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The research on the multimodal transport development within the cross-border area is a result of identified gaps in the system solutions and cooperation between stakeholders of three countries: Poland, the Czech Republic and Slovakia. Freight transport is an especially complex problem. It is an area that is not comprehensively recognized in the context of cross-border cooperation. The results of the research presented in this paper are the continuation of analyses performed within the scope of the international project framework TRANS TRITIA. At the moment, transport policy assumes the struggle for the utilization of multimodality within freight transport. This is justified by the need to reduce external transport costs. At the same time, this necessitates actions of a technical, organizational, and legislation nature as well as cooperation between stakeholders. The multimodal transport ecosystem is a vision of the transport within cross-border areas that assumes the increase in the flow dynamics within the multimodal transport. The main goal of this paper was the stakeholders' analysis and identification of their roles in the ecosystem of multimodal freight transport within the Polish–Czech–Slovak cross-border area. The conceptualization of the multimodal freight transport ecosystem was essential to achieving the objective. To achieve the objective, a stakeholder analysis has been performed based on expert research. As a result of the research, organizational projects have been proposed to strengthen the idea of the coevolution of the multimodal transport ecosystem. The key conclusion from the performed research is the declaration that a holistic view of the multimodal transport ecosystem necessitates the appointment of a coordinator who will synchronize knowledge, business, and innovation ecosystems. [ABSTRACT FROM AUTHOR]

In this paper we have assessed the impact of the European Union's Emissions Trading Scheme (EU ETS) on the level of the carbon premium. The aim of the study is to determine whether there is a stable carbon premium in energy-intensive sectors. Unlike other studies, our research sample included not only companies in the energy sector, but also entities classified as energy-intensive. In the research, we used our own criterion for allocating companies to a clean and dirty portfolio, which made it possible to make the estimation of the carbon premium more resistant to changes in the rules for allocation of emission allowances. We detected a positive, statistically significant carbon premium in the years 2003–2012 and a negative one in the years 2013–2015, but we did not detect a statistically significant carbon premium in the period 2016–2019. This means that there are no grounds for concluding that there is a stable, positive carbon premium for energy-intensive companies subject to the EU ETS over time. We have also noticed that a significant problem in studying the impact of the EU ETS on the carbon premium is the use of static portfolios of clean and dirty companies [ABSTRACT FROM AUTHOR]

Energy efficiency programmes (EEPs) are schemes operated by utilities or other bodies in order to incentivize energy efficiency improvement, in particular by adoption of energy-efficient products and typically by means of an economic reward. Ample experience has been gained, especially in the U.S., where EEPs have been in use for decades, with the rationale of avoiding additional energy supply by improving energy efficiency. More recently, EEPs have been implemented in Europe and in Switzerland. This review paper presents insights from the U.S., the EU and especially from Switzerland, with a focus on levelised programme cost of saved energy (LPC) as a key performance indicator. These LPC values, which take the perspective of the programme operator, are typically low to very low compared to the cost of electricity supply, thereby representing an important argument in favour of their use. The country examples show that EEPs are being effectively and successfully put into practice, for example, in Switzerland both as (i) a national tender-based scheme (called ProKilowatt) and in the form of a (ii) utility-operated obligation-based scheme (in Geneva). EEPs not only call for diligent implementation but also for suitable legal settings, e.g., in the form of mandatory energy efficiency savings targets (as realised for energy efficiency obligations, EEOs) in combination with programme cost recovery. The main criticism of EEPs is the free-rider effect, which needs to be minimised. On the other hand, EEPs are accompanied by significant co-benefits (environmental, health-related and social) and spillover effects. In their currently prevalent form, EEPs allow one to effectively save energy at a (very) low cost ("low-hanging fruit"). They can hence play an important role in fostering the energy transition; however, they should be implemented as part of a policy portfolio, in combination with other policy instruments. [ABSTRACT FROM AUTHOR]

This study has compared Japan's major electricity and gas companies in terms of their corporate performance measures from 2002 to 2018 using three types of Data Envelopment Analysis (DEA) approaches. We develop a new type of efficiency measures and indexes for DEA and then compare the performance of major electric power companies and city gas companies by examining a recent data set that include years after the Fukushima Daiichi Nuclear Power Plant accident. The data set incorporates the number of patents as an output that represents companies' capability for technology innovation to investigate intertemporal changes of efficiency through index measures. The results provide us with two important findings. First, the electricity industry has experienced long-term difficulty due to the nuclear plant disaster; while the gas industry experienced less difficulty from the accident. Second, both industries have been gradually improving performance measures in recent years. However, the gas industry has outperformed the electricity industry. From the results, this study discusses important policy implications for Japan's energy utility industry and academic research on the industry. [ABSTRACT FROM AUTHOR]

In a post-pandemic context, destinations are questioning mass tourism, and are focusing on more sustainable segments, looking for more responsible tourists. This requires obtaining relevant information to assess what kind of tourists visit the destination and, at the same time, to monitor changes in tourists' behavior and attitudes. This study aims to respond to this challenge by creating a measure to assess the tourist's responsibility. Using a scale development method, a sequential mixed-method approach is conducted to identify scale dimensions and items. An initial qualitative approach is implemented for item generation using focus group and face-to-face interviews. Then, a second study based on a survey is conducted for exploratory factor analysis. A third study, also based on a survey is performed to obtain a new sample for confirmatory factor analysis. Findings show two dimensions: civic responsibility and philanthropic responsibility, allowing an understanding of how tourists can act responsibly in destinations without compromising the ecological footprint on the planet. Theoretical and managerial implications are discussed. [ABSTRACT FROM AUTHOR]

