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Objectives: To investigate the interobserver agreement among midwives for the interpretation of intrapartum CTG traces, using both the 2015 FIGO guidelines and the physiology-based guidelines., Material and Methods: Retrospective, single-center, observational study conducted at the Maternity Hospital of the University of Parma, Italy, between November 2022 and July 2023. We selected 100 nonconsecutive intrapartum CTG traces from women undergoing operative delivery (cesarean or instrumental vaginal delivery). Participating midwives received the last 60 min of CTG recording prior to the decision for an operative delivery was made. Five midwives with different professional experience classified the CTG tracing according to the 2015 FIGO guidelines and the physiology-based guidelines at the time of the decision for the operative delivery. Each midwife was categorized as senior or junior if her clinical experience was equal or more or less than 5 years. All participating midwives were blinded to the demographic and clinical variables of each case, as well as to the labor and neonatal outcome. The main outcome of the study was the interobserver agreement among the 5 midwives with either guideline. The secondary outcome was the interobserver agreement based on clinical experience. The agreement between the observers was estimated through the Krippendorff's alpha statistics., Results: The interobserver agreement for the interpretation of intrapartum CTG traces according to the 2015 FIGO guideline was in the upper limit of the "unacceptable" classification, with a Krippendorff's alpha of 0.632 (95% CI, 0.545-0.723). The interobserver agreement of the physiology-based CTG guideline was classified as "unacceptable" with a Krippendorff's alpha of 0.359 (95% CI, 0.125-0.582). The interobserver agreement among senior midwives according to the 2015 FIGO guidelines was considered as "tentative acceptable agreement" with a Krippendorff's alpha of 0.724 (95% CI, 0.636-0.805). Among junior midwives, the interobserver agreement according to the latter guideline was classified as "unacceptable" with a Krippendorff's alpha of 0.569 (95% CI, 0.359-0.751). Using the physiology-based guideline, the interobserver agreement of the senior midwives - Krippendorff's alpha 0.493 (95% CI, 0.320-0.623) - and "junior" midwives - Krippendorff's alpha 0.359 (95% CI, 0.100-0.581) - were considered both "unacceptable"., Conclusions: Our study showed that intrapartum CTG interpretation is characterized by an overall unacceptable level of interobserver agreement among midwives, with the 2015 FIGO guidelines showing better agreement compared to physiology-based guidelines. The interpretation of intrapartum CTG by "senior" midwives using the 2015 FIGO guidelines showed the highest, interobserver agreement, indicating a "tentative acceptable agreement".

Segmentation of multiple sclerosis (MS) lesions on brain MRI scans is crucial for diagnosis, disease and treatment monitoring but is a time-consuming task. Despite several automated algorithms have been proposed, there is still no consensus on the most effective method. Here, we applied a consensus-based framework to improve lesion segmentation on T1-weighted and FLAIR scans. The framework is designed to combine publicly available state-of-the-art deep learning models, by running multiple segmentation tasks before merging the outputs of each algorithm. To assess the effectiveness of the approach, we applied it to MRI datasets from two different centers, including a private and a public dataset, with 131 and 30 MS patients respectively, with manually segmented lesion masks available. No further training was performed for any of the included algorithms. Overlap and detection scores were improved, with Dice increasing by 4-8% and precision by 3-4% respectively for the private and public dataset. High agreement was obtained between estimated and true lesion load (ρ = 0.92 and ρ = 0.97) and count (ρ = 0.83 and ρ = 0.94). Overall, this framework ensures accurate and reliable results, exploiting complementary features and overcoming some of the limitations of individual algorithms., (© 2024. The Author(s).)

