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This article argues that it is only possible to teach without dread today if one does not value academic freedom. For these people, it is perfectly acceptable to be told what course they will teach, the content of those courses, and the modality of instruction. If one does not care about such things, then neoliberal academe with regard to teaching is not a house of dread. But for those who do not want to be told how to teach their course; who want to have a strong role in the shape of the curriculum; who want the ability to choose their preferred modality of instruction; and want to have a reasonable amount of choice in what they teach; for these people, higher education today has become and is a house of teaching dread. The persistence of teaching under such conditions can only be explained by an increase in neurotic dread in academe.

The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colon-Proctologia, SIUCP) on the diagnosis and management of hemorrhoidal disease, with the goal of guiding physicians in the choice of the best treatment option. A panel of experts was charged by the Board of the SIUCP to develop key questions on the main topics related to the management of hemorrhoidal disease and to perform an accurate and comprehensive literature search on each topic, in order to provide evidence-based answers to the questions and to summarize them in statements. All the clinical questions were discussed by the expert panel in multiple rounds through the Delphi approach and, for each statement, a consensus among the experts was reached. The questions were created according to PICO (patients, intervention, comparison, and outcomes) criteria, and the statements were developed adopting the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) methodology. In cases of grade 1 hemorrhoidal prolapse, outpatient procedures including hemorrhoidal laser procedure and sclerotherapy may be considered the preferred surgical options. For grade 2 prolapse, nonexcisional procedures including outpatient treatments, hemorrhoidal artery ligation and mucopexy, laser hemorrhoidoplasty, the Rafaelo procedure, and stapled hemorrhoidopexy may represent the first-line treatment options, whereas excisional surgery may be considered in selected cases. In cases of grades 3 and 4, stapled hemorrhoidopexy and hemorrhoidectomy may represent the most effective procedures, even if, in the expert panel opinion, stapled hemorrhoidopexy represents the gold-standard treatment for grade 3 hemorrhoidal prolapse.

Abstract The development of advanced diabetes technology has permitted persons with type 1 diabetes mellitus to improve metabolic control significantly, particularly with the development of advanced hybrid closed-loop systems which have improved the quality of life by reducing hypoglycemia, decreasing macroangiopathy and microangiopathy-related complications, ameliorating HbA1c and improving glycemic variability. Despite the progression made over the past few decades, there is still significant margin for improvement to be made in terms of attaining appropriate metabolic control. Various factors are responsible for poor glycemic control including inappropriate carbohydrate counting, repeated bouts of hypoglycemia, hypoglycemia unawareness, cutaneous manifestations due to localized insulin use and prolonged use of diabetes technology, psychosocial comorbidities such as eating disorders or ‘diabulimia’, the coexistence of insulin resistance among people with type 1 diabetes and the inability to mirror physiological endogenous pancreatic insulin secretion appropriately. Hence, the aim of this review is to highlight and overcome the barriers in attaining appropriate metabolic control among people with type 1 diabetes by driving research into adjunctive treatment for coexistent insulin resistance and developing new advanced diabetic technologies to preserve β cell function and mirror as much as possible endogenous pancreatic functions.

El Problema de la Adopción (AP) de reglas de inferencia fue un asunto postergado durante algunos años (Kripke, 2024; Padró, 2015; Birman, 2024). Este problema pone el acento en ciertas dificultades alrededor de la adopción ¿Si el antiexcepcionalismo es incorrecto, es posible adoptar una lógica alternativa? ¿Qué sentido tiene la revisión en epistemología de la lógica? Durante 2022 Kripke, Padró y Barrio realizaron seminarios sobre AP. Los últimos dos editaron la primera sección temática sobre este asunto en la revista Análisis Filosófico. Esta contiene el artículo “What the Adoption Problem Does Not Show” de Camilo Fiore, objeto de la presente nota crítica. Fiore sostiene dos tesis y una relación entre ellas: 1) AP es compatible con la tesis según la cual la logica utens es revisable; 2) para evaluar si un agente puede revisar su lógica, es mejor considerar una definición diferente, e.g. adopción débil, según el cual la Instanciación Universal y el Modus Ponens son a veces adoptables. Luego afirma que (1) y (2) son independientes. En este artículo criticaré la independencia entre (1) y (2). Para ello, señalaré que la tesis (1) y (2) se sostienen con los ejemplos de Carrie y Barry, respectivamente, y que el tipo de revisión lógica involucrada en ambos es el mismo y es local. Por ello, (1) y (2) no son independientes. Luego, sostengo que es imposible satisfacer otro tipo de revisión lógica, e.g. revisión global. Por ello, la interdependencia entre (1) y (2) no se debe a los ejemplos propuestos.

