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BackgroundThe performance of a task depends on ongoing brain activity, which can be influenced by attention, excitement, or motivation. Scientific studies have confirmed that mindfulness leads to better performance, health, and well-being. However, these cognitive efficiency modulating factors are nonspecific, can be difficult to control, and are not suitable to specifically facilitate neural processing. ObjectiveThe aim of this study is to evaluate the effects of transcranial direct current stimulation associated with neurofeedback on declarative memory and cerebral blood flow in university students. MethodsIn this study, we will use transcranial direct current stimulation, a low-cost physical resource that is easy to apply, has few adverse effects, and is associated with a neurofeedback resource. This, in turn, has been shown to be a training program capable of improving working memory function. ResultsParticipants will be recruited between July 2022 and December 2022. This study is expected to conclude in July 2023. ConclusionsThis study will provide preliminary results on the benefits of using the direct current neurostimulation and neurofeedback tools on the participants being analyzed. Trial RegistrationBrazilian Clinical Trials Registry RBR-7zs8b5; https://ensaiosclinicos.gov.br/rg/RBR-7zs8b5 International Registered Report Identifier (IRRID)PRR1-10.2196/36294

Abstract Introduction Occupational therapy has been underdeveloped and often neglected in the global health workforce agenda, contrasting with the global rise of population needs for services. The World Federation of Occupational Therapists (WFOT) is utilizing a research-based, multi-step process for developing a Global Strategy for strengthening the occupational therapist workforce. A multi-pronged scoping review, situational analysis, and expert input process enabled the drafting of a provisional Global Strategy. Here, feedback on that draft from representatives of WFOT member organizations was obtained and analyzed as one key intermediate step toward shaping the in-developing Strategy’s content and structure. Methods Two-phased, mixed-methods consultation consisting of: (1) online survey with score ratings and comments on the utility of each strategy and (2) four in-person focus groups discussions on low-scoring items involving a total of 76 representatives of WFOT member organizations. The focus group discussions were analyzed using an inductive thematic analysis approach. Results Strategies involving ‘task shifting/task sharing’ or the ‘harmonization of workforce data-collection requirements’ received the lowest scores in the initial survey and were thereby addressed in the focus groups discussions. The overarching theme of the focus groups was the need to: “clarify, specify, and contextualize the strategies”, including: (1) “clarify the terminology and specify the application”, for example, describe the meaning of task shifting, specify which tasks can (and cannot) be shifted and to whom, to address concerns regarding scope-of-practice, service demand, and safety; and (2) “outline the context of need and the context for the implementation” of the strategies, elucidating why the strategies are needed and how they can be feasibly implemented across the different jurisdictional contexts. Conclusion Within a mixed-methods consultation, WFOT representatives identified challenging topics on the draft workforce strategies and suggested methods to improve the Global Strategy, its acceptability, and implementation. The terms ‘task shifting/task sharing’ raised the greatest discussion among the profession leaders, when the strategy was not sufficiently clarified, specified, or contextualized.

Summary: Background: Severe and prolonged mpox courses have been described during the 2022–2023 outbreak. Identifying predictors of severe evolution is crucial for improving management and therapeutic strategies. We explored the predictors of mpox severity and tested the association between mpox severity and viral load in biological fluids. We also analysed the predictors of disease duration and kinetics of inflammatory markers and described the viral presence and duration of shedding in biological fluids. Methods: This multicentre historical cohort study included adults diagnosed with laboratory-confirmed mpox diagnosis between May 2022 and September 2023 at 15 Italian centres. Patients were followed up from the day of diagnosis until clinical recovery. Biological fluids (blood, urine, saliva, and oropharyngeal and rectal swabs) were collected from each subgroup during the course of the disease and after healing. The primary outcomes were disease severity (presence of mucosal involvement, extended rash, or need for hospitalisation) and its association with the cycle threshold value (Ct-value, surrogate of viral load) in biological fluids, using standard linear and linear mixed-effect logistic regression models. Among the secondary outcomes, predictors of disease duration were assessed using a linear regression model. Findings: A total of 541 patients were enrolled, including four (0.74%) women, with a median age of 38 years (IQR 33–44). Among the 235 people living with HIV (PLWH) (43.44%), 22 (4.07%) had a CD4 count lower than 350 cells/μL. Severe mpox was reported in 215 patients (39.74%). No patient died. Multivariable analysis showed that, severe mpox was more likely among Caucasians (OR 1.82; 95% CI 1.14–2.90, p = 0.012) and patients who had an onset of fever (1.95; 1.27–2.99, p = 0.002), lymphadenopathy (2.30; 1.52–3.48, p

