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Abstract In recent decades, the north Ionian Sea, central Mediterranean Sea, has witnessed shifts in surface current circulation from cyclonic to anticyclonic and vice versa at the quasi-decadal scale, a phenomenon termed the North Ionian Gyre (NIG) reversal. This process impacts parameters such as sea level by altering thermohaline properties and redistributing water masses at the sub-basin scale. Previous studies have shown that during anticyclonic (cyclonic) phases, the Ionian sea-level trend is falling (rising), the opposite of what is observed in other Mediterranean sub-basins. Assuming that sea level records reversals, this study employed signal decomposition to analyze satellite altimetry data and tide gauge observations across the region, some dating back to the 1900s. A distinct quasi-decadal periodicity emerges as the second dominant oscillatory mode from all independent observations, aligning its peaks and troughs (i.e., changes in sea-level trend) with known NIG reversals and associated changes in the state of North Ionian vorticity. Furthermore, this mode from altimetry data clearly depicts the spatial variability of sea level attributed to the opposite NIG states. This periodicity appears coherent among different sub-basins within the domain, especially in the eastern Mediterranean, with a shared generalized out of phase and weakening occurred from the 1930s to the 1950s. This study presents a century-scale reconstruction of NIG reversals, contributing to the understanding of this phenomenon prior to 1987 using direct observations from sea-level data.

Sea-level change is one of the most concerning climate change and global warming consequences, especially impacting coastal societies and environments. The spatial and temporal variability of sea level is neither linear nor globally uniform, especially in semi-enclosed basins such as the Mediterranean Sea, which is considered a hot spot regarding expected impacts related to climate change. This study investigates sea-level trends and their variability over the Mediterranean Sea from 1993 to 2019. We use gridded sea-level anomaly products from satellite altimetry for the total observed sea level, whereas ocean temperature and salinity profiles from reanalysis were used to compute the thermosteric and halosteric effects, respectively, and the steric component of the sea level. We perform a statistical change point detection to assess the spatial and temporal significance of each trend change. The linear trend provides a clear indication of the non-steric effects as the dominant drivers over the entire period at the Mediterranean Sea scale, except for the Levantine and Aegean sub-basins, where the steric component explains the majority of the sea-level trend. The main changes in sea-level trends are detected around 1997, 2006, 2010, and 2016, associated with Northern Ionian Gyre reversal episodes, which changed the thermohaline properties and water mass redistribution over the sub-basins.

Lipari is the largest and most populated island in the Aeolian Archipelago, a UNESCO site, and a highly frequented touristic destination. As in many other insular settings, the low-lying coastal stretches in the E and NE sectors of Lipari are locally exposed to coastal erosion and flooding, enhanced by subsidence effects leading to local sea level rise. Most of these coastal sectors appear critical, being narrow and increasingly threatened by the risk of permanent inundation and beach disappearance. In this study, this setting is placed in the wider context of the decadal evolution of the main beaches, analysed through a multidisciplinary approach, which includes remote sensing techniques (aero-photogrammetry, unmanned aerial vehicle survey, and satellite data), offshore geophysical surveys (high-resolution multibeam bathymetry), and field observations. The results show a variable interaction in space and time between natural and anthropogenic factors in the long- and mid-term evolution of the studied coastal areas. Considering that part of the local economy at Lipari depends on beach tourism, proper future management is required in the view of natural risk reduction and in the light of future climate changes and related impacts.

Coastal flooding and retreat are markedly enhanced by sea-level rise. Thus, it is crucial to determine the sea-level variation at the local scale to support coastal hazard assessment and related management policies. In this work we focus on sea-level change along the Emilia-Romagna coast, a highly urbanized, 130 km-long belt facing the northern Adriatic Sea, by analyzing data from three tide gauges (with data records in the last 25–10 years) and related closest grid points from CMEMS monthly gridded satellite altimetry. The results reveal that the rate of sea-level rise observed by altimetry is coherent along the coast (2.8 ± 0.5 mm/year) for the period 1993–2019 and that a negative acceleration of −0.3 ± 0.1 mm/year is present, in contrast with the global scale. Rates resulting from tide gauge time series analysis diverge from these values mainly as a consequence of a large and heterogeneous rate of subsidence in the region. Over the common timespan, altimetry and tide gauge data show very high correlation, although their comparison suffers from the short overlapping period between the two data sets. Nevertheless, their combined use allows assessment of the recent (last 25 years) sea-level change along the Emilia-Romagna coast and to discuss the role of different interacting processes in the determination of the local sea level.