Forecasting the microeconomics of electricity will turn into a challenging process when electricity is produced through renewable energy technologies (RET). These technologies are mainly sunlight-based photovoltaic (PV), wind power, and tidal resources, which vigorously rely upon ecological conditions. For a reliable and livable energy supply to the electricity grid from renewable means, electrical energy storage technologies can play an important role while considering the weather effects in order to provide immaculate, safe, and continuous energy throughout the generation period. Energy storage technologies (ESTs) charge themselves during the low power demand period and discharge when the demand of electricity increases in such a way that they act as a catalyst to provide energy boost to the power grid. In this paper, we presented and discussed the renewable ESTs for each type with respect to their operational mechanism. In this regard, the renewable energy scenarios of Pakistan and Turkey are first discussed in detail by analyzing the actual potential of each renewable energy resource in both the countries. Then, policy for the EST utilization for both the countries is recommended in order to secure sustainable and reliable energy provision. [ABSTRACT FROM AUTHOR]

Coronavirus Disease 2019 (COVID-19) became a pandemic around the world and has huge impacts on our economic and social systems, particularly on the healthcare system and the transportation and energy sectors. To examine a relationship between healthcare and energy sectors in the COVID-19 era, we propose a holistic application of Data Envelopment Analysis for Environmental Assessment (DEA-EA) to assess the COVID-19 response performance of 33 OECD (Organization for Economic Co-operation and Development) nations and investigate whether health insurance systems contribute to the performance. We also associate the performance with mobility, which is an energy consumption measure, to test the relationship through statistical analyses. In the DEA-EA, particularly, this study incorporates undesirable outputs (i.e., the number of confirmed cases and that of deaths) as well as desirable outputs (i.e., the number of total recovered people and that of total tested people) during April 2020 as the initial stage of COVID-19. While the former outputs need to be maximized, the latter ones need to be minimized in the assessment of healthcare system performance. This study finds that (a) the COVID-19 response performance of countries is varying and those with higher public health coverage have outperformed others with lower public coverage in terms of combating the COVID-19 outbreak, and (b) the healthcare system performance is significantly associated with mobility. Particularly, the second finding indicates that outperforming nations in the healthcare system are returning to the normal (with less volatility) while underperforming ones are still stagnating in terms of mobility. It implies that outperforming countries need to prepare for continuous commitment to clean/sustainable energy transition. [ABSTRACT FROM AUTHOR]

The main purpose of the paper was to present the energy balance in the EU countries. The specific objectives were to show the concentration and directions of changes in the demand, production, import, and export of energy in the EU countries, to determine the degree of variability (or stability) of these energy balance parameters, and to establish the correlation between the energy balance parameters and economic parameters. All members of the European Union were determinedly selected for research on 31 December 2018 (28 countries). The research period embraced the years 2004–2018. The sources of materials were the literature on the topic and data from Eurostat. Descriptive, tabular, and graphical methods, Gini coefficient, Lorenz curve, coefficient of variation, Pearson's linear correlation coefficient, and constant-based dynamics indicators were used in the analysis and presentation of materials. It was determined that only the demand for energy and its import in EU countries were nearly related to the economic situation. In turn, exports and production were medium and weakly correlated. In these parameters, economic factors had a smaller impact than other factors, such as political development or the level of energy development in the country. It was also found that the EU countries' energy imports were characterized by lower volatility than its exports. As a rule, the most significant stabilization in the given parameters occurred in countries with a stable economy, the so-called developed economies, while the most significant volatility was in developing countries. Energy security is of great importance in all EU countries. [ABSTRACT FROM AUTHOR]

In the context of the European Green Deal, the manufacturing industry faces environmental challenges due to its high demand for electrical energy. Thus, measures for improving the energy efficiency or flexibility are applied to address this problem in the manufacturing industry. In order to quantify energy efficiency or flexibility potentials, it is often necessary to predict or forecast the energy consumption. This paper presents a systematic review of state-of-the-art of existing approaches to predict or forecast the energy consumption in the manufacturing industry. Seventy-two articles are classified according to the defined categories System Boundary, Modelling Technique, Modelling Focus, Modelling Horizon, Modelling Perspective, Modelling Purpose and Model Output. Based on the reviewed articles future research activities are derived. [ABSTRACT FROM AUTHOR]

The decentralization of the large-scale energy sector, its replacement with pro-ecological, dispersed production sources and building a citizen dimension of the energy sector are the directional objectives of the energy transformation in the European Union. Building energy self-sufficiency at a local level is possible, based on the so-called Energy Communities, which include energy clusters and energy cooperatives. Several dozen pilot projects for energy clusters have been implemented in Poland, while energy cooperatives, despite being legally sanctioned and potentially a simpler formula of operation, have not functioned in practice. This article presents the coopetitive nature of Energy Communities. The authors analysed the principles and benefits of creating Energy Communities from a regulatory and practical side. An important element of the analysis is to indicate the managerial, coopetitive nature of the strategies implemented within the Energy Communities. Their members, while operating in a competitive environment, simultaneously cooperate to achieve common benefits. On the basis of the actual data of recipients and producers, the results of simulations of benefits in the economic dimension will be presented, proving the thesis of the legitimacy of creating coopetitive structures of Energy Communities. [ABSTRACT FROM AUTHOR]

