances, as well as by considerable extent, complex morphology, or incidental access conditions, due to the simultaneous presence of multiple working groups.In recent years, literature is moving towards an optimization of the investigation phases, by implementing digital technologies for the acquisition, elaboration and interpretation of 2D/3D data, to assess the state of conservation of a building or its main components. Besides, digital image processing and artificial intelligence are progressively rationalizing the analysis of the collected data. Furthermore, easy common devices, like spherical cameras or smartphones, have been introduced for the virtual reconstruction and representation of architectural environments, with the purpose of assessing their morphology and conditions. However, there is still an absence of harmonized standard procedures.To address these issues, the paper proposes a rapid pipeline, involving easy-to-use devices and expeditious procedures, to remotely assess, quantify, and monitor the extension of surface decay of historical buildings. A workflow based on the use of 360° images and videogrammetry has been defined and tested on a representative case study, both for its cultural value and for its limited accessibility, demonstrating a great suitability to the topic.

Background: SARS-CoV-2 virus infection causes coronavirus disease 2019 (COVID-19). Objective: Epidemiologically characterize the patient with COVID-19, Departmental Health Region of Francisco Morazán (RSDFM), Honduras, March 2020-January 2021. Methods: Retrospective descriptive study. Included n=11,401 users who underwent diagnostic confirmation in the RSDFM. General and monthly incidence of COVID-19 was calculated as rates per 10,000 inhabitants, municipal incidence rates (positive cases/10,000). Case fatality rate (deceased/100 positive cases). Results: Of the total 3,680 users, the average age of the positive cases was 36.8 years old (SD+/-17.9; female sex 53.3% (1,962), Valle de Ángeles origin 20.4% (752). The epidemiological nexus was contact with a positive family member or friend. or died from COVID-19 in 96.3% (3544).The general incidence rate was 92.4/10,000.The municipality of Valle de Ángeles presented the highest incidence rate 366.1/10,000. The fatality rate was 1.8% (68 /3680) Discussion: The findings of this study are compatible with other authors regarding the epidemiological characteristics and symptoms, identifying a higher risk of mortality in individuals aged ≥60 years (35/418 vs

Background: DNAJC12 co-chaperone protein deficiency has been recently described as a stand-alone metabolic disorder explaining many cases of mild hyperphenylalaninemia (HPA) that are not caused by variants in the PAH gene, which encodes for the hepatic enzyme phenylalanine hydroxylase (PAH), or inGCH1, PTS, QDPR, PCBD1 and DHPR, involved in tetrahydrobiopterin (BH4) biosynthesis and activity. Results: We describe two sisters born to consanguineous parents. The youngest sister (Patient 1), initially asymptomatic, tested positive at NewBorn Screening (NBS) for mild HPA. After variants in the PAH and BH4 related-genes were excluded, we performed DNAJC12 genetic analysis and found a previously described homozygous deletion [NM_021800.3: c.58_59del p.(Gly20Metfs*2)]. The older sister (Patient 2), homozygous for the same variant and exhibiting mild HPA, was diagnosed subsequently and presented with ataxia and repeated falls, upper limb dyskinesia, intentional tremor, and mild intellectual disability. Patient 1 was started on treatment with low Phenylalanine (Phe) diet, BH4, l-3,4-dihydroxyphenylalanine/carbidopa (L-DOPA) and 5-OH-Tryptophan, soon after diagnosis, and despite poor adherence to the dietary regimen, only manifested language impairment at last follow-up (age 5 years and 4 months). Patient 2, who started the same treatment at school age, experienced a minimal progression of neurological symptoms, with some improvement in her motor skills. Conclusions: These two new patients with DNAJC12-associated HPA, in addition to previous reports, point to DNAJC12 deficiency as a new metabolic syndrome that must be considered in patients with unexplained HPA.

