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Introduction. Viral infections during pregnancy have always been considered to cause complications and adverse events and birth defects during pregnancy. In particular, we do not have any therapeutic or preventive tools aimed at protecting the mother and fetus during the gestational period during pandemics. Methods. The studies were identified by using the PubMed database published until 30 April 2021. The search was performed by using the following keywords: viral infection, SARS-CoV-2, COVID-19, vaccine, pregnancy, gestational period, pandemics, vaccination, complication, adverse events, drugs. Results. It has been reported that viral infections are considered to cause complications and adverse events during pregnancy. In this regard, pregnancy is associated with higher mortality rates and complications during viral infections. In fact, maternal immunization represents a unique approach to protect newborns from several infectious diseases. Conclusion. European Board and College of Obstetrics and Gynecology (EBCOG) and International public health institutions (WHO, CDC) report the recommendations about the use of vaccines during pregnancy.

The present study aimed to investigate the relationship between students’ academic motivation, implicit beliefs about intelligence and learning strategies among undergraduate healthcare students. First-year students of healthcare degree courses from a university in Southern Italy were surveyed. The study measured psychological constructs by means of Academic Motivation Scale, Motivated Strategies for Learning Questionnaire, and Dweck’s implicit questions about beliefs of intelligence. Two regression models were computed to assess the association between students’ beliefs about intelligence, motivations for studying, and learning strategies. In the first regression model, predicting students’ use of cognitive strategies from implicit intelligence beliefs and motivations for studying, stronger autonomous motivations were significant predictors of cognitive strategies. The second regression model, predicting students’ use of metacognitive strategies from implicit intelligence beliefs and motivations for studying, was not significant. These findings can be useful to plan tailored educational interventions to promote students’ motivation, incremental beliefs about intelligence and their use of learning strategies positively related with academic performance.

There is a growing need for biomarkers to predict therapeutic outcome in Crohn's disease (CD).The aim was to evaluate whether NLR (neutrophil-to-lymphocyte ratio), PLR (platelet-to-lymphocyte ratio), ELR (eosinophil-to-lymphocyte ratio), and ENLR (eosinophil*neutrophil-to-lymphocyte ratio), could be prognostic biomarkers of endoscopic response (ER) when starting biologics.Patients with CD who started biologics were enrolled. Multivariate analysis was used to evaluate whether NLR, PLR, ELR and ENLR at baseline and at w12 could predict ER (Simple Endoscopic Score for Crohn's disease [SES-CD] ≤2 or SES-CD≤2 and Rutgeerts i0-i1) after 52 weeks of treatment. Area under the curve (AUC) was calculated to find the cutoffs.107 patients were included. Patients who achieved ER had significantly lower baseline NLR (p = 0.025), ELR (p = 0.013), and ENLR (p = 0.020) compared with those without ER; results after 12 weeks of treatment for ELR (p = 0.006) and ENLR (p = 0.003). AUC was 0.64 (p = 0.003), 0.67 (p = 0.006) and 0.65 (p = 0.014) for NLR, ELR and ENLR.Low NLR, ELR and ENLR can predict ER and could be used in clinical practice for a better management of CD patients.

Megakaryocytes give rise to platelets, which have a wide variety of functions in coagulation, immune response, inflammation, and tissue repair. Dysregulation of megakaryocytes is a key feature of in the myeloproliferative neoplasms, especially myelofibrosis. Megakaryocytes are among the main drivers of myelofibrosis by promoting myeloproliferation and bone marrow fibrosis. In vivo targeting of megakaryocytes by genetic and pharmacologic approaches ameliorates the disease, underscoring the important role of megakaryocytes in myeloproliferative neoplasms. Here we review the current knowledge of the function of megakaryocytes in the JAK2, CALR, and MPL-mutant myeloproliferative neoplasms.

While forensic science is generally focused on associating a trace to its source, trace’s relevance is best addressed at the activity responsible for its genesis. Recurring studies show the potenti...

The number of Left Ventricular Assist Devices (LVADs) implanted each year is rising. Nevertheless, there are minimal data on device acceptance after LVAD implant, and on its relationship with patient-reported outcomes. We designed a cross-sectional study to address this knowledge gap and test the hypothesis that low device acceptance is associated with poorer quality of life, depression and anxiety. Self-report questionnaires were administered to assess quality of life (12-item Kansas City Cardiomyopathy Questionnaire quality of life subscale), level of anxiety (7-item Generalized Anxiety Disorder; GAD-7), level of depression (9-item Patient Health Questionnaire; PHQ-9) and device acceptance (Florida Patient Acceptance Survey; FPAS) to 101 consecutive patients presenting to LVAD clinic. Regression analysis showed a strong correlation between device acceptance and both psychological distress (p

Essentials The BCR-ABL negative myeloproliferative neoplasms are subjected to unknown phenotypic modifiers. GATA-1 is upregulated in ET patients, regardless of treatment regimen or mutational status. Myelofibrosis (MF) megakaryocytes displayed decreased GATA-1 staining. GATA-1 may have utility as a diagnostic marker in ET and in its differential diagnosis from MF. Abstract: Background The BCR-ABL-negative myeloproliferative neoplasms, i.e., polycythemia vera, essential thrombocythemia (ET), and myelofibrosis (MF), are characterized by mutations in JAK2, CALR, or MPL. However, an as yet unknown factor drives the precise disease phenotype. The hematopoietic transcription factor GATA-1 and its downstream targets NFE2 and FLI1 are responsible for determining erythroid and megakaryocyte lineages during hematopoietic stem cell differentiation. Previous studies have demonstrated a low level of GATA-1 expression in megakaryocytes from patients with MF. Objectives and methods The expression of GATA-1, NFE2 and FLI1 was studied for changes in the peripheral blood (PB) of ET patients. Peripheral blood samples were obtained from 36 ET patients, 14 MF patients, and seven healthy control donors. Total RNA from PB mononuclear cells (PBMCs) was extracted, and quantitative polymerase chain reaction was used to determine relative changes in gene expression. Protein levels of GATA-1 were also determined in bone marrow sections from ET and MF patients. Results GATA-1 mRNA was upregulated in ET patients, regardless of treatment regimen or mutational status. FLI1 expression was significantly downregulated, whereas NFE2 expression was unaffected by changes in GATA-1 mRNA levels. Megakaryocytes from ET patients showed increased protein levels of GATA-1 as compared with those from MF patients. Conclusions Our results confirmed, in PB, our previous data demonstrating elevated levels of GATA-1 mRNA in total bone marrow of ET patients. GATA-1 mRNA levels are independent of cytoreductive therapies, and may have utility as a diagnostic marker in ET and in its differential diagnosis from MF.

