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MICE is one of the most profitable sectors of the tourism industry, with an effective impact on local economies. However, the investigation of its spatial agglomeration has not been fully explored. In this study, we use information on the venues' characteristics and territorial distribution to identify convention firms' agglomeration in Emilia-Romagna (Italy), through a constrained clustering algorithm. This approach enables the inclusion of both non-geographical aspects, measured by the Krugman sectoral index, and geographical information. Findings show the existence of developed and developing convention agglomerations, with different MICE offers. Using convention demand data, we improve the cluster's profiles and propose some managerial strategies.

Breast reconstruction is rapidly evolving, thanks to the growing acceptance of synthetic meshes as innovative biomaterials. 276 patients undergoing mastectomy (total of 328 mastectomies) were analyzed in a retrospective observational study to evaluate the pre-pectoral immediate breast reconstruction (IBR) using an implant wrapped with Titanium-Coated Polypropylene Mesh (TCPM) vs. patients treated with tissue expander (TE), equally placed pre-pectorally (and wrapped with the same TCPM in 74.3% of the control group’ breasts). 163 patients, of the study group (SG), underwent mastectomy and pre-pectoral IBR with implant wrapped with TCPM, in a one-step surgery, called direct-to-implant technique (DTI), while 113 patients control group (CG) underwent mastectomy and TE. DTI technique has been performed in 192 breasts of the SG while TE procedure in 136 breasts of the CG. The BREAST-Q questionnaire has been provided before the treatment and 2 years later. Baker scale has been used to evaluate capsular contracture. Oncologic, surgical, and aesthetic outcomes along with BREAST-Q scores were analyzed. Additionally, a histologic evaluation was conducted in 11 capsules' samples randomly chosen (6 derived from SG patients and 5 derived from CG). Complications were recorded in 43 cases (29SG-14CG): 8 skin-nipple necrosis (5SG-3CG), 8 wound dehiscence (6SG-2CG), 3 hematomas (1SG-2CG), and 24 infections (8SG-16CG). Grade IV capsular contracture was detected in 9 breasts (1SG-8CG), whereas 254 breasts were grade I (110SG-144CG), 33 (10SG-23CG) grade II, and 32 (4SG-28CG) grade III. Implant wrinkling was detected in 18 cases (10SG-8CG) after 30 months. The local tumor recurrence rate was 5.8%. Three recurrences were on the nipple-areola complex (1.9%). SG patients showed significantly higher rates in the BREAST-Q overall Satisfaction with Outcome (74.1), overall Satisfaction with Breasts (69.1), Psychosocial Well-being (81.9), and Sexual Well-being (63.1), versus CG's patients (p, Graphical abstract Image 1, Highlights • This retrospective observational study, reports the results of pre-pectoral immediate breast reconstruction (IBR) using a prosthesis wrapped with Titanium-Coated Polypropylene Mesh (TCPM) vs. patients treated with tissue expander (TE) equally placed pre-pectorally (and wrapped with the same TCPM in 74% of the control group), with the aim to reduce the risk of reconstruction failure after conservative mastectomy. • The primary end-points of the study were the clinical outcomes. These outcomes were: the incidence of perioperative and postoperative complications (safety profile), quality of life (QoL) at 2 years after surgery, measured as the change between the pre- and post-op BREAST-Q scores, the aesthetic outcomes, and the capsular contracture grade. Two methods for the clinical analysis of the results have been used: Surgical-Team and patient self-evaluation. The Surgical-team evaluation was an objective evaluation based on clinical assessment, using a scale of six degrees (excellent, good, discreet, enough, poor, inadequate). The subjective patient-based self-evaluation applied the same six degrees. Moreover, secondary end-point of the study, was a histopathological capsule assessment to evaluate the integration of the TCPM in the mastectomy flap as a bioactive material. • Histological, and bio-molecular evaluation of TCPM samples were analyzed. In particular, Hematoxylin-eosin staining of post-operative biopsies of wrapping tissue TCPM mesh was performed focusing on the collagen presence and fibroblasts amount and specifically, on the complete healing and TCPM incorporation without side effects. Additionally, the immunofluorescence using specific markers CD 45 and Collagen 1, and immunohistochemistry using CD 45 on paraffin samples were performed. The endpoint was to evaluate the grade of inflammation represented by the number of lymphocytes in the treated site, and the eventual different collagen type expression (Collagen 1 and Collagen 3) in tissues underwent and not to radiotherapy and during the use of TCPM. • Analyzing the side effects with the use of t-test, the complication rate between SG and CG did not showed statistically significant differences (p=0,8472), although it was slightly higher in the SG. Despite the study group was bigger than the control group (+42%) the side effects' number did not statistically differ, confirming the safety and reliability of the TCPM procedure during DTI. Overall Satisfaction with Breasts, Psychosocial Well-being, and Sexual Well-being scores were all significantly increased after sub-cutaneous pre-pectoral DTI immediate reconstruction with TCPM mesh (p < 0.05) compared to CG. Mean satisfaction with the overall aesthetic result was high after breast reconstruction (8.72) in patients who underwent DTI pre-pectoral immediate reconstruction (SG) after 2 years from surgery. • The histological analysis of fragments of implant's wrapping tissue incorporating TCPM mesh displayed complete incorporation of the mesh with physiological aspects of healing. The immunochemistry concluded the Collagen 1, and 3 expressions did not differ, with statistical significance, between TCPM and NO TCPM samples, showing a process of physiological healing overlapping to perfect device incorporation, confirming that TCPM was a bioactive material. Conservative mastectomies with pre-pectoral IBR assisted by TCPM are resulted oncologically safe preserving breast appearance.

Objective To perform a meta-analysis to determine the effect of loco-regional radiation therapy (RT) compared to no loco-regional RT for operated patients in clinical stage cN2 breast cancer at diagnosis and ypN0 after preoperative chemotherapy (PST). Material and Methods Eligible studies were identified through a systematic search of the medical literature performed independently by two researchers using a validated search strategy. An electronic search of Medline via PubMed and Embase (Breast cancer AND preoperative chemotherapy AND radiation therapy) was conducted with no language or publication status restrictions. The effect of loco-regional RT on overall (OS), disease free (DFS), loco-regional recurrence-free (LRRFS) survival and local recurrence was evaluated. An electronic search of Medline via PubMed and Embase (Toxicity AND radiation therapy breast cancer AND preoperative therapy; toxicity AND breast surgery AND preoperative chemotherapy) was conducted for outcomes of harm: major acute and late skin toxicity, lymphedema and cardiac events. Results Of 333 studies identified, 4 retrospective studies reporting on a total of 1107 patients were included in the meta-analysis. Six and 3 reported data of acute and late skin toxicity, while 2 studies provided information on cardiac events. Pooled results showed no difference in terms of hazard ratio for loco-regional RT versus no loco-regional RT [hazard ratio (HR) = 0.82, 95% confidence interval (CI) 0.63–1.68]. Loco-regional RT was associated with an OS benefit in the subgroup analysis: IIIB-C (loco-regional RT 79.3% vs no loco-regional RT 71.2%, p = 0.027) and T3-T4 (loco-regional RT 82.6% vs no loco-regional RT 76.6%, p = 0.025). No difference was shown in terms of 5-year DFS (loco-regional RT 91.2% vs no loco-regional RT 83%, p = 0.441) and LRRFS (loco-regional RT 98.1% vs no loco-regional RT 92.3%, p = 0.148). There was no significant difference between the groups in terms of acute and late skin toxicities, lymphedema and cardiac events. Conclusions Because of the limitations due to the small number of studies and heterogeneity in the analysis, the present study does not allow to draw any definitive conclusion, highlighting the need for well-controlled trials to determine the effect of loco-regional RT in patients with cN2 having a pathological complete response in the axillary nodes after preoperative chemotherapy., Highlights • The prognostic impact of pCR after primary systemic therapy on DFS and OS has been shown in meta-analyses of randomized phase III trials. • The association of treatment response with loco-regional recurrence has been studied only in retrospective reports. • RNI should be strongly considered in patients with clinically involved lymph nodes regardless of the response to primary systemic therapy, especially in the presence of further risk factors. • In patients with cN2 at diagnosis and ypN0 at surgery after PST, loco-regional RT should be evaluated for each patient in the multidisciplinary team.