Microalgae and cyanobacteria represent a valuable resource with great potential in the production of a large variety of high-added value products in the nutraceutical, cosmetic, pharmaceutical, and food sectors. However, the commercialization of microalgal systems and biorefineries is limited by environmental and economic sustainability concerns. Many life cycle assessments (LCAs) have been conducted so far, but they have the crucial limitation of using data extrapolated from lab-scale experiments or the literature, thus providing qualitative and uncertain projections. In this work, an industrial-scale plant's life cycle inventory (LCI) is compiled with primary data and analyzed. The plant is installed in Sicily (Italy) and has a 1200 kgDW year–1 capacity in the production of Chlorella vulgaris microalgae. The cultivation is performed in vertically stacked horizontal photobioreactors (PBRs) with a total volume of 40.4 m3. Dewatering is performed by centrifugation, producing a final algal suspension at ~200 gDW L–1. Energy, nutrients, water, chemicals, and infrastructure materials are inventoried to characterize the operation and construction. One kg of dry algae biomass is the functional unit chosen to report all elementary input/output flows. The results are compared with relevant LCIs from the literature, providing a picture of the current status of microalgae production in large-scale plants.

ABSTRACTBackground: When exposed to events that transgress one’s moral beliefs, a plethora of negative consequences may follow, which are captured by the concept of moral injury (MI). Despite its relevance to experiences of healthcare workers during a global health emergency, there is lack of validated MI instruments adapted to the healthcare setting.Objective: The present study aims to provide a validation of the Italian version of the Moral Injury Events Scale (MIES) adjusted to the healthcare setting by assessing its factor structure, internal consistency and construct validity.Methods: A sample of 794 healthcare workers (46% nurses, 51% female) engaged in hospital facilities during the COVID-19 pandemic in Italy completed measures of MI, PTSD, anxiety, depression, burnout, meaning in life and positive affect.Results: Using an exploratory structural equation modelling (ESEM) we assessed the scale factor structure for the entire sample and separately for nurse professional and female healthcare worker groups. Findings support a three-factor solution: Factor 1 ‘perceived transgressions by others’; Factor 2 ‘perceived transgressions by self’; and Factor 3 ‘perceived betrayals by others’. Findings also indicate some level of convergence with measures of PTSD, anxiety, depression and burnout.Conclusion: Results suggest that the MIES may be useful in capturing unique experiences of moral injury amongst healthcare workers engaged in a global health emergency. The low range correlations with measures of psychological distress might potentially indicate that MI, which captures cognitive value judgements rather than manifest symptomatology, may uniquely explain a certain amount of variance. Implications for the development of new empirically derived and theoretical guided tools are discussed, highlighting the need for future research to examine the role of individualising and social binding moral principles in gaining a more nuanced understanding of moral injury experiences amongst healthcare professionals across different socio-cultural settings.

The defense of collective rights and the appropriate reparation of damages to victims is a recent development issue in the Colombian legal system. Although some legal provisions mentioned damages to an indeterminate group of people in cases of negligence, it was not until the 1991 Constitution that Colombia established the types of actions all individuals or groups can initiate to advocate for the integrity of their rights in the face of illegal actions or omissions by the State. There is currently no mechanism for groups to sue private entities efficiently that guarantees all individual and collective rights, akin to class actions. This scientific article delves into the multifaceted landscape of collective rights protection in Colombia, focusing specifically on the mechanisms and implications surrounding the deployment of group actions.

