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Deep neural network (DNN) potentials have recently gained popularity in computer simulations of a wide range of molecular systems, from liquids to materials. In this study, we explore the possibility of combining the computational efficiency of the DeePMD framework and the demonstrated accuracy of the MB-pol data-driven, many-body potential to train a DNN potential for large-scale simulations of water across its phase diagram. We find that the DNN potential is able to reliably reproduce the MB-pol results for liquid water, but provides a less accurate description of the vapor–liquid equilibrium properties. This shortcoming is traced back to the inability of the DNN potential to correctly represent many-body interactions. An attempt to explicitly include information about many-body effects results in a new DNN potential that exhibits the opposite performance, being able to correctly reproduce the MB-pol vapor–liquid equilibrium properties, but losing accuracy in the description of the liquid properties. These results suggest that DeePMD-based DNN potentials are not able to correctly “learn” and, consequently, represent many-body interactions, which implies that DNN potentials may have limited ability to predict the properties for state points that are not explicitly included in the training process. The computational efficiency of the DeePMD framework can still be exploited to train DNN potentials on data-driven many-body potentials, which can thus enable large-scale, “chemically accurate” simulations of various molecular systems, with the caveat that the target state points must have been adequately sampled by the reference data-driven many-body potential in order to guarantee a faithful representation of the associated properties.

Deep neural network (DNN) potentials have recently gained popularity in computer simulations of a wide range of molecular systems, from liquids to materials. In this study, we explore the possibility of combining the computational efficiency of the DeePMD framework and the demonstrated accuracy of the MB-pol data-driven many-body potential to train a DNN potential for large-scale simulations of water across its phase diagram. We find that the DNN potential is able to reliably reproduce the MB-pol results for liquid water but provides a less accurate description of the vapor-liquid equilibrium properties. This shortcoming is traced back to the inability of the DNN potential to correctly represent many-body interactions. An attempt to explicitly include information about many-body effects results in a new DNN potential that exhibits opposite performance, being able to correctly reproduce the MB-pol vapor-liquid equilibrium properties but losing accuracy in the description of the liquid properties. These results suggest that DeePMD-based DNN potentials are not able to correctly "learn" and, consequently, represent many-body interactions, which implies that DNN potentials may have limited ability to predict properties for state points that are not explicitly included in the training process. The computational efficiency of the DeePMD framework can still be exploited to train DNN potentials on data-driven many-body potentials, which can thus enable large-scale, "chemically accurate" simulations of various molecular systems, with the caveat that the target state points must have been adequately sampled by the reference data-driven many-body potential in order to guarantee a faithful representation of the associated properties.

Ion–water interactions play a central role in determining the properties of aqueous systems in a wide range of environments. However, a quantitative understanding of how the hydration properties of ions evolve from small aqueous clusters to bulk solutions and interfaces remains elusive. Here, we introduce the second generation of data-driven many-body energy (MB- nrg) potential energy functions (PEFs) representing bromide–water and iodide–water interactions. The MB-nrg PEFs use permutationally invariant polynomials to reproduce two-body and three-body energies calculated at the coupled cluster level of theory, and implicitly represent all higher-body energies using classical many-body polarization. A systematic analysis of the hydration structure of small Br−(H2O)n and I−(H2O)n clusters demonstrates that the MB-nrg PEFs predict interaction energies in quantitative agreement with “gold standard” coupled cluster reference values. Importantly, when used in molecular dynamics simulations carried out in the isothermal-isobaric ensemble for single bromide and iodide ions in liquid water, the MB-nrg PEFs predict extended X-ray absorption fine structure (EXAFS) spectra that accurately reproduce the experimental spectra, which thus allows for characterizing the hydration structure of the two ions with high level of confidence.

Deep neural network (DNN) potentials have recently gained popularity in computer simulations of a wide range of molecular systems, from liquids to materials. In this study, we explore the possibility of combining the computational efficiency of the DeePMD framework and the demonstrated accuracy of the MB-pol data-driven many-body potential to train a DNN potential for large-scale simulations of water across its phase diagram. We find that the DNN potential is able to reliably reproduce the MB-pol results for liquid water but provides a less accurate description of the vapor-liquid equilibrium properties. This shortcoming is traced back to the inability of the DNN potential to correctly represent many-body interactions. An attempt to explicitly include information about many-body effects results in a new DNN potential that exhibits opposite performance, being able to correctly reproduce the MB-pol vapor-liquid equilibrium properties but losing accuracy in the description of the liquid properties. These results suggest that DeePMD-based DNN potentials are not able to correctly "learn" and, consequently, represent many-body interactions, which implies that DNN potentials may have limited ability to predict properties for state points that are not explicitly included in the training process. The computational efficiency of the DeePMD framework can still be exploited to train DNN potentials on data-driven many-body potentials, which can thus enable large-scale, "chemically accurate" simulations of various molecular systems, with the caveat that the target state points must have been adequately sampled by the reference data-driven many-body potential in order to guarantee a faithful representation of the associated properties.