The paper analyses how the bettering in the living standard affects Chinese households' decision-making process regarding tourism. The first novelty of this study relays on the role that living standard, proxy by happiness, Internet use and social connection spending, has on the tourism participation and how it impacts tourism expenditures. We estimate hurdle models and calculate income elasticity with respect to living condition; this is the second main novelty of this study. Empirical results show that living standard is associated with likelihood of participating in tourism and is an essential determinant for tourism consumption behaviour. Some recommendations are finally proposed.

PurposeThis paper aims to focus on the relation between digital transformation and banks’ reputation, as examined through the information disclosed by the five largest Italian banking groups’ efforts to extend and enhance their digital resources. Considering digitalization as a key strategy for managing reputation, which, in turn, can leverage financial and value performance management, the paper investigates whether and how digital activities might affect banks’ reputation. Therefore, this paper proposes the relationship between digitalization and reputation as a lever for performance management and for increasing efficiency.Design/methodology/approachThe authors use content analysis to generate a digital disclosure index, categorizing activities human, structural and relational. For banks’ reputations, the proxies are a measure of corporate reputation and a reputational risk index. Methodologically the study used multiple case studies, considered as particularly suitable to gain an in-depth understanding of the topic in the case of the five banks. A collection of secondary data and semi-structured interviews are included.FindingsOverall, the digitalization-reputation link shows that banks’ reputation is variously affected, not only by exposure to risk (including reputational risk) but also by strategic issues such as digitalization and the effectiveness of the corresponding communication. Consequently, banks should view digitalization as a key driver to be considered not in a stand-alone perspective, but in a combined approach.Research limitations/implicationsContinued research should include the Covid-19 implications. Additionally, it would be important to compare a larger number of banks, with different characteristics, also including variables indicating the corporate governance mechanisms.Practical implicationsThe analysis contributes to fostering scholars’ and practitioners’ management of the digital transformation challenge that is a current key-factor, capable of increasing banks’ value. It considers not only the drivers directly affecting monetary value but also the institutions’ social and relational value, as well as their reputation.Originality/valueThis paper extends prior research on the digitalization-reputation relation by investigating digital transformation through disclosure of activities in this area within the Italian banking sector. It allows to leverage the key-factors that can contribute to increasing banks’ value, considering not only the drivers directly affecting monetary value but also the institutions’ social and relational value, as well as their reputation.

In Parkinson’s disease (PD), physical activity may represent a possible non-pharmacological intervention not only for improving motor symptoms but also for modulating cognitive impairment. To evaluate the efficacy of an intensive physical program on cognitive functions in mid-stage PD patients with mild cognitive impairment (PD-MCI) over a 6-month follow-up. This is a 6-month randomized controlled follow-up study. 40 PD-MCI patients were randomized to receive physical therapy (PT) or no specific intervention beside drug treatment (CT). Cognitive and motor assessments were performed at baseline (T0), 4 weeks after baseline (T1) and 6 months after T0. In a previous study, we reported a significant improvement in global cognitive functioning and attention/working-memory at T1. Here, we evaluated the residual effect of the training intervention at 6 months on both cognitive and motor performances. Intra-group analysis showed that at T2 most of cognitive and motor performances remained stable in the PT when compared to T0, while a significant worsening was observed in the CT. Between-group comparison at T2 showed significantly better results in PT than CT as regards MoCA and motor scales. The percentage change of cognitive and motor performances between T1 and T2 confirmed the benefit of physical therapy on global cognitive functioning scores (MMSE and MoCA). In this follow-up extension of a longitudinal randomized controlled study, we demonstrated that physical therapy has a positive effect on cognitive functions, which extends beyond the duration of the treatment itself to, at least temporarily, reducing cognitive decline. Trial registration number (ClinicalTrials.gov): NCT04012086 (9th July 2019).

Importance: Convalescent plasma (CP) has been generally unsuccessful in preventing worsening of respiratory failure or death in hospitalized patients with COVID-19 pneumonia. Objective: To evaluate the efficacy of CP plus standard therapy (ST) vs ST alone in preventing worsening respiratory failure or death in patients with COVID-19 pneumonia. Design, setting, and participants: This prospective, open-label, randomized clinical trial enrolled (1:1 ratio) hospitalized patients with COVID-19 pneumonia to receive CP plus ST or ST alone between July 15 and December 8, 2020, at 27 clinical sites in Italy. Hospitalized adults with COVID-19 pneumonia and a partial pressure of oxygen-to-fraction of inspired oxygen (Pao2/Fio2) ratio between 350 and 200 mm Hg were eligible. Interventions: Patients in the experimental group received intravenous high-titer CP (≥1:160, by microneutralization test) plus ST. The volume of infused CP was 200 mL given from 1 to a maximum of 3 infusions. Patients in the control group received ST, represented by remdesivir, glucocorticoids, and low-molecular weight heparin, according to the Agenzia Italiana del Farmaco recommendations. Main outcomes and measures: The primary outcome was a composite of worsening respiratory failure (Pao2/Fio2 ratio

PURPOSE To report the long-term results of external-beam accelerated partial-breast irradiation (APBI) intensity-modulated radiation therapy (IMRT) Florence phase III trial comparing whole-breast irradiation (WBI) to APBI in early-stage breast cancer. PATIENTS AND METHODS The primary end point was to determine the 5-year difference in ipsilateral breast tumor recurrence (IBTR) between 30 Gy in 5 once-daily fractions (APBI arm) and 50 Gy in 25 fractions with a tumor bed boost (WBI arm) after breast-conserving surgery. RESULTS Five hundred twenty patients, more than 90% of whom had characteristics associated with low recurrence risk, were randomly assigned (WBI, n = 260; APBI, n = 260) between 2005 and 2013. Median follow-up was 10.7 years. The 10-year cumulative incidence of IBTR was 2.5% (n = 6) in the WBI and 3.7% (n = 9) in the APBI arm (hazard ratio [HR], 1.56; 95% CI, 0.55 to 4.37; P = .40). Overall survival at 10 years was 91.9% in both arms (HR, 0.95; 95% CI, 0.50 to 1.79; P = .86). Breast cancer–specific survival at 10 years was 96.7% in the WBI and 97.8% in the APBI arm (HR, 0.65; 95% CI, 0.21 to 1.99; P = .45). The APBI arm showed significantly less acute toxicity ( P = .0001) and late toxicity ( P = .0001) and improved cosmetic outcome as evaluated by both physician ( P = .0001) and patient ( P = .0001). CONCLUSION The 10-year cumulative IBTR incidence in early breast cancer treated with external APBI using IMRT technique in 5 once-daily fractions is low and not different from that after WBI. Acute and late treatment-related toxicity and cosmesis outcomes were significantly in favor of APBI.

Alzheimer’s disease (AD) and related dementia is one of the growing threats to the sustainability of health and care systems in developed countries, and efforts to find therapies have had scant success. The main reasons for this are lack of efficient therapy, which is linked to too late discovery of the disease itself. With this in mind, biomarkers are recognised as an element which can bring a major contribution to research, helping elucidate the disease and the search for treatments. They are also playing an increasing role in early detection and timely diagnosis, which are considered the principal hopes of effective management in the absence of an effective drug. The current arsenal of biomarkers could already, if more widely deployed, provide an effective minimum service to patients and health systems. A concerted action by policy makers and stakeholders could drive progress in access to AD biomarker testing to provide an optimum service in the medium term. This paper discusses how to improve the use of and access to biomarker testing in the detection and diagnosis of AD and other diseases featuring dementia, and how EU healthcare systems could benefit. It outlines the challenges, lists the achievements to date, and highlights the actions needed to allow biomarker testing to deliver more fully on their potential in AD.

