Search

Sleeping problems are prevalent among children and adolescents, often leading to frequent consultations with pediatricians. While cognitive-behavioral therapy has shown effectiveness, especially in the short term, there is a lack of globally endorsed guidelines for the use of pharmaceuticals or over-the-counter remedies in managing sleep onset insomnia. An expert panel of pediatric sleep specialists and chronobiologists met in October 2023 to develop practical recommendations for pediatricians on the management of sleep onset insomnia in typically developing children. When sleep onset insomnia is present in otherwise healthy children, the management should follow a stepwise approach. Practical sleep hygiene indications and adaptive bedtime routine, followed by behavioral therapies, must be the first step. When these measures are not effective, low-dose melatonin, administered 30–60 min before bedtime, might be helpful in children over 2 years old. Melatonin use should be monitored by pediatricians to evaluate the efficacy as well as the presence of adverse effects. Conclusion: Low-dose melatonin is a useful strategy for managing sleep onset insomnia in healthy children who have not improved or have responded insufficiently to sleep hygiene and behavioral interventions. What is Known: • Pediatric insomnia is a common disorder and impacts children's emotional, behavioral, and cognitive functioning, as well as parents' sleep and daytime functioning. • There is no consensus in Europe on the management of sleep onset insomnia and the use of melatonin in typically developing children. What is New: • A group of European experts has compiled a set of recommendations for the management of insomnia, developing a step-by-step approach. • Sleep hygiene, behavioral strategies, and finally low-dose melatonin represent valid strategies for managing sleep onset insomnia. [ABSTRACT FROM AUTHOR]

The use of SCC in Europe began in the 1990s and was mainly promoted by the precast industry. Precast companies generally prefer high early-strength concrete mixtures to accelerate their production rate, reducing the demoulding time. From a materials science point of view, self-compacting and high early-strength concrete mixes may be challenging because they present contradicting mixture design requirements. For example, a low water/binder ratio (w/b) is key to achieving high early strength. However, it may impact the self-compacting ability, which is very sensitive to Vw/Vp. As such, the mixture design can be complex. The design of the experimental approach is a powerful tool for designing, predicting, and optimising advanced cement-based materials when several constituent materials are employed and multi-performance requirements are targeted. The current work aimed at fitting models to mathematically describe the flow ability, viscosity, and mechanical strength properties of high-performance self-compacting cement-based mortars based on a central composite design. The statistical fitted models revealed that Vs/Vm exhibited the strongest (negative) effect on the slump-flow diameter and T-funnel time. Vw/Vp showed the most significant effect on mechanical strength. Models were then used for mortar optimisation. The proposed optimal mixture represents the best compromise between self-compacting ability—a flow diameter of 250 mm and funnel time equal to 10 s—and compressive strength higher than 50 MPa at 24 h without any special curing treatment. [ABSTRACT FROM AUTHOR]

Background: Aortic valve stenosis (AS) is the most common primary valvular heart disease leading to surgical or percutaneous aortic valve replacement (AVR) in Europe and its prevalence keeps growing. While other risk factors in severe AS are well documented, little is known about the prognostic value of left atrial (LA) function in AS. Our aim is to clarify the relationship between LA function measured at severe AS diagnosis (evaluated by means of volumetric assessment) and all-cause mortality during follow-up.Methods: We retrospectively evaluated patients diagnosed with severe AS for the first time at our echocardiography laboratory. We evaluated LA reservoir, conduit and pump function by measuring LA volumes at different timings of cardiac cycle. Treatment strategy was decided according to heart team consensus and patient decision. We divided patients into groups according to terciles of LA reservoir, conduit and pump function. Primary outcome was defined by the occurrence of all-cause mortality during follow-up.Results: A total of 408 patients were included in the analysis, with a median follow-up time of 45 months (interquartile range 54 months). 57.9% of patients underwent AVR and 44.9% of patients registered the primary outcome during follow-up. Left atrial emptying fraction (LAEF) was the best LA functional parameter and the best overall parameter in discriminating primary outcome (AUC 0.845, 95%CI 0.81-0.88, P < 0.001). After adjustment for clinical, demographic and echocardiographic variables, cumulative survival of patients with LAEF < 37% and LAEF 37 to 53% relative to patients with LAEF ≥54% remained significantly lower (HR 13.91, 95%CI 6.20-31.19, P < 0.001 and HR 3.40, 95%CI 1.57-7.37, P = 0.002, respectively). After adjustment for AVR, excess risk of LAEF < 37% and LAEF 37 to 53% relative to LAEF ≥54% remained significant (HR 11.71, 95%CI 5.20-26.40, P < 0.001 and HR 3.59, 95%CI 1.65-7.78, P = 0.001, respectively).Conclusions: In patients with a first diagnosis of severe AS, LA function, evaluated by means of volumetric assessment, is an independent predictor of all-cause mortality and a more potent predictor of death compared to classical severity parameters. These data can be useful to identify high-risk patients who might benefit of AVR. [ABSTRACT FROM AUTHOR]

