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The importance of supporting parent-child interactions has been noted in the context of prodromal autism, but little consideration has been given to the possible contributing role of parental characteristics, such as psychological distress. This cross-sectional study tested models in which parent-child interaction variables mediated relations between parent characteristics and child autistic behaviour in a sample of families whose infant demonstrated early signs of autism (N = 103). The findings suggest that associations between parent characteristics (psychological distress; aloofness) and child autistic behaviours may be mediated by the child's inattentiveness or negative affect during interactions. These findings have important implications in developing and implementing interventions in infancy which target the synchrony of parent-child interaction with the goal to support children's social communication development.

Many autistic children access some form of early intervention, but little is known about the value for money of different programs. We completed a scoping review of full economic evaluations of early interventions for autistic children and/or their families. We identified nine studies and reviewed their methods and quality. Most studies involved behavioral interventions. Two were trial-based, and the others used various modelling methods. Clinical measures were often used to infer dependency levels and quality-adjusted life-years. No family-based or negative outcomes were included. Authors acknowledged uncertain treatment effects. We conclude that economic evaluations in this field are sparse, methods vary, and quality is sometimes poor. Economic research is needed alongside longer-term clinical trials, and outcome measurement in this population requires further exploration.

This research focuses on integrating seakeeping indices into the trajectory planning of a mother ship in order to minimize risks during UAV (unmanned aerial vehicle) takeoff and landing in challenging sea conditions. By considering vessel dynamics and environmental factors, the proposed trajectory planning algorithm computes optimal paths that prioritize the stability and safety of the ship, mitigating the impact of adverse weather on UAV operations. Specifically, the new adaptive weather routing model presented is based on a genetic algorithm. The model uses the previously evaluated response amplitude operators (RAOs) for the reference ship at different velocities and encounter angles, along with weather forecast data provided by the global wave model (GWAM). Preliminary evaluations confirm the effectiveness of the presented model in significantly improving the reliability of autonomous UAV operations from a mother ship across all encountered sea state conditions, particularly when compared with a graph-based solution. The current results clearly demonstrate that it is possible to achieve appreciable improvements in ship seakeeping performance, thereby making UAV-related operations safer.

Introduction: Caring for the dying can generate anxiety and emotional distress, particularly in nursing students, and perceived competence could play a crucial role in enabling nurses to perform their duties with greater confidence. Unfortunately, few studies describe the relationship between students’ nursing attitudes and perceived self-efficacy in palliative care (PC). To overcome this gap, this survey aimed to assess the attitudes towards dying patients and the perceived competence of nursing students in palliative care at different universities in the south of Italy. Methods: A cross-sectional study was conducted from September 2022 to March 2023 involving nursing students from the three major Sicilian universities (Italy). The study included a survey investigating socio-demographic characteristics, palliative care training, knowledge about pain management, and previous experience with dying. Moreover, the Professional Competence of the Core Curriculum in Palliative Care Nursing (CCPCN) questionnaire and the Frommelt Attitudes Toward Care of the Dying—B Italian version (FATCOD-B-I) assessed competencies and emotional attitudes. Results: A total of 1913 nursing students were recruited, of which 71.3% were females, and 53.9% were in the age range of 18 to 21 years. In the multivariable analysis, practical PC training was a substantial factor in enhancing competencies (Adj-OR 2.78 [95% CI = 2.12–3.65]). Male students had higher competence odds (Adj-OR 1.38 [95% CI = 1.14–1.66]), and perceived knowledge strongly correlated with self-assessed competence. Advancement in academic years also positively influenced competence self-assessment (Adj-OR 1.98 [95% CI = 1.75–2.24]). Regarding emotional attitudes, a per-quartile increase in competence score was found to improve the attitude score (Adj-OR 1.24 [95% CI = 1.13–1.35]). Conclusions: Nursing students gain valuable experience during clinical experience. PC training and perceived knowledge of PC significantly increase nurses’ competencies, and the latter seem to be strongly associated with attitudes. Thus, introducing palliative care education into nurses’ core curricula could be a way to reduce anxiety and emotional distress in young students.

The aryl diester compound, 2-methyl-1,4-phenylene bis(3,5-dibromobenzoate), C21H12Br4O4, was synthesized by esterification of methyl hydroquinone with 3,5-dibromobenzoic acid. A crystalline sample was obtained by cooling a sample of the melt (m.p. = 502 K/DSC) to room temperature. The molecular structure consists of a central benzene ring with anti-3,5-dibromobenzoate groups symmetrically attached at the 1 and 4 positions and a methyl group attached at the 2 position of the central ring. In the crystal structure (space group P\overline{1}), molecules of the title aryl diester are located on inversion centers imposing disorder of the methyl group and H atom across the central benzene ring. The crystal structure is consolidated by a network of C—H...Br hydrogen bonds in addition to weaker and offset π–π interactions involving the central benzene rings as well as the rings of the attached 3,5-dibromobenzoate groups.