The effectiveness of computer-based cognitive training (CCT) remains controversial, especially in older adults with neurodegenerative diseases. To evaluate the efficacy of CCT in patients with Parkinson’s disease and mild cognitive impairment (PD-MCI). In this randomized controlled trial, 53 patients were randomized to receive CCT delivered by means of CoRe software, traditional paper-and-pencil cognitive training (PCT), or an unstructured activity intervention (CG). In each group, the intervention lasted 3 consecutive weeks (4 individual face-to-face sessions/week). Neuropsychological assessment was administered at baseline (T0) and post-intervention (T1). Outcome measures at T0 and T1 were compared within and between groups. The Montreal Overall Cognitive Assessment (MoCA) was taken as the primary outcome measure. Unlike the PCT group and the CG, the patients receiving CCT showed significant medium/large effect size improvements in MoCA performance, global cognition, executive functions, and attention/processing speed. No baseline individual/demographic variables were associated with greater gains from the intervention, although a negative correlation with baseline MoCA performance was found. CCT proved effective in PD-MCI patients when compared with traditional PCT. Further follow-up assessments are being conducted to verify the retention of the gains and the potential ability of the tool to delay conversion to PD-dementia. Trial registration number (ClinicalTrials.gov): NCT04111640 (30th September 2019).

Background Epidemiological evidence suggests that healthy diet is associated with a slowdown of cognitive decline leading to dementia, but the underlying mechanisms are still partially unexplored. Diet is the main determinant of gut microbiota composition, which in turn impacts on brain structures and functions, however to date no studies on this topic are available. The goal of the present paper is to describe the design and methodology of the NutBrain Study aimed at investigating the association of dietary habits with cognitive function and their role in modulating the gut microbiota composition, and brain measures as well. Methods/design This is a population-based cohort study of community-dwelling adults aged 65 years or more living in Northern Milan, Italy. At the point of presentation people are screened for cognitive functions. Socio-demographic characteristics along with lifestyles and dietary habits, medical history, drugs, functional status, and anthropometric measurements are also recorded. Individuals suspected to have cognitive impairment at the screening phase undergo a clinical evaluation including a neurological examination and a Magnetic Resonance Imaging (MRI) scanning (both structural and functional). Stool and blood samples for the gut microbiota analysis and for the evaluation of putative biological markers are also collected. For each subject with a confirmed diagnosis of Mild Cognitive Impairment (MCI), two cognitively intact controls of the same sex and age are visited. We intend to enrol at least 683 individuals for the screening phase and 240 persons for the clinical assessment. Discussion The NutBrain is an innovative study that incorporates modern and advanced technologies (i.e. microbiome and neuroimaging) into traditional epidemiologic design. The study represents a unique opportunity to address key questions about the role of modifiable risk factors on cognitive impairment, with a particular focus on dietary habits and their association with gut microbiota and markers of the brain-aging process. These findings will help to encourage and plan lifestyle interventions, for both prevention and treatment, aiming at promoting healthy cognitive ageing. Trial registration Trial registration number NCT04461951, date of registration July 7, 2020 (retrospectively registered, ClinicalTrials.gov).

Network functions virtualization (NFV) attributes to the substitute of network functions on dedicated appliances such as load balancers and routers with the use of virtualized instances running as software. Any enterprise can easily implement a wide array of network functions using NFV while maximizing efficiencies and introducing new revenue-generating services that are significantly faster and easier than ever before. NFV is a key enabler of the coming 5G infrastructure, supporting the virtualization of various appliances in the network. The scope of this document is to provide a comprehensive overview of the development of NFV-based services, media services in particular, and their specific requirements that are addressed in existing service development kits (SDKs). By supplying an overview of available tools, the development workflow of an example use case on immersive media is demonstrated with an SDK that provides a set of open source tools facilitating the development of media applications.

A continuous liquid level fiber optic sensor has been devised, developed, and tested. The sensor is based on two coupled light-diffusing glass fibers. The light from a laser diode is diffused out from the first fiber by scattering and coupled, always by the scattering, to the second fiber. The working wavelength has been selected in order to be strongly absorbed by most common liquids. The optical power measured at the ends of the collection fiber depends on liquid level. Both co-propagation and counter-propagation coupling configurations have been theoretically analysed and experimentally tested. Differently from counter-propagation configuration, co-propagation configuration exhibits a linear response with the liquid level and allows level measurements with a resolution in the order of millimetres over 1 m range.

Venoarterial extracorporeal membrane oxygenation therapy (VA-ECMO) after refractory cardiogenic shock or cardiac arrest has significant morbidity and mortality. Early outcome prediction is crucial in this setting, but data on neuroprognostication are limited. We examined the prognostic value of clinical neurologic examination, using an automated device for the quantitative measurement of pupillary light reactivity.An observational cohort of sedated, mechanically ventilated VA-ECMO patients was analyzed during the early phase after ECMO insertion (first 72 h). Using the NPi-200 automated infrared pupillometer, pupillary light reactivity was assessed repeatedly (every 12 h) by calculating the Neurological Pupil index (NPi). Trends of NPi over time were correlated to 90-day mortality, and the prognostic performance of the NPi, alone and in combination with the 12-h PREDICT VA-ECMO score, was evaluated.One hundred consecutive patients were studied (51 with refractory cardiogenic shock and 49 with refractory cardiac arrest; 12-h PREDICT VA-ECMO, 40%; observed 90-day survival, 43%). Nonsurvivors (n = 57) had significantly lower NPi than did survivors at all time points (all P .01). Abnormal NPi (3, at any time from 24 to 72 h) was 100% specific for 90-day mortality, with 0% false positives. Adding the 12-h PREDICT VA-ECMO score to the NPi provided the best prognostic performance (specificity, 100% [95% CI, 92%-100%]; sensitivity, 60% [95% CI, 46%-72%]; area under the receiver operating characteristic curve, 0.82).Quantitative NPi alone had excellent ability to predict a poor outcome from day 1 after VA-ECMO insertion, with no false positives. Combining NPi and 12-h PREDICT-VA ECMO score increased the sensitivity of outcome prediction, while maintaining 100% specificity.

In A Treatise on Virtues and Rewards, Dragonetti (1769) advances a theory of action based on rewards for virtues. The idea of rewards, especially of awards, relies on the hypothesis that intrinsic motivations drive the actions of good or virtuous citizens. We apply this theory to virtuous entrepreneurs who voluntarily adopt ethical principles as promoted by a recent Italian law. These firms receive an ethical rating (ER) by the Italian Competition Authority (ICA) and can access a set of economic and non-economic benefits (i.e. rewards). We survey a sample of 152 private companies with an ER and examine their views on the economic and social motivations and benefits as well as the perceived usefulness of the ER for improving ethical behaviour. An exploratory factor analysis detects four categories of motivation (economic, competitive, social, and responsiveness) and two categories of benefits (economic and competitive), which we use in regression models to test Dragonetti’s theory. Overall, respondents see the ER as an effective tool, except in terms of improving economic performance. We also find that entrepreneurs with lower economic and higher responsiveness motivations attain higher ERs. However, in the respondents’ opinions, the ER is (still) not producing any concrete benefits since we find no relationship between the ER and economic or competitive rewards. These findings have implications for the ICA as well as for private companies.

