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The definition of the mandibular angle profile is a common challenge for oral and maxillofacial surgeons. Accurate diagnosis and treatment planning are mandatory in order to properly manage soft and hard tissues. The use of several biomaterials is described in the literature. The present paper reports the treatment of a defect in the right mandibular angle in otomandibular syndrome sequelae by positioning polyetheretherketone (PEEK) patient-specific implants (PSI) in a 25-year-old patient who previously underwent orthognathic surgery. Satisfactory aesthetic results were achieved with no complications 12 months after surgery. Considering its advantageous physical properties and the low rate of postoperative complications reported in the literature, PEEK can increase the treatment options for recontouring not only the upper third and the middle third of the face, but also of the lower third, in particular in cases of large three-dimensional defects.

Nel dibattito culturale circa le mutazioni che la disciplina del Disegno, ed il suoinsegnamento, sta vivendo nell’epoca della transizione digitale, questo contributosi incentra sui ragionamenti utili a mostrare una proposta di organizzazionedidattica che mira ad integrare una tradizionale struttura educativa e comunicativadel sapere in ambito accademico con i nuovi strumenti che la disciplina delDisegno sta incontrando nell’affermazione delle tecnologie digitali nel mondodella progettazione architettonica ed edilizia. Si vuole indagare, in parallelo,quali siano i confi ni culturali che defi niscono la presenza e la collocazione ditali tecnologie nell’alveo della rappresentazione grafi ca di carattere tecnico,nella maturità della modellazione digitale. In particolare, nell’affermarsi dellamodellazione parametrica orientata agli oggetti nello scenario operativodei tecnici, ciò che si intende approfondire riguarda il ruolo della tecnologiasui mutamenti della cultura disciplinare, sulle opportunità di indirizzarne lametabolizzazione nei processi formativi, segnatamente per chi si muoverà nellagestione e nella comunicazione dei contenuti informativi oggi veicolati da regolecodifi cate in seno alla Scienza della Rappresentazione.

Rising daily temperatures and water shortage are two of the major concerns in agriculture. In this work, we analysed the tolerance traits in a tomato line carrying a small region of the Solanum pennellii wild genome (IL12-4-SL) when grown under prolonged conditions of single and combined high temperature and water stress. When exposed to stress, IL12-4-SL showed higher heat tolerance than the cultivated line M82 at morphological, physiological, and biochemical levels. Moreover, under stress IL12-4-SL produced more flowers than M82, also characterized by higher pollen viability. In both lines, water stress negatively affected photosynthesis more than heat alone, whereas the combined stress did not further exacerbate the negative impacts of drought on this trait. Despite an observed decrease in carbon fixation, the quantum yield of PSII linear electron transport in IL12-4-SL was not affected by stress, thereby indicating that photochemical processes other than CO2 fixation acted to maintain the electron chain in oxidized state and prevent photodamage. The ability of IL12-4-SL to tolerate abiotic stress was also related to the intrinsic ability of this line to accumulate ascorbic acid. The data collected in this study clearly indicate improved tolerance to single and combined abiotic stress for IL12-4-SL, making this line a promising one for cultivation in a climate scenario characterized by frequent and long-lasting heatwaves and low rainfall.

Sea surface temperature (SST) is characterized by abundant warm and cold structures that influence the overlying atmospheric boundary layer dynamics through two different mechanisms. First, turbulence and large eddies in the lower troposphere are affected by atmospheric stability, which can be modified by local SST, resulting in enhanced vertical mixing and larger surface winds over warmer waters. Second, the thermodynamic adjustment of air density to the underlying SST structures and the subsequent changes in atmospheric pressure drive secondary circulations. This paper aims to disentangle the effects of these processes and explore the environmental conditions that favor them. Two main environmental variables are considered: the large-scale air–sea temperature difference (proxy for stability) and wind speed. Using 5 years of daily reanalyses data, we investigate the 10-m wind response to SST structures. Based on linear regression between wind divergence and SST derivatives, we show that both mechanisms operate over a large spectrum of conditions. Ten-meter wind divergence is strongly impacted by the local SST via its effect on vertical mixing for midwind regimes in slightly unstable to near-neutral conditions, whereas the secondary circulation is important in two distinct regimes: low wind speed with a slightly unstable air column and high background wind speed with a very unstable air column. The first regime is explained by the prolonged Lagrangian time that the air parcel stays over an SST structure while the second one is related to strong heat fluxes at the air–sea interface, which greatly modify the marine atmospheric boundary layer properties. Location and frequency of the environmentally favorable conditions are discussed, as well as the response in low-cloud cover and rainfall. Significance Statement The main objective of this study is to explore the wind response to thermal structures at the sea surface under different environmental conditions using the latest atmospheric reanalysis. Recent literature suggests that fine-scale air–sea interactions affect a large spectrum of atmospheric dynamics, from seasonal to weather-type regimes. It is thus important to characterize the atmospheric response to ocean surface variability. Our findings describe the environmental conditions for which the two main physical processes through which the atmosphere responds to sea surface temperature structures are active the most and can guide the development of high-resolution observing missions and campaigns in specific geographical locations and seasons to retrieve data that can be used to improve parameterization in models.

