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Chiara Bernuzzi,1 Maria Adele Piccardo,1 Marta Marsilio,2 Valeria Calcaterra,3,4 Gianvincenzo Zuccotti,2,3 Chiara Guglielmetti1 1Department of Economics, Management and Quantitative Methods (DEMM), University of Milan, Milan, 20122, Italy; 2Department of Biomedical and Clinical Science, University of Milan, Milan, 20157, Italy; 3Pediatric Department, Buzzi Children’s Hospital, Milan, 20154, Italy; 4Department of Internal Medicine, University of Pavia, Pavia, 27100, ItalyCorrespondence: Chiara Bernuzzi, Department of Economics, Management and Quantitative Methods (DEMM), University of Milan, via Conservatorio, 7, Milan, 20122, Italy, Email chiara.bernuzzi@unimi.itPurpose: The widespread adoption of telemedicine tools poses new and little-known challenges for healthcare professionals, who are required to adapt their knowledge, skills, and work practices to this innovative scenario. Understanding healthcare professionals’ expectations and concerns about adopting telemedicine can facilitate its effective integration. Therefore, drawing upon the Value Co-Creation in Healthcare model, the current study aims to investigate pediatricians’ expectations regarding antecedents, outcomes, and management activities relevant to the implementation of a telehomecare service.Methods: Interviews invitations were sent to all pediatricians (n=13) involved in a pilot study using the TytoCare device, a telehomecare tool that enables remote medical examinations, at an Italian pediatric hospital. All invited pediatricians agreed to participate. The semi-structured interviews, each lasting approximately 30 to 45 minutes, were conducted remotely via Microsoft Teams prior to the use of the TytoCare device. All interviews were recorded and transcribed verbatim. The content was subsequently analyzed through thematic analysis using MAXQDA software.Results: Five overarching thematic areas emerged from the interviews: factors influencing the adoption of the telehomecare device, advantages of its use, impacts on work practices, changes in the patient-professional relationship, and management activities. While concerns exist about the adequacy of telehomecare compared to in-person visits, the device offers potential benefits, such as improving the hospital experience for children by shortening hospital stays. However, it may lead to an increased workload and necessitate stronger trust and communication in remote care. Successful integration requires dedicated support staff, regulatory adjustments, and effective leadership, with active involvement of healthcare professionals in decision-making.Conclusion: By shedding light on healthcare professionals’ expectations about telehomecare device, this study provides useful insights to healthcare leaders to tailor interventions to accompany technology within care practices to valorize its benefits and promote value co-creation processes.Keywords: telehomecare, expectations about telemedicine, pediatricians, healthcare professionals, co-creation of value, qualitative

This paper explores how the concept of plurilingualism is positioned to act as an impetus for linguistic and cultural inclusion in human-rights-based language education. Drawing on frameworks foregrounding descriptors for plurilingualism and democratic citizenship, the paper employs discourse analysis and sorting techniques to identify and align strategies of linguistic and cultural inclusion found in multimodal plurilingual task artefacts collected from a multi-year, multi-site research partnership between a Canadian university and the Italian Ministry of Education. The findings reveal that the implementation of plurilingual tasks aligns with key elements of democratic, rights-based language education, including critical understanding of communication, openness to cultural otherness, cooperation skills, and the valuing of cultural diversity. The findings of this paper contribute to further understanding of the concept of plurilingualism and to empirically informed perspectives on pedagogies that support language rights as human rights in education.

Background: In relapsing differentiated thyroid cancer (DTC), the in vivo evaluation of natrium–iodide symporter (NIS) expression is pivotal in the therapeutic planning and is achieved by 131/123Iodine (131/123I) whole body scan. However, these approaches have low sensitivity due to the low resolution of SPECT. 18F-Tetrafluoroborate (TFB) has been proposed as a viable alternative, which could outperform 131/123I scans owing to the superior PET resolution. We have reviewed the literature to collect the available data on TFB diagnostic performance and compare it with the standard methods. Methods: Two authors searched PubMed, CENTRAL, Scopus, Web of Science and the web for studies evaluating the biodistribution and dosimetry of TFB in patients with DTC. General characteristics, technical parameters, procedures’ sensitivities and standards of reference were extracted from the selected studies. The risk of bias was evaluated with the QUADAS-2 scoring system. Results: Five studies were included in the review. Two analysed TFB’s biodistribution and dosimetry, while the other three assessed its diagnostic performance. The diagnostic comparators were 18F-FDG PET/CT (all cases), 124I-PET/CT (one study) and diagnostic/therapeutic 131I-SPECT/CT (one study each). TFB performed better than 131I; the TFB and 18F-FDG PET/CT combination achieved the best sensitivity. TFB delivered significantly less dose than the other NIS tracers. Conclusion: TFB is a promising tracer in relapsing DTC, showing higher sensitivity and less radiation exposure than the standard methods. The TFB and 18F-FDG combination appears particularly intriguing, especially when disease heterogeneity is suspected. However, data are still sparse and need to be confirmed by further investigations.

