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Abstract We investigate the evolution of Internet speed and its implications for access to key digital services, as well as the resilience of the network during crises, focusing on six major Brazilian cities: Belo Horizonte, Brasília, Fortaleza, Manaus, Rio de Janeiro, and São Paulo. Leveraging a unique dataset of Internet Speedtest® results provided by Ookla®, we analyze Internet speed trends from 2017 to 2023. Our findings reveal significant improvements in Internet speed across all cities. However, we find that prosperous areas generally exhibit better Internet access, and that the dependence of Internet quality on wealth have increased over time. Additionally, we investigate the impact of Internet quality on access to critical online services, focusing on e-learning. Our analysis shows that nearly 13% of catchment areas around educational facilities have Internet speeds below the threshold required for e-learning, with disadvantaged areas experiencing more significant challenges. Moreover, we investigate the network’s resilience during the COVID-19 pandemic, finding a sharp decline in network quality following the declaration of national emergency. We also find that less wealthy areas experience larger drops in network quality during crises. Overall, this study underscores the importance of addressing disparities in Internet access to ensure equitable digital services and enhance network resilience during crises.

Abstract Sore throat represents one of the main causes of antibiotic overprescription in children. Its management is still a matter of debate, with countries considering streptococcal pharyngotonsillitis a benign and self-limiting condition and others advocating for its antibiotic treatment to prevent suppurative complications and acute rheumatic fever. Italian paediatricians frequently prescribe antibiotics on a clinical basis regardless of microbiological results. Moreover, broad-spectrum antibiotics are inappropriately prescribed for this condition. In this regard, an intersociety consensus conference was issued to promote the judicious use of antibiotic therapy in paediatric outpatient settings. A systematic review of the literature was performed, and updated recommendations were developed according to the GRADE methodology. Antibiotic treatment with amoxicillin (50 mg/kg/day) for 10 days is recommended in all children with proven streptococcal pharyngitis. Benzathine-penicillin could be prescribed in children with impaired intestinal absorption or inability to tolerate enteral intake and in those at high risk of suppurative complications with low compliance to oral therapy. In children with suspected amoxicillin allergy, third-generation cefalosporins for five days are recommended in low-risk patients, and macrolides are recommended in high-risk ones. Candidates for tonsillectomy due to recurrent pharyngitis could be treated with amoxicillin-clavulanic acid, clindamycin, or combined therapy with amoxicillin plus rifampicin for four days, in an attempt to avoid surgery.

In July 2024, poliovirus was identified in Gaza, prompting the World Health Organization (WHO) to issue a warning regarding the potential for polio to spread in the region [...]

Introduction. Nutrition and physical activity are two major issues in the management of CKD patients who are often older, have comorbidities and are prone to malnutrition and physical inactivity, conditions that cause loss of quality of life and increase the risk of death. We performed a multidimensional assessment of nutritional status and of physical performance and activity in CKD patients on conservative therapy in order to assess the prevalence of sedentary behaviour and its relationship with body composition. Methods. 115 consecutive stable CKD patients aged 45-80 years were included in the study. They had no major skeletal, muscular or neurological disabilities. All patients underwent a multidimensional assessment of body composition, physical activity and exercise capacity. Results. Sedentary patients, as defined by mean daily METs < 1.5 were older and differed from non-sedentary patients in terms of body composition, exercise capacity and nutrient intake, even after adjusting for age. Average daily METs were positively associated with lean body mass, muscle strength, 6-MWT performance, but negatively associated with fat body mass, body mass index and waist circumference. In addition, a sedentary lifestyle may have negative effects on free fat mass, muscle strength and exercise capacity, and may increase fat body mass. Conversely, s decrease in muscle mass and/or an increase in fat mass may lead to a decrease in physical activity and exercise capacity. Conclusion. There is a clear association and potential interrelationship between nutritional aspects and exercise capacity in older adults with CKD: they are really the two sides of the same coin.

Abstract Provision of non-invasive vascular imaging results to individuals has been shown to improve cardiovascular disease risk factor control: its impact on diet remains uncertain. In this two-arm, single-blind, parallel, 12-week randomized controlled trial, 240 participants, 57.5% females aged 60–80 y had abdominal aortic calcification and clinical assessments performed at a hospital clinic. Participants were randomized 1:1 to receive (intervention n = 121) or not (control n = 119) their calcification results. Both groups received educational resources on cardiovascular disease risk control and were unblinded to the intervention. Outcome measures were performed at baseline and 12 weeks. The primary outcomes of the study were changes in fruit and vegetable intake measures over 12 weeks assessed using plasma carotenoid concentrations (biomarkers of FV intake) and a food frequency questionnaire. Secondary outcomes included 12-week changes in other aspects of the diet, physical activity, body weight, blood pressure, heart rate, lipid profile, glucose concentrations, estimated cardiovascular disease risk score, and medication use. Between-group differences were tested using linear mixed-effects regression. There were no between-group differences in the primary outcomes at 12 weeks: plasma carotenoids (mean difference +0.03 µg/mL [95%CI −0.06, 0.13]) and fruit and vegetable intakes (+18 g/d [−37, 72]). However, the provision of calcification results led to between-group differences in serum total (−0.22 mmol/L [−0.41, −0.04]) and non-HDL (−0.19 mmol/L [−0.35, −0.03]) cholesterol, and estimated cardiovascular disease risk score (−0.24% [−0.47, −0.02]). No between-group differences were seen for other secondary outcomes. In this work, providing vascular imaging results did not improve diet but did improve some cardiovascular disease risk factors (Australian and New Zealand Clinical Trials Registry ACTRN12618001087246).

Abstract Community-acquired pneumonia (CAP) is an acute infection of the lung parenchyma acquired outside the hospital or other healthcare settings, typically affecting previously healthy individuals. This intersociety consensus aims to provide evidence-based recommendations for the antibiotic treatment of mild to moderate CAP in previously healthy children in Italy. A systematic review was conducted to identify the most recent and relevant evidence. Embase, Scopus, PubMed, and Cochrane databases were systematically screened, with a date restriction from 2012 to April 2024, but without language limitations. The review included studies conducted in high-income countries on antibiotic therapy in children over 3 months of age diagnosed with mild-moderate CAP. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methods. The final recommendations were obtained through a Delphi consensus of an expert panel. Amoxicillin is the first-line treatment if the child is at least immunized against Haemophilus influenzae type b (low/very low quality of evidence, strong recommendations), while amoxicillin-clavulanate or second- or third-generation cephalosporins should be prescribed for those unimmunized or with incomplete immunization coverage for both H. influenzae type b and Streptococcus pneumoniae (low/very low quality of evidence, strong recommendations). Macrolides should be considered in addition to amoxicillin in children over 5 years old, if symptoms persist and the clinical condition remains good after 48 h of therapy (low/very low quality of evidence, strong recommendations). The dosage of amoxicillin is 90 mg/kg/day divided in three doses, although two doses could be considered to improve compliance (moderate quality of evidence, weak recommendations). A five-day duration of therapy is recommended, with clinical monitoring and re-assessment approximately 72 h after the start of antibiotic treatment to evaluate symptom resolution (moderate quality of evidence, strong recommendations). To improve the management of CAP in pediatric patients, we have developed this consensus based on a thorough review of the best available evidence and extensive discussions with an expert panel. However, further efforts are needed. Future research should focus on enhancing diagnostic accuracy, optimizing antibiotic utilization, comparing the efficacy of different antibiotic regimens, and determining the optimal dosage and duration of treatment in different setting.