This paper scrutinizes existing policy efforts to address energy poverty at the governance scale of the European Union (EU) and its constituent Member States. Our main starting point is the recent expansion of energy poverty policies at the EU level, fuelled by the regulatory provisions of the Clean Energy for all Europeans Package, as well as the establishment of an EU Energy Poverty Observatory. Aided by a systematic and customized methodology, we survey the extensive scientific body of work that has recently been published on the topic, as well as the multiple strategies and measures to address energy poverty that have been formulated across the EU. This includes the principal mitigation approaches adopted by key European and national institutions. We develop a framework to judge the distributional and procedural justice provisions within the recently adopted National Energy and Climate Plans, as an indicator of the power, ability and resolve of relevant institutions to combat the causes and consequences of energy injustice. We also provide a research and policy agenda for future action, highlighting a series of scientific and decision-making challenges in the European and global context. [ABSTRACT FROM AUTHOR]

Green hydrogen for mobility represents an alternative to conventional fuel to decarbonize the transportation sector. Nevertheless, the thermodynamic properties make the transport and the storage of this energy carrier at standard conditions inefficient. Therefore, this study deploys a georeferenced optimal transport infrastructure for four base case scenarios in France and Germany that differs by production distribution based on wind power potential and demand capacities for the mobility sector at different penetration shares for 2030 and 2050. The restrained transport network to the road infrastructure allows focusing on the optimum combination of trucks operating at different states of aggregations and storage technologies and its impact on the annual cost and hydrogen flow using linear programming. Furthermore, four other scenarios with production cost investigate the impact of upstream supply chain cost, and eight scenarios with daily transport and storage optimization analyse the modeling method sensitivity. The results show that compressed hydrogen gas at a high presser level around 500 bar was, on average, a better option. However, at an early stage of hydrogen fuel penetration, substituting compressed gas at low to medium pressure levels by liquid organic hydrogen carrier minimizes the transport and storage costs. Finally, in France, hydrogen production matches population distribution, in contrast to Germany, which suffers from supply and demand disparity. [ABSTRACT FROM AUTHOR]

• Embodied energy impact on the energy life cycle analysis of buildings is assessed. • Energy and carbon pay-back largely vary if the embodied values are considered. • Embodied energy plays a critical role on the estimation of wall insulation. The implementation of energy efficiency measures is an effective way to gain energy savings in the Italian residential sector. This paper assesses the embodied energy impact related to the envelope insulation and evaluates the energy and carbon payback of the efficiency measures. The proposed method consists of (1) an estimation of the baseline operational energy consumption, (2) simulations of realistic retrofit solutions and, (3) the assessment of the 'retrofitting' embodied energy and the energy and carbon payback time calculation. The payback is based on the comparison between the saved operational energy and the embodied energy of the materials selected for insulation. Ten Italian cities are analysed, and the results show a deep dependence on the climate zone. In Northern Italian cities, envelope insulation gains relevance as the energy and carbon payback periods are shorter, about 3 years against the 84 years for the Southern city of Palermo. The optimal thickness is estimated for the city of Milan considering the building's typology, the insulation materials, and the energy payback. This study shows how the total energy savings can be used as a criterion to obtain design indications. [ABSTRACT FROM AUTHOR]

The article reports on research which was conducted to investigate the safety of sorafenib therapy in adults with advanced hepatocellular carcinoma. Researchers evaluated the use of sorafenib with 51 patients. They found that the drug was well tolerated and had a positive effect on quality of life in elderly patients with advanced hepatocellular carcinoma.

The use of innovative methods for the design of heating, cooling, and heat storage devices has been mainly oriented in the last decade toward the use of nanofluids, metal foams coupled with working fluids, or phase change materials (PCMs). A network of nine Italian universities achieved significant results and innovative ideas on these topics by developing a collaborative project in the last four years, where different approaches and investigation techniques were synergically employed. They evaluated the quantitative extent of the enhancement in the heat transfer and thermal performance of a heat exchanger or thermal energy storage system with the combined use of nanofluids, metal foams, and PCMs. The different facets of this broad research program are surveyed in this article. Special focus is given to the comparison between the mesoscopic to macroscopic modeling of heat transfer in metal foams and nanofluids, as well as to the experimental data collected and processed in the development of the research. [ABSTRACT FROM AUTHOR]

Background Cefiderocol is a novel siderophore cephalosporin with promising activity against most carbapenem-resistant Gram-negative bacteria (CRGNB). However, extensive postmarketing experiences are lacking. This study aimed to analyse the early experience on cefiderocol postmarketing use at three tertiary care hospitals in Italy. Methods We retrospectively included patients with infections caused by CRGNB treated with cefiderocol at three Italian tertiary care hospitals from 1 March 2021 to 30 June 2022. A multivariate Cox model was used to identify predictors of 30 day mortality. A propensity score (PS) analysis with inverse probability weighting (IPW) was also performed to compare the treatment effect of cefiderocol monotherapy (CM) versus combination regimens (CCRs). Results The cohort included 142 patients (72% male, median age 67 years, with 89 cases of Acinetobacter baumannii infection, 22 cases of Klebsiella pneumoniae , 27 cases of Pseudomonas aeruginosa and 4 of other pathogens). The 30 day all-cause mortality was 37% (52/142). We found no association between bacterial species and mortality. In multivariate analysis, a Charlson Comorbidity Index >3 was an independent predictor of mortality (HR 5.02, 95% CI 2.37–10.66, P  < 0.001). In contrast, polymicrobial infection (HR 0.41, 95% CI 0.21–0.82, P  < 0.05) was associated with lower mortality. There was no significant difference in mortality between patients receiving CM (n  = 70) and those receiving a CCR (n  = 72) (33% versus 40%, respectively), even when adjusted for IPW-PS (HR 1.11, 95% CI 0.63–1.96, P  = 0.71). Conclusions Real-life data confirm that cefiderocol is a promising option against carbapenem-resistant Gram-negative infections, even as monotherapy. [ABSTRACT FROM AUTHOR]