Global warming due to the increased atmospheric carbon dioxide concentration is the driving force for developing strategies that exploit CO2 as raw material to produce interesting compounds for industry. According to this approach, Acetobacterium woodii was modified to convert CO2 and H2 into acetone. Gas fermentation was performed at high pressure to debottleneck the issue of the low availability of gaseous substrates in the liquid medium. This work aimed to investigate the catalytic performance of a modified A. woodii strain for acetone synthesis at 10 bar providing an H2-CO2 blend. First, tests were performed to assess the ability of the biocatalyst to survive heterotrophically at high pressure. Moreover, a reference test was set up in autotrophy at atmospheric pressure to confirm that it produced both acetate and acetone. Feeding the strain at 10 bar with the H2-CO2 mix resulted in growth inhibition and formic acid production. This outcome suggested a metabolism impairment due to bicarbonate build-up in the reactor at high CO2 partial pressure. Thus, bacteria were grown at atmospheric pressure in a medium with an augmented exogenous salt concentration. Results confirmed that formic acid production and growth inhibition could be due to HCO3–. Furthermore, the modified A. woodii grown at atmospheric pressure in a sterile medium pressurized before inoculation showed the same outcomes. Finally, tests at 10 bar lowering the CO2 partial pressure indicated that this gas was responsible for formic acid production but was not the only inhibitory factor for autotrophic cell growth at high pressure.

Abstract Carbon dioxide (CO2) stands out as sustainable feedstock for developing a circular carbon economy whose energy supply could be obtained by boosting the production of clean hydrogen from renewable electricity. H2‐dependent CO2 gas fermentation using acetogenic microorganisms offers a viable solution of increasingly demonstrated value. While gas fermentation advances to achieve commercial process scalability, which is currently limited to a few products such as acetate and ethanol, it is worth taking the best of the current state‐of‐the‐art technology by its integration within innovative bioconversion schemes. This review presents multiple scenarios where gas fermentation by acetogens integrate into double‐stage biotechnological production processes that use CO2 as sole carbon feedstock and H2 as energy carrier for products' synthesis. In the integration schemes here reviewed, the first stage can be biotic or abiotic while the second stage is biotic. When the first stage is biotic, acetogens act as a biological platform to generate chemical intermediates such as acetate, formate and ethanol that become substrates for a second fermentation stage. This approach holds the potential to enhance process titre/rate/yield metrics and products' spectrum. Alternatively, when the first stage is abiotic, the integrated two‐stage scheme foresees, in the first stage, the catalytic transformation of CO2 into C1 products that, in the second stage, can be metabolized by acetogens. This latter scheme leverages the metabolic flexibility of acetogens in efficient utilization of the products of CO2 abiotic hydrogenation, namely formate and methanol, to synthesize multicarbon compounds but also to act as flexible catalysts for hydrogen storage or production.

Improving the quality of laboratory services in the Industrial Revolution 4.0 era, one of which is by utilizing information and communication technology or in this study it is called digitization. Digitization is the process of converting information available on paper to a digital format, digitization can be in the form of a website. Utilization of this website will make it easier for students to access the information needed quickly and easily. So far, inventories in analytical and inorganic chemistry laboratories have only been carried out by entering data in a book, and only some of the data has been entered into a simple Excel so it is too complicated and the risk of losing files is very large. Therefore, the use of a centralized website system needs to be done. This study intends to identify the stages involved in creating a website dedicated to the Laboratory of Analytical and Inorganic Chemistry within the Chemistry Department, Faculty of Mathematics and Natural Science at Universitas Negeri Surabaya. Additionally, it aims to assess user reactions to the website. The research methodology employed is the 4D approach, encompassing the Define, Design, Develop, and Disseminate phases. The initiation of the website design process entails the incorporation of various features to enhance its visual appeal. These elements are then used as a basis for coding both the website’s menu and content.

The morphological changes of a river due to debris flow are essential considerations in understanding the dynamics of a river. The Magila River, located in the Sigi Regency, Central Sulawesi Province, is a small river with an area of approximately 125 hectares, but the average riverbed slope exceeds 10%. This river faced water damage issues, such as debris floods on December 12, 2019, and overflowing floods on October 11, 2022. Based on the ongoing mitigation (Sabo Works and River Improvement), an analysis of flow modeling through HEC-RAS software with non-Newtonian parameters is also being conducted. Simulations are performed on both the existing river scenario and the design river scenario. The flood and sediment transport simulations indicate that the capacity of the existing river is insufficient to accommodate the planned 100-year return period flood discharge, leading to overflow in several river sections with a maximum inundation height of 42.80 centimeters. The river also tends to experience riverbed degradation, triggering landslide events. In contrast, in the design river, overflow in river sections is reduced, although some areas still experience inundation with a maximum height of 18 centimeters. The river morphology in this scenario is more stable, with a balanced level of degradation and aggradation. The conclusion of this research indicates that a series of ongoing mitigation efforts needs to be expanded to minimize the risk of floods but is already optimal in maintaining river morphology stability. The research findings are expected to be beneficial in maximizing the management of the Magila River.