Abstract As seismic events continue to pose significant threats to urban infrastructure, leveraging smartphones equipped with accelerometers for real-time monitoring has gained prominence. To ascertain the reliability and sensitivity of smartphone-based measurements, an in-depth characterization of their response is essential. This article presents a thorough characterization of the performance of typical accelerometers installed on three distinct smartphone models. For this, a novel experimental apparatus has been developed to conduct a comparative study involving three different smartphones against a reference accelerometer. We determine each accelerometer’s transfer functions for Fourier frequencies 0.1–40 Hz, evidencing main differences and demonstrating a higher sensitivity than expected. Possible implementation in future distributed networks of heterogeneous and synchronized sensors, capable of independently generating and validating timely alerts in particular seismic events, are also discussed.

Abstract Objectives To understand how best to further reduce the inappropriate use of pre‐surgical androgen deprivation therapy (ADT), we investigated the determinants (influences) of ADT prescribing in urologists in two European countries using an established behavioural science approach. Additionally, we sought to understand how resource limitations caused by COVID‐19 influenced this practice. Identification of key determinants, of undistributed and disrupted practice, will aid development of future strategies to reduce inappropriate ADT prescribing in current and future resource‐limited settings. Participants and Methods We conducted semi‐structured qualitative interviews with urologists practicing in Italy and the UK from February to July 2022. Interviews focussed on undisrupted (usual) practice and disrupted practice (changes made during COVID‐19 restrictions). Codes were generated inductively and were mapped to the 14 domains of the Theoretical Domains Framework. Relevant domains of influence were identified, and the similarities and differences between the UK and Italy were distinguished. Results We identified 10 domains that were influential to ADT prescribing in the UK and eight in Italy. The role of guidance and evidence, the cancer care setting, the patients and the urologist's beliefs and experiences were identified as areas that were influential to ADT prescribing before surgery. Twenty‐one similarities and 22 differences between the UK and Italy, for usual and COVID‐19 practice, were identified across these 10 domains. Conclusion Similarities and differences influencing ADT prescribing prior to surgery should be considered in behavioural strategy development and tailoring to reduce inappropriate ADT use. We gained an understanding of usual, undistributed care and resource‐limited or disrupted care due to COVID‐19 in two European countries. This gives an indication of how influences on ADT prescribing may change in future resource‐limited circumstances and where efforts can be focused now and in future.

Abstract Background Higher cruciferous vegetable intake is associated with lower cardiovascular disease risk in observational studies. The pathways involved remain uncertain. We aimed to determine whether cruciferous vegetable intake (active) lowers 24-h brachial systolic blood pressure (SBP; primary outcome) compared to root and squash vegetables (control) in Australian adults with mildly elevated BP (SBP 120–160 mmHg inclusive). Methods In this randomized, controlled, crossover trial, participants completed two 2-week dietary interventions separated by a 2-week washout. Cruciferous vegetables were compared to root and squash vegetables (~ 300 g/day) consumed with lunch and dinner meals. Participants were blinded to which interventions were the active and control. Adherence was assessed using food diaries and biomarkers (S-methyl cysteine sulfoxide (SMCSO, active) and carotenoids (control)). Twenty-four-hour brachial ambulatory SBP and secondary outcomes were assessed pre- and post each intervention. Differences were tested using linear mixed effects regression. Results Eighteen participants were recruited (median (IQR) age: 68 (66–70); female: n = 16/18; mean ± SD clinic SBP: 135.9 ± 10.0 mmHg). For both interventions, 72% participants had 100% adherence (IQR: 96.4–100%). SMCSO and carotenoids were significantly different between interventions (mean difference active vs. control SMCSO: 22.93 mg/mL, 95%CI 15.62, 30.23, P

Buffalo is a rustic animal; it can adapt and survive in various environments with different topography, climate and vegetation, and has a greater longevity than cattle. The high resistance to parasites, as well as the ability to improve the efficiency of feed consumption in case of forage shortage, means that even in marshy territories, where any other type of livestock or agricultural activity is impossible, buffalo farming can develop an economy. This review aims to present the key research topics, the evolution and geographic distribution of literature on buffalo welfare, and to underscore potentiality and existing knowledge gaps. A comprehensive search on the Scopus bibliometric database was carried out using various welfare-related keywords such as: ‘buffalo welfare’, ‘buffalo calf welfare’ and ‘buffalo heifers’ welfare’. The research identified 308 papers published in English from January 1992 to December 2023 that, after filtering, became 148 eligible records. Descriptive statistics revealed a significant exponential increase in studies on buffalo welfare since 2020, particularly in Italy, followed by Brazil. Text mining and topic analysis revealed that the most frequently mentioned terms were ‘milk’, ‘water’, ‘behaviour’, ‘farm’ and ‘stun’, confirming the role and the importance of this species in dairy production. Nine identified topics span diverse subject areas such as ‘slaughter process’, ‘dairy production’, ‘general welfare’, ‘housing system’, ‘heat stress’, ‘reproduction performance’, ‘health status’ ‘breeding management’, and ‘stress evaluation’. Although academia shows an increasing interest in buffalo behaviour and welfare, continued research is necessary to fully comprehend how to ensure the welfare of this important species.