Simple Summary The increasing number of data supporting use of a personalized approach in cancer treatment, is changing the path of patient's management. In the same time, the availability of technologies should allow patients to receive the best test for the specific individual condition. This is theoretically true, when a specific test is designed for the specific disease condition, while it is difficult to implement in the setting of agnostic therapies. Financial sources availability related to the non homogeneous health systems working in the different countries do not allow for an immediate implementation of the technologies and test commercially available. Future perspectives for targeted oncology include tumor-agnostic drugs, which target a given mutation and could be used in treating cancers from multiple organ types. Therefore, the present paper is aimed to both underline a how much important is this new view and also to sensitize the international bodies that supervise health policies at the decision-making level, with the aim of harmonizing cancer treatment pathways in at least all European countries. Rapid and continuing advances in biomarker testing are not being matched by uptake in health systems, and this is hampering both patient care and innovation. It also risks costing health systems the opportunity to make their services more efficient and, over time, more economical. The potential that genomics has brought to biomarker testing in diagnosis, prediction and research is being realised, pre-eminently in many cancers, but also in an ever-wider range of conditions-notably BRCA1/2 testing in ovarian, breast, pancreatic and prostate cancers. Nevertheless, the implementation of genetic testing in clinical routine setting is still challenging. Development is impeded by country-related heterogeneity, data deficiencies, and lack of policy alignment on standards, approval-and the role of real-world evidence in the process-and reimbursement. The acute nature of the problem is compellingly illustrated by the particular challenges facing the development and use of tumour agnostic therapies, where the gaps in preparedness for taking advantage of this innovative approach to cancer therapy are sharply exposed. Europe should already have in place a guarantee of universal access to a minimum suite of biomarker tests and should be planning for an optimum testing scenario with a wider range of biomarker tests integrated into a more sophisticated health system articulated around personalised medicine. Improving healthcare and winning advantages for Europe's industrial competitiveness and innovation require an appropriate policy framework-starting with an update to outdated recommendations. We show herein the main issues and proposals that emerged during the previous advisory boards organised by the European Alliance for Personalized Medicine which mainly focus on possible scenarios of harmonisation of both oncogenetic testing and management of cancer patients.

Transition management to tourism sustainability is fundamental for mature and mass tourism destinations. While the literature has largely focused on residents’ evaluations of tourism sustainability, little attention has been devoted to investigate tourists’ perceptions and relevance of environmental practices at the destination. This study fills this gap by analyzing tourists’ evaluations of environmental sustainability experienced during their holiday at a mass and mature tourism destination, by focusing on both tourism-based and complementary products. Mapping and cluster analysis are carried out on a sample of tourists who have chosen an Italian mass and mature tourism destination for their holidays. Findings show that sustainability is a less relevant factor and provides less satisfaction with respect to other aspects. Tourist expectations on environmental sustainability are not met; different perceptions and priorities on environmental sustainability are detected in the different tourist clusters. Managerial and policy strategies can be derived from these results.

Breast conserving surgery (BCS) plus radiation therapy (RT) or mastectomy have shown comparable oncological outcomes in early-stage breast cancer and are considered standard of care treatments. Postmastectomy radiation therapy (PMRT) targeted to both the chest wall and regional lymph nodes is recommended in high-risk patients. Oncoplastic breast conserving surgery (OBCS) represents a significant recent improvement in breast surgery. Nevertheless, it represents a challenge for radiation oncologists as it triggers different decision-making strategies related to treatment volume definition and target delineation. Hence, the choice of the best combination and timing when offering RT to breast cancer patients who underwent or are planned to undergo reconstruction procedures should be carefully evaluated and based on individual considerations. We present an Italian expert Delphi Consensus statements and critical review, led by a core group of all the professional profiles involved in the management of breast cancer patients undergoing reconstructive procedures and RT. The report was structured as to consider the main recommendations on breast reconstruction and RT and analyse the current open issues deserving investigation and consensus. We used a three key-phases and a Delphi process. The final expert panel of 40 colleagues selected key topics as identified by the core group of the project. A final consensus on 26 key statements on RT and breast reconstruction after three rounds of the Delphi voting process and harmonisation was reached. An accompanying critical review of available literature was summarized. A clear communication and cooperation between surgeon and radiation oncologist is of paramount relevance both in the setting of breast reconstruction following mastectomy when PMRT is planned and when extensive glandular rearrangements as OBCS is performed. A shared-decision making, relying on outcome-based and patient-centred considerations, is essential, while waiting for higher level-of-evidence data.

Purpose: To evaluate associations between CD4/CD8 ratio and pregnancy outcomes in women with HIV. Methods: We evaluated, in a national study of pregnant women with HIV receiving antiretroviral treatment (ART), values of CD4/CD8 ratio at entry in pregnancy, changes between first and third trimester, and possible associations with preterm delivery, low birthweight, and HIV-RNA < 50 copies/ml at third trimester in univariate and multivariate analyses. Results: Among 934 women, 536 (57.4%) were already on ART at conception. CD4/CD8 ratio (baseline value 0.570) increased significantly between the first and third trimesters, particularly in women who started ART in pregnancy (+ 0.163, vs. + 0.036 in women already on treatment). The rate of CD4/CD8 ratio normalization, defined by achieving a ratio ≥ 1 at the third trimester, was 13.2%. In multivariable analyses, women who entered pregnancy with a CD4/CD8 ratio < 0.3, compared to women with ratio ≥ 1, were almost four-times less likely to have third-trimester HIV-RNA < 50 copies/ml (AOR 0.258, 95%CI 0.111–0.601), and more than twice as likely to have preterm delivery (AOR 2.379, 95%CI 1.082–5.232). For preterm delivery, also a baseline CD4/CD8 ratio between 0.3 and 0.45 was significantly associated with an increased risk (AOR: 3.415, 95%CI 1.690–6.900). Conclusion: We described for the first time independent associations of low CD4/CD8 ratio with preterm delivery and HIV-RNA suppression.

BACKGROUND: Plantar fasciitis (PF) is a common cause of heel pain. Among the several conservative treatment options, extracorporeal shock wave therapy (ESWT) is considered the standard treatment. However, recent studies suggest that PF may be sustained by a myofascial impairment proximal to the pain area with a biomechanical disequilibrium of the entire limb and pelvis. AIM: By combining the concepts of fascial manipulation and ESWT, the purpose of this study was to evaluate the effectiveness of the ESWT on myofascial points in a sample of subjects with PF. DESIGN: Open label randomized controlled clinical trial. SETTING: Outpatient clinic. POPULATION: Patients with PF were randomly assigned to an experimental treatment group (EG), treated with focused ESWT on myofascial points, and a control group (CG), treated with the focused ESWT traditional approach on the medial calcaneal tubercle. METHODS: Every patient underwent a 3-session program and follow-up after 1 and 4 months. Outcome measures included the Foot and Ankle Outcome Score (FAOS) and the Italian Foot Functional Index (17-iFFI). RESULTS: Thirty patients were enrolled in the study. Four patients of the CG dropped out the study, therefore twenty-six patients were included in the final analysis. Improvement in 17-iFFI and FAOS scores was observed in both groups starting from the third treatment and confirmed at the 1-month and 4-month follow-ups, with earlier improvement in the score values observed in the EG. CONCLUSIONS: Treatment of the myofascial points with ESWT in subjects suffering from plantar fasciitis could be an effective treatment option. It fosters the hypothesis that a global biomechanical re-equilibrium of the body would be necessary to completely solve the pathology. CLINICAL REHABILITATION IMPACT: ESWT on myofascial points could provide an interesting alternative with better outcomes in terms of time needed for recovery compared to traditional ESWT for the conservative management of PF.

COVID-19 respiratory failure is a life-threatening condition. Oxygenation targets were evaluated in a non-ICU setting. In this retrospective, observational study, we enrolled all patients admitted to the University Hospital of Genoa, Italy, between 1 February and 31 May 2020 with an RT-PCR positive for SARS-CoV-2. PaO2, PaO2/FiO2 and SatO2% were collected and analyzed at time 0 and in case of admission, patients who required or not C-PAP (groups A and B) were categorized. Each measurement was correlated to adverse outcome. A total of 483 patients were enrolled, and 369 were admitted to hospital. Of these, 153 required C-PAP and 266 had an adverse outcome. Patients with PaO2 100 had a higher rate of adverse outcome at time 0, in groups A and B (OR 2.52, 3.45, 2.01, respectively). About the PaO2/FiO2 ratio, the OR for < 300 was 3.10 at time 0, 4.01 in group A and 4.79 in group B. Similar odds were found for < 200 in any groups and < 100 except for group B (OR 11.57). SatO2 < 94% showed OR 1.34, 3.52 and 19.12 at time 0, in groups A and B, respectively. PaO2 < 60 and >100, SatO2 < 94% and PaO2/FiO2 ratio < 300 showed at least two- to three-fold correlation to adverse outcome. This may provide simple but clear targets for clinicians facing COVID-19 respiratory failure in a non ICU-setting.

