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Background Epilepsy surgery is recognized for its effectiveness in controlling seizures in a significant number of patients with drug-resistant epilepsy. Despite this, there remains a notable deficiency in referring these patients for video-electroencephalogram (EEG) monitoring and surgical evaluation. Addressing this gap, the Canadian Appropriateness of Epilepsy Surgery (CASES), an online tool for epilepsy surgery evaluation (www.epilepsycases.com), was developed to aid physicians in the referral process of patients with refractory epilepsy to surgical assessments.

Creutzfeldt-Jakob disease (CJD) is a rare, fatal, rapidly progressive neurodegenerative disease resulting from an accumulation of misfolded prion proteins (PrP). CJD affects 1–2 new individuals per million each year, and the sporadic type accounts for 90% of those cases. Though the median age at onset and disease duration vary depending on the subtype of sporadic CJD (sCJD), the disease typically affects middle-aged to elderly individuals with a median survival of 4–6 months. sCJD in younger individuals is extremely rare. Here, we present a 21-year-old female who died with a sporadic prion disease. She presented with psychiatric symptoms followed by a rapidly progressive neurocognitive and motor decline. EEG was negative for periodic sharp wave complexes; however, brain MRI was suggestive of prion disease. The cerebrospinal fluid (CSF) real-time quaking-induced conversion (RT-QuIC) assay was indeterminate. Neuropathologic examination at autopsy revealed severe neuronal loss and gliosis with secondary white matter degeneration but minimal spongiform changes and PrP deposits in the cerebellum and neocortex by immunohistochemistry. Absence of pathogenic mutations and methionine/valine heterozygosity at codon 129 of the prion protein gene (PRNP), atypical type 1 protease-resistant PrP that lacks or shows underrepresentation of the diglycosylated PrP isoform by western blot analysis, and no acquired prion disease risk factors resulted in a final diagnosis of atypical sCJD. Very young onset sCJD often has atypical clinical presentations and disease progression, neuropathological examination results, and/or laboratory test results that may confound diagnosis. It is critical to perform thorough, comprehensive evaluations to make an accurate diagnosis, which includes autopsy confirmation with histology, prion protein typing and prion gene sequencing.

Anorexia nervosa (AN) usually emerges in adolescence when important changes occur in cognitive, emotional, and social processes. Mentalizing, alexithymia, and impulsiveness represent key dimensions for the understanding and interpretation of psychological difficulties in AN. The outbreak of the COVID-19 pandemic has impacted adolescents with AN, showing a worsening of the disease. The main aims of the present paper are (1) to compare adolescents with AN before and during the COVID-19 pandemic and (2) to explore the relationship between mentalizing, alexithymia, impulsiveness, and psychological difficulties related to eating disorders in adolescents with AN during the COVID-19 pandemic. One hundred and ninety-six AN female adolescents (N = 94 before COVID-19; N = 102 during COVID-19) participated in this study. The results show that adolescents with AN during the COVID-19 pandemic had a more impaired functioning profile than the before COVID-19 group. Mentalizing, alexithymia, and impulsiveness had a predictive role on psychological difficulties related to eating disorders in adolescents with AN during the COVID-19 pandemic. In conclusion, our data reveal that the COVID-19 pandemic has likely represented a stress condition that affects mental health; worsening the severity of adolescents with AN clinical condition. Lastly, predictive patterns suggest the existence of a link between difficulties in the ability to face the problems of the present time using effective strategies and the severity of psychological symptoms.

