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Abstract Background Long-term sequelae of SARS-CoV-2 infection, namely long COVID syndrome, affect about 10% of severe COVID-19 survivors. This condition includes several physical symptoms and objective measures of organ dysfunction resulting from a complex interaction between individual predisposing factors and the acute manifestation of disease. We aimed at describing the complexity of the relationship between long COVID symptoms and their predictors in a population of survivors of hospitalization for severe COVID-19-related pneumonia using a Graphical Chain Model (GCM). Methods 96 patients with severe COVID-19 hospitalized in a non-intensive ward at the “Santa Maria” University Hospital, Terni, Italy, were followed up at 3–6 months. Data regarding present and previous clinical status, drug treatment, findings recorded during the in-hospital phase, presence of symptoms and signs of organ damage at follow-up were collected. Static and dynamic cardiac and respiratory parameters were evaluated by resting pulmonary function test, echocardiography, high-resolution chest tomography (HRCT) and cardiopulmonary exercise testing (CPET). Results Twelve clinically most relevant factors were identified and partitioned into four ordered blocks in the GCM: block 1 - gender, smoking, age and body mass index (BMI); block 2 - admission to the intensive care unit (ICU) and length of follow-up in days; block 3 - peak oxygen consumption (VO2), forced expiratory volume at first second (FEV1), D-dimer levels, depression score and presence of fatigue; block 4 - HRCT pathological findings. Higher BMI and smoking had a significant impact on the probability of a patient’s admission to ICU. VO2 showed dependency on length of follow-up. FEV1 was related to the self-assessed indicator of fatigue, and, in turn, fatigue was significantly associated with the depression score. Notably, neither fatigue nor depression depended on variables in block 2, including length of follow-up. Conclusions The biological plausibility of the relationships between variables demonstrated by the GCM validates the efficacy of this approach as a valuable statistical tool for elucidating structural features, such as conditional dependencies and associations. This promising method holds potential for exploring the long-term health repercussions of COVID-19 by identifying predictive factors and establishing suitable therapeutic strategies.

Purpose: AI-powered tools and the use of these tools for teaching and learning have grown exponentially. While there are several studies that examine students' use of AI tools for learning, the results are inconclusive. The purpose of this study is to gain a better understanding of students' familiarity and use of various AI-powered tools for learning, and to gain greater insight into students' perspectives on the benefits and risks of using AI-powered tools in educational settings. Study design/methodology/approach: The study deployed a survey to understand and compare the degree of familiarity and use of AI-powered tools among first and final-year university students. Additionally, several questions focused specifically on students' concerns regarding the use of AI in their studies. Findings: Results indicate that first-year students exhibited a higher level of familiarity with AI tools prior to the start of their studies, while final-year students demonstrated a deeper and more diverse usage of these technologies. Despite concerns raised, the study does not conclusively support negative impacts on student engagement or development of critical thinking skills. While the study indicated that students are well aware of the general limitations of AI use, they did feel not well supported nor informed as to how AI-powered tools can be used within their studies and have expressed the need for greater support and guidance from the university. Originality/value: Research findings have significant implications for educational institutions and policymakers as they strive to leverage AI effectively to enhance the learning experience while addressing concerns and preferences in this rapidly evolving educational environment.

Summary: The ability of rodents to effectively navigate in an environment is based on trial-and-error learning and flexible decision-making and can be analyzed via navigational trajectories. We present a protocol for studying the deployment of search strategies in mice using the Morris water maze. We describe steps for assigning mice to different maze variations and procedures for post-training tracking and analysis. This protocol represents an effective behavioral readout to probe brain networks involved in strategy deployment and goal-oriented behavior.For complete details on the use and execution of this protocol, please refer to Parrini et al.1 : Publisher’s note: Undertaking any experimental protocol requires adherence to local institutional guidelines for laboratory safety and ethics.

Summary: High-penetrance mutations affecting mental health can involve genes ubiquitously expressed in the brain. Whether the specific patterns of dysfunctions result from ubiquitous circuit deficits or might reflect selective vulnerabilities of targetable subnetworks has remained unclear. Here, we determine how loss of ubiquitously expressed fragile X mental retardation protein (FMRP), the cause of fragile X syndrome, affects brain networks in Fmr1y/− mice. We find that in wild-type mice, area-specific knockout of FMRP in the adult mimics behavioral consequences of area-specific silencing. By contrast, the functional axis linking the ventral hippocampus (vH) to the prelimbic cortex (PreL) is selectively affected in constitutive Fmr1y/− mice. A chronic alteration in late-born parvalbumin interneuron networks across the vH-PreL axis rescued by VIP signaling specifically accounts for deficits in vH-PreL theta-band network coherence, ensemble assembly, and learning functions of Fmr1y/− mice. Therefore, vH-PreL axis function exhibits a selective vulnerability to loss of FMRP in the vH or PreL, leading to learning and memory dysfunctions in fragile X mice.