Background and aim. The nature of the association between obesity and poor prognosis of COVID-19 without the evaluation of other co-pathologies associated has not yet been clearly evaluated. The aim of the present pair-matched case–control study was to investigate the outcome of patients with SARS-CoV-2 infection in obese and non-obese patients matched considering gender, age, number of comorbidities, and Charlson Comorbidity Index. Methods. All the adults hospitalized for SARS-CoV-2 infection and with BMI ≥ 30 kg/m2 were included (Cases). For each Case, two patients with BMI < 30 kg/m2 pair matched for gender, age (±5 years), number of comorbidities (excluding obesity), and Charlson Comorbidity Index (±1) were enrolled (Controls). Results. Of the 1282 patients with SARS-CoV-2 infection followed during the study period, 141 patients with obesity and 282 patients without were enrolled in the case and control groups, respectively. Considering matching variables, there was no statistical difference between the two groups. Patients in the Control group developed more frequently a mild–moderate disease (67% vs. 46.1%, respectively), whereas obese patients were more prone to need intensive care treatment (41.8% vs. 26.6%, respectively; p = 0.001). Moreover, the prevalence of death during hospitalization was higher in the Case group than in the Control group (12.1% vs. 6.4%, p = 0.046). Discussion. We confirmed an association between obesity and severe outcome of patients with COVID-19, also considering other factors associated with a severe outcome of COVID-19. Thus, in the case of SARS-CoV-2 infection, the subjects with BMI ≥ 30 kg/m2 should be evaluated for early antiviral treatment to avoid the development of a severe course. [ABSTRACT FROM AUTHOR]

The present paper analyses the evolution of renewable energy generation in the European Union through a decomposition analysis based on the Index Decomposition Analysis together with the Logarithmic Mean Divisia Index within the EU27 between 2000 and 2020. A four factors decomposition approach is considered for decomposing the total RES generation and a five factors model is employed to decompose the carbon emissions. Furthermore, a focus on wind and solar photovoltaic generation is introduced through a four factors decomposition calculated in the period 2010–2020. The most influential factors affecting the RES generation trend in the period 2000–2020 are the RES share and energy efficiency wich determined an increase of 1841 TWh and a decrease of 635 TWh respectively. Variations of carbon emissions are mostly affected by the energy intensity, namely the amount of energy necessary to produce one unit of GDP, which determined a reduction of 1040 Mt. Through the decomposition analysis, the paper successfully identifies the specific drivers supporting RES development and controlling carbon emissions, thus adequate policy measures can be designed to reach planned targets. • LMDI methodology is used to study decomposition of RES generation in EU. • Technical and socio-economic factors are highlighted by using 4 or 5 factors identity. • Technical factors have the main impact on the increase in RES generation. [ABSTRACT FROM AUTHOR]

Background: Sclerotherapy with 3% polidocanol foam is becoming increasingly popular for the treatment of symptomatic I–II or III degree haemorrhoidal disease (HD). However, there are no studies that have reported a follow‐up of more than 1 year. The purpose of this study was to analyse the long‐term outcomes of sclerotherapy with 3% polidocanol foam in the treatment of II–degree HD. Methods: This was an open label, single‐arm, phase 2b trial conducted in 10 tertiary referral centres for HD. A total of 183 patients with II–degree HD, aged between 18 and 75 years with symptomatic HD according to the Goligher classification and unresponsive to medical treatment, were included in the study and underwent sclerotherapy with 3% polidocanol foam. The efficacy was evaluated in terms of bleeding score, haemorrhoidal disease symptom score (HDSS) and short health scale for HD (SHS–HD) score. Successful treatment was defined as the complete absence of bleeding episodes after 7 days (T1) according to the bleeding score. Results: The overall success rate ranged from 95.6% (175/183) at 1 year to 90.2% (165/183) after the final 3 year follow‐up. The recurrence rate, based on the primary outcome, ranged from 12% (15/125) to 28% (35/125). The greatest increase in recurrence (15) was recorded between 12 and 18 months of follow‐up, then another five between 18 and 24 months. Both the HDSS and the SHS score remained statistically significant (p < 0.001) from a median preoperative value of 11 (10–13) and 18 (15–20) to 0 (0–2) and 4 (0–4), respectively. Symptom‐free (HDSS = 0) patients, excluding patients converted to surgery, increased from 55.5% (101/182) at 1 year to 65.1% at 3 years (110/169). There were no intraoperative complications in redo‐sclerotherapy nor additional adverse events (AEs) compared to the first 12 months. Conclusions: Sclerotherapy with 3% polidocanol foam is gradually establishing itself in the treatment of bleeding HD due to its repeatability, safety, convenience in terms of direct and indirect costs with the absence of discomfort for the patient as well as AEs rather than an excellent overall success rate. [ABSTRACT FROM AUTHOR]

Highlights: [•] A fluid-less description of an inverse thermodynamic cycle is provided. [•] On this ground, a steady state model for solar assisted heat pumps is derived. [•] The model results able to describe the averaged behavior of the considered system. [•] The proposed approach appears suitable in view of design and regulation purposes. [ABSTRACT FROM AUTHOR]