For the past 50 years, researchers have sought molecular models that can accurately reproduce water's microscopic structure and thermophysical properties across broad ranges of its complex phase diagram. Herein, molecular dynamics simulations with the many-body MB-pol model are performed to monitor the thermodynamic response functions and local structure of liquid water from the boiling point down to deeply supercooled temperatures at ambient pressure. The isothermal compressibility and isobaric heat capacity show maxima near 223 K, in excellent agreement with recent experiments, and the liquid density exhibits a minimum at ∼208 K. A local tetrahedral arrangement, where each water molecule accepts and donates two hydrogen bonds, is found to be the most probable hydrogen-bonding topology at all temperatures. This work suggests that MB-pol may provide predictive capability for studies of liquid water's physical properties across broad ranges of thermodynamic states, including the so-called water's "no man's land" which is difficult to probe experimentally.

Vaginal birth after caesarean (VBAC) is an option to avoid major abdominal surgery and many consequences related to repeated caesarean delivery. In the last years, many efforts have been made to increase the number of patients attempting trial of labour after caesarean (TOLAC). The aim of our study was to identify the most important factors associated with the success of VBAC. A retrospective study was conducted in two Italian referral centres. Subjects included were singleton and morphologically normal pregnancy with previous C-section. Subjects with an inter-pregnancy interval shorter than 18 months, a large for gestational age baby, a pregnancy complicated with gestational diabetes and a previous unclassified uterine scar were excluded. The characteristics of the subjects were compared and a logistic regression was performed to evaluate variables associated with successful VBAC. Of the 300 patients included, 224 (74.7%) achieved VBAC while 76 (25.3%) underwent C-section after failed TOLAC. The number of previous C-sections was not significantly associated with the success of TOLAC. Factors positively associated with achievement of VBAC were previous vaginal delivery (OR of 6.88 for one and 9.68 for more than one) and oxytocin implementation (OR 3.32). No maternal and neonatal adverse events occurred. Our results show that attempting VBAC is a feasible option in referral centres after adequate evaluation of the potential factors affecting the probability of success. A careful record of obstetrical history and management of labour can provide clinicians useful information to counsel women before and during labour.

For the last 50 years, researchers have sought molecular models that can accurately reproduce water’s microscopic structure and thermophysical properties across broad ranges of its complex phase diagram. Herein, molecular dynamics simulations with the many-body MB-pol model are performed to monitor the thermodynamic response functions and local structure of liquid water from the boiling point down to deeply supercooled temperatures at ambient pressure. The isothermal compressibility and isobaric heat capacity show maxima near 223 K, in excellent agreement with recent experiments, and the liquid density exhibits a minimum at ~208 K. A local tetrahedral arrangement, where each water molecule accepts and donates two hydrogen bonds, is found to be the most probable hydrogen-bonding topology at all temperatures. This work suggests that MB-pol may provide predictive capability for studies of liquid wa- ter’s physical properties across broad ranges of thermodynamic states, including the so-called water’s “no man’s land” which is difficult to probe experimentally.

Earthquake early warning systems are able to issue an alert just after the start of the seismic rupture on the fault plane, but before the ground shaking reaches the sites to be protected. The available lead-time for security actions is very short (seconds to several dozens of seconds), requiring fast and robust methods to make these systems operational. Here, general principles about the two paradigms of early warning systems are presented: the regional and the on-site systems. When these methods are applied to data recorded by very dense networks, such as in near-fault observatories, the blind zone can be shortened to 15–25km. Next generation of early warning systems should reduce the epistemic variability by implementing modeling of finite-source and site effects. Finally, the combination of on-site and regional systems may lead to a real-time estimation of the ground-shaking maps, overcoming the problem of computing the event location, and magnitude.

For the last 50 years, researchers have sought molecular models that can accurately reproduce water’s microscopic structure and thermophysical properties across broad ranges of its complex phase diagram. Herein, molecular dynamics simulations with the many-body MB-pol model are performed to monitor the thermodynamic response functions and local structure of liquid water from the boiling point down to deeply supercooled temperatures at ambient pressure. The isothermal compressibility and isobaric heat capacity show maxima at ~223 K, in excellent agreement with recent experiments, and the liquid density exhibits a minimum at ~208 K. Furthermore, a local tetrahedral arrangement, where each water molecule accepts and donates two hydrogen bonds, is the most probable hydrogen-bonding topology at all temperatures. This work suggests that MB-pol may provide predictive capability for studies of liquid water’s physical properties across broad ranges of thermodynamic states.

The structural and dynamic properties of the Ba2+ cation in water have been studied by combining quantum mechanical (QM) calculations, molecular dynamics (MD) simulations, and extended X-ray absorp...

We present a new data-driven potential energy function (PEF) describing chloride–water interactions which is developed within the many-body-energy (MB-nrg) theoretical framework. Besides quantitatively reproducing low-order many-body energy contributions, the new MB-nrg PEF is able to correctly predict the interaction energies of small chloride–water clusters calculated at the coupled cluster level of theory. Importantly, classical and quantum molecular dynamics simulations of a single chloride ion in water demonstrate that the new MB-nrg PEF predicts X-ray spectra in close agreement with the experimental results. Comparisons with an popular empirical model and a polarizable PEF emphasize the importance of an accurate representation of short-range many-body effect while demonstrating that pairwise additive representations of chloride–water and water–water interactions are inadequate for correctly representing the hydration structure of chloride in both gas-phase clusters and solution. We believe that the analyses presented in this study provide additional evidence for the accuracy and predictive ability of the MB-nrg PEFs which can then enable more realistic simulations of ionic aqueous systems in different environments.