Introduction: Complications in immediate breast reconstruction after skin-preserving mastectomies are recurrent. The authors describe conduct to reduce them and improve the anatomical/esthetic result using implants. The objective is to reduce the incidence of areolar necrosis, improve breast projection in reconstructions with submuscular implants, recover partial or total sensitivity, and facilitate symmetrization. Method: The mastectomy involves a lateral transverse incision from the areolar border to the armpit. Repair with implants included in a mixed plane by divulsion of the pectoral muscle, dividing it into two portions in the direction of its fibers, the association of the serratus muscle fascia and inferior/lateral subcutaneous tissue, and/or pectoralis minor muscle in the superolateral area. The incision is sutured when there is no breast ptosis or superimposed by de-epidermization of one of the borders, which may include a reduction in diameter and relocation of the areola. Or fusiform de-epidermization of the periareolar skin and medially to it. The contralateral risk-reducing mastectomy had a similar procedure, improving symmetry. Results: 106 patients (212 breasts) were operated on with satisfactory results and complications due to infection, positioning of the implants on the learning curve, and surface irregularities. Conclusion: Immediate breast reconstruction after skin-preserving mastectomy by the proposed method is a possible option, obtaining good breast symmetrization and projection, return of sensitivity, and absence of total necrosis of the areola.

A study was carried out to investigate the effects of wildfires on lake water quality using a source dataset of 2024 lakes worldwide, covering different lake types and ecological settings. Satellite-derived datasets (Lakes_cci and Fire_cci) were used and a Source Pathway Receptor approach applied which was conceptually represented by fires (burned area) as a source, precipitation/drought representing transport dynamics, and lakes as the ultimate receptor. This identified 106 lakes worldwide that are likely prone to be impacted by wildfires via a terrestrial pathway. Satellite-derived chlorophyll-a (Chl-a) and turbidity variables were used as indicators to detect changes in lake water quality potentially induced by wildfires over a four-year period. The lakes with the largest catchment areas burned and characterized by regular annual fires were located in Africa. Evidence for a strong influence of wildfires was not found across the dataset examined, although clearer responses were seen for some individual lakes. However, among the hydro-morphological characteristics examined, lake depth was found to be significant in determining Chl-a concentration peaks which were higher in shallow and lower in deep lakes. Lake turbidity responses indicated a dependence on lake catchment and weather conditions. While wildfires are likely to contribute to the nutrient load of lakes as found in previous studies, it is possible that in many cases it is not a dominant pressure and that its manifestation as a signal in lake Chl-a or turbidity values depends to a large part on lake typology and catchment characteristics. Assessment of lake water quality changes six months after a fire showed that Chl-a concentrations either increased, decreased, or showed no changes in a similar number of lakes, indicating that a lake specific ecological and hydro-morphological context is important for understanding lake responses to wildfires.

Two methods dominate the regression analysis of time-to-event data: the accelerated failure time model and the proportional hazards model. Broadly speaking, these predominate in reliability modelling and biomedical applications, respectively. However, many other methods have been proposed, including proportional odds, proportional mean residual life and several other “proportional” models. This paper presents an overview of the field and the concept behind each of these ideas. Multi-parameter modelling is also discussed, in which (in contrast to, say, the proportional hazards model) more than one parameter of the lifetime distribution may depend on covariates. This includes first hitting time (or threshold) regression based on an underlying latent stochastic process. Many of the methods that have been proposed have seen little or no practical use. Lack of user-friendly software is certainly a factor in this. Diagnostic methods are also lacking for most methods.

Acquired factor XIII (FXIII) deficiency is an extremely rare and potentially fatal bleeding disorder. Immune-mediated FXIII deficiency is due to the development of anti-FXIII autoantibodies which may develop with concomitant conditions that cause immune dysregulation such as malignancies or autoimmune disorders. Clinical presentation includes delayed post-operative bleeding or spontaneous soft tissue hematomas and/or cerebral bleeding. Since screening coagulation laboratory tests (prothrombin time, activated partial thromboplastin time, and fibrinogen) are typically normal, acquired FXIII deficiency is likely to be overlooked and underdiagnosed. The management of immune-mediated FXIII deficiency is based on hemostatic therapy, autoantibody removal and eradication of the underlying etiology; however, no treatment guidelines are still available. Here we report a case of acquired FXIII deficiency associated with plasmablastic lymphoma, in order to raise awareness of this rare bleeding disorder and consent prompt life-saving management.

