Search

Despite the WHO target for measles and rubella elimination in 2015, outbreaks still occur in all WHO Regions. After a description of the epidemiological situation of measles and rubella worldwide and especially in Europe, this paper aims to provide a detailed analysis of the current epidemiological context of Italy. The surge in the number of measles cases since the beginning of 2017, together with vaccination coverage still far from the 95% target, requires priority actions to be taken to achieve the elimination goals. Alongside the recently approved decree reintroducing compulsory vaccinations for school admissions, further measures are needed and should include the increase in the commitment of the 21 Regions; the implementation of supplemental immunization activities; improving the communication skills of health care workers; ensuring an effective communication with citizens; the enhancement of the surveillance network.

Introduction: The appropriate application of genomic technologies in healthcare is surrounded by many concerns. In particular, there is a lack of evidence on what constitutes an optimal genetic service delivery model, which depends on the type of genetic test and healthcare context considered. The present project aims to identify, classify, and evaluate delivery models for the provision of predictive genetic testing in Europe and in selected Anglophone extra-European countries (the USA, Canada, Australia, and New Zealand). It also sets out to survey the European public health community's readiness to incorporate public health genomics into their practice., Materials and Equipment: The project consists of (i) a systematic review of published literature and selected country websites, (ii) structured interviews with health experts on the genetic service delivery models in their respective countries, and (iii) a survey of European Public Health Association (EUPHA) members' knowledge and attitudes toward genomics applications in clinical practice. The inclusion criteria for the systematic review are that articles be published in the period 2000-2015; be in English or Italian; and be from European countries or from Canada, the USA, Australia, or New Zealand. Additional policy documents will be retrieved from represented countries' government-affiliated websites. The results of the research will be disseminated through the EUPHA network, the Italian Network for Genomics in Public Health (GENISAP), and seminars and workshops., Expected Impact of the Study on Public Health: The transfer of genomic technologies from research to clinical application is influenced not only by several factors inherent to research goals and delivery of healthcare but also by external and commercial interests that may cause the premature introduction of genetic tests in the public and private sectors. Furthermore, current genetic services are delivered without a standardized set of process and outcome measures, which makes the evaluation of healthcare services difficult. The present study will identify and classify delivery models and, subsequently, establish which are appropriate for the provision of predictive genetic testing in Europe by comparing sets of process and outcome measures. In this way, the study will provide a basis for future recommendations to decision makers involved in the financing, delivery, and consumption of genetic services.

Organometallic perovskites, solution-processable materials with outstanding optoelectronic properties and high index of refraction, provide a platform for all-dielectric metamaterials operating at visible frequencies. Perovskite metasurfaces with structural coloring tunable across visible frequencies are realized through subwavelength structuring. Moreover, a threefold increase of the luminescence yield and comparable reduction of luminescence decay time are observed., (© 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Poly(N-vinyl pyrrolidone)-based-nanogels (NGs), produced by e-beam irradiation, are conjugated with monoclonal antibodies (mAb) for active targeting purposes. The uptake of immuno-functionalized nanogels is tested in an endothelial cell line, ECV304, using confocal and epifluorescence microscopy. Intracellular localization studies reveal a faster uptake of the immuno-nanogel conjugate with respect to the 'bare' nanogel. The specific internalization pathway of these immuno-nanogels is clarified by selective endocytosis inhibition experiments, flow cytometry and confocal microscopy. Active targeting ability is also verified by conjugating a monoclonal antibody which recognizes the αvβ3 integrin on activated endothelial cells. Epifluorescence images of the 'wound healing assay' on ECV304 cells provide evidence of nanogels localization only in the target cells. Therefore, the immuno-nanogels produced have the potential to recognize specific cell types in heterogeneous systems, which makes them promising candidates for targeted drug delivery applications.

Background: Despite substantial progress towards measles and rubella control, outbreaks continue to threaten elimination goals worldwide., Study Design: This paper aims to document progress towards the global eradication of measles and rubella. In particular, it investigates the major challenges faced by Italy in reaching the elimination goals., Methods: A review of the most important literature was carried out. Furthermore, a systematic review of the scientific literature on measles and rubella in the Italian setting was performed for the period 2000-2016., Results: In the National Plan 2010-2015, Italy renewed its commitment to eliminate measles and rubella by 2015. However, Italy recently experienced a high measles burden (2,205 cases in 2013, 1,694 in 2014). Between June 2015 and May 2016, 515 cases were reported, accounting for 28% all cases in Europe. Immunization coverage decreased in recent years, with no Region reaching the 95% target. The systematic review included a total of 175 papers, with an upward trend in the number of published articles, which demonstrates an increasing interest in the field of measles and rubella. The review highlights the need to improve the commitment of the Italian Regions to the elimination goals; to promote Supplementary Immunization Activities (SIAs); to improve the communication skills of health care workers; to improve the health literacy of citizens; and to enhance integrated measles and rubella surveillance., Conclusion: Elimination of measles and rubella in Italy will require a substantial improvement in both commitment of the 21 Regions and activity of the whole country towards the WHO goals.