Through the latter years of the twentieth century and early years of the twenty-first century, there have been a number of high-profile multinational interven­tions by the international community in countries deemed to be sufficiently un­stable to present a threat to global peace or, more controversially, to local pop­ulations. Beginning with the tardy but largely successful intervention in the Yu­goslav civil war in 1990 and culminating in the soon to conclude intervention in Afghanistan after the Al Qaeda attacks on the USA in 2001, there have also been military interventions in Iraq in 2003 and Libya in 2011. The list is not exhaustive. There have been other interventions elsewhere, but these particular examples of military intervention mainly conducted by western powers provide illuminat­ing insights into the success and, sometimes, the failure of such multinational security responses to perceived international threats.

The term assistive technology identifies a wide range of solutions and services to improve the life quality of frail people, by supporting them in performing everyday tasks, accessing public services, participating in education and civic life, as well as performing well at their job [1]—[3]. Potential users of assistive technology are elders, sometimes with disabilities, diseases or mental health conditions. To highlight the crucial role of assistive technologies, it should be considered that by 2050, one out of six people in the world will be over the age of 65, almost doubled as respect to the current situation [1]-[3]. In general, it can be affirmed that frail people may incur difficulties while performing Activities of Daily Living (ADLs), such as eating, drinking, mobility, housework, use of home appliances, social interactions and many other everyday activities.

PURPOSE This guideline provides recommendations for available tissue-based prostate cancer biomarkers geared toward patient selection for active surveillance, identification of clinically significant disease, choice of postprostatectomy adjuvant versus salvage radiotherapy, and to address emerging questions such as the relative value of tissue biomarkers compared with magnetic resonance imaging. METHODS An ASCO multidisciplinary Expert Panel, with representatives from the European Association of Urology, American Urological Association, and the College of American Pathologists, conducted a systematic literature review of localized prostate cancer biomarker studies between January 2013 and January 2019. Numerous tissue-based molecular biomarkers were evaluated for their prognostic capabilities and potential for improving management decisions. Here, the Panel makes recommendations regarding the clinical use and indications of these biomarkers. RESULTS Of 555 studies identified, 77 were selected for inclusion plus 32 additional references selected by the Expert Panel. Few biomarkers had rigorous testing involving multiple cohorts and only 5 of these tests are commercially available currently: Onco type Dx Prostate, Prolaris, Decipher, Decipher PORTOS, and ProMark. With various degrees of value and validation, multiple biomarkers have been shown to refine risk stratification and can be considered for select men to improve management decisions. There is a paucity of prospective studies assessing short- and long-term outcomes of patients when these markers are integrated into clinical decision making. RECOMMENDATIONS Tissue-based molecular biomarkers (evaluating the sample with the highest volume of the highest Gleason pattern) may improve risk stratification when added to standard clinical parameters, but the Expert Panel endorses their use only in situations in which the assay results, when considered as a whole with routine clinical factors, are likely to affect a clinical decision. These assays are not recommended for routine use as they have not been prospectively tested or shown to improve long-term outcomes—for example, quality of life, need for treatment, or survival. Additional information is available at www.asco.org/genitourinary-cancer-guidelines .

Overtopping-type wave power conversion devices represent one of the most promising technology to combine reliability and competitively priced electricity supplies from waves. While satisfactory hydraulic and structural performance have been achieved, the selection of the hydraulic turbines and their regulation is a complex process due to the very low head and a variable flow rate in the overtopping breakwater set-ups. Based on the experience acquired on the first Overtopping BReakwater for Energy Conversion (OBREC) prototype, operating since 2016, an activity has been carried out to select the most appropriate turbine dimension and control strategy for such applications. An example of this multivariable approach is provided and illustrated through a case study in the San Antonio Port, along the central coast of Chile. In this site the deployment of a breakwater equipped with OBREC modules is specifically investigated. Axial-flow turbines of different runner diameter are compared, proposing the optimal ramp height and turbine control strategy for maximizing system energy production. The energy production ranges from 20.5 MWh/y for the smallest runner diameter to a maximum of 34.8 MWh/y for the largest runner diameter.

Obesity and associated metabolic disturbances, which have been increasing worldwide in recent years, are the consequences of unhealthy diets and physical inactivity and are the main factors underlying non-communicable diseases (NCD). These diseases are now responsible for about three out of five deaths worldwide, and it has been shown that they depend on mitochondrial dysfunction, systemic inflammation and oxidative stress. It was also demonstrated that several nutritional components modulating these processes are able to influence metabolic homeostasis and, consequently, to prevent or delay the onset of NCD. An interesting combination of nutraceutical substances, named DMG-gold, has been shown to promote metabolic and physical wellness. The aim of this research was to investigate the metabolic, inflammatory and oxidative pathways modulated by DMG-gold in an animal model with diet-induced obesity. Our data indicate that DMG-gold decreases the metabolic efficiency and inflammatory state and acts as an antioxidant and detoxifying agent, modulating mitochondrial functions. Therefore, DMG-gold is a promising candidate in the prevention/treatment of NCD.

