Search

• Most predictive scores for brain metastases have been developed to predict survival in cancer patients with BMs; • There still needs to be more evidence to select patients most likely to achieve a survival benefit from BM cranial surgery specifically; • ARMO-score is a ten-point simple and comprehensive score for BM patients selected for open surgery, with more surgery-specific predictive elements such as tumor location and volume, presence of seizures at onset, and involvement of eloquent brain areas. • ARMO-score could help in many cases of unknown diagnosis when a prompt decision should be undertaken in emergent patients. • The choice of factors influencing the score is based not only on survival but also on performance status at the end of surgical treatment. Several risk stratification scores have been suggested to aid prognostication and guide treatment strategies for brain metastases (BMs). However, the current scores do not focus on the specific neurosurgical population, therefore not predicting short-term mortality and postoperative performance status. This retrospective observational study of 362 consecutive patients treated with surgery for BMs aims to identify the factors associated with post-surgical outcomes and propose a surgery-specific prognostic score for patients with BMs candidate for open surgery. Factors significantly associated with OS and performance status in multivariate analysis were age, KPS, surgical site, synchronous debut of BM, number, tumor volume, seizure, extra-cranial metastases, and deep-seated location. The variables were incorporated into the Anamnestic Radiological Metastases Outcome Surgical score (ARMO-S). The values range between 0 and 10. Patients were divided into two groups (low-risk and high-risk) based on each significant subgroup's median survival and performance status with an optimal cutoff value determined as 4. The two groups have significant differences in OS (9.6 versus 14 months, p = 0.0048) postoperative KPS (90 versus 70, p = 0.012) and KPS at last follow-up evaluation (75 versus 30, p < 0.001) ARMO-S is a simple and comprehensive score for BM patients selected for neurosurgery, as it incorporates the main factors of the most important prognostic scores, implementing them with more surgery-specific predictive elements such as tumor location and volume, presence of seizures at onset, and involvement of eloquent brain areas. [ABSTRACT FROM AUTHOR]

HBV epidemiology is highly heterogeneous and rapidly evolving worldwide: we studied its last two-decades dynamics in a large single center cohort. In all consecutive HBsAg-positive subjects firstly admitted (2000–2019) at the Pisa-University-Hospital Hepatology-Referral-Center, demographic, virologic and clinical variables were analyzed by admission decade (2000–2009 vs 2010–2019) and origin (Italian vs non-Italian natives). Of 2003, 1878 (93.7%) subjects were eligible: 1798(95.7%) with HBV-chronic [126(7%) HDV, 72(4%) HCV, 11(0.6%) HIV co-infected] and 80(4.3%) HBV-primary infections (93.7% Italians). Among 1589(88.4%) mono-infected, 496(31.2%) were immigrants, younger than Italians [34.0(5.1–77.1)-52.5(10.0–87.2) years], with female prevalence [204/496(41.1%)-340/1093(31.1%); p <0.001] increasing overtime (14.6–45.0%; p <0.001). Italians aged across decades [50.3(11.1–87.2)-56.2(10.0–86.7) years; p <0.001], HBeAg-positivity remained stable (12.3–14.5%) and acute hepatitis increased (4.0–8.0%; p = 0.003). CHB declined [439/721(60.9%)-320/868(36.9%); p <0.001] whereas HBeAg-negative infection increased [277/626(44.2%)-538/755(71.3%); p <0.001]. Cirrhosis declined [195/721(27.0%)-125/868(14.4%); p <0.001], except in anti-HDV-patients [93/126(73.8%); 42(45.1%) non-Italians], younger than HBV-mono-infected (47.4–57.6 years; p <0.001). Effective preventive health care policies and immigration flows account for increasing prevalence of HBeAg-negative infection across the last two decades. Antiviral therapy mitigated disease progression in aging Italian CHB but not in CHD patients, mainly young immigrants, emphasizing the unmet need of effective CHD therapies; HBeAg-positive CHB and acute hepatitis B persist in non-vaccinated Italian adults, prompting vaccination in the elderly with risky behaviors. [ABSTRACT FROM AUTHOR]

Research reported in this abstract was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under award number: R01HL159182. Genetic studies suggest that severe hypercholesterolemia (defined as LDL-C >190mg/dL) can be categorized into four subtypes: monogenic familial hypercholesterolemia (FH), polygenic hypercholesterolemia, elevated lipoprotein(a), and severe hypercholesterolemia with or without a positive family history in the absence of a genetic cause. This information has the potential to improve atherosclerotic cardiovascular disease (ASCVD) risk stratification of individuals affected with severe hypercholesterolemia. By improving understanding and management of the subtypes, health systems can reduce the burden of ASCVD morbidity and mortality in this high-risk population. Due to the complexity and heterogeneity of the severe hypercholesterolemia phenotype, we assessed the readiness and needs of providers who communicate ASCVD risk information to affected individuals. Semi-structured interviews were conducted via videoconference with providers who care for patients with severe hypercholesterolemia. Interviewers described the four classification subtypes to participants and invited responses to hypothetical scenarios involving communication with a patient with each subtype. Interviewers also asked participants how they would respond to a scenario in which a risk stratification tool included genomic information. Participants were compensated after interviews were completed. Interviews were completed with 11 providers (5 primary care providers (PCPs), 3 cardiology specialists, and 3 genetic counselors) from a single integrated healthcare system. Four patterns from provider interviews emerged about managing each subtype (see Table 1). First, providers described how they would treat and talk with patients across subtypes, which revealed key differences between clinical professions. Most PCPs described a lack of knowledge about the differences among subtypes but expressed interest in understanding and following treatment recommendations for each subtype. Second, providers recommended varying communication resources they and their patients would need to effectively talk about and address the ASCVD risks of each subtype. Next, most PCPs and genetic counselors responded with positive reactions to an ASCVD risk stratification tool that incorporates genomic information, however, cardiology specialists expressed hesitancy to trust this such a tool. Finally, providers gave recommendations for how to implement a program including the genomics informed risk stratification tool to better care for patients with each subtype. To design and implement a program to identify and manage severe hypercholesterolemia, health care systems should leverage the value providers place on the importance of ASCVD risk stratification to overcome the barrier of current limited knowledge related the causes of severe hypercholesterolemia. [ABSTRACT FROM AUTHOR]

The aim of this systematic review is to analyze the properties of the different types of orthodontic retainers, identify their differences and define which type of device is most effective and less harmful to periodontal health. A literature search was carried out by a reviewer by consulting PubMed, Lilacs, Embase, Medline full text, Scopus, Web of Science, Cochrane library, and Science Direct electronic databases for biomedical and health literature as well as the grey literature and setting up the search from December 2010 without any restriction about articles languages. The results showed that patients who wear retainers for a long period have significant differences in clinical parameters compared to patients without retainers. The type of retainer chosen also significantly influences the overall periodontal health of patients. Fixed retainers, both glass-fibre reinforced and steel wire retainers, proved to be the retainer type with the highest plaque and calculus accumulation values compared to removable retainers. In addition, among fixed retainers, glass-fibre reinforced retainers proved to be those that mostly promote the plaque and calculus accumulation in the application site. Fixed retainers are the best devices to maintain the alignment of mandibular anterior teeth in the long term. Among these devices, stainless steel lingual retainers, plain or braided, should remain the first choice. Although they are also susceptible to periodontal complications, their effect on periodontal health can be considered statistically insignificant if compared to glass-fibre reinforced retainers which, showing worse periodontal complications, should not be used. [Display omitted] [ABSTRACT FROM AUTHOR]