We use stochastic simulation techniques to sample the conformational space of linear semiflexible polymers in a crowded medium and study how the knotting properties depend on the crowder size and concentration. The abundance of physical knots in the chains, which for definiteness we model on 10 kb long DNA filaments, is shown to have a non-monotonic, unimodal dependence on the colloid diameter, dc. The maximum incidence of knots occurs when dc is about equal to half of the gyration radius of the isolated chain. The degree of enhancement of knots grows rapidly with the solution density and can be very conspicuous relative to the case of isolated chains with no crowders. For instance, at 30% volume fraction the relative increase is more than fourfold. This dramatic enhancement is shown to originate from the depletion-induced chain compaction over multiple and concurring length scales. The same effect accounts for the variations of the knot length that accompany the changes in knotting probability. The findings suggest that crowded media could be viably used as a passive physical means for controlling and modulating the incidence and length of knots in DNA and other types of semiflexible polymers.

We report on reflection spectra of cesium atoms in close vicinity of a nanostructured metallic meta-surface. We show that the hyperfine sub-Doppler spectrum of the 6(2)S1/2-6(2)P3/2 resonance transition at 852 nm is strongly affected by the coupling to the plasmonic resonance of the nanostructure. Fine tuning of dispersion and positions of the atomic lines in the near-field of plasmonic metamaterials could have uses and implications for atom-based metrology, sensing, and the development of atom-on-a-chip devices.

We propose and demonstrate a novel type of coupling between polarons in a conjugated polymer and localized surface plasmons in infrared (IR) nanoantennas. The near-field interaction between plasmons and polarons is revealed by polarized photoinduced absorption measurements, probing mid-IR polaron transitions, and infrared-active vibrational modes of the polymer, which directly gauge the density of photogenerated charge carriers. This work proves the possibility of tuning the polaronic properties of organic semiconductors with plasmonic nanostructures.

Background and Aim: In patients with cirrhosis and small hepatocellular carcinoma (HCC), thermal ablation is currently recognized as an effective local treatment. Among thermal procedures, radiofrequency ablation (RFA) is the most diffusely used and is the standard against which any new treatment should be compared. In retrospective studies, laser ablation (LA) resulted as safe and effective as RFA. Therefore, we performed a non-inferiority randomized trial comparing RFA with LA in patients with cirrhosis and HCC within Milan criteria., Methods: Overall, 140 patients with 157 HCC nodules were randomly assigned to receive RFA or LA. The primary end-point was the proportion of complete tumor ablation (CTA). Secondary end-points were time to local progression (TTLP) and overall survival (OS)., Results: Per patient CTA rates after RFA and LA were 97.4% (95% CI, 91.0-99.3) and 95.7% (88.1-98.5), respectively (difference = 1.4%, 95% CI from -6.0% to + 9.0%). Per nodule CTA rates for RFA and LA were 97.4% (91.0-99.3) and 96.3% (89.6-98.7), respectively (difference = 1.1%, from -5.7% to + 8.1%). The mean TTLP was comparable between RFA group (42.0 months; 95% CI, 36.83-47.3) and LA group (46.7 months; 95% CI, 41.5-51.9) (P = .591). The mean OS was 42 months in both groups and survival probability at 1 and 3 years was 94% and 89% in RFA group, and 94% and 80% in LA group., Conclusion: LA resulted not inferior to RFA in inducing the CTA of HCC nodules and therefore it should be considered as an evaluable alternative for thermal ablation of small HCC in cirrhotic patients., (© 2014 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.)

A coarse-graining strategy, previously developed for polymer solutions, is extended here to mixtures of linear polymers and hard-sphere colloids. In this approach, groups of monomers are mapped onto a single pseudoatom (a blob) and the effective blob-blob interactions are obtained by requiring the model to reproduce some large-scale structural properties in the zero-density limit. We show that an accurate parametrization of the polymer-colloid interactions is obtained by simply introducing pair potentials between blobs and colloids. For the coarse-grained (CG) model in which polymers are modelled as four-blob chains (tetramers), the pair potentials are determined by means of the iterative Boltzmann inversion scheme, taking full-monomer (FM) pair correlation functions at zero-density as targets. For a larger number n of blobs, pair potentials are determined by using a simple transferability assumption based on the polymer self-similarity. We validate the model by comparing its predictions with full-monomer results for the interfacial properties of polymer solutions in the presence of a single colloid and for thermodynamic and structural properties in the homogeneous phase at finite polymer and colloid density. The tetramer model is quite accurate for q ≲ 1 (q=Rg/Rc, where Rg is the zero-density polymer radius of gyration and Rc is the colloid radius) and reasonably good also for q = 2. For q = 2, an accurate coarse-grained description is obtained by using the n = 10 blob model. We also compare our results with those obtained by using single-blob models with state-dependent potentials.

The development of metamaterials, data processing circuits and sensors for the visible and ultraviolet parts of the spectrum is hampered by the lack of low-loss media supporting plasmonic excitations. This has driven the intense search for plasmonic materials beyond noble metals. Here we show that the semiconductor Bi1.5Sb0.5Te1.8Se1.2, also known as a topological insulator, is also a good plasmonic material in the blue-ultraviolet range, in addition to the already-investigated terahertz frequency range. Metamaterials fabricated from Bi1.5Sb0.5Te1.8Se1.2 show plasmonic resonances from 350 to 550 nm, while surface gratings exhibit cathodoluminescent peaks from 230 to 1,050 nm. The observed plasmonic response is attributed to the combination of bulk charge carriers from interband transitions and surface charge carriers of the topological insulator. The importance of our result is in the identification of new mechanisms of negative permittivity in semiconductors where visible range plasmonics can be directly integrated with electronics.

