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Background Older adults living in long-term care facilities (LTCF) have been severely affected by COVID-19. Hospice care (HC) facilities and palliative care are essential in treating patients dying from COVID-19. In Italy, little is known about the impact of COVID-19 on deaths in LTCF and the care provided in HC to COVID-19 patients. Aim To assess overall and case-specific mortality in 2020 in LTC and HC facilities in comparison to the previous five years (2015–2019). Methods We performed a descriptive study using data derived from the Italian national “Cause of Death” registry—managed by the Italian National Institute of Statistics—on deaths occurred in LTC and HC facilities during 2020 and the period 2015–2019. Results Number of deaths significantly increased in 2020 compared with 2015–2019 in LTCF (83,062 deaths vs. 59,200) and slightly decreased in hospices (38,788 vs. 39,652). COVID-19 caused 12.5% of deaths in LTCF and only 2% in hospices. Other than COVID-19, in 2020, cancer accounted for 77% of all deaths that occurred in HC, while cardiovascular diseases (35.6%) and psychotic and behavioral disorders (10%) were the most common causes of death in LTCF. Overall, 22% of the excess mortality registered in Italy during 2020 is represented by the deaths that occurred in LTCF. Discussion and conclusion LTCF were disproportionally affected by COVID-19, while the response to the pandemic in HC was limited. These data can help plan strategies to limit the impact of future epidemics and to better understand residential care response to COVID-19 epidemic.

We complete the study of the model introduced in [11]. It is a two-color urn model with multiple drawing and random (non-balanced) time-dependent reinforcement matrix. The number of sampled balls at each time-step is random. We identify the exact rates at which the number of balls of each color grows to infinity and define two strongly consistent estimators for the limiting reinforcement averages. Then we prove a Central Limit Theorem, which allows to design a statistical test for such averages., arXiv admin note: text overlap with arXiv:2102.06287

Introduction Targeted axillary dissection (TAD) after neoadjuvant chemotherapy (NAC) is a new axillary staging technique that consists of surgical removal of biopsy-proven, positive, clipped axillary nodes (CLN) in addition to the sentinel lymph node biopsy (SLNB), and provides for more conservative axillary surgery1. A question was recently raised whether clipping a positive node for later assessment indeed leads to a management change2. The purpose of our study is to report the feasibility of TAD and to evaluate false negative rate (FNR), impact on surgical ad oncological management. Materials and methods This retrospective, single-institution, study included 73 consecutive women operated between 2019 and 2021 after NAC for cN+ disease confirmed by citology or histology, whose diseased lymph-node was marked with a clip before therapy. At surgery, in case of clinical-radiological complete response, patients underwent TAD (dual mapping with radiocolloid and blue dye + CLN) (n=43), or TAD plus ALND if any residual disease (n=30). The chemoterapeutsic regimen were antracycline/taxane based, with trastuzumab in case of HER2+ tumors. Patients were routinely evaluated with a breast MRI both before and after NAC. Results Clinical and pathological details of the 73 enrolled patients are listed in Table 1. The mean age at diagnosis was 49.53±10 years. Pathologic complete response was achievied in 32 out 73 patients (43.8%) with the greatest rate in HR-/HER2+ tumors (n=10/12; 83.3%). The identification rate of the CLN was 91.8% (68/73), and it was one of SLNs in 68.5% (50/73) of the cases. In cases in which one, two or three or more SLNs were identified, the CLN was in the SLN specimen in 42.9%, 77.8% and 81.8% of cases, respectively. The FNR of the SLN was 18.5% (CI: 4.9-38.1). In 18 cases the CLN was not in the SLN specimen; eleven out of 18 CLNs were positive, leading to ALND, and three of them had additional positive LNs. Only in one case the CLN was negative and the SLN was positive. In 3 cases (4.1%), the CLN was positive in the absence of residual tumour in the breast leading a potential change in the oncological management. Conclusions Removal of CLN after NAC is feasible, allowing de-escalation of surgical management of cN+ women in case of clinical-radiological complete response, as 59% of women avoided a formal ALND. The CLN coincides with SLN in about 70% of cases (more than 80% if three or more SLNs are identified) and reflects the overall status of the axilla in 97.3% of the cases. Adding CLN to SLNB contributes to reduce significantly the FNR of the latter from 18% to 0% (FNR for SLNB =18.5% vs FNR for TAD=0%). Potential changes in surgical (CLN+/SLNs-) and oncological management (CLN+/SLNs- and absence of residual tumor in breast) occurs in 15.1% (11/73) and 4.1% (3/73) of cases, respectively. References 1. Swarnkar PK et al. The Evolving Role of Marked Lymph Node Biopsy (MLNB) and Targeted Axillary Dissection (TAD) after Neoadjuvant Chemotherapy (NACT) for Node-Positive Breast Cancer: Systematic Review and Pooled Analysis. Cancers (Basel) 2021 Mar 26;13(7):1539. 2. Weiss A et al. How Often Does Retrieval of a Clipped Lymph Node Change Adjuvant Therapy Recommendations? A Prospective, Consecutive, Patient Cohort Study. 2022 Jun. Ann Surg Oncol 2022; 29(6): 3764-3771. Table 1: Clinicopathologic characteristics in the cN+ breast cancer patients NAC and clipped Lymph Node NAC Citation Format: Francesca Arienzo, Domenico Campagna, Paola Scavinia, Laura Broglia, Laura Broglia, Alessandra Ascarelli, Helena Colavito, Mirko Montanari, Elena Manna, Tiziana Mastropietro, Emanuele Zarba Meli, Massimo La Pinta, Daniela Musio, Mauro Minelli, Paola Scavina, Michelina Maria Carla Amato, Leopoldo Costarelli. Clipped lymph nodes for cN+ patients decrease false negative rate and lead to potential changes in surgical and oncological management after clinical complete response following neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-27.