Lakes have been observed as sentinels of climate change. In the last decades, global warming and increasing aridity has led to an increase in both the number and severity of wildfires. This has a negative impact on lake catchments by reducing forest cover and triggering cascading effects in freshwater ecosystems. In this work we used satellite remote sensing to analyse potential fire effects on lake water quality of Lake Baikal (Russia), considering the role of runoff and sediment transport, a less studied pathway compared to fire emissions transport. The main objectives of this study were to analyse time series and investigate relationships among fires (i.e., burned area), meteo-climatic parameters and water quality variables (chlorophyll-a, turbidity) for the period 2003–2020. Because Lake Baikal is oligotrophic, we expected detectable changes in water quality variables at selected areas near the three mains tributaries (Upper Angara, Barguzin, Selenga) due to river transport of fire-derived burned material and nutrients. Time series analysis showed seasonal (from April to June) and inter-annual fire occurrence, precipitation patterns (high intensity in summer) and no significant temporal changes for water quality variables during the studied periods. The most severe wildfires occurred in 2003 with the highest burned area detected (36,767 km2). The three lake sub-basins investigated have shown to respond differently according to their morphology, land cover types and meteo-climatic conditions, indicating their importance in determining the response of water variables to the impact of fires. Overall, our finding suggests that Lake Baikal shows resilience in the medium-long term to potential effects of fires and climate change in the region.

The purpose of this study was to elucidate the patterns and mechanisms driving seasonal and interannual variations of carbon and nitrogen stable isotopes in the zooplankton crustacean community of Lake Maggiore (Italy), during the period 2009–2020. Different zooplankton taxa and groups showed different ranges of δ13C signatures, giving an insight into food sources and niche partition. In particular, cyclopoids had a restricted range with more negative δ13C‰ values and an increase in δ13C fractionation with the establishment of water thermal vertical stratification, highlighting the importance of vertical distribution as a key factor for taxa coexistence in a vertically heterogenous environment. The δ13C values of the zooplankton community and of Daphnia were positively related to water temperature (R2 = 0.58 p < 0.0001 and R2 = 0.68 p < 0.0001, respectively), and the δ13C Daphnia signature was positively related to chlorophyll a (R2 = 0.32, p < 0.0001). Decomposition of the time-series data for zooplankton carbon and nitrogen signatures and environmental parameters identified increasing trends in water temperature, chlorophyll a and water conductivity and a decrease in nitrate that matched changes in carbon isotopic signature trends in some zooplankton taxa (Bosmina, Daphnia and Diaptomids). Overall, the observed patterns in zooplankton isotopic signatures were interpreted as integrations of the effects of climate warming in Lake Maggiore, affecting both the availability of food sources and environmental conditions.

Lake Maggiore is a site of the Long-Term Ecosystem Research (LTER) network, belonging to the deep subalpine Lake District in Northern Italy. Studies on the physical, chemical, and biological features of the lake have been performed continuously since the 1980s. The lake recovered from eutrophication reaching the present oligotrophic condition. In the last decade, climate change represents the main driving factor for the long-term evolution of the lake, affecting its hydrodynamics, nutrient status, and biological communities. In 2020 a high-frequency monitoring (HFM) system was deployed, with the aim to integrate long-term monitoring based on discrete sampling and analysis. The system consists of a buoy equipped with sensors for limnological variables and algal pigments. The high-frequency monitoring program is part of a cross-border project between Italy and Switzerland focusing on lake quality monitoring as a critical input for successful lake management. In this paper we focus on Chlorophyll-a data, with the aim to test whether in-situ fluorescence measurements may provide a reliable estimate of lake phytoplankton biovolume and its seasonal dynamic. Sensor’s performance was regularly tested comparing chlorophyll-a data taken by the in-situ fluorescent sensors (Cyclops7, Turner Design), data from laboratory fluorescence analysis (FluoroProbe, BBE Moldaenke), values obtained from chlorophyll-a analysis by UV-VIS spectrophotometry and data from phytoplankton microscopy analysis. We found a general good agreement between the Chlorophyll-a data obtained with the different methods, confirming the use of in-situ sensors as a reliable approach to measure algal pigments, especially to assess their variability in the short-term, but also to describe the seasonal pattern of phytoplankton biovolume. However, phytoplankton community composition played a substantial role in the performance of the different methods and in the reliability of in-situ data as a tool to assess algal biovolume. This study demonstrates that high-frequency monitoring (HFM), used in conjunction with discrete chemical and biological monitoring, represents an important advance and support in the long-term monitoring of freshwaters and is a useful tool to detect ecological changes. Regular checking and validation of the sensor readings through laboratory analyses are important to get trustworthy data.