AbstractAdult horses are susceptible to equine coronavirus (ECoV) and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), although, only ECoV has been linked to clinical disease. Little information is available regarding the seroprevalence against ECoV and SARS-CoV-2 in adult healthy horses. The goal of the present study was to determine the seroprevalence against two coronaviruses known to infect horses using convenience samples collected from horses recently imported from Europe to the United States from 2019 to 2023. A total of 385 banked serum samples were tested against ECoV and SARS-CoV-2 using previously validated ELISA assays. Prevalence factors including date of arrival in the United States, signalment and country of origin were available for the majority of the horses. A total of 9/385 (2.3%) and 4/385 (1.0%) horses tested seropositive for ECoV and SARS-CoV-2, respectively. The ECoV seropositive horses were all mares, ages 4 to 26 years (median 9 years) and originated from Germany, the Netherlands, Ireland, Belgium and Italy. These mares were predominantly imported during the summer and fall months. All SARS-CoV-2 seropositive horses were mares ages 5 to 10 years (median 7.5 years) imported from the Netherlands and the United Kingdom. The majority of the SARS-CoV-2 seropositive horses were imported during the colder months of the year. The study results support the presence of ECoV in Europe and report on the first SARS-CoV-2 seropositive healthy adult horses outside the United States. Commingling for movements by air and close contact to humans may predispose transmission with ECoV and SARS-CoV-2, respectively.

Summary: Despite extensive global research into genetic predisposition for severe COVID-19, knowledge on the role of rare host genetic variants and their relation to other risk factors remains limited. Here, 52 genes with prior etiological evidence were sequenced in 1,772 severe COVID-19 cases and 5,347 population-based controls from Spain/Italy. Rare deleterious TLR7 variants were present in 2.4% of young (

Abstract Background Dilated cardiomyopathy (DCM) is an etiologically heterogeneous group of diseases of the myocardium. With the rapid evolution in laboratory investigations, genetic background is increasingly determined including many genes with variable penetrance and expressivity. Biallelic NEXN variants are rare in humans and associated with poor prognosis: fetal and perinatal death or severe DCMs in infants. Case presentation We describe two male infants with prenatal diagnosis of dilated cardiomyopathy with impaired ventricular contractility. One of the patients showed hydrops and polyhydramnios. Postnatally, a DCM with severely reduced systolic function was confirmed and required medical treatment. In patient 1, Whole Exome Sequencing (WES) revealed a homozygous NEXN variant: c.1156dup (p.Met386fs) while in patient 2 a custom Next Generation Sequencing (NGS) panel revealed the homozygous NEXN variant c.1579_1584delp. (Glu527_Glu528del). These NEXN variants have not been previously described. Unlike the unfavorable prognosis described for biallelic NEXN variants, we observed in both our patients a favorable clinical course over time. Conclusion This report might help to broaden the present knowledge regarding NEXN biallelic variants and their clinical expression. It might be worthy to consider the inclusion of the NEXN gene sequencing in the investigation of pediatric patients with DCM.

Abstract The larvae of Neuroptera are predators that feed by injecting bioactive compounds into their prey and then suctioning the fluids through modified mouthparts. We explore the evolutionary history of this feeding structure through the examination of a new fossil larva preserved in Late Cretaceous Kachin amber, which we describe as new genus and species, Electroxipheus veneficus gen et sp. nov. X-ray phase-contrast microtomography enabled us to study the anatomy of the larva in 3D, including the structure of the mouthparts and that of the venom delivery system. The specimen exhibited a unique combination of morphological traits not found in any known fossil or extant lacewing, including an unusual structure of the antenna. Phylogenetic analyses, incorporating a selection of living and fossil larval Neuroptera and enforcing maximum parsimony and Bayesian inference, identified the larva as belonging to the stem group Mantispoidea. The larva shows that the anatomy of the feeding and venom-delivery apparatus has remained unchanged in Neuroptera from the Cretaceous to the present. The morphology of the specimen suggests that it was an active predator, in contrast with the scarcely mobile, specialized relatives, like mantispids and berothids.

Abstract Movement disorders, such as Parkinson’s disease, essential tremor, and dystonia, are characterized by their predominant motor symptoms, yet diseases causing abnormal movement also encompass several other symptoms, including non-motor symptoms. Here we review recent advances from studies of brain lesions, neuroimaging, and neuromodulation that provide converging evidence on symptom-specific brain networks in movement disorders. Although movement disorders have traditionally been conceptualized as disorders of the basal ganglia, cumulative data from brain lesions causing parkinsonism, tremor and dystonia have now demonstrated that this view is incomplete. Several recent studies have shown that lesions causing a given movement disorder occur in heterogeneous brain locations, but disrupt common brain networks, which appear to be specific to each motor phenotype. In addition, findings from structural and functional neuroimaging in movement disorders have demonstrated that brain abnormalities extend far beyond the brain networks associated with the motor symptoms. In fact, neuroimaging findings in each movement disorder are strongly influenced by the constellation of patients’ symptoms that also seem to map to specific networks rather than individual anatomical structures or single neurotransmitters. Finally, observations from deep brain stimulation have demonstrated that clinical changes, including both symptom improvement and side effects, are dependent on the modulation of large-scale networks instead of purely local effects of the neuromodulation. Combined, this multimodal evidence suggests that symptoms in movement disorders arise from distinct brain networks, encouraging multimodal imaging studies to better characterize the underlying symptom-specific mechanisms and individually tailor treatment approaches.

Abstract Thousands of disease cases and hundreds of deaths occur globally each year due to invasive meningococcal disease. Neisseria meningitidis serogroup B (MenB) is the leading cause of such disease in developed countries. Two vaccines, 4CMenB and MenB‐fHbp, that protect against MenB are available and include one or two forms respectively of factor H binding protein (fHbp), a key protective antigen. Studies of circulating meningococci have identified over 1380 different fHbp amino acid sequences, which form three immunologically distinct clusters, termed variants 1, 2, and 3. Neither of the current vaccines contains a variant 2 antigen, which is less well characterized than fHbp variants 1 and 3. We characterized the interaction of fHbp variant 2 with humAb 1B1 using biochemical methods and live meningococcal assays. Further, we determined the crystal structure of the complex at 2.4 Å resolution, clearly revealing the epitope and providing the first detailed report of an antibody with distinct specificity for fHbp variant 2. Extensive mutagenesis and binding studies elucidated key hotspots in the interface. This combination of structural and functional studies provides a molecular explanation for the bactericidal potency and specificity of humAb 1B1 for fHbp variant 2. Our studies, focused on fHbp variant 2, expand the understanding of this previously under characterized group of the vast family of variants of fHbp, a virulence factor present on all meningococci. Moreover, the definition of a protective conformational epitope on fHbp variant 2 may support the design and development of novel variant 2‐containing MenB vaccines affording greater breadth of protection.