Ralstonia spp. are low-virulent environmental Gram-negative bacteria that can cause serious nosocomial infections in immunocompromised patients. We report the characteristics of a cluster of R. insidiosa bacteremia cases occurring in our oncology day ward in Milan, Italy, between January and March 2022. A case was defined as a cancer patient attending our day ward and whose blood culture (performed because of bacteremia symptoms) led to the isolation of Ralstonia insidiosa. An epidemiological investigation was conducted in order to seek the possible source of infection. Seven adult patients received curative or palliative treatment via infusion through a Port-a-Cath (PAC). All developed symptoms within 24 h of the infusion (three during the infusion itself). Ralstonia insidiosa was isolated in the blood drawn from the PAC in all patients. All of the isolates were susceptible to carbapenems, fluoroquinolones, and piperacillin/tazobactam but resistant to aminoglycosides and cephalosporins. Systemic and/or lock antibiotic therapy led to stable symptom resolution and negative blood cultures in five patients, whereas bacteremia recurred in two patients. An epidemiological investigation suggested that extrinsic contamination of antiseptic solutions was the possible cause of the R. insidiosa infections. Although R. insidiosa is not considered a virulent pathogen, clinicians, microbiologists, and infection control teams should be aware about its potential to cause outbreaks of nosocomial bloodstream infections, especially in immunocompromised patients bearing central venous catheters.

Abstract The almost complete absence of regulations to protect invertebrates is a common condition in legal systems, including the European one, especially when it comes to invertebrates intended for human consumption. Thus, in the vast majority of cases, edible invertebrates do not receive even the most basic protection at slaughter. Despite recent research indicating that invertebrates are capable of feeling pain and stress, the humane step of stunning is not used on them. This is also the case for land snails, which are gastropod invertebrates whose consumption has now reached significant levels, already involving tonnes and that is expected to increase significantly as edible snail farming becomes more popular as a relatively low-cost, easy-to-perform, and sustainable alternative animal husbandry, thereby making land snails an increasingly economically important species. This paper presents and investigates a proposed stunning method based on the immersion of mollusks in CO2-supplemented and refrigerated water that could be used in the snail meat production chain to reduce the slaughter suffering of millions of these invertebrates. To this end, body condition descriptors (hemolymph parameters) in snails were determined before and after CO2 treatment in cold water, while generating useful data for defining a preliminary set of reference intervals for basal values.

Abstract Purpose Besides the well-established efficacy in preventing severe COVID-19, the impact of early treatments, namely antivirals and monoclonal antibodies (mAbs), on the time length to negativization of SARS-CoV-2 nasal swabs is still unclear. The aim of this study was to compare the efficacy of different early treatments in reducing the SARS-CoV-2 viral shedding, identifying a single drug that might potentially lead to a more rapid negativization of SARS-CoV-2 nasal swab. Methods This was a single-centre, retrospective, observational study conducted at Ospedale Luigi Sacco in Milan. Data of high-risk COVID-19 patients who received early treatments between 23 December 2021 and March 2023 were extracted. The comparison across treatments was conducted using the Kruskall-Wallis test for continuous variables. Dunn’s test with Bonferroni adjustment was performed for post-hoc comparisons of days to negativization. Secondly, a negative binomial regression adjusted for age, sex, number of comorbidities, immunosuppression, and SARS-CoV-2 vaccination status was implemented. Results Data from 428 patients receiving early treatments were collected. The majority were treated with Nirmatrelvir/Ritonavir and were affected by SARS-CoV-2 Omicron infection with BA.2 sublineage. The median length time to SARS-CoV-2 nasal swab negativization was 9 days [IQR 7–13 days]. We found that Nirmatrelvir/Ritonavir determined a significant decrease of the length time to SARS-CoV-2 nasal swab negativization compared to mAbs (p = 0.003), but not compared to Remdesivir (p = 0.147) and Molnupiravir (p = 0.156). Conclusion Our findings highlight the importance of promptly treating high-risk COVID-19 patients with Nirmatrelvir/Ritonavir, as it also contributes to achieving a faster time to negative SARS-CoV-2 nasal swabs.

IntroductionRadiofrequency (RF) relieves chronic pain in humans, but it is unexplored in horses affected by chronic lameness. This study aims to describe the technique and the histological effects of ultrasound (US)-guided radiofrequency ablation (RFA) of palmar digital nerves (PDNs) in horse’s fetlock and pastern, ex vivo.MethodsAfter assessing the US anatomy of lateral and medial PDNs in fetlock and pastern in vivo (n = 10 horses; 20 forelimbs), US-guided RFA was performed on these sites in cadaveric forelimbs (n = 10) applying four different settings with increasing invasiveness (n = 40 total treatments): 60°C, 6 min (GROUP LOW); 70°C, 4 min (GROUP MEDIUM); 90°C, 2 min (GROUP HIGH); 80°C, 8 min (GROUP VERY HIGH). Needle-tip-to-nerve proximity was assessed with US and methylene blue, injected through the port of the RF needle. Nerves were collected for microscopical assessment.ResultsTransverse palmaro-lateral and palmaro-medial US images of fetlock and pastern detected PDNs consistently, close to the palmar digital artery. With in-plane US technique, RFA was performed at target in 31/40 cases, with significantly higher number of failures in fetlock (p = 0.008). PDNs histology identified thermal injury/coagulation with axonal degeneration and collagen homogenation. Nuclear smearing of arterial leyomyocytes was also observed. Nerve coagulation was significantly associated with treatment (p = 0.03) and needle-tip-to-nerve proximity (US distance: p = 0.009; blue distance: p = 0.04).DiscussionThe PDNs were easily visualized and reached with the RF needle by US in-plane-guided technique. RFA produced axonal thermal damage and intensity-related coagulation effectiveness. To ensure effective nerve coagulation, it is crucial that the needle is accurately positioned in close proximity to the target nerve. Based on the histopathological findings, HIGH and VERY HIGH RFA treatments might be worth of being tested in vivo in clinical studies aimed at treating chronic lameness of the distal forelimb in horses.