Planar optical lenses are fundamental elements of miniaturized photonic devices. However, conventional planar optical lenses are constrained by the diffraction limit in the optical far-field due to the band-limited wavevectors supported by free-space and loss of high-spatial-frequency evanescent components. As inspired by Einstein's radiation 'needle stick', electromagnetic energy can be delivered into an arbitrarily small solid angle. Such sub-diffraction optical needles have been numerically investigated using diffractive optical elements (DOEs) together with specially polarized optical beams, but experimental demonstration is extremely difficult due to the bulky size of DOEs and the required alignment precision. Planar super-oscillatory lenses (SOLs) were proposed to overcome these constraints and demonstrated that sub-diffraction focal spots can actually be formed without any evanescent waves, making far-field, label-free super-resolution imaging possible. Here we extend the super-oscillation concept into the vectorial-field regime to work with circularly polarized light, and experimentally demonstrate, for the first time, a circularly polarized optical needle with sub-diffraction transverse spot size (0.45λ) and axial long depth of focus (DOF) of 15λ using a planar SOL at a violet wavelength of 405 nm. This sub-diffraction circularly polarized optical needle has potential applications in circular dichroism spectroscopy, super-resolution imaging, high-density optical storage, heat-assisted magnetic recording, nano-manufacturing and nano-metrology.

We determine the phase diagram of mixtures of spherical colloids and neutral nonadsorbing polymers in the thermal crossover region between the θ point and the good-solvent regime. We use the generalized free-volume theory, which takes into account the polymer-concentration dependence of the depletion thickness and of the polymer compressibility. This approach turns out to be quite accurate as long as q = Rg/Rc ≲ 1 (Rg is the radius of gyration of the polymer and Rc is the colloid radius). We find that, close to the θ point, the phase diagram is not very sensitive to solvent quality, while, close to the good-solvent region, changes of the solvent quality modify significantly the position of the critical point and of the binodals. We also analyze the phase behavior of aqueous solutions of charged colloids and polymers, using the approach proposed by Fortini et al. [J. Phys.: Condens. Matter 17, 7783 (2005)].

We demonstrate an efficient core-shell GaAs/AlGaAs nanowire photodetector operating at room temperature. The design of this nanoscale detector is based on a type-I heterostructure combined with a metal-semiconductor-metal (MSM) radial architecture, in which built-in electric fields at the semiconductor heterointerface and at the metal/semiconductor Schottky contact promote photogenerated charge separation, enhancing photosensitivity. The spectral photoconductive response shows that the nanowire supports resonant optical modes in the near-infrared region, which lead to large photocurrent density in agreement with the predictions of electromagnetic and transport computational models. The single nanowire photodetector shows a remarkable peak photoresponsivity of 0.57 A/W, comparable to large-area planar GaAs photodetectors on the market, and a high detectivity of 7.2 × 10(10) cm·Hz(1/2)/W at λ = 855 nm. This is promising for the design of a new generation of highly sensitive single nanowire photodetectors by controlling the optical mode confinement, bandgap, density of states, and electrode engineering.

Introduction: A cross-sectional study was undertaken to determine the prevalence of Giardia and Cryptosporidium in calves of Palermo area (Sicily) and to evaluate the occupational risk associated with occurrence of zoonotic genotypes., Methods: A total of 217 faecal samples, from 149 calves (between 2 and 240 days of age) and 68 farmers, were collected in 19 cattle-farms of Palermo area. A questionnaire regarding demographic characteristics and personal hygienic measures was submitted to all farmers. All faecal samples were analyzed by Immunofluorescence assay and Polimerase Chain Reaction (PCR); genotypes were determined by DNA sequencing of Triose Phosphate Isomerase gene for Giardia and Small Subunit Ribosomal RNA gene for Cryptosporidium., Results: None farmer tested was positive for Giardia and Cryptosporidium, whereas these protozoa were respectively detected in 53 (including 5 with zoonotic G. duodenalis genotype A) and 17 (of which 1 with zoonotic C. ubiquitum) of the examined calves., Discussion: The results indicate that the risk of transmitting both protozoa to farmers in Palermo area is negligible although it cannot be considered null because of identification of human genotypes/species in calves.

Kawasaki syndrome (KS) typically strikes children younger than age 5 and presents with persistent high fever for at least 5 days combined with a heterogeneous polymorphous rash, extremity abnormalities, oropharyngitis, non-exudative conjunctivitis and cervical lymphadenitis. Treatment with high-dose intravenous immunoglobulin reduces substantially the risk of potential cardiovascular complications. For the first time, we report a child presenting all the clinical symptoms of KS, which recurred for 4 times in a period of 33 months. Each relapse was characterized by obstinate high fever combined with mucocutaneous signs and was each time successfully treated with intravenous immunoglobulin without the occurrence of any cardiovascular damage.