The use of artificial intelligence is rapidly increasing in medicine to support clinical decision making mostly through diagnostic and prediction models. Such models derive from huge databases (big data) including a large variety of health-related individual patient data (input) and the corresponding diagnosis and/or outcome (labels). Various types of algorithms (e.g. neural networks) based on powerful computational ability (machine), allow to detect the relationship between input and labels (learning). More complex algorithms, like recurrent neural network can learn from previous as well as actual input (deep learning) and are used for more complex tasks like imaging analysis and personalized (bespoke) medicine. The prompt availability of big data makes that artificial intelligence can provide rapid answers to questions that would require years of traditional clinical research. It may therefore be a key tool to overcome several major gaps in the model of advanced chronic liver disease, mostly transition from mild to clinically significant portal hypertension, the impact of acute decompensation and the role of further decompensation and treatment efficiency. However, several limitations of artificial intelligence should be overcome before its application in clinical practice. Assessment of the risk of bias, understandability of the black boxes developing the models and models' validation are the most important areas deserving clarification for artificial intelligence to be widely accepted from physicians and patients.

Il presente lavoro, volto a ricostruire la storia dell’arredamento dell’Ambasciata d’Italia a Varsavia, ha origine dallo studio dei documenti d’archivio del Fondo STRP (ex Servizio Tecnico di Ricognizione Patrimoniale) conservato presso la Direzione Generale Archeologia Belle Arti e Paesaggio del Ministero della Cultura (MIC). Il fondo è costituito dalla documentazione – perlopiù inedita – prodotta dal Servizio Tecnico, nato nel 1993 come Commissione, voluta dal Ministro Alberto Ronchey, con l’obiettivo di censire i beni culturali concessi in deposito esterno dai musei del demanio ad enti in Italia e all’estero. Nel 1995 la Commissione fu trasformata in Servizio alle dirette dipendenze del Segretariato Generale del Ministero stesso ma nel 2003 venne sospeso. Ben ventuno anni fa fu effettuata l’ultima ricognizione patrimoniale presso l’Ambasciata d’Italia a Varsavia e da allora più nessun controllo è stato fatto. Pertanto, questo lavoro, oltre ad analizzare la storia delle opere d’arte scelte per arredare l’Ambasciata fin dal 1922, ne aggiorna i dati e dà nuove interpretazioni sulle vicende che, sia prima che dopo la Seconda Guerra Mondiale, portarono al suo arredamento; inoltre, vuole essere uno spunto di riflessione sulla tutela di quel patrimonio artistico italiano che ancora oggi, fin dai primi decenni del secolo scorso, si trova in deposito esterno senza i dovuti controlli.

A hallmark of delivering quality adolescent health care services is the provision of confidential care. Key tenets when providing confidential care for adolescents include time alone with a health care provider, maintaining the privacy of health information, and securing informed consent for services without permission from a parent, guardian, or caregiver. While confidentiality is a basic principle for all health care encounters regardless of age, the unique considerations for capable adolescent patients are not always realized or appreciated. By ensuring appropriate quantity and quality of confidential care for adolescents, clinicians are better equipped to elicit a comprehensive history and physical examination, while empowering the adolescent involved to develop agency, autonomy, trust, and responsibility for their own health care decision-making and management.

Résumé La confidentialité des soins fait partie des caractéristiques des services de santé de qualité aux adolescents. Du temps seul à seul avec le professionnel de la santé, l’accès à l’information en matière de santé réservé aux personnes autorisées et l’obtention d’un consentement éclairé avant de donner les services sans demander le consentement d’un parent, d’un tuteur ou d’un proche, font partie des fondements des soins confidentiels aux adolescents. La confidentialité est un principe fondamental qui s’applique à toutes les rencontres médicales, quel que soit l’âge, mais les considérations propres aux patients adolescents aptes ne sont pas toujours comprises ni prises en compte. S’ils donnent aux adolescents des soins confidentiels d’une quantité et d’une qualité appropriées, les cliniciens sont mieux en mesure d’obtenir une anamnèse et un examen physique complets, et ils habilitent les adolescents à développer leur capacité d’agir, leur autonomie, leur confiance et leur responsabilité à l’égard de leurs décisions en matière de santé et de la prise en charge de leurs propres soins.