Location-based analytics will enable a plethora of new services for 5G verticals and will empower the optimized use of network resources. Such analytics build on enhanced 5G positioning obtained through new positioning signals and procedures defined within 5G standardization, together with the integration of hetero- geneous technologies for achieving sub-meter accuracy. This paper proposes an end-to-end architecture integrated within the 5G networkinfrastructure to provide location- based analytics as a service. We also present an overview of cutting-edge applications in 5G and beyond, focusing onpeople-centricandnetwork-centriclocation-based analytics.

The by-products/wastes from agro-food and in particular the fruit industry represents from one side an issue since they cannot be disposed as such for their impact on the environment but they need to be treated as a waste. However, on the other side, they are a source of bioactive healthy useful compounds which can be recovered and be the starting material for other products in the view of sustainability and a circular economy addressing the global goal of zero waste in the environment. An updated view of the state of art of the research on fruit wastes is here given under this perspective. The topic is defined as follows: (i) literature quantitative analysis of fruit waste/by-products, with particular regards to linkage with health; (ii) an updated view of conventional and innovative extraction procedures; (iii) high-value added compounds obtained from fruit waste and associated biological properties; (iv) fruit wastes presence and relevance in updated databases. Nowadays, the investigation of the main components and related bioactivities of fruit wastes is being continuously explored throughout integrated and multidisciplinary approaches towards the exploitation of emerging fields of application which may allow to create economic, environmental, and social value in the design of an eco-friendly approach of the fruit wastes., info:eu-repo/semantics/publishedVersion

Axonal injury is a key determinant of long-term outcomes after traumatic brain injury (TBI) but has been difficult to measure clinically. Fluid biomarker assays can now sensitively quantify neuronal proteins in blood. Axonal components such as neurofilament light (NfL) potentially provide a diagnostic measure of injury. In the multicenter BIO-AX-TBI study of moderate-severe TBI, we investigated relationships between fluid biomarkers, advanced neuroimaging, and clinical outcomes. Cerebral microdialysis was used to assess biomarker concentrations in brain extracellular fluid aligned with plasma measurement. An experimental injury model was used to validate biomarkers against histopathology. Plasma NfL increased after TBI, peaking at 10 days to 6 weeks but remaining abnormal at 1 year. Concentrations were around 10 times higher early after TBI than in controls (patients with extracranial injuries). NfL concentrations correlated with diffusion MRI measures of axonal injury and predicted white matter neurodegeneration. Plasma TAU predicted early gray matter atrophy. NfL was the strongest predictor of functional outcomes at 1 year. Cerebral microdialysis showed that NfL concentrations in plasma and brain extracellular fluid were highly correlated. An experimental injury model confirmed a dose-response relationship of histopathologically defined axonal injury to plasma NfL. In conclusion, plasma NfL provides a sensitive and clinically meaningful measure of axonal injury produced by TBI. This reflects the extent of underlying damage, validated using advanced MRI, cerebral microdialysis, and an experimental model. The results support the incorporation of NfL sampling subacutely after injury into clinical practice to assist with the diagnosis of axonal injury and to improve prognostication.

Introduction Clozapine (CLZ) is the gold standard drug for treatment-refractory schizophrenia (TRS). However, approximately 30% of patients partially respond to CLZ, defining this subset with super refractory schizophrenia (SRS). Alterations in enzyme activity may affect CLZ responses; the CYP3A4, CYP1A2 and CYP2C19 genes are primarily responsible for CLZ metabolism. Objective The aim of this study was to assess if CYP2C19 variants were associated with TRS or SRS. Methods CYP2C19*2 loss-of-function and CYP2C19*17 gain-of-function polymorphism genotype testing were performed in 108 individuals undergoing pharmacological treatment for TRS or SRS. DNA was extracted and polymorphisms were analyzed by polymerase chain reaction (PCR) and sequencing. Results CYP2C19*17 had positive correlations with SRS and lower Brief Psychiatric Rating Scale (BPRS) scores for TRS. In addition, CYP2C19*2 was associated with lower CLZ dosages for TRS. Conclusion These results show that CYP2C19*2 and CYP2C19*17 polymorphisms influence CLZ responses during schizophrenia treatment.

The aim of this paper is to investigate the role interlocking directorships play in the patenting activities of UK companies and provide further insights into the channels through which this relationship emerges. Our empirical analysis produces three main results: first, interlocking leads to a higher number of successful patent applications; second, interlocked firms are more likely to cite each other's patents, especially around the moment of interlocking; and, third, interlocked companies tend to increase the technological similarity of their patent portfolio in the immediate period following their first interlock. To rationalise these results, we develop a theoretical model that identifies interlocking directorships as a practice that prevents property right conflicts that often arise between firms that are technologically close to each other.

Among strategies to reduce the remaining risk of cardiovascular disease, interest has focused on using infusions of synthetic high-density lipoprotein (sHDL).New Zealand rabbits underwent a perivascular injury at both carotids and were randomly allocated into 2 protocols: (1) a single-dose study, where rabbits were treated with a single infusion of sHDL containing a trimeric form of human apoA-I (TN-sHDL, 200 mg/kg) or with Placebo; (2) a multiple-dose study, where 4 groups of rabbits were treated 5 times with Placebo or TN-sHDL at different doses (8, 40, 100 mg/kg). Plaque changes were analysed in vivo by intravascular ultrasound. Blood was drawn from rabbits for biochemical analyses and cholesterol efflux capacity evaluation.In both protocols, atheroma volume in the Placebo groups increased between the first and the second intravascular ultrasound evaluation. A stabilization or a slight regression was instead observed vs baseline in the TN-sHDL-treated groups (P0.005 vs Placebo after infusion). TN-sHDL treatment caused a sharp rise of plasma-free cholesterol levels and a significant increase of total cholesterol efflux capacity. Histologic analysis of carotid plaques showed a reduced macrophage accumulation in TN-sHDL-treated rabbits compared with Placebo (P0.05).Our results demonstrate that acute and subacute treatments with TN-sHDL are effective in stabilizing atherosclerotic plaques in a rabbit model. This effect appears to be related to a reduced intraplaque accumulation of inflammatory cells. Besides recent failures in proving its efficacy, sHDL treatment remains a fascinating therapeutic option for the reduction of cardiovascular risk.

Optical networks are evolving toward self-adaptation exploiting self-observation of network conditions (e.g., through monitoring at the physical layer). Thus, according to monitoring information, reconfiguration of network devices including switches and transponders (e.g., transmission parameters) is acted. Typically, the network is thought as centralized, where a central software defined networking (SDN) controller holds the overall view of network topology and resources and, upon connection request, it decides for routing and spectrum assignment, and, then, it configures accordingly the data plane. Similarly, the central controller receives notifications when failures occur and (re)acts by reconfiguring the data plane. However, centralized solutions can suffer from scalability and responsiveness issues, translating in delays during provisioning and recovery. In this paper, we report the demonstration in a field trial of an automatic and self-reconfigurable network. We leverage a novel control paradigm based on programmable finite state machine where each state is associated to a specific network condition and a state transition implies network reconfiguration. Thanks to this approach the central controller can instruct (pre-program) network devices making them aware of the proper reconfiguration settings associated to the network conditions. Then, the reconfiguration is triggered locally, thus increasing scalability and response speed. Two successful experiments will be shown: first, local transmission parameter adaption according to physical layer conditions; second, connection central frequency optimization mitigating filtering effects and distortions.

HDL-like particles in human cerebrospinal fluid (CSF) promote the efflux of cholesterol from astrocytes toward the neurons that rely on this supply for their functions. We evaluated whether cell cholesterol efflux capacity of CSF (CSF-CEC) is impaired in Alzheimer's disease (AD) by analyzing AD (n = 37) patients, non-AD dementia (non-AD DEM; n = 16) patients, and control subjects (n = 39). As expected, AD patients showed reduced CSF Aβ 1-42, increased total and phosphorylated tau, and a higher frequency of the apoe4 genotype. ABCA1- and ABCG1-mediated CSF-CEC was markedly reduced in AD (−73% and −33%, respectively) but not in non-AD DEM patients, in which a reduced passive diffusion CEC (−40%) was observed. Non-AD DEM patients displayed lower CSF apoE concentrations (−24%) compared with controls, while apoA-I levels were similar among groups. No differences in CSF-CEC were found by stratifying subjects for apoe4 status. ABCG1 CSF-CEC positively correlated with Aβ 1-42 (r = 0.305, P = 0.025), while ABCA1 CSF-CEC inversely correlated with total and phosphorylated tau (r = −0.348, P = 0.018 and r = −0.294, P = 0.048, respectively). The CSF-CEC impairment and the correlation with the neurobiochemical markers suggest a pathophysiological link between CSF HDL-like particle dysfunction and neurodegeneration in AD.