Langerhans cell histiocytosis (LCH) is a myeloid neoplasm characterized by a clonal proliferation of CD1a+/CD207+ dendritic cells. Although individuals of any age can be affected, the disease is most common in infants younger than 5 years of age, especially males. A wide range of manifestations, from asymptomatic to aggressive, have been described, along with multiorgan involvement. Even though the majority of bone lesions are observed, skin, lymph nodes, brain and lungs can also be involved. The involvement of hematopoietic system, including bone marrow, liver and spleen, is less frequent yet associated with worse prognosis, due to a worse treatment response. Diagnosis of LCH is based on the integration of clinical, laboratory, and radiological data; however, only histopathological examination might confirm it. As far as the spleen involvement is concerned, according to literature, it has been reported in about 15% patients with multisystem involvement, nonetheless only a few cases show parenchymal lesions. The present study reports the case of an infant with LCH with multisystem involvement, including bone, skin, liver, and spleen, with evidence of parenchymal lesions.

The energy needs of a Net Zero Energy Building (NZEB) are fully met by renewable energy sources. Nevertheless, the time span of the energy balance can affect the effective energy self-sufficiency of the building. The aim of this paper is to demonstrate the lack of reliability that a yearly energy balance has in characterizing an NZEB. At this scope, comparisons between two different photovoltaic systems (fixed and tracking) and two kinds of energy balance (yearly and monthly) are made for a real NZEB building located in South-Italy. The investigation was carried out through dynamic energy simulations after validating the building model. The results show that the PV surface which attains the NZEB target on yearly basis not always achieves the same objective as the monthly balance. Furthermore, considering a monthly balance, the size of the photovoltaic system with biaxial solar tracking is 50% minor than the fixed one, thanks to a steadier energy production. Also, solar tracking systems show a significantly lower reduction of operational and embodied CO2 emissions. A final technical-economic analysis shows, however, that design solutions that satisfy NZEB target not always can meet the financial interest of the private stakeholder, showing a high discounted payback period.

Three-dimensional difference pair distribution functions (3D-ΔPDFs) from X-ray and neutron diffraction experiments are reported for yttria-stabilized zirconia (Zr0.82Y0.18O1.91). A quantitative analysis of the signatures in the three-dimensional difference pair distribution functions is used to establish that oxygen ions neighbouring a vacancy shift by 0.525 (5) Å along 〈1, 0, 0〉 towards the vacancy while metal ions neighbouring a vacancy shift by 0.465 (2) Å along 〈1, 1, 1〉 away from the vacancy. The neutron 3D-ΔPDF shows a tendency for vacancies to cluster along 〈½, ½, ½〉, which results in sixfold coordinated metal ions.

With the aim to promote a fast and effective characterization of the sound environment in educational facilities and an adequate classroom acoustics design, this work provides a basic measurement protocol which consists of a minimum number of parameters and positions to be considered. The present study involved 29 primary-school classrooms where background noise level during silent and group activities, reverberation time, speech clarity, useful-to-detrimental ratio and speech levels have been acquired in occupied condition along the main axis and in one or two offset positions. Two cut-off values of maximum reverberation time to ensure optimal acoustic conditions in the case of moderate and severe requirements, respectively, were assumed equal to 0.8 s and 0.6 s, according to literature and subjective data. For each cut-off value, classrooms were divided in two consistent groups either if they were compliant or non-compliant with such requirements, respectively. Given the strong correlation among the measured quantities, cut-off values were also identified for the other acoustical parameters. The main result of the work suggests that more convenient parameters, such as clarity in the central location of the classroom, can be used beyond reverberation time, which implies a more laborious measurement procedure.

When tiles decorated to lower their symmetry are joined together, they can form aperiodic and labyrinthine patterns. Such Truchet tilings offer an efficient mechanism of visual data storage related to that used in barcodes and QR codes. We show that the crystalline metal–organic framework [OZn 4 ][1,3-benzenedicarboxylate] 3 (TRUMOF-1) is an atomic-scale realization of a complex three-dimensional Truchet tiling. Its crystal structure consists of a periodically arranged assembly of identical zinc-containing clusters connected uniformly in a well-defined but disordered fashion to give a topologically aperiodic microporous network. We suggest that this unusual structure emerges as a consequence of geometric frustration in the chemical building units from which it is assembled.

In animal species with separate sexes, abnormal individuals with a mix of phenotypically male and phenotypically female body parts are generally indicated as gynandromorphs, whereas individuals with intermediate sexual phenotypic traits are generally indicated as intersexes. However, this distinction, clear as it may seem, is neither universally agreed upon, nor free of critical issues. In consideration of the role of sex anomalies in understanding normal development, we reassess these phenomena of abnormal sexual development, taking into consideration the more recent advances in the study of sex determination and sexual differentiation. We argue that a distinction between gynandromorphism and intersexuality, although useful for descriptive purposes, is not always possible or sensible. We discuss the conceptual and terminological intricacies of the literature on this subject and provide reasons for largely, although not strictly, preferring a terminology based on descriptive rather than causal morphology, that is, on the observed phenotypic patterns rather on the causal process behind them.