Targeted drug delivery requires –among others- specific interaction of nanocarriers with cell surface receptors enabling efficient internalization into the targeted cells. Thus, identification of receptors allowing efficient nanocarrier uptake is essential to improve the design of targeted nanomedicines. Here we used methods based on cell surface biotinylation to identify cell surface receptors mediating nanoparticle uptake by cells. We used human brain and liver endothelial cells as representative examples of cells typically showing very low and very high nanoparticle uptake, respectively. Amino-modified and carboxylated silica were used as model nanoparticles usually associated with high and low uptake into cells, respectively, and carrying different coronas after exposure in full human plasma. Using cell surface biotinylation of live cells and receptor pull-down assays, we compared the receptors internalized in control untreated cells and those internalized upon exposure to nanoparticles. In this way, we identified receptors associated with (high) nanoparticle uptake. The candidate receptors were further validated by decorating the nanoparticles with an artificial corona consisting of the respective receptor ligands. We found that a vitronectin corona can be used to target integrin receptors and strongly enhances nanoparticle uptake in brain and liver endothelial cells. The increased uptake was maintained in the presence of serum, suggesting that the vitronectin-corona could resist interaction and competition with serum. Furthermore, plasminogen-coated nanoparticles promoted uptake in endothelial cells of the liver, but not of the brain. The presented approach using reversible biotinylation of cell surface receptors in live cells allows for receptor-based targeting of nanocarriers that are instrumental in nanoparticle uptake, which can be exploited for targeted drug delivery. In order to deliver drugs to their site of action, drug-loaded nanocarriers can be targeted to cell receptors enabling efficient uptake into target cells. Thus, methods to identify nanocarrier receptors are invaluable. Here we used reversible biotinylation of live cells and receptor pull-down approaches for receptor identification. By comparative analysis of the individual receptors internalized in untreated cells and cells exposed to nanoparticles, we identified receptors enabling high nanoparticle uptake into liver and brain endothelial cells. Their role was confirmed by decorating nanoparticles with an artificial corona composed of the receptor ligands. In conclusion, live cell reversible biotinylation of cell surface proteins is a powerful tool for the identification of potential receptors for receptor-based targeting of nanocarriers. [Display omitted] [ABSTRACT FROM AUTHOR]

benign vocal fold lesions (BVFLs) represent the most common etiology of voice disorders in paediatric population, cause of dysphonia by preventing full vocal fold closure and modifying vibratory characteristics. Of those pathologies, vocal fold nodules represent almost 63% of the cases in children between 0–14 years. Management may include a combination of phonosurgery, voice therapy and pharmacological treatment, but almost 95% of otolaryngologists recommend voice therapy as primary treatment. The Pediatric Voice Handicap Index (pVHI) is nowadays widely used and accepted in the evaluation and monitoring of paediatric patients with dysphonia. The aim of our study was to demonstrate the reliability and validity of PVHI in the evaluation of the effects of voice therapy as treatment of vocal fold nodules in the paediatric population. in this retrospective chart review twenty-seven (27) dysphonic patients with bilateral vocal fold nodules were treated with behavioral voice therapy approaches, and the PVHI surveys was administered to each patient parent's before and after therapy. The age of the patients ranged from 4 to 14 years (mean age 8.7 y-o); 17 (63%) were male and 10 (37%) females. according to our results, behavioral voice therapy effectively improved pVHI scores from pre- to post-treatment in paediatric patients with bilateral vocal fold nodules. [ABSTRACT FROM AUTHOR]

Purpose: De novo truncating mutations of AHDC1 gene cause Xia-Gibbs Syndrome (XGS), characterized by developmental delay, hypotonia, speech disturbances, sleep apnea. Seizures have been reported, yet no studies have depicted the epilepsy characteristics and outcome.Methods: We describe the clinical features of a pair of Caucasian monozygotic female twins affected by severe epilepsy and presenting the same de novo AHDC1 mutation detected by whole exome sequencing.Results: They were concordant with respect to seizure onset and type mimicking Lennox-Gastaut syndrome as well as initial EEG features, but differed in terms of epilepsy prognosis (complete seizure freedom on valproate/lamotrigine versus ongoing daily refractory seizures despite multiple drug combinations).Conclusion: Our findings suggest that patients with Xia-Gibbs Syndrome may exhibit Lennox-Gastaut-like features and that even the same AHDC1 mutation can be poorly predictive of epilepsy prognosis. [ABSTRACT FROM AUTHOR]

This study aims to develop cupcake formulations free of eight main allergens with Brigadeiro-type topping prepared by homemade conditions. Chickpea flour and linseed paste were homemade and developed as cupcake ingredients. The cupcakes had wheat replaced by rice, potato, corn, and chickpea flour; milk replaced by orange juice; soy (margarine) replaced by palm fat; and eggs replaced by linseed paste. For the topping, a brigadeiro-type was developed using cassava. The cupcake formulations were characterized by dough parameters, proximal composition, color and texture parameters, fatty acid profile, microbial parameters, and sensory acceptance by two panels, children and adults. The chickpea flour and linseed paste were suitable for homemade preparation, standing out as an alternative ingredient for gluten-free cupcake elaboration. All allergens-free cupcake formulations had satisfactory visual, physicochemical, and microbiological characteristics. The formulations were considered sources of fiber and had high levels of 18:3n-3 fatty acid (>0.60 g 100 g−1 of the sample), with suitable n-6/n-3 and PUFA/SFA ratio (>0.45). All formulations were sensory accepted by the children; the adults preferred cupcakes with less linseed (≤5.61%). It was possible to produce eight main allergens-free cupcakes with Brigadeiro-type topping under a homemade scale, sensory accepted by children and adults. A cupcake with Brigadeiro-type topping free of eight main allergens was homemade prepared, and accepted by children and adults. [Display omitted] [ABSTRACT FROM AUTHOR]

Pyuria is nonspecific and may result in over-treatment of asymptomatic bacteriuria (ASB). The Infectious Diseases Society of America recommends against antibiotic treatment of ASB for most patients including those presenting with altered mental status (AMS). Close observation is recommended over treatment to avoid missing alternative causes of AMS and overuse of antibiotics resulting in adverse events and resistance. The purpose of this study was to evaluate patient outcomes associated with antibiotic treatment of pyuria in patients presenting with AMS at hospital admission without specific urinary tract infection (UTI) symptoms. The primary objective was to compare 30-day readmission rates of patients with pyuria and AMS treated with antibiotics (AMS+Tx) versus those who were not treated (AMS-NoTx). Secondary outcomes included identifying risk factors for antibiotic treatment, comparing alternative diagnoses for AMS, and comparing safety outcomes. This retrospective cohort study evaluated adult patients with AMS and pyuria (10 WBC/hpf) admitted between February 1, 2020 and October 1, 2021, in a 350-bed community teaching hospital. Patients with documented urinary symptoms were excluded. Additional exclusion criteria included admission to critical care, history of renal transplant, urological surgery, coinfections, pregnancy, and neutropenia. Two-hundred patients were included (AMS+Tx, n = 162; AMS-NoTx, n=38). There was no difference in 30-day hospital readmission rate for AMS between groups (AMS+Tx 16.7% vs AMS-NoTx 23.7%, P = 0.311). An alternative diagnosis of AMS occurred more frequently when antibiotics were withheld (AMS+Tx 66% vs. AMS-NoTx 86.8%, P = 0.012). Urinalyses showing bacteria (odds ratio 2.52; 95% CI, 1.11-5.731) and positive urine culture (OR 3.36; 95% CI, 1.46-7.711) were associated with antibiotic prescribing. Inappropriate antibiotic use is common among hospitalized patients presenting with AMS and pyuria; however, treatment of asymptomatic pyuria did not decrease rates of subsequent readmission for AMS or retreatment of symptomatic UTI. Patients who were monitored off antibiotics had higher rates of alternative AMS diagnosis. [ABSTRACT FROM AUTHOR]

