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Serena Scarpelli,1 Valentina Alfonsi,1 Milena Camaioni,1 Maurizio Gorgoni,1,2 Antonio Albano,3 Alessandro Musetti,4 Maria Catena Quattropani,5,6 Giuseppe Plazzi,7,8 Luigi De Gennaro,1,2 Christian Franceschini3 1Department of Psychology, University of Rome Sapienza, Rome, Italy; 2Body and Action Lab, IRCCS Fondazione Santa Lucia, Rome, Italy; 3Department of Medicine and Surgery, Faculty of Medicine and Surgery, University of Parma, Parma, Italy; 4Department of Humanities, Social Sciences and Cultural Industries, University of Parma, Parma, Italy; 5Department of Educational Sciences, University of Catania, Catania, Italy; 6Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy; 7Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; 8IRCCS Institute of Neurological Sciences, Bologna, ItalyCorrespondence: Serena Scarpelli, Department of Psychology, University of Rome Sapienza, Via dei Marsi 78, Rome, 00185, Italy, Tel +39 06 49917508, Email serena.scarpelli@uniroma1.itPurpose: COVID-19 pandemic waves have strongly influenced individuals’ behaviors and mental health. Here, we analyzed longitudinal data collected in the Spring 2020 and 2021 from a large Italian sample with the aim of assessing changes in dream features between the first and third wave. Specifically, we evaluated the modifications of pandemic dream activity as a function of the general distress variations over time. Also, we detected the best explanatory variables of nightmare frequency and distress.Materials and Methods: Participants previously involved in the web survey during the first wave of the pandemic were asked to complete a new online survey on sleep and dream features available in Spring 2021 (N=728). Subjects decreasing their level of psychological general distress in the third (T3) vs the first (T1) pandemic wave were defined as “Improved” (N=330). In contrast, participants with an unchanged or increased level of general distress were defined as “Not Improved” (N=398).Results: Statistical comparisons revealed that dream recall frequency, nightmare frequency, lucid dream frequency, and emotional intensity show a reduction in T3 than T1. Moreover, the Improved group is characterized by lower nightmare rate and nightmare distress than Not Improved people. Our findings confirmed that beyond the trait-like variables (ie, age, sex), specific sleep-related measures are related to nightmare features. In particular, poor sleep hygiene was one of the best determinants of nightmare distress among Not Improved subjects.Conclusion: Our findings revealed that people experienced an adaptation to the pandemic during the third wave. We also strengthen the notion that nightmares and their variations over time are strongly related to human well-being, suggesting that specific trait-like and sleep-related factors could modulate the relationship between mental health and nightmare features.Keywords: nightmare, distress, sleep, pandemic, third wave, clinical psychology

O artigo visa estudar o impacto socioeconómico do garimpo, no concernente a participação da mulher na exploração do ouro no distrito de Manica – Moçambique. As técnicas de recolha de dados foram: a observação, entrevista e questionário. Foram inqueridos 64 garimpeiros que operam nas localidades de Penhalonga, Munhena e Mucurumadze, Distrito de Manica. Os resultados indicaram que a participação da mulher é vista como preconceituosa, os homens alegam que a mulher nasceu e é foi criada para ser mãe, esposa e dona de casa, portanto a sua participação pode comprometer negativamente nas suas actividades e baixar seus rendimentos. A pesquisa constatou que com o rendimento tirado do garimpo algumas mulheres puderam apoiar na construção das casas, compra de eletrodomésticos, terrenos, farma, compra de meios de transporte e gado.

Groundwater is the most ubiquitous source of liquid freshwater globally, yet its role in supporting diverse ecosystems is rarely acknowledged1,2. However, the location and extent of groundwater-dependent ecosystems (GDEs) are unknown in many geographies, and protection measures are lacking1,3. Here, we map GDEs at high-resolution (roughly 30 m) and find them present on more than one-third of global drylands analysed, including important global biodiversity hotspots4. GDEs are more extensive and contiguous in landscapes dominated by pastoralism with lower rates of groundwater depletion, suggesting that many GDEs are likely to have already been lost due to water and land use practices. Nevertheless, 53% of GDEs exist within regions showing declining groundwater trends, which highlights the urgent need to protect GDEs from the threat of groundwater depletion. However, we found that only 21% of GDEs exist on protected lands or in jurisdictions with sustainable groundwater management policies, invoking a call to action to protect these vital ecosystems. Furthermore, we examine the linkage of GDEs with cultural and socio-economic factors in the Greater Sahel region, where GDEs play an essential role in supporting biodiversity and rural livelihoods, to explore other means for protection of GDEs in politically unstable regions. Our GDE map provides critical information for prioritizing and developing policies and protection mechanisms across various local, regional or international scales to safeguard these important ecosystems and the societies dependent on them.

