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Chiara Bernuzzi,1 Maria Adele Piccardo,1 Marta Marsilio,2 Valeria Calcaterra,3,4 Gianvincenzo Zuccotti,2,3 Chiara Guglielmetti1 1Department of Economics, Management and Quantitative Methods (DEMM), University of Milan, Milan, 20122, Italy; 2Department of Biomedical and Clinical Science, University of Milan, Milan, 20157, Italy; 3Pediatric Department, Buzzi Children’s Hospital, Milan, 20154, Italy; 4Department of Internal Medicine, University of Pavia, Pavia, 27100, ItalyCorrespondence: Chiara Bernuzzi, Department of Economics, Management and Quantitative Methods (DEMM), University of Milan, via Conservatorio, 7, Milan, 20122, Italy, Email chiara.bernuzzi@unimi.itPurpose: The widespread adoption of telemedicine tools poses new and little-known challenges for healthcare professionals, who are required to adapt their knowledge, skills, and work practices to this innovative scenario. Understanding healthcare professionals’ expectations and concerns about adopting telemedicine can facilitate its effective integration. Therefore, drawing upon the Value Co-Creation in Healthcare model, the current study aims to investigate pediatricians’ expectations regarding antecedents, outcomes, and management activities relevant to the implementation of a telehomecare service.Methods: Interviews invitations were sent to all pediatricians (n=13) involved in a pilot study using the TytoCare device, a telehomecare tool that enables remote medical examinations, at an Italian pediatric hospital. All invited pediatricians agreed to participate. The semi-structured interviews, each lasting approximately 30 to 45 minutes, were conducted remotely via Microsoft Teams prior to the use of the TytoCare device. All interviews were recorded and transcribed verbatim. The content was subsequently analyzed through thematic analysis using MAXQDA software.Results: Five overarching thematic areas emerged from the interviews: factors influencing the adoption of the telehomecare device, advantages of its use, impacts on work practices, changes in the patient-professional relationship, and management activities. While concerns exist about the adequacy of telehomecare compared to in-person visits, the device offers potential benefits, such as improving the hospital experience for children by shortening hospital stays. However, it may lead to an increased workload and necessitate stronger trust and communication in remote care. Successful integration requires dedicated support staff, regulatory adjustments, and effective leadership, with active involvement of healthcare professionals in decision-making.Conclusion: By shedding light on healthcare professionals’ expectations about telehomecare device, this study provides useful insights to healthcare leaders to tailor interventions to accompany technology within care practices to valorize its benefits and promote value co-creation processes.Keywords: telehomecare, expectations about telemedicine, pediatricians, healthcare professionals, co-creation of value, qualitative

This paper explores how the concept of plurilingualism is positioned to act as an impetus for linguistic and cultural inclusion in human-rights-based language education. Drawing on frameworks foregrounding descriptors for plurilingualism and democratic citizenship, the paper employs discourse analysis and sorting techniques to identify and align strategies of linguistic and cultural inclusion found in multimodal plurilingual task artefacts collected from a multi-year, multi-site research partnership between a Canadian university and the Italian Ministry of Education. The findings reveal that the implementation of plurilingual tasks aligns with key elements of democratic, rights-based language education, including critical understanding of communication, openness to cultural otherness, cooperation skills, and the valuing of cultural diversity. The findings of this paper contribute to further understanding of the concept of plurilingualism and to empirically informed perspectives on pedagogies that support language rights as human rights in education.

To better understand the factors facilitating or impeding the translation of "promising controversies" (Taylor & Snoddon, 2013, p. 439) of plurilingualism theory into meaningful practices, this article presents a synthesis of 30 empirical studies on plurilingual pedagogy as enacted and experienced by educators and learners in various global K-12 and postsecondary contexts. Informed by plurilingualism (Coste et al., 1997/2009; Council of Europe, 2020), this synthesis forefronts the key contributions of plurilingual pedagogy as it fosters: (a) students' development of plurilingual (and pluri-/intercultural) competence, (b) evolution of language beliefs towards a positive orientation to plurality and hybridity, (c) affirmation of student and teacher identity and promotion of agency, and (d) language and literacy development. The perceived challenges, however, are related to the nature and practical issues of designing and implementing plurilingual pedagogy in the classroom which are interconnected with institutional policies and ideological discourses. The results illuminate the up-to-date progress as well as hurdles of promoting plurilingual pedagogies across different contexts and provide important implications for multiple stakeholders involved in pre-service teacher education, in-service professional development, curriculum improvement, and language policy making in Canada and other multicultural and multilingual societies and communities.