Background and Aims: We aimed to characterize the epidemiologic and comorbidities profiles of patients with chronic Hepatitis D (CHD) followed in clinical practice in Italy and explored their interferon (IFN) eligibility. Methods: This was a cross-sectional study of the PITER cohort consisting of consecutive HBsAg-positive patients from 59 centers over the period 2019-2023. Multivariable analysis was performed by logistic regression model. Results: Of 5492 HBsAg-positive enrolled patients, 4152 (75.6%) were screened for HDV, 422 (10.2%) were anti-HDV positive. Compared with HBsAg mono-infected, anti-HDV positive patients were more often younger, non-Italians, with a history of drug use, had elevated alanine transaminase (ALT), cirrhosis, or hepatocellular carcinoma (HCC). Compared with Italians, anti-HDV positive non-Italians were younger (42.2% age ≤ 40 years vs. 2.1%; P < 0.001), more often females (males 43.0% vs. 68.6%; P < 0.001) with less frequent cirrhosis and HCC. HDV-RNA was detected in 63.2% of anti-HDV-positive patients, who were more likely to have elevated ALT, cirrhosis, and HCC. Extrahepatic comorbidities were present in 47.4% of anti-HDV positive patients and could affect the eligibility of IFN-containing therapies in at least 53.0% of patients in care. Conclusions: CHD affects young, foreign-born patients and older Italians, of whom two-thirds had cirrhosis or HCC. Comorbidities were frequent in both Italians and non-Italians and impacted eligibility for IFN.

Abstract Background Thyroid diseases are one of the most common health problems worldwide. Although they represent a necessary step in order to perform thyroidectomy, hyperextension of the neck can potentially increase postoperative pain. The aim of this study is to determine a correlation between the degree of neck hyperextension on the operative table and the postoperative pain in patients undergoing open thyroidectomy. Methods Patients were prospectively enrolled from the cohort of patients operated at the Endocrine Surgery Unit of the University Hospital of Pisa, between May and July 2021. Both of patients who underwent total thyroidectomy or hemi-thyroidectomy were recruited. The following data were analysed in order to find a correlation with postoperative pain at 24 h: age, gender, type of surgery, BMI, operative time, and degree of neck extension. Results Overall, 195 patients were enrolled. A direct, statistically significant correlation emerged between the degree of neck hyperextension and the postoperative pain 24 h after surgery, regardless of the pain of the surgical wound (p

Background/Objective: Witness’ interviews within a judicial investigation represent a complex procedure because human memory is subjected to suggestions and personal re-elaboration processes. Therefore, it is necessary to use an interview method that guarantees the accuracy of the testimony. Method: This research focused on the development a modified version of the Cognitive Interview based on the use of the five Ws (who, what, where, when and why), commonly used in journalism, which we named the 5Ws-CI. The goal of the present study is to compare this method with two interrogation techniques already present in the literature, the Enhanced Cognitive Interview (ECI) and the Cognitive Interview with the Category Clustering Recall (CCR) and to test the moderating role of Machiavellianism. Seventy-two subjects individually watched a video-clip of a robbery and were randomly assigned to one of the three interview groups (ECI, CCR-CI, or 5Ws-CI) and the veracity condition (truth tellers vs. lie tellers). Results: Subjects in the 5Ws-CI and CCR groups remembered significantly more information than subjects in the ECI condition, without impacting on accuracy. Also, truth tellers reported more details than lie tellers. No significant difference was found between the 5Ws-CI and CI-CCR interview groups. Conclusions: In conclusion, the results indicate that the 5Ws-CI and CCR techniques might be effective methods and outperform the ECI.

Abstract Carbon is considered to exist in three basic forms: diamond, graphite/graphene/fullerenes, and carbyne, which differ in a type of atomic orbitals hybridization. Since several decades the existence of the fourth basic carbon allotropic form with the face-centered cubic (fcc) crystal lattice has been a matter of discussion despite clear evidence for its laboratory synthesis and presence in nature. Here, we obtain this carbon allotrope in form of epitaxial films on diamond in a quantity sufficient to perform their comprehensive studies. The carbon material has an fcc crystal structure, shows a negative electron affinity, and is characterized by a peculiar hybridization of the valence atomic orbitals. Its bandgap (~6 eV) is typical for insulators, whereas the noticeable electrical conductivity (~0.1 S m−1) increases with temperature, which is typical for semiconductors. Ab initio calculations explain this apparent contradiction by noncovalent sharing p-electrons present in the uncommon valence band structure comprising an intraband gap. This carbon allotrope can create a new pathway to ‘carbon electronics’ as the first intrinsic semiconductor with an ultra-wide bandgap.

Abstract The Stöber method is a widely-used sol-gel route for synthesizing amorphous SiO2 colloids and conformal coatings. However, the material systems compatible with this method are still limited. Herein, we have extended the approach to metal-organic frameworks (MOFs) and coordination polymers (CPs) by mimicking the Stöber method. We introduce a general synthesis route to amorphous MOFs or CPs by making use of a base-vapor diffusion method, which allows to precisely control the growth kinetics. Twenty-four different amorphous CPs colloids were successfully synthesized by selecting 12 metal ions and 17 organic ligands. Moreover, by introducing functional nanoparticles (NPs), a conformal amorphous MOFs coating with controllable thickness can be grown on NPs to form core-shell colloids. The versatility of this amorphous coating technology was demonstrated by synthesizing over 100 core-shell composites from 20 amorphous CPs shells and over 30 different NPs. Besides, various multifunctional nanostructures, such as conformal yolk-amorphous MOF shell, core@metal oxides, and core@carbon, can be obtained through one-step transformation of the core@amorphous MOFs. This work significantly enriches the Stöber method and introduces a platform, enabling the systematic design of colloids exhibiting different level of functionality and complexity.

Abstract Background Quantitative techniques such as T2 and T1ρ mapping allow evaluating the cartilage and meniscus. We evaluated multi-interleaved X-prepared turbo-spin echo with intuitive relaxometry (MIXTURE) sequences with turbo spin-echo (TSE) contrast and additional parameter maps versus reference TSE sequences in an in situ model of human cartilage defects. Methods Standardized cartilage defects of 8, 5, and 3 mm in diameter were created in the lateral femora of ten human cadaveric knee specimens (81 ± 10 years old; nine males, one female). MIXTURE sequences providing proton density-weighted fat-saturated images and T2 maps or T1-weighted images and T1ρ maps as well as the corresponding two- and three-dimensional TSE reference sequences were acquired before and after defect creation (3-T scanner; knee coil). Defect delineability, bone texture, and cartilage relaxation times were quantified. Appropriate parametric or non-parametric tests were used. Results Overall, defect delineability and texture features were not significantly different between the MIXTURE and reference sequences (p ≤ 0.47). After defect creation, relaxation times significantly increased in the central femur (T2pre = 51 ± 4 ms [mean ± standard deviation] versus T2post = 56 ± 4 ms; p = 0.002) and all regions combined (T1ρpre = 40 ± 4 ms versus T1ρpost = 43 ± 4 ms; p = 0.004). Conclusions MIXTURE permitted time-efficient simultaneous morphologic and quantitative joint assessment based on clinical image contrasts. While providing T2 or T1ρ maps in clinically feasible scan time, morphologic image features, i.e., cartilage defects and bone texture, were comparable between MIXTURE and reference sequences. Relevance statement Equally time-efficient and versatile, the MIXTURE sequence platform combines morphologic imaging using familiar contrasts, excellent image correspondence versus corresponding reference sequences and quantitative mapping information, thereby increasing the diagnostic value beyond mere morphology. Key points • Combined morphologic and quantitative MIXTURE sequences are based on three-dimensional TSE contrasts. • MIXTURE sequences were studied in an in situ human cartilage defect model. • Morphologic image features, i.e., defect delineabilty and bone texture, were investigated. • Morphologic image features were similar between MIXTURE and reference sequences. • MIXTURE allowed time-efficient simultaneous morphologic and quantitative knee joint assessment. Graphical Abstract

