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Abstract Malaria is one of the major health threats in Africa, and the risk of transmission is projected to be exacerbated by global warming. Rwanda experienced an 11-fold increase in malaria incidence from 2011 to 2015 despite extensive funding and implementation of control measures. Here, we focus on Rwanda as a case study and simulate monthly malaria incidence between 2010 and 2015, employing an ensemble learning method. Next, we project future malaria prevalence using shared socio-economic pathways (SSP2-4.5 and SSP5-8.5). We find that the projected increases in temperature and precipitation may shift malaria transmission risk to the highlands of western and northern Rwanda. These two regions that currently experience low malaria transmission. The seasonal effects of malaria incidence may be less apparent from January to June, and the peak season for malaria transmission in the highlands could occur one month earlier. Our findings highlight the impacts of climate change on malaria epidemics in Rwanda, which have implications for other world regions.

Abstract The inflow of CSF into perivascular spaces (PVS) in the brain is crucial for clearing waste molecules. Inefficiency in PVS flow leads to neurodegeneration. Failure of PVS flushing is associated with CSF flow impairment in the intracranial hydrodynamic condition of CSF hypo-pulsatility. However, enlarged PVS (ePVS), a finding indicative of PVS flow dysfunction, is also present in patients with derangement of CSF dynamics characterized by CSF hyper-pulsatility, which increases CSF flow. Intriguingly, two opposite intracranial hydrodynamic conditions would lead to the same result of impairing the PVS flushing. To investigate this issue, we assessed the subsistence of a dysfunctional interplay between CSF and PVS flows and, if the case, the mechanisms preventing a hyper-pulsatile brain from providing an effective PVS flushing. We analyzed the association between phase contrast MRI aqueductal CSF stroke volume (aqSV), a proxy of CSF pulsatility, and the burden of ePVS in chronic adult hydrocephalus, a disease involving a broad spectrum of intracranial hydrodynamics disturbances. In the 147 (85 males, 62 females) patients, the age at diagnosis ranged between 28 and 88 years (median 73 years). Ninety-seven patients had tri-ventriculomegaly and 50 tetra-ventriculomegaly. According to the extent of ePVS, 113 patients had a high ePVS burden, while 34 had a low ePVS burden. aqSV, which ranged between 0 and 562 μL (median 86 μL), was increased with respect to healthy subjects. Patients presenting with less ePVS burden had higher aqSV (p

CT perfusion (CTP) images can be easily and rapidly obtained on all modern CT scanners and have become part of the routine imaging protocol of patients with aneurysmal subarachnoid haemorrhage (aSAH). There is a growing body of evidence supporting the use of CTP imaging in these patients, however, there are significant differences in the software packages and methods of analysing CTP. In. addition, no quantitative threshold values for tissue at risk (TAR) have been validated in this patients’ population. Here we discuss the contribution of the technique in the identification of patients at risk of aSAH-related delayed cerebral ischemia (DCI) and in the assessment of the response to endovascular rescue therapy (ERT). We also address the limitations and pitfalls of automated CTP postprocessing that are specific to aSAH patients as compared to acute ischemic stroke (AIS).

Two untargeted metabolomics approaches (LC-HRMS and 1H NMR) were combined to classify Amarone wines based on grape withering time and yeast strain. The study employed a multi-omics data integration approach, combining unsupervised data exploration (MCIA) and supervised statistical analysis (sPLS-DA).The results revealed that the multi-omics pseudo-eigenvalue space highlighted a limited correlation between the datasets (RV-score = 16.4%), suggesting the complementarity of the assays. Furthermore, the sPLS-DA models correctly classified wine samples according to both withering time and yeast strains, providing a much broader characterization of wine metabolome with respect to what was obtained from the individual techniques. Significant variations were notably observed in the accumulation of amino acids, monosaccharides, and polyphenolic compounds throughout the withering process, with a lower error rate in sample classification (7.52%).In conclusion, this strategy demonstrated a high capability to integrate large omics datasets and identify key metabolites able to discriminate wine samples based on their characteristics.

Abstract Cerebrovascular Reactivity (CVR) refers to the ability of cerebral blood vessels to dilate or constrict under the effect of vasoactive substances and can be estimated using functional Magnetic Resonance Imaging (fMRI). Computation of CVR maps is relevant in various brain diseases and requires specialized data processing. We introduce CVRmap, an opensource software that automates the computation of CVR map. The toolbox complies with the Brain Imaging Data Structure (BIDS) standards.