IntroductionCardiovascular pathologies represent the first cause of death in uremic patients and are among the leading causes of mortality in patients with hereditary angioedema due to C1-inhibitor deficiency (HAE-C1INH). Before 2020, the most common treatment for long-term prophylaxis in HAE-C1INH patients in Italy was attenuated androgen, which may increase cardiovascular risk by multiple mechanisms.Case descriptionWe present a case report of a 56-year-old patient with HAE-C1INH type I affected by IgA nephropathy with severe kidney impairment. The patient experienced a first kidney transplant and, after late rejection, underwent a second kidney transplant. Further comorbidities included obesity, hypertensive cardiomyopathy, HCV liver disease, and dyslipidemia. His prophylactic therapy to prevent angioedema attacks had consisted of attenuated androgens for about 40 years. Since 2020, new modern targeted therapy for LTP, particularly lanadelumab, has shown promising results. The majority of patients with attenuated androgens have been successfully switched to lanadelumab, including our patient. Since introducing lanadelumab (300 mg subcutaneously every two weeks; after a six-month attack-free period, the dosing interval of lanadelumab was extended to four weeks), the patient has not experienced any acute HAE attack and did not report any adverse events. Moreover, we observed decreased total cholesterol, C-LDL, and body mass index, reducing the Matsushita et al. score for ten years of cardiovascular risk from 13.2% to 9.3%.Conclusionlanadelumab is effective and safe in preventing hereditary angioedema attacks, as well as in reducing cardiovascular risk in an immunosuppressed patient with significant comorbidities. The successful outcomes of this case highlight the potential of lanadelumab as a promising prophylactic therapy.

The present investigation explores the spatial distribution of Cooper pair density in graph-shaped arrays of Josephson junctions using a Ginzburg–Landau approach. We specifically investigate double-comb structures and compare their properties with linear arrays as reference systems. Our findings reveal that the peculiar connectivity of the double-comb structure leads to spatial gradients in the order parameter, which can be readily detected through measurements of Josephson critical currents. We present experimental results which indicate the specific dependence of the order parameter on the branches of the graphs and are evidence of the theoretical predictions.

The difficulties of measuring bedload transport in gravel-bed rivers have given rise to the morphological method wherein sediment transport can be inferred from changes in riverbed elevation and estimates of the distance traveled by sediment: its path length. Because current methods for estimating path length are time- and labor-intensive, we present a method to estimate a characteristic path length from repeat digital elevation models (DEMs of difference, i.e., DoDs). We propose an automated method to extract the spacing between erosional and depositional sites on the DoD by the application of variational mode decomposition (VMD), a signal processing method, to quantify the spacing as a proxy for path length. We developed this method using flume experiments where bed topography and sediment flux were measured and then applied it to published field data with physical path length measured from tracer measurements. Our sediment transport estimates were not significantly different than the measured sediment flux at lower discharges in the lab. However, we observed an underestimation of sediment flux at the higher discharges in the flume study. We interpret this as a limit of the method in confined settings, where sediment transport becomes decoupled from morphological changes. We also explore how the time between survey acquisitions, the morphological active width relative to the channel width, and DoD thresholding techniques affect the proposed method and the potential issues they pose for the morphological method in general.

Objectives: Potential adverse effects and pH-related effectiveness of bleaching agents have raised some concerns. The aim of this study was to compare three bleaching agents containing hydrogen peroxide (HP) and carbamide peroxide (CP) in terms of whitening effectiveness, pH variation, and changes in enamel surface roughness. Methods: After controlled staining with a black tea solution, 42 human enamel specimens underwent bleaching treatment using the following agents: HP 40%; HP 35%; CP 16%. Color changes were evaluated according to the CIEDE2000 system. Gel pH was measured before and after each application. Surface roughness (Sa) was assessed through optical 3D profilometry before and after bleaching treatment. Results: The whitening effectiveness was similar for HP 40% and HP 35% while CP 16% had significantly lower results. HP 40% showed a remarkable pH acidification (−0.41), while HP 35% and CP 16% showed a mild increase in pH values (+0.26 and +0.03, respectively), and the differences between HP 40% and HP 35% and between HP 35% and CP 16% were statistically significant. Sa slightly decreased in all groups after bleaching, with no significant differences among them and a significant difference in HP 40% before and after treatment. Conclusions: Similar bleaching results were achieved regardless of pH and HP concentration for HP-based agents, while a lower bleaching effect was observed for the less concentrated CP-based agent, as anticipated. Higher HP and greater tendency to pH instability induced more pronounced modifications of surface roughness. This in vitro study suggests that bleaching gels with neutral and stable pH ensure good bleaching effectiveness and are less likely to cause enamel surface changes.