Thanks to the frequent revisiting, satellite microwave radiometers have great potential for surface soil moisture (SM) monitoring. However, their spatial resolution is not sufficient for hydrological studies in small catchments as well as applications to precision farming. In this study, a disaggregation technique based on machine learning is proposed: the technique combines Sentinel-1 (S-1) SAR data with SM generated from advanced microwave scanning radiometer 2 by the IFACs HydroAlgo algorithm, with the aim of enhancing the SM spatial resolution from the original 10 km to about 30 m. To this scope, two machine-learning techniques have been considered for the implementation, namely artificial neural networks (ANNs) and random forests (RF). Training is carried out by aggregating and coregistering S-1 data with the HydroAlgo SM at 10-km resolution. After training, the ANN and RF algorithms are applied pixel-by-pixel to the S-1 images at full resolution for generating the enhanced SM maps. The method has been implemented and validated in two agricultural areas located in Central Italy, where a series of experiments has been carried out between 2019 and 2020 for collecting the main soil and vegetation parameters at the same time of satellite overpasses. To assess the actual resolution of the output SM, the validation against in situ measurements has been carried out by aggregating data at 10, 30, 50, and 70 m. The results confirmed the effectiveness of the proposed method: validation carried out at 30 m obtained R≃0.82 and RMSE≃0.05 m3/m3 that represent a noticeable improvement with respect to the results obtained by HydroAlgo at 10 km (R≃0.56 and RMSE >> 0.1 m3/m3). Validation results also pointed out the superior performances of the ANN based with respect to the RF-based disaggregation.

O objetivo deste estudo foi avaliar se a suplementação de Whey Protein exerce efeitos no aumento da força máxima e sobre o desempenho de testes funcionais (Single Hop Test). Foi realizado um estudo clínico randomizado com voluntários do sexo masculino. Preencheram os requisitos de inclusão no estudo 12 homens, sendo doze em cada grupo. O primeiro grupo realizou o protocolo de treinamento e suplementado com Whey Protein mais dextrose (GW), enquanto o segundo grupo realizou o mesmo protocolo de treinamento, sendo suplementado somente com dextrose (GC). O programa de treinamento com exercícios resistidos até a falha concêntrica (80% do RM) teve duração de três semanas e frequência de três vezes por semana com intervalo mínimo de 48 horas entre as sessões. Os participantes foram avaliados através do teste de desempenho funcional (Single Hop Test) e teste de Repetição Máxima (RM). Para comparação dos resultados, utilizamos o valor de delta (∆) obtido da comparação entre os valores pré e pós-treinamento (onde valor-pós menos o valor-pré = valor delta). Quando foi observada normalidade dos dados eles foram analisados pelo teste t, em contrapartida, para os dados que apresentaram distribuição não normal foi utilizado o teste de Mann-Whitney (intergrupo) ou o teste de Wilcoxon (intragrupo). Foi considerado nível de significância de p

Abstract Background The inclusion of dexmedetomidine (DEX) within a balanced general anaesthesia protocol is effective in improving the clinical outcome and recovery quality of anaesthesia in horses. This study aimed to determine the pharmacokinetic profile of DEX following repeated subcutaneous (SC) administration at 2 µg/kg every 60 min till the end of the procedure in comparison to intravenous constant rate infusion (CRI) at 1 µg/kg/h in anaesthetized horses undergoing diagnostic procedures up to the end of the diagnostic procedure. Results In the CRI and SC groups DEX maximum concentrations (Cmax) were 0.83 ± 0.27 ng/mL and 1.14 ± 0.71 ng/mL, respectively, reached at a time (Tmax) of 57.0 ± 13.4 min and 105.5 ± 29.9 min. Mean residence time to the last measurable concentration (MRTlast) was 11.7 ± 6.2 and 55.8 ± 19.7 min for the CRI group and SC groups, respectively. The apparent elimination half-life was 18.0 ± 10.0 min in the CRI group and 94.8 ± 69.8 min for the SC group, whereas the area under the curve (AUC0-last) resulted 67.7 ± 29.3 and 83.2 ± 60.5 min*ng/mL for CRI and SC group, respectively. Clearance was 16.26 ± 8.07 mL/min/kg for the CRI group. No signs of adverse effects were recorded in both groups. Conclusions The pharmacokinetic profile of DEX following repeated SC administration in anaesthetized horses was comparable to intravenous CRI administration during the intranaesthetic period and beneficial during the recovery phase from general anaesthesia. The SC route could be considered as an alternative to CRI for improving the recovery quality of equine patients undergoing general anaesthesia.