BackgroundCardiac neuroendocrine tumour metastases (CNTM) are rare, but advancements in molecular imaging including somatostatin receptor PET/CT (SSTR-PET/CT) could lead to a more frequent identification. The aim of this article is to perform a systematic review and meta-analysis on the detection of CNTM by SSTR-PET/CT.MethodsA comprehensive literature search of studies on CNTM detected by SSTR-PET/CT was carried out. Three different bibliographic databases were screened (Cochrane library, PubMed/MEDLINE, EMBASE) until 20 August 2024. Two review authors independently selected the eligible original articles and performed the quality assessment and the data extraction. Main findings of eligible studies were summarized and a proportion meta-analysis on the prevalence of patients with CNTM among those with neuroendocrine neoplasm (NEN) performing SSTR-PET/CT was carried out using a random-effects model.ResultsTen articles reporting data on 163 patients with CNTM were included in the systematic review. SSTR was able to detect CNTM earlier compared to other radiological imaging techniques. Most patients with CNTM had other metastatic sites and CNTM were often asymptomatic. The meta-analysis of seven articles demonstrated a pooled prevalence of 1.5% (95% confidence interval: 1.0–1.9%) of patients with CNTM (n = 119) among those performing SSTR-PET/CT for NEN (n = 9,300). Moderate statistical heterogeneity was found (I2 test: 62%).ConclusionEvidence-based data demonstrate that SSTR-PET/CT enables early and better detection of CNTM compared to other radiological imaging methods. CNTM are encountered with a pooled prevalence of 1.5% of NEN patients performing SSTR-PET/CT. Prospective and multicentric studies are warranted to better clarify the impact of CNTM detection by SSTR-PET/CT on overall survival and clinical decision-making in NEN patients.

Abstract High-quality optical ring resonators can confine light in a small volume and store it for millions of roundtrips. They have enabled the dramatic size reduction from laboratory scale to chip level of optical filters, modulators, frequency converters, and frequency comb generators in the visible and the near-infrared. The mid-infrared spectral region (3−12 μm), as important as it is for molecular gas sensing and spectroscopy, lags behind in development of integrated photonic components. Here we demonstrate the integration of mid-infrared ring resonators and directional couplers, incorporating a quantum cascade active region in the waveguide core. It enables electrical control of the resonant frequency, its quality factor, the coupling regime and the coupling coefficient. We show that one device, depending on its operating point, can act as a tunable filter, a nonlinear frequency converter, or a frequency comb generator. These concepts extend to the integration of multiple active resonators and waveguides in arbitrary configurations, thus allowing the implementation of purpose-specific mid-infrared active photonic integrated circuits for spectroscopy, communication, and microwave generation.

This paper presents a methodology for directly aligning 'can do' frameworks to each other. The methodology, inspired by the manual for relating examinations to the "Common European Framework of Reference for Languages: Learning, teaching, assessment" (CEFR) (Council of Europe, 2009) and Kane's (2004, 2013) interpretative argument, takes account of both the horizontal dimension (content analysis) and the vertical dimension (benchmarking with Multifaceted Rasch Modelling -- MFRM). The paper exemplifies the application of the methodology by introducing the research conducted to align the "Canadian Language Benchmarks" (CLB)/"Niveaux de compétence linguistique canadiens" (NCLC) to the CEFR, presenting the resulting alignment, and discussing the rationale for the choices made.