BackgroundPre-eclampsia (PE) is a common disorder of pregnancy that usually presents with hypertension and proteinuria. The clinical presentation arises from soluble factors released into the maternal circulation from the placenta owing to the stress of syncytiotrophoblast, consequence of defective placentation occurring in the first half of pregnancy. Reduced tolerance of the semiallogeneic fetus by the maternal immune system has been proposed as first trigger leading to poor placentation. We previously observed aberrant expression of human leukocyte antigen (HLA)-DR molecules in the syncytiotrophoblast of a subset of women with PE. Aim of this study was to investigate abnormal expression of circulating HLA-DR in syncytiotrophoblast-derived extracellular vesicles (STBEVs) in women with PE compared to normal pregnant women.Methodsperipheral venous blood was collected from 22 women with PE and 22 normal pregnant women. Circulating STBEVs were collected by ultra-centrifugation (120000 g) and analyzed for the expression of HLA-DR and placental alkaline phosphatase (PLAP), a specific marker of the placenta, by Western blot analysis and flow cytometry.Resultscirculating STBEVs positive for HLA-DR were observed in 64% of PE women while no HLA-DR positivity was detected in any of the controls (PConclusionsAberrant expression of HLA-DR in circulating STBEVs is specifically associated to PE. Further studies are required: a) to define the role of aberrant placental expression of HLA-DR molecules in the pathogenesis of PE; b) evaluate a possible application of detecting circulating HLA-DR positive STBEVs in the diagnosis and prediction of PE in the first and second trimester of pregnancy.

Prostate cancer is a heterogeneous cancer with widely varying levels of morbidity and mortality. Approaches to prostate cancer screening, diagnosis, surveillance, treatment and management differ around the world. To identify the highest priority research needs across the prostate cancer biomedical research domain, Movember conducted a landscape analysis with the aim of maximizing the effect of future research investment through global collaborative efforts and partnerships. A global Landscape Analysis Committee (LAC) was established to act as an independent group of experts across urology, medical oncology, radiation oncology, radiology, pathology, translational research, health economics and patient advocacy. Men with prostate cancer and thought leaders from a variety of disciplines provided a range of key insights through a range of interviews. Insights were prioritized against predetermined criteria to understand the areas of greatest unmet need. From these efforts, 17 research needs in prostate cancer were agreed on and prioritized, and 3 received the maximum prioritization score by the LAC: first, to establish more sensitive and specific tests to improve disease screening and diagnosis; second, to develop indicators to better stratify low-risk prostate cancer for determining which men should go on active surveillance; and third, to integrate companion diagnostics into randomized clinical trials to enable prediction of treatment response. On the basis of the findings from the landscape analysis, Movember will now have an increased focus on addressing the specific research needs that have been identified, with particular investment in research efforts that reduce disease progression and lead to improved therapies for advanced prostate cancer., The Movember global Landscape Analysis Committee (LAC) was established to act as an independent group of experts across urology, medical oncology, radiation oncology, radiology, pathology, translational research, health economics and patient advocacy to identify the highest priority research needs across the prostate cancer biomedical research domain. Findings from the landscape analysis illustrate the research priorities in prostate cancer and will enable Movember to focus on specific needs, with particular investment in research to reduce disease progression and improve therapies for advanced prostate cancer.

Background During humanitarian crises, health information systems are often lacking and surveys are a valuable tool to assess the health needs of affected populations. In 2013, a mortality and health survey undertaken by Médecins Sans Frontières (MSF) in the conflict affected Walikale territory of North Kivu, Democratic Republic of the Congo (DRC), indicated mortality rates exceeding humanitarian crisis thresholds and a high burden of mortality and morbidity due to malaria. In late 2017, after a period of relative stability, MSF reassessed the health status of the population through a second survey to guide ongoing operations. Methods A two-stage cluster survey, selecting villages using probability proportional to size and households using random walk procedures, was conducted. Household members were interviewed on morbidity and mortality, healthcare use, vaccination status, and bednet availability. Results The sample included 5711 persons in 794 households. The crude mortality rate (CMR) and under-five mortality rate (U5MR) were 0.98 per 10,000 persons/day (95% confidence interval (CI) 0.78–1.2) and 1.3 per 10,000 persons/day (95% CI): 0.82–2.0), respectively. The most frequently reported causes of death were fever/malaria (31%), diarrhoea (15%) and respiratory infections (8%). In 89% of households at least one person was reported as falling ill in the previous 2 weeks, and 58% sought healthcare. Cost was the main barrier amongst 58% of those who did not seek healthcare. Coverage of measles-containing-vaccine was 62% in under-fives. Sufficient bednet coverage (1 bednet/2 people) was reported from 17% of households. Conclusion The second survey illustrates that although mortality is now just below crisis thresholds, the area still experiences excess mortality and has substantial health needs. The study results have supported the further expansion of integrated community case management to improve access to care for malaria, diarrhoea and respiratory infections. Such surveys are important to orient operations to the health needs of the population being served and also highlight the ongoing vulnerability of populations after humanitarian crises.

This paper analyses the use of a simplified ac-side current control algorithm strategy, independent of the number of submodules, applied to a Modular Multilevel Cascade Converter acting as an Active Power Filter (MMCC-APF) with a reduced hardware structure. Here, Model Predictive Control (MPC) with a reduced number of states is used for both ac-side current control and submodules' capacitor voltage balancing algorithm. Furthermore, analytical criteria are developed, to define the minimum number of states required for current control. This approach improves the control strategy, thus reducing computational effort for MMCC in APF applications. For the calculation of APF compensating currents, two main strategies are addressed, in order to assess ac-side currents control limitations: (i) total and (ii) specific frequencies harmonic compensation. The system analyzed in this paper consists of a nine-level MMCC connected to a medium voltage distribution grid, compensating the harmonics drained by a diode rectifier. All the analyses are conducted in the environment of circuit simulation PSIM.