Background: The prevalence of pathogenic germline mutations in DNA damage repair (gDDR) genes in the Italian population is unknown. Objective: In this prospective multicenter cohort study, we evaluated the prevalence of gDDR alterations in the Italian population affected by metastatic prostate cancer (mPCa) and analyzed the impact on response to therapy, survival, and time to castration resistance. Design, setting, and participants: In an observational prospective trial, 300 consecutive Italian mPCa patients, enrolled in the Meet-Uro-10 trial from three academic Italian centers, were recruited between 2017 and 2019 and were screened for gDDR mutations in 107 genes. Outcome measurements and statistical analysis: The primary endpoint was to assess the prevalence of gDDR mutations in the Italian population of patients with mPCa. The secondary endpoints included the association of gDDR subgroups with metastatic onset, Gleason score, and time to castration resistance. Results and limitations: We identified 297 valuable patients. Forty-six patients had a pathogenic/likely pathogenic variant (15.5%, 95% confidence interval: 11.4–19.6): the more frequent was gBRCA2 found in nine cases (3%), followed by gATM in five cases (1.7%). In patients without mutations, longer median overall survival was observed with the sequence docetaxel-androgen receptor signaling inhibitor (ARSI) than with the sequence ARSI-docetaxel (87.9 vs 42 mo, p = 0.0001). In a univariate analysis, the median time to castration resistance in gDDR mutated patients was 19.8 mo, versus 23.7 mo in no mutated patients (p = 0.024). There were no associations of gDDR subgroups with metastatic onset and Gleason score ≥8. In our cohort, variants of unknown significance in gDDR genes were found in 80 patients and might have a prognostic relevance. Conclusions: The study reported the prevalence of gDDR in the Italian population. The presence of gBRCA2 mutations correlates with a shorter time to the onset of castration resistance disease. Patient summary: The prevalence of gBRCA2 in the Italian population is 3%, which is similar to that in the Spanish population, identifying similarities between people of the Western Mediterranean area.

A surging demand for sustainable energy and the urgency to lower greenhouse gas emissions is driving industrial systems towards more eco-friendly and cost-effective models. Biogas from agricultural and municipal organic waste is gaining momentum as a renewable energy source. Concurrently, the European Hydrogen Strategy focuses on green hydrogen for decarbonising the industrial and transportation sectors. This paper presents a multi-objective network design model for urban–industrial symbiosis, incorporating anaerobic digestion, cogeneration, photovoltaic, and hydrogen production technologies. Additionally, a Bayesian best-worst method is used to evaluate the weights of the sustainability aspects by decision-makers, integrating these into the mathematical model. The model optimises industrial plant locations considering economic, environmental, and social parameters, including the net present value, energy consumption, and carbon footprint. The model’s functionalities are demonstrated through a real-world case study based in Emilia Romagna, Italy. It is subject to sensitivity analysis to evaluate how changes in the inputs affect the outcomes and highlights feasible trade-offs through the exploration of the ϵ-constraint. The findings demonstrate that the model substantially boosts energy and hydrogen production. It is not only economically viable but also reduces the carbon footprint associated with fossil fuels and landfilling. Additionally, it contributes to job creation. This research has significant implications, with potential future studies intended to focus on system resilience, plant location optimisation, and sustainability assessment.

In this paper a statistical study of cirrus geometrical and optical properties based on 4 years of continuous ground-based lidar measurements with the Barcelona (Spain) Micro Pulse Lidar (MPL) is analysed. First, a review of the literature on the two-way transmittance method is presented. This method is a well-known lidar inversion method used to retrieve the optical properties of an aerosol–cloud layer between two molecular (i.e. aerosol and cloud-free) regions below and above, without the need to make any a priori assumptions about their optical and/or microphysical properties. Second, a simple mathematical expression of the two-way transmittance method is proposed for both ground-based and spaceborne lidar systems. This approach of the method allows the retrieval of the cloud optical depth, the cloud column lidar ratio and the vertical profile of the cloud backscatter coefficient. The method is illustrated for a cirrus cloud using measurements from the ground-based MPL and from the spaceborne Cloud-Aerosol Lidar with Orthogonal Polarization (CALIOP). Third, the database is then filtered with a cirrus identification criterion based on (and compared to) the literature using only lidar and radiosonde data. During the period from November 2018 to September 2022, 367 high-altitude cirrus clouds were identified at 00:00 and 12:00 UTC, of which 203 were successfully inverted with the two-way transmittance method. The statistical results of these 203 high-altitude cirrus clouds show that the cloud thickness is 1.8 ± 1.1 km, the mid-cloud temperature is −51 ± 8 ∘C and the linear cloud depolarization ratio is 0.32 ± 0.13. The application of the transmittance method yields an average cloud optical depth (COD) of 0.36 ± 0.45 and a mean effective column lidar ratio of 30 ± 19 sr. Statistical results of the errors associated with the two-way transmittance method retrievals are also provided. The highest occurrence of cirrus is observed in spring and the majority of cirrus clouds (48 %) are visible (0.03 < COD < 0.3), followed by opaque (COD > 0.3) with a percentage of 38 %. Together with results from other sites, possible latitudinal dependencies have been analysed together with correlations between cirrus cloud properties. For example, we noted that in Barcelona the COD correlates positively with the cloud base temperature, effective column lidar ratio and linear cloud depolarization ratio and negatively with the cloud base height.

