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Introduction: The use of helicopter emergency medical services is useful for rescuing or transporting highly time-dependent disease patients, from urban remote areas or harsh environments in the hospital, providing advanced pre-hospital life support in an emergency setting., Study Objective: This study aims to identify changes in mission characteristics, crew composition, and operational procedures within the helicopter emergency medical service (HEMS) system of L'Aquila, Italy, to identify operational patterns, mission characteristics, crew composition and patient outcomes over time, with specific attention to changes implemented after the Monte Cefalone incident., Methods: Changes in the characteristics of the rescued patients, the helicopter missions, the crew members and the type of interventions were analysed. T-test or chi-square test were used to compare data before and after the incident., Results: Three thousand three hundred and ninety-two records were reviewed. Following the crash, a pilot was added to the crew. Two hundred and thirteen missions were classified as cancelled: 47 before and 166 after the crash. The cancellations due to the lack of horizontal visibility were: 4 out of 47 (8.5 %) and 24 out of 166 (14.5). Most of the rescued victims had trauma: 45 % before and 50 % after the crash. The helicopter flights were prevalent in harsh environments. After the accident, the percentage of missions in harsh environment decreased from 80 % to 64 %. The type of rescue and operations changed significantly (p < 0.001). The proportion of hospitalized patients increased from 60 % to 93 % while the recorded deaths in place were similar (6 % vs 7 %). A decrease in the number of transport refusals, from 4 % to 0.4 %, was reported., Conclusion: The results of our research highlighted that the helicopter emergency medical service of L'Aquila continued to fly in safety, for patient rescue and hospitalization despite being subjected to harsh conditions and environments, and despite the accident., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Solid waste resulting from bauxite ore (red mud) was converted into useful products consisting in hydrogarnet together with zeolite. Red mud (RM) transformation from disposal material into new source was carried out using potassium hydroxide as an activator and hydrothermal process (HY) or vapor phase crystallization (VPC) approach. HY process was performed at 60, 90, and 130 °C whereas during the VPC method, red mud was contacted only with vapor from the distilled water heated at 60 and 90 °C. The results indicate the formation of katoite and zeolite L (LTL topology) with both approaches. All the synthetic products display magnetic properties. In addition, a preliminary investigation on arsenic removal from drinking water (from 59 to 86%), makes the synthetic materials appealing for environmental applications. Finally, the synthesis of a large amount of very useful newly-formed phases using vapor molecules confirms the efficiency of the innovative and green VPC process in waste material transformation., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Silicon microring resonators serve as critical components in integrated photonic neural network implementations, owing to their compact footprint, compatibility with CMOS technology, and passive nonlinear dynamics. Recent advancements have leveraged their filtering properties as weighting functions, and their nonlinear dynamics as activation functions with spiking capabilities. In this work, we investigate experimentally the linear and nonlinear dynamics of microring resonators for time delay reservoir computing, by introducing an external optical feedback loop. After effectively mitigating the impact of environmental noise on the fiber-based feedback phase dependencies, we evaluate the computational capacity of this system by assessing its performance across various benchmark tasks at a bit rate of few Mbps. We show that the additional memory provided by the optical feedback is necessary to achieve error-free operation in delayed-boolean tasks that require up to 3 bits of memory. In this case the microring was operated in the linear regime and the photodetection was the nonlinear activation function. We also show that the Santa Fe and Mackey Glass prediction tasks are solved when the microring nonlinearities are activated. Notably, our study reveals competitive outcomes even when employing only 7 virtual nodes within our photonic reservoir. Our findings illustrate the silicon microring's versatile performance in the presence of optical feedback, highlighting its ability to be tailored for various computing applications.

