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Two types of variability are discernible in the ocean: a response to the atmospheric forcing and the so-called internal/intrinsic ocean variability, which is associated with internal instabilities, nonlinearities, and the interactions between processes at different scales. Producing an ensemble of 20 multiyear ocean simulations of the Mediterranean Sea, initialized with different realistic initial conditions but using the same atmospheric forcing, the study examines the intrinsic variability in terms of its spatial distribution and seasonality. In general, the importance of the external forcing decreases with depth but dominates in extended shelves such as the Adriatic Sea and the Gulf of Gabes. In the case of temperature, the atmospheric forcing plays a major role in the uppermost 50 m of the water column during summer and the uppermost 100 m during winter. Additionally, intrinsic variability displays a distinct seasonal cycle in the surface layers, with a prominent maximum at around 30 m depth during the summer connected to the summer thermocline formation processes. Concerning current velocity, the internal variability has a significant influence at all depths.

Background: Standardized methods for reporting surgical quality have been described for all the major urological procedures apart from radical nephroureterectomy (RNU). Objective: To propose a tetrafecta criterion for assessing the quality of RNU based on a consensus panel within the Young Association of Urology (YAU) Urothelial Group, and to test the impact of this tetrafecta in a multicenter, large contemporary cohort of patients treated with RNU for upper tract urothelial carcinoma (UTUC). Design, setting, and participants: This was a retrospective analysis of 1765 patients with UTUC treated between 2000 and 2021. Outcome measurements and statistical analysis: We interviewed the YAU Urothelial Group to propose and score a list of items to be included in the “RNU-fecta.” A ranking was generated for the criteria with the highest sum score. These criteria were applied to a large multicenter cohort of patients. Kaplan-Meier curves were built to evaluate differences in overall survival (OS) rates between groups, and a multivariable logistic regression model was used to find the predictors of achieving the RNU tetrafecta. Results and limitations: The criteria with the highest score included three surgical items such as negative soft tissue surgical margins, bladder cuff excision, lymph node dissection according to guideline recommendations, and one oncological item defined by the absence of any recurrence in ≤12 mo. These items formed the RNU tetrafecta. Within a median follow-up of 30 mo, 52.6% of patients achieved the RNU tetrafecta. The 5-yr OS rates were significantly higher for patients achieving tetrafecta than for their counterparts (76% vs 51%). Younger age, lower body mass index, and robotic approach were found to be independent predictors of tetrafecta achievement. Conversely, a higher Eastern Cooperative Oncology Group score, higher clinical stage, and bladder cancer history were inversely associated with tetrafecta. Conclusions: Herein, we present a “tetrafecta” composite endpoint that may serve as a potential tool to assess the overall quality of the RNU procedure. Pending external validation, this tool could allow a comparison between surgical series and may be useful for assessing the learning curve of the procedure as well as for evaluating the impact of new technologies in the field. Patient summary: In this study, a tetrafecta criterion was developed for assessing the surgical quality of radical nephroureterectomy in patients with upper tract urothelial carcinoma. Patients who achieved tetrafecta had higher 5-yr overall survival rates than those who did not.

Introduction: Despite the introduction of robot-assisted surgery in daily clinical practice, complex renal masses are still challenging even for expert surgeon. In this scenario 3D anatomical models and augmented reality represent valuable tools for the surgeon. Materials and methods: We present a challenging case where PN was mandatory to preserve the overall renal function. The patient was 69 years old, with indwelling catheter for BPH and Parkinson disease. After a single episode of hematuria with negative cystoscopy, a cT1N0M0 renal cancer was diagnosed (38 mm maximum diameter). Pre-operative three-dimensional (3D) model was obtained.After multidisciplinary discussion robot-assisted partial nephrectomy was proposed. The surgery was planned according to the anatomical model. Results: Before the procedure a 7Ch single loop ureteral stent was placed. The surgery was carried out in 220 minutes. Selective ischaemia was perfomed for 24 minutes. Estimated blood loss was 400cc. No post-operative complications were observed.Ureteral stent was removed 4 days after the surgery. Definitive histological examination described a pG2-3 T1a Nx R0 clear cell renal carcinoma. Conclusion: In selected cases 3D model result to be a useful tool for the pre-operative planning of the surgery.