Background There is no successful pharmacological treatment for cognitive impairment in Parkinson's Disease, therefore treatments capable of slowing down the progression of cognitive dysfunction are needed. Objective To evaluate the effectiveness of a cognitive training, supported by the CoRe computerized tool, in patients with Parkinson's Disease Mild Cognitive Impairment. Methods This is a prospective, open-unblinded, randomized, controlled study. After baseline cognitive assessment (T0), enrolled patients were randomized to receive motor rehabilitation plus cognitive intervention (G1) or motor rehabilitation only (G2). Follow-up assessments were scheduled 4 weeks (T1) and 6 months after (T2). Global cognitive functioning scores (MOCA and MMSE) were considered as primary outcome. Outcome measures at T0, T1 and T2 were compared within- and between-groups. A percentage change score between T0 and next assessments was calculated to identify patients who improved, remain stable or worsened. Results Differently from G2, G1 showed a medium/large effect size improvement in primary (MoCA) and secondary outcome, both between T0 and T1 and T0 and T2. Moreover, within G1, most patients improved their cognitive state compared to the baseline. Conclusions Patients trained with CoRe showed a better evolution of cognitive decline, while untreated patients tended to get worse over time.

In the past, little or no attention was paid to cognitive disorders associated with depression (a condition sometimes termed pseudodementia). However, recent years have seen a growing interest in these changes, not only because of their high frequency in acute-stage depression, but also because they have been found to persist, as residual symptoms (in addition to affective and psychomotor ones), in many patients who respond well to antidepressant treatment. These cognitive symptoms seem to impact significantly not only on patients' functioning and quality of life, but also on the risk of recurrence of depression. Therefore, over the past decade, pharmacological research in this field has focused on the development of new agents able to counteract not only depressive symptoms, but also cognitive and functional ones. In this context, novel antidepressants with multimodal activity have emerged. This review considers the different issues, in terms of disease evolution, raised by the presence of cognitive disorders associated with depression and considers, particularly from the neurologist's perspective, the ways in which the clinical approach to cognitive symptoms, and their interpretation to diagnostic and therapeutic ends, have changed in recent years. Finally, after outlining the pharmacodynamics and pharmacokinetics of the first multimodal antidepressant, vortioxetine, it reports the main results obtained with the drug in depressed patients, also in consideration of the ever-increasing evidence on its different mechanisms of action in animal models.

Hormonal status and menopause affect human macrophage function and cardiometabolic risk. In polycystic ovary syndrome (PCOS) patients the cardiometabolic risk increases through mechanisms that are largely unknown. We tested the hypotheses that macrophage activation is influenced by menstrual cycle and that ovarian dysfunction in PCOS patients is associated with altered macrophage inflammatory responses and cholesterol efflux capacity of serum HDL. Blood samples were obtained in the follicular and luteal phases from cycling women (n = 10) and on a single visit from PCOS patients with ovarian dysfunction (n = 11). Monocyte-derived macrophage activation and monocyte subsets were characterized ex vivo using flow cytometry. The capacity of HDL to promote cell cholesterol efflux through the main efflux pathways, namely aqueous diffusion, ATP-binding cassette A1 and G1, was also evaluated. Hormone and metabolic profiles differed as expected in relation to menstrual cycle and ovulatory dysfunction. Overall, macrophage responses to activating stimuli in PCOS patients were blunted compared with cycling women. Macrophages in the follicular phase were endowed with enhanced responsiveness to LPS/interferon-γ compared with the luteal phase and PCOS. These changes were not related to baseline differences in monocytes. HDL cholesterol efflux capacity through multiple pathways was significantly impaired in PCOS patients compared to healthy women, at least in part independent from lower HDL-cholesterol levels. Regular menstrual cycles entailed fluctuations in macrophage activation. Such dynamic pattern was attenuated in PCOS. Along with impaired HDL function, this may contribute to the increased cardiometabolic risk associated with PCOS.

The treatment of patients with atrophic maxillary alveolar ridge who need oral rehabilitation is a common problem in Implant Dentistry. One of the techniques used is the alveolar ridge splitting technique to expand alveolar ridges with a horizontal bone decrease. The palatal approach technique is also recommended in cases with an insufficient thickness of the alveolar ridge for the placement of implants in the bone envelope. The aim of this work is to describe the splitting expansion and palatal approach technique for the treatment of atrophic maxillary ridges with a horizontal bone deficit and rehabilitation with implant placement. This technique combines the alveolar ridge splitting/expansion technique and the palatal approach technique. It allows alveolar ridge expansion using piezosurgery and immediate placement of implants without thread exposure in the palatal aspect. With one surgical time, this technique avoids the fracture of the buccal bone plate due to the expansion, eliminates the need for bone graft and donor-site morbidity, is simple and effective, and shows great esthetic results and implant success. El tratamiento de pacientes con reborde alveolar maxilar atrófico que necesitan rehabilitación oral es un problema común en Implantología. Una de las técnicas empleadas es la técnica de separación de crestas alveolares para expandir las crestas alveolares con reducción horizontal del hueso. La técnica de abordaje palatino también se recomienda en casos con un grosor insuficiente de la cresta alveolar para colocar implantes en la envoltura ósea. El objetivo de este trabajo es describir la técnica de separación y expansión y el abordaje palatino para el tratamiento de crestas maxilares atróficas con déficit óseo horizontal y rehabilitación con colocación de implantes. Esta técnica combina la técnica de separación y expansión de la cresta alveolar y la técnica de abordaje palatino. Permite la expansión del reborde alveolar con el uso de piezocirugía y colocación inmediata de implantes, sin exposición de roscas en la cara palatina. Con un tiempo quirúrgico, esta técnica evita la fractura de la placa ósea vestibular por expansión, elimina la necesidad de injerto óseo y la morbilidad del sitio donante, es simple y eficaz, y presenta excelentes resultados estéticos y éxito del implante. O tratamento de pacientes com rebordo alveolar maxilar atrófico que necessitam de reabilitação oral é um problema comum em Implantodontia. Uma das técnicas utilizadas é a técnica de separação do rebordo alveolar para a expansão das cristas alveolares com diminuição óssea horizontal. A técnica de abordagem palatina também é recomendada em casos com espessura insuficiente da crista alveolar para colocação de implantes no envelope ósseo. O objetivo deste trabalho é descrever a técnica de separação e expansão e abordagem palatina para o tratamento de cristas maxilares atróficas com déficit ósseo horizontal e reabilitação com colocação de implantes. Essa técnica combina a técnica de separação e expansão da crista alveolar e a técnica de abordagem palatina. Permite a expansão do rebordo alveolar com o uso de piezocirurgia e colocação imediata de implantes, sem exposição de roscas no aspecto palatino. Com um tempo cirúrgico, essa técnica evita a fratura da tábua óssea vestibular devido à expansão, elimina a necessidade de enxerto ósseo e morbidade do local doador, é simples e eficaz e apresenta excelentes resultados estéticos e sucesso do implante.

