Search

Background: The Pediatric Eating Assessment Tool (PEDI-EAT-10) is a reliable and valid tool for rapid identification of dysphagia in patients aged 18 months to 18 years. Aims: To translate and adapt the PEDI-EAT-10 into the Italian language and evaluate its validity and reliability. Methods & Procedures: The translation and cross-cultural adaptation of the tool consisted of five stages: initial translation, synthesis of the translations, back translation, expert committee evaluation and test of the prefinal version. The internal consistency of the translated tool was analysed in a clinical group composed of 200 patients with special healthcare needs aged between 18 months and 18 years. They were consecutively enrolled at the Rare Disease Unit, Paediatrics Department, Fondazione Policlinico Agostino Gemelli-IRCCS, Rome. For test-retest reliability, 50 caregivers filled in the PEDI-EAT-10 questionnaire for a second time after a 2-week period. Construct validity was established by comparing data obtained from patients with data from healthy participants (n = 200). The study was approved by the local ethics committee. Outcomes & Results: Psychometric data obtained from patients (104 M; mean age = 8.08 ± 4.85 years; median age = 7 years) showed satisfactory internal consistency (Cronbach's a = 0.89) and test-retest reliability (Pearson r = 0.99; Spearman r = 0.96). A total of 30% of children were classified as having a high risk of penetration/aspiration. The Italian PEDI-EAT-10 mean total score of the clinical group was significantly different from that resulting from healthy participants. Conclusions & Implications: The PEDI-EAT-10 was successfully translated into Italian, validated and found to be a reliable one-page rapid screening tool to identify dysphagia in children and adolescents with special needs.

In this article, we analyse teacher professional development in five European countries (Italy, Germany, France, England and Finland), comparing their approaches to teacher professional learning and development (PLD). We performed this task using a general framework based on what several studies highlighted so far as key-features in educational systems. PLD is a recent example of change inside the domain of teaching. It represents not only an evolution but also a break with both previously used notions of in-service training and continuous professional development (CPD). We can speak of PLD as an evolutionary process that generates innovative professional competencies. Competencies are a key-feature of expert professionals, characterised by quicker and deeper perception of a relationship between objects, extended use of analysis before to act, more complex frameworks of situations, wider specific knowledge and meta-cognitive control over task performance.

In order to evaluate the effect of a policy or treatment with pre- and post-treatment outcomes, we propose an approach based on a transition model, which may be applied with multivariate outcomes and accounts for unobserved heterogeneity. This model is based on potential versions of discrete latent variables representing the individual characteristic of interest and may be cast in the hidden (latent) Markov literature for panel data. Therefore, it can be estimated by maximum likelihood in a relatively simple way. The approach extends the difference-in-difference method as it is possible to deal with multivariate outcomes. Moreover, causal effects may be expressed with respect to transition probabilities. The proposal is validated through a simulation study, and it is applied to evaluate educational programs administered to pupils in the sixth and seventh grades during their middle school period. These programs are carried out in an Italian region to improve non-cognitive skills (CSs). We study if they impact also on students' CSs in Italian and Mathematics in the eighth grade, exploiting the pretreatment test scores available in the fifth grade. The main conclusion is that the educational programs aimed to develop noncognitive abilities help the best students to maintain their higher cognitive abilities over time.

Literature highlights how education in the twenty-first century begins to advocate multiple new concepts, such as new technology, new pedagogies, interdisciplinary curricula, open learning, etc. Among these concepts, the recognition and awareness about one's character strengths are demonstrated to improve emotional management and individual/group's quality of life. We studied three fifth-grade Italian classes using an emerging educational model called IARA to verify if it can truly improve emotional literacy, characters strengths awareness, and cohesion in ten-years children. To demonstrate its efficacy, we used Bloom's Taxonomy and Sociogrammatic study. We proved that the IARA could be an efficient model to improve one's character strengths and class milieu awareness.

This study is aimed at exploring how different formulations of the same mathematical item may influence students' answers, and whether or not boys and girls are equally affected by differences in presentation. An experimental design was employed: the same stem-items (i.e., items with the same mathematical content and question intent) were formulated differently and administered to a probability sample of 1647 students (grade 8). All the achievement tests were anchored via a set of common items. Students' answers, equated and then analysed using the Rasch model, confirmed that different formulations affect students' performances and thus the psychometric functionality of items, with discernible differences according to gender. In particular, we explored students' sensitivity to the effect of a typical misconception about multiplication with decimal numbers (often called "multiplication makes bigger") and tested the hypothesis that girls are more prone than boys to be negatively affected by misconception.

The COVID-19 crisis has strongly affected the school system. In Italy, at-distance forms of didactics have been activated, changing the physiognomy of schools in terms of social interaction, practices and the identity of the individuals. In this paper, we address the issue of how teachers are facing the crisis: our focus is on assessment, as a key variable catalyzing personal history; beliefs; the interface between students; teachers and the school system. We study teachers' beliefs as part of their identities and assessment as a fundamental variable of beliefs. A qualitative content analysis of the open-ended answers to an online questionnaire is carried out to understand the main characteristics associated with assessment by teachers and the obstacles to overcome in the context of long distance learning (LDL). The data show that teachers did not identify valid assessment methods for LDL during the lockdown, especially due to the lack of control over the students. A misconception emerges concerning the definition of formative assessment together with a new awareness of the possibilities offered by digital technologies regarding the individualization of didactics. This study helps to understand which teachers' beliefs are related to assessment are and how they are shaped.

Background: The Montreal Children's Hospital Feeding Scale (MCH-FS) allows paediatricians and other health care professionals to identify feeding difficulties among children. Aim: To translate and adapt the MCH-FS into Italian, and to evaluate the validity and reliability of this Italian version of the Montreal Children's Hospital Feeding Scale (I-MCH-FS). Methods & Procedures: A total of 150 children with special healthcare needs were admitted to the Rare Disease Unit of the Paediatrics Department at the Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy, between March 2021 and March 2022 (74 males; mean age = 3.85 ± 1.96 years; median age = 4 years; age range = 6 months-6 years and 11 months) and 150 healthy participants (83 males; mean age = 3.5 ± 1.98 years; median age = 3 years; age range = 6 months-6 years and 11 months) were included in the study, which was approved by the local ethics committee. The original version of the MCH-FS was translated and cross-cultural adapted through five stages: (1) initial translation, (2) synthesis of the translations, (3) back translation, (4) expert committee and (5) test of the prefinal version. Test-retest reliability and internal consistency were assessed using Pearson r, Spearman r and Cronbach's alpha, respectively. Construct validity was established by comparing data obtained from patients with those of healthy participants using the Mann-Whitney U-test. Outcomes & Results: A Pearson "r" of 0.98, a Spearman "r" of 0.95 and Cronbach's alpha value of 0.86 were obtained. In the clinical group, 40.6% children were classified as having feeding disorders (n = 61), while in the normative group 4.7% were diagnosed with feeding problems (n = 7). Mean total score of the clinical group was significatively different from the normative's. Conclusions & Implications: The I-MCH-FS is a valid and reliable one-page, quick screening tool used to identify feeding disorders among children with special needs in outpatient paediatric setting.