BackgroundSeveral recent studies have proposed the possible application of positron emission tomography/computed tomography (PET/CT) administering radiolabelled fibroblast-activation protein (FAP) inhibitors for various forms of thyroid cancer (TC), including differentiated TC (DTC), and medullary TC (MTC).MethodsThe authors conducted an extensive literature search of original studies examining the effectiveness of FAP-guided PET/CT in patients with TC. The papers included were original publications exploring the use of FAP-targeted molecular imaging in restaging metastatic DTC and MTC patients.ResultsA total of 6 studies concerning the diagnostic yield of FAP-targeted PET/CT in TC (274 patients, of which 247 DTC and 27 MTC) were included in this systematic review. The included articles reported high values of FAP-targeted PET/CT detection rates in TC, ranging from 81 to 100% in different anatomical sites and overall superior to the comparative imaging method.ConclusionAlthough there are promising results, the existing literature on the diagnostic accuracy of FAP-guided PET in this context is still quite limited. To thoroughly evaluate its potential significance in TC patients, it is needed to conduct prospective randomized multicentric trials.

Abstract Background Periodontal disease and its bacteria can be responsible for pregnancy complications and transmission of periodontal bacteria from mother to newborn. Methods A salivary swab to 60 healthy, full-term newborns and their mothers was taken immediately after birth. The test was performed with Real Time PCR method to evaluate the expression of the gene through DNA amplification. The species considered were: Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia and Fusobacterium nucleatum ssp. Results The newborn oral microbiome was composed primarily by saprophytes (98.38 + 4.88%), just like the mothers (98.8 + 3.69%). There was a statistically significant difference of the total microbiological density in newborns and mothers (p = 0.0001). Maternal and neonatal oral microbiome had a correlated total microbiological density only in 33.3% (N = 20/60) of cases. The analysis of the oral microbiome showed a pathological composition only in 12/60 babies (20%). The most frequent detected specie in newborns was Fusobacterium nucleatum (9/12 babies, 75%), as well as for the mothers (53.3%). However, the pathogen was present both in baby and his mother only in 3 dyads. Porphyromonas gingivalis showed the highest association mother-baby (4/12 dyads, 33%). Porphyromonas gingivalis was the pathogen with the highest bacterial load in the 12 mothers. We found a statistically significant difference in the total load of Porphyromonas gingivalis in mothers and babies (p = 0.02). Conclusions There was a statistically significant difference in the richness of the microbiome from newborns and mothers. Even comparing the microbiological density in the oral cavity of the individual mother-child pairs, we did not find a significant concordance. These results seem to suggest a low influence of maternal oral microbiome on the richness of the oral neonatal one. We didn’t find mother-child concordance (p = 0.0001) in the presence of pathogenic periodontal micro-organisms. Fusobacterium nucleatum was the most frequent specie detected. Porphyromonas gingivalis instead was the bacteria with the higher possibility of transmission. In conclusion in our study maternal oral health doesn’t affect healthy, full-term newborns’ oral microbiome. Further studies are needed to understand the maternal influence on newborn’s oral microbiome and its effects on babies long-term health.

In the last few years, blockchain has emerged as a cutting-edge technology whose main advantages are transparency, traceability, immutability, enhanced efficiency, and trust, thanks to its decentralized nature. Although many people still identify blockchain with cryptocurrencies and the financial sector, it has many prospective applications beyond digital currency that can serve as use cases for which traditional infrastructures have become obsolete. Governments have started exploring its potential application to public services provision, as confirmed by the increasing number of adoption initiatives, projects, and tests. As the current public administration is often perceived as slow, bureaucratic, lacking transparency, and failing to involve citizens in decision-making processes, blockchain can establish itself as a tool that enables a process of disintermediation, which can revolutionize the way in which public services are managed and provided. In this paper, we will provide a survey of the main application areas which are likely to benefit from blockchain implementation, together with examples of practical implementations carried out by both state and local governments. Later, we will discuss the main challenges that may prevent its widespread adoption, such as government expenditure, technological maturity, and lack of public awareness. Finally, we will wrap up by providing indications on future areas of research for blockchain-based technologies.

