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Between 2001 and 2011, Italy deployed about 36.7 million smart meters. As the older meters approach the end of their 15-year long life, a campaign has been started to replace them with second-generation smart meters. This paper performs a cost–benefit analysis of the roll-out program, considering both the costs and the potential benefits (including a more efficient use of energy, load-shifting, and the reduction of CO2emissions). Benefits are likely to exceed the costs, but that depends on the actual use of the meter-generated data, the cost of carbon allowances, and the discount rate.

Information on the frequency and timing of mental disorder onsets across the lifespan is of fundamental importance for public health planning. Broad, cross-national estimates of this information from coordinated general population surveys were last updated in 2007. We aimed to provide updated and improved estimates of age-of-onset distributions, lifetime prevalence, and morbid risk.

Patient‐reported helpfulness of treatment is an important indicator of quality in patient‐centered care. We examined its pathways and predictors among respondents to household surveys who reported ever receiving treatment for major depression, generalized anxiety disorder, social phobia, specific phobia, post‐traumatic stress disorder, bipolar disorder, or alcohol use disorder. Data came from 30 community epidemiological surveys – 17 in high‐income countries (HICs) and 13 in low‐ and middle‐income countries (LMICs) – carried out as part of the World Health Organization (WHO)’s World Mental Health (WMH) Surveys. Respondents were asked whether treatment of each disorder was ever helpful and, if so, the number of professionals seen before receiving helpful treatment. Across all surveys and diagnostic categories, 26.1% of patients (N=10,035) reported being helped by the very first professional they saw. Persisting to a second professional after a first unhelpful treatment brought the cumulative probability of receiving helpful treatment to 51.2%. If patients persisted with up through eight professionals, the cumulative probability rose to 90.6%. However, only an estimated 22.8% of patients would have persisted in seeing these many professionals after repeatedly receiving treatments they considered not helpful. Although the proportion of individuals with disorders who sought treatment was higher and they were more persistent in HICs than LMICs, proportional helpfulness among treated cases was no different between HICs and LMICs. A wide range of predictors of perceived treatment helpfulness were found, some of them consistent across diagnostic categories and others unique to specific disorders. These results provide novel information about patient evaluations of treatment across diagnoses and countries varying in income level, and suggest that a critical issue in improving the quality of care for mental disorders should be fostering persistence in professional help‐seeking if earlier treatments are not helpful.

ABSTRACTHumans’ willingness to bear costs to benefit others is an evolutionary puzzle. Cultural group selection proposes a possible answer to this puzzle—cooperative norms and institutions proliferate due to group-level benefits. For instance, belief in knowledgeable, moralizing deities is theorized to decrease selfishness and favoritism through threat of supernatural punishment. Similarly, norms of fairness and cooperation are theorized to have coevolved with engagement in markets, which necessitate anonymous exchanges. We investigate these theories among the Tanzanian Hadza who, until recently, have had minimal exposure to markets or major world religions. Engagement with Western tourists, village markets, and Christian missionaries is increasingly leading researchers to ask how such interactions have affected cooperative behavior. We interviewed 172 Hadza from 15 camps varying in market proximity, and measured cooperative decision-making using economic games. We find that exposure to missionaries is associated with increased belief in a knowledgeable and punitive deity, with mixed evidence that these beliefs, in turn, affect game play. In contrast, we find some evidence that those living in market-adjacent regions exhibit less in-group favoritism when cooperating. These results support the claim that market-norms, and to some degree religious beliefs, facilitate greater cooperation and fairness in social interactions.

Aspiration community-acquired pneumonia (ACAP) and community-acquired pneumonia (CAP) in patients with aspiration risk factors (AspRFs) are infections associated with anaerobes, but limited evidence suggests their pathogenic role.

A high percentage of systemic sclerosis (SSc) patients experience interstitial lung disease (ILD) during the disease course. Recent data have shown that lung ultrasound (LUS) can assess ILD by the evaluation of B-lines, the sonographic sign of pulmonary interstitial involvement.