BackgroundAsbestos has been hypothesised as the cause of the recent global increase in the incidence of ‘idiopathic’ pulmonary fibrosis (IPF). Establishing this has important diagnostic and therapeutic implications. The association between occupational asbestos exposure and IPF, and interaction with a common (minor allele frequency of 9% in European populations) genetic variant associated with IPF,MUC5Brs35705950, is unknown.MethodsMulticentre, incident case–control study. Cases (n=494) were men diagnosed with IPF at 21 UK hospitals. Controls (n=466) were age-matched men who attended a hospital clinic in the same period. Asbestos exposure was assessed at interview using a validated job exposure matrix and a source-receptor model. The primary outcome was the association between asbestos exposure and IPF, estimated using logistic regression adjusted for age, smoking and centre. Interaction withMUC5Brs35705950 was investigated using a genetic dominant model.Results327 (66%) cases and 293 (63%) controls ever had a high or medium asbestos exposure risk job; 8% of both cases and controls had cumulative exposure estimates ≥25 fibre ml⁻¹ years. Occupational asbestos exposure was not associated with IPF, adjusted OR 1.1 (95% CI 0.8 to 1.4; p=0.6) and there was no gene–environment interaction (p=0.3). Ever smoking was associated with IPF, OR 1.4 (95% CI 1 to 1.9; p=0.04) and interacted with occupational asbestos exposure, OR 1.9 (95% CI 1 to 3.6; p=0.04). In a further non-specified analysis, when stratifying for genotype there was significant interaction between smoking and work in an exposed job (pMUC5Brs35705950.ConclusionOccupational asbestos exposure alone, or through interaction withMUC5Brs35705950 genotype, was not associated with IPF. Exposure to asbestos and smoking interact to increase IPF risk in carriers of a common genetic variant, the minor allele ofMUC5Brs35705950.Trial registration numberNCT03211507.

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El present estudi de cas pretén entendre la dinàmica dels dissenys pedagògics d’espais d’aprenentatge a l’educació infantil a una escola pública catalana. Les dades de l’estudi inclouen observació a l’aula, entrevistes, notes de camp, enregistraments d’àudio i vídeo i fotografies. Els espais d’aprenentatge es teoritzen com la contrapartida tridimensional, tangible i observable dels entorns d’aprenentatge. Aquest estudi argumenta que els espais d’aprenentatge a l’educació infantil són dissenys pedagògics en què l’elecció és un actiu potent. Els professors i els aprenents exerceixen la presa de decisions sobre aspectes essencials de l’aprenentatge, com ara què s’ha d’aprendre, com s’ha d’aprendre, amb qui es durà a terme l’aprenentatge i a quin ritme. Els professors ho aconsegueixen mitjançant el disseny pedagògic de l’espai d’aprenentatge, i els aprenents ho fan explorant i actualitzant el disseny pedagògic. Els espais d’aprenentatge s’han d’harmonitzar amb l’entorn d’aprenentatge, és a dir, la promoció d’una cultura participativa i creativa impregna tots els aspectes de l’escola.

After 2 years of COVID-19 restrictions, the 8th Young Scientist Symposium was organized again as a face-to-face meeting covering a broad array of scientific presentations. As in the previous editions, the meeting was organized by young scientists for young scientists under the umbrella of the European Bioanalysis Forum and in collaboration with academia. The traditional Science Café was again included as an interactive round table session. This year, the main focus was on the challenges of communication. New for the 8th edition was a session connecting the young scientists with more seasoned experts in an effort to bridge talent and experience. In this article, we share the feedback of the scientific sessions and the Science Café held at the symposium.

Studi clinici ed epidemiologici indicano nella malattia infiammatoria intestinale (IBD) un fattore di rischio per la malattia di Parkinson (PD). Nell'intestino dei pazienti PD si osserva una cospicua presenza di cellule T CD4+ (Th1/Th17) che riconoscono specificamente auto-antigeni derivati dai corpi di Lewy, inducendo infiammazione locale, danno tissutale e ulteriore aggregazione di a-sinucleina. Dall'intestino, l'infiammazione T-mediata si estende al cervello, dove i corpi di Lewy arrivano migrando lungo il nervo vago e diffon- dono per via trans-neurale fino alla sostanza nera del mesencefalo, causando i fenomeni neurodegenerativi e le manifestazioni cliniche del PD. L'alterazione del microbiota intestinale, frequente nei sog- getti parkinsoniani, può anch'essa contribuire alla patogenesi del PD: mediatori prodotti dai batteri commensali, quali acidi grassi a catena corta e dopamina, possono infatti influenzare il compor- tamento dei linfociti T e innescare una risposta T-mediata verso i corpi di Lewy, inizialmente localizzata nella mucosa intestinale e poi estesa al cervello. In sintesi, evidenze molteplici compongono un quadro ipotetico innovativo che attribuisce la patogenesi del PD ad un complesso intreccio di fattori (infiammazione intestinale, alterazione del microbiota, neuroinfiammazione), in cui meccanismi di tipo autoimmunitario giocano un ruolo cruciale

Background Successful bowel preparation (BP) for colonoscopy depends on the instructions, diet, the laxative product, and patient adherence, which all affect colonoscopy quality. Nevertheless, there are no laxatives which combine effectiveness, safety, easy self-administration, good patient acceptance, and low cost. However, mannitol, a sugar alcohol, could be an attractive candidate for use in clinical practice if it is shown to demonstrate adequate efficacy and safety. Aims The present phase II dose-finding study compared three doses of mannitol (50, 100, and 150 g) to identify the best dose to be used in a subsequent phase III study. Methods The Boston Bowel Preparation Scale, caecal intubation rate, adherence, acceptability, and safety profile, including measurement of potentially dangerous colonic gas concentrations (CH4, H2, O2), were considered in all patients. A weighted algorithm was used to identify the best mannitol dose for use in the subsequent study. Results The per-protocol population included 60 patients in the 50 g group, 54 in the 100 g group, and 49 in the 150 g group. The 100 g dose was the best as it afforded optimal colon cleansing efficacy (94.4% of patients had adequate BP), adherence, acceptability, and safety, including negligible gas concentrations. Conclusions The present study demonstrated that the colon cleansing efficacy and safety of mannitol were dose dependent. Conversely, gas concentrations were not dose dependent and negligible in all patients. Combined evaluation of efficacy, tolerability, and safety, using a weighted algorithm, determined that mannitol 100 g was the best dose for the phase III study.