A primary task of a network-based, earthquake early warning system is the prompt event detection and location, needed to assess the magnitude of the event and its potential damage through the predicted peak ground shaking amplitude using empirical attenuation relationships. Most of real-time, automatic earthquake location methods ground on the progressive measurement of the first P-wave arrival time at stations located at increasing distances from the source but recent approaches showed the feasibility to improve the accuracy and rapidity of the earthquake location by using the additional information carried by the P-wave polarization or amplitude, especially with unfavorable seismic network lay-outs. Here, we propose an evolutionary, Bayesian method for the real-time earthquake location which combines the information derived from the differential P-wave arrival times, amplitude ratios and back-azimuths measured at a minimum of two stations. As more distant stations record the P-wave, the posterior pdf is updated and new earthquake location parameters are determined along with their uncertainty. To validate the location method, we performed a retrospective analysis of mainshocks (M > 4.5) occurred during the 2016–2017 Central Italy earthquake sequence by simulating the typical acquisition layouts of in-land, coastal and linear array of stations. Results show that with the combined use of the three parameters, 2–4 s after the first P-wave detection, the method converges to stable and accurate determinations of epicentral coordinates and depth even with a nonoptimal coverage of stations. The proposed methodology can be generalized and adapted to the off-line analysis of seismic records collected by standard local networks.

Seismic sequences are a powerful tool to locally infer geometrical and mechanical properties of faults and fault systems. In this study, we provided detailed location and characterization of events of the 3&ndash, 7 July 2020 Irpinia sequence (southern Italy) that occurred at the northern tip of the main segment that ruptured during the 1980 Irpinia earthquake. Using an autocorrelation technique, we detected more than 340 events within the sequence, with local magnitude ranging between &minus, 0.5 and 3.0. We thus provided double difference locations, source parameter estimation, and focal mechanisms determination for the largest quality events. We found that the sequence ruptured an asperity with a size of about 800 m, along a fault structure having a strike compatible with the one of the main segments of the 1980 Irpinia earthquake, and a dip of 50&ndash, 55&deg, at depth of 10.5&ndash, 12 km and 60&ndash, 65&deg, at shallower depths (7.5&ndash, 9 km). Low stress drop release (average of 0.64 MPa) indicates a fluid-driven initiation mechanism of the sequence. We also evaluated the performance of the earthquake early warning systems running in real-time during the sequence, retrieving a minimum size for the blind zone in the area of about 15 km.

The efficient selection of representative configurations that are used in high-level electronic structure calculations needed for the development of many-body molecular models poses a challenge to current data-driven approaches to molecular simulations. Here, we introduce an active learning (AL) framework for generating training sets corresponding to individual many-body contributions to the energy of an N-body system, which are required for the development of MB-nrg potential energy functions (PEFs). Our AL framework is based on uncertainty and error estimation and uses Gaussian process regression to identify the most relevant configurations that are needed for an accurate representation of the energy landscape of the molecular system under examination. Taking the Cs

The Irpinia Near Fault Observatory (NFO) is an EPOS infrastructure located in the Campania-Lucania Region (Southern Italy). Its goal is to characterize the microseismicity and to understand the underlying chemical and physical processes occurring along the fault systems that can potentially generate large earthquakes in the area. The Irpinia NFO is currently composed of ISNet – Irpinia Seismic Network, with associated products and services. ISNet is a local network of 32 accelerometric, short-period and broad band stations, that cover the seismogenic areas related to the main earthquakes that occurred in the region in the last centuries, including the 23 November 1980 , Ms = 6.9 event. Also, ISNet provides real-time analysis and it represents the prototype network for the testing of early warning systems in Italy.Here we present tools and techniques to accurately locate and characterize the seismicity within the Observatory. Accurate event detection of weak signals from small magnitude events is based on the coherence of arrival times and migration techniques. This method is then coupled with advanced picking and double differences techniques to accurately locate events with a sub-kilometric scale resolution. Source parameters are thus computed inverting the displacement amplitude spectrum, with a probabilistic approach based on the conjunction of states of information in the data and model spaces. This technique is able to automatically rule out unconstrained solutions, while accounting for correlation among parameters. Source location and characterization is here used to investigate the role of the fluids in the region embedding the fault systems; space and time changes in the medium properties or in the source parameters can be used to detect a deviation from the present mechanical state of the faults owing to changes in fluid pore pressure and migration.Finally, local dense arrays are used here to improve our capability to detect events within the noise level and to move from a point-source to an extended source description of small events in the area.

The efficient selection of representative configurations that are used in high-level electronic structure calculations needed for the development of many-body molecular models poses a challenge to current data-driven approaches to molecular simulations. Here, we introduce an active learning (AL) framework for generating training sets corresponding to individual many-body contributions to the energy of a N-body system, which are required for the development of MB-nrg potential energy functions (PEFs). Our AL framework is based on uncertainty and error estimation, and uses Gaussian process regression (GPR) to identify the most relevant configurations that are needed for an accurate representation of the energy landscape of the molecular system under exam. Taking the Cs+–water system as a case study, we demonstrate that the application of our AL framework results in significantly smaller training sets than previously used in the development of the original MB-nrg PEF, without loss of accuracy. Considering the computational cost associated with high-level electronic structure calculations for training set configurations, our AL framework is particularly well-suited to the development of many-body PEFs, with chemical and spectroscopic accuracy, for molecular simulations from the gas to condensed phase.