Objectives To investigate pregnancy outcomes in women with autoimmune rheumatic diseases (ARD) in the Italian prospective cohort study P-RHEUM.it.Methods Pregnant women with different ARD were enrolled for up to 20 gestational weeks in 29 Rheumatology Centres for 5 years (2018–2023). Maternal and infant information were collected in a web-based database.Results We analysed 866 pregnancies in 851 patients (systemic lupus erythematosus was the most represented disease, 19.6%). Maternal disease flares were observed in 135 (15.6%) pregnancies. 53 (6.1%) pregnancies were induced by assisted reproduction techniques, 61 (7%) ended in miscarriage and 11 (1.3%) underwent elective termination. Obstetrical complications occurred in 261 (30.1%) pregnancies, including 2.3% pre-eclampsia. Two cases of congenital heart block were observed out of 157 pregnancies (1.3%) with anti-Ro/SSA. Regarding treatments, 244 (28.2%) pregnancies were treated with glucocorticoids, 388 (44.8%) with hydroxychloroquine, 85 (9.8%) with conventional synthetic disease-modifying anti-rheumatic drugs and 122 (14.1%) with biological disease-modifying anti-rheumatic drugs. Live births were 794 (91.7%), mostly at term (84.9%); four perinatal deaths (0.5%) occurred. Among 790 newborns, 31 (3.9%) were small-for-gestational-age and 169 (21.4%) had perinatal complications. Exclusive maternal breast feeding was received by 404 (46.7%) neonates. The Edinburgh Postnatal Depression Scale was compiled by 414 women (52.4%); 89 (21.5%) scored positive for emotional distress.Conclusions Multiple factors including preconception counselling and treat-to-target with pregnancy-compatible medications may have contributed to mitigate disease-related risk factors, yielding limited disease flares, good pregnancy outcomes and frequency of complications which were similar to the Italian general obstetric population. Disease-specific issues need to be further addressed to plan preventative measures.

ObjectivesThis study aims to test the psychometric proprieties of the Reflective Functioning Questionnaire (RFQ) applied to younger (13-16 years) and older (17-20 years) Italian adolescents examining (1) the factorial structure of RFQ; (2) its invariance across age and sex; (3) correlations between RFQ subscale scores, as well as the associations of the RFQ with (4) psychological problems and alexithymia dimensions.MethodsA cross-sectional study was conducted with 593 adolescents between the ages of 13 and 20 years old recruited from the community within Italy. These participants completed the RFQ, Symptom Checklist-90, and Toronto Alexithymia Scale.ResultsThe two-factor structure of the RFQ was confirmed. However, higher internal consistency of RFQ was obtained by removing two items that seemed problematic within this sample. Using a six-item version of RFQ, the two-factor structure was invariant across adolescent age and sex. Significant correlations among RFQ subscale scores, and between RFQ subscales with both psychological problems and alexithymia dimensions were found.ConclusionsPreliminary results reveal a short version of RFQ (six-item) is a suitable measure to assess mentalizing in adolescents in the Italian context.

The field of inflammatory disease of the heart or cardio-immunology is rapidly evolving due to the wider use of non-invasive diagnostic tools able to detect and monitor myocardial inflammation. In acute myocarditis, recent data on the use of immunomodulating therapies have been reported both in the setting of systemic autoimmune disorders and in the setting of isolated forms, especially in patients with specific histology (e.g., eosinophilic myocarditis) or with an arrhythmicburden. A role for immunosuppressive therapies has been also shown in severe cases of coronavirus disease 2019 (COVID-19), a condition that can be associated with cardiac injury and acute myocarditis. Furthermore, ongoing clinical trials are assessing the role of high dosage methylprednisolone in the context of acute myocarditis complicated by heart failure or fulminant presentation or the role of anakinra to treat patients with acute myocarditis excluding patients with hemodynamically unstable conditions. In addition, the explosion of immune-mediated therapies in oncology has introduced new pathophysiological entities, such as immune-checkpoint inhibitor-associated myocarditis and new basic research models to understand the interaction between the cardiac and immune systems. Here we provide a broad overview of evolving areas in cardio-immunology. We summarize the use of new imaging tools in combination with endomyocardial biopsy and laboratory parameters such as high sensitivity troponin to monitor the response to immunomodulating therapies based on recent evidence and clinical experience. Concerning pericarditis, the normal composition of pericardial fluid has been recently elucidated, allowing to assess the actual presence of inflammation; indeed, normal pericardial fluid is rich in nucleated cells, protein, albumin, LDH, at levels consistent with inflammatory exudates in other biological fluids. Importantly, recent findings showed how innate immunity plays a pivotal role in the pathogenesis of recurrent pericarditis with raised C-reactive protein, with inflammasome and IL-1 overproduction as drivers for systemic inflammatory response. In the era of tailored medicine, anti-IL-1 agents such as anakinra and rilonacept have been demonstrated highly effective in patients with recurrent pericarditis associated with an inflammatory phenotype.