Children who lack functional spoken language are candidates for augmentative and alternative communication (AAC). Aided AAC and naturalistic interventions offer the potential to extend the communication functions demonstrated by children with autism spectrum disorder (ASD) who are nonspeaking. Related intervention research, however, has been limited, in that interventions have generally targeted a limited range of communication functions taught in highly structured, decontextualized environments. The aim of this study was to investigate the efficacy of an intervention that combined aided AAC with a naturalistic intervention -- enhanced milieu teaching (AEMT) - to increase symbolic communication in children with autism spectrum disorder. Three children with autism spectrum disorder participated in a multiple probe design, in which a range of communication functions were targeted using the AEMT. Results showed increases in the use of symbolic communication from baseline to intervention phases, which were found to be statistically significant for two of the three children (phi 0.7-0.81; p < 0.001). Intervention outcomes were generalized to a communication partner not involved in the intervention and maintained over time for all children. The study provides preliminary evidence that communication functions beyond object requests could be taught using a systematic, multi-element approach implemented across activities.

School inclusion of students with disabilities relies on reasonable adjustments to curriculum and class activities. The Reasonable Adjustments for Inclusive Education (RAIE) was designed to elicit reasonable adjustments from stakeholders in mainstream school inclusion for three contrived students with varied learning needs. We evaluated a scale for rating the quality of elicited reasonable adjustments across five dimensions: Agency, Authenticity, Real Learning, Strengths Based, and Inclusion. A trial (n = 5 participants) led to refinement of the scale, which was tested for inter-rater reliability with data from a randomized controlled trial (RCT) of an intervention to improve the quality of reasonable adjustments. RCT participants (10 parents, 10 educators, nine allied health professionals) provided 596 reasonable adjustments, rated for each dimension by two independent raters (n = 2980 ratings). Overall agreement was 75.3%; intraclass correlation (ICC) was 0.778. ICCs were moderate-good (0.612-0.816). Further refinement and testing with multiple raters are recommended.

This article introduces a novel approach to remote laboratory instruction, specifically designed for teaching three-dimensional modeling using Blender software. The lab uses virtual machines to provide students with the necessary computational power to carry out the course activities, along with the correct version of the software. The flipped remote lab approach combines the elements of flipped classroom and peer assessment, making it suitable for face-to-face, totally online, or hybrid classes. Prior to each of the two lectures, students begin to practice by replicating the instructor's demonstrations in a set of concise tutorials. Upon completion of the assigned tasks, students carry out self-assessments of their own modeling, in addition to assessing two models created by their peers. A rubric comprising three questions facilitates the assessment process and allows providing feedback on each response. During the subsequent lecture, students work together with the instructor to address challenges encountered in their modeling, exploring also the advanced aspects of software usage that time constraints preclude in a traditional setting. The analysis of the flipped remote lab results reveals that student responses in peer-assessment activities are relevant to the posed questions. Moreover, the students who realized the models demonstrated a comparable level of rigor in self-assessment as their mates who reviewed their works. While students express a high degree of appreciation for the laboratory activities, a notable concern is the highlighted heavy workload. Increasing the allocated time for task completion can help mitigate the workload impact. The article concludes with insights gained from the implementation of the flipped remote lab approach.

The growing demand for language mediation across different domains of public service interpreting (PSI) poses a challenge for policymakers, stakeholders (institutional representatives, clients), and traditional interpreter education institutions. Alongside university-based interpreter education, different training formats have emerged internationally to meet the increased need for training. Based on a systematic review of extra-university training formats in Austria, this contribution presents the results of a qualitative follow-up study drawing upon data from semi-structured interviews with providers. The aim was to investigate whether entrance assessment procedures are employed by course providers when selecting course participants, and, if so, which they are and what motives lie behind providers' decisions for particular admission procedures. Our study shows that while there is considerable commitment to offering customer-tailored courses to heterogeneous groups of trainees, the training formats differ and there seems to be little communication among providers regarding the establishment and adequacy of different formats for student selection.