Taking into consideration Calvino's 1967 lecture "Cibernetica e  fantasmi," the article discusses wheter the similarities between mathematics and literature previously noticed when reading Calvino's Six Memos for the Next  Millennium (Lezioni americane) may be extended to include both central characteristics of 21st century mathematics and the mechanization of formal proofs.

Background: Cabozantinib use in everyday clinical practice for advanced or metastatic renal cell carcinoma (RCC) is relatively recent, and real-world data on treatment persistence, adherence and sequencing are still limited. Methods: We conducted an analysis based on an integrated administrative database, covering around 6.9 million health-assisted Italian individuals, to explore the use of cabozantinib for RCC. Patients with at least one prescription for cabozantinib during 2017-2020 were searched. These were characterized during all available period (i.e. from 2010 onwards) before the index date and were observed after inclusion. Results: A total of 113 patients treated with cabozantinib in second or subsequent line were included, and their demographic, clinical and treatment characteristics were described. About half of these RCC patients were aged >65 years (47.8%). Sixty patients (53.1%) were highly adherent to cabozantinib therapy, and the median cabozantinib treatment duration of use was 8.7 months (95% confidence interval: 5.8-11.1). During the first year of follow-up, the average total cost per patient was €32,508. Conclusions: We described second or subsequent line cabozantinib treatment for RCC in a real-world setting and the economic burden of disease in Italy, taking advantage of large, integrated administrative databases.

This study discusses third-party online food delivery providers' (OFDPs) continuing dominance post-pandemic and provides recommendations for providers and foodservice operators by analyzing customer comments regarding a third-party OFDP. Thematic Analysis, a data-driven inductive approach, was applied in this study to identify four emergent themes. 1) App Technology- Oriented Quality Attributes, 2) App Service-Oriented Quality Attributes, 3) Delivery Person’s Performance, and 4) Restaurant Food Quality. Technology-Oriented Quality Attributes had the highest frequency of mentions (533), followed by Deliverer’s Performance (531), Service-Oriented Quality Attributes (524), and Restaurant Food Quality (115) for a total of 1,703 mentions of which 461(27%) were positive and 1,242 (73%) negative. Theme 1 had the highest percentage of negative comments at 86%, followed by Theme 2 at 85%, Theme 4 at 77%, and Theme 3 at 48 %, the only surfaced theme that did not have more negative than positive comments.

Microalgae show potential as renewable and environmentally friendly fuel resources. Wastewaters (WWs) can be utilized as growth media, reducing the associated cultivation costs. Therefore, the aim of this study was to investigate how organic-rich WWs affect the growth and fatty acid methyl esters (FAME) profile of Chlorella vulgaris. This particular strain exhibits high biomass productivity and can thrive in a wide range of WWs. It also has the ability to shift its metabolism from autotrophic to hetero/mixotrophic. Glycerol can serve as a means to direct metabolism towards lipids production. Consequently, C. vulgaris was cultivated in brewery wastewater (BWW) containing varying concentrations of glycerol under both metabolic conditions. When C. vulgaris was cultivated in a mixotrophic environment, it achieved a notably higher biomass yield compared to heterotrophic cultivation. The highest biomass yield, reaching 1.33 g L-1, was achieved utilizing 2 mL of glycerol in BWW, surpassing the control with 1.08 g L-1. However, when a two-phase metabolism was applied, comprising the ten days of mixotrophy followed by the final five days in heterotrophy (MHB), the biomass yield was slightly lower than that obtained under continuous mixotrophic conditions. Nevertheless, it was still double the biomass obtained in a strictly heterotrophic environment. The FAME profile analysis revealed that, within the considered trophic conditions, the highest content of saturated fatty acids (SFA), monounsaturated fatty acids (MUFA), and polyunsaturated fatty acids (PUFA) was observed during mixotrophic cultivation with 10 mL of glycerol, mixotrophic cultivation with 4 mL of glycerol, and MHB with 4 mL of glycerol (35.36%wt, 46.89%wt, and 31.60%wt, respectively). An initial examination of the saturated and unsaturated components of the FAME suggests that lipids extracted from C. vulgaris biomass cultivated mixotrophically and heterorophically in BWW could potentially serve as a valuable feedstock for biodiesel production.