Abstract Intra-abdominal infections (IAIs) are common surgical emergencies and are an important cause of morbidity and mortality in hospital settings, particularly if poorly managed. The cornerstones of effective IAIs management include early diagnosis, adequate source control, appropriate antimicrobial therapy, and early physiologic stabilization using intravenous fluids and vasopressor agents in critically ill patients. Adequate empiric antimicrobial therapy in patients with IAIs is of paramount importance because inappropriate antimicrobial therapy is associated with poor outcomes. Optimizing antimicrobial prescriptions improves treatment effectiveness, increases patients’ safety, and minimizes the risk of opportunistic infections (such as Clostridioides difficile) and antimicrobial resistance selection. The growing emergence of multi-drug resistant organisms has caused an impending crisis with alarming implications, especially regarding Gram-negative bacteria. The Multidisciplinary and Intersociety Italian Council for the Optimization of Antimicrobial Use promoted a consensus conference on the antimicrobial management of IAIs, including emergency medicine specialists, radiologists, surgeons, intensivists, infectious disease specialists, clinical pharmacologists, hospital pharmacists, microbiologists and public health specialists. Relevant clinical questions were constructed by the Organizational Committee in order to investigate the topic. The expert panel produced recommendation statements based on the best scientific evidence from PubMed and EMBASE Library and experts’ opinions. The statements were planned and graded according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) hierarchy of evidence. On November 10, 2023, the experts met in Mestre (Italy) to debate the statements. After the approval of the statements, the expert panel met via email and virtual meetings to prepare and revise the definitive document. This document represents the executive summary of the consensus conference and comprises three sections. The first section focuses on the general principles of diagnosis and treatment of IAIs. The second section provides twenty-three evidence-based recommendations for the antimicrobial therapy of IAIs. The third section presents eight clinical diagnostic-therapeutic pathways for the most common IAIs. The document has been endorsed by the Italian Society of Surgery.

Thermal atomic layer deposition (ALD) is used for the first time to deposit iron‐nickel oxides onto carbon nanotubes in a ternary process to produce a wide range of mixed oxide thin films. When using ferrocene (FeCp2) and nickelocene (NiCp2) with ozone (O3) as metals and oxygen sources, respectively, a competition between the metal precursors and the growth modes is observed. Indeed, while ferrocene promotes a 2D‐growth, nickelocene prefers a 3D‐growth. Although both precursors are homoleptic metallocenes, they behave differently in the ALD of their respective metal oxide, leading to unexpected atomic ratios and films morphologies of the iron‐nickel oxides. The 2Fe:1Ni sample displays the best performances in the electrochemical water oxidation (oxygen evolution reaction) exhibiting an overpotential of 267 mV at a current density of 10 mA cm−1, a Tafel slope of 36.8 mV dec−1, as well as a good stability after 15 h of continuous operation.

Background and AimsThe risk of disease progression in MASH increases proportionally to the pathological stage of fibrosis. This latter is evaluated through a semi-quantitative process, which has limited sensitivity in reflecting changes in disease or response to treatment. This study aims to test the clinical impact of Artificial Intelligence (AI) in characterizing liver fibrosis in MASH patients.MethodsThe study included 60 patients with clinical pathological diagnosis of MASH. Among these, 17 received a medical treatment and underwent a post-treatment biopsy. For each biopsy (n = 77) a Sirius Red digital slide (SR-WSI) was obtained. AI extracts >30 features from SR-WSI, including estimated collagen area (ECA) and entropy of collagen (EnC).ResultsAI highlighted that different histopathological stages are associated with progressive and significant increase of ECA (F2: 2.6% ± 0.4; F3: 5.7% ± 0.4; F4: 10.9% ± 0.8; p: 0.0001) and EnC (F2: 0.96 ± 0.05; F3: 1.24 ± 0.06; F4: 1.80 ± 0.11, p: 0.0001); disclosed the heterogeneity of fibrosis among pathological homogenous cases; revealed post treatment fibrosis modification in 76% of the cases (vs 56% detected by histopathology).ConclusionAI characterizes the fibrosis process by its true, continuous, and non-categorical nature, thus allowing for better identification of the response to anti-MASH treatment.

Synthetic genetic oscillators can serve as internal clocks within engineered cells to program periodic expression. However, cell-to-cell variability introduces a dispersion in the characteristics of these clocks that drives the population to complete desynchronization. Here, we introduce the optorepressilator, an optically controllable genetic clock that combines the repressilator, a three-node synthetic network in E. coli, with an optogenetic module enabling to reset, delay, or advance its phase using optical inputs. We demonstrate that a population of optorepressilators can be synchronized by transient green light exposure or entrained to oscillate indefinitely by a train of short pulses, through a mechanism reminiscent of natural circadian clocks. Furthermore, we investigate the system’s response to detuned external stimuli observing multiple regimes of global synchronization. Integrating experiments and mathematical modeling, we show that the entrainment mechanism is robust and can be understood quantitatively from single cell to population level.

Natural hazards hold the potential to impact technological infrastructure, triggering multiple disasters and exposing both the population and the environment at risk. The continuous rise in carbon emissions from anthropogenic activities has led to an escalating climate change crisis, contributing to increased frequency and severity of Natech (Natural Hazard-Triggered Technological Disasters) scenarios. These scenarios pose significant threats to critical infrastructure, including Carbon Capture and Storage (CCS) plants. CCS serves as a crucial short-term decarbonization solution able to combact global warming. However, climate change-related extreme weather events may cause Natech scenarios in CCS facilities, compromising equipment integrity and releasing stored carbon dioxide (CO2) and other substances. This exacerbates global warming, contaminates flood waters, or induces fire. The intricate link between climate change, Natech events, and resilient CCS infrastructure underscores the importance of climate change mitigation and adaptation strategies. Given the lack of literature regarding Natech scenarios affecting CCS plants, this paper investigates the CCS value chain with the objective of identifying vulnerable components to potential natural events. An inherent safety approach is applied to assess how risk increases considering natural events as potential causes of equipment failure. This study on Natech risks in CCS plants aims to enhance environmental protection, secure critical infrastructure, and foster a resilient, sustainable future.