Abstract Large‐scale re‐/afforestation projects afford sizable atmospheric CO2 removals yet questions loom surrounding their potentially offsetting biogeophysical radiative forcings. Forest area change alters not only the surface albedo but also heat, moisture, and momentum fluxes, which in turn modify the atmosphere's radiative, thermodynamical, and dynamical properties. These so‐called radiative forcing “adjustments” have been little examined in re‐/afforestation contexts, and many questions remain surrounding their relevance in relation to the instantaneous forcing from the surface albedo change—and whether they can affect Earth's radiative energy balance in regions remote from where the re‐/afforestation occurs. Here, we quantified biogeophysical radiative forcings and adjustments from realistically scaled re‐/afforestation in Europe at high spatial resolution and found that adjustments with high signal‐to‐noise were largely confined to only a few months and to the region of re‐/afforestation. Adjustments were dominated by perturbed low‐level clouds and rarely exceeded ±25% of the annual albedo change forcing.

To better understand the factors facilitating or impeding the translation of "promising controversies" (Taylor & Snoddon, 2013, p. 439) of plurilingualism theory into meaningful practices, this article presents a synthesis of 30 empirical studies on plurilingual pedagogy as enacted and experienced by educators and learners in various global K-12 and postsecondary contexts. Informed by plurilingualism (Coste et al., 1997/2009; Council of Europe, 2020), this synthesis forefronts the key contributions of plurilingual pedagogy as it fosters: (a) students' development of plurilingual (and pluri-/intercultural) competence, (b) evolution of language beliefs towards a positive orientation to plurality and hybridity, (c) affirmation of student and teacher identity and promotion of agency, and (d) language and literacy development. The perceived challenges, however, are related to the nature and practical issues of designing and implementing plurilingual pedagogy in the classroom which are interconnected with institutional policies and ideological discourses. The results illuminate the up-to-date progress as well as hurdles of promoting plurilingual pedagogies across different contexts and provide important implications for multiple stakeholders involved in pre-service teacher education, in-service professional development, curriculum improvement, and language policy making in Canada and other multicultural and multilingual societies and communities.

Since 24 February 2022, an exhausting local war begins with huge global impacts: in addition to the disastrous consequences in terms of loss of human life and material damage, especially in Ukrainian territory, there are heavy repercussions in agriculture and food, energy, economic and political fields. Diplomacy is struggling and solutions seem far to be found. The reason for this diplomatic stalemate lies in the Russian elite’s unwillingness to sit with conviction at the negotiating table and the lack of a minimum common denominator on which to start working. In addition to contingent problems such as Ukraine’s pro-European positions and its hypothesi-zed annexation to NATO, unwelcome to Moscow, the unresolved issue of Donbass, which has been dragging on for 10 years now, the annexation of Crimea, the question of energy supplies and gas pipelines, as well as broader international scenarios, which also involve Washington and Beijing (and not only), the profound reasons for the conflict lie in a complex and mix of ethnic, territorial, geopolitical and economic problems, which have increased in the area over the of history. Explaining and understanding them means providing a diagnosis not only of the war, but also and above all of the arcane causes that underlie it. The article reconstructs four salient moments of Ukrainian history, which represent as many fundamental turning points for determining the profound reasons for this war: the birth of Kievan Rus’, in medieval times; the creation of several Ukrainian republics during the Russian Revolutions and civil war; some of the problems of independent Ukraine born with the dissolution of the USSR; finally, the emergence of the reasons for the Euromaidan crisis in 2013-2014. Each of these phases reveals, with different intensity, how Ukraine is subject to incessantly changing its dimensions, how fragile its identity is and how its independence has always been precarious. Keywords: Ukraine, Russo-Ukraine war, historical roots, frozen conflicts