Simple Summary: Cytoreductive surgery and intraperitoneal chemotherapy (HIPEC or PIPAC) are effective treatment options for peritoneal carcinomatosis from various primary diseases. An accurate pre-operative assessment and multidisciplinary evaluations are crucial in identifying the most suitable treatment approaches. This study aims to present a case series from a high-volume center to contribute valuable data to the existing literature on peritoneal carcinomatosis managing. Background: Advances in cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) and pressurized intraperitoneal aerosol chemotherapy (PIPAC) have improved outcomes for selected patients with peritoneal surface malignancies (PSMs). Methods: This retrospective study analyzed 743 PSM patients treated at Fondazione Policlinico Universitario Agostino Gemelli from January 2016 to February 2024. The primary aim was to assess median overall survival (mOS), median disease-free survival (mDFS), and median progression-free survival (mPFS) stratified by tumor origin. Secondary outcomes examined the role of diagnostic laparoscopy in the management of PSMs and intra- and postoperative complications' rates. Results: A total of 1113 procedures were performed: 389 CRS, 370 PIPAC, and 354 diagnostic laparoscopies. Colorectal cancer was the predominant indication for CRS (52.4%), with a mOS of 52 months and mDFS of 22 months. Patients affected by gastric cancer undergoing CRS had a mOS of 18 months and a mDFS of 13 months, while PIPAC yielded a mOS of 9 months and a mPFS of 4 months. Among patients with pseudomyxoma peritonei undergoing CRS, the 5-year DFS rate was 64.1%, and OS rate was 89%. Patients affected by mesothelioma and treated with CRS exhibited a median OS of 43 months and a DFS of 26 months. Pancreatic and hepatobiliary cancers were treated with PIPAC, with a respective mOS of 12 and 8 months. Postoperative complications occurred in 12.6% of CRS, 3.2% of PIPAC, and 1.7% of diagnostic laparoscopies. High peritoneal cancer index (PCI), gastric resection, and blood loss over 500 mL were identified as risk factors for major complications in a multivariate analysis. Conclusions: Developing a highly experienced multidisciplinary team is crucial for delivering tailored treatment strategies which aim to achieve optimal oncological outcomes while preserving patients' quality of life. [ABSTRACT FROM AUTHOR]

The research described in this paper focused on the issue of describing and understanding how mathematical discussion develops in a hybrid learning environment, and how students participate in it. The experimental plan involved several classes working in parallel, with pupils and teachers interacting both in their real classrooms and in a digital environment with other pupils and teachers. The research was based on a rich set of data collected from the M@t.abel 2020 project, which was developed in Italy during the COVID health crisis. Based on Complementary Accounts Methodology, the data analysis presented in this paper involved specialists from the fields of mathematics education and inclusive education. In the study we considered the complexity of learning and the different elements that have an impact on students' activity and participation, when they are engaged in mathematical discussions within the multilevel-digital environment that emerged due to the pandemic. These parallel analyses showed that 'mathematical discussion in the classroom' is a complex (and sometimes chaotic) phenomenon wherein different factors interweave. A complementary approach assists in developing a global vision for this dynamic phenomenon and in highlighting local episodes that are crucial in this interplay of factors. It is precisely in these episodes that the role of the teacher is fundamental: these episodes appear as catalysts for the different variables, with the teacher acting as mediator.

Although it is well-established that female participation in study abroad programmes is higher than the male participation, less is known about how this gap has changed over time. Using student-level data from the nationally representative surveys of three European countries (France, Germany and Italy), this paper begins by examining changes in the relationship between gender and participation in study abroad programmes between the beginning of the 2000s and the mid-2010s. It then explores to what extent these changes can be explained by different characteristics of men and women. The results suggest that in none of the countries there is evidence of a systematic decline over time in women's over-representation in study abroad programmes. However, the size of the gap is consistently significantly reduced (or even the sign of the gap reversed) once gender differences in observable traits are accounted for. Field of study and academic performance are important factors contributing to the gender disparity in study abroad.

Although many studies on international student mobility have examined the impact of individual factors (e.g., gender, age, family background) on students' decisions to study abroad, much less attention has been devoted to the role played by the institutional climate and characteristics of their home university. Using data from an Italian survey containing information on a large number of university students, this research investigated the extent to which a more international academic environment incentivizes students to participate in study abroad programs. A logit model was developed to estimate the effect that the degree of internationalization of one's home university has on the probability that its students will study abroad, while controlling for several student-level factors. The empirical estimates indicate that this effect is significant, suggesting that being part of an international academic environment, where domestic students can interact more frequently with international students, helps motivate them to undertake study abroad. This result stresses the importance of engaging domestic students in the internationalization process of their universities.

In this paper we interpret pervasive difficulties with second degree inequalities as a macro-phenomenon emerging from Large Scale Assessment. In line with the theory of reification, we link common students' difficulties to approaches they use that undermine the intertwining of processes and the ensuing emergent mathematical objects. To frame the movement from process to object, we network the theory of objectification with Duval's semio-cognitive approach. We conclude that students' difficulties can be traced back to a disruption of the dialectical movement between process and object. Thus, the students lose the link to meaning, rooted in mathematical activity, and handle semiotic transformations out of the object-sign relation. Such a phenomenon is conceived as a macro-phenomenon emerging from the Italian educational system.

Childhood physical maltreatment may contribute to the onset of borderline personality disorder (BPD) features in adolescence; however, the mechanisms explaining this association warrant investigation. This study focused on insecure attachment styles as mediators in this relationship among a sample of adolescents. Analyses were also conducted to determine whether gender moderated the association between physical maltreatment and BPD features. The sample consisted of 529 Italian adolescents between 14 and 18 years (Mage = 16.48, SD = 1.37). Participants completed a survey including three self-report questionnaires: CTQ-SF, ASQ, and BPI. Physical abuse was related to BPD features through insecure-anxious and insecure-avoidant attachment styles, whereas physical neglect was associated with BPD features only through insecure-avoidant attachment. Gender moderated the pathway between physical maltreatment and BPD features so that boys who experienced childhood physical abuse and neglect reported more BPD features than girls. This study expanded our knowledge of the role of insecure attachment styles in the onset of BPD features among adolescents with early experiences of childhood physical maltreatment. This study also advances our understanding of potential gender differences in the childhood maltreatment-BPD features link in adolescents. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: In the past 2 years, the COVID‐19 pandemic had a robust negative impact on the mental health of healthcare providers, with increasing rates of depression, anxiety, acute stress and burnout.Healthcare workers experiencing poor mental health are reluctant to seek help and treatment because they are afraid of being stigmatized and excluded by their colleagues and employers.During the pandemic positive emotions, resilience and psychological well‐being buffered distress and burnout in healthcare workers. What this paper adds to existing knowledge?: This paper describes positive mental health, depression, anxiety and burnout in healthcare workers during the second wave of the pandemic.Forty‐eight per cent of healthcare workers were flourishing (high levels of positive emotions and well‐being), 10% languishing (absence of well‐being and positivity).Flourishing individuals reported lower levels of depression, anxiety and burnout.These findings documented a relevant number of resilient healthcare workers, who restored/maintained their well‐being also under stressful conditions.Vulnerable healthcare workers were less than 20%, and they reported severe anxiety, depression and burnout.No differences emerged between languishing and moderate mental health groups in their levels of anxiety, depression and burnout. What are the implications for practice?: The condition of flourishing is the only one that provides protection from depression and anxiety and burnout, while moderate mental health does not differ substantially from the languishing state.The study confirms the importance of maintaining and/or promoting the well‐being of healthcare workers.Interventions for promoting positive mental health of vulnerable workers are needed.Mental health nurses can have the skills and expertise for evaluating early symptoms of psychological distress and for implementing interventions for promoting and restoring well‐being.These interventions may include informational campaign (i.e. preparing and distributing pamphlets and guidelines) and emotional support programmes (psychoeducation and training, mental health support team, peer support and counselling) that can be delivered also via digital platforms. Introduction: Few studies focused on healthcare workers' positive mental health (i.e. high levels of psychological well‐being) and its association with anxiety, depression and burnout in the second wave of the pandemic. Aims: To evaluate the protective role of well‐being in buffering burnout and psychological distress. Methods: We evaluated 173 Italian healthcare workers with indicators of psychological distress (Depression Anxiety Stress Scales [DASS]‐21), burnout (Copenhagen Burnout Inventory [CBI]) and positive mental health (Mental Health Continuum) and we cross‐classified them according to their levels of mental health (flourishing, languishing and moderate mental health) and their levels of anxiety, depression and burnout. Results: Forty‐eight per cent of health workers were classified as flourishing, 10% as languishing and 42% as moderate mental health. Flourishing individuals presented lower scores on DASS and CBI scales, whereas no differences emerged between languishing and moderate mental health groups. More than 80% of health workers with clinically significant symptoms of anxiety, depression and risk of burnout were classified as not flourishing. Discussion: This investigation documented the presence of flourishing mental health in almost half of the sample of Italian healthcare workers. However, those with moderate or languishing mental health manifested higher levels of anxiety, depression and higher risks of burnout. Implication for Practice: The study confirms the importance of maintaining and/or promoting the well‐being of this population, with a crucial role of mental health nurses who can easily approach other healthcare workers and provide them informational (training, guidelines) and emotional support programmes (psychoeducation, mental health support team, peer support and counselling) when facing adverse working conditions. [ABSTRACT FROM AUTHOR]