Coronavirus disease 2019 (COVID-19) following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection called for a specific and massive vaccination campaign. Acquired hemophilia A (AHA) is a potential life-threatening coagulopathy. Hematological- targeted autoimmune conditions including immune thrombocytopenia, vaccine-induced thrombotic thrombocytopenia and AHA emerged during large-scale vaccination against SARS-CoV-2 and contributed to vaccination hesitation. The aim of the present study was to evaluate the putative recurrence of AHA after vaccination against SARS-CoV-2 with mRNA vaccines (BNT162b2 and mRNA- 1273) in patients with relatively recent history of AHA. Thirteen patients (8 women and 5 men, mean age = 63.1±16.6 years) with AHA in the previous two-to-five years were enrolled in the study. Platelet count, prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen and Factor VIII levels were evaluated 48 hours prior to each vaccine dose and 10 days post-vaccination. Clinical self-assessment and remote video visits were performed in the presence of even minor hemorrhagic signs. No major bleeding events were detected at any time-point, including evaluation at 30 days after the 3rd vaccine dose. No significant hemorrhagic changes were observed, in particular no thrombocytopenia and/or significant alterations in PTT and Factor VIII emerged across subjects. Patients with a previous history of AHA of various etiology do not seem to have an increased recurrence risk after a COVID-19 vaccination course of 3 doses with either mRNA vaccine. This finding supports this specific safety aspect in the face of the possible continuation of the vaccination campaign based on the trend of the COVID-19 pandemic.

The article is motivated by the lack of studies which address silence as a context- dependent phenomenon; that is, as a phenomenon whose meaning arises within specific contexts, situations and physical spaces. Accordingly, I address the ways in which the phenomenon of silence plays an essential role in particular professional and vocational domains. The analysis leads through some thoughts and considerations of people who work or are active in specialized fields that have a significant connection with the practice and the experience of silence. I especially examine areas such as meditation, teaching, health professions, and other professional and even – to some extent – artistic practices.

ObjectiveThe aim of this paper is to present the AutoInflammatory Disease Alliance (AIDA) international Registry dedicated to Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic (VEXAS) syndrome, describing its design, construction, and modalities of dissemination.MethodsThis Registry is a clinical, physician-driven, population- and electronic-based instrument designed for the retrospective and prospective collection of real-life data. Data gathering is based on the Research Electronic Data Capture (REDCap) tool and is intended to obtain real-world evidence for daily patients' management. The Registry may potentially communicate with other on-line tools dedicated to VEXAS syndrome, thus enhancing international collaboration and data sharing for research purposes. The Registry is practical enough to be easily modified to meet future needs regarding VEXAS syndrome.ResultsTo date (April 22nd, 2022), 113 Centers from 23 Countries in 4 continents have been involved; 324 users (114 Principal Investigators, 205 Site Investigators, 2 Lead Investigators, and 3 data managers) are currently able to access the registry for data entry (or data sharing) and collection. The Registry includes 4,952 fields organized into 18 instruments designed to fully describe patient's details about demographics, clinical manifestations, symptoms, histologic details about skin and bone marrow biopsies and aspirate, laboratory features, complications, comorbidities, therapies, and healthcare access.ConclusionThis international Registry for patients with VEXAS syndrome will allow the achievement of a comprehensive knowledge about this new disease, with the final goal to obtain real-world evidence for daily clinical practice, especially in relation to the comprehension of this disease about the natural history and the possible therapeutic approaches. This Project can be found on https://clinicaltrials.gov NCT05200715.