Background Breast augmentation-mastopexy can yield an aesthetically attractive breast, but the 1-stage procedure is prone to unsatisfactory outcomes, including poor wound healing. Objectives The authors evaluated whether postsurgical application of a polyurethane bra cup coated with oxygen-enriched olive oil (NovoX Cup; Moss SpA, Lesa, Novara, Italy) would decrease pain associated with augmentation-mastopexy and improve the quality of the surgical scar. Methods This retrospective study was conducted at a single center from January 2016 to June 2019. All patients underwent 1-stage augmentation-mastopexy with the inverted T incision. For 2 weeks postsurgically, wounds were dressed either with the oxygen-enriched olive oil bra or with Fitostimoline (Farmaceutici Damor SpA, Naples, Italy). Patients indicated their pain intensity on postoperative days 2, 3, and 10, and patients and independent observers scored scar quality on the Patient and Observer Scar Assessment Scale (POSAS) 6 and 12 months after the procedure. Results A total of 240 women (120 per study arm) completed the study. All the patients had satisfactory aesthetic results, and there were no tolerability concerns with either postoperative dressing. Compared with patients in the Fitostimoline group, patients who received the oxygen-enriched olive oil bra cup had significantly lower pain levels, and their surgical scars were given better scores on the POSAS. Conclusions The results suggest that maintenance of the surgical wound in a film of oxygen-enriched olive oil for 2 weeks is a safe, effective modality for suppressing pain and promoting healing following augmentation-mastopexy. Level of Evidence: 2

In this work, we demonstrated the possibility realize a continuous measurement of liquid level based on light diffusing fibers (LDFs). The sensor consists of two parallel LDFs coupled together. The illuminating fiber is connected to a laser diode. The light scattered into the liquid is then coupled, always by the scattering, to the detection fiber and delivered to a detector. By setting a working wavelength that is strongly absorbed by the liquid, the power coupled between the fibers depends on liquid level. The sensor is made by a polymeric beam of Polyvinyl chloride (PVC), on which two LDF (3M Fibrance) with a diffusion length of 1m have been glued side by side at a distance of 1.5mm. The fiber has a core diameter of 170 μm, a low-index polymeric cladding with a diameter of 230 μm, and loose tube PVC jacket with an outer diameter of 900 μm. As light source a 1550nm fiber coupled laser diode is used. At this wavelength, water, employed as the test liquid, exhibits a strong absorption (=1210 m-1). A high sensitivity photodetector connected to a data acquisition module (DAQ) is used for measuring the detection fiber output power at different liquid levels The optical coupling phenomena between the fibers could be modelled by coupled power equations. Co-propagation and counter-propagation coupling configurations have been analyzed and experimentally validated. The measurements results are in good agreement with the theory, and demonstrate that both configurations could be used for liquid level sensing. The counter-propagation configuration exhibits a nonlinear response as function of the liquid level, while the co-propagation coupling configuration response is linear simplifying the calibration procedure. In the co-propagation configuration, the resolution ranges from ±8mm at low liquid level up to ±2mm at high liquid level over a 1m length measurement range.

Objetivo: descrever as internacoes e os custos hospitalares por tratamento cirurgico de fratura do tornozelo unimaleolar; por tratamento cirurgico de fratura do tornozelo bimaleolar, trimaleolar, da fratura luxacao do tornozelo; e por retirada de placa e/ou parafusos, no periodo de 2014 a 2019, no municipio de Belo Horizonte, Minas Gerais. Metodos: estudo retrospectivo descritivo realizado entre 2014 a 2019 com dados epidemiologicos obtidos no banco de dados do Departamento de Informatica do Sistema Unico de Saude, oriundos do cadastro da Autorizacao de Internacao Hospitalar e dos valores, total e por servicos hospitalares, despendidos com o tratamento cirurgico de fratura do tornozelo unimaleolar; o tratamento cirurgico de fratura do tornozelo bimaleolar, trimaleolar, da fratura de luxacao do tornozelo; e o procedimento de retirada de placa e/ou parafusos. Resultados: entre 2014 e 2019 foram registrados 13.721 procedimentos cirurgicos em regiao de tornozelo, sendo gastos R$ 7.889.737,75 com as intervencoes invasivas. Conclusao: sugere-se a partir dos resultados desta pesquisa a necessidade de reforcar politicas publicas voltadas para a implementacao de acoes concretas, para a busca de melhor eficacia no processo de selecao de materiais, revisao de protocolos clinicos e cirurgicos. Palavra-chave: fraturas do tornozelo; fixacao interna de fraturas; traumatismos do tornozelo; financiamento da assistencia a saude; ortopedia. Descriptive study on health care financing for surgical treatment of ankle fractures and removal of plates / screws in Belo Horizonte, Minas Gerais, Brazil, 2014-2019 ABSTRACT Objective: to describe hospitalizations and hospital costs for surgical treatment of unimaleolar ankle fractures; by surgical treatment of bimaleolar, trimaleolar ankle fracture, ankle dislocation fracture; and by removing the plate and / or screws, from 2014 to 2019, in the city of Belo Horizonte, Minas Gerais. Methods: retrospective descriptive study carried out between 2014 and 2019 with epidemiological data obtained in the database of the Department of Informatics of the Unified Health System, from the Hospitalization Authorization record and the values, total and for hospital services, spent on treatment surgical fracture of the unimaleolar ankle; surgical treatment of bimaleolar, trimaleolar ankle fracture, ankle dislocation fracture; and the procedure for removing the plate and / or screws. Results: between 2014 and 2019, 13,721 surgical procedures were recorded in the ankle region, with R$ 7,889,737.75 being spent on invasive interventions. Conclusion: it is suggested from the results of this research the need to reinforce public policies aimed at implementing concrete actions, in order to seek better efficiency in the process of selecting materials, reviewing clinical and surgical protocols. Keywords: ankle fractures; internal fracture fixation; ankle injuries; health care financing; orthopedics.

We re-evaluated acute and early-late toxicity-related factors among pre-pectoral immediate tissue expander/implant (TE/I) breast reconstruction (BR) unselected, first-era, cases, including previous breast radiation treatment and post-mastectomy radiation therapy (PMRT). A retrospective analysis of 146 (117 therapeutic and 29 prophylactic) pre-pectoral reconstructions, between 2012 and 2016, considered patient-related (age, body mass index [BMI], smoke-history, comorbidity, BRCA mutation), and treatment-related characteristics (previous irradiation, axillary surgery, PMRT, pre- and postoperative chemotherapy, endocrine therapy, and target-therapy). Safety was evaluated as acute and early-late complications, and TE/I failures. At multivariate analysis of the 146 cases (117 patients submitted to BR) a significant factor related to acute toxicity was: BMI ≥ 25 (31.3% [≥ 25] vs 8.8% [

Background Selective pectoralis major muscle (PMM) denervation has been described in retro-pectoral reconstructions to obtain the advantages of the pre-pectoral approach. Present study compared subjective evaluations between retro-pectoral implant based breast reconstructions (IBBRs) with denervation to traditional techniques without denervation. Methods. In 2020, two 2 groups of patients submitted to retro-pectoral IBBR, minimum 12-month follow-up, were compared through BREAST-Q post-operative questionnaire. Group-1 included direct-to-implant or two2-stage tissue expanderTE cases with selective PMM denervation, while Group-2 similar procedures, in the same time span 2017-2019, without denervation. BREAST-Q was divided into five 5 independent scales and for each scale item responses were summed up and transformed into a score, ranging from 0 to 100, to analyze and compare the results. Results. 50 patients were included both in Group1 and Group-2. Group-1 patients reported significantly higher scores in “satisfaction with the reconstructed breast” scale compared to Group-2, means-medians of 56-58 and 47-50, respectively. A trend in favor of Group-1 was recorded in the scales of “psycho-social well-being”, 64-65 vs. 58-53, and “sexual well-being”, 53-47 vs. 48-47, albeit not significant. Substantial equivalence was found in “satisfaction with the result overall” and “physical well-being”. Conclusion. PMM denervation can improve cosmetic results in retro-pec IBBRs, thus leading to better QoL. Possible pain and physical discomfort weren't caused by denervation with scores similar to non-denervated controls.

Non-communicable diseases (NCDs) are non-infectious chronic pathologies [...]

