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Critically ill patients are at risk of presenting with gastrointestinal dysfunction at intensive care unit admission or during their stay. However, identifying gastrointestinal dysfunction is difficult because clinical evaluation is frequently nonspecific and validated biomarkers are lacking. In this context, ultrasound of the digestive tract may help to identify gastrointestinal dysfunction. In this narrative review, we summarize available evidence and propose a protocol for assessment of the gastrointestinal tract with ultrasound. First, we report available evidence from use of four available protocols: the gastrointestinal and urinary tract sonography protocol, the acute gastrointestinal injury ultrasound score, the transabdominal gastrointestinal ultrasound protocol, and the Lai protocol, each addressing somewhat different aspects. Outputs from these protocols have been associated with clinical scores of gastrointestinal failure, feeding intolerance, and 28‐day mortality. Second, we describe the potential pitfalls of using ultrasound in the critically ill, such as obesity, abdominal dressings, or the presence of intraluminal gas. Third, we suggest perspectives of ultrasound in monitoring the response to enteral nutrition and for early identification of nonocclusive mesenteric ischemia. Fourth, we propose a structured protocol for gastrointestinal ultrasound describing all the different structures that should be evaluated and provide detailed guidance for a clockwise abdominal examination. In conclusion, the use of a specific and structured protocol might help to identify patients presenting with gastrointestinal dysfunction, guide nutrition, and allow the proposal of pathophysiological hypotheses (complications of enteral nutrition, intra‐abdominal infection, bowel ischemia, etc.). The benefit of using a structured protocol requires further investigation. [ABSTRACT FROM AUTHOR]

Background/Objectives: The discrepancy between the current perceived body image (BI) and beauty ideals leads to dissatisfaction, which is believed to be common among adolescents. This study aimed to investigate the stability in BI perceptions and dissatisfaction during early adolescence. Another aim was to highlight differences in dissatisfaction according to Body Mass Index (BMI) and inconsistencies in weight status perception. Methods: Two hundred and nine participants (mean age at first survey: 11.33 ± 0.38 years) were enrolled in this longitudinal study with three years of follow-up. Data on size and BI perceptions were collected through individual interviews. Stature and weight were directly measured. Results: Findings indicated significant changes over three years in anthropometric traits but not in weight status prevalence or BI perception and dissatisfaction, except for the ideal figure in males and weight control in females. The results also indicated a significant difference in BI perception and dissatisfaction by BMI categories. Self-reported body measurements were found to be unreliable with a weak-to-moderate agreement between self-perceived and actual weight status. Conclusions: BI perception appears quite stable across the three years considered. Dissatisfaction is similar in both genders, although a tendency toward different gender aesthetic ideals is already appreciable in early adolescence. We suggest that the lower frequency of normal-weight adolescents compared with peers in previous studies is attributable to the effects of the recent pandemic. Given the growing dissatisfaction with increasing BMI and misinterpretations of weight status, school actions to promote a healthy lifestyle and positive BI should be undertaken. [ABSTRACT FROM AUTHOR]

Regular physical activity is generally deemed to positively affect health, but studies on children are scarce. Among the kinds of physical activity, sports practice is the most common and easiest to quantify and report by children. This cross-sectional study aimed to compare the two genders and evaluate the association between organized sports practice and body dissatisfaction in a sample of 214 Italian schoolchildren (55.6% males) aged 5 to 12. Body image perception and data on sports practice expectations and facilitators were collected in individual face-to-face interviews; weight and stature were directly measured. Girls tended to be sportier than boys (91.6% of girls vs. 86.3% of boys practiced sports), with an earlier start in sports (5.48 ± 1.47 vs. 5.72 ± 1.38 years) and a greater amount of weekly sports (3.41 ± 2.95 vs. 3.01 ± 2.11 h/week). In both genders, the ideal silhouette was more slender than the feel silhouette, and in girls more than in boys. According to the outcomes of multiple regression models, years of organized sports participation were a significant predictor of the weekly amount of sports in both genders, in addition to the feel weight status minus actual weight status inconsistency score, fun in sports, and parental support only in boys and teacher support only in girls. Children’s needs and interests and sports facilitators should be considered to promote an early active lifestyle.