In the scheme of developing an application for funding from any federal or foundation source, it is reasonable to place significant attention on the science. However, it is also imperative to remember that your budget is what will provide the resources to make sure you can complete your proposed investigations and, as such, deserves appropriate consideration. In the competitive arena of extramural funding, funding agencies are incentivized to ensure that the funds committed to research will yield maximum impact. A well-thought-out budget demonstrates to the funding agency 2 key factors: (1) that you understand the needs of the project and (2) you have a realistic expectation of the project costs. When these 2 things are communicated to the funding agency, in addition to the significance of your science, it is more likely that you will receive the budget you request. Herein, we put forth the fundamentals for preparing your budget and the nuances that may help you not only be in compliance but also improve your chances of success. This article will discuss issues to consider when designing a budget for large research grants, using the NIH R&R Budget as a prototype. [ABSTRACT FROM AUTHOR]

This study examines the intrinsic relationship between land degradation and the accumulation of wealth at various planning scales in Italy, a desertification hotspot in Southern Europe. Local development was scrutinized at four planning scales (administrative regions, provinces, economic districts, and municipalities) to verify if land sensitivity to degradation increases over time more rapidly in economically advanced contexts. Land sensitivity to degradation increased between the early 1990s and the early 2010s contrary to the level of income per-capita based on linear, squared, cubic, and fourth-grade polynomial specifications. Spatially implicit and explicit statistical approaches indicate linear models are the best fit at all planning scales. The income-land degradation relationship was negative, showing the role of both centralized and decentralized planning scales, and suggesting that developmental policies may have less impact on land degradation in specific territorial contexts. More suited local models displayed a negative socio-economic development impact in more affected Southern districts. Checking for spatial heterogeneity, multi-scale regressions provided insights into complex ecological-economic processes whilst also evaluating the impact of regional development at different planning levels contributing to design scalable mitigation policies against desertification. • Land degradation and wealth were analysed at various planning scales in Italy. • Land sensitivity to degradation increases more rapidly in economically advanced contexts. • Linear models are the best fit at all planning scales. • Developmental policies have less impact on land degradation in specific local contexts. • Multi-scale regressions provided insights into complex ecological-economic processes. [ABSTRACT FROM AUTHOR]

Epilepsy is a common, often severe, feature of LAMA2-related muscular dystrophy (LAMA2-RD) and could represent its onset and main manifestation, even in the absence of overt muscle involvement. To date, there is no systematic characterization of epilepsy in LAMA2-RD, and its impact on neurodevelopment and on the clinical course remains poorly established. In view of this knowledge gap, we conducted a systematic review of the literature and, as an illustrative example, reported the clinical case of a boy with late-onset LAMA2-related limb-girdle muscular dystrophy presenting with severe epilepsy. Our analyses of the literature data revealed a mean age at first seizure of 8 years, with significant differences between early- versus late-onset disease (5.78 ± 4.11 and 9.00 ± 2.65 years, respectively; p = 0.0007), and complete versus partial merosin deficiency (5.33 ± 3.70 and 10.36 ± 5.49 years, respectively; p = 0.0176). A generalized onset was the most common seizure presentation, regardless of merosin expression levels or the timing of muscular distrophy onset. Cortical malformations were not significantly associated with an earlier epilepsy onset, and were found to be quasi-significantly associated with a greater incidence of focal, or focal and generalized, onset seizures. No clear conclusions could be reached on the electrophysiological and neurodevelopmental features of the disorder, or on the relative efficacy of anti-epileptic treatments; further research on these aspects is needed. This systematic review helps to show that epilepsy in LAMA2-RD may be more than an ancillary manifestation of the disease, but rather one of its core features. A targeted and prompt electroencephalographic and epilepsy assessment, in addition to the specific neuromuscular workup, is therefore mandatory in early clinical management to pursue the best possible outcome for affected children. [ABSTRACT FROM AUTHOR]

Pyuria is nonspecific and may result in over-treatment of asymptomatic bacteriuria (ASB). The Infectious Diseases Society of America recommends against antibiotic treatment of ASB for most patients including those presenting with altered mental status (AMS). Close observation is recommended over treatment to avoid missing alternative causes of AMS and overuse of antibiotics resulting in adverse events and resistance. The purpose of this study was to evaluate patient outcomes associated with antibiotic treatment of pyuria in patients presenting with AMS at hospital admission without specific urinary tract infection (UTI) symptoms. The primary objective was to compare 30-day readmission rates of patients with pyuria and AMS treated with antibiotics (AMS+Tx) versus those who were not treated (AMS-NoTx). Secondary outcomes included identifying risk factors for antibiotic treatment, comparing alternative diagnoses for AMS, and comparing safety outcomes. This retrospective cohort study evaluated adult patients with AMS and pyuria (10 WBC/hpf) admitted between February 1, 2020 and October 1, 2021, in a 350-bed community teaching hospital. Patients with documented urinary symptoms were excluded. Additional exclusion criteria included admission to critical care, history of renal transplant, urological surgery, coinfections, pregnancy, and neutropenia. Two-hundred patients were included (AMS+Tx, n = 162; AMS-NoTx, n=38). There was no difference in 30-day hospital readmission rate for AMS between groups (AMS+Tx 16.7% vs AMS-NoTx 23.7%, P = 0.311). An alternative diagnosis of AMS occurred more frequently when antibiotics were withheld (AMS+Tx 66% vs. AMS-NoTx 86.8%, P = 0.012). Urinalyses showing bacteria (odds ratio 2.52; 95% CI, 1.11-5.731) and positive urine culture (OR 3.36; 95% CI, 1.46-7.711) were associated with antibiotic prescribing. Inappropriate antibiotic use is common among hospitalized patients presenting with AMS and pyuria; however, treatment of asymptomatic pyuria did not decrease rates of subsequent readmission for AMS or retreatment of symptomatic UTI. Patients who were monitored off antibiotics had higher rates of alternative AMS diagnosis. [ABSTRACT FROM AUTHOR]

[Display omitted] In the past years, a significant amount of effort has been directed at the observation and characterisation of caries using experimental techniques. Nevertheless, relatively little progress has been made in numerical modelling of the underlying demineralisation process. The present study is the first attempt to provide a simplified calculation framework for the numerical simulation of the demineralisation process at the length scale of enamel rods and its validation by comparing the data with statistical analysis of experimental results. FEM model was employed to simulate a time-dependent reaction-diffusion equation process in which H ions diffuse and cause demineralisation of the enamel. The local orientation of the hydroxyapatite crystals was taken into account. Experimental analysis of the demineralising front was performed using advanced high-resolution synchrotron X-ray micro-Computed Tomography. Further experimental investigations were conducted by means of SEM and STEM imaging techniques. Besides establishing and validating the new modelling framework, insights into the role of the etchant solution pH level were obtained. Additionally, some light was shed on the origin of different types of etching patterns by simulating the demineralisation process at different etching angles of attack. The implications of this study pave the way for simulations of enamel demineralisation within different complex scenarios and across the range of length scales. Indeed, the framework proposed can incorporate the presence of chemical species other than H ions and their diffusion and reaction leading to dissolution and re-precipitation of hydroxyapatite. It is the authors' hope and aspiration that ultimately this work will help identify new ways of controlling and preventing caries. [ABSTRACT FROM AUTHOR]