Purpose: Myelofibrosis is characterized by bone marrow fibrosis, atypical megakaryocytes, splenomegaly, constitutional symptoms, thrombotic and hemorrhagic complications, and a risk of evolution to acute leukemia. The JAK kinase inhibitor ruxolitinib provides therapeutic benefit, but the effects are limited. The purpose of this study was to determine whether targeting AURKA, which has been shown to increase maturation of atypical megakaryocytes, has potential benefit for patients with myelofibrosis. Patients and Methods: Twenty-four patients with myelofibrosis were enrolled in a phase I study at three centers. The objective of the study was to evaluate the safety and preliminary efficacy of alisertib. Correlative studies involved assessment of the effect of alisertib on the megakaryocyte lineage, allele burden, and fibrosis. Results: In addition to being well tolerated, alisertib reduced splenomegaly and symptom burden in 29% and 32% of patients, respectively, despite not consistently reducing the degree of inflammatory cytokines. Moreover, alisertib normalized megakaryocytes and reduced fibrosis in 5 of 7 patients for whom sequential marrows were available. Alisertib also decreased the mutant allele burden in a subset of patients. Conclusions: Given the limitations of ruxolitinib, novel therapies are needed for myelofibrosis. In this study, alisertib provided clinical benefit and exhibited the expected on-target effect on the megakaryocyte lineage, resulting in normalization of these cells and reduced fibrosis in the majority of patients for which sequential marrows were available. Thus, AURKA inhibition should be further developed as a therapeutic option in myelofibrosis. See related commentary by Piszczatowski and Steidl, p. 4868

Different solutions have been proposed to address orientation in indoor/outdoor environments and among them, radio frequency identification (RFID)-based systems represent a strategic choice for its reduced complexity and cost. Widespread practices to validate the behavior of RFID-based systems use specific metrics related to the addressed application, while a general strategy to assess technical performances of the RFID-based system is lacking. In this paper, a novel measurement approach is proposed to perform optimal choices in developing an RFID-based orientation system and to impartially assess its technical performances. A multivariate measurement strategy is suggested to fully investigate performances of the system as a function of a set of operating quantities (user-tag distance, tag height, and intertag distance). An analysis is also proposed, which aims to assess the system performances in terms of sensitivity and specificity. Moreover, the use of a synthetic index, representing the overall behavior of the system under investigation is addressed. A case of study is presented. The system uses transparent RFID tags positioned in the environment and an embedded system including an RFID reader, as well as a dedicated module to convey audio messages to end-users. Results highlight that the device sensitivity improves in the case of a high intertag distance while the specificity decreases for short intertag distance, which is also confirmed by the synthetic index proposed. Specifically, an optimal tag height of 1 m has been estimated, while best performances are obtained in the case of intertag distance and user-tag distance belonging to ranges [1.50–2.50] m and [0.40–1.60] m, respectively.

Smart homes/offices based on wireless sensor networks (WSNs) can provide an assisted living and working environment to the users. In these applications, the distributed network nodes are made up of low-power low-cost high-energy-efficient electronic platforms equipped with sensors, microcontroller, radio, and antenna, able to periodically sense, receive, store, pre-process, and transmit ambient data to a remote host station. Conventional nodes are usually supplied by batteries, resulting in a significant limitation to the lifetime and to the maximum number of deployable devices. To meet the demand of the next Internet-of-Things (IoT) applications, requiring a vast plurality of interconnected wireless network nodes, this paper presents the design and implementation of a WSN platform whose nodes are energetically autonomous thanks to an embedded photovoltaic panel associated to a rechargeable battery and a power-efficient design with optimized power-management strategy. The implemented node is able to harvest indoor ambient light starting from 100 lux and, according to the available energy, adaptively sets the sensors acquisition and RF transmission rate. Moreover, it provides long-distance data transmission with air data rate from 1 to 500 kbps. The WSN node device is implemented on an $8.6\times 5.4$ cm2 flexible PCB, being therefore amenable to conform even to curved surfaces. Comparison with the commercial IoT nodes reveals a significant improvement in the state of the art.

This article provides the patient perspective on cancer clinical trials. (1) How do patients find them? (2) What design elements are important to patients? (3) What are some of the criteria patients use to determine whether to participate? (4) What expectations do patients have of clinical staff? (5) What should be done to disseminate results?

Beam diagnostic and especially beam current measurements represent a key aspect in the production of a high-quality beam. Due to the known interplay between beam current and beam and plasma properties, many solutions have been addressed to solve this need. Although precise beam current measuring systems exist, they cannot provide noninvasive solutions for the measurement of very low-frequency currents in electron cyclotron resonance ion source (ECRIS) beamline, with a range from tens to hundreds of microamperes. To address the above-mentioned needs, this paper proposes an indirect measurement methodology based on the estimation of the magnetic field produced by target current exploiting a residence time difference fluxgate and a flux concentrator (a mechanical structure able to constrain produced magnetic field in a given area). The main advantage of this approach is related to the possibility to perform a noninvasive current measurement. An optimal geometry for the flux concentrator has been investigated by using a finite-element method analysis that has led to the definition of a minimum value of the magnetic field generated by the minimum value of the target current, around $5.0~\mu \text{A}$ , equal to 3.07 nT. To assess the solution, an experimental setup, miming real magnetic flux intensity inside ECRIS beamlines, has been realized. The measuring strategy has a magnetic resolution of 1 nT and a current resolution of $1.6~\mu \text{A}$ , that is, in line with requirements. Results obtained demonstrate the suitability of the measurement system for the specific application addressed in this paper, both in terms of operating range and resolution.