Background: Previous studies have shown that laser ablation with the multifiber technique is effective in the treatment of liver tumors. However, the correct positioning of multiple needles may be challenging., Purpose: To investigate the use of a novel needle guide system that was developed to perform percutaneous laser ablation of liver tumors with the multifiber technique under ultrasonographic guidance., Material and Methods: Between February 2009 and June 2011, 116 patients (104 hepatocellular carcinomas and 12 metastases) with 127 liver nodules (median diameter, 3.0 cm; range, 1.5-6.0) were treated. Nineteen nodules were in high-risk locations. A needle guide with separate channels to insert two needles in a parallel position and at a prefixed distance was used., Results: Needles were positioned inside the target nodule easily and quickly, and correct spacing (1.5-1.8 cm) between light sources was immediately achieved. Complete tumor ablation was achieved in a single session in 112 (88.2%) lesions. In nodules ≤3.0 cm and >3.0 cm in size, ablation was complete in 93.6% and 79.6% of cases, respectively. Of note, complete ablation was achieved in 91.7% of nodules up to 5.0 cm., Conclusion: With the new guidance system, needles could be inserted in parallel fashion, which facilitated positioning the needles in geometrical configurations to maximize the ablative effect. Worthy of note, the complete ablation rate in nodules >3.0 cm using the new guide system was higher than what has been reported in the literature so far.

We extend our previously developed coarse-graining strategy for linear polymers with a tunable number n of effective atoms (blobs) per chain [G. D'Adamo et al., J. Chem. Phys. 137, 024901 (2012)] to polymer systems in thermal crossover between the good-solvent and the θ regimes. We consider the thermal crossover in the region in which tricritical effects can be neglected, i.e., not too close to the θ point, for a wide range of chain volume fractions Φ = c∕c* (c* is the overlap concentration), up to Φ ≈ 30. Scaling crossover functions for global properties of the solution are obtained by Monte Carlo simulations of the Domb-Joyce model with suitably rescaled on-site repulsion. They provide the input data to develop a minimal coarse-grained model with four blobs per chain (tetramer model). As in the good-solvent case, the coarse-grained model potentials are derived at zero density, thus avoiding the inconsistencies related to the use of state-dependent potentials. We find that the coarse-grained model reproduces the properties of the underlying, full-monomer system up to some reduced density Φ which increases when lowering the temperature towards the θ state. Close to the lower-temperature crossover boundary, the tetramer model is accurate at least up to Φ ~/= 10, while near the good-solvent regime reasonably accurate results are obtained up to Φ ~/= 2. The density region in which the coarse-grained model is predictive can be enlarged by developing coarse-grained models with more blobs per chain. We extend the strategy used in the good-solvent case to the crossover regime. This requires a proper treatment of the length rescalings as before, but also a proper temperature redefinition as the number of blobs is increased. The case n = 10 is investigated in detail. We obtain the potentials for such finer-grained model starting from the tetramer ones. Comparison with full-monomer results shows that the density region in which accurate predictions can be obtained is significantly wider than that corresponding to the tetramer case.

We reconsider the structure-based route to coarse graining in which the coarse-grained model is defined in such a way to reproduce some distribution functions of the original system as accurately as possible. We consider standard expressions for pressure and chemical potential applied to this family of coarse-grained models with density-dependent interactions and show that they only provide approximations to the pressure and chemical potential of the underlying original system. These approximations are then carefully compared in two cases: we consider a generic microscopic system in the low-density regime and polymer solutions under good-solvent conditions. Moreover, we show that the state-dependent potentials depend on the ensemble in which they have been derived. Therefore, care must be used in applying canonical state-dependent potentials to predict phase lines, which is typically performed in other ensembles.

Objective: The aim of this research was to investigate relationships between cognitive function and non-invasive, repeatable cardiac parameters in elderly subjects suffering from mild cognitive impairment (MCI) or Alzheimer's disease (AD)., Methods: Two hundred and twenty-four community-living elderly subjects, 31 AD patients, 77 MCI patients, and 116 cognitively normal subjects (CNS), were evaluated for cognitive abilities (Mini Mental State Examination score (MMSE)) and for electrocardiographic [corrected heart rate QT interval dispersion (QTcD)] and echocardiographic [Left ventricular ejection fraction (LVEF)] parameters., Results: Mean values of LVEF were not significantly different between the three groups; QTcD mean values were significantly lower in CNS group than in subjects with MCI and AD. The Pearson Product Moment Correlation test, carried out in the three study groups, showed a significant inverse correlation between QTcD and MMSE score (r = -0.357; p < 0.01) in the group of MCI patients, only. In multivariable-adjusted linear regression tests, QTcD (p = 0.030) and education (p = 0.021) are associated with MMSE score in MCI group. Only the parameter of education appears to predict MMSE in CNS group; none of these parameters appear to predict MMSE in the group of patients with AD., Conclusion: The association between QTcD and MMSE requires cautious interpretation and further extensive investigation. However, if confirmed by longitudinal studies, the finding could play a role in the management of the subjects with MCI., (Copyright © 2012 John Wiley & Sons, Ltd.)

Imaging localized plasmon modes in noble-metal nanoparticles is of fundamental importance for applications such as ultrasensitive molecular detection. Here, we demonstrate the combined use of optical dark-field microscopy (DFM), cathodoluminescence (CL), and electron energy-loss spectroscopy (EELS) to study localized surface plasmons on individual gold nanodecahedra. By exciting surface plasmons with either external light or an electron beam, we experimentally resolve a prominent dipole-active plasmon band in the far-field radiation acquired via DFM and CL, whereas EELS reveals an additional plasmon mode associated with a weak dipole moment. We present measured spectra and intensity maps of plasmon modes in individual nanodecahedra in excellent agreement with boundary-element method simulations, including the effect of the substrate. A simple tight-binding model is formulated to successfully explain the rich plasmon structure in these particles encompasing bright and dark modes, which we predict to be fully observable in less lossy silver decahedra. Our work provides useful insight into the complex nature of plasmon resonances in nanoparticles with pentagonal symmetry.