ABSTRACTWhether those who believe in God are more prosocial has been a long debated topic. Here we shed new light on this question by examining giving in incentivized Dictator Games where no mention of religion was made, played online with anonymous strangers. Study 1 (N = 15,827) found a significant correlation between belief and giving, r = .122 (robust to demographics). Study 2 (N = 2334) included the Cognitive Reflection Test (CRT) to examine whether this relationship could be explained by intuitive cognitive style driving both belief and prosociality. Study 2 replicated the correlation between belief and giving, r = .106, and found CRT to be negatively correlated with both belief, r = −.229, and giving, r = −.174. Critically, the relationship between belief and giving was reduced by 34% when controlling for CRT; and also adding basic demographics rendered the relationship non-significant. Our results suggest that—at least in this task and population—believers doshow greater prosociality, but more due to intuitive cognitive style than belief per se.

Nucleating agents (NAs) are widely used for speeding up processing and tuning the final optical and mechanical properties. Despite their industrial importance, the search for highly efficient NAs is still mainly empirical. In this work, the heterogeneous nucleation process of isotactic polypropylene (i-PP) droplets containing nucleating agents (i.e., sodium benzoate (SB), (4,6-di-tert-butylphenyl)phosphate (NA-11), quinacridone quinone (QQ)) dispersed in an immiscible polystyrene matrix has been studied by differential scanning calorimetry (DSC) using an isothermal step crystallization protocol. When semicrystalline polymers are confined into isolated micro- or nanodomains, nucleation can kinetically control the overall crystallization. Differently, in a bulk polymer, the contributions of the nucleation and growth steps to the overall crystallization rate are commonly of similar importance. In the studied system, it is shown for the first time that the crystallization of nucleated i-PP droplets exhibits a first-order kinetics, with characteristic times much larger than those required for the crystals to grow and occupy the whole microdomain volume. Therefore, the kinetics of heterogeneous nucleation can be directly assessed. On the contrary, when neat i-PP droplets are self-nucleated, the crystallization kinetics shows a sigmoidal trend, with times comparable to those for the crystal space filling. This indicates the absence of any primary nucleation barrier for ideally self-nucleated PP melts, or at least that this nucleation barrier is negligible in comparison to the one for secondary nucleation/crystal growth. For the first time, it is evidenced that, as long as nucleation is the rate-determining step in the overall crystallization kinetics, a first-order kinetics can be obtained for both homo- or heterogeneously nucleated droplets in immiscible blends. A novel way to calculate an “intrinsic” nucleation efficiency, based on the derived free-energy barriers of the different NAs, is proposed. This fundamental knowledge of heterogeneous nucleation can serve as a tool for a more rational search for new nucleating agents and can provide a method to unambiguously identify the origin of multiple-crystallization exotherms in fractionated crystallization of immiscible blends.

How does violence affect prosociality? Previous work shows that exposure to intergroup violence is positively related prosociality. Here, we test whether this finding extends to other types of community violence. In a sample of 100 residents from New Haven, CT, we examine the relationship between exposure to—and committing of—violence and economic games measuring prosociality (paying a cost to benefit others) as well as norm-enforcing punishment (paying a cost to impose a cost on selfish actors). We find that both exposure to violence and committing a violent crime are not associated with cooperation but are positively associated with norm-enforcing punishment. These results suggest that unlike during intergroup conflict, violence is unrelated to cooperation when it occurs in a community context. Rather, norm-enforcing punishment is more commonly employed by individuals who have been exposed to community violence and engaged in violent behaviors themselves.

Objectives: The aim of our study is to report a case of a child with subglottic thymus that was suspected during diagnostic work-up for severe airway obstruction, excised surgically and confirmed with final histopathological examination. Moreover, we performed a narrative literature review to outline clinical and diagnostic features of this rare condition and to report suggestions for the management of subglottic masses.Methods: We report the case of a 7-month-old boy who was admitted to our Pediatric Airway Team Unit due to a history of worsening biphasic stridor and recurrent episodes of upper airway obstruction. The successful diagnostic work-up and a narrative literature of analogous cases of subglottic thymus were reported.Results: Ectopic thymus is a very rare condition in which thymic tissue is found outside the normal pathway of its embryonic migration. It usually presents as a cystic or, more rarely, solid mass, showing an indolent course toward spontaneous involution. In some cases, however, it becomes symptomatic exerting compression on surrounding vital structures. Due to its rarity, the initial diagnosis is normally mistaken with inflammatory diseases or malignancies and the definitive diagnosis is only achieved after histological examination of the excised specimen. To our knowledge, only four other cases of subglottic ectopic thymic tissue have been reported in the English literature so far and the diagnosis has never been suspected preoperatively.Conclusion: It is mandatory to consider ectopic thymic tissue in the differential diagnosis in children presenting with airways obstruction in order to prevent unnecessary, extensive, and exploratory surgery.