Acid-induced enamel demineralisation affects many individuals either by exposure to acidic diets, acidic gas pollution (dental erosion) or to dental plaque acids (dental caries). This study aimed to develop in situ X-ray and light imaging methods to determine progression of enamel demineralisation and the dynamic relationship between acid pH and mineral density. Hourly digital microradiograph time-lapse sequences showed the depth of enamel demineralisation in 500 µm thick sections progressed with time from the surface towards the dentine following a power-law function, which was 21% faster than the lateral demineralisation progression after exposure for 85 h to lactic acid (10%, pH 2.2). The minimum greyscale remaining (mineral content) within the induced enamel lesion followed an exponential decay, while the accumulated total greyscale loss with time was linear, which showed a constant anisotropic mineral release within the enamel architecture. This 85 h demineralisation method studied by polarised light microscopy time-lapse sequences showed that once the demineralisation front reached the enamel Hunter-Schreger bands, there was preferential demineralisation along those bands. Mineral density loss was linear with increasing pH acidity between pH 5.2 and pH 4.0 (with 0.4 pH increments) when incubated over a 3-week period exposed to 0.5% lactic acid. At pH 4.0, there was complete mineral loss in the centre of the demineralised area after the 3-week period and the linear function intercepted the x-axis at ~ pH 5.5, near the critical pH for hydroxyapatite (HAp). These observations showed how intrinsic enamel structure and pH affected the progression of demineralisation. Hydroxyapatite crystallites (HAp) in human enamel dissolve when exposed to an acidic environment but little is known about how the intrinsic structures in enamel and pH influence the demineralisation kinetics. We have developed a time-lapse in situ microradiography method to quantify microscopic anisotropic mineral loss dynamics in response to an acid-only caries model. Correlation with polarised light microscopy time-lapse sequences showed that larger structures in enamel also influence demineralisation progression as demineralisation occurred preferentially along the Hunter-Schreger bands (decussating prismatic enamel). The pH-controlled enamel mineral release in a linear manner quantifying the relationship between HAp orientation and acid solubility. These findings should direct the development of improved anti-demineralisation/ remineralisation treatments to retain/ restore the natural intrinsic enamel structure. Image, graphical abstract [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate the performance of percutaneous femoral access with large-bore sheaths (>21F outer diameter) mainly employed for thoracic and thoracoabdominal aortic endovascular treatment and to stratify the outcomes on the basis of the introducer size. Between December 2015 and December 2018, all consecutive patients who received endovascular repair through a percutaneous approach with a suture-mediated vascular closure device (VCD) and the preclose technique were included in a retrospective single-center study called Totally Percutaneous Approach to Endovascular Treatment of Aortic Aneurysms (PEVAR-PRO). The morphologic characteristics of the access vessels and patients' demographics were recorded, and 30-day closure success was defined as the primary end point. Analysis of the closure success comparing large-bore sheaths vs small-bore sheaths (≤21F outer diameter) was performed after 1:1 propensity score matching of preoperative confounding variables. The closure success rate of the entire study cohort was 94% (622 femoral accesses in 360 patients; median age, 74 years; 84% male). Univariate analysis identified eight different factors associated with failure, but only two remained significant on multivariate analysis: diabetes (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.3-6.2; P =.011) and common femoral artery stenosis >50% (OR, 4.5; 95% CI, 1.3-13.7; P =.019). After propensity score matching (1:1, 172 femoral accesses per group), closure success rate was not significantly different between large-bore and small-bore sheaths (90.7% vs 93.0%; P =.43). Multivariate analysis of the large-sheath group identified two factors associated with failure: small (<9 mm) femoral arteries (OR, 6.9; 95% CI, 1.5-31.6; P =.13) and access vessel calcifications involving more than one-third of the circumference (OR, 7.9; 95% CI, 2.1-29.4; P =.002). Neither previous femoral cutdown (44 accesses [23%]) nor percutaneous closure with VCDs (38 accesses [20%]) affected the closure success rate in the large-sheath group. Closure failure did not significantly increase the need for postoperative blood transfusions or hospital length of stay. Off-label use of VCDs and the preclose technique for percutaneous approach with large-bore sheaths needed for complex aortic endovascular procedures is safe and feasible. Closure success rate is not significantly different from that obtained with on-label application of VCDs with smaller sheaths. [ABSTRACT FROM AUTHOR]

Hypnosis could extend the time of Intraoperative Neuropsychological Testing and Brain Mapping in Awake Surgery. A clinical validation for the Hypnosis aided AS (HAs) is still ongoing and further evidences are required. The objective of the present study is to compare two homogeneous cohorts of patients undergoing AS, the first with the aid of the hypnosis and the second according to a standard AS (SAs) protocols. The clinical, radiological and surgical data of two comparable procedures cohorts were retrospectively examined for the present study. All surgeries in Group A were performed with a HAs protocol. Procedures belonging to Group B were performed with a SAs protocol. Endpoints: to compare 1. Incidence of complications in the immediate postoperative period, 2. Clinical and neurological status in the immediate postoperative period and 30 days after surgery, 3. Duration of surgical interventions, 4. Extent of Resection (EOR). The final cohort is composed of 15 procedures; 6 belonging to Group A and 9 to Group B. The different methods outline statistically comparable results from the clinical (Neurological outcomes) both in the postoperative period and one month after surgery and from the surgical point of view (comparable EOR). The incidence of complications is comparable either. The duration of the procedures was significantly longer in HAs group. Hypnosis is a promising approach to increasing the duration of intraoperative "testability" of patients at the price of a longer operative time. A specific professional is needed to induce hypnosis in the difficult intraoperative setting. [ABSTRACT FROM AUTHOR]

Pharmacy educational standards provide requirements for interprofessional education (IPE). However, there has not been a comparison of IPE structure between doctor of pharmacy programs in the United States (US). The purpose of this study was to gather information regarding current IPE programs and curricula in schools/colleges of pharmacy (S/COP) across the US. A survey was developed and emailed to at least one faculty member or administrator from each S/COP responsible for IPE or experiential education. The survey gathered information on IPE status, structure, and oversight. It also explored mechanisms promoting IPE success, pieces of advice for starting or expanding IPE, and hurdles for IPE implementation. Eighty-five S/COP representing 59.9% of programs in the US responded to the survey. All respondents felt IPE was either very important or important to pharmacy education. Mechanisms that promoted IPE success included partnerships, faculty interest in IPE, having an IPE center, being located on an academic medical center, administrative support, and integrating IPE during curricular development. IPE hurdles included logistics, faculty buy-in, sustainability, distance from other programs, and differing accreditation standards across programs. Themes of advice for others were to be innovative/patient/flexible, collaborative, identify key initial partners, develop a director or coordinator of IPE position, and receive administrative support. IPE is a vital component to training the next generation of health professionals, but the process for can be daunting. Building on the successes of others and predicting barriers can assist S/COP in developing effective IPE. • Mechanisms that promote IPE success include partnerships, faculty interest, having an IPE center, being located on an academic medical center, administrative support, and integrating IPE during curricular change • Barriers to IPE include logistics, faculty buy-in, sustainability/funding, distance from other programs, and differing accreditation standards across programs • Advice for others developing IPE include be innovative/patient/flexible, collaborate with others, identify key initial partners, develop a director or coordinator of IPE positon, and receive administrative support [ABSTRACT FROM AUTHOR]

Nano-sized objects such as liposomes are modified by adsorption of biomolecules in biological fluids. The resulting corona critically changes nanoparticle behavior at cellular level. A better control of corona composition could allow to modulate uptake by cells. Within this context, in this work, liposomes of different charge were prepared by mixing negatively charged and zwitterionic lipids to different ratios. The series obtained was used as a model system with tailored surface properties to modulate corona composition and determine the effects on liposome interactions with cells. Uptake efficiency and uptake kinetics of the different liposomes were determined by flow cytometry and fluorescence imaging. Particular care was taken in optimizing the methods to isolate the corona forming in human serum to prevent liposome agglomeration and to exclude residual free proteins, which could confuse the results. Thanks to the optimized methods, mass spectrometry of replicate corona isolations showed excellent reproducibility and this allowed semi-quantitative analysis to determine for each formulation the most abundant proteins in the corona. The results showed that by changing the fraction of zwitterionic and charged lipids in the bilayer, the amount and identity of the most abundant proteins adsorbed from serum differed. Interestingly, the formulations also showed very different uptake kinetics. Similar approaches can be used to tune lipid composition in a systematic way in order to obtain formulations with the desired corona and cell uptake behavior. Liposomes and other nano-sized objects when introduced in biological fluids are known to adsorb biomolecules forming the so-called nanoparticle corona. This layer strongly affects the subsequent interactions of liposomes with cells. Here, by tuning lipid composition in a systematic way, a series of liposomes with tailored surface properties has been prepared to modulate the corona forming in human serum. Liposomes with very different cellular uptake kinetics have been obtained and their corona was identified in order to determine the most enriched proteins on the different formulations. By combining corona composition and uptake kinetics candidate corona proteins associated with reduced or increased uptake by cells can be identified and the liposome formulation can be tuned to obtain the desired uptake behavior. Image, graphical abstract [ABSTRACT FROM AUTHOR]