Biochar is currently garnering interest as an alternative to commercial fertilizer and as a tool to counteract global warming. However, its use is increasingly drawing attention, particularly concerning the fine dust that can be developed during its manufacture, transport, and use. This work aimed to assess the toxicity of fine particulate Biochar (10 ) via in-vitro and in-vivo experiments as a first step for the evaluation of toxicity values. As in-vitro experiments, cell lines showed inhibition of proliferation following the reduction of expression genes involved in cell cycle control, increase in the production of ROS and IL-8, and decrease in intracellular ATP. In-vivo rat exposure induced hyperemia, edema, and inflammatory phenomena with infiltrations of neutrophil granulocytes and macrophages at the alveolar and bronchiolar levels. Both in-vitro and in-vivo studies highlighted how exposure to Biochar particulates leads to an inflammatory condition and oxidative stress., Competing Interests: Declaration of Competing Interest 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., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background and Objective: Contextual effects (e.g. patient expectations) may play a role in treatment effectiveness. This study aimed to estimate the magnitude of contextual effects for conservative, non-pharmacological interventions for musculoskeletal pain conditions. A systematic review and meta-analysis of randomized controlled trials (RCTs) that compared placebo conservative non-pharmacological interventions to no treatment for musculoskeletal pain. The outcomes assessed included pain intensity, physical functioning, health-related quality of life, global rating of change, depression, anxiety and sleep at immediate, short-, medium- and/or long-term follow-up., Databases and Data Treatment: MEDLINE, EMBASE, CINAHL, Web of Science Core Collection, CENTRAL and SPORTDiscus were searched from inception to September 2021. Trial registry searches, backward and forward citation tracking and searches for prior systematic reviews were completed. The Cochrane risk of bias 2 tool was implemented., Results: The study included 64 RCTs (N = 4314) out of 8898 records. For pain intensity, a mean difference of (MD: -5.32, 95% confidence interval (CI): -7.20, -3.44, N = 57 studies with 74 outcomes, GRADE: very low) was estimated for placebo interventions. A small effect in favour of the placebo interventions for physical function was estimated (SMD: -0.22, 95% CI: -0.35, -0.09; N = 37 with 48 outcomes, GRADE: very low). Similar results were found for a broad range of patient-reported outcomes. Meta-regression analyses did not explain heterogeneity among analyses., Conclusion: The study found that the contextual effect of non-pharmacological conservative interventions for musculoskeletal conditions is likely to be small. However, given the known effect sizes of recommended evidence-based treatments for musculoskeletal conditions, it may still contribute an important component., Significance: Contextual effects of non-pharmacological conservative interventions for musculoskeletal conditions are likely to be small for a broad range of patient-reported outcomes (pain intensity, physical function, quality of life, global rating of change and depression). Contextual effects are unlikely, in isolation, to offer much clinical care. But these factors do have relevance in an overall treatment context as they provide almost 30% of the minimally clinically important difference., (© 2023 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation ‐ EFIC ®.)

Miniaturized aqueous zinc ion batteries are attractive energy storage devices for wearable electronics, owing to their safety and low cost. Layered vanadium disulfide (VS 2 ) has demonstrated competitive charge storage capability for aqueous zinc ion batteries, as a result of its multivalent states and large interlayer spacing. However, VS 2 electrodes are affected by quick oxide conversion, and they present predefined geometries and aspect ratios, which hinders their integration in wearables devices. Here, we demonstrate the formulation of a suitable ink for extrusion-based 3D printing (direct ink writing) based on micro flowers of layered VS 2 obtained using a scalable hydrothermal process. 3D printed architectures of arbitrary design present electrochemically active, porous and micron-sized struts with tuneable mass loading. These were used as cathodes for aqueous zinc-ion battery electrodes. The 3D printed VS 2 cathodes were assembled with carbon/zinc foil anodes to form full cells of zinc-ion, demonstrating a capacity of ∼1.98 mA h cm -2 with an operating voltage of 1.5 V. Upon cycling a capacity retention of around 65% was achieved after ∼100 cycles. The choice of the electrolyte (a water-in-salt electrolyte) and the design of the pre-processing of the 3D printed cathode ensured improved stability against dissolution and swift oxidation, notorious challenges for VS 2 in an aqueous environment. This works paves the way towards programmable manufacturing of miniaturized aqueous batteries and the materials processing approach can be applied to different materials and battery systems to improve stability.

Aim: This study aimed to investigate Italian dentists' knowledge of and attitudes toward obstructive sleep apnea (OSA) in children., Methods: An anonymous questionnaire was prepared using Google Forms and sent to dentists in Italy through private social platforms. The first part of the questionnaire contained basic demographic data questions, and the second part included items about pediatric OSA., Results: A total of 125 responses were collected within 1 month. The interviews revealed gaps in undergraduate and post-graduate training on OSA, and consequently, low self-evaluation of knowledge and self-confidence in managing young patients with OSA. Dentists showed unfavorable attitudes and poor knowledge of the general findings, risk factors, and consequences of pediatric OSA but demonstrated good knowledge of the beneficial effects of rapid maxillary expansion. Orthodontists showed a more favorable attitude and better recognition of the craniofacial features associated with OSA. In addition, a comparison was made between dentists who had graduated more than 5 years ago and new graduates, and differences were found in undergraduate education, which was better for new graduates, and a small number of questions were better answered by experienced dentists., Conclusion: This study showed a lack of knowledge about pediatric OSA and its management among Italian dentists, revealing the need to update the dentistry curriculum and organize educational interventions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Arcidiacono, Santagostini, Tagliaferri, Ghezzi, Manfredi and Segù.)