Elevated inflammatory markers are associated with severe coronavirus disease 2019 (COVID-19), and some patients benefit from Interleukin (IL)-6 pathway inhibitors. Different chest computed tomography (CT) scoring systems have shown a prognostic value in COVID-19, but not specifically in anti-IL-6-treated patients at high risk of respiratory failure. We aimed to explore the relationship between baseline CT findings and inflammatory conditions and to evaluate the prognostic value of chest CT scores and laboratory findings in COVID-19 patients specifically treated with anti-IL-6. Baseline CT lung involvement was assessed in 51 hospitalized COVID-19 patients naive to glucocorticoids and other immunosuppressants using four CT scoring systems. CT data were correlated with systemic inflammation and 30-day prognosis after anti-IL-6 treatment. All the considered CT scores showed a negative correlation with pulmonary function and a positive one with C-reactive protein (CRP), IL-6, IL-8, and Tumor Necrosis Factor α (TNF-α) serum levels. All the performed scores were prognostic factors, but the disease extension assessed by the six-lung-zone CT score (S24) was the only independently associated with intensive care unit (ICU) admission (p = 0.04). In conclusion, CT involvement correlates with laboratory inflammation markers and is an independent prognostic factor in COVID-19 patients representing a further tool to implement prognostic stratification in hospitalized patients.

The TGFβ signaling mediator SMAD4 is frequently mutated or deleted in colorectal and pancreatic cancers. SMAD4 acts as a tumor suppressor and its loss is associated with poorer patient outcomes. The purpose of this study was to find synthetic lethal interactions with SMAD4 deficiency to find novel therapeutic strategies for the treatment of patients with SMAD4-deficient colorectal or pancreatic cancers. Using pooled lentiviral single-guide RNA libraries, we conducted genome-wide loss-of-function screens in Cas9-expressing colorectal and pancreatic cancer cells harboring altered or wild-type SMAD4. The small GTPase protein RAB10 was identified and validated as a susceptibility gene in SMAD4-altered colorectal and pancreatic cancer cells. Rescue assays showed that RAB10 reintroduction reversed the antiproliferative effects of RAB10 knockout in SMAD4-negative cell lines. Further investigation is necessary to shed light on the mechanism by which RAB10 inhibition decreases cell proliferation of SMAD4-negative cells. Significance: This study identified and validated RAB10 as new synthetic lethal gene with SMAD4. This was achieved by conducting a whole-genome CRISPR screens in different colorectal and pancreatic cell lines. A future RAB10 inhibitors could correspond to a new therapeutic solution for patients with cancer with SMAD4 deletion.

In this paper, we examine the balance between allocative efficiency and price discovery in blockchain-based finance. Our analysis reveals that the use of private pools, while improving blockspace allocation efficiency, negatively impacts price discovery. We show that the presence of private pools limits the amount of information revealed through pending orders and increases the execution risk of informed orders. We argue that price discovery can be improved by increasing the number of validators monitoring private pools or the block production rate on the chain.

Aim: This guideline (GL) is aimed at providing a reference for the management of non-functioning, benign thyroid nodules causing local symptoms in adults outside of pregnancy. Methods: This GL has been developed following the methods described in the Manual of the National Guideline System. For each question, the panel appointed by Associazione Medici Endocrinology(AME) identified potentially relevant outcomes, which were then rated for their impact on therapeutic choices. Only outcomes classified as “critical” and “important” were considered in the systematic review of evidence and only those classified as “critical” were considered in the formulation of recommendations. Results: The present GL contains recommendations about the respective roles of surgery and minimally invasive treatments for the management of benign symptomatic thyroid nodules. We suggest hemithyroidectomy plus isthmectomy as the first-choice surgical treatment, provided that clinically significant disease is not present in the contralateral thyroid lobe. Total thyroidectomy should be considered for patients with clinically significant disease in the contralateral thyroid lobe. We suggest considering thermo-ablation as an alternative option to surgery for patients with a symptomatic, solid, benign, single, or dominant thyroid nodule. These recommendations apply to outpatients, either in primary care or when referred to specialists. Conclusion: The present GL is directed to endocrinologists, surgeons, and interventional radiologists working in hospitals, in territorial services, or private practice, general practitioners, and patients. The available data suggest that the implementation of this GL recommendations will result in the progressive reduction of surgical procedures for benign thyroid nodular disease, with a decreased number of admissions to surgical departments for non-malignant conditions and more rapid access to patients with thyroid cancer. Importantly, a reduction of indirect costs due to long-term replacement therapy and the management of surgical complications may also be speculated.