The anthropogenic marine debris, especially abandoned, lost or otherwise discarded Fishing Gear (ALDFG), represents a rising concern, because of its potential harmful impact on the marine animal forests. We carried out 13 km of video recordings, by means of a remotely operated vehicle, from 10 to 210 m depth, in an anthropised area of the Tyrrhenian Sea (Mediterranean Sea). This site, for its high ecological importance and biodiversity value, has been identified for the establishment of a new marine protected area (MPA). The aim of this paper was to assess marine litter abundance and its effects on the benthic fauna. The debris density, in the study area, ranged from 0.24 to 8.01 items/100 m2, with an average of 3.49 (±0.59) items/100 m2. The derelict fishing gear, mainly fishing lines, were the main source of marine debris, contributing 77.9% to the overall litter. The impacts of debris on the benthic fauna were frequently recorded, with 28.5% of the litter entangling corals and impacting habitats of conservation concern. These impacts were exclusively caused by the derelict fishing gear (91.2% by longlines), and the highest percentage (49.1%) of ALDFG causing impacts was observed from 41 to 80 m depth, in the coralligenous biocenosis. The results of the present study will help the fulfilment of "harm" monitoring, as recommended by the Marine Strategy Framework Directive (MSFD) and the UN Environment/MAP Regional Plan on the marine litter management in the Mediterranean Sea. Regarding the actions to reduce the derelict fishing gear, preventive measures are usually preferred instead of the extensive removals based on cost-effectiveness and sustainability. The establishment of a new MPA in the area could be a good solution to reduce ALDFG, resulting in the improvement of the ecological status of this coastal area. Image 1 • Marine litter was quantified within a new Marine Protected Area. • Litter density ranged from 0.24 to 8.01 items/100 m2 (mean = 3.49 items/100 m2). • Derelict fishing gear represented 77.9% of the total litter items. • Fishing lines have been recognized as a cause of coral damage. The derelict fishing gear, mostly fishing lines, were the main source of marine debris, contributing 77.9% to the overall litter observed in the Milazzo Marine Protected Area. [ABSTRACT FROM AUTHOR]

This study investigates changes over time (2006–2012) in the composition of agro-forest landscape mosaics in Rome, Italy, and discusses landscape dynamics in light of ecological networks' design and management. A multi-temporal analysis of land-use dynamics allows an empirical test of the hypothesis that urban expansion has a non-negligible role in degradation and loss of natural and agricultural land under environmental constraints. Recent urban expansion in different components of Rome's ecological network (REP) negatively affected frequency and size of natural and semi-natural habitats. Empirical results pointed out that establishing a statutory REP in Rome, has partially contained metropolitan expansion in natural areas, while cropland were still converted to urban settlements in a relatively high rate. Implications of such dynamics for policies preserving agro-environmental connectivity are discussed in light of a more 'holistic' strategy of land fragmentation containment. [ABSTRACT FROM AUTHOR]

Simulation debriefing is a critical component of interprofessional education (IPE). The purpose of this IPE report was to determine if there is a difference in a student pharmacist's ability to articulate areas for improvement and continued growth in interprofessional practice between those who participated in a large group debrief compared to a small group debrief after an interprofessional simulation. One hundred pharmacy students participated in an interprofessional standardized patient simulation. Other participants included medicine or physician assistant, nursing, and physical therapy students. Students were randomly assigned to large or small group debriefing. Students completed a reflection to determine their ability to articulate areas for improvement and continued growth. Forty-six students in the large group debrief and 49 students in the small group debrief completed a post-simulation reflection. Reflections were analyzed quantitatively and qualitatively. Quantitative analysis was based on a scoring rubric used to determine whether the student was able to successfully articulate areas for improvement or continued growth. Reflections were evaluated qualitatively to identify the areas for improvement. There was no difference in the ability to identify an area for improvement or continued growth between the large group debrief compared to the small group debrief. There was no difference in students' post-simulation reflections based on participation in small group or large group debriefing following an interprofessional simulation. Students were able to effectively articulate areas for improvement and continued growth in interprofessional practice. [ABSTRACT FROM AUTHOR]

Highlights • About 10% of TBI patients have a severe brain damage with severe motor and cognitive dysfunctions. • New cognitive interventions, including VR training, can be useful in TBI. • VR creates a positive, motivating and enjoyable learning experience for the TBI patients. Abstract Traumatic brain injury (TBI) is a clinical condition characterized by brain damage due to an external, rapid and violent force. TBI causes attention, memory, affectivity, behaviour, planning, and executive dysfunctions, with a significant impact on the quality of life of the patient and of his/her family. Cognitive and motor rehabilitation programs are essential for clinical recovery of TBI patients, improving functional outcomes and the quality of life. Various researches have underlined the possible effectiveness of innovative techniques, with regard to virtual reality (VR), during the different phases of rehabilitation after TBI. This review aims to evaluate the role of VR tools in cognitive assessment and rehabilitation in individuals affected by TBI. Studies performed between 2010 and 2017 and fulfilling the selected criteria were found on PubMed, Scopus, Cochrane and Web of Sciences databases. The search combined the terms VR, assessment, rehabilitation and TBI. Our review has shown that VR has the potential to provide an effective assessment and rehabilitation tool for the treatment of cognitive and behavioral impairment on TBI patients. [ABSTRACT FROM AUTHOR]

Graphical abstract Highlights • In situ synchrotron X-ray study of PLA-HAp composite multi-scale thermo-mechanics. • Mullins effect attributed to non-linear strain interaction of PLA lamella with HAp. • Reversible PLA phase transformation at ∼60 °C, and irreversible above 92 °C. • Compression → tension change of PLA lamella strain under tensile load & temperature. • Addition of HAp filler enhances PLA shape memory effect and mechanical properties. Abstract Polylactide (PLA)-hydroxyapatite (HAp) composite components have attracted extensive attentions for a variety of biomedical applications. This study seeks to explore how the biocompatible PLA matrix and the bioactive HAp fillers respond to thermo-mechanical environment of a PLA-HAp composite manufactured by 3D printing using Fused Filament Fabrication (FFF). The insight is obtained by in situ synchrotron small- and wide- angle X-ray scattering (SAXS/WAXS) techniques. The thermo-mechanical cyclic loading tests (0–20 MPa, 22–56 °C) revealed strain softening (Mullins effect) of PLA-HAp composite at both room and elevated temperatures (<56 °C), which can be attributed primarily to the non-linear deformation of PLA nanometre-scale lamellar structure. In contrast, the strain softening of the PLA amorphous matrix appeared only at elevated temperatures (>50 °C) due to the increased chain mobility. Above this temperature the deformation behaviour of the soft PLA lamella changes drastically. The thermal test (0–110 °C) identified multiple crystallisation mechanisms of the PLA amorphous matrix, including reversible stress-induced large crystal formation at room temperature, reversible coupled stress-temperature-induced PLA crystal formation appearing at around 60 °C, as well as irreversible heating-induced crystallisation above 92 °C. The shape memory test (0–3.75 MPa, 0–70 °C) of the PLA-HAp composite demonstrates a fixing ratio (strain upon unloading/strain before unloading) of 65% and rather a ∼100% recovery ratio, showing an improved shape memory property. These findings provide a new framework for systematic characterisation of the thermo-mechanical response of composites, and open up ways towards improved material design and enhanced functionality for biomedical applications. [ABSTRACT FROM AUTHOR]