We present a coarse-grained model for linear polymers with a tunable number of effective atoms (blobs) per chain interacting by intra- and intermolecular potentials obtained at zero density. We show how this model is able to accurately reproduce the universal properties of the underlying solution of athermal linear chains at various levels of coarse-graining and in a range of chain densities which can be widened by increasing the spatial resolution of the multiblob representation, i.e., the number of blobs per chain. The present model is unique in its ability to quantitatively predict thermodynamic and large scale structural properties of polymer solutions deep in the semidilute regime with a very limited computational effort, overcoming most of the problems related to the simulations of semidilute polymer solutions in good solvent conditions.

We consider a coarse-grained model in which polymers under good-solvent conditions are represented by soft spheres whose radii, which should be identified with the polymer radii of gyrations, are allowed to fluctuate. The corresponding pair potential depends on the sphere radii. This model is a single-sphere version of the one proposed in Vettorel et al. [Soft Matter 6, 2282 (2010)], and it is sufficiently simple to allow us to determine all potentials accurately from full-monomer simulations of two isolated polymers (zero-density potentials). We find that in the dilute regime (which is the expected validity range of single-sphere coarse-grained models based on zero-density potentials) this model correctly reproduces the density dependence of the radius of gyration. However, for the thermodynamics and the intermolecular structure, the model is largely equivalent to the simpler one in which the sphere radii are fixed to the average value of the radius of gyration and radii-independent potentials are used: for the thermodynamics there is no advantage in considering a fluctuating sphere size.

Unlabelled: Ascites is a common complication of liver cirrhosis, occurring in more than 50-60% of the patients within 10 years of the diagnosis. In 5-10% of patients, ascites cannot be mobilized, or its early recurrence cannot be prevented by medical treatment. This condition is known as "refractory ascites". The use of terlipressin in cirrhotic patients with refractory ascites and normal renal function has not been evaluated. This prospective study was aimed at evaluating whether terlipressin in addition to standard therapy (diuretics plus albumin) might improve the outcome of refractory ascites in cirrhotic patients without HRS., Patients: 26 cirrhotic patients with refractory ascites were prospectively enrolled in this study. All the patients had tense (grade 3) ascites, and 10/26 showed also massive peripheral edema. Patients received maximum diuretic treatment plus albumin and terlipressin., Results: Complete response was seen in 16/26 patients. The higher response to therapy was seen during the 2nd week of treatment. 6 patients showed a decrease of at least two points in the ascites score. No differences in clinical response to treatment were seen according to the etiology of the disease., Conclusions: In conclusion, our study shows a synergistic effect of terlipressin vs treatment with albumin plus diuretics in patients with refractory ascites. One could speculate that albumin might enhance the vasoconstrictive response to terlipressin, thus contributing to counterbalance the negative effects of systemic vasodilation, which characterizes the hyperdynamic circulation of cirrhotic patients., (Copyright © 2011 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)

We report a characterization of the relative stability and structural behavior of various micellar crystals of an athermal model of AB-diblock copolymers in solution. We adopt a previously developed coarse-graining representation of the chains which maps each copolymer on a soft dumbbell. Thanks to this strong reduction of degrees of freedom, we are able to investigate large aggregated systems and for a specific length ratio of the blocks f = M(A)∕(M(A) + M(B)) = 0.6, to locate the order-disorder transition of the system of micelles. Above the transition, mechanical and thermal properties are found to depend on the number of particles per lattice site in the simulation box, and the application of a recent methodology for multiple occupancy crystals [B. M. Mladek et al., Phys. Rev. Lett. 99, 235702 (2007)] is necessary to correctly define the equilibrium state. Within this scheme we have performed free energy calculations at two reduced density ρ∕ρ∗ = 4, 5 and for several cubic structures such as fcc, bcc, and A15. At both densities, the bcc symmetry is found to correspond to the minimum of the unconstrained free energy, that is to the stable symmetry among the few considered, while the A15 structure is almost degenerate, indicating that the present system prefers to crystallize in less packed structures. At ρ∕ρ∗ = 4 close to melting, the Lindemann ratio is fairly high (∼0.29) and the concentration of vacancies is roughly 6%. At ρ∕ρ∗ = 5 the mechanical stability of the stable bcc structure increases and the concentration of vacancies accordingly decreases. The ratio of the corona layer thickness to the core radius is found to be in good agreement with experimental data for poly(styrene-b-isoprene)(22-12) in isoprene selective solvent which is also reported to crystallize in the bcc structure.