Hydrogen is assuming a pivotal role in the energy sector, intending to lead the decarbonization and overcome the fossil fuel use. In evaluating its key applications, the role of hydrogen in mobility stands out. It could transform one of the most polluting sectors, drastically reducing emissions without changing the drivers’ needs. In this perspective, the focus should be placed on hydrogen refueling infrastructures, which are a key factor, along with fuel cell vehicles, for extending the hydrogen chain in the mobility sector. Given this, the study analyzes the hydrogen refueling station performance, investigating the hydrogen flow features, and estimating the evolution of pressure and temperature within the vehicle tank. An ad-hoc model for hydrogen performance analysis is used by customizing its main blocks. In addition, the main safety aspects of the hydrogen refueling stations are evaluated. The behavior of each component of the refueling infrastructure, such as hydrogen storage tanks, compressors, and cooling systems, is examined and introduced in the model, characterizing the whole system. The model is then validated by comparing its performance with experimental data. The results show the pressure, temperature, and mass flow rate between the dispenser and the vehicle tank. These findings could help boost hydrogen use in mobility since crucial aspects are investigated and important information is provided for promising integrated systems, based on the interconnection between infrastructures and vehicles.

Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are commonly used for glucose lowering and weight-loss. However, their association with gastrointestinal cancer remains uncertain. This meta-analysis assesses the risk of gastrointestinal cancer in patients treated with GLP-1 RAs. Methods: We searched Medline/PubMed, Embase, and Scopus databases from inception to November 15, 2023, for randomized controlled trials (RCTs) with at least 24 weeks of safety follow-up. Pooled risk ratios (RRs) were calculated using fixed- and random-effect models. Risk of bias was assessed using the revised Cochrane risk-of-bias tool, and certainty of evidence was determined using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Results: We included 90 RCTs with 124,791 participants, with an average follow-up of 3.1 years per participant. No significant association was found between GLP-1 RAs and the risk of any gastrointestinal cancer (RRrandom=0.99, 95 % CI: 0.86−1.13), or site-specific gastrointestinal cancers including biliary tract (RR=0.98, 0.54−1.78), colorectal (RR=1.13, 0.92−1.39), gallbladder (RR=1.32, 0.43−4.00), gastric (RR=0.88, 0.58−1.33), hepatic (RR=0.79, 0.51−1.21), oesophageal (RR=0.70, 0.38−1.28), pancreatic (RR=1.05, 0.77−1.43), and small intestine cancer (RR=0.78, 0.20−3.04). The corresponding absolute risk differences excluded important impacts on risk. Additional analyses, limited to placebo-controlled trials, high-dose studies, or those with a follow-up duration of ≥5 years, confirmed these findings. Risk of bias was generally low and the certainty of evidence was high for all outcomes. Conclusions: This meta-analysis found no significant impact of GLP-1 RAs on gastrointestinal cancer risk. Long-term safety monitoring of these agents remains important. Systematic review registration: CRD42023476762.

Ultrasound-assisted extraction of (poly)phenols from pumpkin pulp was optimized using response surface methodology. Time, solvent-to-sample ratio and percentage of water in ethanol were considered and a full factorial design was applied. The optimized conditions (10 min; 30 mL/g; 50% water in ethanol) were used to isolate (poly)phenols from five pumpkin varieties (Hokkaido, Lunga di Napoli, Mantovana, Moscata di Provenza, Violina rugosa), collected for two successive years. Phenolic acids were the most abundant phenolic class (gallic acid up to 413.50 μg/g), even if differences were observed among varieties and harvesting years. Generally, Violina rugosa harvested in 2021 showed the highest total phenol content (7.59 mg gallic acid equivalents/g) and antioxidant properties (16.93 mg Trolox equivalents/g). All pumpkin variety exhibited antimicrobial activity within a concentration range of 1.95 to 250 μg/mL. In conclusion, the pumpkin pulp can be considered a promising natural source of (poly)phenols for the development of health-promoting products.

Leaf area index (LAI) is an important biophysical parameter describing vegetation. LAI is typically retrieved from optical remote sensing by empirical models relating LAI to vegetation indices, such as the Normalized Difference Vegetation Index (NDVI). As the relationship between LAI and NDVI is non-linear and crop type dependant, several specific empirical equations relating LAI to NDVI have been developed using field data. This study presented LAIr, an R package to derive LAI from NDVI data from the most comprehensive library of conversion equations. In the package, the range of functions differs on environmental factors, sensors, and vegetation types, allowing flexibility in choosing appropriate options based on specific application, scale of investigation and data availability. We illustrated the use of the package with a case study to compare a generic LAI product with specific NDVI-based LAI estimations. By leveraging empirical knowledge, LAIr enables accurate and context-specific estimation of LAI. The deployment of an open-source R package serves as a valuable tool for aiding researchers in selecting the most appropriate equations for conducting NDVI-to-LAI conversion.

Background Antibodies that target immune checkpoints such as cytotoxic T lymphocyte antigen 4 (CTLA-4), programmed cell death protein/ligand 1 (PD-1/PD-L1) are approved for treatment of multiple cancer types. Chemotherapy is often administered with immune checkpoint blockade (ICB) therapies that target CTLA-4 and/or PD-(L)1. ICB targeting other immune checkpoints such as lymphocyte activating gene-3 (LAG-3) has the potential to improve antitumor responses when combined with chemotherapy. Response to anti-PD-1 ICB is dependent on progenitor exhausted CD8+ T cells (TPEX) in the tumor, but it is unclear how chemotherapy alters TPEX proportions and phenotype.Methods Here we investigated whether sequential chemotherapy altered TPEX frequency and immune checkpoint expression in multiple murine tumor models.Results Two doses of two different anti-metabolite chemotherapies increased tumor infiltrating CD4+, and CD8+ TPEX expressing LAG-3 in multiple mouse models, which was not restricted to tumor antigen specific CD8+ T cells. To determine if LAG-3+tumor infiltrating lymphocytes (TILs) could be targeted to improve tumor control, we administered anti-LAG-3 and anti-PD-1 ICB after two doses of chemotherapy and found combination therapy generated robust antitumor responses compared with each agent alone. Both anti-LAG-3 and anti-PD-1 ICB with chemotherapy were required for the complete tumor regression observed.Conclusions Changes in immune checkpoint expression on TILs during chemotherapy administration informs selection of ICB therapies to combine with.