Abstract: A method is presented and tested which, implemented along with a lumped dynamical model of an inverse cycle, allows for the description of the system with very simple mathematical tools, without any need to possess information about the thermophysical properties of the refrigerant fluid operating in the cycle. The algorithm, based on the fluid independent Carnot cycle, is applied both to a household refrigerator and to a direct expansion, variable capacity, solar assisted heat pump (DX-SAHP). The validity of the approach is established by comparing the numerical results of the proposed simplified approach to transient and time averaged data based on consolidated thermodynamic-cycle simulators which make use of full standard fluid properties description. Simulations comparisons confirm the ability of the proposed model to closely adhere to the dynamic behavior of the considered devices and disclose the opportunity to develop inverse-cycle models so simple to be easily embedded, along with their sensitivity features, in cheap model-based regulators and transient control strategy developments. [Copyright &y& Elsevier]

The present paper presents a methodology to effectively address the evaluation of building energy retrofitting projects in a highly uncertain context. Buildings are modelled in terms of archetypes which are characterized by specific features, e.g., U-values, heating plant typology, surface to volume ratio, etc. By using the Monte Carlo approach, the proposed method can address the influence of more than thirty important parameters on the final result in terms of energy savings, Net Present Value and other indices aimed to quantify the level of risk associated to complex energy efficiency interventions, e.g., energy saving at risk. The methodology is tested on a case study related to a building built in the '60s and located in Rome, Italy. However, the method is applicable irrespectively of the location, climatic conditions, and typology of the building. Results highlight that a retrofitting intervention consisting in wall insulation has a risk to be unprofitable equal to 47%. This can be ascribed to the mild climatic conditions of the location. • The Monte Carlo approach for analysing energy efficiency interventions in buildings is proposed. • Metrics are introduced for estimating the technical and financial risk of the interventions. • The proposed approach is relevant for any retrofitting project where high level of uncertainty is expected. [ABSTRACT FROM AUTHOR]

Cross-subsidy in electric power industry distorts normal pricing without achieving the goals of fair and equitable access to electricity for all and leads to wasteful electricity consumption. The paper focuses on the analysis of cross-subsidy between the residential and non-residential (industry) electricity consumers in Russia and the establishment of economically and socially optimal prices. First, benefits and deficiencies of various research approaches to tariff setting in the industry are outlined. Second, the review of ultimate electricity prices in over 50 countries allowed identifying cases for tariff policy analysis and comparison. Third, recommended electricity tariffs for the industrial and household consumers (well-off and lower income) were calculated for 10 Russia's regions. The results for the first time suggest no price increase if the consumption is within the block tariff, challenging the dominant premises that the household tariff has to grow for the entire population. These findings allow unblocking further policy and public discussion of the issue, as they offer solutions for cross-subsidy elimination, while guaranteeing the affordable electricity for all. Lowering inefficient expenditures of retail energy companies may allow further electricity price reduction. Importantly, tariffs and the social consumption norm should be tailored for each of Russia's 85 regions. • The paper offers solutions to reduce cross-subsidy in the Russian electric power industry. • Optimal electricity tariffs for industrial and household consumers in 10 regions were calculated. • The results for the first time suggest no price increase within the block tariff. • These findings allow unblocking further policy and social discussion of the issue. • Tariffs and the social consumption norm should be tailored for each of Russia's 85 regions. [ABSTRACT FROM AUTHOR]

Highlights: [•] The experimental study focuses on the feasibility of hybrid PV/T panels retrofitting. [•] The critical role of a thin layer of air between PV panel and back plate is evidenced. [•] The benefit of the addition of a conductive paste layer is analyzed via FEM simulations. [•] The use of wood ribs to stick the back plate represents a cheap effective solution. [ABSTRACT FROM AUTHOR]

Background: Nutrition exerts a fundamental role in the prevention of obesity (OB). The aim of this study was to assess the extent to which well recognized risk factors for early OB can be associated to overweight (OW) or OB under a standardized nutritional approach and surveillance in toddlers., Methods: The eligible population was represented by 676 toddlers aged 24-36 months, assigned to 18 primary care pediatricians trained on nutritional issues who shared a standardized nutritional approach. Six-hundred-twenty-nine children (333 boys), mean age 27.8 ± 4.2 months were effectively included in this observational study. Parents received nutritional advice with particular emphasis to proteins and sugar composition supported by leaflets and reinforced at each visit. Body mass index was assessed at the age of 24-36 months. The following individual and family risk factors were considered: gestational age, birth weight, eutocic/caesarean delivery, milk feeding history, household smoking or antibiotics exposure, parents' weight, height and educational level. Prevalence of OW/OB was compared to a group of 742 toddlers (373 boys) under usual care., Results: Under a standardized nutritional counselling, 28.1% toddlers were classified as OW/OB compared to 36.9% toddlers under usual care (p = 0.005). In unadjusted models, parental OW/OB was significantly associated to OW/OB in toddlers (p < 0.01), while high birth weight did not reach statistical significance (p = 0.07). In adjusted models, including all the explanatory variables studied, only paternal OW/OB vs. normal weight was significantly associated to OW/OB in toddlers (OR 2.035, 95% confidence interval 1.206-3.436). No protective effect of exclusive breast feeding during the first 6 months of age was demonstrated., Conclusions: Toddlers under a standardized nutrition counselling focused to limit protein and simple sugars, showed lower prevalence of OW/OB compared to usual care. Healthy promotion activities should take into account the influence of paternal BMI on the offspring adiposity., (© 2024. The Author(s).)