Introduction: We conducted a survey interviewing end-stage renal disease (ESRD) patients just after they began chronic dialysis (CD) to describe characteristics and factors associated with early (ER) and late referral (LR), and to analyze the consequences of timing of referral to a nephrologist., Methods: We interviewed 673 patients via telephone starting CD between 2004 and 2006 in Lazio, Italy, to collect information about the year before CD. Multiple logistic regression was performed to evaluate the factors associated with LR., Results: We found that 22% of patients reported being LRs. A lower probability for LR was found for older age, family history of renal diseases, abnormal test for renal functions, presence of hypertension, married status and awareness of a nephrology outpatient center near home. LR patients had a lower frequency of hepatitis B virus (HBV) vaccination (14.9% vs. 41.7%), arteriovenous fistula (31.8% vs. 75.6%) and information about renal replacement therapy modalities (33.8% vs. 72.6%), and they more often started CD in an emergency (85.8% vs. 41.5%)., Conclusions: The percentage of self-reported LR was lower than reported in other studies. However, many patients started CD in an emergency, with a catheter as first vascular access, without vaccination against HBV and without the possibility of choosing their dialysis modality. Individual conditions facilitating contact with medical care (older age and presence of comorbidities) seem to be associated with a lower probability of LR. These findings emphasize the importance of predialysis patient training, confirming the important role that information plays in health service access, to improve early and long-term dialysis outcomes.

Since the early description of Randall plaques in 1937, studies of the pathogenesis of stone formation mainly focused on the chemistry involving salt precipitation and crystallization, rather than tubular and interstitial medullar mechanisms of calcium concentration and supersaturation. In 2003, Bushinsky published a suggestive and inspiring sequence of events aimed to show that the basement membrane of the thin limb of the loop of Henle can be the first site of nucleation, as recently shown by the impressive work by Evan et al. The aim of this minireview is to verify the consistency of the Evan and Bushinsky theory with the current literature in the field.

Context: Despite growing interest in medical communication by certification bodies, significant methodological and logistic challenges are evident in experiential methods of instruction., Objective: There were three study objectives: 1) to explore the acceptability of an innovative video feedback programme to residents and faculty; 2) to evaluate a brief teaching intervention comprising the video feedback innovation when linked to a one-hour didactic and role-play teaching session on paediatric residents' communication with a simulated patient; and 3) to explore the impact of resident gender on communication change., Design: Pre/post comparison of residents' performance in videotaped interviews with simulated patients before and after the teaching intervention. Individually tailored feedback on targeted communication skills was facilitated by embedding the Roter Interaction Analysis System (RIAS) within a software platform that presents a fully coded interview with instant search and review features., Setting/participants: 28 first year residents in a large, urban, paediatric residency programme., Results: Communication changes following the teaching intervention were demonstrated through significant improvements in residents' performance with simulated patients pre and post teaching and feedback. Using paired t-tests, differences include: reduced verbal dominance; increased use of open-ended questions; increased use of empathy; and increased partnership building and problem solving for therapeutic regimen adherence. Female residents demonstrated greater communication change than males., Conclusions: The RIAS embedded CD-ROM provides a flexible structure for individually tailoring feedback of targeted communication skills that is effective in facilitating communication change as part of a very brief teaching intervention.

Changes in psychiatric health care delivery driven by such major shifts as deinstitutionalization, community-based care, and managed care have greatly altered the educational milieu for third-year psychiatry clerkships. Students may be assigned exclusively to alcohol and substance abuse treatment units, consultation-liaison services, or outpatient clinics, and may not have as broad an exposure as is desirable to patients with a variety of psychiatric illnesses. The authors describe a pilot course they developed in 2001, Clinical Psychiatric Assessment and Diagnosis, for third-year medical students at the Uniformed Services University of the Health Sciences medical school. The course uses standardized patients (SPs) to help students gain broader clinical experience. In psychiatry, a growing body of literature supports the acceptability, reliability, and validity of objective structured clinical examination assessment using SPs for medical students. Only a few articles report the use of SPs to primarily teach psychiatry instead of evaluating student proficiency in clinical psychiatry. Since this course was developed, the National Board of Medical Examiners announced that all medical students will be required to pass a clinical skills test in order to practice medicine, beginning with the class of 2005. The examination will use SPs modeling different clinical scenarios. In light of this change, many medical schools may have to reevaluate and possibly revamp their curriculums to insure sufficient acquisition of clinical skills in different specialties. The use of SPs in psychiatry could provide an effective, primary clinical teaching experience to address this new requirement as well.

Background: In Lazio, only about 5% of uremic patients are on peritoneal dialysis (PD). The present study focuses on the parameters of PD selection, the treatment schedules, and the clinical outcomes of PD patients in the nine public facilities offering a PD program. A cohort of 249 first-time PD patients, from July 1, 1994 to December 31, 2000, was retrospectively considered., Methods: For the enrollment of the patients, the Regional Dialysis Registry databank was consulted. On December 31, 2000, a systematic review of patient charts was performed to extract the reasons for the PD choice, details of PD schedule, peritonitis episodes, reasons for drop-out, and patient survival rates. In regard to technique success-defined as the probability of having a patient alive on PD-change of modality and death were considered as final events. In regard to patient survival, only death, even in the first 2 months after a shift to hemodialysis, was considered the end point., Result: The main PD selection reasons were patient and/or nephrologist preference in 90% of cases. One-hundred eighty-nine patients (76%) had been started on CAPD. During the follow-up, 38.2% dialysis schedules had been modified at least once. At the end of follow-up, 41.2% patients were on APD. The peritonitis rate was one episode per 30 patient-months (1 per 27 patient-months in CAPD; 1 per 37 patient-months in APD; p = 0.08). The technique success rate was 66.3% after 2 years and 49.8% after 3 years. The patient survival rate was 81.1% after 2 years and 68.7% after 3 years., Conclusions: Patients chose PD as a first dialysis treatment mainly because of reasons unrelated to their clinical status. The technique's success, patient mortality rates, and the peritonitis rate do not explain the low PD diffusion in the region. The peritonitis rate meets the target criteria for excellence recommended by the Italian Society of Nephrology. The observed outcomes may have been favored by the selection of motivated patients and by the increased use of APD.