Background Patients with obesity have a suppressed incretin effect and a consequent imbalance of glycemic homeostasis. Several studies have shown improved type 2 diabetes after Roux-en-Y gastric bypass (RYGB). The mechanisms of early action are linked to caloric restriction, improvement of insulin resistance, pancreatic beta cell function, and the incretin effect of glycogen-like protein 1 and gastric inhibitory polypeptide, but reported data are conflicting. Objective The objective of this study was to evaluate glycemic metabolism, including the oral glucose tolerance test and enterohormonal profile in the early postoperative period in severely obese patients who underwent RYGB with gastrostomy, comparing the preoperative supply of a standard bolus of nutrient against the postoperative administration through an oral and a gastrostomy route. Setting Clinics Hospital of University of Sao Paulo, Brazil. Methods Eleven patients with obesity and diabetes underwent RYGB with a gastrostomy performed in the excluded gastric remnant. Patients were given preoperative assessments of glycemic and enterohormone profiles and an oral glucose tolerance test; these were compared with early postoperative assessments after oral and gastrostomy route administrations. Results The mean preoperative body mass index of the group was 44.1 ± 6.6 kg/m2, mean fasting blood glucose of 194.5 ± 62.4 mg/dL, and glycated hemoglobin 8.7 ± 1.6%. In 77.7% of the patients, there was normalization of the glycemic curve in the early postoperative period as evaluated by the oral glucose tolerance test. Significant decreases in glycemia, insulinemia, and homeostatic model assessment-insulin resistance were also observed, regardless of the route of administration. There was significant increase in glycogen-like protein 1 by the postoperative oral route and reduction of gastric inhibitory polypeptide in both routes. Ghrelin did not change. Conclusion Glycemia and peripheral insulin resistance reductions were observed in early-postoperative RYGB, independent of the oral or gastrostomy route. Incretin improvement, mediated by glycogen-like protein 1 increased was observed only in the postoperative oral route, while GIP reduced for both routes.

Telemedicine provides access to specialty care to critically ill patients from a geographic distance. The effects of using telemedicine on (1) teamwork and communication (TC), (2) task workload during resuscitation, and (3) the processes of critical care have not been well described.To evaluate the impact of telemedicine on (1) TC, (2) task workload during a resuscitation, and (3) the processes of critical care during a simulated pediatric resuscitation.Prospective single-center randomized trial. Teams of two physicians (senior and junior resident) and two standardized confederate nurses were randomized to either telemedicine (telepresent senior physician team leader) or usual care (both physicians in the room) during a simulated infant resuscitation. Simulations were video recorded and assessed for teamwork, workload, and processes of care using the Simulated Team Assessment Tool (STAT), the NASA Task Load Index (NASA-TLX) tool, and time between onset of ventricular fibrillation and defibrillation, respectively.Twenty teams participated. There was no difference in teamwork between the groups (mean STAT score 72% vs. 69%; p = 0.383); however, there was a significantly greater workload in the telemedicine group (mean TLX score 56% vs. 48%, p = 0.020). Using linear regression, no difference was found in time-to-defibrillation between groups (p = 0.671), but higher teamwork scores predicted faster time to defibrillation (p = 0.020).In this simulation-based study, a telepresent team leader was associated with increased team workload compared to usual care. However, no differences were noted in teamwork and processes of care metrics.

The development of low-cost mass sensors is of unique interest for the scientific community due to the wide range of fields requiring these kind of devices. In this paper, a full inkjet-printed mass sensor is proposed. The device is based on a PolyEthylene Terephthalate (PET) cantilever beam (operating in its first natural frequency) where a strain-sensor and a planar coil have been realized by a low-cost InkJet Printing technology to implement the sensing and actuation strategies, respectively. The frequency readout strategy of the sensor presents several advantages, such as the intrinsic robustness against instabilities of the strain sensor, the residual stress of the cantilever beam, the target mass material, and the distance between the permanent magnet and the actuation coil (which changes as a function of the target mass values). However, the frictionless actuation mode represents another shortcoming of the sensor. The paper describes the sensor design, realization, and characterization while investigating its expected behavior by exploiting dedicate models. The working span of the device is 0–0.36 g while its resolution is in the order of 0.001 g, thus addressing a wide range of potential applications requiring very accurate mass measurements within a narrow operating range.

Children with Down syndrome are at an elevated risk of leukemia, especially myeloid leukemia (ML-DS). This malignancy is frequently preceded by transient abnormal myelopoiesis (TAM), which is self-limited expansion of fetal liver derived megakaryocyte progenitors. An array of international studies has led to consensus in treating ML-DS with reduced intensity chemotherapy leading to excellent outcomes. In addition, studies performed in the past 20 years, have revealed many of the genetic and epigenetic features of the tumors, including GATA1 mutations which are arguably associated with all cases of both TAM and ML-DS. Despite these advances in understanding the clinical and biological aspects of ML-DS, little is known about the mechanisms of relapse. Upon relapse, patients face a poor outcome, and there is no consensus on treatment. Future studies need to be focused on this challenging aspect of leukemia in children with DS.

Background: Immune thrombocytopenia (ITP) is an acquired autoimmune disorder against platelets characterized by a low platelet count and increased bleeding risk. ITP is likely to rise from defective immune tolerance in addition to a triggering event, such as vaccination. COVID-19 vaccination is associated with a small increased risk of development of de novo ITP. In patients historically diagnosed with ITP, relapse of thrombocytopenia after COVID-19 vaccination has been described. However, the precise platelet dynamics in previously diagnosed ITP patients after COVID-19 vaccination is unknown Aims: To investigate the effect of the COVID-19 vaccine on platelet count, the occurrence of severe bleeding complications and necessity of rescue medication in patients historically diagnosed with ITP. Methods: Platelet counts of ITP patients and healthy controls were collected immediately before, 1 and 4 weeks after the first and second vaccination. Linear mixed effects modelling was applied to analyse platelet count dynamics over time. Results: We included 218 ITP patients (50.9% women) with a mean (SD) age of 58 (17) years and 200 healthy controls (60.0% women) with a mean (SD) age of 58 (13) years. Healthy controls and ITP patients had similar baseline characteristics (Table 1). 201/218 (92.2%)ITP patients received the mRNA-1273 vaccine, 16/218 (7.3%) the BNT162b vaccine and 1/218 (0.46%) the Vaxzevria vaccine. All healthy controls received the mRNA-1273 vaccine. Fifteen (6.8%) patients needed rescue medication (Table 1). Significantly more ITP patients who needed rescue medication were on ITP treatment prior COVID-19 vaccination compared to patients without exacerbation (56.2% (7/16) vs 27.4% (55/202), p=0.016). We found a significant effect of vaccination on platelet count over time in both ITP patients and healthy controls (Figure 1A). Platelet counts of ITP patients decreased 7.9% between baseline and 4 weeks after second vaccination (p=0.045). Rescue medication and prior treatment significantly increased platelet count over time (p=0.042 and p=0.044). Healthy controls decreased 4.5% in platelet count (p150x10 9/L had a significant decrease of platelet count 4 weeks after second vaccination compared to baseline (median platelet count (IQR) 205 (94) vs 203 x10 9/L (109) p=0.001). No significant decrease was seen in ITP patients with a baseline platelet count