Pronunciation is a common topic of interest in ELT but teachers may be unsure of what features of pronunciation to prioritise, especially in multilingual classes. While research calls for explicit pronunciation instruction that focuses on improving intelligibility and comprehensibility, implementation is still a challenge. This article presents pedagogical applications following the new CEFR descriptors for phonological control. We discuss a 40-hour pronunciation course for international ESL students from diverse L1s in a Canadian university. Pronunciation instruction was delivered through controlled speech practice and drama tasks for practice of extemporaneous speech. Students completed weekly audio recordings, received extensive feedback and completed self-reflections. Moreover, the teacher assessed pre- and post-course recordings to identify change over time. Results show that students developed awareness of pronunciation features that can contribute to more intelligible and comprehensible speech and that a listener's lack of familiarity with speech diversity can play a role in how speech is perceived.

Change and innovation in education require carefully thought-through procedures as well as time, and benefit both from exchanges of expertise between contexts and from quality assurance (QA) processes. A key document that stimulates change in planning, teaching, and assessment is the Council of Europe's (2001) Common European Framework of Reference for Languages (CEFR). However, its innovation potential in language education has been affected by a lack of impact studies and QA procedures. This article reports on the QualiCEFR study, which aims to encourage a culture of QA in relation to planning, teaching, and assessment and to identify promising practices in those processes. The study compared CEFR implementation in Switzerland and Canada employing a mixed-methods design and a QA approach, thematically analyzing data from over 40 interviews. Results have helped to inform the development of an online tool produced in a sister project of the European Centre for Modern Languages (ECML).

The increasing availability of remotely sensed data have offered unprecedented possibilities for monitoring and analysis of environmental variables, including boosting recent studies in the field of ecosystem resilience relying on indicators derived from timeseries analysis, such as the temporal autocorrelation of vegetation indices. A forest ecosystem with decreased resilience will be more susceptible to external drivers and their change and could shift into an alternative system configuration by crossing a tipping point. Nevertheless, remote sensing data quantifying vegetation and forests properties inherently carry information related to the climate as well, which has to be accounted for before performing any modelling exercise. In this paper, we aim to present the general workflow and the challenges encountered in processing and analysing the historical, high-frequency and high-resolution timeseries of vegetation and climatic data. The final aim is training a machine learning model (Random Forest) in order to model and explore the performance and importance of a set of climatic and environmental metrics in predicting an indicator of the resilience of forests. In this case, the resilience of forests is quantified through the temporal autocorrelation (TAC) of the kernel NDVI (kNDVI). Climatic and environmental predictors include 2-meter air temperature, total precipitation, vapour pressure deficit, surface solar radiation, forest cover and soil organic carbon content. Results show a good performance of the Random Forest model and the ranking in the importance of the predicting variables captured in terms of background climate and climate variability. This application allows to separate and identify the main drivers of the temporal autocorrelation of kNDVI.

The effective management of marine ecosystems in the face of growing anthropogenic pressures requires the integration of data from different ecological components. Holistic approaches to evaluate the ecological status of marine ecosystems are still scarce, likely due to the challenge of integrating the complex information from a variety of indicators. In this study, we provided an application of a quantitative Weight-Of-Evidence (WOE) model based on the Sediqualsoft® software, combining environmental and biological data to assess ecological risk in soft-bottom habitats within Natura sites 2000 in the Northern Adriatic Sea (Mediterranean Sea). Here, the WOE approach combined three lines of evidence (LOE): chemical characterization (LOE1), ecotoxicological properties (LOE4), and benthic community status (LOE5). A separate hazard quotient was derived for each LOE prior to a weighted integration into a synthetic WOE assessment. The chemical analysis of the sediments revealed concentrations of pollutants far lower the reference limits, except for As and Hg and for polycyclic aromatic hydrocarbons which determined a ‘Slight’ to ‘Severe’ chemical hazard in coastal sites. Ecotoxicological hazard was rated as ‘Absent’ at all sampling stations, and the analysis of benthic communities indicated ‘undisturbed’ conditions for most sites. The WOE approach classified the overall ecological risk to be ‘Absent’ for offshore sites and ‘Slight’ in nearshore sites. Although results suggested a general low ecological risk, the potential for future risks is recognized, especially in coastal areas, due to well-known sediment pollution in the region. The application of the WOE approach may represent a valuable tool for managing marine protected sites, and to characterize the overall ecological status of these areas and improve conservation strategies in highly anthropized environmental contexts.