Resumo A proposta deste artigo é fazer uma discussão a respeito do que é denominado na região do alto rio Negro de ‘nome sagrado’, a partir da experiência etnográfica junto ao povo Yuhupdeh e tomando o benzimento de nominação como ponto de partida. Os ‘nomes sagrados’ são nomes próprios dados após o nascimento, escolhidos a partir de um estoque específico correspondente a cada grupo e conforme um princípio de senioridade que estabelece uma escala orientada pela ordem de nascimento – do irmão maior para o irmão menor. Ao mesmo tempo, eles também são designados de sopro de vida (na língua Yuhup, se diz hãg-wäg) e devem ser cuidados e protegidos para que possam crescer junto com as pessoas que os carregam. Mais do que abordar os nomes apenas como categorias classificatórias de parentesco ou prerrogativas – que determinam posições entre as pessoas através do gradiente da senioridade –, pretende-se abordá-los a partir daquilo que ativam, fazem e associam.

Introduction: We describe the first case of acute flaccid myelitis (AFM) related to enterovirus D68 (EV-D68) infection in Belgium. The clinical and radiological presentation of AFM associated with EV-D68 although well described currently remains a challenging diagnosis. Through this interesting clinical case, we aimed to review the differential diagnosis of acute flaccid palsy in a child and discuss the specific point of interest related to AFM. Case Presentation: We present the case of a 4-year-old girl with a torticollis associated with an acute palsy of the right upper limb. The magnetic resonance imaging revealed an increased T2 signal intensity of the entire central gray matter of the cervical cord with involvement of the posterior brainstem. A polymerase chain reaction (PCR) conducted on a nasopharyngeal swab was found positive for EV-D68. The definition of AFM proposed by the Center for Disease Control and Prevention (CDC) is an acute-onset flaccid weakness of one or more limbs in the absence of a clear alternative diagnosis and the radiological evidence of gray matter involvement on an MRI picture, and our case fits these two criteria. A prompt and detailed workup is required to distinguish this emergent disease from other forms of acute flaccid palsy. The functional prognosis of AFM is poor, and there are no evidence-based treatment guidelines so far. Conclusion: AFM is an emerging pathology that requires the attention of pediatricians to quickly rule out differential diagnoses and adequately manage the patient. Further research is needed to optimize treatments, improve outcomes, and provide scientifically based guidelines.

Abstract Professorships in Italy are assigned following public competitions. However, favouritism affects faculty hiring. Researchers lacking clientelistic support remain excluded from academia and are obliged to seek employment abroad or at non-university institutions, or to abandon their career. Do non-recruited researchers have better or worse scientific capacity than those who have attained professorships in Italy? Files regarding the competitions in bibliometric disciplines won by 186 professors in Florence were analysed. An equal number of professors recruited at other Italian universities and scientists who never attained professorship in Italy were randomly drawn from the pool of individuals having national scientific qualification (the prerequisite for professorship) in the same disciplines as each Florentine professor. H-indexes of the year of qualification (T1), of the Florence call (T2), and in July 2021 (T3) were obtained from Scopus. Non-recruited individuals were more likely (Chi-square test) to show a higher H-index than both Florentine (T1 p = 0.0005, T2 p = 0.0015, T3 p = 0.0095) and non-Florentine professors (T1 p = 0.0078, T2 p = 0.0245, T3 p = 0.0500). Fifty-four non-recruited scientists serve in foreign universities, 100 at national/international research centres. The remaining scientists (25 who continue producing despite precarious employment, and seven who have stopped publishing) were as likely as Florentine (T3 p = 0.69) and non-Florentine (T3 p = 0.14) professors to show a higher H-index. Italian faculty hiring disregards merit. A more challenging qualification would limit the access of researchers with lower scientific capacity, and favour those with greater proficiency. As it stands, competition is useless. Once professors obtain permanent employment, they seem less motivated to publish.

Abstract Earth’s atmosphere, whose ionization stability plays a fundamental role for the evolution and endurance of life, is exposed to the effect of cosmic explosions producing high energy Gamma-ray-bursts. Being able to abruptly increase the atmospheric ionization, they might deplete stratospheric ozone on a global scale. During the last decades, an average of more than one Gamma-ray-burst per day were recorded. Nevertheless, measurable effects on the ionosphere were rarely observed, in any case on its bottom-side (from about 60 km up to about 350 km of altitude). Here, we report evidence of an intense top-side (about 500 km) ionospheric perturbation induced by significant sudden ionospheric disturbance, and a large variation of the ionospheric electric field at 500 km, which are both correlated with the October 9, 2022 Gamma-ray-burst (GRB221009A).