For network-based Earthquake Early Warning Systems (EEWS), the real-time earthquake location is crucial for a correct estimation of event location/magnitude and therefore, for a reliable prediction of the potential expected shaking at the target sites in terms of predicted maximum ground shaking. Different approaches have been recently proposed for the real-time location which mainly use absolute (or differential) P-wave travel times at a set of minimum available stations or measurement of the initial P-wave arrival time (Elarms, Presto, Horiuchi), polarization (Eiserman and Bock) or amplitude and time (Yamada). In this work, we propose a new method which is able to exploit the continuous, real-time information available from both time, amplitude and polarization of initial P-wave signals acquired by dense three component arrays deployed in the source zones. The methodology we propose is an evolutionary and Bayesian probabilistic technique that combines three different observed parameters: 1) the differential arrival times of P-waves (which are computed using a 1D velocity model for the estimation of the theoretical arrival times); 2) the differential P-wave amplitudes in terms of P-wave peak velocity) [reference] (which are computed using an existing P-peak motion prediction equation) and 3) the real-time estimation of back-azimuthal direction, measured shortly after the P-wave arrival. These three parameters are measured in real-time and are used as prior and conditional information to estimate the posterior probability of the event location parameters, e.g. the hypocenter coordinates and the origin time. The method is evolutive, since it updates the location parameters as new data are acquired by more and more distant stations as the P-wavefront propagates across the network. The output is a multi-dimensional Probability Density Function (PDF), which contains the complete information about the maximum likelihood parameter estimation with their uncertainty. The method is computationally efficient and optimized for running in real-time applications, where the earthquake location has to be retrieved in a very short time window (around 1 sec) after data acquisition. We tested the proposed strategy on a sequence of 29 earthquakes of the 2016-2017 central Italy seismic sequence acquired by the RAN (Rete Accelerometrica Nazionale) network with a magnitude range of 4.2-6.5. For the testing phase, we also simulated non-optimal conditions in terms of source-to-receiver geometry. Specifically, we tested the method by ssimulating the case of “offshore” earthquakes recorded by a coastal network and in the case of a linear “barrier-type” geometry of the network. Our approach turned out to be suitable to work in condition of a sparse network, with a limited number of nodes and poor azimuthal coverage. In most of the cases, reliable location errors, less than 10 km, are achieved within few seconds from the first recorded P wave. As compared to other classical location techniques (i.e RTLOC in PRESTo) our approach shows an improvement of the solutions, especially for the first instants (2 seconds after the first P-wave arrival at network) when a poor number of stations (less than 4) is available.

Background To evaluate the trends in AIDS detection and the AIDS-attributed death rate in Brazil between 2007 and 2015 and to determine the population characteristics associated with AIDS detection. Methods Surveillance data including demographics, mode of HIV transmission, AIDS cases, and AIDS-attributed deaths were analysed. A logistic regression model was fitted to assess the trends in AIDS cases by mode of HIV transmission throughout the study period. A segmented Poisson regression model was used to assess changes in the trends of AIDS detection and mortality rates before (2007–2014) and after (2015) the introduction of the Test and Treat Initiative. Results In the segmented Poisson regression, the decline in the AIDS detection rate from 2007 to 2014 was 2.0% annually (i.e., the odds ratio (OR) for annual decline was 0.98 (95% [CI: 0.98–1.00, p-value

Cesarean section (CS) may have several acute complications that can occur in the early postoperative period. The most common acute complications are hematomas and hemorrhage, infection, ovarian vein thrombosis, uterine dehiscence and rupture. Pelvic hematomas usually occur at specific sites and include bladder flap hematoma (between the lower uterine segment and the bladder) and subfascial or rectus sheath hematoma (rectus sheath or prevescical space). Puerperal hemorrhage can be associated with uterine dehiscence or rupture. Pelvic infections include endometritis, abscess, wound infection, and retained product of conception. Radiologists play an important role in the diagnosis and management of postoperative complications as a result of increasing use of multidetector CT in emergency room. The knowledge of normal and abnormal postsurgical anatomy and findings should facilitate the correct diagnosis so that the best management can be chosen for the patient, avoiding unnecessary surgical interventions and additional treatments. In this article we review the surgical cesarean technique and imaging CT technique followed by description of normal and abnormal post-CS CT findings.