Objectives The aim of the present randomized clinical trial (RCT) with a parallel arm design was to evaluate the clinical and microbiological efficacy of repeated ICG-aPDT as an adjunct to full-mouth subgingival debridement in the treatment of periodontitis. Materials and methods Twenty-four periodontitis patients were treated with full-mouth ultrasonic subgingival debridement (FMUD). Initial sites with probing depth (PD) > 4 mm were randomly assigned to receive the test (ICG-aPDT with an 810 nm diode laser) or the control treatment (off-mode aPDT) one and four weeks after FMUD. Clinical parameters were registered after 3 and 6 months. The presence of the main periodontal pathogens in subgingival samples was assessed with real-time PCR. Results Both treatment modalities resulted in significant clinical improvements at 3 and 6 months. The only significant differences in favour of the test group were found at 6 months for a higher PD reduction in initial deep pockets (PD ≥ 6 mm) and a higher percentage of closed pockets (PD ≤ 4 mm/no bleeding on probing). Limited microbiological changes were observed in both groups after treatment with no inter-group difference, except for a more significant reduction in Aggregatibacter actinomycetemcomitans and Parvimonas micra levels in the test group at 3 months. Conclusion The combination of repeated ICG-aPDT and FMUD provided no benefits except for selective clinical and microbiological improvements compared to FMUD alone. Clinical relevance Based on the obtained results, only limited adjunctive effects could be found for the combined use of ICG-aPDT and FMUD. Further, well-designed RCT with larger sample sizes are required to confirm these findings. Trial registration ClinicalTrials.gov NCT04671394.

Tomato Prosystemin (ProSys), the precursor of Systemin, a small peptidic hormone, is produced at very low concentration in unchallenged plants, while its expression greatly increases in response to several different stressors triggering an array of defence responses. The molecular mechanisms that underpin such a wide array of defence barriers are not fully understood and are likely correlated with the intrinsically disordered (ID) structure of the protein. ID proteins interact with different protein partners forming complexes involved in the modulation of different biological mechanisms. Here we describe the ProSys-protein network that shed light on the molecular mechanisms underpinning ProSys associated defence responses. Three different approaches were used. In silico prediction resulted in 98 direct interactors, most clustering in phytohormone biosynthesis, transcription factors and signal transduction gene classes. The network shows the central role of ProSys during defence responses, that reflects its role as central hub. In vitro ProSys interactors, identified by Affinity Purification-Mass Spectrometry (AP-MS), revealed over three hundred protein partners, while Bimolecular Fluorescent Complementation (BiFC) experiments validated in vivo some interactors predicted in silico and in vitro. Our results demonstrate that ProSys interacts with several proteins and reveal new key molecular events in the ProSys-dependent defence response of tomato plant.

Anabolic deficiencies play a pivotal role in left-sided heart failure. Little is known about their impact on idiopathic pulmonary arterial hypertension (iPAH). Therefore, the aim of this study was to assess the impact of multiple hormone-metabolic deficiencies on clinical features and outcomes in idiopathic pulmonary arterial hypertension. We have demonstrated that the assessment of anabolic hormone levels in patients with iPAH allows the identification of a subpopulation with worse exercise capacity, pulmonary hemodynamics, right ventricular size, and function generating the hypothesis about the potential role of hormonal replacement therapy. These data should be confirmed by larger studies.

In agricultural ecosystems, bees are exposed to combinations of pesticides that may have been applied at different times. For example, bees visiting a flowering crop may be chronically exposed to low concentrations of systemic insecticides applied before bloom and then to a pulse of fungicide, considered safe for bees, applied during bloom. In this study, we simulate this scenario under laboratory conditions with females of the solitary bee, Osmia bicornis L. We studied the effects of chronic exposure to the neonicotinoid insecticide, Confidor® (imidacloprid) at a realistic concentration, and of a pulse (1 day) exposure of the fungicide Folicur® SE (tebuconazole) at field application rate. Syrup consumption, survival, and four biomarkers: acetylcholinesterase (AChE), carboxylesterase (CaE), glutathione S-transferase (GST), and alkaline phosphatase (ALP) were evaluated at two different time points. An integrated biological response (IBRv2) index was elaborated with the biomarker results. The fungicide pulse had no impact on survival but temporarily reduced syrup consumption and increased the IBRv2 index, indicating potential molecular alterations. The neonicotinoid significantly reduced syrup consumption, survival, and the neurological activity of the enzymes. The co-exposure neonicotinoid-fungicide did not increase toxicity at the tested concentrations. AChE proved to be an efficient biomarker for the detection of early effects for both the insecticide and the fungicide. Our results highlight the importance of assessing individual and sub-individual endpoints to better understand pesticide effects on bees.