ObjectiveCalcitonin (Ctn) measurement is crucial for the early diagnosis of medullary thyroid carcinoma (MTC). However, Ctn levels can be skewed/elevated due to other reasons, and the Ctn upper reference value remains controversial. In this field, studies have heterogeneous settings, published data are controversial, and no evidence has been achieved. The study’s aim was to evaluate all previously investigated Ctn determinants in a population with histological exclusion of MTC.MethodsThe institutional records from 2010 to 2022 were reviewed to select patients with thyroid nodules who had undergone total thyroidectomy with histological exclusion of MTC and who had tested for Ctn just before surgery. Thyroid features, demographic and anthropometric data, comorbidities, medications, and lifestyle information were collected. Univariate and multivariate analyses were performed.ResultsA total of 127 cases were included. The median age for thyroidectomy was 51 years. Median Ctn was 1.04 pg/mL (interquartile range (IQR) 1.04–2.77), with two cases having values above 10 pg/mL. In univariate analysis, Ctn was correlated with gender (p < 0.001), body weight (p = 0.016), height (p = 0.031), body surface area (p = 0.016), thyroid size (p = 0.03), thyroglobulin (p < 0.001), and chronic kidney disease (p < 0.001). After multivariate analysis, the model with the highest accuracy included gender, chronic kidney disease, and thyroid-stimulating hormone (TSH) with an adjusted R-squared of 0.4.ConclusionsThis study demonstrates, in a population histologically proven as MTC-free, that the Ctn value is mainly influenced by gender, anthropometric/thyroid features, and chronic kidney disease, with the further impact of TSH.

Abstract The population experiencing high temperatures in cities is rising due to anthropogenic climate change, settlement expansion, and population growth. Yet, efficient tools to evaluate potential intervention strategies to reduce population exposure to Land Surface Temperature (LST) extremes are still lacking. Here, we implement a spatial regression model based on remote sensing data that is able to assess the population exposure to LST extremes in urban environments across 200 cities based on surface properties like vegetation cover and distance to water bodies. We define exposure as the number of days per year where LST exceeds a given threshold multiplied by the total urban population exposed, in person ⋅ day. Our findings reveal that urban vegetation plays a considerable role in decreasing the exposure of the urban population to LST extremes. We show that targeting high-exposure areas reduces vegetation needed for the same decrease in exposure compared to uniform treatment.

Cushing’s syndrome due to ectopic adrenocorticotropic hormone (ACTH) secretion (EAS) by a pheochromocytoma is a challenging condition. A woman with hypertension and an anamnestic report of a ‘non-secreting’ left adrenal mass developed uncontrolled blood pressure (BP), hyperglycaemia and severe hypokalaemia. ACTH-dependent severe hypercortisolism was ascertained in the absence of Cushingoid features, and a psycho-organic syndrome developed. Brain imaging revealed a splenial lesion of the corpus callosum and a pituitary microadenoma. The adrenal mass displayed high uptake on both 18F-FDG PET/CT and 68Ga-DOTATOC PET/CT; urinary metanephrine levels were greatly increased. The combination of antihypertensive drugs, high-dose potassium infusion, insulin and steroidogenesis inhibitor normalized BP, metabolic parameters and cortisol levels; laparoscopic left adrenalectomy under intravenous hydrocortisone infusion was performed. On combined histology and immunohistochemistry, an ACTH-secreting pheochromocytoma was diagnosed. The patient's clinical condition improved and remission of both hypercortisolism and catecholamine hypersecretion ensued. Brain magnetic resonance imaging showed a reduction of the splenial lesion. Off-therapy BP and metabolic parameters remained normal. The patient was discharged on cortisone replacement therapy for post-surgical hypocortisolism. EAS due to pheochromocytoma displays multifaceted clinical features and requires prompt diagnosis and multidisciplinary management in order to overcome the related severe clinical derangements.