Currently, it is necessary to maintain the quality of aquifers and water bodies, which means the need for sensors that detect molecules as emerging pollutants (EPs) at low concentrations in aqueous complex solutions. In this work, an electronic tongue (e-tongue) prototype was developed to detect 17β-estradiol in tap water. To achieve such a prototype, an array of sensors was prepared. Each sensor consists of a solid support with interdigitated electrodes without or with thin films prepared with graphene oxide, nanotubes, and other polyelectrolytes molecules adsorbed on them. To collect data from each sensor, impedance spectroscopy was used to analyze the electrical characteristics of samples of estrogen solutions with different concentrations. To analyze the collected data from the sensors, principal components analysis (PCA) method was used to create a three-dimensional plane using the calculated principal components, namely PC1 and PC2, and the estrogen concentration values. Then, damped least squares (DLS) was used to find the optimal values for the hyperplane calibration, as the sensitivity of this e-tongue was not represented by a straight line but by a surface. For the collected data, from nanotubes and graphene oxide sensors, a calibration curve for concentration given by the 10PC1×0.492−PC2×0.14–14.5 surface was achieved. This e-tongue presented a detection limit of 10−16 M of 17β-estradiol in tap water.

IntroductionAmong patients with traumatic brain injury (TBI), balance problems often persist alongside hearing and vision impairments that lead to poorer outcomes of functional independence. As such, the ability to regain premorbid independent gait may be dictated by the level of sensory acuity or processing decrements that are shown following TBI assessment. This study explores the relationships between standardized sensory acuity and processing outcomes to postural balance and gait speed.MethodsSecondary analysis was performed on the Long-Term Impact of Military- Relevant Brain Injury Consortium Chronic Effects of Neurotrauma Consortium LIMBIC (CENC) data set. Separate regression analyses were carried out for each of the balance assessments (via Computerized Dynamic Posturography, CDP) and walking speed.DiscussionTBI frequency was significantly related to the majority of single CDP outcomes (i.e., Conditions 2–6), while various sensory processing outcomes had task-specific influences. Hearing impairments and auditory processing decrements presented with lower CDP scores (CDP Conditions 3,5,6, and 1–3 respectively), whereas greater visual processing scores were associated with better CDP scores for Conditions 2,5, and 6. In sum, patients with TBI had similar scores on static balance tests compared to non-TBI, but when the balance task got more difficult patients with TBI scored worse on the balance tests. Additionally, stronger associations with sensory processing than sensory acuity measures may indicate that patients with TBI have increased fall risk.

Abstract Nest survival has been identified as one of the most influential vital rates causing population change in game birds, and depredation, often influenced by habitat loss and fragmentation, is the primary cause of nest failure of upland game birds. We were interested in quantifying and comparing the perspectives of landowners and biologists in South Dakota regarding complex predator‐prey interactions to improve communication and management efficacy. We developed a questionnaire regarding the following: 1) general attitude statements about game bird species; 2) perceived impacts of 9 factors (e.g., development, pollution, predators) and 13 potential predators on game bird abundances; and 3) attitude statements regarding use of lethal predator control and nesting habitat management practices. A cluster analysis using landowner attitude statements about predator management identified 3 landowner segments that had strong (most supportive; 37%), moderate (moderately supportive; 35%), or weak (least supportive; 28%) attitude statements about lethal predator control. Landowner segments most supportive and moderately supportive of predator control rated predators as the primary negative factor impacting game bird abundances and agreed that predators were the primary cause of game bird abundance declines, whereas the landowner segment least supportive of predator control rated habitat loss as the top factor and disagreed that predators were the primary cause of game bird declines. Biologists rated habitat loss as the top factor negatively impacting game bird abundances and disagreed that predators were the primary cause of game bird abundance declines. Thus, when considering the effectiveness of strategies to reduce nest depredation, most landowners focused on the direct cause of nest failures (predators), whereas biologists focused on an indirect cause (habitat loss). Perception differences among these groups emphasizes the need for better communication on proximate and ultimate factors affecting game bird populations and how these differences may impact management decisions.