Benign liver lesions are increasingly diagnosed in daily clinical practice due to the growing use of imaging techniques for the study of the abdomen in patients who have non-specific symptoms and do not have an increased risk of hepatic malignancy. They include simple or parasitic cysts and solid benign tumors which differ widely in terms of prevalence, clinical relevance, symptoms and natural history and often lead to significant clinical problems relating to diagnosis and clinical management. Following the need to have updated guidelines on the management of benign focal liver lesions, the Scientific Societies mainly involved in their management have promoted the drafting of a new dedicated document. This document was drawn up according to the present Italian rules and methodologies necessary to produce clinical, diagnostic, and therapeutic guidelines based on evidence. Here we present the first part of the guideline, concerning the characterization of focal hepatic lesions detected by ultrasound, and the diagnosis and clinical management of simple and parasitic hepatic cysts, and of polycystic liver disease.

The Enhanced Recovery After Surgery (ERAS) or Fast Track is defined as a multi-disciplinary, peri- and post-operative approach finalized to reduce surgical stress and simplify post-operative recovery. It has been introduced more than 20 years ago by Khelet to improve outcomes in general surgery. Fast Track is adapted to the patient’s condition and improves traditional rehabilitation methods using evidence-based practices. Fast Track programs have been introduced into total hip arthroplasty (THA) surgery, with a reduction in post-operative length of stay, shorter convalescence, and rapid functional recovery without increased morbidity and mortality. We have divided Fast Track into three cores: pre-, intra-, and post-operative. For the first, we analyzed the standards of patient selection, for the second the anesthesiologic and intraoperative protocols, for the third the possible complications and the appropriate postoperative management. This narrative review aims to present the current status of THA Fast Track surgery research, implementation, and perspectives for further improvements. By implementing the ERAS protocol in the THA setting, an increase in patient satisfaction can be obtained while retaining safety and improving clinical outcomes.

Unlike many composers of his generation, Iannis Xenakis personally devised and implemented the sound synthesis techniques used in some of his creative efforts. Eight of his works feature – in part or exclusively – sounds obtained with analogue or digital synthesis techniques, in a time span that goes from Analogique B (1959) to S.709 (1994). All of his electroacoustic music after La Légend d’Eer (1977) has sounds synthesized with computer technology. The sound synthesis procedures he devised, reflect peculiar operational and technological conditions, and indeed represent tokens of musical and sonological knowledge characteristic of a truly unique practice. In this paper we provide a survey of Xenakis’s efforts with sound synthesis, delineating their historical path through the experimenting of different technical contexts of material production and the corresponding theoretical and musical implications. Xenakis’ approach on sound synthesis is viewed as a domain of design of direct compositional relevance. Across subsequent steps in his carrier, Xenakis’s notion of ‘synthesis’ appears as a process or device generative of sound and music at once, in a single compact constructive gesture or strategy making it difficult to tell matter from form. Gradually, the musical work’s identity seemed to incorporate not just a specific linguistic-formal configuration, but the set of conditions of possibility elaborated by the composer – that is, eventually, the computer programming code (Gendy3, 1992). Iannis Xenakis’ commitment to crafting sound generation techniques – before using them to also craft music – witnesses at an attitude in which the appropriation of the material means of creative labour is an irreducible precondition for freedom of expression and musical aesthetics.

OBJECTIVE To determine the prevalence, progression, and modifiable risk factors associated with the development of diabetic retinopathy (DR) in a population-based cohort of youth-onset diabetes. RESEARCH DESIGN AND METHODS We conducted a multicenter, population-based prospective cohort study (2002–2019) of youth and young adults with youth-onset type 1 diabetes (n = 2,519) and type 2 diabetes (n = 447). Modifiable factors included baseline and change from baseline to follow-up in BMI z score, waist/height ratio, systolic and diastolic blood pressure z score, and A1C. DR included evidence of mild or moderate nonproliferative DR or proliferative retinopathy. Prevalence estimates were standardized to estimate the burden of DR, and inverse probability weighting for censoring was applied for estimating risk factors for DR at two points of follow-up. RESULTS DR in youth-onset type 1 and type 2 diabetes is highly prevalent, with 52% of those with type 1 diabetes and 56% of those with type 2 diabetes demonstrating retinal changes at follow-up (mean [SD] 12.5 [2.2] years from diagnosis). Higher baseline A1C, increase in A1C across follow-up, and increase in diastolic and systolic blood pressure were associated with the observation of DR at follow-up for both diabetes types. Increase in A1C across follow-up was associated with retinopathy progression. BMI z score and waist/height ratio were inconsistently associated, with both positive and inverse associations noted. CONCLUSIONS Extrapolated to all youth-onset diabetes in the U.S., we estimate 110,051 cases of DR developing within ∼12 years postdiagnosis. Tight glucose and blood pressure management may offer the opportunity to mitigate development and progression of DR in youth-onset diabetes.