Abstract Background Mitochondrial diseases (MDs) are systemic disorders that can affect multiple organs. Renal manifestations, including renal tubular acidosis, are common because kidneys are particularly vulnerable to energy deprivation. Treatment of MDs is often complex and electrolyte replacement can be difficult especially in pediatric patients, because large and repeated amounts of oral supplements are needed but are not well tolerated. Case presentation We describe the case of a girl affected by Kearns-Sayre disease with severe renal tubular acidosis. The management of her metabolic acidosis was challenging because she showed persistent low levels of serum bicarbonates despite a progressive incrementation of oral bicarbonates. Furthermore, as a result to the ingestion of large amounts of alkali, the girl developed an aversion to oral supplementation. After positioning a percutaneous gastrostomy (PEG) and starting enteral administration of bicarbonates (with daily boluses and continuous nocturnal infusion), she finally obtained an adequate electrolyte control, with a significant increase in her quality of life. Conclusions In MDs, the combination of nocturnal continuous enteral administration of alkali plus diurnal boluses may represent a valid solution to correct metabolic acidosis. It can also result in an improved patients’ quality of life, particularly in pediatric settings, where compliance to oral therapy is often lacking due to the large and repeated amounts of unpalatable bicarbonates solutions required.

Abstract Waste management is crucial for advancing the circular economy, and Italy has begun to address this issue by organizing municipalities into collaborative communities of municipalities, named ATOs. In this paper, we propose a quantitative approach based on conditional efficiency analysis to estimate viable eco-efficiency targets for these waste collection communities. The proposed targets are both eco-efficient, because they reflect optimal resource allocation within the eco-efficiency framework, and viable, because they consider the unique specificities of each waste community. The methodology determines a pathway or direction for municipalities to reach the eco-efficiency frontier based on specific external factors, ensuring that each municipality is benchmarked against others with similar contexts within the same community. Our analysis focuses on 89 Italian municipalities within the ATO “Città metropolitana di Roma Capitale” in 2021, revealing that size and economic development significantly contributed to viable eco-efficiency within the community during this period. The proposed approach is general and flexible and can be applied to other municipalities in Italy or across Europe. It can also be extended to meso (regional) or macro (country) levels of analysis.

This work proposes a framework for Earth Observation (EO) cloud platforms to carry out a self-assessment from a user experience perspective. The study outlines the methodological approach used to develop the framework, including the classification of existing EO platforms through a literature review of EU-funded projects. Additionally, a survey on user experience was conducted to further inform the design of the framework. We consider as target users the developers of policy-relevant use cases. The final phase of the methodology identifies user requirements across ten dimensions within the EO value chain and suggests a range of indicators to facilitate self-assessment. The paper emphasises the need to address the identified challenges and limitations to improve the usability and user satisfaction of existing EO cloud platforms. It also highlights the importance of principles such as FAIR (findability, accessibility, interoperability, and reusability) and TRUST (transparency, responsibility, user focus, sustainability and technology), open source components, and Open Geospatial Consortium (OGC) standards in shaping the future of EO data platforms and infrastructures.