Background and objective: Collagen biosynthesis is intricately involved in the development and progression of solid tumors. Renin-angiotensin system inhibitors (RASi) impede TGF-β-mediated collagen synthesis in tumors by hindering activation of the angiotensin receptor. Our aim was to investigate a potential association between RASi use and the aggressiveness of prostate cancer (PCa). Methods: We conducted a retrospective multicenter analysis for a cohort of 1250 patients with PCa who underwent radical prostatectomy (RP) between 1990 and 2023 in four European high-volume centers. The study cohort comprised 625 RASi-treated patients and 625 age-matched RASi-naïve patients. Data for various parameters were collected, including age at RP, body mass index (BMI), prostate volume, prostate-specific antigen (PSA), percentage of free PSA, Gleason score (GS) at biopsy and RP, TNM stage, and the rate of biochemical recurrence (BCR). Clinical parameters for patients with and without RASi treatment were documented. Differences between the groups were compared using a Mann-Whitney U test and χ2 tests. Survival analyses were performed using the Kaplan-Meier method. Key findings and limitations: As expected, the RASi group had higher BMI levels than the RASi-naïve group (p

Background: Therapeutic plasma exchange (TPE) is a highly effective rescue treatment for patients with acute exacerbation of neuroimmunological disease that removes circulating autoantibodies and inflammatory components from the bloodstream. The aims of this study are to explore the safety and the effectiveness of TPE in patients with autoimmune neurological disorders. Methods: We retrospectively evaluated the frequency of adverse events (AEs) and the effectiveness of TPE using the modified Ranking Scale (mRS) in patients with acute neurological flares who underwent TPE at the University Hospital of Palermo. Results: Of 59 patients, the majority underwent TPE due to multiple sclerosis (MS) relapse. In 23.7% of cases, TPE was performed before obtaining a definite diagnosis due to the severity of the clinical presentation. After TPE, the mRS score was globally reduced (p < 0.0001), and this effect was marked in patients with MS, Guillain–Barré syndrome, and myasthenia gravis crisis but not in those with paraneoplastic syndromes. Circulating pathogenetic antibodies, younger age, and the early use of TPE were factors strongly associated with TPE effectiveness. The overall safety profile of TPE was satisfactory with an AE frequency of 15%. Conclusions: These results highlight the early use of TPE in patients with circulating pathogenetic antibodies as well as its favorable safety profile.

The Ionian Sea is a crucial intersection for various water masses in the Mediterranean. Its hydrography and dynamics play a significant role in the seawater budgets and biogeochemistry of the neighboring sub-basins. Multiple theories have been formulated to gain a better understanding of the Ionian dynamics. These theories primarily attribute the variability of the near-surface Ionian circulation to internal processes. Here, we utilize horizontal currents and temperature–salinity profiles from the Copernicus reanalysis to examine the contribution of baroclinic modes to the variability of the basin horizontal circulation. Our findings demonstrate that, although the basin vertical structure is characterized by three layers, the primary patterns of the Ionian circulation can be attributed to the first baroclinic mode. This mode, along with the barotropic mode, accounts for over 85% of the overall variability in the Ionian circulation, suggesting that only one of the three interfaces separating the different water masses in the basin is dynamically active. We estimate the depth of this interface to be about 490 m. Additionally, our analysis shows that more than 90% of the kinetic energy over the water column is localized above this interface, indicating that the deep layer of the Ionian is dynamically nearly inert.

Summary: Thyroid carcinoma represents the first malignancy among the endocrine organs. Investigating the cellular hierarchy and the mechanisms underlying the initiation of thyroid carcinoma is crucial in thyroid cancer research. Here, we present a protocol for deriving thyroid cell lineage from human embryonic stem cells. We also describe steps for engineering thyroid progenitor cells utilizing CRISPR-Cas9 technology, which can be used to perform in vivo studies, thus facilitating the development of representative thyroid tumorigenesis models.For complete details on the use and execution of this protocol, please refer to Veschi et al.1 : Publisher’s note: Undertaking any experimental protocol requires adherence to local institutional guidelines for laboratory safety and ethics.

Early support should help autistic children lead flourishing lives. We sought to understand parents' experiences of their children's involvement in early intervention and associated research, through focus groups with 23 parents (of 22 children) enrolled in a university-affiliated service. Reflexive thematic analysis revealed four themes. Parents conveyed a strong sense of gratitude (Theme 1) arising from their perceptions of the importance of early intervention and feelings of having 'hit the jackpot' to secure access to the service from which they perceived their children 'gained so much'. They valued the service and staff expertise which made them feel secure (Theme 2). University affiliation and the associated research also contributed to parents' sense of safety, from perceived 'accountability' and 'integrity'. Parents conveyed deep commitment to the service (Theme 3) but shared often-negative experiences as their child's enrolment came to an end (Theme 4) and they expressed feelings of abandonment and disempowerment, being confronted with the reality of needing to secure next-stage support for their children and of perceived critical need for 'conversion of research into practice'. These parents' accounts offer insights into the benefits and ongoing challenges of achieving truly effective supports for autistic preschoolers and their families.