Early detection of disease progression is a crucial issue in the management of cancer patients, especially in metastatic settings. Currently, treatment selection mostly relies on criteria based on radiologic evaluations (RECIST). The aim of the present retrospective study is to evaluate the potential inclusion of circulating tumor cells (CTCs) in hybrid criteria. CTC counts from a total of 160 patients with different metastatic tumors were analyzed for this purpose. In our cohort, 73 patients were affected by breast cancer, 69 by colorectal cancer and 18 by prostate cancer. PFS and OS were evaluated according to the corresponding prediction of disease progression by CTCs and RECIST criteria. In breast cancer, CTC-I has an important impact on the progression-free survival (PFS) and overall survival (OS) values. When CTC-I predicted earlier than RECIST-I, the disease progression, the PFS and OS were shorter with respect to the opposite case. In particular, PFS was 11 (5-16) vs. 34 (23-45)-with p < 0.001-and OS was 80 (22-138) vs. 116 (43-189), p = 0.33. The results suggest a promising role of CTCs as complementary information which could significantly improve the clinical outcomes, and they encourage consideration of future trials to evaluate new hybrid criteria, particularly for patients with breast cancer.

This work is aimed to investigate the carbon emissions trend in the European Union. Logarithmic Mean Divisia Index and Tapio's methodology are used for decomposing the carbon emissions and investigating the decoupling factors respectively. Seven indexes are identified, namely carbon intensity of the energy sector, energy consumption structure, energy intensity, climatic factor, Gross Domestic Product per Capita, population distribution, and population evolution. These indexes are then grouped in three macro-categories, specifically technical factors, climatic effect, and socio-economic factors. The study covers the period 1995-2019 and considers EU 27 countries at an aggregate and individual level. Carbon emissions in EU 27 reduced of 689 Mt from 1995 to 2019. Technical factors are responsible for a decrease of 1723 Mt, the climatic effect determines a reduction of 362 Mt, whereas socio-economic factors cause an increase of 1397 Mt. The Strong Decoupling status is achieved in EU 27 in the period 1995-2019 with a decoupling index equal to -0.4. This means that carbon emissions reduced while Gross Domestic Product increased. To provide more precise insights, the paper also presents analyses at individual country level and the splitting in five temporal sub-periods., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Background/aim: We conducted a retrospective analysis in our center (Umberto I Polyclinic) in collaboration with Campus Biomedico Polyclinic to assess the results of the REFLECT study, which was the first study that demonstrated the non-inferiority of Lenvatinib to Sorafenib., Patients and Methods: We identified 21 patients affected by advanced hepatocellular carcinoma during the last 3 years who were treated in our centers. They were subdivided according to the treatment administered (Lenvatinib or Sorafenib). Progression-free survival (PFS) and overall survival (OS) were calculated, and subgroups were compared using the log-rank test. Specific predictive and prognostic factors were identified. The safety profile of the two drugs and the collateral effects were evaluated., Results: The OS in patients in the Lenvatinib arm was 19 (months and 12.5 months in the Sorafenib arm. PFS in patients in the Lenvatinib arm was 6 months and 2.5 months in the Sorafenib arm. OS and PFS in patients treated with Lenvatinib were higher in any subcategory analyzed whereas no positive predictors of response to Sorafenib were found. Based on data from literature, the albumin bilirubin index (ALBI) grade was found to be a key prognostic factor. Patients treated with Sorafenib had more adverse events than those treated with Lenvatinib (100% versus 81.8%, respectively). Patients treated with Sorafenib had more frequently hand-foot syndromes, diarrhea, and nausea whereas patients treated with Lenvatinib commonly had hypertension, proteinuria, and weight loss., Conclusion: Lenvatinib was found to be better than Sorafenib in terms of both survival and toxicity, in advanced hepatic cell carcinoma patients., (Copyright © 2023 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Objectives: To describe clinical characteristics and outcomes of COVID-19 patients who developed secondary infections due to carbapenem-resistant Enterobacterales (CRE)., Methods: Retrospective observational study including COVID-19 patients admitted to 12 Italian hospitals from March to December 2020 who developed a superinfection by CRE. Superinfection was defined as the occurrence of documented bacterial infection >48 h from admission. Patients with polymicrobial infections were excluded. Demographic, clinical characteristics and outcome were collected. Isolates were classified as KPC, metallo-β-lactamase (MBL) and OXA-48-producing CRE. A Cox regression analysis was performed to identify factors independently associated with 30 day mortality., Results: Overall, 123 patients (median age 66 years, IQR 59-75) were included. The majority of infections occurred in the ICU (81, 65.9%), while 42 (34.1%) in medical wards. The most common types of infection were bloodstream infections (BSI) ( n  = 64, 52%), followed by urinary-tract infections (UTI) ( n  = 28, 22.8%), hospital-acquired/ventilator-associated pneumonia (HAP/VAP) ( n  = 28, 22.8%), intra-abdominal infections ( n  = 2, 1.6%) and skin infections ( n  = 1, 0.8%). Sixty-three (51.2%) infections were caused by KPC-, 54 (43.9%) by MBL-, and 6 (4.8%) by OXA-48-producing CRE. Thirty-day mortality was 33.3% (41/123). On Cox regression analysis, HAP/VAP compared with UTI (HR 7.23, 95% CI 2.09-24.97, P  = 0.004), BSI compared with UTI (HR 3.96, 95% CI, 1.33-11.77, P  = 0.004), lymphopenia on admission (HR 3, 95% CI 1.44-6.26, P  = 0.003) and age (HR 1.05, 95% CI 1.02-1.08, P  = 0.002) were predictors of 30 day mortality., Conclusions: Superinfections by CRE were associated with high risk of 30 day mortality in patients with COVID-19. HAP/VAP was the strongest predictor of death in these patients., (© The Author(s) 2022. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.)