Abstract Rational design of efficient pH‐universal hydrogen evolution reaction catalysts to enable large‐scale hydrogen production via electrochemical water splitting is of great significance, yet a challenging task. Herein, Ru atoms in the Ru2P structure were replaced with M = Co, Ni, or Mo to produce M2−xRuxP nanocrystals. The metals show strong site preference, with Co and Ni occupying the tetrahedral sites and Ru the square pyramidal sites of the CoRuP and NiRuP Ru2P‐type structures. The presence of Co or Ni in the tetrahedral sites leads to charge redistribution for Ru and, according to density functional theory calculations, a significant increase in the Ru d‐band centers. As a result, the intrinsic activity of CoRuP and NiRuP increases considerably compared to Ru2P in both acidic and alkaline media. The effect is not observed for MoRuP, in which Mo prefers to occupy the pyramidal sites. In particular, CoRuP shows state‐of‐the‐art activity, outperforming Ru2P with Pt‐like activity in 0.5 M H2SO4 (η10 = 12.3 mV; η100 = 52 mV; turnover frequency (TOF) = 4.7 s−1). It remains extraordinarily active in alkaline conditions (η10 = 12.9 mV; η100 = 43.5 mV) with a TOF of 4.5 s−1, which is 4x higher than that of Ru2P and 10x that of Pt/C. Further increase in the Co content does not lead to drastic loss of activity, especially in alkaline medium, where, for example, the TOF of Co1.9Ru0.1P remains comparable to that of Ru2P and higher than that of Pt/C, highlighting the viability of the adopted approach to prepare cost‐efficient catalysts.

Background & Aims: Porto-sinusoidal vascular disorder (PSVD) is a group of vascular disorders characterized by lesions involving portal venules and sinusoids, irrespective of the presence of portal hypertension. Liver biopsy is essential for diagnosis. In a single-center study, we demonstrated high rates of PSVD in patients with persistently elevated gamma-glutamyltransferase (GGT). This multicenter study aims to establish PSVD prevalence in a larger dataset of individuals with persistent and unexplained GGT elevation, and to identify associated risk factors. Methods: The study included all patients who underwent liver biopsy for persistent and unexplained GGT elevation in five Italian hepatology units between March 2015 and December 2021. Results: A total of 144 patients met the inclusion criteria. The majority were males (76/144, 52.8%) and mean age was 51.9 years (range 19-74). Only 12 (8.3%) had liver stiffness measurements (LSM) >10 kPa, while 7 (4.8%) had ultrasound evidence of portal hypertension. Histological findings were consistent with PSVD in 96 patients (67%). Alternative diagnoses were steatohepatitis in 13 (9%), sarcoidosis in 3 (2%) and congenital hepatic fibrosis in 3 (2%) patients. Histological findings were non-specific in 29 (20%) patients. PSVD was associated with male sex (odds ratio [OR] 2.60, 95% CI 1.13-5.99), LSM

In four experiments, we examined whether pairs of truth tellers could be distinguished from pairs of lie tellers by taking advantage of the fact that only pairs of truth tellers can refer to shared events by using brief expressions (high-context communication style). In Experiments 1 and 2, pairs of friends and pairs of strangers pretending to be friends answered (i) questions they likely had expected to be asked (e.g., ‘How did you first meet’?) and (ii) unexpected questions (e.g., ‘First, describe a shared event in a few words. Then elaborate on it’). Pairs were interviewed individually (Experiment 1, N = 134 individuals) or collectively (Experiment 2, N = 130 individuals). Transcripts were coded for the verbal cues details, complications, plausibility, predictability, and overlap (Experiment 1 only) or repetitions (Experiment 2 only). In two lie detection experiments observers read the individual transcripts in Experiment 3 (N = 146) or the collective transcripts in Experiment 4 (N = 138). The verbal cues were more diagnostic of veracity and observers were better at distinguishing between truths and lies in the unexpected than in the expected questions condition, but only when the pair members were interviewed individually.

Both aryl and benzyl polybromides have gained significant importance as reactive building blocks in polymer and materials chemistry. Their preparation primarily relies on established synthetic methods using molecular bromine or N-bromosuccinimide, known for their reliability and effectiveness. However, from a sustainability perspective, these methods suffer from the generation of stoichiometric amounts of byproducts and often encounter selectivity troubles. To mitigate these issues, we extended the greener peroxide-bromide halogenation method, initially developed for monobromides, to afford aryl-cored polybromides in high yields. The same method can be employed in two variants modulated by light irradiation. This external switch can be used to selectively trigger side-chain or core halogenation.

Abstract Aim To examine the associations of a diet high in flavonoid-rich foods, as reflected by a “Flavodiet Score” (FDS), the major individual food contributors to flavonoid intake, and flavonoid subclasses with type 2 diabetes (T2D) risk in the UK Biobank cohort. Materials and methods Flavonoid intakes were estimated from ≥2 dietary assessments among 113,097 study participants [age at enrolment: 56 ± 8 years; 57% female] using the U.S Department of Agriculture (USDA) databases. Multivariable Cox proportional hazards models were used to investigate associations between dietary exposures and T2D. Results During 12 years of follow-up, 2628 incident cases of T2D were identified. A higher FDS (compared to lower [Q4 vs. Q1]), characterised by an average of 6 servings of flavonoid-rich foods per day, was associated with a 26% lower T2D risk [HR: 0.74 (95% CI: 0.66–0.84), ptrend =

Abstract Background Equine herpes virus type 1 (EHV‐1) infection in horses is associated with upper respiratory disease, neurological disease, abortions, and neonatal death. Review Question Does pharmacological therapy decrease either the incidence or severity of disease or infection caused by EHV‐1 in domesticated horses? Methods A systematic review was preformed searching AGRICOLA, CAB Abstracts, Cochrane, PubMed, Web of Science, and WHO Global Health Index Medicus Regional Databases to identify articles published before February 15, 2021. Selection criteria were original research reports published in peer reviewed journals, and studies investigating in vivo use of therapeutic agents for prevention or treatment of EHV‐1 in horses. Outcomes assessed included measures related to clinical outcomes that reflect symptomatic EHV‐1 infection or virus infection. We evaluated risk of bias and performed a GRADE evaluation of the quality of evidence for interventions. Results A total of 7009 unique studies were identified, of which 9 met the inclusion criteria. Two studies evaluated valacyclovir or small interfering RNAs, and single studies evaluated the use of a Parapoxvirus ovis‐based immunomodulator, human alpha interferon, an herbal supplement, a cytosine analog, and heparin. The level of evidence ranged between randomized controlled studies and observational trials. The risk of bias was moderate to high and sample sizes were small. Most studies reported either no benefit or minimal efficacy of the intervention tested. Conclusions and Clinical Importance Our review indicates minimal or limited benefit either as a prophylactic or post‐exposure treatment for any of the studied interventions in the mitigation of EHV‐1‐associated disease outcome.