Background: Rimegepant, a novel oral calcitonin gene-related peptide receptor antagonist, has been recently approved for the acute migraine treatment. While its efficacy was confirmed in randomized clinical trials, no data is available regarding real-life effectiveness and tolerability. GAINER, a prospective, multicentric study, aimed to evaluate rimegepant effectiveness and tolerability in the real-world setting. Methods: Our study involved 16 headache centers across Italy. The main outcomes were: i) 2 h pain freedom, and ii) occurrence of treatment-emergent adverse events after administration. Participants were instructed to treat one migraine attack with rimegepant 75 mg orally disintegrating tablet. Using an ad hoc diary, participants prospectively collected migraine attack features at baseline and every 30 min after rimegepant administration, up to 2 h post dose. A 24 h follow up was also collected. Results: We enrolled 103 participants with migraine (74.8% female, mean age 44.4 [42.0 – 46.7] years, 24.3% with chronic migraine of whom 44.0% presented a concomitant diagnosis of medication overuse headache). The number of previously failed preventive classes was 2.7 [2.3 – 3.2]. Participants presented a mean of 9.6 [8.2 – 10.9] monthly migraine days at baseline. At rimegepant intake, 40.8% of patients rated migraine intensity as severe. Pain freedom 2 h post dose was reported in 44.7% (46/103) of individuals. Pain freedom 2 h post dose was not influenced by baseline pain severity (p = 0.316), but it was associated with timing of intake (p = 0.032) with a higher rate of 2 h pain freedom when rimegepant was taken within 1 h from pain onset. Mild adverse events were reported in 15.5% total attacks (16/103), predominantly fatigue (n = 6), gastrointestinal symptoms (n = 6), somnolence (n = 4), and transient cognitive difficulties (n = 3). Tolerability was rated as good-to-excellent in 85.4% cases (88/103). Conclusions: Our data confirms rimegepant effectiveness and safety in the acute migraine treatment in a real-world setting in a cohort of participants that includes subjects with episodic or chronic migraine, medication overuse and a high number of prior preventive treatment failures. Trial registration: The study was preregistered on clinicaltrial.gov, NCT05903027. [ABSTRACT FROM AUTHOR]

Italian economic thought between the 1960s and 1990s provided important scientific contributions and one of its most authoritative representatives was certainly Augusto Graziani (1933–2014). On the international plane, Graziani is mainly known for his monetary theory of production while his theory of development and his analysis of the Italian economic have drawn relatively little debate. The purpose of this work is to illustrate his analysis of development in the light of two main considerations: (i) Graziani was very interested in long-term development issues for a long time. The 1969 collective book Lo sviluppo di un'economia aperta (The development of an open economy), the various editions of his L'economia italiana (The Italian economy) (1972, 1979 and 1989) and his contributions on the economy of Southern Italy (Mezzogiorno) are part of an organic, continuous, detailed and impressive explanatory work of the economic events that affected Italy from the 1950s onward and on which Graziani devoted more than thirty years of his scientific activity. (ii) His analysis of development offers interesting tools for interpreting the effects of some Italian policy choices critically debated by a part of the contemporary literature. [ABSTRACT FROM AUTHOR]

We report a multicenter experience of open conversions (OC) for aortic endograft infections (AEI). We retrospectively analyzed all patients who underwent OC for AEI after endovascular aneurysm repair (EVAR), from 1997 to 2021 in 12 Italian centers. The endpoints were as follows: mortality (30-days, in-hospital), major postoperative complications. Follow-up data included: survival, aortic-related complications, infection persistence or reoccurrence. Fifty-eight patients (mean age: 73.8 ± 6.6 years) were included. Median time from EVAR to OC was 14 months (interquartile range 7–45). Thirty-five patients (60.3%) were symptomatic at presentation. Aortic reconstruction was anatomic in 32 patients (55.2%), extra-anatomic in 26 (44.8%). Thirty-day mortality was 31% (18/58). Six additional patients died after 30 days during the same hospitalization (in-hospital mortality: 41.4%). Most common post-operative complications included respiratory failure (38.6%) and renal insufficiency (35.1%). During 28.1 ± 4 months follow-up, 4 aneurysm-related deaths were recorded. Infection re-occurred in 29.4% of the patients. Estimated survival was 50% at 1 year, and 30% at 5 years, and was significantly lower for patients who underwent extra-anatomic reconstructions (37 vs 61% at 1 year, 16 vs 45% at 5 years; log-rank P =.021). OC for AEI is associated with high early mortality. The poor mid-term survival is influenced by aortic complications and infection re-occurrence. [ABSTRACT FROM AUTHOR]

Copyright of Mediterranea - Ricerche Storiche is the property of Mediterranea-Ricerche Storiche and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Our Hospital in Northern Italy assists 3817 people living with HIV (PLWH) and has faced the impact of COVID-19. Little is known about the impact of HIV infection on the risk of post-COVID-19 conditions (PCCs) onset. We aim to assess the incidence of PCC in PLWH and the factors associated with its occurrence. Methods: We performed a retrospective, observational study including all PLWH > 18 years registered in the Brescia Health Protection Agency database, assessing SARS-CoV-2 burden, vaccination status, socio-demographic, and viro-immunological parameters from February 2020 until May 2022. Persistence of self-reported symptoms (clustered into gastrointestinal, respiratory, osteo-muscular, and neuro-behavioral symptoms) was evaluated after 3 months by a telephone-administered questionnaire. We estimated the associations between all variables and outcomes through univariate and multivariable logistic models. Results: In the study period, 653 PLWH were diagnosed with SARS-CoV-2 infection (17.1%). We observed 19 (2.9%) reinfections, 71 (10.9%) hospitalizations, and 3 (0.5%) deaths. We interviewed 510/653 PLWH (78%), and 178 (PCCs prevalence 34.9%; CI 95% 30.7–39.2) reported persistent symptoms. Asthenia/fatigue was the most reported symptom (60/178), followed by muscular pain (54/178). In the multivariate regression model, there was a lower risk of PCCs in males respect to females (adjusted OR = 0.64; CI 95% 0.99–3.66), while hospitalization during acute infection was associated with an increased the risk of PCCs (adjusted OR = 1.9; CI 95% 0.99–3.66). Notably, no viro-immunological variable modified the PCCs risk onset. Conclusions: Our study highlights a substantial prevalence of PCCs among PLWH, three months post-SARS-CoV-2 infection, independent of viro-immunological features or vaccination status. [ABSTRACT FROM AUTHOR]