Abstract Background Public health organizations have been alerted to the high levels of sedentary behaviour (SB) among adolescents as well as to the health and social consequences of excess sedentary time. However, SB changes of the European Union (EU) adolescents over time have not been reported yet. This study aimed to identify SB of the EU adolescents (15–17 years) in four-time points (2002, 2005, 2013 and 2017) and to analyse the prevalence of SB according to the sex. Methods SB of 2542 adolescents (1335 boys and 1207 girls) as a whole sample and country-by-country was analysed in 2002, 2005, 2013, and 2017 using the Sport and Physical Activity EU Special Eurobarometers’ data. SB was measured using the sitting time question from the short version of the International Physical Activity Questionnaire (IPAQ), such that 4h30min of daily sitting time was the delineating point to determine excess SB behaviour (≥4h30min of sitting time) or not (≤4h30min of sitting time). A χ2 test was used to compare the prevalence of SB between survey years. Furthermore, SB prevalence between sexes was analysed using a Z-Score test for two population proportions. Results The prevalence of SB among EU adolescents across each of the four survey years ranged from 74.2 and 76.8%, rates that are considered high. High levels of SB were also displayed by both sexes (girls: 76.8 to 81.2%; boys: 71.7 to 76.7%). No significant differences in the prevalence of SB among years (p > 0.05) were found for the whole sample, and for either girls or boys. Also, no significant differences in the prevalence of SB between girls and boys were found. Conclusion The SB prevalence in European adolescents is extremely high (76.8% in 2017) with no differences between girls and boys. No significant improvements have been seen between 2002 and 2017. Eurobarometer should increase the adolescents’ sample to make possible benchmarking comparisons among the EU countries and extend the survey to the younger children population.

Abstract Background Despite the current debate about the effects of high intensity interval training (HIIT), HIIT elicits big morpho-physiological benefit on Metabolic Syndrome (MetS) treatment. However, no review or meta-analysis has compared the effects of HIIT to non-exercising controls in MetS variables. The aim of this study was to determine through a systematic review, the effectiveness of HIIT on MetS clinical variables in adults. Methods Studies had to be randomised controlled trials, lasting at least 3 weeks, and compare the effects of HIIT on at least one of the MetS clinical variables [fasting blood glucose (BG), high-density lipoprotein (HDL-C) triglyceride (TG), systolic (SBP) or diastolic blood pressure (DBP) and waist circumference (WC)] compared to a control group. The methodological quality of the studies selected was evaluated using the PEDro scale. Results Ten articles fulfilled the selection criteria, with a mean quality score on the PEDro scale of 6.7. Compared with controls, HIIT groups showed significant and relevant reductions in BG (− 0.11 mmol/L), SBP (− 4.44 mmHg), DBP (− 3.60 mmHg), and WC (− 2.26 cm). Otherwise, a slight increase was observed in HDL-C (+ 0.02 mmol/L). HIIT did not produce any significant changes in TG (− 1.29 mmol/L). Conclusions HIIT improves certain clinical aspects in people with MetS (BG, SBP, DBP and WC) compared to people with MetS who do not perform physical exercise. Plausible physiological changes of HIIT interventions might be related with large skeletal muscle mass implication, improvements in the vasomotor control, better baroreflex control, reduction of the total peripheral resistance, increases in excess post-exercise oxygen consumption, and changes in appetite and satiety mechanisms.

Abstract Background Sedentary behaviour (SB) has been identified as an important mortality risk factor. Health organizations have recognised SB as a public health challenge with major health, social, and economic consequences. Researchers have alerted the need to develop specific strategies, to monitor, prevent, and reduce SB. However, there is no systematic analysis of the SB changes in European Union adults. We aimed to examine SB changes between 2002 and 2017 in the European Union (EU) adult population. Methods SB prevalence (>4h30mins of sitting time/day) of 96,004 adults as a whole sample and country-by-country was analysed in 2002, 2005, 2013, and 2017 of the Sport and Physical Activity EU Special Eurobarometers’ data. The SB question of a modified version of the International Physical Activity Questionnaire was considered. SB prevalence between countries and within years was analysed with a χ2 test, and SB between genders was analysed with the Z-Score test for two population proportions. Results An association between the SB prevalence and the years was found (p