The unsustainable use of natural resources, in particular soil degradation and pollution, is one of the main factors contributing to the climate and biodiversity crisis. The European Union has outlined a new European Green Deal, whose objectives include increasing the overall quality of the agri-food chain in relation to environmental sustainability, focusing on reducing the use of pesticides and increasing the share of organic in overall production. A Nexus thinking perspective is applied to analyse this topic over a 50-year time horizon (2010–2060) for the agricultural system of the Basilicata Region (Southern Italy), represented by the TIMES Land-WEF, an optimizing, bottom-up energy-technology model, built to investigate the interactions and interrelations between water, energy food and land. The novelty of this modelling approach is the choice of land use as the guiding parameter of the optimization process. The main objectives of the Farm to Fork Strategy are modelled as system constraints and the scenario analysis allows to characterise their effects on the evolution of the agricultural system over the examined time. The results show that the pesticide reduction constraint leads to an increase in land use by organic crops from 24.6 % to 32.4 % in 2060. In particular, this is due to the increased contribution of cereal, forage, olive growing crops, permanent meadows and pastures, which lead to a 46 % reduction in irrigation water consumption. On the other hand, the reduction in inorganic fertilizers is not accompanied by a significant increase in organic crops, but resulted in the reduction of cereal crops.

Musculoskeletal modeling is a powerful tool to quantify biomechanical factors typically not feasible to measure in vivo, such as hip contact forces and deep muscle activations. While technological advancements in musculoskeletal modeling have increased accessibility, selecting the appropriate modeling approach for a specific research question, particularly when investigating pathological populations, has become more challenging. The purposes of this review were to summarize current modeling and simulation methods in structural hip disorder research, as well as evaluate model validation and study reproducibility. MEDLINE and Web of Science were searched to identify literature relating to the use of musculoskeletal models to investigate structural hip disorders (i.e., involving a bony abnormality of the pelvis, femur, or both). Forty-seven articles were included for analysis, which either compared multiple modeling methods or applied a single modeling workflow to answer a research question. Findings from studies comparing methods were summarized, such as the effect of generic versus patient-specific modeling techniques on model-estimated hip contact forces or muscle forces. The review also discussed limitations in validation practices, as only 11 of the included studies conducted a validation and used qualitative approaches only. Given the lack of information related to model validation, additional details regarding the development and validation of generic models were retrieved from references and modeling software documentation. To address the wide variability and under-reporting of data collection, data processing, and modeling methods highlighted in this review, we developed a template that researchers can complete and include as a table within the methodology section of their manuscripts. The use of this table will help increase transparency and reporting of essential details related to reproducibility and methods without being limited by word count restrictions. Overall, this review provides a comprehensive synthesis of modeling approaches that can help researchers make modeling decisions and evaluate existing literature.

Book Review

La relación entre las características del paisaje y los servicios ecosistémicos se modifica por los procesos de urbanización y es un desafío valorar esos cambios en el tiempo y en espacio. En este trabajo se desarrolló un trayecto metodológico para evaluar los servicios ecosistémicos hídricos que son capaces de proveer diferentes unidades de paisaje con distinto grado de urbanización en un sector del sur de la provincia de Santa Fe. Se definieron siete unidades de paisaje por sus diferencias en las estructuras fisiográficas y funcionalidad sistémica y se determinaron sus capacidades para brindar esos servicios. Se vincularon las capacidades con la proporción de superficie urbanizada de cada una de ellas para determinar cuáles están en mejores condiciones para proveerlos. El vínculo entre paisaje-urbanización-servicios ecosistémicos hídricos define un eje de intervención en el territorio insoslayable al momento de diseñar el ordenamiento territorial ambiental, promoviendo la consideración de las capacidades de los bienes naturales comunes para sostener la vida humana.