Drosophila melanogaster is an important model for antiviral immunity in arthropods, but very few DNA viruses have been described from the family Drosophilidae. This deficiency limits our opportunity to use natural host-pathogen combinations in experimental studies, and may bias our understanding of the Drosophila virome. Here, we report fourteen DNA viruses detected in a metagenomic analysis of 6668 pool-sequenced Drosophila , sampled from forty-seven European locations between 2014 and 2016. These include three new nudiviruses, a new and divergent entomopoxvirus, a virus related to Leptopilina boulardi filamentous virus, and a virus related to Musca domestica salivary gland hypertrophy virus. We also find an endogenous genomic copy of galbut virus, a double-stranded RNA partitivirus, segregating at very low frequency. Remarkably, we find that Drosophila Vesanto virus, a small DNA virus previously described as a bidnavirus, may be composed of up to twelve segments and thus represent a new lineage of segmented DNA viruses. Two of the DNA viruses, Drosophila Kallithea nudivirus and Drosophila Vesanto virus are relatively common, found in 2 per cent or more of wild flies. The others are rare, with many likely to be represented by a single infected fly. We find that virus prevalence in Europe reflects the prevalence seen in publicly available datasets, with Drosophila Kallithea nudivirus and Drosophila Vesanto virus the only ones commonly detectable in public data from wild-caught flies and large population cages, and the other viruses being rare or absent. These analyses suggest that DNA viruses are at lower prevalence than RNA viruses in D.melanogaster , and may be less likely to persist in laboratory cultures. Our findings go some way to redressing an earlier bias toward RNA virus studies in Drosophila , and lay the foundation needed to harness the power of Drosophila as a model system for the study of DNA viruses. [ABSTRACT FROM AUTHOR]

The paper presents an analysis of the basic parameters of Ro-Pax ships and double-ended ferries. The study was carried out within the framework of the project METRO (Maritime Environment-friendly TRanspOrt systems), funded from 2014-2020 Interreg V-A Italy-Croatia CBC Programme. The aim of the project is an improvement of the environmental sustainability in the field of maritime transport, with particular emphasis on multimodality and "green" solutions for the coastal transport. The specific focus is on touristic connections in the North Adriatic area. One of the project goals is a development of short-medium range hybrid ships and of concern are Ro-Pax ships and double-ended ferries, which are the most common ship types for coastal shipping in the Adriatic area. Two extensive databases were created encompassing a large number of ferries that operate in Europe, by one for each ship type. The databases will serve as basis for the preliminary design of the new hybrid Ro-Pax ship and double-ended ferry. [ABSTRACT FROM AUTHOR]

Background: In Europe, the enhanced safety surveillance (ESS) of seasonal influenza vaccines is mandatory, in order to detect any potential increase in reactogenicity when the vaccine composition is updated. The MF59®‐adjuvanted influenza vaccine (Fluad™) is the first and the only licensed adjuvanted seasonal influenza vaccine in Europe. Objective: Our objective was to summarize the safety data of Fluad™ over three consecutive seasons. Methods: A passive approach to ESS (EPSS) was adopted, in which reporting of spontaneous adverse events (AEs) by vaccinees and vaccine exposure was estimated, in order to generate a near real‐time reporting rate. EPSS was conducted in Italy during the 2015, 2016, and 2017 influenza seasons in the primary care setting. All AEs reported within 7 days following immunization were analyzed by season, type and seriousness. Fisher's exact test was used to compare frequencies between seasons. Results: Total exposure accounted for approximately 1,000 doses of Fluad™ for each season. A total of 0.5% (2015), 0.7% (2016), and 0.5% (2017) individual case safety reports (ICSRs) were received, corresponding to a total of 9 (2015), 18 (2016), and 12 (2017) spontaneous AEs. The frequencies of AEs of interest were below those expected on the basis of the known safety profile of the vaccine. Most AEs were mild‐to‐moderate in severity. No between‐season difference was found. Conclusions: Our analyses confirmed that the safety data observed were consistent with the known safety profile of Fluad™, which has been amply established over the last 20 years. No significant changes in the safety profile were observed. [ABSTRACT FROM AUTHOR]