Background This study was conducted to determine the seroprevalence of HIV among pregnant women in Brazil and to describe HIV testing coverage and the uptake of antenatal care (ANC). Methods Between October 2010 and January 2012, a probability sample survey of parturient women aged 15-49 years who visited public hospital delivery services in Brazil was conducted. Data were collected from prenatal reports and hospital records. Dried blood spot (DNS) samples were collected and tested for HIV.We describe the agespecific prevalence of HIV infection and ANC uptake with respect to sociodemographic factors. Results Of the 36,713 included women, 35,444 (96.6%) were tested for HIV during delivery admission. The overall HIV prevalence was of 0.38% (95% confidence interval [CI]: 0.31-0.48), and it was highest in: the 30 to 39 year-old age group (0.60% [0.40- 0.88]), in the Southern region of Brazil (0.79% [0.59-1.04]), among women who had not completed primary (0.63% [0.30-1.31]) or secondary (0.67% [0.49-0.97]) school education, and among women who self-reported as Asian (0.94% [0.28-3.10]). The HIV testing coverage during prenatal care was of 86.6% for one test and of 38.2% for two tests. Overall, 98.5% of women attended at least 1 ANC visit, 90.4% attended at least 4 visits, 71% attended at least 6 visits, and 51.7% received ANC during the 1st trimester. HIV testing coverage and ANC uptake indicators increased with increasing age and education level of education, and were highest in the Southern region. Conclusions Brazil presents an HIV prevalence of less than 1% and almost universal coverage of ANC. However, gaps in HIV testing and ANC during the first trimester challenge the prevention of the vertical transmission of HIV. More efforts are needed to address regional and social disparities. Introdução Este estudo foi realizado com o objetivo de determinar a soroprevalência do HIV entre as mulheres grávidas no Brasil e descrever a cobertura de exames de HIV e a integração dos cuidados pré-natais (CPN). Métodos Entre outubro de 2010 e janeiro de 2012, foi realizada uma pesquisa de probabilidade por amostragem direcionada a mulheres grávidas com idade entre 15 e 49 anos, que utilizaram serviços de parto em hospitais públicos do Brasil. Os dados foram coletados a partir de relatórios pré-natais e registros hospitalares. Amostras de sangue foram coletadas e submetidas a exames de HIV. Descrevemos a prevalência da infecção pelo HIV específica de acordo com a idade e a absorção dos CPN em relação a fatores demográficos. Resultados Das 36.713 mulheres incluídas, 35.444 (96,6%) foram submetidas a exames de HIV durante a admissão para o trabalho de parto. A prevalência global de HIV foi de 0,38% (intervalo de confiança [IC] de 95%: 0,31-0,48), e foi maior no grupo com a faixa etária entre 30 e 39 anos de idade (0,60% [0,40-0,88]), da região Sul (0,79% [0,59-1,04]), entre as mulheres com o ensino fundamental incompleto (0,63% [0,30-1,31]) ou ensino médio incompleto (0,67% [0,49-0,97]), e entre as mulheres que se identificam como asiáticas (0,94% [0,28-3,10]). A cobertura do exame de HIV durante os CPN foi de 86,6% para um exame e de 38,2% para dois exames. No geral, 98,5% das mulheres foram atendidas em pelo menos 1 consulta de CPN, 90,4% compareceram a pelo menos 4 consultas, 71% compareceram a pelo menos 6 visitas, e 51,7% receberam CPN durante o 1o trimestre. A cobertura de exames de HIV e os indicadores de captação de CPN aumentaram de forma proporcional ao aumento da idade e do nível de educação, e foram maiores na região Sudeste. Conclusões O Brasil apresenta uma prevalência de menos de 1% e cobertura praticamente universal de CPN. No entanto, as lacunas nos exames de HIV e CPN durante o primeiro trimestre representam um desafio à prevenção contra a transmissão vertical do HIV. São necessários mais esforços a fim de reduzir as disparidades regionais e sociais.

The efficient selection of representative configurations that are used in high-level electronic structure calculations needed for the development of many-body molecular models poses a challenge to current data-driven approaches to molecular simulations. Here, we introduce an active learning (AL) framework for generating training sets corresponding to individual many-body contributions to the energy of an N-body system, which are required for the development of MB-nrg potential energy functions (PEFs). Our AL framework is based on uncertainty and error estimation and uses Gaussian process regression to identify the most relevant configurations that are needed for an accurate representation of the energy landscape of the molecular system under examination. Taking the Cs+-water system as a case study, we demonstrate that the application of our AL framework results in significantly smaller training sets than previously used in the development of the original MB-nrg PEF, without loss of accuracy. Considering the computational cost associated with high-level electronic structure calculations, our AL framework is particularly well-suited to the development of many-body PEFs, with chemical and spectroscopic accuracy, for molecular-level computer simulations from the gas to the condensed phase.

In September 2016 and again in November 2017, Korea witnessed some of the largest magnitude earthquakes occurred in-land in its recent history. They were located in the South-Eastern part of the pe...

Background Induction of labor (IOL) is one of the most common procedures performed in obstetrics, accounting for about the 20% of deliveries in the developed countries and it still represents a challenge to obstetricians. The aim of this study is the comparison between two techniques for IOL: oral misoprostol and Propess®. Methods A retrospective study has been carried out in a single tertiary referral center. Clinical maternal, fetal and neonatal information was recorded. Results A total of 863 women were included. the vaginal delivery (VD) rate was significantly higher in the misoprostol group. The cesarean section rate was comparable between groups. Adverse events and neonatal outcomes were comparable between groups. Conclusions Misoprostol shows a higher VD rate with fewer patients needing a second type of induction and a shorter time to the onset of active labor and to VD.