This exploratory cross-sectional study attempts to understand the mechanisms underlying the role of parental mentalizing in a child's psychological functioning during middle childhood by using Parental Reflective Functioning (PRF) and Parental Insightfulness (PI) constructs. The main aims are to examine the role of PI and PRF as processes capable of influencing a child's psychological functioning in terms of emotional-behavioral difficulties and social-emotional competencies. Eighty-six community parents (48 mothers, 38 fathers) and their 50 children in middle childhood (Mage = 10.10, SD = 1.13) participated in this study, recruited through a non-probabilistic sampling. The following measures were used to assess the aims of this study: Insightfulness Assessment, Parental Reflective Functioning Questionnaire, Child Behavior Checklist (CBCL) and Devereux Student Strengths Assessment (DESSA) questionnaires. Results showed that parental mentalizing was found to be significantly associated with both child's internalizing and externalizing symptoms and social-emotional competencies as reported by parents through the CBCL and DESSA questionnaires. This study may offer a contribution to the study of parental mentalizing during middle childhood, supporting the hypothesis that both parents' ability to understand their child's mental states could affect the child's psychological functioning. Clinical and theoretical implications are geared toward a family-based view with a specific focus on the importance of fostering in both parents a positive attitude toward mentalizing processes.

Although many studies have documented associations between insecure attachment and psychopathology, attachment may not confer risk for psychopathology independently, but rather through its interaction with emotional, social, and biological factors. Understanding the variables through which attachment may lead to psychopathology is therefore important. Within this domain of research, the role of physiological factors is poorly investigated. What are the relevant domains and why, when, or for whom do they influence mental disorders relating to attachment? The current systematic review aims to answer these questions. Results reveal that physiological indices of emotional regulation play a role in explaining and/or determining the relationship between attachment and psychopathology. Specifically: (1) combined with insecure attachment, higher skin conductance level (SCL), lower cardiac slowing, and respiratory sinus arrhythmia modulation (RSA) contribute to different psychopathological indicators and behavioral/psychological dysfunctions, although the latter predicts a contradictory pattern of findings; (2) insecure-avoidant attachment is more consistently linked with stress and emotional dysregulation when combined with RSA, while anxious attachment confers risk of depressive symptoms when combined with SCL. We concluded our discussion of the results of seven studies by outlining a plan to move the field forward. We discuss the quality of the assessment, methodological limitations, and future directions, highlighting the need to extend the research to clinical samples.