Abstract Background Dental anxiety is a condition associated with avoidance of dental treatment and increased medical and surgical risks. This systematic review aims to summarize available evidence on conscious sedation techniques used for the management of Dental anxiety in patients scheduled for third molar extraction surgery, to identify best approaches and knowledge gaps. Methods A comprehensive search was conducted including MEDLINE/Pubmed, EMBASE, SCOPUS, clinicaltrials.gov and the Cochrane Database of Systematic Reviews through March 2019. Only randomized controlled trials were included. PRISMA guidelines were followed. Risk of bias was appraised as reported in the Cochrane Handbook for Systematic Reviews of Interventions. Results Seventeen RCTs with a total of 1788 patients were included. Some aspects limited the feasibility of a meaningful meta-analysis, thus a narrative synthesis was conducted. Conscious sedation was associated with improvement in Dental anxiety in six studies. One study reported lower cortisol levels with midazolam vs. placebo, while another study found significant variation in perioperative renin levels with remifentanil vs. placebo. Conclusions This review found inconclusive and conflicting findings about the role of Conscious sedation in managing Dental anxiety during third molar extraction surgery. Relevant questions remain unanswered due to the lack of consistent, standardized outcome measures. Future research may benefit from addressing these limitations in study design.

Postsurgical pain is commonly associated with dental and oral surgery, and the use of analgesics has been investigated in the management of postoperative pain. This systematic review summarizes available evidence on analgesics used to manage dental implant surgery postoperative pain, to identify best therapeutic protocols and knowledge gap. A comprehensive search was conducted including MEDLINE/Pubmed, EMBASE, SCOPUS, clinicaltrials.gov, and the Cochrane Database of Systematic Reviews through May 2020. Only randomized controlled trials were included. PRISMA guidelines were followed, and risk of bias was appraised using Cochrane RoB2 tool. Eleven trials (762 patients overall) were included. Some aspects limited the feasibility of a meaningful meta-analysis; thus, a narrative synthesis was conducted. Risk of bias was low in four studies and high in two studies, while five studies raised some concerns due to the randomization process. Analgesic use seemed to be associated with improved postoperative outcomes (pain, patient’s satisfaction, and need for rescue medication) when compared to placebo. Overall, this review suggests that the administration of analgesics may provide some advantages in the management of postoperative outcomes after dental implant placement, while indications about the best analgesics cannot be provided.

Background. Falling is a major clinical problem in elderly people, demanding effective solutions. At present, the only effective intervention is motor training of balance and strength. Executive function-based training (EFt) might be effective at preventing falls according to evidence showing a relationship between executive functions and gait abnormalities. The aim was to assess the effectiveness of a motor and a cognitive treatment developed within the EU co-funded project I-DONT-FALL. Methods. In a sample of 481 elderly people at risk of falls recruited in this multicenter randomised controlled trial, the effectiveness of a motor treatment (pure motor or mixed with EFt) of 24 one-hour sessions delivered through an i-Walker with a non-motor treatment (pure EFt or control condition) was evaluated. Similarly, a 24 one-hour session cognitive treatment (pure EFt or mixed with motor training), delivered through a touch-screen computer was compared with a non-cognitive treatment (pure motor or control condition). Results. Motor treatment, particularly when mixed with EFt, reduced significantly fear of falling (F(1,478) = 6.786, p = 0.009) although to a limited extent (ES −0.25) restricted to the period after intervention. Conclusions. This study suggests the effectiveness of motor treatment empowered by EFt in reducing fear of falling.