Abstract Total and per-capita urbanization rates are increasingly divergent worldwide, indicating an accelerated land consumption and an increased ecological footprint of cities. Under the hypothesis that spatio-temporal divides in total and per-capita urbanization rates are representative of the evolving urban footprint, this study proposed a multivariate analysis of land consumption spatial patterns in a southern European city (Athens, Greece) throughout a building cycle (1948–2015) reflecting sequential waves of economic expansion and stagnation. The footprint's spatial structure was investigated along the urban gradient using descriptive statistics, mapping, multivariate techniques and inferential approaches. The increase of total and per-capita built-up area over time followed a non-linear trend as a result of distinct growth waves. Socioeconomic profiles of municipalities with diverging (total and per-capita) urbanization rates changed over the study period as a result of joint transformations in metropolitan form and functions. Population aging, land-use diversification, vertical profile of buildings and a viable agricultural sector were associated to a low divergence between total and per-capita urbanization rates. Results of our study indicate that effective policies for sustainable development of fringe districts may incorporate urban containment strategies based on specific measures: (i) supporting settlement densification, (ii) stimulating brownfield recovery and (iii) concentrating new development in already fragmented, low-quality land, taking account of the background socioeconomic context and the demographic structure of local communities. Highlights • Spatio-temporal divides in urbanization rates reveal changes in urban footprints. • Long-term land consumption patterns reflect economic and urban cycles. • Per-capita built-up area followed a non-linear trend with distinct growth waves. • Distinct socioeconomic profiles characterized metropolitan form and functions. • Urban containment strategies are key to sustainable management of peri-urban land. [ABSTRACT FROM AUTHOR]

Abstract Analysis of changes over time in the spatial structure of housing prices provides reliable information to infer latent patterns and processes of urban growth. Although the 2008 financial recession had a negative impact on building activity in Europe - and especially in southern Europe - the overall impact of the global crisis on the spatial structure of housing prices has been occasionally investigated at the local scale. The present study compares the spatial structure of transaction prices under economic expansion (2003–2009) and recession (2009–2015) in Rome (central Italy), evaluating the combined influence of demography, land-use and territorial factors. Transaction prices increased significantly during expansion and decreased less sharply during recession. The highest housing prices were recorded in downtown Rome. Convergence and divergence in the level of housing prices between urban and rural areas were observed respectively during economic expansion and recession. The empirical results of this study indicate that the 2008 financial crisis influenced considerably the spatial structure of housing prices in Rome, weakening the urban-rural divide and consolidating the gap between wealthy and poor neighbourhoods. [ABSTRACT FROM AUTHOR]

Due to the increasing occurrence of natural hazards, such as floods, a significant number of lives are lost each year worldwide. The risk of experiencing catastrophic losses from flooding is exacerbated due to the changing climate and increasing anthropogenic activities. Consequently, predicting the conditions leading to fatalities is crucial in the assessment of flood risk. However, the existing modeling capabilities in this field are limited, emphasizing the critical need for the development of such tools. Here, we show that the occurrence of flood fatalities can be estimated using a random forest (RF) algorithm applied to nine explanatory variables characterizing each fatality. Furthermore, by converting the RF model outcomes into a user-friendly tool, it is possible to predict the probability of the occurrence of flood-related fatalities, based on variables describing hazard intensity and the environmental and sociodemographic conditions contributing to such events. Our results represent an initial attempt towards a predictive model of flood fatalities in the Italian context. They reveal the key factors that together influence flood fatalities, enabling the prediction of such occurrences. These findings can serve as a foundational framework for quantitatively assessing the risk to the population from such events and as a valuable resource for identifying strategies to mitigate flood risk. • A novel approach to predict flood fatalities using Italian historical data. • Probability of flood fatalities estimated by Random forest based on 9 key factors. • Developed user-friendly tool for quantitative estimation of risk to the population. • The outcomes constitute non-structural mitigation measures. [ABSTRACT FROM AUTHOR]

In light of the 'zero-net land degradation strategy', the United Nations Convention to Combat Desertification (UNCCD) guidelines for policy-relevant indicators of land quality, have stressed the importance of comparable indexes' informative value across spatial scales. However, the proliferation of composite indexes of land sensitivity, vulnerability, or exposure to desertification risk, has been occasionally grounded on a systematization of theoretical concepts – both in advanced economies and in emerging countries. Rationalization of the operational approaches to land degradation assessment implies a (spatially explicit) comparison and verification of their outcomes at different (policy-relevant) spatial scales. To answer this issue, we implemented a statistical approach evaluating the coherence and reliability of four composite indexes of land degradation (ES3, ES4, LVI, DSI), with a practical application for Italy, a Mediterranean country classified as 'affected' by UNCCD. Using (municipal) administrative units as the elementary analysis' domain, sequential econometric techniques were used to test the internal (spatially explicit) coherence of the four composite indexes, and the role of information redundancy, for calibration of local-scale land degradation strategies. The outcomes of spatial regressions documented the potential of the four indexes in a short-term assessment of land vulnerability, confirming that such indexes provided a coherent ranking of Italian municipalities based on their intrinsic degree of land degradation. Principal Component Analysis documented the superior informative power of the ES4 index and confirms the appropriateness of an extensive use of the Environmentally Sensitive Area Index (ESAI) at small spatial scales. The proposed framework supports the creation of an index dashboard to monitoring complex environmental phenomena. • Proliferation of land degradation indexes is not reflected in operational approaches. • We evaluate spatial coherence of a panel of composite indices of land degradation. • Results highlight the reliability in a joint use of composite indexes. • We highlighted the role of information redundancy in land degradation strategies. • Results illustrates the superior informative power of the ESAI index. [ABSTRACT FROM AUTHOR]

HBsAg clearance (functional cure) is the optimal endpoint of chronic hepatitis B treatment. Nucleo(s)tide analogues (NAs) have a limited impact on HBsAg decline, however achieving low HBsAg serum levels correlates with loss after discontinuation. To investigate mechanisms of HBsAg decline during NAs. We set up a mathematical model describing: 1) dynamics of replication-competent hepatocytes (cccDNA>1 copy/cell) producing HBsAg by either cccDNA or integrated DNA (intDNA); 2) cccDNA turnover; 3) dynamics of non-replication-competent hepatocytes which lost cccDNA by cell division, but still produce HBsAg by intDNA. Baseline I 0-cccDNA and their immune-mediated clearance rate were computed by ALT decline upon NAs block of HBV replication; cccDNA lifetime by fitting ALT, HBV-DNA and HBsAg; HBsAg production rate constants (from I 0-cccDNA and I 0-intDNA), I 0-intDNA and their lifetime by fitting HBsAg. We applied the model in 29 HBeAg-neg and 2 HBeAg-pos patients, median age 56.1(30-76.6) years, 21(65.6%) males, 17(54.8%) with cirrhosis. Median NAs treatment was 123.1(41.2-260.1) months. HBV-DNA (COBAS-TaqMan, Roche) and HBsAg (Architect, Abbott) were tested every six months. HBsAg during NAs showed 3 different patterns: steady (3;9.6%), monophasic (18;58.1%) and multiphasic (10;32.3%) decline. Mean baseline ALT and HBsAg were lower in monophasic (121±95vs666±565 U/L, p=0.0004 and 4,421.9±2,876,2vs18,846.8±22,861.3 IU/mL, p=0.0272). Overall, 6(19.4%) lost HBsAg: 5(17.2%) HBeAg-neg (4 during, 1 after NAs) and 1 (50%) HBeAg-pos (after discontinuation-retreatment). Patients who lost HBsAg on-therapy had multiphasic declines, successfully described by the model (Figure). Monophasic patients had lower I 0-cccDNA (22.0%±15.4%vs54.8%±27.3%, p=0.0159) and HBsAg production by cccDNA (1.7%±2.3vs53.3%±27.3%, p<0.0001). Lifetime of I intDNA was longer in monophasic (3,938±2,681 vs 1,340±875 days, p=0.0065), cccDNA lifetime was similar (52±52vs31±14 days, p=0.2288). Mathematical modeling showed that faster HBsAg decline after NAs was associated with higher disease activity and prevalent HBsAg production from cccDNA, with lifetime shorter of intDNA. HBsAg loss was characterized by multiphasic declines. [ABSTRACT FROM AUTHOR]