Purpose: Doctoral candidates possess specialized knowledge that could support sustainability transitions. Doctoral education, however, often focusses on discipline-specific topics and working methods, making it difficult to "see the bigger picture". This summer school on wood construction gathered doctoral candidates from different fields to explore how solutions to complex sustainability issues could be found by working together across disciplines and by engaging multiple stakeholders. The purpose of this study is to report the pedagogical approaches taken and to understand whether these fostered the candidates' ability to develop systemic solutions and professional competency. Design/methodology/approach: Twenty doctoral candidates from various backgrounds participated in a two-week summer school organized by a consortium of four universities. Interdisciplinary groups worked on real-life challenges using a systemic approach to co-create tangible solutions. To support the creation of socio-technical innovations, stakeholders and experts from different fields were involved. The participants completed two questionnaires during the summer school to help elucidate their learning experiences. Findings: The doctoral candidates showed strong willingness to cooperate across disciplines, though they found it important to connect this learning experience to their research. The candidates reported that the experience enhanced their ability to work in a multidisciplinary capacity. The experience identified a solid basis for interdisciplinary learning principles that could be replicated. Originality/value: The summer school focussed on an innovative learning experience based on a systems thinking approach and the development of interdisciplinary capacity in the research-business ecosystem.

Background: Although differentiated thyroid carcinoma (DTC) is the most freq uent endocrine pediatric cancer, it is rare in childhood and adolescence. While tumor persistence and recurrence are not uncommon, mortality remains extremely low. Complications of treatment are however reported in up to 48% of the survivors. Due to the rarity of the disease, current treatment guidelines are predominantly based on the results of small observational retrospective studies and extrapolations from results in adult patients. In order to develop more personalized treatment and follow-up strategies (aiming to reduce complication rates), there is an unmet need for uniform international prospective data collection and clinical trials. Methods and analysis: The European pediatric thyroid carcinoma registry aims to collect clinical data for all patients ≤18 years of age with a confirmed diagnosis of DTC who have been diagnosed, assessed, or treated at a participating site. This registry will be a component of the wider European Registries for Rare Endocrine Conditions project which has close links to Endo-ERN, the European Reference Network for Rare Endocrine Conditions. A multidisciplinary expert working group was formed to develop a minimal dataset comprising information regarding demographic data, diagnosis, treatment, and outcome. We constructed an umbrella-type registry, with a detailed basic dataset. In the future, this may provide the opportunity for research teams to integrate clinical research questions. Ethics and dissemination: Written informed consent will be obtained from all participants and/or their parents/guardians. Summaries and descriptive analyses of the registry will be disseminated via conference presentations and peer-reviewed publications.

Resonators are key components in optics. In this work, the authors introduce a class of optical resonators with distinctly different properties from conventional resonators, allowing fundamental design trade-offs to be circumvented.

At present, no European recommendations for the management of pediatric thyroid nodules and differentiated thyroid carcinoma (DTC) exist. Differe nces in clinical, molecular, and pathological characteristics between pediatric and adult DTC emphasize the need for specific recommendations for the pediatric populati on. An expert panel was instituted by the executive committee of the European Thyroid Association including an international community of experts from a variety of disciplines including pediatric and adult endocrinology, pathology, endocrine surgery, nuclear medicine, clinical genetics, and oncology. The 2015 American Thyroid Association Pediatric Guideline was used as framework for the present guideline. Areas of discordance were identified, and clinical questions were formulated. The expert panel members discussed the evidence and formulated recommendations based on the latest evidence and expert opinion. Children with a thyroid nodule or DTC require expert care in an experienced center. The present guideline provides guidance for healthcare professionals to make well-considered decisions together with patients and parents regarding diagnosis, treatment, and follow-up of pediatric thyroid nodules and DTC.