Geohistorical retrospective analysis attempts to establish the location of industrial mineral extractive sites. This paper is based on a study of the Rotunda of Mosta, a feat in architectural engineering structures inspired by the Pantheon in Rome. It was designed and erected in local Lower Globigerina Limestone. This Neoclassical church is the third largest unsupported masonry dome in the ecclesiastical architectural history of Europe. According to oral tradition, the architect Giorgio Grognet de Vassé had opted to use limestone from Ta' Vnezja in the limits of Mosta. A retrospective analysis of the geological fabric used in the construction of the church proves that the limestone was not from this area but from a locality in its close proximity, namely Ta' Qali. Although the geology present at both sites was considered similar at the time of erecting the church and the respective relative suitability for use as dimension stone was known, the limestone at Ta' Vnezja is lithologically different from Ta' Qali. At both these localities quarries were sunk in their lithostratigraphic sub-formation namely the Middle Globigerina Limestone Member and the Lower Globigerina Limestone Member respectively. [ABSTRACT FROM AUTHOR]

Peer assessment provides students with multiple benefits during their learning process. The aim of our study is to examine students’ perception of peer assessment. Questionnaires were administered before and after the peer-assessment process to 416 students studying 11 different subjects in four different fields taught at the University of Girona. Results suggest that students have a positive predisposition towards this methodology, both before and after its implementation. Students perceive it as a both motivating and recommended methodology that facilitates the acquisition of learning at different levels. As for its limitations, students highlight the responsibility that comes with it and a certain amount of distrust in fellow students’ abilities to peer-assess. [ABSTRACT FROM PUBLISHER]

Purpose – The purpose of this paper is to discuss the potentialities of innovative accounting tools in supporting “transparency” and “resource allocation” in public hospitals, by describing the implementation of a pilot project of time-driven activity-based costing (TDABC). Design/methodology/approach – An interventionist research (IR) approach has been adopted: two medical doctors, three financial controllers and three researchers were involved. Collection of data used to implement the accounting model is based on hospital databases and interviews. Findings – The information produced may allow a higher coherence between resources and activities. TDABC may enhance transparency and support decisions toward a better organization of work and an informed allocation of resources. Research limitations/implications – Further studies are required to analyze decisions following the implementation of the TDABC model. Originality/value – The accounting literature lacks case studies describing the application of TDABC in hospital settings, despite its good informative potentialities and the limited investment required to introduce TDABC. Moreover, the use of the IR approach and the involvement of medical doctors may help to get coherence between accounting data and clinical work and may support the further diffusion and development of this costing model in hospitals. [ABSTRACT FROM AUTHOR]

In this paper we demonstrate the potential of combining electric hybridization with a dual-fuel natural gas-Diesel engine. We show that carbon dioxide emissions can be reduced to 43 gram per kilometer with a subcompact car on the New European Driving Cycle (NEDC). The vehicle is operated in charge-sustaining mode, which means that all energy is provided by the fuel. The result is obtained by hardware-in-the-loop experiments where the engine is operated on a test bench while the rest of the powertrain as well as the vehicle are simulated. By static engine measurements we demonstrate that the natural gas-Diesel engine reaches efficiencies of up to 39.5%. The engine is operated lean at low loads with low engine out nitrogen oxide emissions such that no nitrogen oxide aftertreatment is necessary. At medium to high loads the engine is operated stoichiometrically, which enables the use of a cost-efficient three-way catalytic converter. By vehicle emulation of a non-hybrid vehicle on the Worldwide harmonized Light vehicles Test Procedure (WLTP), we demonstrate that transient operation of the natural gas-Diesel engine is also possible, thus enabling a non-hybridized powertrain as well. [ABSTRACT FROM AUTHOR]