Simple Summary: Despite the promising results of radiomics for the characterisation of primary prostate cancer, its use in clinical practice is still limited due to a lack of results validation. In this study, we validated a previously published radiomics signature in a bicentric setting. Then, we also explored the role of the previously identified radiomics features if models are trained on new data. Furthermore, we investigated the performance of radiomics analysis if feature selection and model training are performed in the bicentric cohort. Results show that radiomics models work well when tested in their development settings, but generalise poorly to new datasets, thus warning about the need to interpret with caution results from single-centre studies or studies lacking proper external validation. Background: PSMA PET radiomics is a promising tool for primary prostate cancer (PCa) characterisation. However, small single-centre studies and lack of external validation hinder definitive conclusions on the potential of PSMA PET radiomics in the initial workup of PCa. We aimed to validate a radiomics signature in a larger internal cohort and in an external cohort from a separate centre. Methods: One hundred and twenty-seven PCa patients were retrospectively enrolled across two independent hospitals. The first centre (IRCCS San Raffaele Scientific Institute, Centre 1) contributed 62 [68Ga]Ga-PSMA-11 PET scans, 20 patients classified as low-grade (ISUP grade < 4), and 42 as high-grade (ISUP grade ≥ 4). The second centre (Stanford University Hospital, Centre 2) provided 65 [68Ga]Ga-PSMA-11 PET scans, and 49 low-grade and 16 high-grade patients. A radiomics model previously generated in Centre 1 was tested on the two cohorts separately and afterward on the entire dataset. Then, we evaluated whether the radiomics features selected in the previous investigation could generalise to new data. Several machine learning (ML) models underwent training and testing using 100-fold Monte Carlo cross-validation, independently at both Centre 1 and Centre 2, with a 70–30% train–test split. Additionally, models were trained in one centre and tested in the other, and vice versa. Furthermore, data from both centres were combined for training and testing using Monte Carlo cross-validation. Finally, a new radiomics signature built on this bicentric dataset was proposed. Several performance metrics were computed. Results: The previously generated radiomics signature resulted in an area under the receiver operating characteristic curve (AUC) of 80.4% when tested on Centre 1, while it generalised poorly to Centre 2, where it reached an AUC of 62.7%. When the whole cohort was considered, AUC was 72.5%. Similarly, new ML models trained on the previously selected features yielded, at best, an AUC of 80.9% for Centre 1 and performed at chance for Centre 2 (AUC of 49.3%). A new signature built on this bicentric dataset reached, at best, an average AUC of 91.4% in the test set. Conclusions: The satisfying performance of radiomics models when used in the original development settings, paired with the poor performance otherwise observed, emphasises the need to consider centre-specific factors and dataset characteristics when developing radiomics models. Combining radiomics datasets is a viable strategy to reduce such centre-specific biases, but external validation is still needed. [ABSTRACT FROM AUTHOR]

In the frame of national Italian standardized assessments in mathematics, a didactic phenomenon has been observed concerning students' behaviour when answering an item: students are inclined towards not accepting an output which is not clearly recognizable with something distinct from the starting inputs. The observed effect seems to originate from the teacher-student relationship and could be described as a typical didactic contract situation but it also affects the general relationship between the student and mathematics. Adopting a mixed-method apparatus including large-scale assessments results, questionnaires and interviews, we can describe several behavioural features related to the observed phenomenon. In particular, we show how it is present in different grades and in pupils of different abilities. We consider the 'ruling principle' as a connecting concept for the different constructs used here to analyse this phenomenon, i.e. an organizational or normative criterion that shapes the action of the student facing a mathematical task.

Simple Summary: Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a new surgical procedure used in the treatment of peritoneal surface malignancies (PSMs). Despite encouraging clinical results, the high costs of PIPAC and the need to repeat the treatment multiple times make the procedure difficult to sustain economically. A retrospective study was conducted in order to evaluate the cost of hospitalization for patients undergoing PIPAC treatment at a high-volume center in Italy. Currently, the Italian National Health System only partially covers the hospitals' costs. Therefore, there is an urgent need for an economical redefinition of this procedure, by creating dedicated reimbursement codes. PIPAC is a new surgical procedure and a viable treatment option for PSM patients, due to promising therapeutic outcomes, minimal invasiveness, limited surgical morbidity, and systemic toxicity side effects. However, its implementation throughout hospitals is hard to obtain due to its fragile economical sustainability. A retrospective health economic analysis was conducted in order to evaluate the cost of hospitalization for patients undergoing PIPAC treatment at Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, in Rome. The average cost of a PIPAC procedure was defined based on the cost of surgery (cost of surgical material, operating room, intraperitoneal chemotherapy), hospital stay, diagnostic examinations, and drugs used during the stay. A total of 493 PIPAC procedures were performed on 222 patients with peritoneal metastases or primary peritoneal cancer from 2017 to 2023. Since the mean remuneration for each PIPAC hospitalization is €5916 and the mean expenditure per hospitalization is €6538, this results in an operating profit per PIPAC hospitalization of −€622. The reimbursement of PIPAC treatment by the Italian National Health System currently only partially covers the hospital's costs. Development of specific codes and adequate reimbursement for PIPAC by recognizing this procedure as a proper treatment for peritoneal carcinomatosis is essential. [ABSTRACT FROM AUTHOR]

In our everyday life, we often need to anticipate the potential occurrence of events and their consequences. In this context, the way we represent contingencies can determine our ability to adapt to the environment. However, it is not clear how agents encode and organize available knowledge about the future to react to possible states of the world. In the present study, we investigated the process of contingency representation with three eye-tracking experiments. In Experiment 1, we introduced a novel relational-inference task in which participants had to learn and represent conditional rules regulating the occurrence of interdependent future events. A cluster analysis on early gaze data revealed the existence of 2 distinct types of encoders. A group of (sophisticated) participants built exhaustive contingency models that explicitly linked states with each of their potential consequences. Another group of (unsophisticated) participants simply learned binary conditional rules without exploring the underlying relational complexity. Analyses of individual cognitive measures revealed that cognitive reflection is associated with the emergence of either sophisticated or unsophisticated representation behavior. In Experiment 2, we observed that unsophisticated participants switched toward the sophisticated strategy after having received information about its existence, suggesting that representation behavior was modulated by strategy generation mechanisms. In Experiment 3, we showed that the heterogeneity in representation strategy emerges also in conditional reasoning with verbal sequences, indicating the existence of a general disposition in building either sophisticated or unsophisticated models of contingencies.