BackgroundCardiac neuroendocrine tumour metastases (CNTM) are rare, but advancements in molecular imaging including somatostatin receptor PET/CT (SSTR-PET/CT) could lead to a more frequent identification. The aim of this article is to perform a systematic review and meta-analysis on the detection of CNTM by SSTR-PET/CT.MethodsA comprehensive literature search of studies on CNTM detected by SSTR-PET/CT was carried out. Three different bibliographic databases were screened (Cochrane library, PubMed/MEDLINE, EMBASE) until 20 August 2024. Two review authors independently selected the eligible original articles and performed the quality assessment and the data extraction. Main findings of eligible studies were summarized and a proportion meta-analysis on the prevalence of patients with CNTM among those with neuroendocrine neoplasm (NEN) performing SSTR-PET/CT was carried out using a random-effects model.ResultsTen articles reporting data on 163 patients with CNTM were included in the systematic review. SSTR was able to detect CNTM earlier compared to other radiological imaging techniques. Most patients with CNTM had other metastatic sites and CNTM were often asymptomatic. The meta-analysis of seven articles demonstrated a pooled prevalence of 1.5% (95% confidence interval: 1.0–1.9%) of patients with CNTM (n = 119) among those performing SSTR-PET/CT for NEN (n = 9,300). Moderate statistical heterogeneity was found (I2 test: 62%).ConclusionEvidence-based data demonstrate that SSTR-PET/CT enables early and better detection of CNTM compared to other radiological imaging methods. CNTM are encountered with a pooled prevalence of 1.5% of NEN patients performing SSTR-PET/CT. Prospective and multicentric studies are warranted to better clarify the impact of CNTM detection by SSTR-PET/CT on overall survival and clinical decision-making in NEN patients.

This paper presents a methodology for directly aligning 'can do' frameworks to each other. The methodology, inspired by the manual for relating examinations to the "Common European Framework of Reference for Languages: Learning, teaching, assessment" (CEFR) (Council of Europe, 2009) and Kane's (2004, 2013) interpretative argument, takes account of both the horizontal dimension (content analysis) and the vertical dimension (benchmarking with Multifaceted Rasch Modelling -- MFRM). The paper exemplifies the application of the methodology by introducing the research conducted to align the "Canadian Language Benchmarks" (CLB)/"Niveaux de compétence linguistique canadiens" (NCLC) to the CEFR, presenting the resulting alignment, and discussing the rationale for the choices made.

Abstract Background Periodontal disease and its bacteria can be responsible for pregnancy complications and transmission of periodontal bacteria from mother to newborn. Methods A salivary swab to 60 healthy, full-term newborns and their mothers was taken immediately after birth. The test was performed with Real Time PCR method to evaluate the expression of the gene through DNA amplification. The species considered were: Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia and Fusobacterium nucleatum ssp. Results The newborn oral microbiome was composed primarily by saprophytes (98.38 + 4.88%), just like the mothers (98.8 + 3.69%). There was a statistically significant difference of the total microbiological density in newborns and mothers (p = 0.0001). Maternal and neonatal oral microbiome had a correlated total microbiological density only in 33.3% (N = 20/60) of cases. The analysis of the oral microbiome showed a pathological composition only in 12/60 babies (20%). The most frequent detected specie in newborns was Fusobacterium nucleatum (9/12 babies, 75%), as well as for the mothers (53.3%). However, the pathogen was present both in baby and his mother only in 3 dyads. Porphyromonas gingivalis showed the highest association mother-baby (4/12 dyads, 33%). Porphyromonas gingivalis was the pathogen with the highest bacterial load in the 12 mothers. We found a statistically significant difference in the total load of Porphyromonas gingivalis in mothers and babies (p = 0.02). Conclusions There was a statistically significant difference in the richness of the microbiome from newborns and mothers. Even comparing the microbiological density in the oral cavity of the individual mother-child pairs, we did not find a significant concordance. These results seem to suggest a low influence of maternal oral microbiome on the richness of the oral neonatal one. We didn’t find mother-child concordance (p = 0.0001) in the presence of pathogenic periodontal micro-organisms. Fusobacterium nucleatum was the most frequent specie detected. Porphyromonas gingivalis instead was the bacteria with the higher possibility of transmission. In conclusion in our study maternal oral health doesn’t affect healthy, full-term newborns’ oral microbiome. Further studies are needed to understand the maternal influence on newborn’s oral microbiome and its effects on babies long-term health.

Pronunciation is a common topic of interest in ELT but teachers may be unsure of what features of pronunciation to prioritise, especially in multilingual classes. While research calls for explicit pronunciation instruction that focuses on improving intelligibility and comprehensibility, implementation is still a challenge. This article presents pedagogical applications following the new CEFR descriptors for phonological control. We discuss a 40-hour pronunciation course for international ESL students from diverse L1s in a Canadian university. Pronunciation instruction was delivered through controlled speech practice and drama tasks for practice of extemporaneous speech. Students completed weekly audio recordings, received extensive feedback and completed self-reflections. Moreover, the teacher assessed pre- and post-course recordings to identify change over time. Results show that students developed awareness of pronunciation features that can contribute to more intelligible and comprehensible speech and that a listener's lack of familiarity with speech diversity can play a role in how speech is perceived.