The electrification of mobility has introduced considerable challenges to distribution networks due to varying demand patterns in both time and location. This underscores the need for adaptable tools to support strategic investments, grid reinforcement, and infrastructure deployment. In this context, the present study employs real-world datasets to propose a comprehensive spatial–temporal energy model that integrates a traffic model and geo-referenced data to realistically evaluate the flexibility potential embedded in the light-duty transportation sector for a given study region. The methodology involves assessing traffic patterns, evaluating the grid impact of EV charging processes, and extending the analysis to flexibility services, particularly in providing primary and tertiary reserves. The analysis is geographically confined to the Lombardy region in Italy, relying on a national survey of 8.2 million trips on a typical day. Given a target EV penetration equal to 2.5%, corresponding to approximately 200,000 EVs in the region, flexibility bands for both services are calculated and economically evaluated. Within the modeled framework, power-intensive services demonstrated significant economic value, constituting over 80% of the entire potential revenues. Considering European markets, the average marginal benefit for each EV owner is in the order of 10 € per year, but revenues could be higher for sub-classes of users better fitting the network needs.

Soil degradation in Europe is mostly represented by soil erosion that, as a sediment production mechanism, is the main environmental threat to many watersheds, including the Bovilla watershed (Tirana), useful for the supply of drinking water to the city, and therefore, the care of water quality is of particular interest. The soil erosion of the Bovilla watershed was monitored in a work set up in June 2017. Following this work, this research updates the previous data on soil loss at the Bovilla watershed in t/ha/year to September 2019 and focuses on the identification and monetary evaluation of the ecosystem services (ESs) linked to soil erosion (loss of carbon, loss of mineral elements, habitat quality, crop productivity, and sustainable tourism suitability). Then, we applied the replacement cost analysis to test the economic convenience and suggest the adoption of sustainable land management practices (e.g., reforestation) able to improve the quality water in this watershed. The study carried out demonstrates that the values of soil lost due to erosion vary depending on the type of land use (ranging from average values of 120.32 t/ha for bare land to values of 8.16 t/ha for wooded areas). Furthermore, from the application of monetary methods for the evaluation of some ecosystem services linked to erosion (loss of carbonaceous and mineral elements, habitat quality, productivity, suitability for sustainable tourism), it clearly emerges that the value of the productivity of agricultural crops varies from EUR 0 to 35,320.50/ha and that the service represents a more incisive service than the previous ones, so much so as to make the conversion of some agricultural land with high productivity values into wooded areas economically disadvantageous. The data from this study may help to develop Bovilla watershed management strategies for erosion and pollution control and sediment remediation mainly in agricultural lands. A program of measures can be effective for controlling soil erosion, but it must be implemented over long time frames, and it requires relevant investments from the public and private sectors, also with a view to increase the allocation of economic values of monetary compensation aimed at those who decide to start forestation projects on highly productive soils.

Background: Mpox virus (MPXV) has recently spread outside of sub-Saharan Africa. This large multicentre study was conducted in Lombardy, the most densely populated Italian region accounting for more than 40% of Italian cases. The present study aims to: i) evaluate the presence and the shedding duration of MPXV DNA in different body compartments correlating the MPXV viability with the time to onset of symptoms; ii) provide evidence of MPXV persistence in different body compartment as a source of infection and iii) characterize the MPXV evolution by whole genome sequencing (WGS) during the outbreak occurred in Italy. Material and methods: The study included 353 patients with a laboratory-confirmed diagnosis of MPXV infection screened in several clinical specimens in the period May 24th - September 1st, 2022. Viral isolation was attempted from different biological matrices and complete genome sequencing was performed for 61 MPXV strains. Results: MPXV DNA detection was more frequent in the skin (94.4%) with the longest median time of viral clearance (16 days). The actively-replicating virus in cell culture was obtained for 123/377 (32.6%) samples with a significant higher viral quantity on isolation positive samples (20 vs 31, p