Allergic rhinitis (AR) is the most frequent IgE-mediated disease, mainly in children and adolescents. Management of AR in the pediatric age may be heterogeneous, and the available guidelines do not adequately consider this issue. As a result, the Italian Society of Pediatric Allergy and Immunology (SIAIP) promoted a Delphi Consensus to define and evaluate the most relevant aspects of AR management in the pediatric setting in Italy. A qualified board of experts prepared a list of statements that a panel of Italian experts voted on using a web platform. Forty-two pediatricians participated. The results showed that all statements had consensus (> 80% of scores 4 + 5). In particular, there was awareness that AR is a type 2 inflammatory disease requiring adequate treatment. Topical drugs should be preferred, as they are better with cycles. Combined antihistamine/corticosteroid is also considered effective and safe in adolescents. In conclusion, AR deserves adequate attention and care. Current medications are safe and effective; treatment should be addressed to dampen type 2 inflammation and relieve complaints. [ABSTRACT FROM AUTHOR]

Fish otoliths from three localities in northern Italy (Piedmont), Grazzano, Rio Freddo di Albugnano and Valle Ceppi, ranging in age from late Oligocene (Chattian) to Early Miocene (Burdigalian) are described herein. One of these localities, Rio Freddo di Albugnano, straddles the Oligocene/Miocene boundary, and the otoliths are interpreted to reflect a late Oligocene age. The other two localities are from the upper Burdigalian (Lower Miocene). The otolith assemblages described herein complement previously described associations from the northern Mediterranean region and contain a total of 68 species-level taxa, 16 of which are new and 12 remain in open nomenclature. The upper Oligocene strata yielded 24 species and the Lower Miocene strata 48 species; four species are shared. The results are compared with previous studies and discussed. Deepwater taxa are abundant in the assemblages, particularly those pertaining to the mesopelagic family Myctophidae. The otolith assemblage fills a stratigraphic gap in the record of this family in Europe and thus contributes to refinement of stratigraphic ranges of myctophid species. The otolith assemblages are also compared with coeval assemblages known from other regions of the world and their paleobiogeographic significance is discussed. Myctophid species particularly show often a very wide geographic distribution pattern across ocean basins during the Miocene similar to that characteristic of this family today. In combination with refined stratigraphic ranges of myctophid species, this wide geographic distribution could ultimately become useful as a biostratigraphic tool in a supra-regional perspective. [ABSTRACT FROM AUTHOR]

Background: The shortage of hospital beds for COVID-19 patients has been one critical cause of Emergency Department (ED) overcrowding. Purpose: We aimed at elaborating a strategy of conversion of hospital beds, from non-COVID-19 to COVID-19 care, minimizing both ED overcrowding and the number of beds eventually converted. Research Design: Observational retrospective study. Study Sample: We considered the centralized database of all ED admissions in the Lombardy region of Italy during the second "COVID-19 wave" (October to December 2020). Data collection and Analysis: We analyzed all admissions to 82 EDs. We devised a family of Monte Carlo simulations to evaluate the performance of hospital beds' conversion strategies triggered by ED crowding of COVID-19 patients, determining a critical number of beds to be converted when passing an ED-specific crowding threshold. Results: Our results suggest that the maximum number of patients waiting for hospitalization could have been decreased by 70% with the proposed strategy. Such a reduction would have been achieved by converting 30% more hospital beds than the total number converted in the region. Conclusions: The disproportion between reduction in ED crowding and additionally converted beds suggests that a wide margin to improve the efficiency of the conversions exists. The proposed simulation apparatus can be easily generalized to study management policies synchronizing ED output and in-hospital bed availability. [ABSTRACT FROM AUTHOR]

Background: Malignant Distal Biliary Obstruction (MBDO) is a common event occurring along the natural history of both pancreatic cancer and cholangiocarcinoma. Epidemiological and biological features make MBDO one of the key elements of the clinical management of patients suffering for of pancreatic cancer or cholangiocarcinoma. The development of dedicated biliary lumen-apposing metal stents (LAMS) is changing the clinical work up of patients with MBDO. i-EUS is an Italian network of clinicians and scientists with a special interest in biliopancreatic endoscopy, EUS in particular. Methods: The scientific methodology was chosen in line with international guidance and in a fashion similar to those applied by broader scientific associations. PICO questions were elaborated and subsequently voted by a broad panel of experts within a simplified Delphi process. Results and conclusions: The manuscripts describes the results of a consensus conference organized by i-EUS with the aim of providing an evidence based-guidance for the appropriate use of the techniques in patients with MBDO. [ABSTRACT FROM AUTHOR]

After disruption in the influenza circulation due to the emergence of SARS-CoV-2, the intensity of seasonal outbreaks has returned to the pre-pandemic levels. This study aimed to evaluate the evolution and variability of whole-genome sequences of A(H1N1)pdm09, the predominant influenza virus in Sicily (Italy) during the season 2023–2024. The potential vaccine efficacy was calculated using the pepitope model based on amino acid changes in the dominant epitope of hemagglutinin. The HA gene sequences showed several amino acid substitutions, some of which were within the major antigenic sites. The phylogenetic analysis showed that Sicilian strains grouped into two main genetic clades (6B.1A.5a.2a.1 and 6B.1A.5a.2a) and several subclades. Notably, about 40% of sequences partially drifted from the WHO-recommended vaccine strain A/Victoria/4897/2022 for the Northern Hemisphere. These sequences mostly belonged to the subclades C.1.8 and C.1.9 and harboured the amino acid mutations responsible for the modest predicted vaccine efficacy (E = 38.12% of 53%, pepitope = 0) against these viruses. Amino acid substitutions in other gene segments were also found. Since influenza viruses are constantly evolving, genomic surveillance is crucial in monitoring their molecular evolution and the occurrence of genetic and antigenic changes, and, thus, their potential impact on vaccine efficacy. [ABSTRACT FROM AUTHOR]

Background: Nowadays, video-assisted thoracic surgery (VATS) lobectomy represents the treatment of choice for early-stage lung cancer. Over the years, different methods for VATS training have evolved. The aim of this study is to present an innovative beating-heart filled-vessel cadaveric model to simulate VATS lobectomies. Methods: Via selective cannulation of the cadaver heart, the pulmonary vessels were filled with a gel to improve their haptic feedback. An endotracheal tube with a balloon on its tip then allowed movement of the heart chambers, transmitting a minimum of flow to the pulmonary vessels. A simulated OR was created, using all instrumentation normally available during surgery on living patients, with trainees constantly mentored by experienced surgeons. At the end of each simulation, the participants were asked 5 questions on a scale of 1 to 10 to evaluate the effectiveness of the training method ("1" being ineffective and "10" being highly effective). Results: Eight models were set up, each with a median time of 108 min and a cost of €1500. Overall, 50 surgeons were involved, of which 39 (78%) were consultants and 11 (22%) were residents (PGY 3–5). The median scores for the 5 questions were 8.5 (Q1; IQR1–3 8-9), 8 (Q2; IQR1–3 7–9), 9 (Q3; IQR1–3 8–10), 9 (Q4; IQR1–3 8–10), and 9 (Q5; IQR1–3 8–10). Overall, the model was most appreciated by young trainees even though positive responses were also provided by senior surgeons. Conclusions: We introduce a new beating-heart filled-vessel cadaveric model to simulate VATS lobectomies. From this initial experience, the model is cost effective, smooth to develop, and realistic for VATS simulation. [ABSTRACT FROM AUTHOR]