A full century before Darwin, Linnaeus placed firmly our species in his classification of the animal kingdom, assigning it to the Primates, together with monkeys. To this day, however, Homo sapiens has retained a position of privilege, despite the advent of evolutionary theory: in many phylogenetic trees, the highest branch is reserved for our species. Nevertheless, anatomy and physiology do not ignore the structural and functional faults of our body, which suggest a more articulated vision of biological evolution. This opens, or reopens, the possibility of evaluating the distance that separates man from his closest cousins not in terms of genes, presumed custodians of a program for development, but of culture and its fundamental tool, the language. In fact, human history is has been running through a plurality of languages and cultures. Fascinating parallels emerge between biological species and human languages, parallels that also reveal their fragility and disclose the fast decline of their diversity, increasingly due to behaviors adverse to our nature of cultural animals and eventually stifle our creativity. Lectio Gioenia, delivered at the Scuola Superiore di Catania, on July 8, 2022

Introduction A visible jowl is a reason patients consider lower facial rejuvenation surgery. The anatomical changes that lead to formation of the jowl remain unclear. The aim of this study was to elucidate the anatomy of the jowl, the mandibular ligament and the labiomandibular crease, and their relationship with the marginal mandibular branch of the facial nerve. Materials and Methods Forty-nine cadaver heads were studied (16 embalmed, 33 fresh, mean age 75 years). Following preliminary dissections and macro-sectioning, a series of standardized layered dissections were performed, complemented by histology, sheet plastination and micro-CT. Results The jowl forms in the subcutaneous layer where it overlies the posterior part of the mandibular ligament. The mandibular ligament proper exists only in the deep, sub-platysma plane, formed by the combined muscular attachment to the mandible of the specific lower lip depressor muscles and the platysma. The mandibular ligament does not have a definitive subcutaneous component. The labiomandibular crease inferior to the oral commissure marks the posterior extent of the fixed dermal attachment of depressor anguli oris. Conclusion Jowls develop as a consequence of aging changes on the functional adaptions of the mouth in humans. To accommodate wide jaw opening with a narrowed commissure requires hypermobility of the tissues overlying the mandible immediately lateral to the level of the oral commissure. This hypermobility over the mandibular attachment of the lower lip depressor muscles occurs entirely in the subcutaneous layer to allow the mandible to move largely independent from the skin. The short, elastic subcutaneous connective tissue, which allows this exceptional mobility without laxity in youth, lengthens with aging, resulting in laxity. The development of subcutaneous and dermal redundancy constitutes the jowl in this location. Level of Evidence IV "This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266." Graphical Abstract

Introduction: Although Nepal joined the WHO program for International Drug Monitoring in 2006, published data about Nepalese health professionals’ understanding of pharmacovigilance and spontaneous reporting of adverse drug reactions (ADRs) is limited. Objectives: The purposes of this study were to: (1) investigate awareness, knowledge, attitude, and practice (KAP) of pharmacovigilance among health professionals and (2) gain insight into the ADRs reported for statins in Nepal. Methods: 125 health professionals (doctors, pharmacists/assistant pharmacists, and nurses) were recruited from health care institutions (hospitals, clinics, pharmacies) in Kathmandu, Nepal. Electronic and paper survey data were collected with the use of a validated questionnaire between April and December 2018. The multiple-choice questionnaire was structured to assess the KAP of pharmacovigilance, and ADRs associated with statins, and consisted of two open-ended questions for health professionals to give suggestions for the improvement of the pharmacovigilance system. Statistical Package for the Social Sciences (SPSS, version 25) was used to analyze the demographic and pharmacovigilance data. The main outcome measures were KAP of pharmacovigilance and ADRs reported for statins. Results:100 (80%) participants (44 doctors, 32 pharmacists / assistant pharmacists, 24 nurses) completed the self-administered questionnaire. Pharmacovigilance knowledge, attitude, and practice scores were 71%, 81%, and 53%, respectively. There was a significant difference between the number of knowledgeable health professionals (71 vs. 29%, p < 0.05) and had a favorable attitude (81 vs. 19%, p < 0.05) toward pharmacovigilance and ADR reporting compared with those who did not. The number of participants who did not report ADR was higher than those who did (90 vs. 10%, p < 0.05). The adverse reactions associated with statins were muscle symptoms (62%), elevated activity of liver enzymes (24%), and gastrointestinal symptoms (9%). Conclusion: Despite the knowledge and willingness of health professionals to report ADRs, the practice of pharmacovigilance remains low in Nepal. There is a need for clear and enforceable regulations for monitoring and reporting ADRs, and effective educational interventions to promote pharmacovigilance practices.

The management of old trees suffering from precarious health state and biomechanical issues represents a very common task for many cities in Italy. It is not possible to determine when or whether trees are going to fall, but renewal can be planned to prevent expensive management and monitoring practices in the face of poor biological, ornamental and architectural results, as well as of high levels of risk. To be precise, while the ornamental and functional services exhaust, the emotional value gets fuelled and surges over time by citizens' affection. Given this, renewal plans for tree-lined avenues are not welcomed and the lack of an effective, scientific-based communication could exacerbate the problem. The search for a shared method represents an objective starting line to assess and make far-sighted decisions. The work illustrates a method for evaluating and managing old and/or dangerous trees in urban environment so that citizens are involved too. Economic and environmental aspects are analyzed by comparing the safeguard of an old tree line both to simultaneous or gradual renewal plans. Here we focus on the extent of the environmental services brought in urban areas by the diversely managed tree lines, estimating their leaf area indexes along 10-year span. Basing on results, Public Administrations can show citizens clear and objective data making management choices and strategies easier to share and agree with. Even though necessary and fundamental, the research for a comprehensive assessment of economic, social and environmental aspects related to tree lines is poorly explored.