The present paper describes standardized procedures within clinical sleep medicine. As such, it is a continuation of the previously published European guidelines for the accreditation of sleep medicine centres and European guidelines for the certification of professionals in sleep medicine, aimed at creating standards of practice in European sleep medicine. It is also part of a broader action plan of the European Sleep Research Society, including the process of accreditation of sleep medicine centres and certification of sleep medicine experts, as well as publishing the Catalogue of Knowledge and Skills for sleep medicine experts (physicians, non-medical health care providers, nurses and technologists), which will be a basis for the development of relevant educational curricula. In the current paper, the standard operational procedures sleep medicine centres regarding the diagnostic and therapeutic management of patients evaluated at sleep medicine centres, accredited according to the European Guidelines, are based primarily on prevailing evidence-based medicine principles. In addition, parts of the standard operational procedures are based on a formalized consensus procedure applied by a group of Sleep Medicine Experts from the European National Sleep Societies. The final recommendations for standard operational procedures are categorized either as 'standard practice', 'procedure that could be useful', 'procedure that is not useful' or 'procedure with insufficient information available'. Standard operational procedures described here include both subjective and objective testing, as well as recommendations for follow-up visits and for ensuring patients' safety in sleep medicine. The overall goal of the actual standard operational procedures is to further develop excellence in the practice and quality assurance of sleep medicine in Europe. [ABSTRACT FROM AUTHOR]

In recent years in Italy, as in other European countries, profound changes have been introduced in health care both at central and regional levels. Most of them were oriented towards a shift from 'hospital-centred' health care to health care based more on primary care services. This transition pursues two objectives: giving more effective responses to citizens' needs and reducing public health expenditure. Changes that involve organizational structure must also be carried out with the introduction of measurement tools that can help in planning and can control the changes. The paper provides the results obtained through the experience of modelling a measurement system for primary care carried out in 2004 and 2005 by some territorial managers and controllers in the Tuscan Health system, and the main issues in measuring primary care services emerging from this pilot experience focused on integrated home care services. [ABSTRACT FROM AUTHOR]

The production of canned fish has decreased in recent years; however, several European countries still consume large amounts of these products. It is well known that such products may contain some toxic metals such as mercury, cadmium and lead. in order to determine the level of these three elements in canned seafood, several products were analyzed (more than 1800 samples). The mean total mercury level was 0.12 ± 0.14 mg/kg wet weight, with the highest content found in canned tuna. However, such values did not exceed the proposed limit for tuna by EU (1.0 mg/kg). All analyzed samples showed lead levels lower than the indicated limits. On the other hand, a few samples (less than 2%) of canned tuna and squid exceeded the limit values proposed for cadmium, 0.1 and 1.0 mg/kg, respectively. Taking into account the way in which these products are consumed, it can be concluded that canned seafood products do not represent a risk in terms of human diet. [ABSTRACT FROM AUTHOR]

Helicoverpa armigera is a major pest on a wide range of crops in Europe, Africa, Asia and Australia. Insecticide treatments are currently indispensable for its control in almost all crops, which has resulted in insecticide resistance occuring in some situations. However, since information about insecticide resistance of H. armigera in Europe is very limited, the current resistance status of this pest was investigated in Spain from 1995 to 1999. Toxicological bioassays were conducted in the laboratory, LD50''s estimated by probit analysis and resistance factors (RF) calculated at the LD50 level. Eleven chemicals, including endosulfan, carbamates (carbaryl, methomyl, thiodicarb) and organophosphates (chlorpyrifos, fenitrothion, methamidophos, azinphos-methyl, trichlorphon, acephate, monocrotophos) were tested. Ninety-seven percent of insecticide–strain combinations showed susceptibility (RF=1) or low insecticide resistance (RF=2–10) (157 of 162, 97%). Moderate resistance (RF=11–18) was only recorded to carbamates (carbaryl, methomyl and/or thiodicarb) in five strains. Insecticide resistance of H. armigera in Spain was therefore not as high or widespread as in other areas of the world. Since insecticide pressure against the pest in Spain is not likely to be lower, nor IPM implementation better, than elsewhere, additional factors that potentially account for low levels of insecticide resistance of H. armigera, including migration and cropping structure leading to the existence of refugia are discussed from an agroecological perspective. [Copyright &y& Elsevier]