Aims.While there are effective treatments for psychiatric disorders, many individuals with such disorders do not receive treatment and those that do often take years to get into treatment. Information regarding treatment contact failure and delay in Argentina is needed to guide public health policy and planning. Therefore, this study aimed to provide data on prompt treatment contact, lifetime treatment contact, median duration of treatment delays and socio-demographic predictors of treatment contact after the first onset of a mental disorder.Methods.The Argentinean Study of Mental Health Epidemiology (EAESM) is a multistage probability sample representative of adults (aged 18+) living in large urban areas of Argentina. A total of 2116 participants were evaluated with the World Mental Health Composite International Diagnostic Interview to assess psychiatric diagnosis, treatment contact and delay.Results.Projections of cases that will make treatment contact by 50 years taken from a survival curve suggest that the majority of individuals with a mood (100%) or anxiety disorder (72.5%) in Argentina whose disorder persist for a sufficient period of time eventually make treatment contact while fewer with a substance disorder do so (41.6%). Timely treatment in the year of onset is rare (2.6% for a substance disorder, 14.6% for an anxiety disorder and 31.3% of those with a mood disorder) with mean delays between 8 years for mood disorders and 21 years for anxiety disorders. Younger cohorts are more likely to make treatment contact than older cohorts, whereas those with earlier ages of disorder onset are least likely to make treatment contact. Those with anxiety disorders and major depressive disorder are more likely to make treatment contact when they have comorbid disorders, whereas those with substance use disorders are less likely.Conclusions.Argentina needs to implement strategies to get individuals with substance use disorders into treatment, and to reduce treatment delays for all, but particularly to target early detection and treatment among children and adolescents.

Adsorption of orange and yellow dyes, containing mono- and di-azoic groups, respectively, were studied by the use of a natural and organo-bentonites, which were obtained by treatment with hexadecyl-trimethyl-ammonium bromide (Br-HDTMA). Two different bentonites from Argentina were used. X-ray diffraction, UV–visible spectrometry, infrared spectrometry and thermal analysis were used for the characterizations. The results were interpreted by using isotherms that fit properly to the mathematical model of Langmuir. The structural and physicochemical properties of the clay, and the arrangement of hexadecyl-trimethyl-ammonium cation (HDTMA+) into the interlayer of the smectites, the main clay mineral composition of the bentonites, were responsible for the retention of dyes. The retention of the azo dyes not only increased with the HDTMA+modification of the bentonites but also depended on the clay mineral (smectite types) composition of the pristine bentonite.

Despite the apparent simplicity, it is notoriously difficult to measure rainfall accurately because of the challenging environment within which it is measured. Systematic bias caused by wind is inherent in rainfall measurement and introduces an inconvenient unknown into hydrological science that is generally ignored. This paper examines the role of rain gauge shape and mounting height on catch efficiency (CE), where CE is defined as the ratio between nonreference and reference rainfall measurements. Using a pit gauge as a reference, we have demonstrated that rainfall measurements from an exposed upland site, recorded by an adjacent conventional cylinder rain gauge mounted at 0.5 m, were underestimated by more than 23% on average. At an exposed lowland site, with lower wind speeds on average, the equivalent mean undercatch was 9.4% for an equivalent gauge pairing. An improved‐aerodynamic gauge shape enhanced CE when compared to a conventional cylinder gauge shape. For an improved‐aerodynamic gauge mounted at 0.5 m above the ground, the mean undercatch was 11.2% at the upland site and 3.4% at the lowland site. The mounting height of a rain gauge above the ground also affected CE due to the vertical wind gradient near to the ground. Identical rain gauges mounted at 0.5 and 1.5 m were compared at an upland site, resulting in a mean undercatch of 11.2% and 17.5%, respectively. By selecting three large rainfall events and splitting them into shorter‐duration intervals, a relationship explaining 81% of the variance was established between CE and wind speed. This study was motivated by how challenging it is to measure rainfall accurately, despite it appearing to be very simple. Rainfall measurement is important to society because it has so many everyday uses, such as food production and weather forecasting, and applications that are critical to life, such as flood warning and effective management of water resources. Rainfall is difficult to measure because it varies so much in time and space, and the measurement of rain is highly affected by how windy it is, which also varies in time and space. Therefore, when it rains at the same time as being very windy, which is common during many storms, rainfall measurements are greatly underestimated. The uplands generally receive more rainfall and higher wind speeds than the lowlands, therefore it follows that we underestimate rainfall by more in the uplands. This is important because rainfall measurements in the uplands are sparse, yet it is in such areas where many floods originate. This study shows that the underestimation of rainfall at a site in the windy Scottish uplands was more than 23% on average. It then suggests some techniques that can be implemented to improve the measurement of rainfall. Rainfall in windy upland areas can be greatly underestimated due to wind‐induced undercatchThe mounting height and shape of a rain gauge is more important for accurate rainfall measurement than is widely appreciatedAn improved‐aerodynamic rain gauge shape is the simplest and cheapest method of enhancing rainfall catch