The European Commission (EC), being the co-lead of the European Regional Group on Earth Observations (EuroGEO), is currently outlining an ecosystem that will interconnect European technologies, digital infrastructures and data and enable the implementation of policy-relevant use cases using shared standards. This ecosystem will in turn strengthen Europe’s contribution to GEOSS, which is the Global Earth Observation System of Systems. To evaluate and demonstrate the potential of this ecosystem, prioritization of use cases is necessary. This work presents a methodology for this prioritization, taking into consideration policy relevance, data and digital infrastructures and adherence to European approaches, principles and values. This methodology can also be used for identifying noteworthy research projects in the Earth observation (EO) domain that possess policy relevance and have the potential to be transformed into sustained and operational services beyond the funding period, focusing on research projects funded by Horizon 2020 (H2020) and Horizon Europe EU Framework Programmes for Research and Innovation. We applied this methodology to an H2020 project named “EuroGEO Showcases: Applications Powered by Europe (e-shape)”, composed of 37 pilots, and here we present the results. This process led to the identification of a priority pilot on solar energy potential assessment in urban areas, for which EC Knowledge Centre on Earth Observation (KCEO) will participate in co-design activities with ARMINES, the leader of this pilot. We finally present the pilot shortly and elaborate on the next steps.

Background: Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease worldwide. One way to resolve this reversible condition is by making dietary changes. Extra virgin olive oil (EVOO) is often associated with an improvement in this disease. The aim of this study was to explore the protective role of EVOO on NAFLD conditions, stratified by gender. Methods: The study cohort included 1426 participants assessed in the second recall of the NUTRIHEP cohort (2014–2018), subdivided by gender and dividing the EVOO intake into quartiles of daily gram intake. Results: The results indicated a protective role of the last quartile of EVOO only for female subjects, OR = 0.43, p = 0.02, 0.21 to 0.85 at 95% C.I., whereas in the male sub-cohort, the effect was not statistically significant. Conclusions: The protective role of EVOO is different between genders. This difference has not been explored in the literature, so we conclude that this is one of the few papers in the literature to evaluate a gender difference in the intestinal absorption of humans based on an epidemiological study.

Intestinal anti-endomysium antibodies are a specific marker of celiac disease. The diagnostic accuracy of this marker seems high in pediatric patients and has not yet been investigated in adults, so the aim of this prospective multicentric study was to evaluate the specificity and sensitivity of this marker in childhood and adulthood. Pediatric and adult patients undergoing intestinal endoscopy for any intestinal condition were enrolled. Serological celiac disease markers and HLA type were evaluated in all patients. Intestinal biopsies were analyzed for standard histology and for intestinal anti-endomysium antibodies with biopsy culture assay. In this study, 291 patients (145 adults and 146 children) were included. In the adult population, 34 were diagnosed with celiac disease, 105 were controls, and, in 6, celiac disease was not confirmed. In the pediatric population, 77 were diagnosed with celiac disease, 57 were controls, and, in 12, celiac disease was not confirmed. High diagnostic sensitivity and specificity of intestinal anti-endomysium antibodies were confirmed in children and additionally proven in adults. To conclude, we can affirm that intestinal anti-endomysium antibodies can be detected with high diagnostic accuracy in both children and adults. The implementation of this marker in the diagnostic work-up would help clinicians to correctly identify celiac disease.

Abstract Contemporary students increasingly benefit from non‐hierarchical education, including peer‐led work, which moves beyond more ridged traditional educational structures. Such approaches encourage engagement, two‐way communication, diversity of thought and collaboration. This piece shares the stories and experiences of students with a shared interest in health promotion and lifestyle medicine who took part in a peer‐led, internationally based online student group. The forum aimed to provide a space for students to explore and discuss diverse topics within the health sphere in an attempt to bridge the gap between areas of expertise and education. The group capitalised on the normalisation of remote video meetings following the COVID‐19 pandemic to bring together a small group of diverse students from across the globe on a weekly basis for journal clubs, presentations, debates and guest lectures. Group member feedback was obtained and highlighted key gaps in much traditional education, which the group addressed. These included moving beyond educational and research silos, the importance of preventative health approaches and the need for more judgement‐free and inclusive learning environments. Alignment with the current health landscape and potential for scaling the group format more widely is discussed. The article concludes by emphasising the advantages of this approach in fostering a network of learners prepared to tackle future health challenges.