In this paper an Integrated Platform of Assistive Technology supporting elderly and people with impairments in their own premises is presented. The platform consists of a network of interconnected and sensor-based intelligent objects, with the purpose of monitoring parameters of end-users and their living environment. Both wearable (smartwatch, RFID reader, ECG) and environmental (environmental monitoring, passive RFID tags, smart switches, smart Reed relays, power monitors, RGB-D cameras, seat-posture monitoring) sensors and devices have been installed in the Living Labs. Data collected by the sensors are conveyed to a remote server, hosting also smart paradigms to extract suitable information related to the status and habits of end-users. Such information is then made available to caregivers. The architecture presented through this paper represents an example of a customizable and flexible assistive system, aimed to improve the life quality of elderly through the implementation of the “Smart Home concept”, which is strategic to promote an Active and Healthy Ageing (AHA) society.

The ageing population is posing new challenges regarding the health and social care systems. In the health domain, major threats are falls and postural instabilities. Focusing on postural instabilities, in this article, the Wavelet theory has been used for the sake of postural sway classification for its capability to highlight important postural control mechanisms in the human body. In particular, the proposed methodology is based on a 5-level Discrete Wavelet Transform and the use of features computed on the new transformed domain. Preliminary analysis have led to 100% S e and 96% S p in the classification task.

During past years, the increasing knowledge of molecular mechanisms of inflammatory bowel disease (IBD) have led to the development of several targeted biological therapies. This great expansion of available medical options has prompted the need for comparative data between drugs. For years, given that most randomized controlled trials (RCTs) were performed only versus placebo, this demand has clashed with the absence of head-to-head trials comparing two or more treatments. The quality of evidence coming from real-world experience was low overall, so it was extremely difficult to clarify the correct positioning of the biologicals inside the therapeutic algorithms for IBD. Fortunately, times are changing: head-to-head comparative RCTs have been conducted or are ongoing, and the methodological quality of real-world studies is gradually increasing, mainly thanks to a higher rate of application of statistical methods capable of reducing the selection bias, such as the propensity score. In this evolving scenario, the increasing number of comparative RCTs is providing high-quality data for a correct drug positioning in IBD. In parallel, real-world observational studies are supporting the data coming from RCTs, and covering those comparisons not performed in the RCT setting. We believe that there is moderate evidence already available to support clinicians in the correct choice between different biologicals, and data will certainly be more robust in the near future.

Inflammatory bowel diseases, including Crohn's disease and ulcerative colitis, are chronic diseases associated with increased morbidity and reduced quality of life. Age may represent a risk factor for adverse events, due to the multimorbidity and polypharmacy, common in elderly patients. Elderly are often not included in clinical trials evaluating efficacy and safety of study drugs for the treatment of inflammatory bowel diseases. Several drugs, such as aminosalicylates, systemic corticosteroids, immunosuppressant drugs, biological drugs and Janus Kinase inhibitors, are available for the management of inflammatory bowel diseases. With the increasing spectrum of therapeutic options, it is therefore important to analyze the evidence regarding the safety of the use of these agents in elderly patients. Selection of immunosuppressive therapy is a challenge in the management of elderly patients with inflammatory bowel diseases, for whom biologics with a lower risk of infection or cancer, such as vedolizumab and ustekinumab, may be preferred in elderly patients. Concomitant therapies and comorbidities must be thoroughly investigated before initiating any immunosuppressive or biological therapy in order to minimize the risk of drug-drug interactions. This review aims to provide an overview of the safety of thiopurines, methotrexate and target therapies as well as their drug-drug interactions in patients with inflammatory bowel diseases.

The Internet of Things paradigm envisions the interoperation among objects, people, and their surrounding environment. In the last decade, the spread of IoT-based solutions has been supported in various domains and scenarios by academia, industry, and standards-setting organizations. The wide variety of applications and the need for a higher level of autonomy and interaction with the environment have recently led to the rise of the Internet of Robotic Things (IoRT), where smart objects become autonomous robotic systems. As mentioned in the recent literature, many of the proposed solutions in the IoT field have to tackle similar challenges regarding the management of resources, interoperation among objects, and interaction with users and the environment. Given that, the concept of the IoT pattern has recently been introduced. In software engineering, a pattern is defined as a general solution that can be applied to a class of common problems. It is a template suggesting a solution for the same problem occurring in different contexts. Similarly, an IoT pattern provides a guide to design an IoT solution with the difference that the software is not the only element involved. Starting from this idea, we propose the novel concept of the IoRT pattern. To the authors’ knowledge, this is the first attempt at pattern authoring in the Internet of Robotic Things context. We focus on pattern identification by abstracting examples also in the Ambient Assisted Living (AAL) scenario. A case study providing an implementation of the proposed patterns in the AAL context is also presented and discussed.

The authors have requested that this preprint be removed from Research Square.