Cystoisospora belli causes intestinal infection in immunocompromised hosts, including human immunodeficiency viruses (HIV)-positive patients, especially from tropical and sub-tropical areas, with watery and recurrent diarrhea, leading in advanced cases to malabsorption and death. Microbiological diagnosis is limited by intermittent or low shedding of oocysts in stool; therefore, endoscopy may be necessary to identify the pathogen in histological samples. Trimethoprim-sulfamethoxazole (TMP-SMX) represents the treatment of choice, and alternative agents are used in recurrences, but limited efficacy is described. Here, we present recently observed case of severe and fatal infection due to C. belli in a HIV-positive 40-year-old man from Brazil, revealing several limitations in diagnosis and therapy, which need to be investigated further. In particular, it is still not clear how the infection persisted over time leading to malabsorption, kidney injury, and subsequent death, even if a reasonable immune reconstitution was demonstrated. Additionally, we investigated what mechanisms might cause, whether failure of recovery of the immune response specifically to C. belli, drug malabsorption, resistance to TMP-SMX, sequestration into lymphoid tissue, or co-presence of visceral untreated Kaposi sarcoma. Also, the appropriate dosage and way of administration of the best therapeutic regimen were examined, since there is a lack of literature on these issues. Globalization and wider use of immunosuppressive therapies underline the importance of maintaining adequate awareness, also in HIV-negative and non-immigrant populations.

This study aims to evaluate the efficiency of basalt with two botanical aqueous extracts of Citrus aurantium and Nerium oleander (50g/L) against Aphis punicae and Planococcus citri in an organic pomegranate orchard. Basalt was applied as a foliar spray with two doses (1.5% and 3%), in the ground as a fertiliser (1.5%), and as a combined application (1.5%). Phenolic compounds of both plants were identified by HPLC-PDA/ESI-MS analysis. Seven and six flavonoids were detected in C. aurantium and N. oleander extracts, respectively. Hesperidin was more abundant in C. aurantium extracts; however, N. oleander extracts contained more quercetin rutinoside. A. punicae populations were significantly higher in control trees compared to the treated ones. A. punicae mortality rates reached high values above 90% for basalt and plants extracts and efficacy rates exceeded 80%. P. citri mortality rates reached 88% and 77%, and efficacy rates exceeded 75% and 66% for basalt and plant extracts, respectively. These findings may help to plan Integrated pest management strategies in organic orchards to avoid toxic chemical pesticides.

Objectives: We aimed to study whether people living with HIV (PLWH) are at higher risk of in-hospital COVID-19 mortality compared to the general population (GenPop). Methods: This was a retrospective study in 19 Italian centers (February 2020 to November 2022) including hospitalized PLWH and GenPop with SARS-CoV-2 infection. The main outcome was in-hospital mortality. Competing risk analyses by Fine-Gray regression model were used to estimate the association between in-hospital mortality and HIV status/age. Results: A total of 7399 patients with COVID-19 were included, 239 (3.2%) PLWH, and 7160 (96.8%) GenPop. By day 40, in-hospital death occurred in 1283/7160 (17.9%) among GenPop and 34/239 (14.2%) among PLWH. After adjusting for potential confounders, compared to GenPop 350 (aSHR 1.11 [95% CI 0.41-2.99]). Conclusions: In PLWH aged

Once a patient has been diagnosed with severe COVID-19 pneumonia, treatment options have limited effectiveness. Opaganib is an oral treatment under investigation being evaluated for treatment of hospitalized patients with severe COVID-19 pneumonia. A randomized, placebo-controlled, double-blind phase 2/3 trial was conducted in 57 sites worldwide from August 2020 to July 2021. Patients received either opaganib (n = 230; 500 mg twice daily) or matching placebo (n = 233) for 14 days. The primary outcome was the proportion of patients no longer requiring supplemental oxygen by day 14. Secondary outcomes included changes in the World Health Organization Ordinal Scale for Clinical Improvement, viral clearance, intubation, and mortality at 28 and 42 days. Pre-specified primary and secondary outcome analyses did not demonstrate statistically significant benefit (except nominally for time to viral clearance). Post-hoc analysis revealed the fraction of inspired oxygen (FIO2) at baseline was prognostic for opaganib treatment responsiveness and corresponded to disease severity markers. Patients with FIO2 levels at or below the median value (≤60%) had better outcomes after opaganib treatment (n = 117) compared to placebo (n = 134). The proportion of patients with ≤60% FIO2 at baseline that no longer required supplemental oxygen (≥24 h) by day 14 of opaganib treatment increased (76.9% vs. 63.4%; nominal p-value = 0.033). There was a 62.6% reduction in intubation/mechanical ventilation (6.84% vs. 17.91%; nominal p-value = 0.012) and a clinically meaningful 62% reduction in mortality (5.98% vs. 16.7%; nominal p-value = 0.019) by day 42. No new safety concerns were observed. While the primary analyses were not statistically significant, post-hoc analysis suggests opaganib benefit for patients with severe COVID-19 requiring supplemental oxygen with an FIO2 of ≤60%. Further studies are warranted to prospectively confirm opaganib benefit in this subpopulation.