Introduction Behavioral disorders have been defined as a “health crisis” of modern times that has a significant impact on the parent-child relationship. In this scenario, the emotional regulation (ER) of each partner plays a central role and serves a protective factor, configuring as an area to intervene. The Connect Parent Group, an attachment-based intervention for parents, has shown evidence of effectiveness. However, its online version (e-Connect) has not yet garnered specific evidence related to emotional and physiological regulation in parents and preadolescents. Objectives This study aimed to explore changes in the short and medium term regarding ER abilities - both self-reported and measured through physiological indices - in parents and preadolescents with behavioral disorders, building upon initial findings from an online parenting intervention. Methods 28 parents (82.1% mothers, 17.9% fathers, M_age = 47.48, SD = 4.73) and their 28 preadolescents with behavioral disorders (M_age = 11.22 years, SD = 2.69, 35.7% girls) were recruited from child neuropsychiatry services in Northern Italy and subsequently took part in the pilot study. They were assessed at three time points: before intervention (T1), one months after the intervention (T2) and at 6-months follow-up (T3). ER were assessed with a multimethod approach: parents and children completed a self-report questionnaire (i.e., Difficulties in Emotion Regulation Scale and How I Feel, respectively) and then they interact during a stress-task in which physiological parameters (i.e., Galvanic Skin Response, GSR; Heart Rate/Beat per Minute, BPM) have been measured. Results Regarding self-reported ER, mixed-effects regression models showed an improvement in parent emotion dysregulation between T1 and T3 (p=0.004), a decrease in preadolescents’ negative emotions (p=.012) between T1 and T2 and a lower emotion intensity in preadolescents between the three-time points (p=.003). Regarding physiological ER, the two overall models of GSR and BPM were not significant for both parents and children. Yet GSR correlations within three-time points were positive and significant for children (T1-T2: r=.58; T1-T3: r=.68) but not for parents, while BPM correlations between T1 and T2 were significant for parents (r=.49) but not for children. Conclusions The online attachment-based parenting program appears to have contributed to a reduction in emotional dysregulation in parents and preadolescents, which seems to persist to some extent in the medium term. The non-significant results at the physiological level may suggest that changes reported by parents and children through self-report questionnaires do not align with changes in the physiological response to interpersonal stress experienced after an online intervention. Clinical and research implications will be discussed. Disclosure of Interest None Declared

Background: While substantial research focuses on the psychological characteristics of adolescents with Anorexia Nervosa (AN), little is known about the psychopathological profiles of their parents, especially of the fathers. Therefore, this study aims to investigate the psychopathological profiles of AN adolescents and their parents compared with a control group. Methods: This observational case-control study involved 94 families of adolescents aged 12 to 17: 47 families diagnosed with AN were matched with 47 control families. The sample mean is 15.9 with a standard deviation of 2.9 for BMI across the AN group. Inclusion criteria included adolescents aged 12 to 17 with a diagnosis of AN, and both parents available for the study. Exclusion criteria included AN secondary to medical conditions, severe psychotic disorders, intellectual disabilities, or insufficient understanding of the Italian language. The Symptom Checklist 90–Revised (SCL-90-R) assessing psychopathological symptoms in adolescents and their parents was administered. Statistical analyses compared SCL-90-R scores between AN and control groups and assessed inter-variability within the AN family. Results: Adolescents with AN and their parents displayed significantly higher SCL-90-R scores than controls across multiple dimensions. Specifically, mothers of AN adolescents exhibited higher scores on depression and psychoticism scales, while fathers exhibited higher psychoticism, total positive symptoms, and positive symptom distress. Notably, AN family showed reduced inter-individual variability in psychopathological profiles compared to controls, both within dyads (adolescent-mother, adolescent-father) and the entire family. Conclusion: This study highlights distinct psychopathological profiles in AN family and suggests potential factors of illness maintenance related to parental psychopathology. The findings emphasize the importance of involving the entire family, including fathers, in the therapeutic process for adolescents with AN. Further research with larger samples and structured interviews is needed to validate these results and expand our understanding of family involvement in AN psychopathology.

The climate resilience of river deltas is threatened by rising sea levels, accelerated land subsidence, and reduced sediment supply from contributing river basins. Yet, these uncertain and rapidly changing threats are rarely considered in conjunction. Here we provide an integrated assessment, on basin and delta scales, to identify key planning levers for increasing the climate resilience of the Mekong Delta. We find, first, that 23 to 90% of this unusually productive delta might fall below sea level by 2100, with the large uncertainty driven mainly by future management of groundwater pumping and associated land subsidence. Second, maintaining sediment supply from the basin is crucial under all scenarios for maintaining delta land and enhancing the climate resilience of the system. We then use a bottom-up approach to identify basin development scenarios that are compatible with maintaining sediment supply at current levels. This analysis highlights, third, that strategic placement of hydropower dams will be more important for maintaining sediment supply than either projected increases in sediment yields or improved sediment management at individual dams. Our results demonstrate 1) the need for integrated planning across basin and delta scales, 2) the role of river sediment management as a nature-based solution to increase delta resilience, and 3) global benefits from strategic basin management to maintain resilient deltas, especially under uncertain and changing conditions.