Objectives: Major depressive disorder (MDD) is a psychiatric disorder with pathogenesis influenced by both genetic and environmental factors. To date, the molecular-level understanding of its aetiology remains unclear. Thus, we aimed to identify genetic variants and susceptibility genes for MDD with a genome-wide association study (GWAS) approach. Methods: We performed a meta-analysis of GWASs and a gene-based analysis on two Northern Italy isolated populations (cases/controls n = 166/472 and 33/320), followed by replication and polygenic risk score (PRS) analyses in Italian independent samples (cases n = 464, controls n = 339). Results: We identified two novel MDD-associated genes, KCNQ5 (lead SNP rs867262, p = 3.82 × 10-9) and CTNNA2 (rs6729523, p = 1.25 × 10-8). The gene-based analysis revealed another six genes (p < 2.703 × 10-6): GRM7, CTNT4, SNRK, SRGAP3, TRAPPC9, and FHIT. No replication of the genome-wide significant SNPs was found in the independent cohort, even if 14 SNPs around CTNNA2 showed association with MDD and related phenotypes at the nominal level of p (

Net Zero Energy Buildings (NZEBs) play a key role to save energy. However, unpredictable scenarios and uncertainties about stability of energy production from renewables frequently cause measured performance of the building-plants system that differs from predictions. So, it is crucial to individuate the best alternatives in the early-stage design of the building and related energy systems, also considering uncertain circumstances. Hence, the aim of this paper is to enhance reliability of the building design process by providing an innovative workflow based on multi-objective optimization that encompasses robustness assessment of different design alternatives against uncertain scenarios. The standard genetic algorithm optimization routine has been deeply improved to set as a key performance indicator the robustness of energy performance of several building-HVAC system configurations, also considering the financial aspects optimization. Compliance with NZEB target of the obtained optimal solutions is then automatically verified by the algorithm. The new methodology combines open-source coding language Python and the dynamic energy simulation engine EnergyPlus. The robustness of each solution is evaluated through Taguchi method. First obtained results are related to energy-efficient solutions for the building envelope. Regarding the HVAC system, ground source (instead of air source) heat pumps and variable refrigerating flow systems are preferable. Finally, medium–high size of photovoltaic panels is preferred, although with high investment costs.

Purpose of Review The purpose of this review is to describe the main features of the aging chest, studied through different imaging modalities. Recent Findings Aging-related changes of the respiratory system are inevitable. Therefore, it is mandatory to be familiar with the para-physiological changes that occurs, in order to avoid inappropriate interpretation of radiological findings that put patients at risk of over or undertreatment. Summary The role of the radiologist is fundamental in evaluating aging-related processes affecting the respiratory system and in distinguishing them from frank diseases.

In this study the effect of a high pressure homogenization (HPH) treatment, alone and in combination with a biodegradable polylactic acid (PLA) packaging activated with lysozyme on a smoothie made with apple, carrot and rice beverage was evaluated. In particular, the effects of treatments on the microbiological and quality characteristics of smoothies were assessed during storage at 4 and 10 ◦C in climatic chambers at RH of 50 %. Obtained results showed the efficacy of HPH at 100 MPa to reduce the initial cell load of mesophilic and psycothrophic aerobic bacteria, lactic acid bacteria, yeasts and aerobic spore-forming bacteria. Moreover, the combination of HPH and lysozyme activated packaging resulted in an increased antimicrobial effect against mesophilic, psychrotrophic and lactic acid bacteria during product storage at 10 ◦C. Yeast and spore forming bacteria showed, instead, lower cell loads independently from samples. Samples packed in active packaging, both treated and not, showed a better color retention in terms of lightness and red index, compared to control (C) ones both when stored at 4 and 10 ◦C. The HPH treated smoothies, both activated and not, at 4 ◦C remained microbiologically stable for more than 20 days. However, the use of active packaging has also allowed to reduce the microbiological proliferation during storage at 4 ◦C. Moreover, few differences in color indices were highlighted between samples stored at 4 ◦C. Obtained results indicate that the combination of HPH treatment and active packaging may represent a useful strategy to increase safety and shelf-life of vegetable smoothies.

Objectives: To evaluate the capability of digital tomosynthesis (DTS) to characterize suspected pulmonary lesions in the so-called hidden areas at chest X-ray (CXR). Materials and Methods: Among 726 patients with suspected pulmonary lesions at CXR who underwent DTS, 353 patients (201 males, 152 females; age 71.5 ± 10.4 years) revealed suspected pulmonary lesions in the apical, hilar, retrocardiac, or paradiaphragmatic lung zones and were retrospectively included. Two readers analyzed CXR and DTS images and provided a confidence score: 1 or 2 = definitely or probably benign pulmonary or extra-pulmonary lesion, or pulmonary pseudo-lesion deserving no further diagnostic work-up; 3 = indeterminate lesion; 4 or 5 = probably or definitely pulmonary lesion deserving further diagnostic work-up by CT. The nature of DTS findings was proven by CT (n = 108) or CXR during follow-up (n = 245). Results: In 62/353 patients the suspected lung lesions were located in the lung apex, in 92/353 in the hilar region, in 59/353 in the retrocardiac region, and in 140/353 in the paradiaphragmatic region. DTS correctly characterized the CXR findings as benign pulmonary or extrapulmonary lesion (score 1 or 2) in 43/62 patients (69%) in the lung apex region, in 56/92 (61%) in the pulmonary hilar region, in 40/59 (67%) in the retrocardiac region, and in 106/140 (76%) in the paradiaphragmatic region, while correctly recommending CT in the remaining cases due to the presence of true solid pulmonary lesion, with the exception of 22 false negative findings (60 false positive findings). DTS showed a significantly (p < 0.05) increased sensitivity, specificity, and overall diagnostic accuracy and area under ROC curve compared to CXR alone. Conclusions: DTS allowed confirmation or exclusion of the presence of true pulmonary lesions in the hidden areas of the chest.