Metabolic syndrome (MS) increases the risk of cardiovascular disease and affects children and adolescents. Butyrylcholinesterase (BChE) is an enzyme associated with obesity. The aim of this study was to investigate the effects of different physical training protocols on MS indicators and their relationship with BChE activity. This randomized clinical trial included 80 adolescents randomly assigned to 4 groups (CG: Control Group; ATG: Aerobic Training Group; STG: Strength Training Group; and CTG: Concurrent Training Group). The EFC, lipid profile, glycemia, waist circumference, and blood pressure were analyzed. With the exception of the CG, all the groups underwent training protocols for 12 consecutive weeks, 4 times a week, as follows: (ATG: 75% of heart rate on an electric treadmill; STG: 85% of 1 maximum repetition; CTG: 20 min of aerobic training at the same intensity as the ATG, and 20 min of resistance training in the same way as the STG). The training reduced MS-related biomarkers, such as the lipid profile, glycemia, waist circumference, and blood pressure. STG reduced BChE activity. The training methods led to improvements in the majority of the MS indicators. In addition, aerobic training significantly reduced BChE activity after a 12-week training protocol. The results suggest that different types of exercise can benefit MS.

Abstract Primary care services are key to population health and for the efficient and equitable organisation of national health systems. This is why they are often financed through public funds. Primary care doctors are instrumental for the delivery of preventive services, continuity of care, and for the referral of patients through the system. These cadres are also the single largest health expenditure at the core of such services. Although recruitment and retention of primary care doctors have always been challenging, shortages are now exacerbated by higher demand for services from aging populations, increased burden of chronic diseases, backlogs from the COVID-19 pandemic, and patient expectations. At the same time, the supply of primary care physicians is constrained by rising retirement rates, internal and external migration, worsening working conditions, budget cuts, and increased burnout. Misalignment between national education sectors and labour markets is becoming apparent, compounding staff shortages and maldistribution. With their predominantly publicly funded health systems and in the aftermath of COVID-19, countries of the European region appear to be now on the cusp of a multi-layered, slow-burning primary care crisis, with almost every country reporting long waiting lists for doctor appointments, shortages of physicians, unfilled vacancies, and consequently, added pressures on hospitals’ Accident and Emergency services. This articles collection aims at pulling together the evidence from countries of the European Region on root causes of such workforce crisis, impacts, and effectiveness of existing policies to mitigate it. Original research is needed, offering analysis and fresh insights into the primary care medical workforce crisis in wider Europe. Ultimately, the aim of this articles collection is to provide an evidence basis for the identification of policy solutions to present and future primary health care crises in high as well as lower-income countries.

Objective To define macro symptoms of long COVID and to identify predictive factors, with the aim of preventing the development of the long COVID syndrome.Design A single-centre longitudinal prospective cohort study conducted from May 2020 to October 2022.Setting The study was conducted at Luigi Sacco University Hospital in Milan (Italy). In May 2020, we activated the ARCOVID (Ambulatorio Rivalutazione COVID) outpatient service for the follow-up of long COVID.Participants Hospitalised and non-hospitalised patients previously affected by COVID-19 were either referred by specialists or general practitioners or self-referred.Intervention During the first visit, a set of questions investigated the presence and the duration of 11 symptoms (palpitations, amnesia, headache, anxiety/panic, insomnia, loss of smell, loss of taste, dyspnoea, asthenia, myalgia and telogen effluvium). The follow-up has continued until the present time, by sending email questionnaires every 3 months to monitor symptoms and health-related quality of life.Primary and secondary outcome measures Measurement of synthetic scores (aggregation of symptoms based on occurrence and duration) that may reveal the presence of long COVID in different clinical macro symptoms. To this end, a mixed supervised and empirical strategy was adopted. Moreover, we aimed to identify predictive factors for post-COVID-19 macro symptoms.Results In the first and second waves of COVID-19, 575 and 793 patients (respectively) were enrolled. Three different post-COVID-19 macro symptoms (neurological, sensorial and physical) were identified. We found significant associations between post-COVID-19 symptoms and (1) the patients’ comorbidities, and (2) the medications used during the COVID-19 acute phase. ACE inhibitors (OR=2.039, 95% CI: 1.095 to 3.892), inhaled steroids (OR=4.08, 95% CI: 1.17 to 19.19) and COVID therapies were associated with increased incidence of the neurological macro symptoms. Age (OR=1.02, 95% CI: 1.01 to 1.04), COVID-19 severity (OR=0.42, 95% CI: 0.21 to 0.82), number of comorbidities (OR=1.22, 95% CI: 1.01 to 1.5), metabolic (OR=2.52, 95% CI: 1.25 to 5.27), pulmonary (OR=1.87, 95% CI: 1.10 to 3.32) and autoimmune diseases (OR=4.57, 95% CI: 1.57 to 19.41) increased the risk of the physical macro symptoms.Conclusions Being male was the unique protective factor in both waves. Other factors reflected different medical behaviours and the impact of comorbidities. Evidence of the effect of therapies adds valuable information that may drive future medical choices.