The recent advancements in climate modeling partially build on the improvement of horizontal resolution in different components of the simulating system. A higher resolution is expected to provide a better representation of the climate variability, and in this work we are particularly interested in the potential improvements in representing extreme events of high temperature and precipitation. The two versions of the Centro Euro-Mediterraneo sui Cambiamenti Climatici (CMCC-CM2) model used here adopt the highest horizontal resolutions available within the last family of the global coupled climate models developed at CMCC to participate in the Coupled Model Intercomparison Projects, Phase 6 (CMIP6) effort. The main aim of this study is to document the ability of the CMCC-CM2 models to represent the spatial distribution of extreme events of temperature and precipitation, under the historical period, comparing model results to observations, the European Centre for Medium-Range Weather Forecasts (ECMWF) reanalysis (ERA5), multi-source weighted-ensemble precipitation (MSWEP) and Climate Hazards Group infrared precipitation with station data (CHIRPS) observations. For a more detailed evaluation we use both 6-hourly and daily time series, to compute indices representative of intense and extreme conditions. In terms of mean climate, the two models are able to realistically reproduce the main patterns of temperature and precipitation. The high resolution version (1/4∘ horizontal resolution) of the atmospheric model provides better results than the standard resolution one (1°), not only in terms of means but also in terms of intense and extreme events of temperature defined at daily and 6-hourly frequencies. This is also the case of average and intense precipitation. On the other hand the extreme precipitation is not improved by the adoption of a higher horizontal resolution.

Abstract Background Post-acute sequelae of SARS-CoV-2 infection (PASC) affect millions of individuals worldwide. Rehabilitation interventions could support individuals during the recovery phase of COVID-19, but a comprehensive understanding of this new disease and its associated needs is crucial. This qualitative study investigated the experience of individuals who had been hospitalized for COVID-19, focusing on those needs and difficulties they perceived as most urgent. Methods This naturalistic qualitative study was part of a single-center mix-method cross-sectional study (REACT) conducted in Italy during the first peak of the SARS-CoV-2 pandemic. The qualitative data collection took place through a telephone interview conducted 3 months after hospital discharge. The experience of individuals discharged after hospitalization for COVID-19 was investigated through the main research question – “Tell me, how has it been going since you were discharged?”. Two secondary questions investigated symptoms, activities, and participation. Data were recorded and transcribed verbatim within 48 h. An empirical phenomenological approach was used by the researchers, who independently analyzed the data and, through consensus, developed an interpretative model to answer the research question. Translation occurred after data was analyzed. Results During the first peak of the COVID-19 pandemic, 784 individuals with COVID-19 were discharged from the hospitals of the Local Health Authority of the Province of Reggio Emilia (Italy); 446 were excluded due to the presence of acute or chronic conditions causing disability other than COVID-19 (n. 339), inability to participate in the study procedures (n. 56), insufficient medical documentation to allow for screening (n. 21), discharge to residential facilities (n. 25), and pregnancy (n. 5). Overall, 150 individuals consented to participate in the REACT study, and 56 individuals (60.7% male, average age 62.8 years ±11.8) were interviewed in June–July 2020, up to data saturation. Persistent symptoms, feelings of isolation, fear and stigma, emotional distress, a fatalistic attitude, and return to (adapted) life course were the key themes that characterized the participants’ experience after hospital discharge. Conclusions The experience as narrated by the participants in this study confirms the persistence of symptoms described in PASC and highlights the sense of isolation and psychological distress. These phenomena may trigger a vicious circle, but the participants also reported adaptation processes that allowed them to gradually return to their life course. Whether all individuals are able to rapidly activate these mechanisms and whether rehabilitation can help to break this vicious circle by improving residual symptoms remain to be seen. Trial registration ClinicalTrials.com NCT04438239.

Delirium remains a challenging clinical problem in hospitalized older adults, especially for postoperative patients. This complication, with a high risk of postoperative mortality and an increased length of stay, frequently occurs in older adult patients. This brief narrative paper aims to review the recent literature regarding delirium and its most recent update. We also offer physicians a brief and essential clinical practice guide to managing this acute and common disease.