The Small Magellanic Cloud (SMC) is the host of a rich system of globular clusters (GCs) that span a wide age range. The chemical composition of the SMC clusters is still poorly understood, despite their significance to chemical evolution studies. Here, we provide the first detailed chemical study of evolved giants in three distinct clusters, NGC 121 (10.5 Gyr), NGC 339 (6 Gyr), and NGC 419 (1.4 Gyr). Results are based on high-resolution spectra obtained with FLAMES at the Very Large Telescope. The chemical fingerprints of these clusters closely resemble those of SMC field stars, supporting the SMC's specific history of chemical enrichment relative to the Milky Way. The approximately solar-scaled [alpha/Fe] observed in all three clusters, independent of their [Fe/H], demonstrate the SMC's low star formation efficiency. Compared to their Milky Way counterparts, elements primarily produced by massive stars are severely underrepresented. Particularly, the young cluster NGC 419's extremely low [Zn/Fe] shows that hypernovae have contributed relatively little during the past two Gyr. The three GCs have high [Eu/Fe] values regardless of their age. This suggests that the production of the r-process elements in the SMC was extremely efficient up to 1.5 Gyr ago, with an enrichment timescale comparable to that from Type Ia supernovae. When the properties of the oldest SMC object NGC 121 are compared to those of in-situ Milky Way clusters and accreted clusters linked to the Gaia-Enceladus merger event, it is shown that the SMC had already attained the same metallicity as Gaia-Enceladus but with lower [Fe/H] ratios at the age of NGC 121. This suggests that the chemical enrichment histories of the early SMC and Gaia-Enceladus differed, and that the SMC probably had a lower mass in its early ages than Gaia-Enceladus., 17 pages, 7 figures, 9 tables. Accepted for publication in Astronomy and Astrophysics

Background: Laboratory Automation (LA) is an innovative technology that is currently available for microbiology laboratories. LA can be a game changer by revolutionizing laboratory workflows through efficiency improvement and is also effective in the organization and standardization of procedures, enabling staff requalification. It can provide an important return on investment (time spent redefining the workflow as well as direct costs of instrumentation) in the medium to long term. Methods: Here, we present our experience with the WASPLab® system introduced in our lab during the COVID-19 pandemic. We evaluated the impact due to the system by comparing the TAT recorded on our samples before, during, and after LA introduction (from 2019 to 2021). We focused our attention on blood cultures (BCs) and biological fluid samples (BLs). Results: TAT recorded over time showed a significant decrease: from 97 h to 53.5 h (Δ43.5 h) for BCs and from 73 h to 58 h (Δ20 h) for BLs. Despite the introduction of the WASPLab® system, we have not been able to reduce the number of technical personnel units dedicated to the microbiology lab, but WASPLab® has allowed us to direct some of the staff resources toward other laboratory activities, including those required by the pandemic. Conclusions: LA can significantly enhance laboratory performance and, due to the significant reduction in reporting time, can have an effective impact on clinical choices and therefore on patient outcomes. Therefore, the initial costs of LA adoption must be considered worthwhile.

Poverty is strongly associated with all-cause and chronic obstructive pulmonary disease (COPD) mortality. Less is known about the contribution of poverty to spirometrically defined chronic airflow obstruction (CAO) – a key characteristic of COPD. Using cross-sectional data from an asset-based questionnaire to define poverty in 21 sites of the Burden of Obstructive Lung Disease study, we estimated the risk of CAO attributable to poverty. Up to 6% of the population over 40 years had CAO attributable to poverty. Understanding the relationship between poverty and CAO might suggest ways to improve lung health, especially in low- and middle-income countries.

The allergic asthma phenotype is characterized by a T helper type 2 (Th2) immune response, based on Immunoglobulin E (IgE)-mediated type 1 hypersensitivity reactions. Total IgE is the sum of all IgE types produced by the human body and is used as a biomarker of inflammation in asthma. We analysed data collected in 143 asthma cases (median age 42.1 years) from the general Italian population (GEIRD survey; 2008–2010) to identify single nucleotide polymorphisms (SNPs) in candidate genes that are associated with total IgE in adult subjects with asthma. These patients reported respiratory symptoms in response to perennial allergens and provided data on 166 SNPs tagging 50 candidate genes or gene regions. Replication of the statistically significant results was performed in 842 asthma cases from other European countries (ECRHS II survey; 1998–2002). SNP rs549908 in interleukin 18 (IL18) gene was significantly associated with total IgE in GEIRD, and this result was replicated in ECRHS II. SNP rs1063320 in the human leukocyte antigen G (HLA-G) gene was identified in GEIRD, but this association was not replicated in ECRHS II. Further investigating IL18 and its biological pathways could be important for developing new therapeutic targets, due to its involvement in inflammatory response processes.

This presentation has been given the 7th of June 2023 at the last INFO/RAC National Focal Points meetingand it has beenalready presented in some bilateral meetings with the Contracting Parties(https://doi.org/10.5281/zenodo.7645445), but it is reported here with an homongeneized stylization after the entire meeting slides. Itdescribes the implications of the UNEP-MAP Data Policy for the Contracting Parties. The presentationis related to the document "MAP Data Policy – Implications for the Contracting Parties(UNEP/MED WG.566/Inf. 7)".