OBJECTIVETo analyze the impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Approach (IMA) and the INICC Surveillance Online System (ISOS) on central line-associated bloodstream infection (CLABSI) rates in 14 intensive care units (ICUs) in Argentina from January 2014 to April 2017.DESIGNThis prospective, pre–post surveillance study of 3,940 ICU patients was conducted in 11 hospitals in 5 cities in Argentina. During our baseline evaluation, we performed outcome and process surveillance of CLABSI applying Centers for Disease Control and Prevention/National Health Safety Network (CDC/NHSN) definitions. During the intervention, we implemented the IMA through ISOS: (1) a bundle of infection prevention practice interventions, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback on CLABSI rates and consequences, and (6) performance feedback of process surveillance. Bivariate and multivariate regression analyses were performed using a logistic regression model to estimate the effect of the intervention on the CLABSI rate.RESULTSDuring the baseline period, 5,118 CL days and 49 CLABSIs were recorded, for a rate of 9.6 CLABSIs per 1,000 central-line (CL) days. During the intervention, 15,659 CL days and 68 CLABSIs were recorded, for a rate of 4.1 CLABSIs per 1,000 CL days. The CLABSI rate was reduced by 57% (incidence density rate: 0.43; 95% confidence interval, 0.34–0.6; P<.001).CONCLUSIONSImplementing IMA through ISOS was associated with a significant reduction in the CLABSI rate in ICUs in Argentina.Infect Control Hosp Epidemiol2018;39:445–451

The airflow surrounding any catching-type rain gauge when impacted by wind is deformed by the presence of the gauge body, resulting in the acceleration of wind above the orifice of the gauge, which deflects raindrops and snowflakes away from the collector (the wind-induced undercatch). The method of mounting a gauge with the collector at or below the level of the ground, or the use of windshields to mitigate this effect, is often not practicable. The physical shape of a gauge has a significant impact on its collection efficiency. In this study, we show that appropriate “aerodynamic” shapes are able to reduce the deformation of the airflow, which can reduce undercatch. We have employed computational fluid-dynamic simulations to evaluate the time-averaged airflow realized around “aerodynamic” rain gauge shapes when impacted by wind. Terms of comparison are provided by the results obtained for two standard “conventional” rain gauge shapes. The simulations have been run for different wind speeds and are based on a time-averaged Reynolds-Averaged Navier-Stokes model. The shape of the aerodynamic gauges is shown to have a positive impact on the time-averaged airflow patterns observed around the orifice compared to the conventional shapes. Furthermore, the turbulent air velocity fields for the aerodynamic shapes present “recirculating” structures, which may improve the particle-catching capabilities of the gauge collector. Atmospheric precipitation measurementsWind-induced undercatch of precipitation gaugesComputational fluid-dynamics modeling

We examine the possibility that self-interest, typically thought to undermine social welfare, might reduce in-group bias. We compared the dictator game (DG), where participants unilaterally divide money between themselves and a recipient, and the ultimatum game (UG), where the recipient can reject these offers. Unlike the DG, there is a self-interested motive for UG giving: If participants expect the rejection of unfair offers, they have a monetary incentive to be fair even to out-group members. Thus, we predicted substantial bias in the DG but little bias in the UG. We tested this hypothesis in two studies (N= 3,546) employing a 2 (in-group/out-group, based on abortion position) × 2 (DG/UG) design. We observed the predicted significant group by game interaction, such that the substantial in-group favoritism observed in the DG was almost entirely eliminated in the UG: Giving the recipient bargaining power reduced the premium offered to in-group members by 77.5%.