The currently available nebulization devices have a slow aerosol flow and produce vapor with large microdrops. Improved devices that achieve higher airflow and produce smaller microdrops are needed to improve the clinical care of patients. To address this critical need, we developed a novel system for the molecular vaporization of liquids. This device vaporizes an active pharmacological substance dissolved in water, alcohol, or a mixture of water and alcohol using two energy sources at the same time: high-frequency ultrasound and thermal induction. Application of energy to a solution contained in the device’s tank allows, within tens of seconds, for the vaporization of the solution itself, with the generation of a vapor consisting of microdrops of very small diameter (0.2–0.3 μm). In this article, we illustrate the technology used, the main verification tests performed, and the primary fields of application for this device. In particular, the advantages of both the aerosol delivery system and the administration system are highlighted.

Hail is a meteorological phenomenon with adverse impacts that affects multiple socio-economic sectors such as agriculture, renewable energy, and insurance. Nevertheless, the understanding of the favourable environmental conditions for hail formation and the models’ inadequacy to represent these phenomena have been limited by the scarce temporal and spatial coverage of hail observations. This is a major concern for the mitigation of hail-related risk in sensitive regions such as Italy, which is one of the more hail-prone areas in Europe. In this work, we present a hail model that has been developed to describe the hail hazard over Italy. This model relies on several ERA5 large-scale meteorological variables and convective indices that are combined following the statistical method described in Prein and Holland (2018). The identification of the best set of variables to be used as predictors in the hail model has been performed by a systematic machine learning procedure based on a genetic algorithm. The hail model estimates the hail probability over Italy in the 1979–2020 period, on the ERA5 spatial grid resolution (∼ 30 km). The output of the hail model has been used to characterize the seasonality and long-term variability of hail events in Italy. Furthermore, the categorical verification of the hail probability over the Friuli Venezia Giulia region has revealed that the hail model is able to effectively estimate the hail occurrences in specific Italian regions.

We report a dataset of known and published occurrence records of Italian taxa from species (and subspecies) to family rank of the phylum Rotifera; we considered only Bdelloidea, Monogononta, and Seisonacea, and did not include Acanthocephala. The dataset includes 15,525 records (12,015 of which with georeferenced coordinates) of 584 valid species and subspecies names, gathered from 332 published papers. The published literature spans the period from 1838 to 2022, with the lowest number of papers published during the Second World War followed by an increasing number of papers, from 20 to more than 60 in each decade. The Italian regions with the highest number of records and species are Emilia-Romagna, Lombardy, and Piedmont, whereas no records are known for Molise. The number of species known from each region mostly mirrors sampling efforts, measured as the number of publications per region. The dataset is available through the Open Science Framework (OSF), and all the georeferenced occurrence data have been uploaded to the Global Biodiversity Information Facility (GBIF).

Abstract The plague of 1630–1632 was one of the deadliest plague epidemics to ever hit Northern Italy, and for many of the affected regions, it was also the last. While accounts on plague during the early 1630s in Florence and Milan are frequent, much less is known about the city of Imola. We analyzed the full skeletal assemblage of four mass graves (n = 133 individuals) at the Lazaretto dell’Osservanza, which date back to the outbreak of 1630–1632 in Imola and evaluated our results by integrating new archival sources. The skeletons showed little evidence of physical trauma and were covered by multiple layers of lime, which is characteristic for epidemic mass mortality sites. We screened 15 teeth for Yersinia pestis aDNA and were able to confirm the presence of plague in Imola via metagenomic analysis. Additionally, we studied a contemporaneous register, in which a friar recorded patient outcomes at the lazaretto during the last year of the epidemic. Our multidisciplinary approach combining historical, osteological and genomic data provided a unique opportunity to reconstruct an in-depth picture of the last plague of Imola through the city's main lazaretto.

As an important element in the regional containment of the COVID-19 pandemic a PCR testing laboratory with a cooperative character was founded in spring 2021 to screen for SARS-CoV-2 in the Nuremberg region, Germany. The aim was to detect asymptomatic infections in day care facilities for children, schools, and companies. The laboratory used an established RT-PCR protocol and analyzed approximately 18,500 pools of up to 25 pooled samples each from gargles or swabs (“lollipops”) from up to 135 facilities between July 2021 and June 2022. Usually, the participating facilities were informed about positive pools within a few hours. Retention samples from positive pools were usually analyzed on the same day, and the results were reported to the facilities as well as the German Electronic Reporting and Information System (DEMIS). In the laboratory results, both the local incidences and the transition from the Delta- to the Omicron surge in early 2022 were well reflected. It is plausible that about 4,800 secondary infections could be prevented from the approximately 1,570 positive individual samples detected in conjunction with appropriate isolation measures. Such a PCR laboratory, which is characterized by short response times and high flexibility, can thus provide valuable services for regional surveillance of infection incidence.