This presentation has been given the 7th of June 2023 at the last INFO/RAC National Focal Points meetinganddetails the UNEP-MAP Data Policy application rules for each mandatory and not mandatory data flow. The presentationis related to the documents "Data Policy Annex on Barcelona Convention Reporting System (BCRS) data flow(UNEP/MED WG.566/6)", "Data Policy Annex on National Baseline Budget (NBB) data flow (UNEP/MED WG.566/7)", "Data Policy Annex on IMAP data flow (UNEP/MED WG.566/8)" and "Data Policy Annex on InfoMAP Node data flow (UNEP/MED WG.566/9)".

This presentation has been given the 7th of June 2023 at the last INFO/RAC National Focal Points meetinganddescribes the path towards a Knowledge Management Strategy for UNEP-MAP knowledge heritage. The presentationis related to the documents "Main elements of the MAP Knowledge Management Strategy: towards a Knowledge Management Platform for the Mediterranean Sea(UNEP/MED WG.566/4)" and "Towards a MAP Digital Transformation: Actions pursued in the last biennium (UNEP/MED WG.566/5)"

Background: Patients with refractory mCRC rarely undergo third-line or subsequent treatment. This strategy could negatively impact their survival. In this setting, regorafenib (R) and trifluridine/tipiracil (T) are two key new treatment options with statistically significant improvements in overall survival (OS), progression-free survival (PFS), and disease control with different tolerance profiles. This study aimed to retrospectively evaluate the efficacy and safety profiles of these agents in real-world practice. Materials and Methods: In 2012–2022, 866 patients diagnosed with mCRC who received sequential R and T (T/R, n = 146; R/T, n = 116]) or T (n = 325]) or R (n = 279) only were retrospectively recruited from 13 Italian cancer institutes. Results: The median OS is significantly longer in the R/T group (15.9 months) than in the T/R group (13.9 months) (p = 0.0194). The R/T sequence had a statistically significant advantage in the mPFS, which was 8.8 months with T/R vs. 11.2 months with R/T (p = 0.0005). We did not find significant differences in outcomes between groups receiving T or R only. A total of 582 grade 3/4 toxicities were recorded. The frequency of grade 3/4 hand-foot skin reactions was higher in the R/T sequence compared to the reverse sequence (37.3% vs. 7.4%) (p = 0.01), while grade 3/4 neutropenia was slightly lower in the R/T group than in the T/R group (66.2% vs. 78.2%) (p = 0.13). Toxicities in the non-sequential groups were similar and in line with previous studies. Conclusions: The R/T sequence resulted in a significantly longer OS and PFS and improved disease control compared with the reverse sequence. R and T given not sequentially have similar impacts on survival. More data are needed to define the best sequence and to explore the efficacy of sequential (T/R or R/T) treatment combined with molecular-targeted drugs.

We reply to the comments made by Benvenuti et al. (2022) about our paper on the Italian natural history museums and scientific collections and the need of a centralized hub and repository. While agreeing that digitization is a useful tool to valorize each museum and collection, we still believe that the suggestion of a centralized hub is valid and necessary. This would largely help in boosting coordination among museums, sharing personnel and resources, and in providing a place to deposit scientific collections that do not fit the scope of smaller museums.

The safety and effectiveness of facial cosmetic surgery procedures are dependent on detailed 3D understanding of the complex surgical anatomy of the face. Traditional, small sample size anatomical dissection studies have limitations in providing definitive clarification of the fascial layers of the face, and especially in their relationship with the facial nerve, and their reaction to surgical manipulation. The objective study of large tissue areas is required to effectively demonstrate the broader architecture. Conventional histology techniques were modified to handle extraordinarily large tissue samples to fulfill this requirement. Full-thickness soft tissue samples (skin to bone) of maximum length 18 cm, width 4 cm, and tissue thickness 1 cm, were harvested from 20 hemifaces of 15 fresh human cadavers (mean age at death = 81 years). After fixation, the samples were processed with an automated processor using paraffin wax for 156 h, sectioned at 30 mu m, collected on gelatin-chromium-coated glass slides, stained with a Masson's Trichrome technique and photographed. Using this technique, excellent visualization was obtained of the fascial connective tissue and its relationship with the facial mimetic muscles, muscles of mastication and salivary glands in 73 large histological slides. The resulting slides improved the study of the platysma and superficial musculo-aponeurotic system (SMAS), the spaces and ligaments, the malar fat pad, and the facial nerve in relations to the deep fascia. Additionally, surgically induced changes in the soft-tissue organization were successfully visualized. This technique enables improved insight into the broad structural architecture and histomorphology of large-scale facial tissues.

Background The inverted-V deformity is an unwanted aesthetic consequence of dorsal hump resection. Despite their attachment to the nasal bones, the upper lateral cartilages (ULCs) can separate from the nasal bones, creating a step-off after cartilaginous dorsal hump removal. Objectives The mechanism of how the ULCs can separate from the nasal bones despite their attachment was studied to improve understanding of the inverted-V complication and its prevention. Methods A dorsal hump resection (bony and cartilaginous) was performed on 12 fresh cadavers to observe the effect on the ULCs. As a secondary study, the effect of different preventative maneuvers was investigated. Results Cartilaginous dorsal resection destroys the spreader mechanism of the T-frame and impacts the stabilization of the ULCs, resulting in them becoming free-floating. This causes them to migrate in a posterior, medial, and cranial direction relative to the nasal bones. The dynamic attachment of the ULCs to the nasal bones is key in this mechanism and allows actual separation of the ULCs from the nasal bones to result in the inverted-V deformity. Caudal traction to the ULCs re-tensions these attachments, pulling the ULCs against the nasal bones again. Conclusions This anatomic dissection study has established that the connection between the nasal dorsum and ULCs is not a static fusion but is dynamic. This attachment can be used in primary rhinoplasty to prevent inverted-V deformity by applying caudal traction to the ULCs when reconstructing the dorsum which will tension the ULCs toward the nasal bones.