Stent placement is commonly used to treat aortic coarctation. Although invasive angiography remains the gold standard, follow-up is often performed using computed tomography, which allows rapid, noninvasive assessment of the aorta and surrounding tissues. The goal of this pictorial essay is to provide a guide to the interpretation of these examinations. Normal and abnormal computed tomographic appearance of different stent types is shown along with reconstructions that can help assess stent integrity and the stent position in relation to the aortic wall and branches. Furthermore, imaging findings of complications including aortic wall injuries, restenosis, and intimal hyperplasia are depicted.

Substance use is a major cause of disability globally. This has been recognized in the recent United Nations Sustainable Development Goals (SDGs), in which treatment coverage for substance use disorders is identified as one of the indicators. There have been no estimates of this treatment coverage cross-nationally, making it difficult to know what is the baseline for that SDG target. Here we report data from the World Health Organization (WHO)'s World Mental Health Surveys (WMHS), based on representative community household surveys in 26 countries. We assessed the 12-month prevalence of substance use disorders (alcohol or drug abuse/dependence); the proportion of people with these disorders who were aware that they needed treatment and who wished to receive care; the proportion of those seeking care who received it; and the proportion of such treatment that met minimal standards for treatment quality (“minimally adequate treatment”). Among the 70,880 participants, 2.6% met 12-month criteria for substance use disorders; the prevalence was higher in upper-middle income (3.3%) than in high-income (2.6%) and low/lower-middle income (2.0%) countries. Overall, 39.1% of those with 12-month substance use disorders recognized a treatment need; this recognition was more common in high-income (43.1%) than in upper-middle (35.6%) and low/lower-middle income (31.5%) countries. Among those who recognized treatment need, 61.3% made at least one visit to a service provider, and 29.5% of the latter received minimally adequate treatment exposure (35.3% in high, 20.3% in upper-middle, and 8.6% in low/lower-middle income countries). Overall, only 7.1% of those with past-year substance use disorders received minimally adequate treatment: 10.3% in high income, 4.3% in upper-middle income and 1.0% in low/lower-middle income countries. These data suggest that only a small minority of people with substance use disorders receive even minimally adequate treatment. At least three barriers are involved: awareness/perceived treatment need, accessing treatment once a need is recognized, and compliance (on the part of both provider and client) to obtain adequate treatment. Various factors are likely to be involved in each of these three barriers, all of which need to be addressed to improve treatment coverage of substance use disorders. These data provide a baseline for the global monitoring of progress of treatment coverage for these disorders as an indicator within the SDGs.

Introduction Although often asymptomatic, cardiac involvement is common in systemic sclerosis (SSc), and is associated with an increased morbidity and mortality. The aim of this study is to investigate whether high-sensitivity troponin (HSTn) might represent a useful tool to detect subclinical scleroderma heart involvement (SHI) in SSc.Methods We enrolled 65 consecutive SSc patients who performed HSTn test, electrocardiogram and an echocardiogram within six months of HSTn test. We acquired also data about N-terminal segment of proBNP (NT-proBNP) and cardiac magnetic resonance imaging (cMRI). We excluded patients with overt pulmonary arterial hypertension. We defined as subclinical SHI the presence of the following conditions: diastolic dysfunction, pericardial effusion, conduction abnormalities/arrhythmias, oedema and/or T2 weighted non-ischemic pattern showed by cMRI.Results Twelve patients showed SHI, and 23 and 29, respectively, had high levels of HSTn and of NT-proBNP. SHI is correlated with high levels of HSTn (p = 0.02) with a significant difference between HSTn values in patients with or without SHI (59 vs. 13 ng/mL; p = 0.0097). Moreover, among patients with abnormal NT-proBNP, 18 also had out of range HSTn (Spearman rank correlation 0.5; p<0.0001). According to ROC curve analysis, the best HSTn cut-off value in distinguishing between patients with and patients without SHI was 16 ng/mL (sensitivity 66.7%, specificity 83%; area under the curve: 0.77 (95% CI: 0.65-0.87) p<0.001.Conclusions Our data show a close relationship between HSTn and NT-proBNP in SSc patients with SHI. HSTn might be a marker of SHI while NT-proBNP seems to be less specific for heart dysfunction.