BackgroundCancer is a life-threatening disease that triggers not only vulnerability to distressing symptoms but also a meaning-making process that may lead to post-traumatic growth. As people often struggle to integrate cancer illness into their meaning system to reach an adaptive meaning, psychological interventions focused on a reappraisal of the illness experience can facilitate this process. This multicenter randomized controlled trial (RCT) was primarily aimed at assessing the efficacy of a writing intervention known as a guided disclosure protocol (GDP), compared to a generic writing intervention, in promoting post-traumatic growth in stage I-III breast and colon cancer patients at the end of their adjuvant chemotherapy.MethodsBetween January 2016 and August 2020 recruitment of eligible subjects took place during follow-up clinical consultations. Assessment occurred at baseline (T0), after the intervention (T1, 3 months from baseline), and at 6 months from baseline (T2). Both interventions consisted of three 20-min writing sessions to be performed once every two weeks. Change in post-traumatic growth was assessed using the Posttraumatic Growth Inventory, meaning with the Constructed Meaning Scale, and psychological distress with the Impact of Event Scale and the Hospital Anxiety and Depression Scale.ResultsIn the five participating centers, 102 eligible patients were randomized and 72 participants completed follow-up evaluation. Most patients were women (79.4%), had breast cancer (68.6%), and stage I (27.5%), or stage II (44.1%) disease. Mean differences did not reach statistical significance for any of the dependent variables. However, an effect of the GDP, although not statistically relevant, was observed after the intervention in terms of enhanced post-traumatic growth and increased distress measured with the Impact of Event Scale.ConclusionThis is the first RCT investigating the efficacy of a GDP in cancer patients having post-traumatic growth as the primary aim. Though GDP is a promising intervention in promoting post-traumatic growth, the lack of statistical significance of our findings may be due to the study being underpowered, hence this trial should be replicated with an adequate sample size, paying attention to supporting recruitment.Clinical trial registration: ClinicalTrials.gov, identifier: 2015/0024360.

PurposeDiastasis of rectus abdominis (DRA) refers to a separation of the rectus abdominis from the linea alba, which is common in the female population during pregnancy and in the postpartum period. The present study aimed at investigating DRA severity, risk factors and associated disorders.MethodsIn the present cross-sectional study, a web-based questionnaire was addressed to the 23,000 members of the Women's Diastasis Association. The questionnaire comprised three parts, dedicated respectively to diastasis characteristics, possible risk factors, and related disorders. Faecal and urinary incontinences were assessed using the Wexner and ICIQ-SF score, respectively. Risk factors for diastasis severity (5 cm) were evaluated by a multinomial regression model.ResultsFour thousand six hundred twenty-nine women with a mean age (SD) of 39.8 (6.5) years and a median BMI of 23.7 kg/m2 (range 16.0–40.0) responded to the questionnaire. Proportion of DRA >5 cm increased from 22.8% in norm weight women to 44.0% in severely obese women, and from 10.0% in nulliparous women to 39.3% in women with >3 pregnancies. These associations were confirmed in multivariable analysis. DRA severity was associated with the risk of abdominal hernia and pelvic prolapse, whose prevalence more than doubled from women with DRA 5 cm (68.2% and 20.2%). In addition, most patients reported postural pain and urinary incontinence, whose frequency increased with DRA severity.ConclusionThe present study confirmed that DRA severity increases with increasing BMI and number of pregnancies. Larger separation between rectal muscles was associated with increased risk of pain/discomfort, urinary incontinence, abdominal hernia and pelvic prolapse. Prospective studies are needed to better evaluate risk factors.