Abstract. On looking at the female labour supply in Europe, it is immediately noticed that there is a large variation among countries. One possible explanation for this fact is that different countries have different tax policies, leading to variations in incentive and costs. This has been investigated in papers such as that of Gustafsson (1992a,b) for countries such as Germany and Sweden. The same exercise has been performed by the present authors for a low-income, southern European country, Portugal, which has one of the highest rates of female participation (out of line with neighbouring countries). Female labour supply does not seem to be very sensitive to fiscal policies, as those policies have only a small influence on the take-home wage. This result appears to be independent of the fact that the female labour supply shows a higher elasticity to wages than that which has been reported for other countries. The present authors also show that Portuguese women contribute a much larger proportion of family earnings than do their counterparts in Sweden and Germany, and that the Portuguese fiscal system is rather neutral. Further studies with data from other countries are needed in order to shed more light on the issue of tax harmonization. [ABSTRACT FROM AUTHOR]

The authors discuss the concept of resilience and the importance of being clear about its particular significance to foster meaningful action to strengthen it to improve health and well-being. Topics covered include four types of resilience capacity that can be applied to individual, community, and system levels, the definition of individual level resilience according to the American Psychological Association, and the 2017 European Public Health Conference in Stockholm, Sweden.

Background: Predation and predator abundance may significantly affect bird populations, especially ground nesting species, because nest predation is often the major cause of nest failure. Predator control by means of culling is frequently employed to benefit threatened prey species or to increase the abundance of small game species for hunting. The red fox (Vulpes vulpes), a generalist mesopredator of global relevance, is a major target of predator control. Commonly, in central Europe, red fox culling efforts intended to benefit prey species remain restricted to small areas. It is unclear, however, whether such restricted-area culling effectively lowers predation risk at a site or whether red fox abundance is more important than culling in shaping predation risk. We conducted an experiment using 273 camera supervised artificial nests at multiple study sites in clusters of hunting concessions with or without targeted fox culling in a fragmented montane forest landscape in Germany. Results: Using generalized additive models, we assessed whether incentivized recreational culling of red foxes was associated with local reductions in an index of predation risk and fox occurrence probability, or whether both were explained by red fox abundance instead. Final models indicated that restricted-area culling of red foxes was not associated with local reductions in predation risk, nor lower probability of a fox sighting, even for the plots with the largest hunting bags. Predation risk at a plot instead appeared to be driven by variation in the abundance of red foxes in the landscape surrounding the plots. After accounting for fox abundance, we found no additional relationship of artificial nest predation risk with landscape configuration. Conclusions: Our results imply that the scale and intensity of predator control achieved by incentivized recreational hunting was ineffective at altering fox abundance patterns and associated predation risk. We thus find no evidence to support incentives for uncoordinated recreational red fox culling as a conservation measure. [ABSTRACT FROM AUTHOR]

Abstract: Background: Research on hepatitis C virus (HCV) prevalence among non-injecting drug treatment clients in the United States, Europe and Asia indicate substantial differences by place. To date, little or no research on HCV and non-injection drug use (NIDU) has been conducted in Mexico. Methods: We examined the prevalence of HCV, hepatitis B virus (HBV), and HIV among non-injecting drug users (NIDUs) in community-based drug treatment (N =122) and NIDUs in a prison-based drug treatment program (N =30), both located in west central Mexico. Results: Among the community clients, prevalence was 4.1% (95% confidence interval [CI]: 1.8–9.2) for HCV, 5.7% for HBV (95% CI: 2.8–11.4), and 1.6% for HIV (95% CI: 0.4–5.8). Among the in-prison clients, prevalence was 40.0% (95% CI: 24.6–57.7) for HCV, 20.0% for HBV (95% CI: 9.5–37.3), and 6.7% for HIV (95% CI: 1.9–21.3). None of the clients were aware of being infected. Conclusion: The HCV prevalence found for the NIDU community treatment clients ranks among the lower HCV estimates published for NIDUs in treatment to date. The prevalence found for the in-prison clients ranks among the higher, raising a concern of possible elevated HCV infection among NIDUs in the west central Mexico prison—one compounded by the finding that none of this study''s clients knew they were HCV positive. [Copyright &y& Elsevier]