Understanding the presence of post-traumatic stress disorder (PTSD) symptoms in quarantined/isolated individuals is essential for decreasing morbidity and mortality caused by the COVID-19 pandemic. However, there is a paucity of evidence quantifying PTSD status globally during confinement in quarantine/isolation facilities during COVID-19. Therefore, we aimed to assess the PTSD status and factors contributing to PTSD development in quarantined/isolated people during pandemic. Using the Impact of Event Scale-Revised (IES-R) scale, our multicentre, multinational, and cross-sectional online survey assessed the psychological impacts on the quarantine/isolation experience of participants suspected or confirmed to have COVID-19, their PTSD status, and various correlates with developing PTSD. We had 944 (35.33%) valid responses (51.1% from females), mostly from Asian countries (635, 71.4%), and 33.9% were healthcare workers. The number of quarantine days in the PTSD symptoms group (using the IES-R cutoff of 24 for symptomatic or full PTSD) was significantly shorter compared to the non-PTSD group (14 (range 14–40) vs. 14 (14–23.75), p = 0.031). Lower rates of PTSD symptoms were observed in participants practicing Buddhist religion than in participants having no religion (OR: 0.30, 95% CI: 0.13–0.68, p = 0.005), individuals with vocational training had a higher risk of developing PTSD symptoms (OR: 2.28 (1.04–5.15), p = 0.043) compared to university graduates. Individuals forced to be quarantined/isolated had higher odds of developing PTSD symptoms than those voluntarily quarantined/isolated (OR: 2.92 (1.84–4.74), p &lt, 0.001). We identified several PTSD correlations among individuals quarantined/isolated during the COVID-19 pandemic, including religious practice, reason for quarantine/isolation, education level, and being a case of the infection. These findings can inform worldwide policies to minimize the adverse effects of such social control measures.

Learning objectives After participating in this activity, learners should be better able to:• Assess the rates of co-occurring obsessive-compulsive personality disorder (OCPD) in patients with obsessive-compulsive disorder (OCD)• Identify characteristics related to OCD with co-occurring OCPD. Abstract The current literature discloses discrepant findings regarding the rates of co-occurring obsessive-compulsive personality disorder (OCPD) in patients with obsessive-compulsive disorder (OCD). In addition, it is not clear which characteristics are related specifically to OCD with co-occurring OCPD. We conducted the first systematic review and meta-analysis of the studies of the prevalence of OCPD in patients with OCD. We also investigated potential moderators of the prevalence, including OCD severity, age of onset of OCD, sex, current age, methodological quality, and publication date of the studies. Electronic databases and gray literature were searched by two independent reviewers. A PRISMA systematic review with a random-effect meta-analysis was conducted. Thirty-four studies were included. A significant mean effect size of 0.25 without publication bias indicated that OCPD was present in 25% of patients with OCD, suggesting that the two conditions are distinct clinical entities. This prevalence was higher than the rates found in the literature for any other personality disorders among OCD patients. OCPD that occurs in the context of OCD was more likely to be present in males and to be characterized by a later age of onset of OCD, older age at assessment, and less severe OCD symptoms. Clinicians should consider these findings when assessing and planning treatment of OCD with co-occurring OCPD.

Obstructive Sleep Apnea Syndrome (OSAS) is a respiratory sleep disorder characterized by repeated episodes of complete or partial obstruction of the upper airway. OSAS has a frequency of 4 percent and is classified according to the number of obstructive sleep apnea-hypopnea episodes. The OSAS diagnostic path starts with the evaluation of the patient’s clinical framework and follows an instrumental procedure, depending on the clinical severity of the patient. Dental practitioners have the ability to intercept early on the signs and symptoms of OSAS. At the same time, they can assess whether the patient has the indications for treatment with specific oral devices (Oral Appliances, OA). The purpose of this paper is to provide guidance for dental management of obstructive sleep apnea syndrome in adult individuals.

The overtopping phenomenon at the rear side of breakwaters has particular importance in harbor protection. Undoubtedly, this topic needs to be taken even more seriously, considering the sea level rise. The present study focuses on the effectiveness in the reduction of the wave overtopping of a triangular parapet placed on the top of an innovative concrete superstructure. The last is part of the OBREC device (Overtopping BReakwater for wave Energy Conversion), an overtopping structure which is integrated into a traditional rubble-mound breakwater, to convert wave energy into electricity. Parametric laboratory tests, including the influence of water depth, have led to the evaluation of the accuracy of the main literature formulations and to the introduction of a new overtopping formula to take into account the influence of the parapet geometry. The results highlight the capability of the parapet in significantly increasing the hydraulic protection compared to a breakwater with a traditional crown wall. The findings from this work are expected to support in promoting and developing adaptive management strategies for existing coastal defenses and smart approaches in the construction and maintenance of new ones, with special reference to future sea-level-rise scenarios.

The OBREC is an overtopping structure which is integrated into a traditional rubble-mound breakwater to convert wave energy into electricity. The relatively simple geometry of this overtopping device, with a single frontal ramp and a reservoir, makes the technology suitable to be fully combined also with existing structures. OBREC has been deeply investigated over the last years with physical and numerical model tests, and it is still under development with the ongoing monitoring activities at full-scale in real environments focusing on the wave-OBREC interaction. A comprehensive review of the research studies during the last ten years is here presented. The paper contains some unpublished details on OBREC geometry and power take-off strategy. A special attention is also directed to the description of the full-scale prototype of OBREC at Naples harbour, where an experimental campaign is still continuing.

Tumor resistance to chemotherapy represents an important challenge in modern oncology. Although platinum (Pt)-based drugs have demonstrated excellent therapeutic potential, their effectiveness in a wide range of tumors is limited by the development of resistance mechanisms. One of these mechanisms includes increased cisplatin sequestration/efflux by the copper-transporting ATPase, ATP7B. However, targeting ATP7B to reduce Pt tolerance in tumors could represent a serious risk because suppression of ATP7B might compromise copper homeostasis, as happens in Wilson disease. To circumvent ATP7B-mediated Pt tolerance we employed a high-throughput screen (HTS) of an FDA/EMA-approved drug library to detect safe therapeutic molecules that promote cisplatin toxicity in the IGROV-CP20 ovarian carcinoma cells, whose resistance significantly relies on ATP7B. Using a synthetic lethality approach, we identified and validated three hits (Tranilast, Telmisartan, and Amphotericin B) that reduced cisplatin resistance. All three drugs induced Pt-mediated DNA damage and inhibited either expression or trafficking of ATP7B in a tumor-specific manner. Global transcriptome analyses showed that Tranilast and Amphotericin B affect expression of genes operating in several pathways that confer tolerance to cisplatin. In the case of Tranilast, these comprised key Pt-transporting proteins, including ATOX1, whose suppression affected ability of ATP7B to traffic in response to cisplatin. In summary, our findings reveal Tranilast, Telmisartan, and Amphotericin B as effective drugs that selectively promote cisplatin toxicity in Pt-resistant ovarian cancer cells and underscore the efficiency of HTS strategy for identification of biosafe compounds, which might be rapidly repurposed to overcome resistance of tumors to Pt-based chemotherapy.