ObjectiveThe present paper describes the design, development, and implementation of the AutoInflammatory Disease Alliance (AIDA) International Registry specifically dedicated to patients with Schnitzler's syndrome.MethodsThis is a clinical physician-driven, population- and electronic-based registry implemented for the retrospective and prospective collection of real-life data from patients with Schnitzler's syndrome; the registry is based on the Research Electronic Data Capture (REDCap) tool, which is designed to collect standardized information for clinical research, and has been realized to change over time according to future scientific acquisitions and potentially communicate with other existing or future similar registries.ResultsSince its launch, 113 centers from 23 countries in 4 continents have been involved. Fifty-seven have already obtained the approval from their local Ethics Committees. The platform counts 324 users (114 Principal Investigators, 205 Site Investigators, 2 Lead Investigators, and 3 data managers) at current (April 28th, 2022). The registry collects baseline and follow-up data using 3,924 fields organized into 25 instruments, including patient's demographics, history, clinical manifestations and symptoms, trigger/risk factors, laboratory, instrumental exams, therapies, socioeconomic information, and healthcare access.ConclusionsThis International Registry for patients with Schnitzler's syndrome facilitates standardized data collection, enabling international collaborative projects through data sharing and dissemination of knowledge; in turn, it will shed light into many blind spots characterizing this complex autoinflammatory disorder.

Introduction: Here we propose a tactic to fill the upper poles of breasts that are emptied by ptosis in primary and secondary cases to obtain anatomically beautiful breasts with sufficient breast volume. Objective: To describe breast tissue flaps used to fill the upper breast pole when there is adequate or surplus volume. Methods: In primary or secondary cases, if the measurement from point A to the submammary fold is long and that to the upper glandular ridge is short, one obtains from the difference between them a flap with an upper pedicle, termed a “book leaf,” and sutured at the upper mammary pole. Glandular detachment preserves the skin’s thickness with subcutaneous tissue in all maneuvers similar to the adjacent thorax according to the mammary gland’s vascular anatomy, which is irrigated and innervated from the subcutaneous tissue to the gland. Results: The six patients presented no complications related to flap irrigation. Adequate mammary shape and volume were achieved by inverting measurements between the lower and upper poles. Discussion: Here we proposed an innovative manner to fill the upper pole of the breast with a breast upper pedicle flap. A larger number of cases should be analyzed in the long term. Conclusion: The flap is used to fill the upper pole of the breast when the largest volume is in the lower pole.

Introduction: An increased nasal tip projection is sometimes necessary to achieve an appropriate proportion between nasal tip and dorsum. Numerous techniques and tactics have been described for this purpose using cartilaginous grafts obtained from the nasal septum, auricular concha, and costal cartilage. When this increased projection must be discrete, the use of excess lateral alar cartilage in the form of "pseudo-flaps" is proposed. Methods: In primary open rhinoplasty, excess alar cartilage, which is generally removed, was used to produce "pseudo-flaps". The cartilages were folded over themselves in the form of a "French soldier's suspender" over the domes of the alar cartilage and supported by interdomal soft tissue padding raised over the domus. It was kept detached, and relocated to the nasal tip and was contained by "pseudoflaps" of the alar cartilages sutured there or covering the columella's structural graft. Thirty-six patients underwent surgery using this technique. Results: Thirty-five had good results and one had a nasal tip abscess, caused by endonasal exposure to a non-absorbable suture, which was removed. A second intervention was then performed using a new auricular graft, but the result was still unsatisfactory. The "pseudoflaps" method is relatively simple for those performing nasal surgery. Conclusion: The nasal tip can be projected discretely using the excess of alar cartilage "pedicled" in the domus.

Tre frammenti di una stele di marmo rinvenuti nei pressi del tempio di Zeus a Olimpia; ricomposti e integrati da K. Purgold nel 1881 grazie alla Periegesi di Pausania (5.10.4). Si tratta di un’iscrizione di sei linee: le prime quattro, riportate da Pausania, costituiscono un epigramma di due distici elegiaci relativo a uno scudo di bronzo dorato posizionato sul frontone orientale del tempio di Zeus e dedicato dagli Spartani per la vittoria riportata a Tanagra nel 457 a.C. sugli Ateniesi e i loro alleati. Le ultime due linee, non presenti nella Periegesi, dovevano essere in prosa, e probabilmente contenevano una lista degli alleati spartani. L’iscrizione utilizza l’alfabeto arcaico di Corinto, come dimostrano il segno complementare X nel valore di chi, il delta e il dittongo ου, ma un alfabeto che nel V secolo a.C. si sta evolvendo: da notare infatti epsilon e iota classiche, non più notate rispettivamente con B e sigma a tre o quattro tratti.