Purpose: Post-neurosurgical infection caused by extensively drug resistant Pseudomonas aeruginosa (XDR-PA) are becoming a matter of great concern due to limited therapeutic options. Although not approved for these indications, the new BetaLactam-BetaLactamase Inhibitor combinations (BLBLIs) could represent a valid salvage treatment. We describe one nosocomial meningitis and two cervical osteomyelitis due to an XDR-PA who were treated with ceftazidime/avibactam (CZA) and ceftolozane/tazobactam (C/T) and review the literature., Methods: The first and the third patients developed an osteomyelitis following cervical stabilization surgery due to an XDR-PA. Although the first patient started treatment with a high dose of C/T, resistance to C/T occurred, so therapy was switched to CZA plus aztreonam. The third patient switched to aztreonam plus CZA due to development of acute kidney injury during therapy with colistin. The second patient had an XDR-PA meningitis following the insertion of an external ventricular catheter and he was treated with C/T plus meropenem and amikacin., Results: All three cases reported were successfully conservatively treated thanks to the use of the new BLBLIs with different combinations. Only few experiences demonstrated an equally favorable outcome: one patient treated with C/T plus fosfomycin for otogenic meningitis caused by an XDR-PA and another case of XDR-PA post-surgical meningitis with CZA in combination with colistin. Finally, the combination of CZA plus aztreonam has proven to be effective on XDR-PA only in limited mostly in vitro studies., Conclusion: These recently developed antibiotics, C/T and CZA are promising and complementary therapy options against post-neurosurgical hard-to-treat P. aeruginosa infections. Further prospective real-life studies are required to validate these findings in this special setting.

Riassunto. L'angiogenesi svolge un ruolo importante sia nei tessuti epiteliali normali sia in quelli maligni. Negli ultimi anni questo fenomeno è stato ampiamente studiato in oncologia sperimentale e clinica perché ci sono evidenze che sia coinvolto nella diffusione e nella diffusione metastatica del carcinoma ovarico. Il fattore di crescita dell'endotelio vascolare (vascular endothelial growth factor - VEGF) è l'attore principale nel meccanismo di angiogenesi e svolge un ruolo strategico nella proliferazione e migrazione delle cellule neoplastiche, con un impatto significativo sulla sopravvivenza e sull'outcome clinico. Secondo quanto emerge da molti studi sperimentali e clinici, le nostre conoscenze sulla biologia dell'angiogenesi e del VEGF sono aumentate portando allo sviluppo farmacologico di specifici agenti in grado di targeting VEGF. Questo nuovo campo di indagine offre agli scienziati l'opportunità di testare nuove possibilità terapeutiche nei pazienti con carcinoma ovarico con nuovi agenti mirati. Il bevacizumab, un anticorpo monoclonale anti-VEGF umanizzato, è stato il primo farmaco anti-VEGF scoperto ed è usato oggi per il trattamento di diversi tumori solidi. Negli ultimi anni questo agente è stato ampiamente testato nei pazienti con carcinoma ovarico, mostrando un'attività clinica interessante e un profilo di tossicità tollerabile sia nelle pazienti giovani sia in quelle anziane. Il bevacizumab, combinato con carboplatino e paclitaxel e successivamente utilizzato come agente singolo, è indicato per il trattamento del carcinoma epiteliale dell'ovaio di stadio III o IV, tuba di Falloppio o carcinoma peritoneale primario dopo iniziale resezione chirurgica. Il bevacizumab è anche usato per il trattamento di pazienti con carcinoma ovarico epiteliale ricorrente e resistente al platino, delle tube di Falloppio o dal tumore peritoneale primario che hanno ricevuto non più di 2 regimi precedenti di chemioterapia. Inoltre, il bevacizumab, combinato con carboplatino e paclitaxel o con carboplatino e gemcitabina (e usato come agente singolo), è indicato per il trattamento di pazienti con carcinoma epiteliale dell'ovario sensibile al platino, tuba di Falloppio o tumore peritoneale primario. Le linee guida più accreditate suggeriscono quando bevacizumab deve essere usato nel trattamento del carcinoma ovarico avanzato e ricorrente. Altri agenti anti-VEGF, come gli inibitori della tirosin-chinasi del recettore VEGF (VEGFR), sono stati ampiamente testati nel carcinoma ovarico e molti altri sono in corso di studi al fine di testare la loro attività e sicurezza rispetto a bevacizumab. Gli agenti anti-VEGF e gli inibitori di PARP svolgono oggi un ruolo strategico nel trattamento del cancro ovarico con agenti mirati in associazione con la chemioterapia e la chirurgia in un'ottica multidisciplinare e personalizzata.