Dental caries is one of the most common chronic diseases that affect human teeth. It often initiates in enamel, undermining its mechanical function and structural integrity. Little is known about the enamel demineralisation process caused by dental caries in terms of the microstructural changes and crystallography of the inorganic mineral phase. To improve the understanding of the carious lesion formation process and to help identify efficient treatments, the evolution of the microstructure at the nano-scale in an artificially induced enamel erosion region was probed using advanced synchrotron small-angle and wide-angle X-ray scattering (SAXS and WAXS). This is the first in vitro and time-resolved investigation of enamel demineralisation using synchrotron X-ray techniques which allows in situ quantification of the microstructure evolution over time in a simulated carious lesion. The analysis revealed that alongside the reduction of mineral volume, a heterogeneous evolution of hydroxyapatite (HAp) crystallites (in terms of size, preferred orientation and degree of alignment) could be observed. It was also found that the rate and direction of dissolution depends on the crystallographic orientation. Based on these findings, a novel conceptual view of the process is put forward that describes the key structural parameters in establishing high fidelity ultrastructure-based numerical models for the simulation of the enamel demineralisation process. Statement of significance Hydroxyapatite (HAp) crystallites in the enamel dissolve during dental caries although little is known about the structural-chemical relationships that control the dynamic demineralisation process. For the first time this work investigated the in situ evolution of nano-scale morphology and the spatial distribution of ultrastructural HAp crystallites of human enamel during demineralisation in simulated caries. Advanced synchrotron SAXS and WAXS techniques showed that the heterogeneous evolution of crystallites (size, preferred orientation and degree of alignment) could be attributed to crystallographic-orientation-dependent anisotropic dissolution. Hence we propose a novel conceptual schematic diagram to describe the demineralisation process. These findings have important implications for understanding the detailed mechanisms of enamel demineralisation and provide insight into potential enamel remineralisation that could restore structural integrity and function. [ABSTRACT FROM AUTHOR]

The main objective of this research was to investigate climate-growth relationships and if climate is a possible cause of oak decline in a very representative peri-urban forest in the Mediterranean area. The dendrochronological behaviours of healthy trees and declining trees were compared according to compromised vitality as assessed by crown defoliation. The analysed parameters were ring and latewood widths. The results showed that ring widths and latewood depended directly on spring precipitation (April-May-June) and, inversely, on spring-summer temperature (April-May-June-July). The growth histories of healthy and declining deciduous oaks in Castelporziano, as evaluated by their crown vitality, were very similar. The onset of decline dates back to the middle of the 1940s, and a further irreversible growth depression was based on the increase in temperature in the 1980s. This climatic change is reflected roughly 13 years later in declining trees, 17 years later in the healthy ones, in a strong growth depression that appears very exacerbated by the recurrent warm extreme events after the 2000s. Latewood in our study did not add more to the total ring-width measurements, potentially because of a high state of tree suffering. Declining trees were in general older than healthy ones, but in this study, the difference in age was not different from a statistical point of view. [ABSTRACT FROM AUTHOR]

Abstract Background Traditional interprofessional educational (IPE) exercises are those where learning exists "about, from, and with" trainees in two or more professions in order to prepare health sciences professionals to work on interprofessional teams. One emerging difficulty with IPE is the paucity of health profession students at single institutions, and the geographic and financial constraints of multi-institutional collaboration. Interprofessional education activity To circumvent these barriers, we developed a multi-institution telehealth team-based learning (TBL) event between medical and pharmacy students on the topic of pharmacogenomics (PGx). Using a validated pre-post survey design, student attitudes and perceptions were measured before and after an educational intervention designed to simulate interprofessional telehealth collaboration. The survey results showed significant improvement across all areas of student attitudes toward interprofessional collaboration. Also, medical student PGx confidence increased substantially during the exercise even though the only PGx instruction they received was from pharmacy students. Discussion These data demonstrate that learning exists "about, from, and with" trainees in other professions, even if they do not physically train in the same location. Free tools are available to create virtual interactions between students on different campuses, and telehealth exercises using these tools are a valid way to conduct IPE across different campuses. The instructional experience does not need to be identical for all participants in the IPE event; rather, tailoring the educational experience to each group of students provides opportunities for inter-student teaching. [ABSTRACT FROM AUTHOR]

Agricultural marginality is a multifaceted issue, being related to place-specific socioeconomic contexts and highly-variable technological conditions. The coexistence of different classification systems of these variables makes hard any attempt to have a general definition of agricultural marginality. Moreover, the spatially explicit identification of marginal lands is still challenging mostly due to the lack of reliable data sources at both country and regional scale. Accordingly, this paper evaluates the degree of economic marginality of agricultural land, using Italy as a representative case study for southern Europe. A spatial analysis of farmland profitability and constraints for agricultural activities (topography and biodiversity conservation) is proposed to identify three classes of agricultural land, namely ‘unsuitable’, ‘supramarginal’ and ‘marginal’ lands. Results show that almost 39% of agricultural land in Italy can be classified as ‘marginal'; its spatial distribution and characteristics are also analyzed and discussed in relation to different background conditions. The proposed approach provides a valuable methodology supporting land-use planning and decision-making under restricted geo-spatial data availability. [ABSTRACT FROM AUTHOR]

For hundreds of years, bamboo has been employed for a variety of applications ranging from load-bearing structures to textiles. Thanks to its hierarchical structure that is functionally graded and naturally optimised, bamboo displays a variation in properties across its stem that ensures exceptional flexural performance. Often, alkaline solutions are employed for the treatment of bamboo in order to alter its natural elastic behaviour and make it suitable for particular applications. In this work we study the effect of NaOH solutions of five different concentrations (up to 25%) on the elastic properties of bamboo. By exploiting the capabilities of modern experimental techniques such as in situ synchrotron X-ray scattering and Digital Image Correlation, we present detailed analysis of the deformation mechanisms taking place in the main constituents of bamboo, i.e. fibres and matrix (Parenchyma). The principal achievement of this study is the elucidation of the deformation mechanisms at the fibre scale, where the relative sliding of fibrils plays a crucial role in the property modification of the whole bamboo stem. Furthermore, we shed light on the parenchyma toughness variation as a consequence of alkali treatments. Statement of Significance Alkaline solutions are often employed for the treatment of bamboo in order to alter its natural elastic behaviour. In this work we study the effect of alkaline solutions on the elastic properties of bamboo. Using state of the art experimental techniques allowed shedding light on the deformation mechanisms occurring in the bamboo main constituents, i.e. fibres and matrix (parenchyma cells). Enhancement of fibre stiffness was experienced when up to 20% NaOH solution was employed, while for higher concentration a decay was observed. This effect was imputed to the modification of adhesion between fibrils induced by disruption of ligand elements (e.g. lignin). Modification of the matrix toughness was also experienced, that indicated an improved resistance to cracking when the concentration of NaOH is 25%, while reduction of toughness was revealed for lower concentrations. [ABSTRACT FROM AUTHOR]