Unhealthy behaviors may contribute to the development and the progression of chronic diseases with negative consequences on patients' quality of life. The present study aimed to investigate the relationship between unhealthy behaviors (physical inactivity, tobacco consumption, and alcohol consumption) and health-related quality of life, measured with the SF-36 questionnaire, in women with endometriosis. To achieve this, data from a previous cross-sectional web survey among Italian adult women were analyzed. A total of 1045 responses were included in the analysis. Among the SF-36 subscales, the lowest score was recorded in the energy/fatigue domain: mean = 35.536 (Standard Deviation = 18.452). Smoking and physically inactive women had lower scores than non-smoking and physically active women, respectively, in each SF-36 domain. Women who drank more than one unit of alcohol a day, on average, reported lower scores than women with an alcohol intake <1 unit a day, for the following SF-36 domains: role limitations due to physical health, role limitations due to emotional problems, and emotional well-being. The multivariable analysis evidenced that employment, physical inactivity, and tobacco consumption were significant predictors for each SF-36 domain ( p < 0.05). Physical inactivity and tobacco consumption had negative effects on the SF-36 subscales. Our results showed the need to monitor unhealthy behaviors to improve the overall well-being of women with endometriosis. Tailored strategies addressing smoking cessation, promoting physical activity, and moderating alcohol intake may aid in enhancing health-related quality of life in this vulnerable population.

Objectives: Corporate health programs (CHPs) aim to improve employees' health through health promotion strategies at the workplace. Physical activity (PA) plays a crucial role in primary prevention, leading many companies to implement PA-based CHPs. However, there is limited examination in the scientific literature on whether PA-based CHPs (PA-CHPs) lead to economic benefits. This systematic review aimed to summarize the available literature on the economic aspects of PA-CHPs., Methods: A systematic review was conducted to identify studies focused on PA-CHPs targeting healthy sedentary workers and reporting at least one economic outcome, such as return on investment (ROI), costs, or sick leave., Results: Of 1036 studies identified by our search strategy, 11 studies involving 60 020 participants met the inclusion criteria. The mean (±SD) cost per capita for PA-CHPs was estimated as 359€ (±238€) (95% CI, 357-361€). In 75% of the studies, the net savings generated by PA-CHPs in 12 months were reported, with an average of 1095€ (±865€) (95% CI, 496-1690€). ROI was assessed in 50% of the included studies, with an average of 3.6 (±1.41) (95% CI, 2.19-5.01)., Conclusions: In addition to promoting a healthy lifestyle, PA-CHPs have the potential to generate significant economic returns. However, the heterogeneity among the existing studies highlights the need for standardization and accurate reporting of costs in future research., (© The Author(s) [2024]. Published by Oxford University Press on behalf of Journal of Occupational Health.)

The Frontiers in Neurophotonics Symposium is a biennial event that brings together neurobiologists and physicists/engineers who share interest in the development of leading-edge photonics-based approaches to understand and manipulate the nervous system, from its individual molecular components to complex networks in the intact brain. In this Community paper, we highlight several topics that have been featured at the symposium that took place in October 2022 in Québec City, Canada., (© 2024 The Authors.)

In this work, we show how the structural features of photoactive azobenzene derivatives can influence the photoexcited state behavior and the yield of the trans/cis photoisomerization process. By combining high-resolution transient absorption experiments in the vis-NIR region and quantum chemistry calculations (TDDFT and RASPT2), we address the origin of the transient signals of three poly-substituted push-pull azobenzenes with an increasing strength of the intramolecular interactions stabilizing the planar trans isomer (absence of intramolecular H-bonds, methyl, and traditional H-bond, respectively, for 4-diethyl-4'-nitroazobenzene, Disperse Blue 366, and Disperse Blue 165) and a commercial red dye showing keto-enol tautomerism involving the azo group (Sudan Red G). Our results indicate that the intramolecular H-bonds can act as a "molecular lock" stabilizing the trans isomer and increasing the energy barrier along the photoreactive CNNC torsion coordinate, thus preventing photoisomerization in the Disperse Blue dyes. In contrast, the involvement of the azo group in keto-enol tautomerism can be employed as a strategy to change the nature of the lower excited state and remove the nonproductive symmetric CNN/NNC bending pathway typical of the azo group, thus favoring the productive torsional motion. Taken together, our results can provide guidelines for the structural design of azobenzene-based photoswitches with a tunable excited state behavior.