Background: In Italy, Diagnosis-Related Groups (DRGs) have been adopted for hospital services reimbursement. In some Italian regions, nurse staffing allocation is purely volume-based, with different minutes/patient/day categories determined by the type of hospital ward. The Information System of Nursing Performance (SIPI) is a valid and reliable tool assessing nursing care complexity as an indicator of the actual nursing care demand. Evidence is lacking about the ability of current resource allocation methods to account for the nursing care demand. Objective: To evaluate the association between (1) DRG rates and nursing care complexity and (2) hospital ward categories of nurse staffing and nursing care complexity. Methods: All patients discharged from the medical department of an Italian hospital over a data collection period were eligible. To assess the association between nursing care complexity (SIPI) and DRGs, the distribution of the DRG rate (median and first–third quartile) was compared for cases with high or low complexity. To evaluate the association between nursing care complexity (SIPI) and nurse staffing, the frequency of high complexity within nurse staffing categories (120/180/240 min/patient/day) was compared. Because the sample was very large, methods of statistical inference were not applied, and only descriptive measures were reported. Results: 6872 hospitalizations were included. The median DRG rate for high and low complexity admissions were very similar (EUR 3536 and EUR 3285, respectively). The proportion of admissions with high complexity decreased for wards with higher staffing allocation rates. Conclusion: DRG reimbursement and the nurse staffing allocation systems were ineffective in accounting for nursing care complexity. The SIPI could help identify areas requiring more financial and staffing resources for nursing care. [ABSTRACT FROM AUTHOR]

Several technologies have been introduced into neurorehabilitation programs to enhance traditional treatment of individuals with Spinal Cord Injury (SCI). Their effectiveness has been widely investigated, but their adoption has not been properly quantified. The aim of this study is to assess the distribution of conventional (Treatment As Usual—TAU) and technology-aided (Treatment With Technologies—TWT) treatments conveniently grouped based on different therapeutic goals in a selected SCI unit. Data from 104 individuals collected in 29 months were collected in a custom database and categorized according to both the conventional American Impairment Scale classification and a newly developed Multifactor (MF) clustering approach that considers additional sources of information (the lesion level, the level of independence in the activities of daily living, and the hospitalization duration). Results indicated an average technology adoption of about 30%. Moreover, the MF clusters were less overlapped, and the differences in TWT adoption were more pronounced than in AIS-based clustering. MF clustering was capable of grouping individuals based both on neurological features and functional abilities. In particular, individuals with motor complete injuries were grouped together, whereas individuals with sensorimotor incomplete SCI were collected separately based on the lesion level. As regards TWT adoption, we found that in the case of motor complete SCI, TWT for muscle tone control and modulation was mainly selected (about 90% of TWT), while the other types of TWT were seldom adopted. Even for individuals with incomplete SCI, the most frequent rehabilitation goal was muscle tone modulation (about 75% of TWT), regardless of the AIS level, and technologies to improve walking ability (about 12% of TWT) and balance control (about 10% of TWT) were mainly used for individuals with thoracic or lumbar lesions. Analyzing TAU distribution, we found that the highest adoption of muscle tone modulation strategies was reported in the case of individuals with motor complete SCI (about 42% of TAU), that is, in cases when almost no gait training was pursued (about 1% of TAU). In the case of cervical motor incomplete SCI, compared to thoracic and lumbar incomplete SCI, there was a greater focus on muscle tone control and force recruitment in addition to walking training (38% and 14% of TAU, respectively) than on balance training. Overall, the MF clustering provided more insights than the traditional AIS-based classification, highlighting differences in TWT adoption. These findings suggest that a wider overview that considers both neurological and functional characteristics of individuals after SCI based on a multifactor analysis could enhance the personalization of neurorehabilitation strategies. [ABSTRACT FROM AUTHOR]

A new fossil gray whale genus and species, Glaucobalaena inopinata, is established based on craniomandibular remains from the Pliocene Sabbie d'Asti Formation, Piedmont, northwestern Italy. The holotype (MGPT-PU 19512) consists of two cranial fragments corresponding to the posterolateral corners of the skull, including both partial periotics, and in the posterior portion of the right mandibular ramus preserving the condyle and angular process. The new taxon is characterized by gray whale (eschrichtiid) synapomorphies in the posterior portion of the mandible (dorsally raised mandibular condyle with articular surface faced dorsoposteriorly, well-developed and robust angular process of the mandible) and in the earbone (massive transverse elongation of the pars cochlearis, indistinct flange of the ventrolateral tuberosity, and triangular and short anterior process of the periotic). A CT scan of the cranial fragments allowed us to reconstruct tridimensional renderings of the periotic, revealing the dorsal morphology of this bone. A phylogenetic analysis confirmed the inclusion of Glaucobalaena inopinata within Eschrichtiidae (the family to whom gray whales are included) and showed that it is monophyletic with Gricetoides aurorae; our phylogenetic results show that Eschrichtioides gastaldii is the sister group of the genus Eschrichtius. Our work lends further support to the idea that Eschrichtiidae is a separate family of baleen whales, characterized by specialized ecomorphological characters evident in both skull and mandibular architecture. [ABSTRACT FROM AUTHOR]

Simple Summary: In situ/microinvasive adenocarcinoma of the uterine cervix represents the majority of cervical glandular lesions and can be treated conservatively. In contrast to squamous lesions, approximately 15–20% of glandular disease may be HPV-negative and therefore associated with a worse prognosis. Furthermore, up to 4% of cases may show recurrence after three years of follow-up. Given the abovementioned risk, knowing the predictive factors of disease recurrence becomes crucial for post-treatment management. In the present study, HPV testing in follow-up was the best predictor for recurrences in women with in situ/microinvasive AC undergoing conservative treatment. So, its use in clinical practice is of pivotal importance. However, attention should be paid to non-high-risk HPV women in follow-up with non-usual-type histopathology, given that it seems to represent a sub-population at increased risk of recurrences. Objective: The present study aimed to assess long-term follow-up outcomes in women with in situ/microinvasive adenocarcinoma (AC) of the uterine cervix treated conservatively. Methods: Retrospective multi-institutional study including women with early glandular lesions and 5-year follow-up undergoing fertility-sparing treatment. Independent variables associated with recurrence were evaluated. Logistic regression analysis and Kaplan–Meier survival analysis with Logrank test were performed. Results: Of 269 women diagnosed with in situ/microinvasive AC, 127 participants underwent conservative treatment. During follow-up, recurrences were found in nine women (7.1%). The only factor associated with recurrence during follow-up was positive high-risk Human Papillomavirus (hr-HPV) testing (odds ratio 6.21, confidence interval 1.47–26.08, p = 0.012). HPV positivity in follow-up showed a recurrence rate of 21.7% against 3.8% in patients who were HPV-negative (p = 0.002, Logrank test). Among women with negative high-risk HPV tests in follow-up, recurrences occurred in 20.0% of non-usual-type histology vs. 2.1% of usual-type cases (p = 0.005). Conclusion: HPV testing in follow-up is of pivotal importance in women with early glandular lesions undergoing conservative treatment, given its recurrence predictive value. However, women who are high-risk HPV-negative in follow-up with non-usual-type histopathology may represent a sub-population at increased risk of recurrences. Further studies should confirm these findings. [ABSTRACT FROM AUTHOR]

Purpose: Higher education institutions draw up codes of ethics, but in several countries there are no standards to follow. Most universities have autonomy and can freely draw up their codes of ethics in terms of structure and content. The purpose of this paper is to understand the main ethics issues that universities identify in their codes of ethics and what activities they implement to respond to these issues toward appropriate educational management of their institutions in ethical terms. Design/methodology/approach: This study was performed through content analysis of codes of ethics of Italian public universities (64 codes), and may be considered a single in-depth case study. The main ethics issues and related activities were inductively codified in relation to the research purpose. The four constitutive aspects of business ethics (individual, managerial, organizational and societal ethics) proposed by Melé were chosen as the framework to investigate the main ethical needs and related activities implemented by universities to respond to these ethical issues. Findings: This research has identified nine main ethical issues and related activities that contribute to guarantee the ethical compliance of universities under the four interrelated aspects different individual behaviors, managerial initiatives, organization strategies and responsibilities toward society. The analysis shows some relevant differences among Italian universities that have important implications in the ethical vision of academic communities and of managerial role in universities. Practical implications: The research can help managers of higher education institutions to identify the main ethical issues to draw up codes of ethics and to formulate consistent development strategies that are able to improve the conditions of collaboration, work and productive participation in activities for all members of academic communities. Originality/value: To the best of the authors' knowledge, this is one of the first studies that connect codes of ethics and higher education. This research brings to light the main ethical issues and related activities that universities can consider to orient their strategic choices toward the public interest as well as educational management improvement.