International interest in the teaching and assessment of clinical skills across the professional continuum has fueled extensive use of simulated parents in multiple station events by medical schools and professional organizations devoted to assessment. The author discuss achievements and challenges in the use of the objective structured clinical examination (OSCE) and simulated patient (SP) for medical education and assessment. The author revisits and expands subject put forth as 'technical issues related to logistics' that summarize group discussions of conference attendees in 1992 by Anderson and Kassebaum, editors of the Proceedings of the Association of American Medical Colleges' Consensus Conference on the Use of Standardised Patients in the Teaching and Evaluation of Clinical Skills. The author describes and discusses current terminology; evolving conceptual and practical applications of the OSCE that utilize simulated patients in medical education and high-stakes assessment for licensure and certification; standards of practice in SP case materials development, recruitment, training and quality assurance; operational and research questions for the future in the use of SPs, centralized SP programs and staffing; faculty development in the use of the SP and OSCE; program costs, event space, test and web-based video access and security issues; document and data management of SP programs; development of web-based and online resources and the founding of the Association of Standardized Patient Educators(ASPE), a specialist professional organization.

The American Academy of Pediatrics' statement on palliative care for children emphasizes the need to identify and address barriers to effective palliative care. The authors describe a seminar for pediatrics residents on death and bereavement that addresses these issues. The day-long seminar for second-year residents has been offered annually since 1996. The seminar is conducted offsite so that residents can concentrate without distraction. The seminar uses an intense and comprehensive multidisciplinary approach to accomplish seven goals: (1) to have residents gain expertise in talking with parents about the death of their child; (2) to have residents practice and experience how it feels to be in emotionally charged situations; (3) to train residents to become more knowledgeable concerning autopsy and organ donation, and to learn strategies to approach these topics with a child's parents; (4) to have residents gain an understanding of the role of the ministry for families who are grieving; (5) to provide residents with multidisciplinary strategies to support a family after a child has died; (6) to help residents gain insight into the impact of death on their own emotions and the importance of addressing their own emotions to cope with stress and potential burnout; (7) and to help residents better understand the parents' perceptions of the medical care providers and their dying child. In their evaluation comments, the residents report value from a seminar designed to help them address issues of patient death and bereavement. This type of educational intervention should be considered for the curriculum by other residency programs.

Gastrin has been suggested to be involved in the promotion and progression of colon cancer. Mice colon cancers and colon-carcinoma cell lines are stimulated to grow by gastrin, and gastrin receptors have been found in the majority of human colon-tumor specimens. High serum gastrin levels have been reported in patients with colon polyps and cancers, together with increased ornithine decarboxylase (ODC) activity. Since gastrin stimulates ornithine decarboxylase in colon cancer cells in vitro it has been suggested that increased synthesis of intracellular polyamines is one of the mechanisms activated by the hormone. In order to confirm the presence of hypergastrinemia in colon cancer and to investigate the relationship between plasma gastrin and tumor growth, we used an animal model of colon carcinogenesis that minimizes the possible bias of human studies, related to varying diet, age and environmental factors. We evaluated blood gastrin levels in 35 rats with colon cancer induced by the carcinogen azoxymethane (AOM), and we correlated gastrinemia with tumor proliferation, assessed by thymidine-labeling index (TLI) and ODC activity; 6 animals constituted the control group. Gastrin levels in rats with AOM-induced tumors were significantly higher than in controls. Significantly higher TLI and ODC activity were found in the tumors of hypergastrinemic rats than in neoplasms of animals with normal gastrin levels. Our data provide additional evidence of a role for gastrin as trophic hormone for colon neoplastic cells.

We studied the proliferative activity and the modifications in ornithine decarboxylase (ODC) and diamine oxidase (DAO), enzymes involved in polyamine metabolism, in the apparently normal intestinal mucosae of rats with azoxymethane induced tumours. Fifty rats were treated with six weekly injections of 15 mg/kg body weight azoxymethane (AOM). Six rats died during the treatment. All the surviving rats developed intestinal tumours; tumour incidence was 93.1% (41/44) in the left colon, 40.9% (18/44) in the right colon and 45.4% (20/44) in the small bowel. In the normal-appearing mucosa close to intestinal tumours we found an extension of the normal proliferative compartment to the upper third of the crypts (stage I abnormality) and a shift of most of the DNA synthesizing cells from the basal region to the middle and upper third (stage II abnormality). Furthermore, the intestinal mucosa characterized by proliferative abnormalities showed an ODC activity significantly higher than the normal mucosa of control rats (small bowel: 1.01 +/- 0.26 vs 0.42 +/- 0.15, P < 0.01; right colon: 1.32 +/- 0.34 vs 0.25 +/- 0.02, P < 0.001; left colon: 1.93 +/- 0.35 vs 0.22 +/- 0.01, P < 0.01). We also detected a significant decrease of DAO activity in the mucosa of the small bowel and right colon of treated rats compared to controls (0.86 +/- 0.09 vs 4.39 +/- 0.85, P < 0.01; 1.04 +/- 0.43 vs 3.80 +/- 0.91, P < 0.01, respectively), while DAO activity in the left colon was unchanged. The lower incidence of tumours in the small bowel and right colon suggests the presence of factors protecting these segments from carcinogenesis.(ABSTRACT TRUNCATED AT 250 WORDS)

One hundred-twenty-six pediatricians were questioned about their attitudes concerning the practice of immunization, their feelings about the new vaccines (measles, mumps, german measles, hepatitis b) and about the pertussis vaccine. 80% of them reported that indications and contraindications were still unclear: Down's syndrome and atopic eczema are still thought to be real contraindications--despite the mass of papers suggesting that they are not so--, moreover 95% of the participants persists into the unnecessary evaluation of the antibody title following hepatitis b immunization. We conclude that it would be wise to periodically diffuse to pediatricians update recommendations about the extended immunization program, especially in our region, were still an high number of children are not properly immunized.