OBJECTIVE Long noncoding RNAs (lncRNAs) are involved in diabetogenesis in experimental models, yet their role in humans is unclear. We investigated whether circulating lncRNAs associate with incident type 2 diabetes in older adults. RESEARCH DESIGN AND METHODS A preselected panel of lncRNAs was measured in serum of individuals without diabetes (n = 296) from the Vienna Transdanube Aging study, a prospective community-based cohort study. Participants were followed up over 7.5 years. A second cohort of individuals with and without type 2 diabetes (n = 90) was used to validate our findings. RESULTS Four lncRNAs (ANRIL, MIAT, RNCR3, and PLUTO) were associated with incident type 2 diabetes and linked to hemoglobin A1c trajectories throughout the 7.5-year follow-up. Similar results (for MIAT and PLUTO also in combined analysis) were obtained in the validation cohort. CONCLUSIONS We found a set of circulating lncRNAs that independently portends incident type 2 diabetes in older adults years before disease onset.

Han intentado siempre hacernos vivir en un zoológico de cuerpos sin pensamiento, en una filosofía de la miseria del cuerpo que ha terminado siendo una miseria de filosofía del cuerpo. Hay que volver a pensar la ley de movimiento del cuerpo, puesto que no tiene - felizmente- leyes naturales, instintos predeterminados, animales. Es más, hay que volver a pensar cómo construir el cuerpo según un método, es decir, por medio de la relación con otros cuerpos pensados y pensantes. Finalmente, habitando el cuerpo podemos habitar el mundo, engendrar un universo de cuerpos pensados y pensantes.

Aims/Hypotheses. People with type 1 (T1D) or type 2 diabetes (T2D) who also have diabetes complications can have pronounced cognitive deficits. It remains unknown, however, whether and how multiple diabetes complications co-occur with cognitive dysfunction, particularly in youth-onset diabetes. Methods. Using data from the SEARCH for Diabetes in Youth Study cohort, a prospective longitudinal cohort, we examined clustering of complications and their underlying clinical factors with performance on cognitive tests in young adults with youth-onset T1D or T2D. Cognition was assessed via the NIH Toolbox Cognition Battery. The main cognitive variables were age-corrected scores for composite fluid cognition and associated cognitive subdomains. Diabetes complications included retinopathy, microalbuminuria, and peripheral neuropathy (PN). Lipids, systolic blood pressure (SBP), hemoglobin A1c, and other clinical factors were included in the analyses. Clustering was applied separately to each group (T1D = 646; T2D = 165). A three-cluster (C) solution was identified for each diabetes type. Mean values and frequencies of all factors were compared between resulting clusters. Results. The average age-corrected score for composite fluid cognition differed significantly across clusters for each group ( p < 0.001 ). People with T1D and the lowest average fluid cognition scores had the highest frequency of self-reporting at least one episode of hypoglycemia in the year preceding cognitive testing and the highest prevalence of PN. Persons with T2D and the lowest average fluid cognition scores had the highest SBP, the highest central systolic and diastolic blood pressures, and highest prevalence of PN. Conclusions/Interpretations. These findings highlight shared (PN) and unique factors (hypoglycemia in T1D; SBP in T2D) that could be targeted to potentially mitigate cognitive issues in young people with youth-onset diabetes.

Ancient dental calculus represents one of the most recent and innovative sources of archaeobotanical record. Exploring this matrix, diet, past ecology, and ethnobotanical practices of antique communities may be elucidated. In the present case-study, the tartar of an Imperial Roman man, likely a salt worker, found in the necropolis of Castel Malnome (Rome, Latium, Italy) and affected by bilateral temporo-mandibular joint ankylosis, was investigated. Despite his rare and extremely disabling affection, this male individual reached adulthood thanks to the forced removal of the anterior teeth, which allowed him to eat. Starches of Poeae and Triticeae tribe were detected, although the largest amount of the granules appeared gelatinized, suggesting that maybe the inhumate consumed well-cooked and semi-liquid stuff, due to his non-functional masticatory activity. Urticaceae and clover pollen grains documented unintentional aspiration or voluntary use of these plants as ingredients for meals and therapeutic decoctions. Indeed, since Roman times, written sources have documented nettle as an anti-inflammatory remedy to treat joint and muscle pains. Finally, the identification of secondary metabolites ascribable to the Brassicaceae family, Artemisia L., and Ephedra L. genera, paves the way for hypothesizing the consumption of these Mediterranean species with several nutritional and nutraceutical properties. All this evidence opens a picture window onto the life of this man, which should be well integrated into his community and natural environment despite the functional impairment.