Ferroelectric oxides are currently being studied as absorbing materials in photovoltaic devices due to their spontaneous polarization that facilitates charge separation. KBiFe2O5 (KBFO) is a ferroelectric oxide with a perovskite like structure that has a low band gap; however, it has a relatively low electrical conductivity, which makes it difficult to transport and collect carriers. One way of overcoming that deficiency would be by decreasing the dimensions of the active layer. Thus, in this work, for the first time, nanofibers of KBFO were produced by electrospinning. Aqueous solutions of the ceramic precursors in the form of Fe, K and Bi nitrates were electrospun using poly (vinylpyrrolidone) (PVP) as the carrier. The as-spun fibers were calcinated at different temperatures and times. The pure KBFO phase was obtained after calcination at 750 °C, during 1.5 h at 15 °C/min; the nanofibers had diameters between 300 nm and 800 nm as analyzed by scanning electron microscopy (SEM). The interplanar distances of the (100) and (111‾) planes were 0.78 and 0.37 nm, respectively, as calculated by a VESTA software, x-ray diffraction (XRD) and transmission electron microscopy (TEM). Using a Magnetization-Field (MxH) curve, KBFO was found to be highly paramagnetic with low magnetization. The band gap was measured by spectrophotometry via a Tauc plot, resulting in a value of 1.72 eV. Therefore, KBFO in the form of nanofibers seems to have a high potential as an absorbing material in photovoltaic cells.

Objectives: The purpose of this pilot porcine study was to explore and illustrate the surgical application of human amniotic membrane (hAM) in an ex vivo model of medication-related osteonecrosis of the jaw (MRONJ).Material and methods: Five oral and maxillofacial surgeons participated to this study. MRONJ was simulated on porcine mandible specimens. hAM was applied using four different techniques: implantation with complete coverage, implantation with partial coverage, apposition and covering graft material. At the same time, the surgeons evaluated how well the hAM handled and its physical properties during the surgery.Results: Surgeons found that hAM had suitable mechanical properties, as it was easy to detach from the support, handle, bind to the defect and bury. hAM was also found to be strong and stable. The “implantation with complete coverage” and “implantation with partial coverage” techniques were the preferred choices for the MRONJ indication.Conclusion: This study shows that hAM is a graft material with suitable properties for oral surgery. It is preferable to use it buried under the gingiva with sutures above it, which increases its stability. This technical note aims to educate surgeons and provide them with details about the handling of hAM in oral surgery.Clinical relevance: Two surgical techniques for hAM application in MRONJ were identified and illustrated. hAM handling and physical properties during surgery were reported.

Introduction The chikungunya virus infection is still an epidemic in Brazil with an incidence of 59.4 cases per 100 000 in the Northeast region. More than 60% of the patients present relapsing and remitting chronic arthralgia with debilitating pain lasting for years. Transcranial direct current stimulation (tDCS) appears promising as a novel neuromodulation approach for pain-related networks to alleviate pain in several pain syndromes. Our objective is to evaluate the effectiveness of tDCS (C3/Fp2 montage) on pain, muscle strength, functionality and quality of life in chronic arthralgia.Methods and analysis This protocol is a single-centre, parallel-design, double-blind, randomised, sham-controlled trial. Forty participants will be randomised to either an active or sham tDCS. A total of 10 sessions will be administered over 2 weeks (one per weekday) using a monophasic continuous current with an intensity of 2 mA for 20 min. Participants will be evaluated at baseline, after the 10th session, 2 weeks and 4 weeks after intervention. Primary outcome: pain assessed using numeric rating scale and algometry. Secondary outcomes: muscle strength, functionality and quality of life. The effects of stimulation will be calculated using a mixed analysis of variance model.Ethics and dissemination The study was approved by the ethics committee of the Faculty of Health Sciences of Trairí, Federal University of Rio Grande do Norte (No. 2.413.851) and registered on the Brazilian Registry of Clinical Trials. Study results will be disseminated through presentations at conferences and publications in peer-reviewed journals.Trial registration number RBR-469yd6.