Worldwide the needlestick injuries of health care workers (HCWs) still represent a major health problem. The authors aimed to evaluate the risk of HCW needlestick injuries in a tertiary university hospital in southern Italy in relation to some HCW characteristics (age, sex, professional profile, work department) and the source of infection. All HCWs of the University Hospital "Federico II" in Naples, Italy, attending the Infectious Diseases Unit after potential accidental contact to blood-borne viruses through needlestick injuries were enrolled during a 22-year period. HCWs underwent clinical analysis and were administered a specific questionnaire to collect (in anonymous fashion) data about age, sex, professional profile and work department. From 1995 to 2016 1,477 needlestick injuries in the same number of people (one accident per person) were recorded by our service. The HCWs were predominately males (n = 806, 55%) and the mean age was 39.4 years (±10.1 SD). The job categories most involved were: physicians (41%), followed by nurses (33%) and healthcare assistants (HCAs, 10%). The incidence proportion was calculated for these highest-risk categories in three defined time points (at the beginning, in the middle and at the end of the study period): 104/2149 (4.86%) in 1995, 41/2498 (1.64%) in 2005 and 25/2057 (1.22%) in 2015. Most injuries occurred in General Surgery (14.21%), Gynecology and Obstetrics (9%) and Pediatrics (6.49%). In about 34% the HCWs had been exposed to HCV infected fluids. Over time, a significant decrease in accidental exposure was recorded for physicians (p= 0.019), nurses (p< 0.0001) and HCAs (p< 0.0001). Our results confirm that some profiles, namely physicians, nurses and healthcare assistants, are still at risk of needlestick injuries, especially in surgical areas, including obstetric wards. Further primary and secondary prevention strategies are needed to decrease the incidence of new cases of needlestick injuries.

Bevacizumab (BV) is a humanized monoclonal antibody targeting vascular endothelial growth factor and it is the first molecular-targeted agent to be used for the treatment of ovarian cancer (OC). Randomized Phase III trials evaluated the combination of BV plus standard chemotherapy for first-line treatment of advanced OC and for platinum-sensitive and platinum-resistant recurrent OC. These trials reported a statistically significant improvement in progression-free survival but not in overall survival. Furthermore, BV effectively improved the quality of life with regard to abdominal symptoms in recurrent OC patients. Bevacizumab is associated with adverse events such as hypertension, bleeding, thromboembolism, proteinuria, delayed wound healing, and gastrointestinal events. However, most of these events can be adequately managed. This review describes the latest evidence for BV treatment of OC and selection of patients for personalized treatment.

Unlabelled: Cisplatin and etoposide (PE) is the most used chemotherapy regimen in extensive-stage disease small-cell lung cancer (ED-SCLC), and usually achieves a high initial response rate. An intriguing maintenance strategy could be the combination of the angiogenic agent bevacizumab (Bev) with a convenient and well tolerated chemotherapy agent such as oral etoposide. Results of the current single-institutional phase II study suggest that a regimen that includes conventional PE chemotherapy combined with Bev followed by oral etoposide and Bev as maintenance treatment is feasible and effective in terms of 9-month disease control rate in patients with ED-SCLC., Background: In the present study we evaluated the efficacy and safety of a cisplatin (P), etoposide (E), and bevacizumab (Bev) regimen followed by maintenance oral E and Bev in patients with extensive-stage disease small-cell lung cancer (ED-SCLC)., Patients and Methods: Patients were administered 3-day fractionated P 25 mg/m(2) and E 100 mg/m(2) on days 1 to 3, every 3 weeks. After 3 PE cycles, all patients whose disease did not progress continued treatment with PE combined with Bev 15 mg/kg on day 3 every 3 weeks. After completion of 3 PE/Bev cycles, patients who did not experience tumor progression continued maintenance treatment with oral E 50 mg on days 1 to 14 every 21 days combined with Bev 3 times per week until occurrence of disease progression or unacceptable toxicity., Results: At our institution, 22 patients were enrolled and their median age was 66 years (range, 38-79 years). After completion of induction chemotherapy (3 PE cycles with 3 PE/Bev cycles) the objective response rate was in 17 patients (77.2%) (95% confidence interval [CI], 54.6-92.1). Twenty-one patients received maintenance treatment with oral E and Bev. The 9-month disease control rate was 8 patients (36.3%). Median progression-free survival was 7.8 months (95% CI, 7.0-11.3 months) and median overall survival was 13.2 months (95% CI, 11.8-18.7 months). Grade 3 to 4 neutropenia occurred in 12 patients (54.4%) and 14 patients (63.6%) of patients during cycles 1 to 3 and cycles 4 to 6 of induction chemotherapy, respectively. Severe adverse events during maintenance treatment were rarely observed., Conclusion: A PE and Bev regimen followed by oral E and Bev maintenance treatment appears feasible and effective in terms of 9-month disease control rate in patients with ED-SCLC., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Introduction: In the past the unfavourable profile of toxicity of antineoplastic drugs employed (i.e. cisplatinum) weakened the role of chemotherapy in aged patients with non-small cell lung cancer (NSCLC). Recently, new active drugs with lesser toxicity have became widely used in this setting. In this prospective study we evaluated the efficacy and tolerability of gemcitabine in elderly patients with stages III-IV NSCLC., Materials and Methods: From December 1996 to April 1999, we enrolled 52 previously untreated elderly patients with advanced/metastatic NSCLC. Gemcitabine was administered at 1000 mg/mq i.v. over 30 minutes weekly for three consecutive weeks every 28 days. The planned number of cycles was three while responding or stable patients received chemotherapy until disease progression or the ninth cycle. A total of 291 cycles were delivered with a median number of 6 cycles (range: 3-9). An evaluation of the quality of life was performed every three courses of gemcitabine., Results: After three cycles of treatment, a complete response was seen in four patients (7.7%), partial response in 16 patients (30.8%) with an overall response rate of 38.5%. Nineteen patients (36.5%) showed stable disease, while thirteen patients (25%) progressed. Median progression-free survival was 22 weeks, median duration of response 26 weeks, median overall survival 34 weeks and 1-year overall survival 46.1%. A statistically significant improvement in the quality of life was registered only after the first three cycles of gemcitabine (p = 0.045). Toxicity was extremely mild., Conclusion: In elderly patients with stages III-IV NSCLC gemcitabine showed good activity with a mild toxicity and could be considered a valid therapeutic option in this setting.