Background & Aims: Although worsening liver-related symptoms during pregnancy can occur in primary sclerosing cholangitis (PSC), there are insufficient data to effectively counsel patients on their pre-conception risk and no clear recommendations on monitoring and management during pregnancy. We aimed to describe maternal liver-related symptoms in pregnancy, both before and after PSC diagnosis, and explore factors associated with worsening symptoms and liver-related outcomes., Methods: We conducted a multicentre retrospective observational study of females with PSC and known pregnancy with live birth, via the International PSC Study Group. We included 450 patients from 12 European centres. Data included clinical variables, liver-related symptoms (pruritus and/or cholangitis) during pregnancy, and liver biochemistry. A composite primary endpoint of transplant-free survival from time of PSC diagnosis was used., Results: There were 266 pregnancies in 178 patients following PSC diagnosis. Worsening liver-related symptoms were reported in 66/228 (28.9%) pregnancies; they had a reduced transplant-free survival ( p  = 0.03), which retained significance on multivariate analysis (hazard ratio 3.02, 95% CI 1.24-7.35; p  = 0.02).Abnormal biochemistry and/or liver-related symptoms (pruritus and/or cholangitis) were noted during pregnancy before PSC diagnosis in 21/167 (12.6%) patients. They had a reduced transplant-free survival from pregnancy ( p  = 0.01), which did not retain significance in a multivariable model (hazard ratio 1.10, 95% CI 0.43-2.85; p  = 0.84)., Conclusions: Liver-related symptoms are frequently encountered during pregnancies before the diagnosis of PSC, and pregnancy may expose the pre-clinical phase of PSC in some patients. Worsening liver-related symptoms were seen in a third of our cohort with known PSC during pregnancy; and this subgroup had a poorer prognosis, which may be related to more advanced liver disease at time of pregnancy and/or a more severe disease phenotype., Impact and Implications: Patients with PSC can develop worsening of their liver-related symptoms during pregnancy; however, risk factors for this and the long-term implications are not known. We identified that there is a significant risk of these symptoms in pregnancy, both before and after PSC has been diagnosed, particularly in patients with elevated alkaline phosphatase. Furthermore, our findings suggest that worsening symptoms during pregnancy may be associated with adverse long-term clinical outcomes of liver transplantation and death in patients with known PSC. This may be related to the presence of more advanced liver disease at time of pregnancy. This information can be used to counsel patients with PSC before conception and identify patients who need close follow-up after delivery., Competing Interests: The authors have no relevant disclosures. Please refer to the accompanying ICMJE disclosure forms for further details., (© 2023 The Author(s).)

Primary Biliary Cholangitis (PBC) is a chronic cholestatic liver disease with a heterogeneous presentation, symptomatology, disease progression, and response to therapy. The current risk stratification assessment, aimed at identifying patients with a higher risk of disease progression, encompasses an in-depth analysis of demographic data, clinical and laboratory findings, antibody profiles, and the evaluation of liver fibrosis using both invasive and noninvasive techniques. Treatment response scores after one year of therapy remain to date a major factor influencing the prognosis of PBC patients. While the initial therapeutic approach with ursodeoxycholic acid (UDCA) is universally applied, new second-line treatment options have recently emerged, with many others under investigation. Consequently, the prevailing one-size-fits-all approach is poised to be supplanted by tailored strategies, ensuring high-risk patients receive the most appropriate treatment regimen from diagnosis. This will require the development of a risk prediction model to assess, at the time of diagnosis, the course, outcome, and response to first and additional treatments of PBC patients. This manuscript provides a comprehensive overview of the current and emerging tools used for risk stratification in PBC and speculates on how these developments might shape the disease landscape in the near future.

Per- and polyfluorinated alkyl substances (PFAS) are anthropogenic compounds which have recently drawn great attention due to their high biological, chemical and physical stability and lipid/water repelling properties. The present work aims to provide for the first time insights on the thermal behaviour of Ag-exchanged Y zeolite loaded with perfluorooctanoic acid (PFOA, C 8 HF 15 O 2 ) and perfluorooctane sulfonate (PFOS, C 8 HF 17 O 3 S) emphasizing the close link between crystal structure and desorption/dehydration processes. Elemental and isotopic abundance of carbon analysis, thermal analysis, and in situ high-temperature synchrotron X-ray powder diffraction were used to evaluate critically if the thermal regeneration affects the initial zeolites structural features. Rietveld refinements revealed that PFAS sites are emptied in the 550-650 °C temperature range, when the thermal degradation of PFOA and PFOS are reached. The crystallinity of the samples is not affected by the adsorption/desorption processes. Upon heating, the removal of both PFAS and coadsorbed water molecules induced a cation migration of the silver ions and changes of initial geometry of the framework. The dimensions of the channels remain comparable to those of the pristine materials thus suggesting the potential re-use of the samples in other adsorption PFAS cycles. Additionally, once regenerated and reloaded Ag-exchanged Y can re-adsorb PFAS in amounts comparable to that adsorbed in the first cycle with clear benefits on the costs of the whole water treatment process.