Multi-annual to decadal changes in climate are accompanied by changes in extreme events that cause major impacts on society and severe challenges for adaptation. Early warnings of such changes are now potentially possible through operational decadal predictions. However, improved understanding of the causes of regional changes in climate on these timescales is needed both to attribute recent events and to gain further confidence in forecasts. Here we document the Large Ensemble Single Forcing Model Intercomparison Project that will address this need through coordinated model experiments enabling the impacts of different external drivers to be isolated. We highlight the need to account for model errors and propose an attribution approach that exploits differences between models to diagnose the real-world situation and overcomes potential errors in atmospheric circulation changes. The experiments and analysis proposed here will provide substantial improvements to our ability to understand near-term changes in climate and will support the World Climate Research Program Lighthouse Activity on Explaining and Predicting Earth System Change.

Introduction Self-efficacy is associated with management of diseases, psychological well-being, improved quality of life and rehabilitation adherence. Several instruments related to behaviour or specific disease (eg, coronary artery disease (CAD)) assess self-efficacy. The evaluation of cardiac self-efficacy in individuals with CAD will support healthcare professionals to improve self-efficacy via interventions; therefore, a suitable instrument is crucial. This systematic review aims to assess measurement properties, methodological quality and content of outcome measures of cardiac self-efficacy instruments for individuals with CAD.Methods and analysis The study has been developed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol and Consensus Norms for Selection of Health Measuring Instruments (COSMIN). The following databases will be searched: MEDLINE (Ovid), Web of Science, EMBASE and PsycINFO. Studies assessing measurement properties of cardiac self-efficacy instruments for individuals with CAD will be included. No date or language restrictions will be applied to the search. Two independent authors will be responsible for assessing the eligibility of studies. Methodological quality of studies will be assessed using the COSMIN RoB Checklist, and the Grading of Recommendations, Assessment, Development and Assessment will be used to assess the quality of each study. Two authors will independently evaluate the content of instruments and link this to the International Classification of Functioning, Disability and Health.Ethics and dissemination This study does not require ethics committee approval since it is based on previously published data. Evidence from this systematic review will be disseminated through publication in peer-reviewed journals and presentation at scientific conferences.PROSPERO registration number CRD42021262613.

Medication-related osteonecrosis of the jaw (MRONJ) is a complication of certain pharmacological treatments such as bisphosphonates, denosumab, and angiogenesis inhibitors. There are currently no guidelines on its management, particularly in advanced stages. The human amniotic membrane (hAM) has low immunogenicity and exerts anti-inflammatory, antifibrotic, antimicrobial, antiviral, and analgesic effects. It is a source of stem cells and growth factors promoting tissue regeneration. hAM acts as an anatomical barrier with suitable mechanical properties (permeability, stability, elasticity, flexibility, and resorbability) to prevent the proliferation of fibrous tissue and promote early neovascularization at the surgical site. In oral surgery, hAM stimulates healing and facilitates the proliferation and differentiation of epithelial cells in the oral mucosa and therefore its regeneration. We proposed using cryopreserved hAM to eight patients suffering from cancer (11 lesions) with stage 2–3 MRONJ on a compassionate use basis. A collagen sponge was added in some cases to facilitate hAM grafting. One or three hAMs were applied and one patient had a reapplication. Three patients had complete closure of the surgical site with proper epithelialization at 2 weeks, and two of them maintained it until the last follow-up. At 1 week after surgery, three patients had partial wound dehiscence with partial healing 3 months later and two patients had complete wound dehiscence. hAM reapplication led to complete healing. All patients remained asymptomatic with excellent immediate significant pain relief, no infections, and a truly positive impact on the patients’ quality of life. No adverse events occurred. At 6 months of follow-up, 80% of lesions had complete or partial wound healing (30 and 50%, respectively), while 62.5% of patients were in stage 3. Radiological evaluations found that 85.7% of patients had stable bone lesions (n = 5) or new bone formation (n = 1). One patient had a worsening MRONJ but remained asymptomatic. One patient did not attend his follow-up radiological examination. For the first time, this prospective pilot study extensively illustrates both the handling and surgical application of hAM in MRONJ, its possible association with a collagen sponge scaffold, its outcome at the site, the application of multiple hAM patches at the same time, and its reapplication.