This study addressed the scarcity of NH3 measurements in urban Europe and the diverse monitoring protocols, hindering direct data comparison. Sixty-nine datasets from Finland, France, Italy, Spain, and the UK across various site types, including industrial (IND, 8), traffic (TR, 12), urban (UB, 22), suburban (SUB, 12), and regional background (RB, 15), are analyzed to this study. Among these, 26 sites provided 5, or more, years of data for time series analysis. Despite varied protocols, necessitating future harmonization, the average NH3 concentration across sites reached 8.0 ± 8.9 μg/m3. Excluding farming/agricultural hotspots (FAHs), IND and TR sites had the highest concentrations (4.7 ± 3.2 and 4.5 ± 1.0 μg/m3), followed by UB, SUB, and RB sites (3.3 ± 1.5, 2.7 ± 1.3, and 1.0 ± 0.3 μg/m3, respectively) indicating that industrial, traffic, and other urban sources were primary contributors to NH3 outside FAH regions. When referring exclusively to the FAHs, concentrations ranged from 10.0 ± 2.3 to 15.6 ± 17.2 μg/m3, with the highest concentrations being reached in RB sites close to the farming and agricultural sources, and that, on average for FAHs there is a decreasing NH3 concentration gradient towards the city. Time trends showed that over half of the sites (18/26) observed statistically significant trends. Approximately 50 % of UB and TR sites showed a decreasing trend, while 30 % an increasing one. Meta-analysis revealed a small insignificant decreasing trend for non-FAH RB sites. In FAHs, there was a significant upward trend at a rate of 3.51[0.45,6.57]%/yr. Seasonal patterns of NH3 concentrations varied, with urban areas experiencing fluctuations influenced by surrounding emissions, particularly in FAHs. Diel variation showed differing patterns at urban monitoring sites, all with higher daytime concentrations, but with variations in peak times depending on major emission sources and meteorological patterns. These results offer valuable insights into the spatio-temporal patterns of gas-phase NH3 concentrations in urban Europe, contributing to future efforts in benchmarking NH3 pollution control in urban areas.

Abstract Introduction The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (SIUCP: Società Italiana Unitaria di Colon-Proctologia) on the diagnosis and management of anal fissure, with the purpose to guide every physician in the choice of the best treatment option, according with the available literature. Methods A panel of experts was designed and charged by the Board of the SIUCP to develop key-questions on the main topics covering the management of anal fissure and to performe an accurate search on each topic in different databanks, in order to provide evidence-based answers to the questions and to summarize them in statements. All the clinical questions were discussed by the expert panel in different rounds through the Delphi approach and, for each statement, a consensus among the experts was reached. The questions were created according to the PICO criteria, and the statements developed adopting the GRADE methodology. Conclusions In patients with acute anal fissure the medical therapy with dietary and behavioral norms is indicated. In the chronic phase of disease, the conservative treatment with topical 0.3% nifedipine plus 1.5% lidocaine or nitrates may represent the first-line therapy, eventually associated with ointments with film-forming, anti-inflammatory and healing properties such as Propionibacterium extract gel. In case of first-line treatment failure, the surgical strategy (internal sphincterotomy or fissurectomy with flap), may be guided by the clinical findings, eventually supported by endoanal ultrasound and anal manometry.

Stem and progenitor cells have been observed to contribute to regenerative processes in acute renal failure and chronic kidney disease. Recent research has delved into the intricate mechanisms by which stem and progenitor cells exert their influence on kidney diseases. Understanding how these cells integrate with the existing renal architecture and their response to injury could pave the way for innovative treatment strategies aimed at promoting kidney repair and regeneration. Overall, the role of stem and progenitor cells in kidney diseases is multifaceted, with their ability to contribute to tissue regeneration, immune modulation, and the maintenance of renal homeostasis. Here, we review the studies that we have available today about the involvement of stem and progenitor cells both in regenerative therapies and in the causes of renal diseases, as well as in natural healing mechanisms, taking into account the main kidney disorders, such as IgA nephropathy, lupus nephritis, diabetic nephropathy, C3 glomerulopathy, focal segmental glomerulosclerosis, idiopathic membranous nephropathy, anti-glomerular basement membrane glomerulonephritis, and ANCA-associated crescentic glomerulonephritis. Moreover, based on the comprehensive data available in the framework of the specific kidney diseases on stem cells and renal progenitors, we hypothesize a possible role of adult renal progenitors in exacerbating or recovering the illness.