Abstract Neuroblastoma (NB) is the most common pediatric tumor and is currently treated by several types of therapies including chemotherapies, such as bortezomib treatment. However, resistance to bortezomib is frequently observed by mechanisms that remain to be deciphered. Bortezomib treatment leads to caspase activation and aggresome formation. Using models of patients-derived NB cell lines with different levels of sensitivity to bortezomib, we show that the activated form of caspase 3 accumulates within aggresomes of NB resistant cells leading to an impairment of bortezomib-induced apoptosis and increased cell survival. Our findings unveil a new mechanism of resistance to chemotherapy based on an altered subcellular distribution of the executioner caspase 3. This mechanism could explain the resistance developed in NB patients treated with bortezomib, emphasizing the potential of drugs targeting aggresomes.

“Comunicazione Digitale XR” is a project that exploits the EON-XR platform to enrich Information Technology education by incorporating interactive 360-degree visuals and 3D models to complement traditional teaching methods. This study probes the efficacy of Extended Reality (XR) technologies in augmenting educational experiences through the integration of gamification techniques within the curriculum. The evaluation, involving twenty-six students, delved into factors such as engagement levels, comprehension of material, and the contributory role of XR in exam readiness. Data collection was conducted using electronic log files, which provided detailed quantitative metrics on student interactions, and a post-intervention survey that assessed changes in comprehension and engagement. Additionally, qualitative data was gathered through semi-structured interviews. Quantitative data from surveys and log files were analyzed using descriptive statistics, while qualitative data from interviews were subjected to thematic analysis. This investigation has demonstrated substantial enhancements in student comprehension and engagement with the educational content facilitated by XR technologies. These findings underscore the potential of XR to augment the educational paradigm and improve students’ preparedness for academic evaluations.

ABSTRACTWe present maps of geohazard features identified across north-western Sicily and Pantelleria in the framework of the Magic project (MArine Geohazard along Italian Coasts), which involved Italian marine geological researchers in 2007-2013. These seafloor features were recognized using high-resolution bathymetry data and rely on the morphological expression of the seafloor and shallow sub-surface processes. The north-western Sicily is a complex continental margin, affected by morphodynamic, depositional, and tectonic processes. The Egadi offshore is controlled by fault escarpments and alternating retreating and progradational processes. Ustica and Pantelleria submerged edifices show the effect of volcanic activity. The Ustica seafloor is interested in volcanic, tectonic, and gravitational instability processes, while the Pantelleria offshore underwent erosive-depositional processes and the effect of bottom currents. Two levels of interpretation are represented: the physiographic domain at a scale of 1:250.000 and the morphological units and morpho-bathymetric elements at a 1:100.000 scale.

Background: Medical students are at high risk for mental disorders, and the COVID-19 pandemic might have exacerbated psychological distress. However, no data are available for the southern part of Italy. The SMS-ME (Sicilian Medical Students’ MEntal health) project aimed to estimate the prevalence of and predictors of depression, anxiety, stress, and suicidal ideation in a sample of Sicilian medical students. Methods: A web-based cross-sectional survey was carried out from September 2022 to December 2022. The study protocol investigated sociodemographic factors and clinical data including Depression, Anxiety, Stress Scale-21 (DASS-21), and a specific question addressing suicidal ideation frequency over the last six months. Multivariate regression models were assessed to examine the association between symptoms and relevant predictors and then regressed their residuals with suicidal thought frequency. Result: We collected 1,866 records (age=22.5, SD=3.4; 65.2 % females). One out of four students presented highly severe depression (25 %) and referred to the presence of some suicidal ideation in the six months preceding the interview (26.1 %). DASS-21 scores, especially depression (F(5, 1,828)=58.8, p = 6.59–57), increasingly predicted the frequency of suicidal thoughts when above the sample's mean. Limitations: The cross-sectional study design does not allow inferences on temporal relationships and the self-report strategy could be intrinsically biased by the person's feelings at the time of the interview. Conclusions: High prevalence of anxiety and depressive symptoms and suicidal thoughts were observed among Sicilian medical students. The DASS-21 was a good predictor for suicidal ideation that Universities could use as a simple tool to assess the need for psychological healthcare in this population.