We describe a successful case of hybrid revascularization of a totally occluded aortobifemoral bypass with retrograde use of the Rotarex S catheter (BD) and complete relining with a Gore Excluder iliac branch endoprosthesis (W.L. Gore & Associates). The repair procedure was performed with femoral surgical access and percutaneous brachial access. Despite left renal artery endoclamping, after the final angiography, deployment of a covered stent in the left renal artery was needed because of residual thrombotic material at the vessel ostium. The procedure was completed with reconstruction using a common femoral artery Dacron graft and bilateral complete iliac surgical branch relining using self-expanding covered stents, with recovery of distal pulses.

Este artículo en la modalidad de experiencia educativa presenta algunas consideraciones sobre los avances, luego de ocho años de implementación del proyecto LIDERAZGO PARA GESTION DE PROYECTO DE VIDA SOSTENIBLE que orienta el núcleo de profundización de educación media en el colegio Heladia Mejía IED. El acompañamiento pedagógico integral y oferta diversa en las asignaturas Emprendimiento, Investigación, Matemáticas Financieras y Fundamentos de Mecatrónica, teniendo como pilares las competencias del siglo XXI, habilidades socioemocionales y los ODS, con exitosa aplicación del ABP ha permitido a los estudiantes de grados 10 y 11 el desarrollo de proyectos articulados con las cuatro asignaturas, que constituyen su trabajo de grado, que además de aportar avances en ciencia y tecnología, facilitan la articulación con la educación superior y/o el mundo laboral. Esto ha contribuido a la formación de jóvenes con calidad humana, que construyendo su proyecto de vida trascenderán en la sociedad como ciudadanos competentes.

Some results on nonexistence of nontrivial solutions to some time and space fractional differential evolution equations with transformed space argument are obtained via the nonlinear capacity method. The analysis is then used for a [Formula: see text] system of equations with transformed space arguments.

The paper is focused on the historical-architectural evolution and material-technical qualification of polychrome majolica domes that were built between the 17th and 19th centuries in Apulian religious buildings. In particular, the cultural context in which this solution spread throughout the Mediterranean area is identified. Moreover, the case history of construction and decorative techniques that are distinctive of the regional territory is discussed in terms of underlying structure, installation of elements and surface colours. The study is then detailed on the Church of Santa Maria della Vetrana in Castellana Grotte (BA), for which the morpho-typological survey and mapping of the decay state are presented, based on the use of terrestrial and aerial digital photogrammetry. Finally, based on the identification of the main pathologies from both direct and indirect alteration factors, the most appropriate conservation and maintenance interventions are outlined, with specific focus on repair and integration of the majolica tiles, according to principles of high compatibility and low intrusiveness for a solution meeting artisan tradition and technical practice.