The dynamic scenario of di-aryls-pyrano-chromenes was investigated using DFT calculations. The symmetry of the chromene scaffold and the presence of two ortho -substituted aryls substituents can generate two syn / anti diastereoisomers and conformational enantiomers with different rotational barriers. The relative conformations and configurations were derived using NOESY-1D experiments. Depending on the energies related to the conformational exchange, the experimental energy barriers were determined through Dynamic NMR, Dynamic HPLC or kinetic studies. The atropisomeric pairs were resolved in the latter scenario, and their absolute configuration was assigned using the ECD/TD-DFT method.

Chronic consequences of mild traumatic brain injury (mTBI) are heterogeneous, but may be treatable with targeted medical and rehabilitation interventions. A biological signature for the likelihood of response to therapy (i.e., "predictive" biomarkers) would empower personalized medicine post-mTBI. The purpose of this study was to correlate pre-intervention blood biomarker levels and the likelihood of response to targeted interventions for patients with chronic issues attributable to mTBI. Patients with chronic symptoms and/or disorders secondary to mTBI >3 months previous (104 days to 15 years; n  = 74) were enrolled. Participants completed pre-intervention assessments of symptom burden, comprehensive clinical evaluation, and blood-based biomarker measurements. Multi-domain targeted interventions for specific symptoms and impairments across a 6-month treatment period were prescribed. Participants completed a follow-up testing after the treatment period. An all-possible model's backward logistic regression was built to identify predictors of improvement in relation to blood biomarker levels before intervention. The minimum clinically important difference (MCID) of the change score (post-intervention subtracted from pre-intervention) for the Post-Concussion Symptom Scale (PCSS) to identify treatment responders from non-responders was the primary outcome. The MCID for total PCSS score was 10. The model to predict change in PCSS score over the 6-month intervention was significant ( R 2  = 0.09; p  = 0.01) and identified ubiquitin C-terminal hydrolase L1 (odds ratio [OR] = 2.53; 95% confidence interval [CI], 1.18-5.46; p  = 0.02) and hyperphosphorylated tau (p-tau; OR = 0.70; 95% CI, 0.51-0.96; p  = 0.03) as significant predictors of symptom improvement beyond the PCSS MCID. In this cohort of chronic TBI subjects, blood biomarkers before rehabilitation intervention predicted the likelihood of response to targeted therapy for chronic disorders post-TBI., Competing Interests: No competing financial interests exist., (© Shawn R. Eagle et al., 2023; Published by Mary Ann Liebert, Inc.)

Sleep disturbances occur in up to 70% of patients with mild traumatic brain injury (mTBI). Modern mTBI management recommends targeted treatment for the patient's unique clinical manifestations (i.e., obstructive sleep apnea, insomnia). The purpose of this study was to evaluate the association of plasma biomarkers with symptom reports, overnight sleep evaluations, and response to treatment for sleep disturbances secondary to mTBI. This study is a secondary analysis of a prospective multiple interventional trial of patients with chronic issues related to mTBI. Pre- and post-intervention assessments were conducted, including overnight sleep apnea evaluation, the Pittsburgh Sleep Quality Index (PSQI), and blinded analysis of blood biomarkers. Bivariate Spearman correlations were conducted for pre-intervention plasma biomarker concentrations and 1) PSQI change scores and 2) pre-intervention sleep apnea outcomes (i.e., oxygen saturation measures). A backward logistic regression model was built to evaluate the association of pre-intervention plasma biomarkers with improvement in PSQI over the treatment period ( p  < 0.05). Participants were 36.3 ± 8.6 years old and 6.1 ± 3.8 years from their index mTBI. Participants reported subjective improvements (PSQI = -3.7 ± 3.8), whereas 39.3% ( n  = 11) had improved PSQI scores beyond the minimum clinically important difference (MCID). PSQI change scores correlated with von Willebrand factor (vWF; ρ = -0.50; p  = 0.02) and tau (ρ = -0.53; p  = 0.01). Hyperphosphorylated tau correlated with average saturation (ρ = -0.29; p  = 0.03), lowest desaturation (ρ = -0.27; p  = 0.048), and baseline saturation (ρ = -0.31; p  = 0.02). The multi-variate model ( R 2  = 0.33; p  = 0.001) retained only pre-intervention vWF as a predictor (odds ratio = 3.41; 95% confidence interval, 1.44-8.08; p  = 0.005) of improving PSQI scores beyond the MCID. vWF had good discrimination (area under the curve = 0.83; p  = 0.01), with an overall accuracy of 77%, sensitivity of 46.2%, and specificity of 90.0%. Validation of vWF as a potential predictive biomarker of sleep improvement post-mTBI could optimize personalized management and healthcare utilization., Competing Interests: No competing financial interests exist., (© Shawn R. Eagle et al., 2023; Published by Mary Ann Liebert, Inc.)