Introdução: Na ginástica rítmica é elevada a exigência por um padrão corporal, sendo necessário controle de peso e da alimentação, na busca da estética corporal pretendida, o que pode provocar efeitos adversos na saúde das atletas. Objetivo: Avaliar as atitudes alimentares e a percepção da imagem corporal de atletas de ginástica rítmica. Materiais e Métodos: A pesquisa foi de abordagem quantitativa, observacional e transversal. A amostra foi composta por 36 atletas paranaenses nas categorias juvenil e adulta. A coleta de dados ocorreu por meio do Google Forms, utilizando os seguintes instrumentos: Questionário Sociodemográfico; Eating Attitudes Test (EAT-26) e Body Shape Questionnaire (BSQ). Resultados: Os resultados obtidos mostraram que no questionário EAT-26, 61,5% das ginastas adultas e 73,9% das juvenis não apresentaram riscos para desenvolver transtornos alimentares. Em relação à imagem corporal, a maioria das atletas da categoria adulta (46,2%) indicou uma leve insatisfação com a imagem corporal, enquanto na categoria juvenil, a maioria das ginastas (73,9%) não estava insatisfeita com o corpo. Quanto às correlações dos questionários aplicados, houve correlação positiva do questionário sobre a imagem corporal com o teste de atitudes alimentares (r=0,6925; p=

The concept of mentalized affectivity (MA) encompasses the dimensions of identifying, processing, and expressing emotions and describes the process of making sense of and reevaluating one’s affects in light of autobiographical memory. This construct was developed within the theoretical framework of mentalization and, due to its interpersonal nature, added further complexity to the emotion regulation construct. This research aimed to examine the factor structure and psychometric properties of the Brief-Mentalized Affectivity Scale for adolescents (B-MAS-A) on an Italian sample of young people (aged 13-19 years). Data were collected using non-probabilistic sampling and an online survey. Participants were asked to complete a large battery of instruments, including the B-MAS-A, the Toronto Alexithymia Scale, the Reflective Functioning Questionnaire, the Epistemic Trust, Mistrust, and Credulity Questionnaire, the Strengths and Difficulties Questionnaire, and the General Self-Efficacy Scale. In study 1, factor analyses carried out on a total sample of 566 adolescents identified 3 distinct dimensions of the same components of MA found in the adult population: i) identifying; ii) processing; iii) expressing emotions. The subscales showed excellent internal consistency. Study 2 (involving a subsample of 288 participants) demonstrated good levels of construct and criterion validity. These results confirm that the B-MAS-A represents a valid and robust instrument for assessing the complex and multifaceted characteristics of MA in adolescents. The B-MAS-A can make a significant contribution to clinical practice and research and encourage systematic studies on MA in psychotherapy, taking into account the developmental stage of adolescence.

This study evaluated the incidence of unfilled second mesiobuccal (MB2) canals and periapical lesions in first maxillary molars using CBCT e-Vol DX software. Hence, 326 CBCT images of first maxillary molars of patients undergoing endodontic treatment were selected. The e-Vol DX software performed a retrospective review of these images, recording the presence or absence of MB2 canals, filling, and periapical lesions in first maxillary molars. Specific statistical analysis was performed at a 5% significance level. Unfilled MB2 canals were highly frequent in first maxillary molars and significantly associated with periapical lesions in the mesiobuccal root of these teeth (p

Todo hace suponer que el virus Covid 19 llegó para quedarse y que de una situación de riesgo total (pandemia) estamos transitando, con algunos sobresaltos, a una situación de normalización o aceptación del riesgo (endemia). Nuestro análisis intenta explorar la importancia de las ceremonias en las que se emplean plantas sagradas con propiedades psicoactivas y discutir su condición patrimonial en el contexto local-global que remite a los circuitos de turismo espiritual, chamánico, a los discursos y las imágenes a partir de las cuales son valoradas como mediadores privilegiados por sus efectos curativos y espirituales. Nos interesa compartir las narrativas y las concepciones sobre la pandemia que se han ido procesando a lo largo de este tiempo entre las personas que participan en los rituales de plantas sagradas, lo cual, desde luego, remite a formas alternativas de leer y situarse en la crisis sanitaria.