Jordan is rich in the flora of ethnobotanical importance. This scoping review aims to highlight the ethnopharmacological value of Jordanian medicinal plants using the Preferred Reporting Items of Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A total of one hundred twenty-four articles published between 2000 and 2022 obtained from PubMed, EBSCO, and Google Scholar databases were included in this review. These plants own several classes of secondary bioactive metabolites, including alkaloids, flavonoids, phenolics, and terpenes. Jordanian plants exhibited potential therapeutic activity against various tumors, bacterial infections, elevated blood glucose levels, hyperlipidemia, platelets aggregation disorders, and gastrointestinal disorders. Phytochemicals’ biological activities depend on their structures, parts used, methods of extraction, and evaluation model. In conclusion, this review highlights the need of researching Jordan's abundant naturally occurring medicinal plants and their phytochemicals as novel lead molecules in drug discovery and development. Studying active phytochemicals for disease treatment will help develop drugs for safe treatment and cure in the future.

Multiparametric magnetic resonance imaging (mpMRI) is currently the most effective diagnostic tool for detecting prostate cancer (PCa) and evaluating adenocarcinoma-mimicking lesions of the prostate gland, among which granulomatous prostatitis (GP) represents the most interesting diagnostic challenge. GP consists of a heterogeneous group of chronic inflammatory lesions that can be differentiated into four types: idiopathic, infective, iatrogenic, and associated with systemic granulomatous disease. The incidence of GP is growing due to the increase in endourological surgical interventions and the adoption of intravesical instillation of Bacillus Calmette-Guerin in patients with non-muscle invasive bladder cancer; therefore, the difficulty lies in identifying specific features of GP on mpMRI to avoid the use of transrectal prostate biopsy as much as possible.

5-(2-Aminopropyl)benzofuran (5-APB), also known as “Benzo Fury,” is a novel psychoactive substance (NPS) belonging to a new class of synthetic phenethylamines. It acts by disrupting serotonergic circuits as a serotonin–norepinephrine–dopamine reuptake inhibitor and is classified as an entactogen, similar to MDMA and MDA. Despite its popularity among users, recent toxicity events have been associated with the consumption of 5-APB and other benzofurans, highlighting the need for a better understanding of their pharmacodynamics and toxicity. One way to achieve this is by developing the synthesis of 5-APB metabolites as biomarkers of exposure. In this study, we present a six-step synthesis for one of the 5-APB metabolites, 2-(5-(2-aminopropyl)-2-hydroxyphenyl)acetic acid (1), involving methylation, formylation, Aldol-type condensation, reduction, and hydrolysis reactions. The compound was obtained in an overall yield of 11%.

Rapid solidification techniques, such as gas atomisation, have been widely implemented in metallic alloys/composites to increase solid solubility, avoid or mitigate segregation phenomena, and favour metastable phase formation to enhance performance. Particularly, gas atomisation can enhance the solid solubility of low diffusion coefficient elements like Fe, Ni, Mn, Zr, and Cr in the α-Al matrix, yielding metastable phases. As a result, Al alloys exhibit excellent strength at high temperatures. In this study, the AISI 304L alloy was employed to introduce Fe, Ni, and Cr elements into the AlSi10Mg alloy through gas atomisation, resulting in the formation of two distinct hypereutectic AlFe-based alloys: AlFe9Si8Cr2Ni and AlFe18Si8Cr5Ni2. Gas-atomised alloy powders were separated into different size fractions by sieving and characterised using X-ray diffraction, differential scanning calorimetry, optical microscopy, and scanning electron microscopy. Microstructural analyses revealed dendritic patterns with distinct phases, highlighting the influence of the alloying element content on the solidification processes. Furthermore, a synergic evaluation of the XRD and EDS analysis results allowed the identification of intermetallic phases and their distribution in the two systems.

The constructal law is used to improve the analysis of the resonant heat transfer in cancer cells. The result highlights the fundamental role of the volume/area ratio and its role in cancer growth and invasion. Cancer cells seek to increase their surface area to facilitate heat dissipation; as such, the tumour expansion ratio declines as malignant cells start to migrate and the cancer expands locally and systemically. Consequently, we deduce that effective anticancer therapy should be based on the control of some ion transport phenomena in an effort to increase the volume/area ratio. This emphasises restricting the local and systemic spatial expansion of the tumour system and thus gives further credence to the superior role of novel anti-migratory and anti-invasive treatment strategies over conventional anti-proliferative options only.