Professorships in Italy are assigned following public competitions. However, favouritism affects faculty hiring. Researchers lacking clientelistic support remain excluded from academia and are obliged to seek employment abroad or at non-university institutions, or to abandon their career. Do non-recruited researchers have better or worse scientific capacity than those who have attained professorships in Italy? Files regarding the competitions in bibliometric disciplines won by 186 professors in Florence were analysed. An equal number of professors recruited at other Italian universities and scientists who never attained professorship in Italy were randomly drawn from the pool of individuals having national scientific qualification (the prerequisite for professorship) in the same disciplines as each Florentine professor. H-indexes of the year of qualification (T1), of the Florence call (T2), and in July 2021 (T3) were obtained from Scopus. Non-recruited individuals were more likely (Chi-square test) to show a higher H-index than both Florentine (T1 p = 0.0005, T2 p = 0.0015, T3 p = 0.0095) and non-Florentine professors (T1 p = 0.0078, T2 p = 0.0245, T3 p = 0.0500). Fifty-four non-recruited scientists serve in foreign universities, 100 at national/international research centres. The remaining scientists (25 who continue producing despite precarious employment, and seven who have stopped publishing) were as likely as Florentine (T3 p = 0.69) and non-Florentine (T3 p = 0.14) professors to show a higher H-index. Italian faculty hiring disregards merit. A more challenging qualification would limit the access of researchers with lower scientific capacity, and favour those with greater proficiency. As it stands, competition is useless. Once professors obtain permanent employment, they seem less motivated to publish.

Background: Endometriosis is a persistent inflammatory condition that affects women of reproductive age and causes pelvic pain. Chronic pelvic pain is a chronic regional pain syndrome involving the pelvic area. Objectives: This survey aimed to characterize the clinical and sociodemographic characteristics, lifestyles, quality of life, and perceptions of quality of care in women with endometriosis who reported chronic pelvic pain during the Covid pandemic. Design: We conducted a cross-sectional survey among the Italian population from July to September 2021. Methods: Snowball sampling was used to interview a large sample of adult women who reported a diagnosis of endometriosis, through a self-reported questionnaire. Univariate and multivariable logistic regression analyses were performed to identify the factors associated with chronic pelvic pain. The primary outcome was describing women who reported chronic pelvic pain. Results: A total of 661 out of 1045 (63%) women who responded to the survey reported chronic pelvic pain. The multivariable analysis evidenced that chronic pelvic pain was related to physical and mental quality perception, pelvic floor disorders (adjusted odds ratio = 1.58; 95% CI = 1.10–2.27; p = 0.012), dyspareunia (adjusted odds ratio = 1.87; 95% CI = 1.31–2.65; p

Background: Vedolizumab (VDZ) and infliximab are used to treat moderate to severe ulcerative colitis (UC). The choice of the drug to use at first-line is often based on a combination of clinical and economic factors. The cost of treatment pathway is rarely considered. Therefore, this cost-consequence analysis (CCA) investigated the overall costs of treatment pathway for vedolizumab followed by infliximab (VDZ → IFX) compared to infliximab followed by vedolizumab (IFX → VDZ). Methods: We used a published cost-consequence model (CCM), based on a targeted literature search reporting the time-on-treatment data for vedolizumab or infliximab in UC in first and second-line of treatment. CCM time horizon was defined by the length of treatment sequences. Considering the Italian hospital perspective, the CCA evaluated the biologic drugs acquisition costs, drug administration costs, hospitalization costs, switch costs, colectomy costs and third-line treatment costs. Third-line options included colectomy, tofacitinib, ustekinumab or dose escalation of second-line biologic. Results: Over the 5.2-year time horizon (duration of the longer VDZ → IFX pathway), the mean cost per patient of VDZ → IFX pathway was slightly lower than the mean cost per patient of IFX → VDZ pathway (€ 86,339 vs 89,636). The CCM predicted that using VDZ as first-line treatment delayed the time to costly third-line therapies compared to first-line using IFX (VDZ-first-line median time-on-treatment 3.6-years and IFX-second-line 1.6-years; IFX-first-line 1.4-years and VDZ-second-line 2.3-years and third-line 1.5-years). Conclusion: The CCA showed that a biologic treatment pathway that begins with first-line vedolizumab is not more expensive than one beginning with first-line infliximab and delayed the time to costly third-line.