Multiple-choice questions (MCQs) are widely used in educational assessments and professional certification exams. Managing large repositories of MCQs, however, poses several challenges due to the high volume of questions and the need to maintain their quality and relevance over time. One of these challenges is the presence of questions that duplicate concepts but are formulated differently. Such questions can indeed elude syntactic controls but provide no added value to the repository. In this paper, we focus on this specific challenge and propose a workflow for the discovery and management of potential duplicate questions in large MCQ repositories. Overall, the workflow comprises three main steps: MCQ preprocessing, similarity computation, and finally a graph-based exploration and analysis of the obtained similarity values. For the preprocessing phase, we consider three main strategies: (i) removing the list of candidate answers from each question, (ii) augmenting each question with the correct answer, or (iii) augmenting each question with all candidate answers. Then, we use deep learning-based natural language processing (NLP) techniques, based on the Transformers architecture, to compute similarities between MCQs based on semantics. Finally, we propose a new approach to graph exploration based on graph communities to analyze the similarities and relationships between MCQs in the graph. We illustrate the approach with a case study of the Competenze Digitali program, a large-scale assessment project by the Italian government.

Laparoscopic anterior lumbar interbody fusion (L-ALIF), which employs laparoscopic cameras to facilitate a less invasive approach, originally gained traction during the 1990s but has subsequently fallen out of favor. As the envelope for endoscopic approaches continues to be pushed, a recurrence of interest in laparoscopic and/or endoscopic anterior approaches seems possible. Therefore, evaluating the current evidence base in regard to this approach is of much clinical relevance. To this end, a systematic literature search was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the following keywords: (laparoscopic OR endoscopic) AND (anterior AND lumbar). Out of the 441 articles retrieved, 22 were selected for quantitative analysis. The primary outcome of interest was the radiographic fusion rate. The secondary outcome was the incidence of perioperative complications. Meta-analysis was performed using RStudios metafor package. Of the 1,079 included patients (mean age, 41.8±2.9 years), 481 were males (44.6%). The most common indication for L-ALIF surgery was degenerative disk disease (reported by 18 studies, 81.8%). The mean follow-up duration was 18.8±11.2 months (range, 6-43 months). The pooled fusion rate was 78.9% (95% confidence interval [CI], 68.9-90.4). Complications occurred in 19.2% (95% CI, 13.4-27.4) of L-ALIF cases. Additionally, 7.2% (95% CI, 4.6-11.4) of patients required conversion from L-ALIF to open surgery. Although L-ALIF does not appear to be supported by studies available in the literature, it is important to consider the context from which these results have been obtained. Even if these results are taken at face value, the failure of endoscopy to have a role in the ALIF approach does not mean that it should not be incorporated in posterior approaches.

Abstract Introduction Adult-onset Still’s disease is a rare systemic autoinflammatory disease. We present a case of a young man with a constellation of symptoms and myopericarditis as a complication of this disease. Case A 36-year-old Hispanic man with no significant past medical history developed a quotidian fever pattern following an upper respiratory tract infection. He initially presented with chest pain concerning for myocardial infarction and underwent cardiac catheterization, which revealed non-obstructive coronary artery disease. He was found to have myopericarditis, significant neutrophilic leukocytosis, and hyperferritinemia. He improved on high-dose corticosteroids but developed steroid-induced psychosis, and 4 months from symptom onset, he finally received tocilizumab, which eventually induced remission without adverse reactions. Discussion Adult-onset Still’s disease should be considered in a patient with fevers of undetermined origin. Due to its multisystemic involvement, adult-onset Still’s disease is often a diagnosis arrived at after an extensive cardiac, hematologic, malignant, and infectious workup. Imaging, laboratory testing, and bone marrow biopsy were necessary to rule out alternative etiologies of this patient’s presentation. Steroids are the mainstay of treatment because they are easily affordable, although the high risk of adverse effects makes them less desirable. Interleukin-1 inhibitors (anakinra or canakinumab) and interleukin-6 inhibitor tocilizumab are the steroid-sparing biologic agents of choice but are cost-prohibitive. Conclusion Adult-onset Still’s disease should be considered in the differential diagnoses of fever of undetermined origin. Early identification and initiation of treatment are critical to faster recovery and prevention of progression to severe complications. Steroids remain the standard first-line therapy and should be followed by disease-modifying steroid sparing drugs. The social determinants of health may preclude their timely initiation and should alert providers of proactive ways to avoid further delays.