Introduction Alcohol and illicit drugs impair cognitive and psychomotor skills and may thereby increase the risk of involvement in a road traffic crash and other types of injuries. However, the knowledge on the use of psychoactive substances among injured patients presenting to emergency departments in low and middle-income countries remains limited. Aims To estimate the prevalence of alcohol and illicit drug use among patients with traumatic injuries admitted to an emergency department in Sao Paulo, Brazil. Methods Blood samples from injured patients requiring hospitalization for more than 24 hours due to road traffic crashes, falls, or violence, were collected from July 2018 to June 2019. The samples were analyzed for alcohol and illicit drugs. Results A total of 376 patients were included in this study; the median age was 36 years and 80% of patients were male. The majority (56%) of injuries resulted from road traffic crashes, with approximately half of them being motorcyclists. Alcohol, drugs, or both were detected in 32% of samples. The proportion that tested positive was highest for males (35%), for the age group 18-39 years (41%), for singles (43%), and for patients injured at night-time (44%). Patients injured due to violence had the highest prevalence of alcohol or drugs in their blood samples (44%). Alcohol was most prevalent (23%), followed by cocaine (12%) and cannabis (5%). Conclusion The use of alcohol and illicit drugs was common among injured patients in Sao Paulo; it was likely a contributing factor in a third of the injurious accidents. Alcohol was the most prevalent substance followed by cocaine and cannabis.

Background/objectives: The aim of the present study was to validate a short questionnaire on habitual dietary salt intake, to quickly and easily identify individuals whose salt consumption exceeds recommended levels. Subjects/methods: A total of 1131 hypertensive subjects participating in the MINISAL-SIIA study were included in the analysis. Anthropometric indexes, blood pressure, and 24-h urinary sodium excretion (NaU) were measured. A fixed-sequence questionnaire on dietary salt intake was administered. Results: NaU was significantly associated with scores, with a linear association across categories (p for trend 85 mmol/day) and “very high NaU” (NaU > 170 mmol/day) was 86 and 35%, respectively. The score of the questionnaire had a significant ability to detect both “high NaU”—with a specificity of 95% at the score of 10 points—and “very high NaU”—with a specificity of 99.6% at score of 13 points. Conclusions: The main results of the study indicates that a higher score of this short questionnaire is distinctive of habitual high salt consumption in hypertensive patients.

Background Atazanavir and darunavir represent the main HIV PIs recommended in pregnancy, but comparative data in pregnant women are limited. We assessed the safety and activity profile of these two drugs in pregnancy using data from a national observational study. Methods Women with atazanavir or darunavir exposure in pregnancy were evaluated for laboratory measures and main pregnancy outcomes (e.g. preterm delivery, low birthweight, non-elective caesarean section and neonatal gestational age-adjusted birthweight Z-score). Results Final analysis included 500 pregnancies with either atazanavir (n = 409) or darunavir (n = 91) exposure. No differences in pregnancy outcomes, weight gain in pregnancy, drug discontinuations, undetectable HIV-RNA, haemoglobin, ALT, total cholesterol, HDL cholesterol and LDL cholesterol were observed between the two groups. At third trimester, exposure to darunavir was associated with higher levels of plasma triglycerides (median 235.5 versus 179 mg/dL; P = 0.032) and a higher total cholesterol/HDL cholesterol ratio (median 4.03 versus 3.27; P = 0.028) and exposure to atazanavir was associated with higher levels of plasma bilirubin (1.54 versus 0.32 mg/dL; P

Purpose The purpose of this study is to analyse the impact of two different financial reporting models (revenue-expense vs asset-liability) on several earnings attributes. Design/methodology/approach The analysis compares the earnings attributes of non-financial private firms using the Italian generally accepted accounting principles (Italian GAAP, based on a revenue-expense model) with those of the Italian non-financial private firms voluntarily adopting the international financial reporting standards (IFRS, based on the asset-liability model). To address major methodological concerns, the research design is based on a single-country analysis and on three different samples as follows: firms voluntarily adopting IFRS; a matched sample of Italian GAAP firms; Italian GAAP firms belonging to the Elite programme, and therefore, comparable to the IFRS adopters in terms of incentives towards financial reporting transparency. Findings The results show that firms reporting under a revenue-expense model are characterized by a stronger revenue-expense matching degree, along with higher earnings’ persistence, earnings’ predictability and conditional conservatism than firms adopting an asset-liability model. In addition, contrary to the expectations, Italian GAAP firms do not present smoother earnings and do not report greater abnormal accruals than IFRS adopters do. Overall, the findings suggest that the switch from a revenue-expense model to an asset-liability model negatively affects several earnings attributes of non-financial private companies, shedding new light on the drawbacks associated with the adoption of the IFRS accounting model. Originality/value This study addresses a theme characterized by sparse research efforts, adding new insights to the debate on the decline in the quality of earnings and on the drawbacks associated with the adoption of the IFRS accounting model.

Prostate Cancer Diagnosis and Treatment Enhancement Through the Power of Big Data in Europe (PIONEER) is a European network of excellence for big data in prostate cancer, consisting of 32 private and public stakeholders from 9 countries across Europe. Launched by the Innovative Medicines Initiative 2 and part of the Big Data for Better Outcomes Programme (BD4BO), the overarching goal of PIONEER is to provide high-quality evidence on prostate cancer management by unlocking the potential of big data. The project has identified critical evidence gaps in prostate cancer care, via a detailed prioritization exercise including all key stakeholders. By standardizing and integrating existing high-quality and multidisciplinary data sources from patients with prostate cancer across different stages of the disease, the resulting big data will be assembled into a single innovative data platform for research. Based on a unique set of methodologies, PIONEER aims to advance the field of prostate cancer care with a particular focus on improving prostate-cancer-related outcomes, health system efficiency by streamlining patient management, and the quality of health and social care delivered to all men with prostate cancer and their families worldwide.Prostate Cancer Diagnosis and Treatment Enhancement Through the Power of Big Data in Europe (PIONEER) is a European network of excellence for big data in prostate cancer, consisting of 32 private and public stakeholders from 9 countries across Europe. In this Perspectives article, the authors introduce the PIONEER project and describe its aims and plans for ultimately improving prostate cancer care through the use of big data.

A key strategy for supporting destination competitiveness is to enhance endogenous amenities, and tourists are the best candidate to evaluate them at the destination. The analysis in this paper uses a comprehensive data set on foreign travellers to investigate their happiness at Italian destinations between 2005 and 2014. Using a theory-dependent approach to model happiness at the destination with respect to endogenous and exogenous amenities, personal characteristics and trip features, a great diversity in the mix of amenities affecting tourist happiness is shown. However, some clear spatial patterns emerge. The findings call for place-based policies targeted at the specific needs of each area.

Rapid and continuing advances in biomarker testing are not being matched by take-up in health systems, and this is hampering both patient care and innovation. It also risks costing health systems the opportunity to make their services more efficient and, over time, more economical. This paper sets out the potential of biomarker testing, the unfolding precision and range of possible diagnosis and prediction, and the many obstacles to adoption. It offers case studies of biomarker testing in breast, ovarian, prostate, lung, thyroid and colon cancers, and derives specific lessons as to the potential and actual use of each of them. It also draws lessons about how to improve access and alignment, and to remedy the data deficiencies that impede development. And it suggests solutions to outstanding issues - notably including funding and the tangled web of obtaining reimbursement or equivalent coverage that Europe's fragmented health system implies. It urges a European evolution towards an initial minimum testing scenario, which would guarantee universal access to a suite of biomarker tests for the currently most common conditions, and, further into the future, to an optimum testing scenario in which a much wider range of biomarker tests would be introduced and become part of a more sophisticated health system articulated around personalised medicine. For exploiting genomics to the full, it argues the need for a new policy framework for Europe. Biomarker testing is not an issue that can be treated in isolation, since the purpose of testing is to improve health. Its use is therefore always closely linked to specific health challenges and needs to be viewed in the broader policy context in the EU and more widely. The paper is the result of extensive engagement with experts and decision makers to develop the framework, and consequently represents a wide consensus of views on how healthcare systems should respond from push and pull factors at local, national and cross-border and EU level. It contains strong views and clear recommendations springing from the convictions of patients, clinicians, academics, medicines authorities, HTA bodies, payers, the diagnostic, pharmaceutical and ICT industries, and national policy makers. ispartof: Biomed Hub vol:5 issue:3 pages:182-223 ispartof: location:Switzerland status: Published online