Atorvastatins play an important role in the inhibition of HMG-CoA reductase, an enzyme present in the liver that takes part in the biosynthesis of cholesterol. In this article, we report the total synthesis of a lactone-atorvastatin prodrug with additional atropisomeric features. Conformational and experimental studies of model compounds were designed to test the stability of the chiral axis. Docking calculations were performed to evaluate the constant inhibition of a library of atorvastatins. Full synthesis of the best candidate was achieved and thermally stable atropisomeric lactone-atorvastatin was obtained. The absolute configuration of the chiral axis of the atropisomers was assigned by means of chiroptical ECD spectroscopy coupled with TD-DFT calculations.

A novel 1,2-azaborine ( i.e. , 4-methyl-2-(pyridin-2-yl)-2,1-borazaronaphthalene, 1a ) has been synthesized and used for the first time as a B-N alternative to common cyclometalating ligands to obtain neutral phosphorescent iridium(III) complexes ( i.e. , 2a , 3 , and 4 ) of general formula [Ir(C ∧ N) 2 (N ∧ NB)], where C ∧ N indicates three different cyclometalating ligands (Hppy = 2-phenylpyridine; Hdfppy = 2-(2,4-difluoro-phenyl)pyridine; Hpqu = 2-methyl-3-phenylquinoxaline). Moreover, the azaborine-based complex 2a was compared to the isoelectronic C═C iridium(III) complex 2b , obtained using the corresponding 2-(naphthalen-2-yl)pyridine ligand 1b . Due to the dual cyclometalation mode of such C═C ligand, the isomeric complex 2c was also obtained. All new compounds have been fully characterized by NMR spectroscopy and high-resolution mass spectrometry (MS), and the X-ray structure of 2a was determined. The electronic properties of both ligands and complexes were investigated by electrochemical, density functional theory (DFT), and photophysical methods showing that, compared to the naphthalene analogues, the azaborine ligand induces a larger band gap in the corresponding complexes, resulting in increased redox gap (basically because of the highest occupied molecular orbital (HOMO) stabilization) and blue-shifted emission bands ( e.g. , λ max = 523 vs 577 nm for 2a vs 2b , in acetonitrile solution at 298 K). On the other hand, the 3 LC nature of the emitting state is the same in all complexes and remains centered on the pyridyl-borazaronaphthalene or its C═C pyridyl-naphthalene analogue. As a consequence, the quantum yields of such azaborine-based complexes are comparable to those of the more classical C═C counterparts ( e.g. , photoluminescence quantum yield (PLQY) = 16 vs 22% for 2a vs 2b , in acetonitrile solution at 298 K) but with enhanced excited-state energy. This proves that such type of azaborine ligands can be effectively used for the development of novel classes of photoactive transition-metal complexes for light-emitting devices or photocatalytic applications.

We synthesized bis-aryl carbazole borane derivatives having emissive properties and axial chirality. The resolution of a thermally stable atropisomeric pair (compound 1b ), due to a B-C chiral axis, was achieved by chiral stationary-phase high-performance liquid chromatography (CSP-HPLC). Complete photophysical properties of all compounds were measured and simulated by time-dependent density functional theory (TD-DFT) calculations of the complete fluorescence cycle, and circularly polarized luminescence spectra were obtained for the atropisomers of compound 1b , whose absolute configuration was derived using a TD-DFT simulation of the electronic circular dichroism (ECD) spectra.