The rich-get-richer rule reinforces actions that have been frequently chosen in the past. What happens to the evolution of individuals’ inclinations to choose an action when agents interact? Interaction tends to homogenize, while each individual dynamics tends to reinforce its own position. Interacting stochastic systems of reinforced processes have recently been considered in many papers, in which the asymptotic behavior is proven to exhibit almost sure synchronization. In this paper we consider models where, even if interaction among agents is present, absence of synchronization may happen because of the choice of an individual nonlinear reinforcement. We show how these systems can naturally be considered as models for coordination games or technological or opinion dynamics.

This study aimed to: a) investigate the most common signs and symptoms reported by people infected by the COVID-19, b) compare total time and weekly level of physical activity of people between pre- and post-infection period, and c) examine the association between physical activity levels and signs and symptoms reported during the disease cycle. Twenty-two adult people (14 males and 8 females, mean age 37.9 ± 16.8 years) living in Ribeirão Preto, Brazil participated in this study. Participants received a positive diagnosis for COVID-19 by PCR. Physical activity and sitting time was assessed using the International Physical Activity Questionnaire. Variables such as body mass index and the clinical condition of the disease (signs and symptoms) were collected. The most frequent signs and symptoms reported by active and inactive individuals, respectively, were loss of taste (77.8% and 25%), headache (66.7% and 25%), coughing (66.7% and 25%), difficulty breathing (61.1% and 25%), and sore throat (61.1% and 75%). A 120-minute reduction (p = 0.010) in the total time of weekly physical activity and a 155 minute reduction (p = 0.003) of weekly moderate physical activity was observed in the pre- and post-diagnostic COVID-19 infection comparison. There was further an association between difficulty breathing and being physically inactive (odds ratio = 0.222; 95%CI: 0.094 – 0.527). Our findings suggest that COVID-19 had a negative impact on physical activity and that being physically active may reduce the likelihood of presenting with difficulty breathing if infected with the SARS-CoV-2 and associated disease COVID-19.

The Guidelines for Stroke Rehabilitation are the result of a joint effort by the Scientific Department of Neurological Rehabilitation of the Brazilian Academy of Neurology aiming to guide professionals involved in the rehabilitation process to reduce functional disability and increase individual autonomy. Members of the group participated in web discussion forums with predefined themes, followed by videoconference meetings in which issues were discussed, leading to a consensus. These guidelines, divided into two parts, focus on the implications of recent clinical trials, systematic reviews, and meta-analyses in stroke rehabilitation literature. The main objective was to guide physicians, physiotherapists, speech therapists, occupational therapists, nurses, nutritionists, and other professionals involved in post-stroke care. Recommendations and levels of evidence were adapted according to the currently available literature. Part I discusses topics on rehabilitation in the acute phase, as well as prevention and management of frequent conditions and comorbidities after stroke. RESUMO As Diretrizes Brasileiras para Reabilitação do AVC são fruto de um esforço conjunto do Departamento Científico de Reabilitação Neurológica da Academia Brasileira de Neurologia com o objetivo de orientar os profissionais envolvidos no processo de reabilitação para a redução da incapacidade funcional e aumento da autonomia dos indivíduos. Membros do grupo acima participaram de fóruns de discussão na web com pré-temas, seguidos de reuniões por videoconferência em que as controvérsias foram discutidas, levando a um consenso. Essas diretrizes, divididas em duas partes, focam as implicações de recentes ensaios clínicos, revisões sistemáticas e metanálises sobre reabilitação do AVC. O objetivo principal é servir de orientação a médicos, fisioterapeutas, fonoaudiólogos, terapeutas ocupacionais, enfermeiros, nutricionistas e demais profissionais envolvidos no cuidado pós-AVC. As recomendações e níveis de evidência foram adaptados de acordo com a literatura disponível atualmente. Aqui é apresentada a Parte I sobre tópicos de reabilitação na fase aguda, prevenção e tratamento de doenças e comorbidades frequentes após o AVC.

According to the standard cosmological scenario, the large galaxies that we observe today have reached their current mass via mergers with smaller galaxy satellites (Moore et al.1999). This hierarchical process is expected to take place on smaller scales for the satellites themselves, that should build-up from the accretion of smaller building blocks (D'Onghia & Lake 2008). The best chance we have to test this prediction is by looking at the most massive satellite of the Milky Way (MW): the Large Magellanic Cloud (LMC). Smaller galaxies have been revealed to orbit around the LMC (Erkal & Belokurov 2020, Patel et al. 2020), but so far the only evidence for mutual interactions is related to the orbital interplay with the nearby Small Magellanic Cloud (SMC), which is the most massive LMC satellite. In this work, we report the likely discovery of a past merger event that the LMC experienced with a galaxy with a low star formation efficiency and likely having a stellar mass similar to those of dwarf spheroidal galaxies. This former LMC satellite has now completely dissolved, depositing the old globular cluster (GC) NGC 2005 as part of its debris. This GC is the only surviving witness of this ancient merger event, recognizable through its peculiar chemical composition. This discovery is the observational evidence that the process of hierarchical assembly has worked also in shaping our closest satellites., 32 pages, 7 figures, 3 table. Published in Nature Astronomy