BACKGROUND:The objective of the present study is to review the literature regarding the management of fertile patients under lithium treatment for bipolar disorder and to report the experience of our Teratology Information Service over the past thirteen years in managing women treated with lithium during preconception, pregnancy and breastfeeding. METHODS:This research focuses on a selective review of the literature and a retrospective survey has been carried out on fertile women under lithium treatment who called our service at A. Gemelli University Hospital in Rome from May 2002 to December 2015. RESULTS:A total of 140 women under lithium treatment called our TIS. A complete follow-up has been performed on 34 patients: 29 called during pregnancy and 5 called during preconception. None of the patients called during breastfeeding, while half of the patients were taking concomitant drugs during pregnancy. One major cardiac malformation (hypoplastic left heart syndrome) has been reported. No minor malformations have been detected. Twenty-one patients delivered a living child, with one premature neonate. Two patients underwent voluntary interruption of pregnancy and six patients had early spontaneous abortion. In one patient, intrauterine growth retardation occurred, but with no adverse neonatal outcomes. Four neonates experienced transient respiratory distress at birth. Two children developed mild to severe language delay, but normal motor development. CONCLUSIONS:Lithium treatment in fertile women is a very delicate topic, where risks and benefits of discontinuing therapy when women plan to become pregnant should be accurately evaluated. Thorough peri-conceptional counselling is crucial for the outcome of pregnancy and for maternal health status during preconception, gestation and breastfeeding.

Objectives To estimate the burden of tuberculosis (TB) in reported AIDS cases, to compare the characteristics of TB/HIV subjects with those without TB and to evaluate survival with or without TB in Brazil. Methods The data source was the linked database between AIDS (2011–2014) and TB (2011–2014) databases from the Notifiable Diseases Information System (SINAN). The sociodemographic, clinical, laboratory results and use of antiretroviral therapy (ART) data were compared by TB occurrence or not. Survival probability was estimated using the Kaplan-Meier method and associated factors were sought using Cox regression. Results The proportion of TB diagnosed from 2011 to 2014 among AIDS cases reported between 2006 and 2014 was 6.3%. Subjects coinfected with TB were predominantly male, older, with lower schooling, with lower CD4 count, higher viral load, and higher proportion of ART initiation than those without TB. 57.5% were diagnosed with HIV before TB, 38.2% as concurrent TB/HIV and 4.3% with TB before HIV. 16,466 reported TB cases were not found in the AIDS database, although registered as HIV-infected in the SINAN TB database between 2011 and 2014. Median survival for PLHIV was 581 days, with 582 for those without TB, significantly higher than 547 for those with TB (log-rank teste, p = 0,001). In the Cox multivariate analysis, male gender [aHR = 1.27 (CI 95% 1.22–1.33)], older age [aHR = 1.020 (CI 95% 1.019–1.022)] and TB coinfection [aHR = 1.97 (CI 95% 1.88–2.07)] were positively associated with adjusted hazard of death, whereas CD4 count 200–499 cells [aHR = 0.21 (CI 95% 0.20–0.22)] and receiving ART [aHR = 0.2 2(CI 95% 0.21–0.23)] reduced the risk of death. Conclusions HIV-infected subjects should be screened for TB at care entry, to minimize diagnosis and treatment delays when active TB is present or to increase the odds of being offered latent TB infection therapy to prevent TB. On the other hand, TB cases should be promptly tested for HIV. All those will contribute to reduce mortality among people living with AIDS.

The aim of our study is to identify - in a cohort of obese women - cardiovascular and clinical risk factors in women with previous complicated pregnancies and protective factors in women with previous physiological pregnancies. A total of 135 nonpregnant obese women referring to Policlinico Gemelli in Rome were prospectively collected in 2009-2010. Thirty-two women matched inclusion criteria: 16 reported a previous physiological pregnancy and 16 reported previous obstetric complications. A clinical, instrumental and laboratory evaluation has been performed for each patient. Statistical analysis was performed using StatView Software. Values are expressed as mean ± standard error (SEM). All tests were two-tailed with a confidence level of 95% (p

Background In Brazil, due to the rapid increase in programmes for the prevention of mother-to-child transmission (PMTCT), routine programme data are widely available. The objective of this study was to assess the utility of programmatic data to replace HIV surveillance based on the antenatal care (ANC) surveillance survey (SS). Methods We analysed ANC SS data from 219 maternity service clinics. PMTCT variables were extracted from the ANC SS data collection form, which allowed us to capture and compare the ANC SS data and PMTCT HIV test results for each pregnant woman who completed the ANC SS. Both the PMTCT programme and the ANC SS tested for HIV using sequential ELISA and western blot for confirmation. We assessed the completeness (% missing) of the PMTC data included in the ANC SS. Results Of the 36,713 pregnant women who had ANC SS HIV tests performed, 30,588 also underwent PMTCT HIV testing. The HIV prevalence rate from routine PMTCT testing was 0.36%, compared to 0.38% from the ANC SS testing (relative difference −0.05%; absolute difference −0.02%). The relative difference in prevalence rates between pregnant women in northern Brazil and pregnant women central-west Brazil was −0.98 and 0.66, respectively. Of the 29,856 women who had HIV test results from both the PMTCT and ANC SS, the positive percent agreement of the PMTCT versus the surveillance test was 84.1% (95% confidence interval [CI]: 74.8–91.0), and the negative percent agreement was 99.9% (95% CI: 99.9–100.0). The PMTCT HIV testing uptake was 86.4%. The ANC SS HIV prevalence was 0.33% among PMTCT non-refusers and 0.59% among refusers, with a percent bias of −10.80% and a differential prevalence ratio of 0.56. Syphilis and HIV testing results were complete in 98% and 97.6% of PMTCT reports, respectively. The reported HIV status for the women at clinic entry was missing. Conclusions Although there were consistent HIV prevalence estimates from the PMTCT data and the ANC SS, the overall positive percent agreement of 84.1% falls below the World Health Organization benchmark of 94.7%. Therefore, Brazil must continue to reinforce data collection practices and ensure the quality of recently introduced rapid HIV testing before replacing the PMTCT data with surveillance techniques. However, some regions with better results could be prioritized to pilot the use of PMTCT data for surveillance.