BackgroundThe use of Non-Pharmaceutical Interventions (NPIs) during the COVID-19 pandemic is debated. Understanding the consequences these measures may have on vulnerable populations including children and adolescents is important.MethodsThis is a multicenter, quasi-experimental before-after study involving 12 hospitals of the North Italian Emilia-Romagna Region, with NPI implementation as the intervention event. The 3 years preceding NPI implementation (in March 2020) constituted the pre-pandemic phase. The subsequent 2 years were further subdivided into a school closure phase (SC) and a subsequent mitigation measures phase (MM) with milder restrictions. Interrupted Time Series (ITS) regression analysis was used to calculate PED Standardized Incidence Rate Ratios (SIRR) on the diagnostic categories exhibiting the greatest frequency and/or variation.ResultsIn the 60 months of the study there were 765,215 PED visits. Compared to the pre-pandemic rate, overall PED presentations dropped by 58 and 39% during SC and MM, respectively. “Symptoms, signs and Ill-defined conditions,” “Injury and poisoning” and “Diseases of the Respiratory System” accounted for 74% of the reduction. A different pattern was instead seen for “Mental Disorders,” which exhibited the smallest decrease during SC, and is the only category which rose already at the end of SC. ITS analysis confirmed the strong decrease during SC (level change, IRR 0.17, 95%CI 0.12–0.27) and a significant increase in MM (slope change, IRR 1.23, 95%CI 1.13–1.33), with the sharpest decline (−94%) and rise (+36%) observed in the “Diseases of the Respiratory System” category. Mental Disorders showed a significant increasing trend of 1% monthly over the whole study period exceeding pre-pandemic levels at the end of MM. Females and adolescents showed higher increasing rates both in SC and MM.ConclusionNPIs appear to have influenced PED attendance in different ways according to diagnostic categories, mirroring different mechanisms of action. These effects are beneficial in some cases and harmful in others, and establishing a clear balance between pros and cons is a difficult task for public health decision makers. The role of NPIs on PED use appropriateness deserves investigation. The rise in pediatric mental disorders independent of the pandemic makes interventions addressing these issues urgent.

Abstract Non‐native species can affect ecosystems by influencing native predator‐prey dynamics. Therefore, management interventions designed to remove non‐natives may inadvertently lead to increased predation on native species. Feral horses are widely distributed throughout the arid parts of western North America. A growing body of research indicates that horses can be an important prey species to mountain lions in ecosystems where they overlap. In December 2020, the Bureau of Land Management removed 455 horses from the Delamar Mountains, Nevada, USA. We leveraged this management intervention to implement a before–after–control–impact study to test hypotheses about predation on horses and native ungulates. We predicted (1) that horses would comprise an important part of the diet in this mixed‐prey community, (2) following removal, the proportion of horses in the diet would decrease and native ungulates would increase, and (3) mountain lion home ranges overlapping the treatment areas would increase in response to decreased prey availability. From 2018 to 2022, we investigated 1360 clusters from 29 GPS‐collared lions and identified 1056 prey items. To model the probability of a predation event (a kill), we fit a mixed‐effects logistic regression model for ungulate prey as a function of lion sex, treatment area (in/out), and treatment period (pre‐/post‐removal). We used a log‐linear regression model to evaluate changes in home range size. The most common prey were mule deer (55%), feral horses (32%), and coyotes (4%). Twenty‐two of 29 lions consumed horses, although the rate of horse consumption was highly variable across individuals. Horses of both sexes and all age classes were predated. In contrast to predictions, our models detected no effect of removals on diet composition (βinteraction = 0.30 ± 1.1), nor did the removal influence home range size (βinteraction = 0.02 ± 0.02). Despite a 46% reduction in horse abundance, we found no evidence for prey‐switching following the horse removal treatment. Removal magnitude, rapid horse immigration, and/or behavioral specialization of individual mountain lions may help explain these results. Our findings have important implications for mountain lion and feral horse management in arid environments characterized by high prey diversity, but low prey abundance.

Dabrafenib plus trametinib is a promising new therapy for patients affected by BRAFV600E-mutant glioma, with high overall response and manageable toxicity. We described a complete and long-lasting response in a case of recurrent anaplastic pleomorphic xanthoastrocytoma CNS WHO-grade 3 BRAFV600E mutated. Due to very poor prognosis, there are a few described cases of high-grade glioma (HGG) patients treated with the combined target therapy as third-line treatment. The emergence of optimized sequencing strategies and targeted agents, including multimodal and systemic therapy with dabrafenib plus trametinib, will continue to broaden personalized therapy in HGG improving patient outcomes.