Abstract Background The World Health Organization (WHO) considers physical inactivity (PIA) as a critical noncommunicable factor for disease and mortality, affecting more women than men. In 2013, the WHO set a 10% reduction of the PIA prevalence, with the goal to be reached by 2025. Changes in the 2013–2017 period of physical inactivity prevalence in the 28 European Union (EU) countries were evaluated to track the progress in achieving WHO 2025 target. Methods In 2013 and 2017 EU Special Eurobarometers, the physical activity levels reported by the International Physical Activity Questionnaire of 53,607 adults were analyzed. Data were considered as a whole sample and country-by-country. A χ2 test was used to analyze the physical inactivity prevalence (%) between countries, analyzing women and men together and separately. Additionally, PIA prevalence was analyzed between years (2013–2017) for the overall EU sample and within-country using a Z-Score for two population proportions. Results The PIA prevalence increased between 2013 and 2017 for the overall EU sample (p

Objectives Computerised physician order entry (CPOE) systems facilitate the review of medication orders by pharmacists. Reports have emerged that show conception flaws or the misuse of CPOE systems generate prescribing errors. We aimed to characterise pharmacist interventions (PIs) triggered by prescribing errors identified as system-related errors (PISREs) in French hospitals.Design This was a cross-sectional observational study based on PIs prospectively documented in the Act-IP observatory database from January 2014 to December 2018.Setting PISREs from 319 French computerised healthcare facilities were analysed.Participants Among the 319 French hospitals, 232 (72.7%) performed SRE interventions, involving 652 (51%) pharmacists.Results Among the 331 678 PIs recorded, 27 058 were qualified as due to SREs (8.2%). The main drug-related problems associated with PISREs were supratherapeutic (27.5%) and subtherapeutic dosage (17.2%), non-conformity with guidelines/contraindications (22.4%) and improper administration (17.9%). The PI prescriber acceptation rate was 78.9% for SREs vs 67.6% for other types of errors. The PISRE ratio was estimated relative to the total number of PIs. Concerning the certification status of CPOE systems, the PISRE ratio was 9.4% for non-certified systems vs 5.5% for certified systems (p

Abstract Background Physical inactivity (PIA) is a mortality risk factor defined as performing lower levels of physical activity than recommended by the World Health Organization (WHO). After 2002, the WHO released the WHA55.23 Resolution and the Global Strategy which produced several changes in policymaking, but with no subsequent analyses of the impact of these changes in European Union (EU) policymaking while examining PIA prevalence. Methods PIA of 31,946 adults as a whole sample and country-by-country were analyzed in the 2002 and 2005 EU Special Eurobarometers. PIA prevalence between countries was performed with the χ2 test and PIA between both years and between genders was analyzed with the Z-Score test for two population proportions. A retrospective analysis of national plans was performed to interpret the suitability of such policy documents, considering changes in PIA prevalence. Results Differences in PIA prevalence were observed between countries (p 0.05). When considering gender, there were no gender reductions in subsamples for Denmark, Finland, Ireland, Portugal, Spain, and United Kingdom, neither in Luxemburg for men, nor in France and Italy for women. When analyzing gender differences across the entire sample, PIA was higher in women than men for both years (p