Uremic patients have been shown to be frequently malnourished. The amount of glucose absorbed from dialysis solution makes caloric malnutrition unusual among CAPD (Continuous Ambulatory Peritoneal Dialysis) patients. Protein malnutrition is more likely because of loss of nutrients into the dialysate and inhibition of appetite. Present study evaluates nutritional status of 29 patients (20 F, 9 M), 60.31 +/- 16.04, on CAPD since 15.2 months (4-50). Dialysis was scored adequate in all patients, based on the Clinical Assessment Score proposed by the Columbia University Group. Nutritional status was evaluated with (1) Marckmann score, based on relative body weight (RBW), triceps skin fold (TSF), midarm muscular circumference (MAMC), S-transferrin, and (2) Subjective Global Assessment (SGA) based on history, physical examination, anthropometric (BW, skin folds, % body fat according to Durnin, MAMC) and laboratory data (S-albumin, C3, S-transferrin, Hb, lymphocyte count, creatinine appearance rate [CAR], urea nitrogen appearance normalized by BW [NUNA], protein catabolic rate [pcr]). RBW was 118.2% because of excess stored fat; % body fat was > 40% in 6 females and 34.4 +/- 5 in 14 females. Lymphocytes, total proteins, S-albumin, S-transferrin, C3, IgG were normal. CAR (12.2 +/- 3.2 mg/kg/die) and NUNA (101.1 +/- 37.3 mg/kg/die) were lower than normal, as reported for dialysis patients. Marckmann score (26 patients) defined 10 cases of slight malnutrition; SGA (29 patients) identified 2 severely and 14 slightly malnourished patients. Marckmann and SGA scoring however agreed only in 13 over 26 patients. Slight or severe malnutrition has been assessed in CAPD patients in spite of clinically adequate dialysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Experience with chronic intermittent peritoneal dialysis is reviewed to focus on automated peritoneal dialysis (APD) regimens, adequacy and indications. From 1969 to 1990, 74 ESRD patients were treated: 59 patients with Intermittent Peritoneal Dialysis (IPD: 30-40 l x 3/week) and fifteen patients with hour Daily Peritoneal Dialysis (DPD: 25 l x 6 nights/week). Fourty-four patients were regularly treated with IPD. Of these 33 were adequately dialysed, maintaining residual renal function, whilst oligo-anuric patients developed underdialysis. DPD patients were adequately dialysed, having satisfactory peritoneal clearances. Peritonitis rate was 1/19.2 pt months in IPD patients and 1/13.4 pt months in DPD patients. Technique survival was 78% at the end of the first year, and 52% the second year. IPD is adequate only for low body weight patients with residual renal function. In-hospital IPD must be taken into account only for patients unable to perform dialysis without partner assistance. Home DPD, like CCPD and NPD, is generally adequate and yields fairly good quality of life, but the cost is high, probably because of limited ADP diffusion. Prescription must be therefore restricted to patients unable to perform dialysis with working partners, workers who cannot cope with CAPD exchanges, and CAPD failures.

A young woman presented with nephrotic syndrome due to membranous nephropathy and a localized form of giant lymph node hyperplasia (Castleman's disease) occurring as a large intra-abdominal mass. Five months after surgical removal of the mass, only mild proteinuria persisted. Twenty months later a second kidney biopsy showed a near-normal morphology. Six years later the patient was free of symptoms and had normal urinalysis. Reviewing the pertinent literature, it seems to be the first case of a biopsy-proven cure of membranous nephropathy in a patient with membranous nephropathy and Castleman's disease.

Diagnostic sonographic and radioisotope scanning techniques have been shown to be useful in the diagnosis of obstructive uropathy. The accuracy of both methods was compared and sonography was found to provide the more accurate data (sensitivity, 90%; specificity, 98%; accuracy, 97%). Sonography provides excellent anatomic information and enables one to grade the degree of dilatation. Renal radionuclide studies were less sensitive in detecting obstruction, particularly in the presence of chronic renal disease, but offered additional information regarding relative renal blood flow, total effective renal plasma flow, and interval change in renal parenchymal function.

An avulsion fracture on the dorsolateral aspect of the calcaneus at the origin of the extensor digitorum brevis muscle was identified after inversion injuries of the ankle. The avulsion occurred in 10% of emergency room patients with clinically suspected ankle fractures. The routine dorsoplantar view of the foot and/or the routine anteroposterior view of the ankle demonstrated the fracture. The fracture is most often confused with the os peroneum, or with the fracture of the anterior process of the calcaneus. Treatment is conservative with elevation, supportive bandage, and early activity.