The impact of climate change on stratification and mixing patterns has important effects on nutrient availability and plankton dynamics in deep lakes. We demonstrate this in a long-term study of Lake Maggiore, a deep oligomictic lake located in the subalpine lake district in Northern Italy. Studies on physical, chemical and biological features of the lake have been performed continuously since the 1980s. The lake recovered from eutrophication in response to a reduction of catchment nutrient loads and reached a stable oligotrophic status by the end of the 1990s, with average total phosphorus concentrations in the water column around 10 µg L-1. However, both reactive and total phosphorus have slightly increased since 2010, leading to a shift in the lake trophic state towards mesotrophy. The increase in phosphorus has been limited to the hypolimnetic layers, concentrations being fairly stable or decreasing in the epilimnion. Reactive silica also progressively increased in the hypolimnion, while nitrate and total nitrogen concentrations have steadily decreased in both deep and surface layers, especially in the summer period. These changes were assessed in relation to catchment loads, atmospheric deposition and climate-related variations in stratification and mixing patterns and in nutrient retention. Long-term changes in primary production, represented by chlorophyll levels, and biovolume of the main algal groups were also considered. During the eutrophication period and until the 1990s, in-lake phosphorus concentrations were tightly related to external loads; successively, phosphorus and its vertical distribution up the water column became more controlled by internal processes, in particular by stratification and mixing regime. An increase of thermal stability and a reduced frequency and intensity of deep mixing events has fostered oxygen depletion and phosphorus and silica accumulation in the hypolimnion. Another consequence of reduced deep mixing events, has been a reduction in nutrient replenishment of the upper layers at spring mixing. External loads are still the main driver of change for nitrogen compounds: the decrease in the atmospheric load of nitrogen that occurred in the Lake Maggiore area over the last decade, as an effect of reduced nitrogen emissions, has caused decreasing concentration of inorganic nitrogen in the lake. However, the phytoplankton community changes observed might also play a role in nitrogen dynamics, particularly in the nitrate minima observed during summer in recent years.

Purpose: Problem-based learning (PBL) provides an appropriate instructional strategy to engage a student in active learning, enhance student interest, improve retention, and promote problem-solving and critical thinking skills. This study aims to report on student and faculty experiences in a problem-based learning course consisting of a preparation phase and a reporting phase during the COVID-19 lockdown and present potential implications for online PBL course design. Study design/methodology/approach: A survey was conducted to compare the two instructional PBL settings, i.e. face-to-face and online. Descriptive statistics as well as a general inductive approach for analysing the qualitative data are used to evaluate the results of the survey. Findings: The results show that students appreciated the new small group discussion format in the online PBL course over the whole class discussion in the face-to-face setting and that an online PBL course can help students integrate knowledge and promote the deep learning approach. Originality/value: The study contributes to PBL research by examining student and faculty experiences in a case-based PBL course. A new instructional online PBL course design is presented, with the main change in the reporting phase. The study shows that the shift from a physical to an online setting has no detectable negative impact on the ability of students to achieve set learning goals if the PBL approach is slightly modified. https://www.doi.org/10.53615/2232-5697.10.21-30

A high frequency monitoring (HFM) system for the deep subalpine lakes Maggiore, Lugano and Como is under development within the EU INTERREG project SIMILE. The HFM system is designed to i) describe often neglected but potentially relevant processes occurring on short time scale; ii) become a cost-effective source of environmental data; and iii) strengthen the coordinated management of water resources in the subalpine lake district. In this project framework, a first HFM station (LM1) consisting of a monitoring buoy was placed in Lake Maggiore. LM1 represents a pilot experience within the project, aimed at providing the practical know-how needed for the development of the whole HFM system. To increase replicability and transferability, LM1 was developed in-house, and conceived as a low-cost modular system. LM1 is presently equipped with solar panels, a weather station, and sensors for water temperature, pH, dissolved oxygen, conductivity, and chlorophyll-a. In this study, we describe the main features of LM1 (hardware and software) and the adopted Quality Assurance/Quality Control (QA/QC) procedures. To this end, we provide examples from a test period, i.e., the first 9-months of functioning of LM1. A description of the software selected as data management software for the HFM system (IstSOS) is also provided. Data gathered during the study period provided clear evidence that coupling HFM and discrete sampling for QA/QC controls is necessary to produce accurate data and to detect and correct errors, mainly because of sensor fouling and calibration drift. These results also provide essential information to develop further the HFM system and shared protocols adapted to the local environmental (i.e., large subalpine lakes) and technical (expertise availability) context. Next challenge is making HFM not only a source of previously unaffordable information, but also a cost-effective tool for environmental monitoring.

Learning often involves multiple exposures and trials, but it is not known whether those are treated independently, or integrated during dedicated time windows. Here, Chowdhury and Caroni show mice learn new associations during 5 h time windows, where related experiences are integrated in a process requiring coordinated cFos-activated neuronal assemblies.