Multiple valve heart disease refers to the simultaneous presence of several valvular anomalies, while mixed valvular heart disease refers to the combination of stenotic lesions or regurgitation affecting the same valve. The pathophysiology of multiple and mixed valvular heart disease depends on the combination of affected valves and the severity of the individual valvular defects. Imaging is essential for diagnosis and assessment of disease severity. The treatment of combined valvular defects currently represents a challenge for both cardiac surgeons and interventional cardiologists since only few data in the literature address the clinical and therapeutic decision-making process related to these complex lesions. These are heterogeneous conditions, which differ from each other in the combination of the valves involved, in the pathogenesis with which they develop, in the severity of the individual lesions, in the associated surgical risk, in the possibility of being repaired, and in the undergoing transcatheter treatments. In addition to the severity of the individual valve defects, the choice of treatment also depends on the ventricular function and the general condition of the patient. This work aims to provide a review of the state of the art regarding the possible management strategies of the most common multiple valve diseases in clinical practice.

Preconception counseling is recommended for all women with diabetes starting at puberty to convey the importance of optimal diabetes management for maternal and fetal outcomes. This study included 622 female participants from the SEARCH for Diabetes in Youth study with a mean age of 22.2 years (range 14–35 years). Only 53.7% reported ever receiving preconception counseling, which was significantly lower among women seeing pediatric providers than those seeing adult or all-age providers. Older age and history of prior pregnancy were associated with increased odds of reporting having received preconception counseling. Identification of barriers to delivering preconception counseling to young females with diabetes and strategies to overcome them are needed to reduce the risk for pregnancy complications and adverse offspring health outcomes.

Torrential processes are among the main actors responsible for sediment production and mobility in mountain catchments. For this reason, the understanding of preferential pathways for sediment routing has become a priority in hazard assessment and mitigation. In this context, the sediment Connectivity Index (IC) enables to analyse the existing linkage between sediment sources and the selected target (channel network or catchment outlet). The IC is a grid-based index that allows fast computation of sediment connectivity based on landscape information derived from a single Digital Terrain Model (DTM). The index computation is based on the log-ratio between an upslope and a downslope component, including information about drainage area, slope, terrain roughness, and distance to the analysis target (e.g. outlet). The output is a map that highlights the degree of structural connectivity of sediment pathways over analysed catchments. Until now, these maps are however rarely used to help defining debris-flow hazard maps, notably due to a lack of guidelines to interpret the IC spatial distribution. This paper proposes an exploitation procedure along profiles to extract more information from the analysis of mapped IC values. The methodology relies on the analysis of the IC and its component variables along the main channel profile, integrated with information about sediment budgeting derived from Difference of DEMs (DoD). The study of connectivity was applied in the unmanaged sub-catchment (without torrent control works) of the Rio Soial (Autonomous Province of Trento – NE Italy) to understanding the geomorphic evolution of the area after five debris flows (in ten years) and the related changes of sediment connectivity. Using a recent DTM as validation, we demonstrated how an IC analysis over the older DTM can help predicting geomorphic changes and associated hazards. The results show an IC aptitude to capture geomorphic trajectories, anticipate debris flow deposits in a specific channel location, and depict preferential routing pathways..

Water awareness is inextricably linked to climate change awareness. In 1987, renowned climate scientist William W. Kellogg wrote an article about “the evolution of awareness” of humankind’s impact on the climate. He noted that over 150 years separated the first observations of this im- pact to the first explicit mention of the greenhouse effect in 1957 (Kellogg 1987). Over 35 years after Kellogg’s article, “awareness” is no longer the greatest challenge: it is “action.” The Water Conference of 1977 in Mar del Plata, Argentina, which aimed at establishing an international water resource management program, proposed an Action Plan to guarantee orderly administration of water resources as a key element for improving socio-economic conditions and quality of life for humankind (United Nations 1983). However, the plan did not result in widespread action and one reason was the broadness with which it was written. The 1977 Action Plan addressed countries generally, without considering specific climates, political structures, economic differences or so- cio-cultural contexts. Almost 50 years later and halfway into the Water Action Decade (2018–2028), progress on wa- ter-related goals and targets remains alarmingly off-track (United Nations 2023). The Water Action Agenda and the UN 2023 Water Conference promises a different approach and calls for commit-ments and actions. The president of the General Assembly remarked on the need for game chang- ers: methods, strategies, approaches and programs able to connect multiple disciplines, levels of governance and ways of thinking to enhance cooperation across actors, sectors and scales for sustainable development, beyond a “business as usual” approach (United Nations 2022).