Change and innovation in education require carefully thought-through procedures as well as time, and benefit both from exchanges of expertise between contexts and from quality assurance (QA) processes. A key document that stimulates change in planning, teaching, and assessment is the Council of Europe's (2001) Common European Framework of Reference for Languages (CEFR). However, its innovation potential in language education has been affected by a lack of impact studies and QA procedures. This article reports on the QualiCEFR study, which aims to encourage a culture of QA in relation to planning, teaching, and assessment and to identify promising practices in those processes. The study compared CEFR implementation in Switzerland and Canada employing a mixed-methods design and a QA approach, thematically analyzing data from over 40 interviews. Results have helped to inform the development of an online tool produced in a sister project of the European Centre for Modern Languages (ECML).

In the last few years, blockchain has emerged as a cutting-edge technology whose main advantages are transparency, traceability, immutability, enhanced efficiency, and trust, thanks to its decentralized nature. Although many people still identify blockchain with cryptocurrencies and the financial sector, it has many prospective applications beyond digital currency that can serve as use cases for which traditional infrastructures have become obsolete. Governments have started exploring its potential application to public services provision, as confirmed by the increasing number of adoption initiatives, projects, and tests. As the current public administration is often perceived as slow, bureaucratic, lacking transparency, and failing to involve citizens in decision-making processes, blockchain can establish itself as a tool that enables a process of disintermediation, which can revolutionize the way in which public services are managed and provided. In this paper, we will provide a survey of the main application areas which are likely to benefit from blockchain implementation, together with examples of practical implementations carried out by both state and local governments. Later, we will discuss the main challenges that may prevent its widespread adoption, such as government expenditure, technological maturity, and lack of public awareness. Finally, we will wrap up by providing indications on future areas of research for blockchain-based technologies.

BackgroundSeveral recent studies have proposed the possible application of positron emission tomography/computed tomography (PET/CT) administering radiolabelled fibroblast-activation protein (FAP) inhibitors for various forms of thyroid cancer (TC), including differentiated TC (DTC), and medullary TC (MTC).MethodsThe authors conducted an extensive literature search of original studies examining the effectiveness of FAP-guided PET/CT in patients with TC. The papers included were original publications exploring the use of FAP-targeted molecular imaging in restaging metastatic DTC and MTC patients.ResultsA total of 6 studies concerning the diagnostic yield of FAP-targeted PET/CT in TC (274 patients, of which 247 DTC and 27 MTC) were included in this systematic review. The included articles reported high values of FAP-targeted PET/CT detection rates in TC, ranging from 81 to 100% in different anatomical sites and overall superior to the comparative imaging method.ConclusionAlthough there are promising results, the existing literature on the diagnostic accuracy of FAP-guided PET in this context is still quite limited. To thoroughly evaluate its potential significance in TC patients, it is needed to conduct prospective randomized multicentric trials.

ObjectiveCalcitonin (Ctn) measurement is crucial for the early diagnosis of medullary thyroid carcinoma (MTC). However, Ctn levels can be skewed/elevated due to other reasons, and the Ctn upper reference value remains controversial. In this field, studies have heterogeneous settings, published data are controversial, and no evidence has been achieved. The study’s aim was to evaluate all previously investigated Ctn determinants in a population with histological exclusion of MTC.MethodsThe institutional records from 2010 to 2022 were reviewed to select patients with thyroid nodules who had undergone total thyroidectomy with histological exclusion of MTC and who had tested for Ctn just before surgery. Thyroid features, demographic and anthropometric data, comorbidities, medications, and lifestyle information were collected. Univariate and multivariate analyses were performed.ResultsA total of 127 cases were included. The median age for thyroidectomy was 51 years. Median Ctn was 1.04 pg/mL (interquartile range (IQR) 1.04–2.77), with two cases having values above 10 pg/mL. In univariate analysis, Ctn was correlated with gender (p < 0.001), body weight (p = 0.016), height (p = 0.031), body surface area (p = 0.016), thyroid size (p = 0.03), thyroglobulin (p < 0.001), and chronic kidney disease (p < 0.001). After multivariate analysis, the model with the highest accuracy included gender, chronic kidney disease, and thyroid-stimulating hormone (TSH) with an adjusted R-squared of 0.4.ConclusionsThis study demonstrates, in a population histologically proven as MTC-free, that the Ctn value is mainly influenced by gender, anthropometric/thyroid features, and chronic kidney disease, with the further impact of TSH.