Prelimbic (PL) and infralimbic (IL) cortical areas are known to have complementary roles in learning and decision making. Here the authors report reciprocal connectivity between the two areas and elucidate their functional impact on different aspects of learning.

INTRODUCTION: Studies recommend reducing the size of the scar on mammoplasties to the smallest possible, using L-scars as one of the techniques. However, its use is limited based on the resections of excess skin because of mammary ptosis. The objective of this study is to determine the limitations of L-mammoplasty. METHODS: To describe the process of breast implantation, mammary lines are used to guide the mammoplasty to achieve anatomically perfect and beautiful breasts. This classifies as "aesthetic pathologies" with quantification of ptosis in centimeters and the limitations being considered in choosing the surgical technique. The proposed classification was used to reduce and model the hypertrophic and ptotic breasts. The suturing maneuvers involved a "semicolon" incision from the lateral side of the submammary groove to the medial and then upward toward point A, terminating in vertical suture, VY, or "areolar circular compensation bag," depending on the excess skin in the periareolar region. This maneuver reduces the extension of the horizontal scar to the maximum of AM plus 2 cm. RESULTS: When mammary ptosis was less than 7 cm, the results were of good quality, without significant residual ptosis and distortion of the areola, achieving a cone shape. CONCLUSION: L-mammoplasty is a good technique, but it should be limited to cases with AM flaccidness below 7 cm and good skin quality.

The development of axonal arbors is a critical step in the establishment of precise neural circuits, but relatively little is known about the mechanisms of axonal elaboration in the neocortex. We used in vivo two-photon time-lapse microscopy to image axons in the neocortex of green fluorescent protein-transgenic mice over the first 3 wk of postnatal development. This period spans the elaboration of thalamocortical (TC) and Cajal-Retzius (CR) axons and cortical synaptogenesis. Layer 1 collaterals of TC and CR axons were imaged repeatedly over time scales ranging from minutes up to days, and their growth and pruning were analyzed. The structure and dynamics of TC and CR axons differed profoundly. Branches of TC axons terminated in small, bulbous growth cones, while CR axon branch tips had large growth cones with numerous long filopodia. TC axons grew rapidly in straight paths, with frequent interstitial branch additions, while CR axons grew more slowly along tortuous paths. For both types of axon, new branches appeared at interstitial sites along the axon shaft and did not involve growth cone splitting. Pruning occurred via retraction of small axon branches (tens of microns, at both CR and TC axons) or degeneration of large portions of the arbor (hundreds of microns, for TC axons only). The balance between growth and retraction favored overall growth, but only by a slight margin. Given the identical layer 1 territory upon which CR and TC axons grow, the differences in their structure and dynamics likely reflect distinct intrinsic growth programs for axons of long projection neurons versus local interneurons.

Climate change has increased the temperature and altered the mixing regime of high-value lakes in the subalpine region of Northern Italy. Remote sensing of chlorophyll-a can help provide a time series to allow an assessment of the ecological implications of this. Non-parametric multiplicative regression (NPMR) was used to visualize and understand the changes that have occurred between 2003–2018 in Lakes Garda, Como, Iseo, and Maggiore. In all four deep subalpine lakes, there has been a disruption from a traditional pattern of a significant spring chlorophyll-a peak followed by a clear water phase and summer/autumn peaks. This was replaced after 2010–2012, with lower spring peaks and a tendency for annual maxima to occur in summer. There was a tendency for this switch to be interspersed by a two-year period of low chlorophyll-a. Variables that were significant in NPMR included time, air temperature, total phosphorus, winter temperature, and winter values for the North Atlantic Oscillation. The change from spring to summer chlorophyll-a maxima, relatively sudden in an ecological context, could be interpreted as a regime shift. The cause was probably cascading effects from increased winter temperatures, reduced winter mixing, and altered nutrient dynamics. Future trends will depend on climate change and inter-decadal climate drivers.

The superformula generates curves called Gielis curves, which depend on a small number of input parameters. Recovering parameters generating a curve that adapts to a set of points is a non-trivial task, thus methods to accomplish it are still being developed. These curves can represent a great variety of forms, such as living organisms, objects and geometric shapes. In this work we propose a method that uses a genetic algorithm to minimize a combination of three objectives functions: Euclidean distances from the sample points to the curve, from the curve to the sample points and the curve length. Curves generated with the parameters obtained by this method adjust better to real curves in relation to the state of art, according to observational and numeric comparisons.