Background: Cemented stems are designed to follow 1 of 2 principles of fixation: composite beams or slide taper. Stems in the latter category have a collarless, polished, tapered (CPT) design and subside into the cement mantle, creating hoop stresses. We compared the rate of periprosthetic fracture (PPF) of stem designed with these 2 principles of fixation. In addition, we examined radiographic factors that may predispose to the development of PPF.Methods: We retrospectively reviewed all patients who underwent primary THA by a single surgeon using highly polished cemented stems. PPF rates were compared between CPT stems (follow-up, 21 months; standard deviation [SD], 22) and composite beam stems (follow-up, 21.7 months; SD, 26). Demographic data were compared between patients with and without a PPF. Three preoperative radiographic parameters (canal bone ratio [CBR], canal-calcar ratio, and canal flare index), stem alignment, and cement mantle were compared in match-paired patients with and without a PPF (1:34).Results: Seven of 1460 THA patients developed a PPF (0.479%); 4 hips of 185 with a CPT stem (2.2%); and 3 of 1275 hips with a composite beam stem (0.23%; P = .0064). Three of the 4 PPFs in the CPT group and none in the composite beam group were classified as Vancouver B2. The CBR in patients with a PPF was 0.50 (SD, 0.07) and 0.43 (SD, 0.07) in the match cohort of hips without PPF (P = .013).Conclusion: CPT stems may be associated with a higher risk of PPF that often require reoperation. An increased CBR may be a risk factor for postoperative PPF. [ABSTRACT FROM AUTHOR]

Background and study object The Dominant Atrium (DA) is a crossroad of eloquent white matter bundles difficult to preserve with a standard “anatomical” approach. The aim of this work is to evaluate the results of a cohort of patients who underwent surgery with the aid of a purely functional MRI and DTI-based approach. Materials and methods 43 patients suffering from lesions involving the DA have been included in the final cohort and studied in regards to quality of life (KPS); a special attention was lent on the incidence of new or worsening of preexisting neurological deficits, with a focus on motor, visual and speech disturbances after the surgical treatment. Patient, surgery and lesion-related data were recorded to identify the relationships with outcome. Eloquent areas fMRI and the course of Arcuate Fasciculus (AF), Inferior frontooccipital fasciculus (IFOF), Optic radiation (OR) and corticospinal tract (CST) have been investigated with preoperative MRI sequences and DTI reconstruction. Results The final cohort consisted of 43 patients, 19 males and 24 females; average age was 56.8 years. We recorded 9 transient and 3 permanent postoperative deficits, only one of those was caused by an edema interference with DTI reconstruction. Preoperative functional status, histology and volume of the lesion proved to be independent factors affecting results. Conclusions A purely functional surgical approach to the DA provided promising preliminary results. A direct DTI-fMRI visualization of the eloquent structures proximal to DA allows surgeon to conceive an ultra-precise and “tailored” cortico-leucotomy for an optimal exposure of the lesion. [ABSTRACT FROM AUTHOR]

Many countries have implemented laws and planning instruments to preserve farmland on the urban fringe. This paper aims at a better understanding of the governance changes in peri-urban farmland protection following decentralisation processes in France and Italy. We compare the implementation of farmland protection instruments in the two city regions of Montpellier and Rome. From a governance perspective, we highlight the practical issues of effectiveness and social acceptability arising from power devolution, different forms of governance, and the potential conflicts when planning control shifts to lower-than-regional bodies. Our analysis is based on qualitative methods. Primary data were collected through document analysis, participant observation and in-depth interviews aimed at understanding local stakeholders’ practices and points of view on access to farmland, housing and building rights. We find that around Rome and Montpellier, decentralisation has produced multiple decision-making authorities and increased the complexity of procedures. Despite more regulatory constraints in agricultural areas, farmland conversion has persisted. However, decentralisation processes have also changed ways of governing and favoured local alternative initiatives for farmland protection and farming development on the urban fringe. New modes of governance involve public local authorities, farmers’ representative bodies (Montpellier) and civil society organisations (Rome). In both cities, they have a positive but limited impact on the effectiveness of farmland protection instruments. Their social acceptability varies, depending on who is really included in the participation process. [ABSTRACT FROM AUTHOR]

Peri-urban agriculture has preserved around central cities a land-use mosaic and contributes to the sustainable growth of metropolitan regions constituting green infrastructures, supplying urban markets, and improving social inclusion. The present study provides a quali-quantitative overview of peri-urban agriculture vis à vis urban expansion investigating the recent evolution of peri-urban farms (1988–2010) in Toulouse, the fourth largest metropolitan region in France. Socioeconomic dynamics in the study area, are representative of latent spatial and functional relationships between urban growth and peri-urban agriculture in contemporary European cities. Two complementary approaches were developed (i) identifying and analysing socioeconomic and environmental indicators that characterize changes over time in peri-urban agriculture by linking urban expansion with the evolution of fringe land-use; and (ii) carrying out a qualitative survey on a sample of farmers with the aim to relate farms' evolution strategies and land-use dynamics. Results of the present study indicate that urban expansion affects the characteristics of peri-urban farms, altering economic size, crop productions and social characteristics of farmers, and widening the spatial divide between large enterprises located in the peri-urban periphery and smaller farms in the immediate surroundings of urban areas. The qualitative survey investigates farmers' strategies to maintain their business in peri-urban areas. By recognizing that structural and functional characteristics of urban growth are interpretative keys to identify sustainable land management strategies, the role of peri-urban agriculture is finally outlined according to the empirical evidence from different socioeconomic contexts in the study area. [ABSTRACT FROM AUTHOR]

This study moves in the debate on polycentric development in Europe proposing an entropy-based indicator of urban centrality based on local-scale diversity in soil sealing levels. This indicator reflects a progressive transition from a mono-centric and hyper-compact morphology towards polycentric agglomerations, with formation (or consolidation) of sub-centres structurally and functionally distinct from central cities. The proposed approach was tested in three metropolitan regions (Barcelona, Rome and Athens) with the aim to provide a comparative analysis of recent urbanization patterns in European countries affected by rapid processes of urban spillover. The local socioeconomic structure underlying urban expansion was investigated using descriptive, correlation and multivariate analysis of 52 contextual indicators. Results of this study shed light on long-term urbanization patterns in the examined cities, providing evidence of a progressive settlement scattering in Rome and Athens. Early signals of polycentrism were observed in Barcelona. Diversification in the level of soil sealing decreased with the distance from central cities. The article finally debates on the use of composite indexes of diversification in the level of soil sealing when assessing polycentric urban development. [ABSTRACT FROM AUTHOR]

Within the variation of energy performance at urban scale, the relation between solar irradiation and urban form takes a central role. The solar availability on façades which is influenced by the morphology of the urban context, is strictly related to building energy performance indeed. In this paper, we aim at identifying a set of urban morphology indicators (UMIs) that show the most accurate relations with the solar availability on façades (SIy) in the Mediterranean context. The analysis that relates to 14 urban textures of Rome and Barcelona comprises seven UMIs: gross space index, floor space index, façade-to-site ratio, average building height, volume-area ratio, building aspect ratio and sky factor of building façades. The SIy in each texture has been calculated with Heliodon2 software, using normalised models; the relation between SIy and UMIs were investigated using least-square regression analysis. Results suggest that gross space index, façade-to-site ratio and sky factor show very good correlation with SIy (R2 = 0,91) and could be used to develop a comparative assessment tool of solar performance at fabric scale. This could ease the work of urban planners and architects in the early stage of design, reducing both data and time normally needed to perform solar analyses at urban scale. [ABSTRACT FROM AUTHOR]