Objective: To assess differences in the five year abdominal aortic aneurysm (AAA) sac regression rate after endovascular aneurysm repair (EVAR) in patients with and without diabetes mellitus (DM)., Methods: An international prospective registry (Europe, USA, Brazil, Australia, and New Zealand) of patients treated with the GORE EXCLUDER endograft. All scheduled EVARs for infrarenal AAA between 2014 and 2016 with complete five year imaging follow up were included. Emergency procedures, ancillary proximal procedures, and inflammatory and infectious aetiologies were excluded. Descriptive and inferential statistics, and Cox proportional hazards survival models were used. A control group of patients without DM with similar age and comorbidities was selected using propensity scores, matched in a 1:2 scheme., Results: A total of 2 888 patients (86.1% male; mean age 73.5 ± 8 years) was included, of whom 545 (18.9%) had DM. Patients with DM had higher rates of hypertension (89.2% vs. 78.4%), dyslipidaemia (76.0% vs. 60.7%), coronary artery disease (52.3% vs. 37.9%), and chronic renal impairment (20.9% vs. 14.0%) (all p < .001). The mean pre-procedural AAA diameter was 58.1 ± 10 mm. Five years post-EVAR, the type 1A endoleak rate was 1.1% (0.6% DM vs. 1.2% non-DM), the endograft related re-intervention rate was 7.3% (6.2% vs. 7.6%), the major adverse cardiovascular event (MACE) rate was 1.4% (1.1% vs. 1.5%), and aortic related mortality rate was 1.0% (0.6% vs. 1.2%), without statistically significant differences between groups. The overall five year mortality rate was higher in diabetics (36.3% vs. 30.5%; hazard ratio [HR] 1.30, 95% confidence interval [CI] 1.07 - 1.58; p = .001). No statistically significant differences were found in sac regression rate (≥ 5 mm) between diabetics and non-diabetics 70.0% vs. 73.1%; HR 0.88, 95% CI 0.75-1.04; p = .131. These differences remained statistically non-significant after excluding patients performed out of instructions for use (p = .61) and patients with types 1, 2 or 3 endoleaks (p = .39)., Conclusion: The paradoxical relationship between DM and AAA does not appear to result in differences in post-EVAR sac regression rates. However, even when controlling for other comorbidities, patients with DM undergoing EVAR may have a higher five year mortality rate., (Copyright © 2023 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)

SARS-CoV-2 virus has infected nearly 300 M people worldwide and has been associated with over 6 M deaths by March 2022. Since the virus emergence in December 2019 in Wuhan, several new mutations have been described. The World Health Organization has developed a working name for these emerging variants according to their impact on the worldwide population. In this context a high alert has been paid to variants of concern (VOC) due to their high infectiousness and transmissibility patterns. The most recent VOC, Omicron (B.1.1.529), has become dominant in the shortest time ever and has placed Europe under an overwhelming and unprecedented number of new cases. This variant has numerous mutations in regions that are associated with higher transmissibility, stronger viral binding, affinity and antibody escape. Moreover, the mutations and deletions present in the spike protein suggest that the SARS-CoV-2 specific attachment inhibitors may not be the best option for Omicron therapy. Omicron is the dominant variant circulating worldwide and, at the end of February 2022, it was responsible for nearly all sequences reported to GISAID. Omicron is made up of several sublineages, where the most common are BA.1 and BA.2 (or Nextstrain clade 21K and 21L, respectively). At a global level, it is possible to say that the proportion of BA.2 has been increasing relative to BA.1 and in some countries it has been replacing it at high rates. In order to better assess the Omicron effectiveness on antibody escape, spread and infectious ability it is of the highest relevance to maintain a worldwide tight surveillance. Even though this variant has been associated with a lower death rate, it is important to highlight that the number of people becoming infected is concerning and that further unpredictable mutations may emerge as the number of infected people rises., (© 2022 John Wiley & Sons Ltd.)