IntroductionArterial blood gas analysis is the gold standard for the assessment of oxygenation, ventilation, and metabolic status in dogs; however, its execution is difficult and painful. Therefore, venous blood gas analysis is used in its replacement for the assessment of the metabolic status, but it is not clear whether it can be used to assess respiratory function, too. This study aimed at: 1) comparing jugular and saphenous pH and partial pressure of carbon dioxide (pCO2) with the correspondent arterial pH and pCO2 (paCO2) in healthy dogs during general anesthesia; 2) clarifying whether the arterial-venous relationship is better expressed in jugular or saphenous blood samples; 3) mathematically transforming venous pCO2 (pvCO2) and evaluating whether the calculated values more accurately agree with paCO2.MethodsNinety dogs were included and randomly divided into three groups: Group 1 - arterial vs jugular; Group 2 - arterial vs saphenous; Group 3 - arterial vs jugular vs saphenous blood gases. Each group counted 30 dogs. Pearson correlations were calculated. Bland-Altman plots were generated to describe the agreement between venous and arterial values; clinical limits for pH and pCO2 set by the authors were, respectively, ± 0.1 and ± 2.5 mmHg. Univariate linear regression was applied for predicting paCO2 from pvCO2.ResultsSaphenous samples showed strong positive correlations with arterial samples for both pCO2 and pH. Pearson ρ values were stronger for pH than for pCO2. Bland-Altman plots showed good agreement between venous and arterial pH, and poor agreement between pvCO2 and paCO2 for both jugular and saphenous samples. Results suggested that saphenous pvCO2 is preferable with respect to jugular as predictor of paCO2. The transformation of saphenous pvCO2 through univariate linear regression produced a model for predicting paCO2; a Bland-Altman plot assessed the transformed pvCO2 agreement with paCO2.DiscussionIn healthy, anesthetized, mechanically ventilated dogs, variations of pH between venous and arterial values are clinically acceptable. Venous and arterial blood gases cannot be interchanged for the evaluation of pCO2. Saphenous pvCO2 is to be preferable to jugular pvCO2 as predictor of paCO2. A formula for the estimation of predicted paCO2 from saphenous pvCO2 is proposed.

Cultural ecosystem services (CES) are non-material intangible benefits that humans derive from ecosystems, which are indispensable for the well-being of communities and directly influence the quality of life. CES are deeply interconnected to each other and to providing and regulating services, thus influencing everyday life. CES are among the most important values that people associate with nature, but understanding them may be challenging. The definition of CES is both self-evident and elusive, specifically because they consist of the interaction between two dynamic systems: human societies and natural ecosystems. This paper updates the state of the art about CES evaluation methods, underlining the gap between their economic values and their incorporation into planning and decision-making on different scales and in different sectors, and emphasizes their importance in conservation policies and sustainable development programs. This study reviewed 68 articles published between August 2019 and May 2023 from the SCOPUS database, and classified CES assessment into 15 evaluation methods. This review reveals that the choice of CES assessment methodologies has often depended on evaluation purposes. In addition, specific CES classifications are required, since different definitions and unstandardized economic concepts for assigning market values to the CES can lead to conflicting results. The combination of different methods, monetary and non-monetary, can aid better evaluation of CES by focusing on the interaction between different components, and can facilitate the mapping and quantification of social values of ecosystem services. This can help decision-makers to develop sustainable territorial planning and policies.

ABSTRACTThis study focused on monitoring the water status of vegetation and soil by exploiting the synergy of optical and microwave satellite data with the aim of improving the knowledge of water cycle in cultivated lands in Egyptian Delta and Tunisian areas. Environmental analysis approaches based on optical and synthetic aperture radar data were carried out to set up the basis for future implementation of practical and cost-effective methods for sustainable water use in agriculture. Long-term behaviors of vegetation indices were thus analyzed between 2000 and 2018. By using SAR data from Sentinel-1, an Artificial Neural Network-based algorithm was implemented for estimating soil moisture and monthly maps for 2018 have been generated to be compared with information derived from optical indices. Moreover, a novel drought severity index was developed and applied to available data. The index was obtained by combining vegetation soil difference index, derived from optical data, and soil moisture content derived from SAR data. The proposed index was found capable of complementing optical and microwave sensitivity to drought-related parameters, although ground data are missing for correctly validating the results, by capturing drought patterns and their temporal evolution better than indices based only on microwave or optical data..

Thromboprophylaxis/anticoagulation treatment is often required in hospitalized COVID-19 patients. We aimed to estimate the prevalence of major bleeding events in hospitalized COVID-19 patients. This was a retrospective observational study including all COVID-19 hospitalized patients ≥18 years of age at one reference center in northern Italy. The crude prevalence (between February 2020–2022) of major bleeding events was estimated as the number of major bleeding episodes divided by patients at risk. Uni- and multivariable Cox models were built to assess factors potentially associated with major bleeding events. Twenty-nine (0.98%) out of 2,945 COVID-19 patients experienced a major bleeding event [prevalence of 0.55% (95%CI 0.37–0.79)], of which five were fatal. Patients who experienced a major bleeding event were older [78 years (72–84 IQR) vs. 67 years (55–78 IQR), p-value < 0.001] and more frequently exposed to anti-aggregating therapy (44.8% vs. 20.0%, p-value 0.002) when compared to those who did not. In the multivariable Cox model, age [per 1 year more AHR 1.05 (CI95% 1.02–1.09)] was independently associated with an increased risk of major bleeding events. A strict monitoring of older hospitalized COVID-19 patients is warranted due to the risk of major bleeding events.