Amyloidosis is defined as a rare group of 30 protein-folding diseases characterized by the extracellular deposition of a specific soluble precursor protein that aggregates in the form of insoluble fibrils. The gastrointestinal tract (GI) is a common site for amyloid deposits: Among patients with systemic amyloidosis, at least 70% present with gastrointestinal deposition. Rarely, the deposition is exclusively localized in this area, leading to various gastrointestinal symptoms (bleeding, weight loss, etc.). In this case report, we present a rare and unusual form of localized gastrointestinal amyloidosis, diagnosed after a post-mortem examination of an 83-year-old woman who died due to septic shock resulting from post-colonoscopy iatrogenic perforation of the sigma, in a suspected medical liability case. Morphological examination revealed AL amyloid deposits within the muscular wall of the submucosal vessels of the rectum, which caused increased friability of the vessels and ischemic changes in the intestinal mucosa. A renal cell carcinoma (RCC) was found, which might be related to amyloid deposits, as reported by the literature. Amyloid deposits are an unknown and unpredictable pathological substrate that increase the risk of iatrogenic perforation. Analysis of the medical documentation did not reveal any censurable conduct in terms of prescribing the procedure, technical execution, or subsequent management of the patient following the perforation. GI amyloidosis should be part of the risk stratification of patients with rectal bleeding and gastrointestinal symptoms, and awareness is essential to guide subsequent diagnostic and therapeutic approaches and investigate underlying causes.

Species distribution models (SDMs) have been used to forecast the impact of climate change on species’ potential distribution, with results that might support decisions for conservation and biodiversity management. Despite their vulnerability to parameterization and data quality input, SDM use has been increasing in the last decades. In fact, inappropriate inputs and the lack of awareness about the effects of methodological decisions on results can lead to potential unreliability in results, a problem that might gain relevance when SDMs are used to predict climate change impacts on species-suitable areas. Aiming to assess how far such a topic is considered, an analysis of the calibration data and methodological decisions was conducted for recent publications (2018 to 2022) that include SDMs in this context, aiming to identify putative deviations from the consensual best practices. Results show that the parameters presented more consistently are the algorithm in use (MaxEnt was used in 98% of the studies), the accuracy measures, and the time windows. But many papers fail to specify other parameters, limiting the reproducibility of the studies. Some papers fail to provide information about calibration procedures, others consider only a fraction of the species’ range, and others provide no justification for including specific variables in the model. These options can decrease reliability in predictions under future scenarios, since data provided to the model are inaccurate from the start or there is insufficient information for output discussion.

Recent research has demonstrated an intersectional approach to the study of differential item functioning (DIF). This approach expands DIF to account for the interactions between what have traditionally been treated as separate grouping variables. In this paper, we compare traditional and intersectional DIF analyses using data from a state testing program (nearly 20,000 students in grade 11, math, science, English language arts). We extend previous research on intersectional DIF by employing field test data (embedded within operational forms) and by comparing methods that were adjusted for an increase in Type I error (Mantel-Haenszel and logistic regression). Intersectional analysis flagged more items for DIF compared with traditional methods, even when controlling for the increased number of statistical tests. We discuss implications for state testing programs and consider how intersectionality can be applied in future DIF research.

Background. Cutaneous melanoma is an aggressive form of skin cancer. It has become an increasingly common neoplasm in the most developed countries, especially among individuals of European origin.