Litchi (Litchi chinensis Sonn.) is a tropical fruit characterized by a rapid pericarp browning and dehydration during postharvest, resulting in an accelerated shelf life and in a loss of consumer appreciation and consequently of its market value. The aim of our study was to assess litchi fruit chemical-physical and sensory quality changes during postharvest and shelf life using rapid refrigeration (RR) and active modified atmosphere packaging (MAP). Litchi fruits were picked at commercial harvest and were divided in 4 groups: not treated fruit (CTR); rapid refrigerated fruit (RRF); modified atmosphere packed fruit (MAP); hydrogen peroxide treated and modified atmosphere packed fruit (MAP+). CTR and RRF fruit were packed in microperforated plastic bag whereas MAP and MAP+ fruit were packed in unperforated high-density polyethylene package in which a gas mixture (60 kPa N2, 30% CO2 and 10 kPa O2) was flushed and then the bag was hermetically sealed. RRF, fruit were submitted to cooling in order to rapidly reduce their temperature using a blast cabinet which allows to reach 4° C in 15 minutes in three different steps. Finally, all the treated fruit were submitted to cold storage (5°C) for 12 days. Chemical-physical and sensory characteristics were analyzed after 4, 8 and 12 days of cold storage and their shelf life was monitored after 2 and 4 days at 20° C. Generally, the fruit submitted to RRF treatment presents a more intense red color in particular referring to L parameter and the best chemical-physical characteristics. Moreover, RRF fruit revealed having more consistency, juicy flesh, fruity flavour and exotic flavour after 4 days and of fruity odor and exotic odor after 8 days of cold storage. After 12 days, MAP and MAP+ showed a sensory decay. Finally, RRF technique, by rapid refrigeration, permits to prolong fruit color and taste during cold storage and consequent shelf life.

Application of passive modified atmosphere packaging (MAP) for shelf life extension of mixed pineapple slices, mango pieces and orange segments, was evaluated. Fruits of Ananas cv ‘Gold’, Mango cv ‘Keitt’ and Orange cv ‘Washington Navel’ were washed, sanitized, peeled and cut. Minimal processed fruits were packed under 2 different atmospheres, passive (air) and active MAP (70% N2, 10 %O2, 20 %CO2), and stored at 10±1 °C with 85±5% RH for 12 days. Changes in package atmosphere composition, weight loss, color, texture, pH, soluble solids, sensory attributes, were evaluated after cutting and at three subsequent stages of storage (the 3 day, 6d, 9d, and the 12 day). Color parameters L* and b* significantly decreased over time in all packaging conditions and L* variation was directly attributed to the translucency phenomenon in the fruit flesh. The pineapple and orange parameters highlighted the best visual score during the storage period, the lowest values of the browning index and the highest scores of all sensory descriptors at each sampling date. Organoleptic attributes have not been influenced by the storage time and no off-flavors were detected in the treated fruit. We conclude that pineapple slices and orange segments can be maintained in excellent condition for up 9 days at 10±1°C following the treatment with active MAP.

The variability of crop quality accounts for most of seasonal variation of farmers' incomes, since fruit growth and quality components may greatly change according to various environmental and within-tree factors. Canopy architecture and orchard layout are mainly responsible for fruit size, quality and its variability. A positive relationship was measured in peach between intercepted radiation and PAR and Trolox equivalent antioxidant capacity (TEAC). This study was carried out to measure within tree and orchard variability of fruit of the early ripening cv. Silver King nectarine (Prunus persica (L.), Batsch) 8-years-old peach trees trained to a Y-shape and Delayed vase. Fruit were picked twice and all harvested fruit were analysed in terms of size, soluble solids content, titratable acidity, pH, firmness and TEAC. Fruit weight variability between single trees was larger than within the tree and between training systems. Fruit soluble solid content and firmness had a higher variability than fruit size and within tree variability was higher in Delayed vase trees than in Y-shaped ones. TEAC changed with fruit position within the canopy.

‘Vittoria’ and ‘Red Globe’ table grapes were packed in microperforated polypropylene films (passive MAP) and non-perforated polyethylene (active MAP: 1) 20% CO2 + air; 2) 5% O2 + 15% CO2 + N) and stored at 5 °C for 28 days. Microperforated polypropylene packages had the highest postharvest performance in both cultivars until 14 days of cold storage, with reduced weight losses, rachis and berry decay. Total soluble solids content slightly increased in non-perforated polyethylene boxes as a consequence of the higher weight losses, particularly in active MAP with 5% O2 + 15% CO2 + N, while no significant differences were found for titratable acidity. Non-perforated polyethylene packages showed excessively high CO2 concentrations (30-60%) in headspace gas composition, causing berry and rachis decay. The highest postharvest performances in terms of weight losses, Total soluble solids, titratable acidity, crunchiness, juiciness and berry decay were found with micro-perforated polypropylene packages after 14 d of 5 °C cold storage, and 6 days of shelf-life (15-18°C).