Introduction: Income inequality, a pivotal determinant of general and mental health, operates through intricate mechanisms at various geographical scales. While established at country or region levels, the impact of lower-level (municipal or neighborhood) inequality remains inconsistent. This study explores the influence of regional- and municipal-level income inequality on individual psychological distress during the COVID-19 pandemic in Italy, employing a multilevel data analysis. Materials and methods: In a post hoc analysis of data from the first wave of the pandemic (March to April 2020), three hierarchical levels were considered: individual participants, municipalities, and regions. Depressive and anxiety symptoms were measured using the PHQ-9 and GAD-7 scales, while the Gini coefficient gauged income inequality at municipal and regional levels. The analysis incorporated demographic variables as potential confounders. Results: The study encompassed 21 regions, 3,900 municipalities, and 21,477 subjects. Income inequality at both regional and municipal levels exhibited associations with distress scores, suggesting independent effects. Notably, higher distress scores were identified in southern regions with elevated inequality, despite a more substantial COVID-19 impact in the north. Discussion: Findings contribute to existing literature by emphasizing the independent impact of lower-level (municipal) and higher-level (regional) income inequality on population psychopathology. The study supports theories suggesting diverse pathways through which inequality at different levels influences health, such as potential associations with healthcare system dysfunction at the regional level and welfare dysfunction at the municipal level. The observed north-south gradient in distress scores highlights the need for psychosocial interventions to alleviate income inequality, especially in historically disadvantaged southern regions. Future research should explore the nuanced interplay between income inequality and various ecological variables to provide a comprehensive understanding of its health impact. [ABSTRACT FROM AUTHOR]

Pediatric asthma management is a compelling challenge for every pediatrician. Different aspects require attention and definition. The present Intersocietal Survey aimed to collect real-world experiences from a sample of Italian pediatricians. A web platform was used to collect anonymous answers to the survey questions. Four hundred four pediatricians participated in this initiative promoted by the Italian Society of Pediatric Allergy and Immunology (SIAIP), the Society of Preventive and Social Pediatrics (SIPPS), and the Federation of Italian Pediatricians (FIMP). The results showed an extensive participation of primary care pediatricians (72%). There was a large consensus about diagnostic criteria and medication choice. However, treatment duration and device choice were various. Adherence to guidelines on general aspects of practical clinical management was high. In conclusion, the present Intersocietal Survey confirmed that pediatric asthma management is rather satisfactory, even if further improvement should concern a more widespread use of ICS for acute asthma/wheezing attacks, a better definition of the duration of ICS and bronchodilator use, and hospital-primary care integration. [ABSTRACT FROM AUTHOR]

Background: Oncology nurses support cancer patients in meeting their self-care needs, often neglecting their own emotions and self-care needs. This study aims to investigate the variations in the five facets of holistic mindfulness among Italian oncology nurses based on gender, work experience in oncology, and shift work. Method: A cross-sectional study was carried out in 2023 amongst all registered nurses who were employed in an oncology setting and working in Italy. Results: There were no significant differences in all five facets of holistic mindfulness (p ≥ 0.05) according to gender, work experience in the oncology field, and shift work. Conclusion: Could holistic mindfulness be defined as an intrinsic individual characteristic? Surely, more insights will be necessary to better define the holistic trend in oncology nursing. [ABSTRACT FROM AUTHOR]

Background: Influenza represents a serious public health threat, especially for the management of severe cases and complications of the disease, requiring the implementation of control measures. We aimed to assess the acceptance and impact of qLAIV vaccination among a representative sample of family paediatricians (FPs) operating in Palermo Local Health Authority (LHA). To this end we evaluated vaccination coverage rates, comparing it with that observed in Sicilian context, while actively monitoring possible adverse reactions and their severity. Methods: An observational descriptive non-controlled study was conducted in two phases, from September 2022 to June 2023. The first phase involved a formative and educational intervention with a pre-intervention questionnaire to assess the knowledge and attitudes of FPs on paediatric influenza vaccination. The second phase consisted of an active surveillance on qLAIV safety and acceptance among the paediatric population assisted by the participating FPs, from October 2022 to April 2023. Frequencies, chi-squared tests, and comparisons statistics were performed using Stata/MP 14.1. Results: The overall coverage rate among the paediatric population involved in the intervention was 13.2%, with an I.M./qLAIV ratio of vaccine administered of 1/4.25. This coverage rate was significantly higher (p-value <0.001) when compared to the average values reported in the population under the Palermo Local Health Authority (LHA) (6.7%) and in the entire Sicily (5.9%). Adverse events in the qLAIV group were mild, with only 3.3% experiencing them, primarily presenting as a feverish rise (3.2%). No severe adverse reaction was reported. Conclusions: The educational intervention significantly raised paediatric influenza vaccination rates among the participating FPs, and in general improved influenza vaccination coverage rates in the Palermo's LHU. Minimal, non-serious adverse events underscored the vaccine's safety. Training sessions ensured paediatricians stayed informed, enabling them to provide comprehensive information to parents for secure and informed vaccination decisions in their practices. [ABSTRACT FROM AUTHOR]

Several psychological dimensions influence the psychological adjustment of terminally ill cancer patients' caregivers, during the end-of-life phase. The present study explored the associations between attachment styles, mentalization, preparedness for death, and the severity of pre-loss grief symptoms in 102 caregivers of terminal cancer patients. The results of the network analysis showed that insecure attachment dimensions were positively associated with several central pre-loss grief symptoms. Mentalization and preparedness for death showed negative associations with several pre-loss grief symptoms. Interestingly, bitterness showed a negative association with need for approval and a positive association with mentalization. The results provided insight into the grieving process for palliative care providers to implement effective caregiver support interventions. [ABSTRACT FROM AUTHOR]

The San Michele Bridge in Paderno, Italy, is a prime example of the refurbishment of a historic structure. An architectural and historical landmark, it is the last of a remarkable group of trussed arch bridges built in the late XIX century to be fully operational, and serves the Seregno-Bergamo railway line and the provincial road SP54/166 connecting Paderno d'Adda and Calusco. In 2014, after 130 years of service, the bridge was subjected to an extensive survey and inspection campaign to acquire a more profound knowledge of the structure and its reliability. Overall, the inspections revealed that the bridge was still in a decent state but needed refurbishment. This article will briefly present the challenges faced in the design and execution of the refurbishment works. [ABSTRACT FROM AUTHOR]