Metallic powders are widely utilized as feedstock materials in metal additive manufacturing (MAM). However, only a limited number of alloys can currently be processed using these technologies, with most of them being casting alloys. The objective of this study is to investigate novel aluminum alloys produced via a close-coupled gas atomizer (CCGA) by adding an increasing amount of copper (4, 8, and 20 wt%) to an AlSi10Mg alloy. The obtained powders were fully characterized to evaluate the effect of copper, a well-established strengthener for aluminum alloys, in order to correlate the obtained hardness to the powder phase composition and microstructure. In particular, a dendritic microstructure was observed in all alloys, and, as the copper content was increased, the size of the secondary dendrite arm spacing (SDAS) decreased progressively. Consequently, the hardness measured on the powder cross-section linearly increased with the copper content, and the hardness value of 185 ± 13 HV of the AlCu20Si10Mg composition was found to be twice that of the AlSi10Mg alloy (88 ± 5 HV).

Affective Dependence (AD) is a problematic model of the love relationship that is becoming increasingly prevalent and evident in the context of couple relationships. Similarly, the phenomenon is being observed with growing frequency in daily clinical practice, making it increasingly necessary to identify treatment guidelines that can help clinicians in dealing with AD, while waiting for the literature to reach a consensus on its definition and nosographic profile. The main objective of this work is to explore the existing evidence of effectiveness regarding feasible treatments for Affective Dependence through a scoping review of the international literature carried out using the main scientific databases and following the PRISMA-ScR (PRISMA Extension for Scoping Reviews) guidelines. Seven studies were included in this review, and the results show that several pharmaceuticals, as well as different types of individual and group therapies, are proposed as treatment plans for AD. However, there is a lack of clinical trials that can verify the efficacy of the AD treatments reported so far in the literature. Some reflections that may help to distinguish a “healthy” addiction from a dysfunctional or markedly pathological one are considered alongside potential prevention perspectives.

Objetivos: describir el resultado materno y perinatal de las gestantes con infección confirmada por COVID-19 en una institución hospitalaria en Comayagua, Honduras. Materiales y métodos: estudio descriptivo tipo serie de casos. Se incluyeron gestantes sintomáticas que consultaron o fueron remitidas desde el 1 de marzo de 2020 hasta el 31 de marzo del 2021 a una institución pública de referencia, con diagnóstico confirmado por PCR de infección por COVID-19. Se midieron variables sociodemográficas, obstétricas, severidad de la infección, estancia hospitalaria, complicaciones maternas y perinatales. Se estimó la frecuencia de infección por COVID-19 y los resultados maternos y perinatales de estas gestaciones; se realizó análisis descriptivo. Resultados: en el periodo descrito consultaron 2.258 gestantes, de estas se incluyeron 23, quienes cumplieron con los criterios de selección, para una frecuencia de infección por COVID-19 del 1,01 %. La población de estudio se caracterizó por estar constituida por mujeres jóvenes y en unión libre. Trece pacientes recibieron manejo ambulatorio por cuadro clínico leve, diez requirieron hospitalización. Las embarazadas manejadas ambulatoriamente finalizaron la gestación vía cesárea (76,9 %) por estado fetal insatisfactorio, con edad gestacional mayor o igual a 37 semanas, y tres casos fueron pretérmino (36 semanas). De las gestantes hospitalizadas, una desarrolló aborto espontáneo, y nueve finalizaron la gestación por una indicación obstétrica. Se presentó un parto prematuro y se documentó una muerte materna (4 %) y neonatal. Conclusiones: el 1 % de las gestantes adquirieron la infección por COVID-19 en el Hospital Santa Teresa de Comayagua en el periodo de estudio. Se requieren más estudios que analicen el impacto materno perinatal de la infección por COVID-19 en la región centroamericana.