Greek engineering Schools have a high status and attract good students. However, we show that in the leading institution, the National Technical University of Athens, only 27% of the students admitted in 1992-2003 graduated after the nominal five years study: the median graduation time was 73 months (reaching 93 months in one School) and 12% are predicted never to graduate at all, most without withdrawing officially. Results differ between Schools, between routes of admission and by gender (females being better than males). Systematic study of reasons for not completing or delay in completing studies is urgently needed. Overall, 4% of the students withdraw officially during their first year. The percentage of withdrawals by School is negatively correlated with the percentage that gave that School as first choice in the entrance procedure, indicating problems in the admission system. (Contains 4 figures and 2 tables.)

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Zooplankton is crucial for the transfer of matter, energy, and pollutants through aquatic food webs. Primary and secondary consumers contribute to the abundance and standing stock biomass, which both vary seasonally. By means of taxa- and size-specific carbon and nitrogen stable isotope analysis, the path of pollutants through zooplankton is traced and seasonal changes are addressed, in an effort to understand pollutant dynamics in the pelagic food web. We analyzed zooplankton plurennial changes in concentration of polychlorinated biphenyls (PCBs) and dichlorodiphenyltrichloroethane and its relatives (DDTs) and in taxa-specific δ15N signatures in two size fractions, ≥450 µm and ≥850 µm, representative of the major part of zooplankton standing stock biomass and of the fraction to which fish predation is mainly directed, respectively. Our work is aimed at verifying: (1) A link between nitrogen isotopic signatures and pollutant concentrations; (2) the predominance of size versus seasonality for concentration of pollutants; and (3) the contribution of secondary versus primary consumers to carbon and nitrogen isotopic signatures. We found a prevalence of seasonality versus size in pollutant concentrations and isotopic signatures. The taxa-specific δ15N results correlated to pollutant concentrations, by means of taxa contribution to standing stock biomass and δ15N isotopic signatures. This is a step forward to understanding the taxa-specific role in pollutant transfer to planktivores and of zooplankton enrichment in PCBs and DDTs.

The generalised extreme value (GEV) distribution is often fitted to environmental time series of extreme values such as annual maxima and minima of temperatures. It is often necessary to allow the distribution’s parameters to depend on time or other covariates (non-stationary GEV). Increasingly, model fitting within the GAMLSS framework is being used as an alternative approach. A case study is presented of temperature extremes in a mountainous area of Greece divided into nine zones by altitude. Model fitting supported non-stationary GEV models for temperature with the location parameter depending linearly on year and zone, showing the expected dependence on altitude along with an increasing trend in annual maxima and declining trend in annual minima. The scale parameter for maxima depended on zone, with greater variability at higher altitudes. The scale parameter for minima increased over time. Fitting non-stationary Inverse Gaussian, Lognormal and Gamma distributions within the GAMLSS framework identified the same dependence on zone and year. There was little difference in goodness of fit of the various distributions.

Objective: To determine the prevalence of resistant strains of Staphylococcus aureus (S. aureus) isolated from Skin and soft tissue infections (SSTI) to various antibiotics. Material and Methods: All culture-positive results for S. aureus from swabs taken from patients presenting at one Greek hospital with a skin infection between the years 2010–2015 were examined retrospectively. Bacterial cultures, identification of S. aureus and antimicrobial susceptibility testing were performed using the disk diffusion method according to Clinical and Laboratory Standards Institute (CLSI) guidelines and European Committee on Antimicrobial testing (EUCAST) breakpoints. EUCAST breakpoints were applied if no CLSI were available. Results: Of 2069 S. aureus isolates identified, 1845 (88%) were resistant to one or more antibiotics. The highest resistance was observed for benzylpenicillin (71.9%), followed by erythromycin (34.3%). Resistant strains to cefoxitin defined as MRSA (methicillin-resistant S. aureus) represented 21% of total isolates. Interestingly, resistance to fusidic acid was 22.9% and to mupirocin as high as 12.7%. Low rates were observed for minocycline, rifampicin and trimethoprim/sulfamethoxazole (SXT). Resistance to antibiotics remained relatively stable throughout the six-year period, with the exception of cefoxitin, fusidic acid and SXT. A high percentage of MRSA strains were resistant to erythromycin (60%), fusidic acid (46%), clindamycin (38%) and tetracycline (35.5%). Conclusions: Special attention is required in prescribing appropriate antibiotic therapeutic regimens, particularly for MRSA. These data on the susceptibility of S. aureus may be useful for guiding antibiotic treatment.