Ensuring user safety in transformerless photovoltaic (PV) inverters is crucial due to the high leakage current caused mainly by the PV modules’ capacitance. Compliance with safety standards IEC 62109-2:2011 and IEC 63112:2021 demands leakage current tests utilizing a variable resistive-capacitive (RC) load. However, limited research has been conducted to assess the impact of test parameters on result conclusiveness. To address this gap, this paper investigates the influence of AC mains voltage phase angle on trip time results in the continuous leakage current test as per these standards. Our experiments, performed with five commercial transformerless PV inverters, reveal significant sensitivity of the results to this specific parameter. Supported by RMANOVA analysis, our findings substantiate this observation. Subsequently, we discuss potential strategies to enhance the accuracy of test outcomes and propose a well-defined methodology to ensure repeatability and reliability of results.

The transboundary Mekong Basin has been dubbed the "Battery of Southeast Asia" for its large hydropower potential. Development of hydropower dams in the six riparian countries proceeds without strategic analyses of dam impacts, e.g., reduced sediment delivery to the lower Mekong. This will impact some of the world's largest freshwater fisheries and endangers the resilience of the delta, which supports 17 million livelihoods, against rising sea levels. To highlight alternatives, we contribute an optimization-based framework for strategic sequencing of dam development. We quantify lost opportunities from past development and identify remaining opportunities for better tradeoffs between sediment and hydropower. We find that limited opportunities remain for less impactful hydropower in the lower basin, where most development is currently planned, while better trade-offs could be reached with dams in the upper Mekong in China. Our results offer a strategic vision for hydropower in the Mekong, introduce a globally applicable framework to optimize dam sequences in space and time, and highlight the importance of strategic planning on multiple scales to minimize hydropower impacts on rivers.

Proton MRS (1 H MRS) provides noninvasive, quantitative metabolite profiles of tissue and has been shown to aid the clinical management of several brain diseases. Although most modern clinical MR scanners support MRS capabilities, routine use is largely restricted to specialized centers with good access to MR research support. Widespread adoption has been slow for several reasons, and technical challenges toward obtaining reliable good-quality results have been identified as a contributing factor. Considerable progress has been made by the research community to address many of these challenges, and in this paper a consensus is presented on deficiencies in widely available MRS methodology and validated improvements that are currently in routine use at several clinical research institutions. In particular, the localization error for the PRESS localization sequence was found to be unacceptably high at 3 T, and use of the semi-adiabatic localization by adiabatic selective refocusing sequence is a recommended solution. Incorporation of simulated metabolite basis sets into analysis routines is recommended for reliably capturing the full spectral detail available from short TE acquisitions. In addition, the importance of achieving a highly homogenous static magnetic field (B0 ) in the acquisition region is emphasized, and the limitations of current methods and hardware are discussed. Most recommendations require only software improvements, greatly enhancing the capabilities of clinical MRS on existing hardware. Implementation of these recommendations should strengthen current clinical applications and advance progress toward developing and validating new MRS biomarkers for clinical use.

The study aimed to investigate relational outcomes of Italian emancipated foster youth across open-ended reflections about their perceptions of their relationships with the biological and foster family, with partner and peers. A total of 26 Italian emancipated foster youth (19–25 years old) recruited by social services completed a single in-depth interview. A qualitative thematic analysis was selected for this study. The results revealed two major themes of foster care experience that emerged often simultaneously from the participants’ narration: (1) Positive Relational Outcomes including “Feeling supported,” “Sense of belonging,” “Good memories,” “Relationship with family of choice,” and “Staying in touch”; and (2) Negative Relational Outcomes referring “Devaluation,” “Refuse,” “Bad memories,” and “Isolation.” Foster care experience leads to complex relational perceptions in emerging adulthood according to different relational outcomes and ways of processing foster care experience. Professionals could work on relational outcomes and memories, especially during a critical transition like emerging adulthood, to support youth in making sense of their past experiences.