Background There are many contradictions about pregnancy and fetal/neonatal outcomes after topical use of timolol alone or timolol in combination with other antiglaucoma medications. Methods Seventy-five pregnant women exposed to antiglaucoma medications were followed prospectively by phone interviews. 27 women used timolol as monotherapy, 48 women used timolol as a part of multidrug therapy. We selected a control group of 187 healthy pregnant women. Results Topical use of timolol alone or timolol in combination with other antiglaucoma medications does not influence pregnancy or fetal/neonatal outcomes. Conclusion Beta-blocker is the first choice treatment for glaucoma in pregnancy but, when necessary, multidrug therapy should not to be excluded.

An earthquake early warning (EEW) system is a real-time seismic monitoring infrastructure that has the capability to provide warnings to target cities before the arrival of the strongest shaking waves. In order to provide a rapid alert when targets are very close to the epicenter of the events, we developed an on-site EEW approach and evaluated its performance at the Italian national scale. The system is a P wave-based method that measures in real time two parameters: the initial peak displacement (Pd) and the average period (τc). As output, the system provides the predicted ground-shaking intensity at the monitored site, the alert level, and a qualitative classification of both earthquake magnitude and source-to-receiver distance. We applied the on-site EEW methodology to a data set of Italian earthquakes, with magnitude ranging from 3.8 to 6, and evaluated the performance of the system in terms of correct warning and lead times (i.e., time available for security actions at the target). The results of this retrospective analysis show that for the large majority of the analyzed cases, the method is able to deliver a correct warning shortly after the P wave detection, with more than 80% of successful intensity predictions at the target site. The lead times increase with distance, with a value of 8–10 s at 50 km and 15–18 s at 100 km.

Summary Introduction Megacystis is a condition of abnormal enlarged fetal bladder for gestational age, which is usually associated with urological malformations that may constitute a life-threatening condition for the baby. Objective The purpose of this study was to assess the prognostic and etiological criteria of fetal megacystis and to describe the neonatal outcome in a large series collected in a single tertiary center. Study design A retrospective observational study was conducted between 2008 and 2012. We reviewed all consecutive cases of fetal megacystis diagnosed during routine ultrasound (US) screening. The following data were collected and analyzed: maternal age, gestational age at diagnosis, prenatal ultrasonographic details of the urinary system, extra-urinary ultrasonographic anomalies, fetal karyotype, pregnancy outcome, postnatal diagnosis, and medical/surgical follow-up. Results Of the 25 fetuses included in this study, 76% were males. The mean gestational age (GA) at diagnosis was 23.1 ± 7.5 weeks (range 12–34), among them only four (16%) were diagnosed during the first trimester. Associated urological malformations were detected in 92% (n = 23) of the cases, while other malformations were detected in 36% (n = 9). Oligohydramnios or anyhydramnios were observed in 52% (n = 13) of the cases. Twelve (48%) fetuses were considered as having poor prognosis for renal function. Vesicocentesis with or without vesico-amniotic infusion were performed in 28% (n = 7) of the cases. Pregnancy outcome was surprisingly good, with only one case of prenatal death and survival rate of 96% (n = 24) of liveborn babies. Posterior urethral valve (PUV) (n = 9, 36%) was the most common etiology of the fetal megacystis, followed by persistent urogenital sinus (n = 2, 8%), Prune belly syndrome (n = 2, 8%) and bilateral vescico-ureteral reflux (VUR) (n = 2, 8%). Surgical or endoscopic procedures were performed in 75% (n = 18) of the cases. Six (24%) newborns presented with moderate/severe respiratory distress that requested invasive assisted ventilation. Three cases (n = 3, 12%) of perinatal death were observed due to severe impaired renal function. After a median follow-up of 29 months renal function was good in 79% (n = 19) of the cases. Conclusions Fetal megacystis may underline a wide range of associated pathologies with the highest prevalence of urinary malformation. Optimal counseling of the involved parents requires a multidisciplinary approach to allow the best management during the pregnancy and the perinatal period. Despite the high risk of renal failure, lung hypoplasia, and severe associated anomalies, the outcome of fetuses with megacystis could be improved thanks to an appropriate perinatal diagnosis and neonatal management.