The diffusion of electric vehicles is fundamental for transport sector decarbonization. However, a major concern about electric vehicles is their compatibility with power grids. Adopting a whole-power-system approach, this work presents a comprehensive analysis of the impacts and benefits of electric vehicles’ diffusion on a national power system, i.e., Italy. Demand and flexibility profiles are estimated with a detailed review of the literature on the topic, allowing us to put forward reliable charging profiles and the resulting flexibility, compatible with the Italian regulatory framework. Distribution network planning and power system dispatching are handled with dedicated models, while the uncertainty associated with EV charging behavior is managed with a Monte Carlo approach. The novelty of this study is considering a nationwide context, considering both transmission and distribution systems, and proposing a set of policies suitable for enabling flexibility provision. The results show that the power and energy demand created by the spread of EVs will have localized impacts on power and voltage limits of the distribution network, while the consequences for transmission grids and dispatching will be negligible. In 2030 scenarios, smart charging reduces grid elements’ violations (−23%, −100%), dispatching costs (−43%), and RES curtailment (−50%).

Probiotic supplementation has been identified as a potential target to reduce inflammatory mediators associated with obesity. Therefore, this study assessed the effect of probiotic Lacticaseibacillus rhamnosus LB1.5 on anxiety-like behavior, gene expression in the prefrontal cortex, and neuroinflammation in the cerebral cortex and hippocampus of male mice fed a high-fat diet. Mice aged 21 days were divided into four groups: control (CONT), control plus probiotic (CONT + PROB), high-fat diet (HFD), and high-fat diet plus probiotic (HFD + PROB), and fed for 13 weeks. The probiotic Lact. rhamnosus 1.5 (3.1 × 108 CFU/mL, derived from raw buffalo milk) was administered by gavage three times a week. Probiotic supplementation provided an anxiolytic effect in CONT and HFD. The IL-6 showed lower levels after probiotic supplementation in the HFD. Regarding immunoreactivity for GFAP in the cerebral cortex, we demonstrated that animals HFD-fed had a reduction in cells number compared to CONT. In the hippocampus, we found an interaction between diet and supplementation, as well as an effect of probiotic supplementation. A higher number of Th positive cells was observed in the cerebral cortex in mice fed HFD. Lact. rhamnosus LB1.5 supplementation decreased serum IL-6 levels in HFD-fed mice and promoted a reduction in anxiety-like behavior.

Este artigo apresenta os resultados de uma pesquisa realizada no contexto do Mestrado em Educação Tecnológica, com o propósito de analisar o impacto da inteligência artificial (IA) na transformação das práticas pedagógicas de professores na educação profissional técnica de nível médio (EPTNM). Utilizando uma abordagem qualitativa e descritiva, o estudo envolveu quatro professores e uma coordenadora pedagógica. Os dados foram coletados por meio de entrevista semiestruturada e questionário online, especificamente utilizando a ferramenta Google Forms. Os resultados da pesquisa evidenciaram que a adoção da inteligência artificial na prática pedagógica, na instituição em foco, foi avaliada positivamente, apesar de ter apresentado desafios aos professores, como a necessidade de compreensão do funcionamento da plataforma, que nesta instituição se referia a Geekie One. Isso ocorre porque a inteligência artificial não só otimizou o tempo em sala de aula, mas também promoveu maior engajamento dos alunos nas atividades, possibilitando melhoria na aprendizagem. Além disso, incentivou interações mais profundas entre alunos e docentes e enriqueceu as discussões com base nos recursos didáticos disponíveis.

Background: Meeting the challenge of antiretroviral therapy (ART) whose efficacy can last a lifetime requires continuous updating of the virological, pharmacological, and quality of life outcomes to be pursued and a continuous review of literature data on the efficacy and tolerability of new drugs and therapeutic strategies. Methods: With the aim of identifying open questions and answers about the current controversies in modern ART, we adapted the Design Thinking methodology to the needs of the design phase of a scientific article, involving a team of experts in HIV care. Results: Five main pillars of treatment success were discussed: sustained virologic suppression over time; immunological recovery; pharmacological attributes; long-term tolerability and safety of ART; and people’s satisfaction and quality of life. The definition of the outcomes to be achieved in each thematic area and the tools to achieve them were reviewed and discussed. Conclusions: Long-term treatment success should be intended as a combination of HIV-RNA suppression, immune recovery, and high quality of life. To achieve this, the regimen should be well-tolerated, with high potency, genetic barrier, and forgiveness, and should be tailored by a person-centered perspective, based on individual needs, preferences, and therapeutic history.