In 2014, the Association of American Medical Colleges (AAMC) published a list of 13 Core Entrustable Professional Activities for Entering Residency (Core EPAs) that medical school graduates might be expected to perform, without direct supervision, on the first day of residency. Soon after, the AAMC commissioned a five-year pilot with 10 medical schools across the United States, seeking to implement the Core EPA framework to improve the transition from undergraduate to graduate medical education.In this article, the pilot team presents the organizational structure and early results of collaborative efforts to provide guidance to other institutions planning to implement the Core EPA framework. They describe the aims, timeline, and organization of the pilot as well as findings to date regarding the concepts of entrustment, assessment, curriculum development, and faculty development. On the basis of their experiences over the first two years of the pilot, the authors offer a set of guiding principles for institutions intending to implement the Core EPA framework. They also discuss the impact of the pilot, its limitations, and next steps, as well as how the pilot team is engaging the broader medical education community. They encourage ongoing communication across institutions to capitalize on the expertise of educators to tackle challenges related to the implementation of this novel approach and to generate common national standards for entrustment. The Core EPA pilot aims to better prepare medical school graduates for their professional duties at the beginning of residency with the ultimate goal of improving patient care.

Polymer-based nanocomposites containing inorganic ferroelectric inclusions, typically ABO3perovskites, have emerged as innovative dielectric materials for energy storage and electric insulation, potentially coupling the high breakdown strength (BDS) and easy processing of polymers with the enhancement of dielectric constant provided by the ferroelectric phase. In this paper, experimental data and three-dimensional finite element method (3D FEM) simulations were combined to shed some light on the effect of microstructures on the dielectric properties of poly(vinylidene fluoride) (PVDF)-BaTiO3composites. The existence of particle aggregates or touching particles has a strong effect on the effective dielectric constant and determines an increase of the local field in the neck region of the ferroelectric phase with a detrimental effect on the BDS. The distribution of the field and the effective permittivity are very sensitive to the specific microstructure considered. The degradation of the BDS can be overcome by coating the ferroelectric particles with a thin shell of an insulating oxide with a low dielectric constant, such as SiO2(εr= 4). The local field is highly concentrated on the shell, while the field in the ferroelectric phase is reduced almost to zero and that on the matrix is close to the applied one. The electric field in the matrix becomes less homogeneous with increasing the dielectric constant of the shell material, as happens with TiO2(εr= 30). These results provide a solid background to explain the enhanced dielectric properties and the superior BDS of composites containing core–shell inclusions.

Background:Thyroid disease during pregnancy is associated with multiple adverse maternal and fetal outcomes. In particular, multiple observational studies have demonstrated an association between the presence of thyroid antibodies in euthyroid women in the first trimester of miscarriage and an increased rate of spontaneous miscarriage and preterm delivery. The present study is a prospective intervention trial of the effect of levothyroxine on the rate of miscarriage and preterm delivery in euthyroid thyroid-antibody positive women in the first trimester of pregnancy.Methods:A total of 8530 women in the first trimester of pregnancy in Southern Italy were screened for TSH and thyroid antibodies. Group A consisted of 198 euthyroid thyroid antibody positive women treated with levothyroxine, group B consisted of 195 untreated euthyroid thyroid antibody positive women, and group C consisted of 197 untreated thyroid antibody negative women.Results:The rate of miscarriage did not differ between the 3 groups (11.6%, 14.9%, and 8.1 %, P= .11). The rate of preterm delivery between the 3 groups was 6.9%, 10.8%, and 2.8% and was statistically significant (P= .01). The rate of preterm delivery was significantly different between groups B and C (P= .02) but was not significantly different between groups A and B (P= .27).Conclusions:In conclusion, the present study found that levothyroxine intervention had no impact on the rate of miscarriage and preterm delivery in euthyroid thyroid antibody positive women.