The ultrasonographic detection of renal anomalies may modify obstetric management and facilitate pediatric care of the newborn. We performed prenatal differential diagnosis of an isolated unilateral cystic renal mass (71 × 74 × 82 mm) in a pregnant woman at 26 weeks of gestation. No other abnormalities were detected by ultrasonography, except for polyhydramnios. Repeated percutaneous cyst aspirations were required because of the increasing risk of vital organ damage. Postnatal nephroureterectomy was performed. Anatomopathologic analysis led to the diagnosis of segmental renal dysplasia, which could not be included in any of the four groups of Potter's classification of cystic renal dysplasia.

We present the results of a feasibility study of an earthquake early warning system (EEWS) for the Campania region (southern Italy) using schools as specific targets. The study considered the seismogenic zones as sources of potential earthquakes for the area, the Italian accelerometric network as the recording network for seismic event occurrence, and the performances of the software platform PRESTo Plus for data analysis and processing. We analyze the distribution of lead-times for all possible threatening seismic sources for each municipality in the region under study by extracting the lead-time value corresponding to the 5th, 10th and 25th percentiles of the distributions. We discuss the results for the 5th percentile in order to analyze the worst-case scenario: in the case of a single site, the lead-time is expected to be larger than this value in the 95 % of the cases. Since the population distribution in Campania is uneven and most of the people live nearby the coast, whilst the most destructive earthquakes occur along the Apennine chain, we can conclude that an efficient EEWS can allow most of the schools in the area to undertake some mitigating actions. The testing of the EEWS was carried out in the high school ITIS ‘E. Majorana’, located at Somma Vesuviana, about 80 km from the seismogenic Irpinia region. For this purpose, the Sentinel, an actuator made up of low-cost hardware (i.e., Arduino®), was developed in close cooperation with students and teachers of the school to receive alert messages from the PRESTo Plus platform and warn the school users in case of a seismic event. The EEWS and the Sentinel were successfully tested during some blind drills performed during normal school activities.

Aim: To investigate whether healthy women with a previous pregnancy complicated by a small for gestational age (SGA) infant have normal endothelial function, carbohydrate and lipid metabolism, and normal inflammation parameters. Material and Methods: Brachial artery flow-mediated dilatation (FMD, endothelium-dependent) was measured in 16 subjects with previous SGA, and in 15 controls (CTR) with previous normal pregnancies. Lipid panel, glucose, insulin, tumor necrosis factor alpha (TNF-alpha), soluble intercellular adhesion molecule-1 (s-ICAM), soluble vascular (s-VCAM-1) adhesion molecule-1 (s-VCAM-1), and androgens were also measured. Results: FMD was reduced in women with previous SGA compared to controls (P

Objective: To report the experience developed in a Third Level Referral Center in performing a multifaceted intervention strategy to reduce Caesarian Sections (CS) rate. A comparison of our results with the performance of the best Italian hospitals for number of deliveries and CS has been performed.Methods: A monitoring system was set up, based on a prospective collection of all deliveries from 2013 to 2017, according to Robson’s classification. Data have also been collected retrospectively at a regional and national level to compare our results to other institutions. The multi-approach intervention consisted of evidence based tools: process management, training, multiprofessionalism, development of planning and control systems, continuous monitoring, audit and feedback.Results: The percentage of primary CS decreased from 26.71% in 2013 to 15.03% in 2017 (RR adjusted considering the regional average: 0.87 in 2013; 0.57 in 2017, p < .001). A raise of 19.76% in the annual volume of deliveries was registered. Such results have also been confirmed after comparing to the best performing Italian centers. From 2013 to 2016 the percentage of primary CS decreased from 27.02% to 18.04% (RR adjusted considering the regional average: 1.04 in 2013, p > .05; 0.74 in 2016, p < .001), while there was an increase in the annual volume of deliveries from 3,311 to 4,219.Conclusions: Our study confirms that multifaceted interventions can strengthen a continuous quality and safety improvement approach. This is of crucial relevance in the obstetric field and in the Italian country, where overall performance in CS needs to be improved.

Citation Ticconi C, Rotondi F, Veglia M, Pietropolli A, Bernardini S, Ria F, Caruso A, Di Simone N. Antinuclear autoantibodies in women with recurrent pregnancy loss. Am J Reprod Immunol 2010; 64: 384–392 Problem To investigate the possibility that antinuclear antibodies (ANA) are involved in recurrent pregnancy loss (RPL). Methods Case–control study carried out on 294 women (194 cases and 100 controls) in two University hospitals. The presence, the serum titers and the indirect immunofluorescence (IIF) patterns of ANA were determined in women with RPL and in control women. Results Antinuclear antibodies at titers ≥ 1:80 were detected in 97 (50%) women with RPL and in 16 (16%) control women. Elevated ANA titers (≥1:180) were detected only in RPL women, whereas all control women had ANA titers no greater than 1:80. No differences could be detected in the IIF patterns between RPL and control women. No differences in ANA positivity could be detected according to the type (primary or secondary) or number (>2 versus ≥3) of losses. Conclusions ANA could be of some value in identifying women with RPL with potential, although still not fully defined, immune abnormalities.