Study of the relationships of fossil and living billfishes is crucial for understanding the ecological drivers that control their biodiversity through time and how distributional patterns of extant populations may be affected by current abiotic events. Here we describe six istiophorid species that lived sympatrically in the central Mediterranean Sea during the Late Miocene, based on fossil istiophorids from Italy. Of these, †Pizzikoskerma salentina, †Sicophasma macrocanalata, †Makaira adensa and †Makaira cyclovata are new, while †M. belgica and †M. cf. colonense were described previously. The taxon Istiophorus is reported here for the first time in the Tortonian based on an unidentified species. We reconstructed the evolutionary direction of morphological traits by including the earliest known billfish, †Hemmingwaya sarissa, in our phylogenetic analysis as outgroup. A bill with circular cross‐section, 12 caudal vertebrae, a slim body and elongated first dorsal fin are shown to be plesiomorphic traits, while 13 caudal vertebrae, fusiform body, a shorter and pointed first dorsal fin, lateral process and quadrangular spines on the vertebral centra are traits associated with larger body sizes. The Makaira species described here have trabecular bone in the premaxilla forming the rostrum, an unusual pattern interpreted as an adaptation to reduce weight while simultaneously increasing body size. The fossil billfish assemblage suggests sea‐surface temperatures between 23°C and 24°C, much warmer than the modern central portion of the Mediterranean. The exquisite preservation of one specimen shows a trophic interaction between marlins and barracudas, the first direct evidence of predator–prey relationships in fossil istiophorids. [ABSTRACT FROM AUTHOR]

Background: The treatment of aggressive behavior and agitation in pediatric patients with autism spectrum disorder (ASD) in the emergency department is topical and challenging. Case Presentation: We described an adolescent with autism spectrum disorder treated ten times in the pediatric emergency department for severe episodes of aggressiveness and agitation. After resolving the acute phase of these behavioural crises, sedation was maintained with a continuous infusion of dexmedetomidine to prevent the resurgence of agitation and to organize discharge properly, considering the family's needs. The continuous infusion of dexmedetomidine allowed the patient to remain asleep most of the time during his stay at the emergency department. No adverse events were recorded. Conclusions: The continuous infusion of dexmedetomidine could represent a safe and valuable tool to facilitate the permanence of the patient in the PED. [ABSTRACT FROM AUTHOR]

Purpose The incidence of endocrine sequelae following central nervous system (CNS) infections in pediatric age is not known. We conducted this scoping review to assess the incidence of endocrinological alterations in patients with prior CNS infections in pediatric age. Methods Our screening process included both randomized and non-randomized controlled trials. All types of observational studies, prospective and retrospective, have been included. Results Ten studies were included in our review. The cumulative number of patients in all of the studies was 211, the mean age of the population study was 4.9 (±5 years). The included papers described the following acute CNS infections: meningitis (nine studies reported eighty-five cases) and encephalitis (three studies described sixty-five cases). Two case reports and one retrospective study reported hypopituitarism as a consequence of Mycobacterium tuberculosis CNS infection. In five studies the patients developed endocrine comorbidities at the time of infection. Another study analyzed 49 young adults who previously had tuberculous meningitis at a mean age of 5.9 ± 5.0 years: seven patients had growth hormone deficiency, four of whom also had gonadotropin deficiency; the other three had gonadotropin deficiency, corticotropin deficiency, and mild hyperprolactinemia. Conclusion Standardized multidisciplinary follow-up and research of patients with prior CNS infection is crucial. Although pituitary reserve screening is not commonly performed in these patients, clinical and research centers should set up an endocrinological evaluation with monitoring of auxological parameters to detect the signs and symptoms of hypopituitarism early and to initiate the appropriate care in children with previous CNS infections. [ABSTRACT FROM AUTHOR]

Food supplements are defined as foodstuffs the purpose of which is to supplement the normal diet and which are concentrated sources of nutrients or other substances with a nutritional or physiological effect, often referred to as nutraceuticals, may exert benefit to the human body. Their use is increasing worldwide, including Europe and in Italy. However, some doctors are skeptical about their effectiveness and safety. This reluctance may depend on poor knowledge of the mechanisms of action and clinical evidence in literature. The Italian Society of Pediatric Allergy and Immunology (SIAIP) promoted the institution of an ad hoc Committee. The first initiative performed by this Committee was the administration of a questionnaire to the members of SIAIP. The results of this survey provided interesting results. Most pediatricians know the food supplement concept but frequently need help understanding the mechanisms of action. Most prescribe food supplements, mainly for preventing infections or enhancing immune defense. In addition, they prefer to use food supplements as cycles or add-on therapy. Finally, most participants like to attend events on this issue and contribute to new evidence through trials. In conclusion, this survey underscores the relevance of food supplement issues and attests to interest in this topic. However, there is a need to provide information and promote studies on this matter. [ABSTRACT FROM AUTHOR]

Pestalotioid fungi were isolated in pure culture from symptomatic plants of Callistemon laevis, C. viminalis, Luma apiculata (marketed as "Myrtus luma"), Myrtus communis subsp. tarentina, and M. communis var. microphylla (M. communis 'Microphylla'), showing twig canker, dieback and defoliation. The isolates were identified to species by ITS, tef1 and tub2 sequences, which revealed the presence of six species of Neopestalotiopsis (N. camelliae-oleiferae, N. hispanica, N. iberica, N. rosae, N. rosicola, and N. zakeelii) and one species of Pestalotiopsis (P. biciliata). While most species were isolated only once or twice, the majority of isolates belonged to N. rosae (13) and N. hispanica (8). Pathogenicity was investigated by pathogenicity tests on all hosts, which confirmed the pathogenicity of all Neopestalotiopsis species on at least some of the hosts tested, while P. biciliata did not cause any disease symptoms. Neopestalotiopsis hispanica and N. rosae caused symptoms in all hosts of the present study, while the other Neopestalotiopsis species tested showed no symptoms on Luma apiculata. [ABSTRACT FROM AUTHOR]

Hydrochemical and geophysical methods were used to assess saline paleo-water mass transfer induced by piston flow in the alluvial aquifer of the Oltrepò Pavese plain (northern Italy). The surface aquifer shows salinity contamination from a Tertiary substrate of marine origin, due to mixing of the shallower fresh groundwater with the Po Plain's deep brines. The study also used continuous monitoring of groundwater electrical conductivity, temperature and piezometric levels. Well logging and geophysical imaging, conducted at different times, revealed that the contamination varies over time, and that the water salinity and the depth of the transition zone (between the surface freshwaters and the deep saline waters) are subject to modifications. This is due to a pressure transfer—and, subsequently, mass transfer−from the groundwater circuits of the nearby Apennine mountains. It suggests that a hydraulic connection exists between the fractured Apennine water circuits and the deeper Mio-Pliocene and Tertiary saline-water circuits found below the plain's alluvial aquifer. Coinciding with significant recharge episodes that affect Apennine water circuits (prolonged rainfall and snow melt at mid-high altitudes), there is a pressure transfer transmitted along the water circuits in which saline water resides, providing an impulse to rise along the discontinuities and reach the alluvial aquifer. The conceptual model is supported by evidence that wells constructed in correspondence to hydraulically active tectonic discontinuities are affected by the arrival of saline waters with variable delays, while wells sited in sectors not affected by tectonic discontinuities are diluted by 'fresh' waters connected to alluvial aquifer recharge. [ABSTRACT FROM AUTHOR]