Aims Patients with atrial fibrillation frequently experience sleep disorder breathing, and both conditions are highly prevalent in presence of heart failure (HF). We explored the association between the combination of an HF and a sleep apnoea (SA) index and the incidence of atrial high-rate events (AHRE) in patients with implantable defibrillators (ICDs). Methods and results Data were prospectively collected from 411 consecutive HF patients with ICD. The IN-alert HF state was measured by the multi-sensor HeartLogic Index (>16), and the ICD-measured Respiratory Disturbance Index (RDI) was computed to identify severe SA. The endpoints were as follows: daily AHRE burden of ≥5 min, ≥6 h, and ≥23 h. During a median follow-up of 26 months, the time IN-alert HF state was 13% of the total observation period. The RDI value was ≥30 episodes/h (severe SA) during 58% of the observation period. An AHRE burden of ≥5 min/day was documented in 139 (34%) patients, ≥6 h/day in 89 (22%) patients, and ≥23 h/day in 68 (17%) patients. The IN-alert HF state was independently associated with AHRE regardless of the daily burden threshold: hazard ratios from 2.17 for ≥5 min/day to 3.43 for ≥23 h/day (P < 0.01). An RDI ≥ 30 episodes/h was associated only with AHRE burden ≥5 min/day [hazard ratio 1.55 (95% confidence interval: 1.11–2.16), P = 0.001]. The combination of IN-alert HF state and RDI ≥ 30 episodes/h accounted for only 6% of the follow-up period and was associated with high rates of AHRE occurrence (from 28 events/100 patient-years for AHRE burden ≥5 min/day to 22 events/100 patient-years for AHRE burden ≥23 h/day). Conclusions In HF patients, the occurrence of AHRE is independently associated with the ICD-measured IN-alert HF state and RDI ≥ 30 episodes/h. The coexistence of these two conditions occurs rarely but is associated with a very high rate of AHRE occurrence. Clinical trial registration URL: http://clinicaltrials.gov/Identifier: NCT02275637.

Radiology residents in their final year of training at our institution are required to deliver a grand rounds presentation prior to graduation in order to facilitate resident involvement in the medical tradition of ground rounds. We evaluated this requirement by conducting a survey of recent residency alumni on their experience delivering grand rounds and its perceived value in radiology training.We developed an anonymous, 10-question survey regarding the alumni experience with the grand rounds presentation requirement, which has been required since 2007. Question formats included yes-or-no and 5 point Likert-type formats, as well as a space to provide comments.Eighty-three alumni were contacted and 39 responded (46.9% response rate). Current practice setting was academic in 41.0%, 46.2% have reused material from their presentation, and 46.2% have given a grand rounds presentation since completing residency. When asked if delivering the presentation was a valuable experience, 2.6% disagreed, 23.1% were neutral, 35.9% agreed, and 38.5% strongly agreed. When asked if they would recommend future senior residents to give a grand rounds presentation, 2.6% strongly disagreed, 30.8% were neutral, 30.8% agreed, and 35.9% strongly agreed.The majority of survey respondents agree or strongly agree their grand rounds presentation experience was valuable and would recommend future residents to continue this process. Based on survey comments, we conclude this experience is valuable for multiple reasons, including the opportunity to demonstrate mastery of a radiology topic, the ability to repurpose presentation material in the future, and the experience of delivering a formal presentation.

The goal of this study was to test the efficacy of training community-based psychotherapists who were part of a practice research network to be more attuned to their patients' experiences of the therapeutic relationship. We were particularly interested in the effect of therapist training on the congruence of alliance ratings with their patients. Forty psychotherapists who treated 117 patients were randomly assigned to receive either no training or training, whose learning objectives were to help therapists to develop and maintain a therapeutic alliance. The training included workshops and ongoing consultations to help the clinician to strengthen the therapeutic relationship with the use of mentalizing, attachment theory, countertransference management, and metacommunication. Therapeutic alliance and well-being outcomes were measured at each of six consecutive early psychotherapy sessions. We used the truth and bias model and response surface analysis within a multilevel modeling context to test hypotheses. There was a significantly faster rate of alliance growth in the training versus the no training condition when the alliance was rated by therapists, but not when rated by patients. Trained therapists experienced greater temporal congruence in alliance ratings with their patients compared to untrained therapists. Patient well-being outcomes improved in a session when trained therapists and their patients agreed in their positive alliance ratings in a previous session. This association not significant among untrained therapists. Training therapists in key interpersonally focused skills may lead them to be better attuned to their patients' experiences of the therapeutic relationship. (PsycInfo Database Record (c) 2022 APA, all rights reserved).