BackgroundThe use of skin-lightening products (SLPs) among Jordanian women has immensely increased and healthcare professionals have a vital role in raising public awareness of SLPs. The aim of this study is to identify SLPs practices among Jordanian women and their basic knowledge of the agents and the side effects associated with using these products.MethodsA cross-sectional study conducted during October to December of 2022. Jordanian women above 18 years of age were invited to participate via a survey link. Descriptive statistics were used, and logistic regression was applied to screen for variables affecting the knowledge score of the participants.ResultsThe mean age of the study participants (n = 384) was 32.04 (SD = 12.678). Results demonstrated that more than half of the participants (n = 193) reported current or past use of SLPs. Additionally, less than one-fifth (18.2%) of the participants (n = 70) reported previously experiencing some side-effects after using SLPs. About 90% of participants thought that these side-effects were caused by the active ingredients in SLPs. Most of the participants were able to identify some of the active ingredients used in SLPs such as Vitamin C (87.8%) and Hydroquinone (62.0%). It was also found that young participants, and those employed, or university students had higher knowledge scores of SLPs' active ingredients, and of their side-effects.ConclusionThis study demonstrated that Jordanian women are adequately informed about skin-lightening products. Moreover, the practices revealed an educated pattern of action when obtaining information regarding SLPs. Fundamentally, healthcare providers should be influential in educating consumers on the proper use. Strict guidelines and policies should target the practices concerned with these products.

Abstract Objective: Assess urgent care (UC) clinician prescribing practices and factors associated with first-line antibiotic selection and recommended duration of therapy for sinusitis, acute otitis media (AOM), and pharyngitis. Design: Retrospective cohort study. Participants: All respiratory UC encounters and clinicians in the Intermountain Health (IH) network, July 1st, 2019–June 30th, 2020. Methods: Descriptive statistics were used to characterize first-line antibiotic selection rates and the duration of antibiotic prescriptions during pharyngitis, sinusitis, and AOM UC encounters. Patient and clinician characteristics were evaluated. System-specific guidelines recommended 5–10 days of penicillin, amoxicillin, or amoxicillin-clavulanate as first-line. Alternative therapies were recommended for penicillin allergy. Generalized estimating equation modeling was used to assess predictors of first-line antibiotic selection, prescription duration, and first-line antibiotic prescriptions for an appropriate duration. Results: Among encounters in which an antibiotic was prescribed, the rate of first-line antibiotic selection was 75%, the recommended duration was 70%, and the rate of first-line antibiotic selection for the recommended duration was 53%. AOM was associated with the highest rate of first-line prescriptions (83%); sinusitis the lowest (69%). Pharyngitis was associated with the highest rate of prescriptions for the recommended duration (91%); AOM the lowest (51%). Penicillin allergy was the strongest predictor of non–first-line selection (OR = 0.02, 95% CI [0.02, 0.02]) and was also associated with extended duration prescriptions (OR = 0.87 [0.80, 0.95]). Conclusions: First-line antibiotic selection and duration for respiratory UC encounters varied by diagnosis and patient characteristics. These areas can serve as a focus for ongoing stewardship efforts.

Virtual reality (VR) is a promising and cost-effective tool that has the potential to reduce the prevalence of falls and locomotor impairments in older adults. However, we believe that existing VR-based approaches to prevent falls do not mimic the full breadth of perceptual, cognitive, and motor demands that older adults encounter in daily life. Researchers have not yet fully leveraged VR to address affective factors related to fall risk, and how stressors such as anxiety influence older adult balance and real-world falls. In this perspective paper, we propose developing VR-based tools that replicate the affective demands of real-world falls (eg, crossing the street) to enhance fall prevention diagnostics and interventions by capturing the underlying processes that influence everyday mobility. An effort to replicate realistic scenarios that precipitate falls in VR environments will inform evidence-based diagnostics and individualize interventions in a way that could reduce falls in older adults in daily life.