The 1,1a,2,7b-tetrahydrocyclopropa[ c ]chromene, arising from fusion of chromane and cyclopropane rings is the core of medicinally relevant compounds. Engaging sulfoxonium ylides in enantioselective aminocatalytic reactions for the first time, a convenient entry to this scaffold is presented. Several ring-fused derivatives were obtained in moderate-to-good yields and enantioselectivities and with perfect diastereoselectivity at the cyclopropane, using an α,α-diphenylprolinol aminocatalyst. The versatility of the hemiacetal moiety in the products was leveraged to effect various synthetic manipulations.

In photonic neural network a key building block is the perceptron. Here, we describe and demonstrate a complex-valued photonic perceptron that combines time and space multiplexing in a fully passive silicon photonics integrated circuit to process data in the optical domain. A time dependent input bit sequence is broadcasted into a few delay lines and detected by a photodiode. After detection, the phases are trained by a particle swarm algorithm to solve the given task. Since only the phases of the propagating optical modes are trained, signal attenuation in the perceptron due to amplitude modulation is avoided. The perceptron performs binary pattern recognition and few bit delayed XOR operations up to 16 Gbps (limited by the used electronics) with Bit Error Rates as low as [Formula: see text]., (© 2022. The Author(s).)

Vortex-sheet (V-S) models of jets are widely used to describe the dynamics of modes, such as the Kelvin-Helmholtz instability and guided acoustic waves. However, the absence of the free-stream acoustic modes in the V-S eigenspectrum is seldom pointed out in the literature. This family of modes is important if, for example, one is interested into the problems of sound emission or flow-acoustic interactions. In this work, it is shown how a distantly confined jet may be used as a surrogate problem for the free jet, in which the free-stream acoustic waves appear as a set of discrete modes. Comparing the modes observed in the free jet with those of the distantly confined jet, we show that other than the free-stream acoustic modes, the eigenvectors and eigenvalues converge exponentially with the wall distance. The proposed surrogate problem, thus, efficiently reproduces the dynamics of the original problem while accounting for the dynamics of the free-stream acoustic eigenmodes.

Lycium intricatum Boiss also called 'Awsadj' is a subshrub belonging to the Solanaceae family and producing red berries. In the present work, we report the isolation of a new compound, ((1 R,3aR,7aS)-3a,7-dimethyl-1-((E)-prop-1-en-1-yl)-1,3a,4,7a-tetrahydroisobenzofuran-5(3H)-one ( 1 )). Three known compounds were also isolated for the first time from L. intricatum , and identified as isoscopoletin ( 2) , 3,4,5-trimethoxybenzyl alcohol ( 3 ), and (+)-isolariciresinol ( 4 ). Compounds 1 - 4 were isolated from the extract of leaves using chromatographic techniques, and the structure of compound 1 was fully elucidated by NMR, MS and ECD experiments.

Microring resonators (MRRs) are a key photonic component in integrated devices, due to their small size, low insertion losses, and passive operation. While the MRRs have been established for optical filtering in wavelength-multiplexed systems, the nonlinear properties that they can exhibit give rise to new perspectives on their use. For instance, they have been recently considered for introducing optical nonlinearity in photonic reservoir computing systems. In this work, we present a detailed numerical investigation of a silicon MRR operation, in the presence of external optical feedback, in a time delay reservoir computing scheme. We demonstrate the versatility of this compact, passive device, by exploiting different operating regimes and solving computing tasks with diverse memory requirements. We show that when large memory is required, as it occurs in the Narma 10 task, the MRR nonlinearity does not play a significant role when the photodetection nonlinearity is involved, while the contribution of the external feedback is significant. On the contrary, for computing tasks such as the Mackey-Glass and the Santa Fe chaotic timeseries prediction, the MRR and the photodetection nonlinearities contribute both to efficient computation. The presence of optical feedback improves the prediction of the Mackey-Glass timeseries while it plays a minor role in the Santa Fe timeseries case.