While police chiefs are the main managers in policing, this chapter also underlines their role in the provision of forensic science, hardly known to be able to help define policing. A recent survey of high-ranking officers of various police forces in Quebec showed that police managers tend to focus mainly, if not exclusively, on the ability of forensic science to serve justice. It is therefore argued that the police managers’ conception of forensic science may hinder its potential to be proactively implemented in policing models. This situation should be addressed, as a more holistic application of forensic science could offer relevant insights to policing, including threat identification and resource allocations.

According to the registered databases of air accidents around the world, landing overruns are the most probable accidents among all runway excursion events. Although new aircraft are enhanced with the latest technologies that improve the maneuvers safety, the frequency of landing overruns are bound to increase because of the ascending growth rate of annual traffic. The principal scope of this paper is to evaluate the functionality of Engineered Materials Arresting System (EMAS) as a mitigation strategy to reduce the possible consequences of landing overrun events and in particular to determine if installing an EMAS can help land-locked airports to meet Federal Aviation Administration (FAA) recommendations in order to upgrade their Runway End Safety Areas (RESAs). In the previous studies, not enough investigations are dedicated to predicting the behavior of the aircraft and its deceleration rate after interfering EMAS and how different materials as arrestor beds would modify aircraft braking distance in RESA. Therefore, secondary objective of this paper is to determine the most optimum height of EMAS slabs, in function of execution costs and accident severity reduction rate. In this regard, a MATLAB®-based numerical code, which simulate the tire-pavement interface, is developed in order to evaluate the functionality of EMAS for aircraft ground maneuvers. Although this code is developed for both dry and wet runway conditions, dry runway’s surface is selected as the boundary condition of this study. It simulates aircraft arresting distance by calculating a dynamic skid resistance between aircraft main gear and runway pavement with a fix time step. The results are plotted as risk contour intervals on the layout of EMAS that is installed at the RESA. In addition, this numerical code is adopted in order to perform a sensitivity analysis on five arresting bed materials, which consist of three low-density concretes with maximum crushing stress thresholds of 172500, 345000 and 930000 Pa, one gravel-based material and one foam aggregate-based mixture. Among all, low-density concrete with the highest crushing strength causes shorter aircraft arresting distance.

The summary presented herein represents Part I of the two-part series dedicated to Advanced Prostate Cancer: AUA/ASTRO/SUO Guideline discussing prognostic and treatment recommendations for patients with biochemical recurrence without metastatic disease after exhaustion of local treatment options as well as those with metastatic hormone-sensitive prostate cancer. Please refer to Part II for discussion of the management of castration-resistant disease.The systematic review utilized to inform this guideline was conducted by an independent methodological consultant. A research librarian conducted searches in Ovid MEDLINE (1998 to January Week 5 2019), Cochrane Central Register of Controlled Trials (through December 2018), and Cochrane Database of Systematic Reviews (2005 through February 6, 2019). An updated search was conducted prior to publication through January 20, 2020. The methodology team supplemented searches of electronic databases with the studies included in the prior AUA review and by reviewing reference lists of relevant articles.The Advanced Prostate Cancer Panel created evidence- and consensus-based guideline statements to aid clinicians in the management of patients with advanced prostate cancer. Such statements are summarized in figure 1[Figure: see text] and detailed herein.This guideline attempts to improve a clinician's ability to treat patients diagnosed with advanced prostate cancer. Continued research and publication of high-quality evidence from future trials will be essential to improve the level of care for these patients.

Purpose: In metastatic castrate-sensitive prostate cancer (mCSPC), combined androgen axis inhibition is a standard of care. Noninvasive biomarkers that guide initial therapy decisions are needed. We hypothesized that CellSearch circulating tumor cell (CTC) count, an FDA-cleared assay in metastatic castrate-resistant prostate cancer (mCRPC), is a relevant biomarker in mCSPC. Experimental Design: SWOG S1216 is a phase III prospective randomized trial of androgen deprivation therapy (ADT) combined with orteronel or bicalutamide for mCSPC. CellSearch CTC count was measured at registration (baseline). Prespecified CTC cut-off points of 0, 1–4, and ≥5 were correlated with baseline patient characteristics and, in a stratified subsample, were also correlated with two prespecified trial secondary endpoints: 7-month PSA ≤0.2 ng/mL versus 0.2–4.0 versus >4.0 (intermediate endpoint for overall survival); and progression-free survival (PFS) ≤ versus >2 years. Results: A total of 523 patients submitted baseline samples, and CTCs were detected (median 3) in 33%. Adjusting for two trial stratification factors (disease burden and timing of ADT initiation), men with undetectable CTCs had nearly nine times the odds of attaining 7-month PSA ≤ 0.2 versus > 4.0 [OR 8.8, 95% confidence interval (CI), 2.7–28.6, P < 0.001, N = 264] and four times the odds of achieving > 2 years PFS (OR 4.0, 95% CI, 1.9–8.5, P < 0.001, N = 336) compared with men with baseline CTCs ≥5. Conclusions: Baseline CTC count in mCSPC is highly prognostic of 7-month PSA and 2-year PFS after adjusting for disease burden and discriminates men who are likely to experience poor survival outcomes.