Abstract Background Equine herpes virus type 1 (EHV‐1) infection in horses is associated with respiratory and neurologic disease, abortion, and neonatal death. Hypothesis Vaccines decrease the occurrence of clinical disease in EHV‐1‐infected horses. Methods A systematic review was performed searching multiple databases to identify relevant studies. Selection criteria were original peer‐reviewed research reports that investigated the in vivo use of vaccines for the prevention of disease caused by EHV‐1 in domesticated horses. Main outcomes of interest included pyrexia, abortion, neurologic disease, viremia, and nasal shedding. We evaluated risk of bias, conducted exploratory meta‐analyses of incidence data for the main outcomes, and performed a GRADE evaluation of the quality of evidence for each vaccine subtype. Results A total of 1018 unique studies were identified, of which 35 met the inclusion criteria. Experimental studies accounted for 31/35 studies, with the remainder being observational studies. Eight vaccine subclasses were identified including commercial (modified‐live, inactivated, mixed) and experimental (modified‐live, inactivated, deletion mutant, DNA, recombinant). Risk of bias was generally moderate, often because of underreporting of research methods, and sample sizes were small leading to imprecision in the estimate of the effect size. Several studies reported either no benefit or minimal vaccine efficacy for the primary outcomes of interest. Meta‐analyses revealed significant heterogeneity was present, and our confidence in the quality of evidence for most outcomes was low to moderate. Conclusions and Clinical Importance Our review indicates that commercial and experimental vaccines minimally reduce the incidence of clinical disease associated with EHV‐1 infection.

Abstract Equine herpesvirus‐1 (EHV‐1) is a highly prevalent and frequently pathogenic infection of equids. The most serious clinical consequences of infection are abortion and equine herpesvirus myeloencephalopathy (EHM). The previous consensus statement was published in 2009 and considered pathogenesis, strain variation, epidemiology, diagnostic testing, vaccination, outbreak prevention and control, and treatment. A recent survey of American College of Veterinary Internal Medicine large animal diplomates identified the need for a revision to this original consensus statement. This updated consensus statement is underpinned by 4 systematic reviews that addressed key questions concerning vaccination, pharmaceutical treatment, pathogenesis, and diagnostic testing. Evidence for successful vaccination against, or effective treatment of EHV‐1 infection was limited, and improvements in experimental design and reporting of results are needed in future studies of this important disease. This consensus statement also updates the topics considered previously in 2009.

Abstract Background Equine herpes virus type 1 (EHV‐1) infection in horses is associated with upper respiratory disease, neurological disease, abortions, and neonatal death. Objective To determine if there is an association between the level and duration of EHV‐1 viremia and either abortion or equine herpesvirus myeloencephalopathy (EHM) in domesticated horses? Methods A systematic review was performed searching numerous databases to identify peer reviewed reports that evaluated viremia and EHM, or viremia and abortion published before January 19, 2021. Randomized controlled trials and observational studies were assessed for risk of bias or publication quality. Results A total of 189 unique studies were identified, of which 34 met the inclusion criteria. Thirty studies evaluated viremia and neurologic outcomes including 4 observational studies. Eight experimental studies examined viremia and abortion, which used the Ab4 and OH03 virus strains or recombinant Ab4 derivatives. Incidence rates for both EHM and abortion in experimental studies varied among the studies as did the level of evidence. Viremia was generally detectable before the onset of either EHM or abortion. Risk of bias was generally low to moderate, sample sizes were small, and multiple studies reported negative outcome data. Conclusions and Clinical Importance The results of this study support that viremia is regularly present before EHM or abortion occurs. However, no inferences could be made about the relationship between the occurrence of either neurological signs or abortion and the magnitude or duration of viremia.

Abstract Background Equine herpesvirus type 1 (EHV‐1) infection is associated with upper respiratory disease, EHM, abortions, and neonatal death. Research Questions Are nasal secretions a more sensitive biological sample compared to blood for the detection of EHV‐1 infection? How long is EHV‐1 detectable after primary infection by PCR? Methods MedLine and Web of Science searches identified original peer‐reviewed reports evaluating nasal shedding and viremia using virus isolation methods or PCR published in English before October 9, 2023. Results Sixty experimental and 20 observational studies met inclusion criteria. EHV‐1 detection frequency by qPCR in nasal secretions and blood from naturally‐infected horses with fever and respiratory signs were 15% and 9%, respectively; qPCR detection rates in nasal secretions and blood from horses with suspected EHM were 94% and 70%, respectively. In experimental studies the sensitivity of qPCR matched or exceeded that seen for virus isolation from either nasal secretions or blood. Detection of nasal shedding typically occurred within 2 days after EHV‐1 inoculation with a detection period of 3 to 7 days. Viremia lasted 2 to 7 days and was usually detected ≥1 days after positive identification of EHV‐1 in nasal secretions. Nasal shedding and viremia decreased over time and remained detectable in some horses for several weeks after inoculation. Conclusions and Clinical Importance Under experimental conditions, blood and nasal secretions have similar sensitivity for the detection of EHV‐1 when horses are sampled on multiple consecutive days. In contrast, in observational studies detection of EHV‐1 in nasal secretions was consistently more successful.

Abstract Background The WHO highlight alcohol, tobacco, unhealthy food, and sugar-sweetened beverage (SSB) taxes as one of the most effective policies for preventing and reducing the burden of non-communicable diseases. This umbrella review aimed to identify and summarise evidence from systematic reviews that report the relationship between price and demand or price and disease/death for alcohol, tobacco, unhealthy food, and SSBs. Given the recent recognition as gambling as a public health problem, we also included gambling. Methods The protocol for this umbrella review was pre-registered (PROSPERO CRD42023447429). Seven electronic databases were searched between 2000–2023. Eligible systematic reviews were those published in any country, including adults or children, and which quantitatively examined the relationship between alcohol, tobacco, gambling, unhealthy food, or SSB price/tax and demand (sales/consumption) or disease/death. Two researchers undertook screening, eligibility, data extraction, and risk of bias assessment using the ROBIS tool. Results We identified 50 reviews from 5,185 records, of which 31 reported on unhealthy food or SSBs, nine reported on tobacco, nine on alcohol, and one on multiple outcomes (alcohol, tobacco, unhealthy food, and SSBs). We did not identify any reviews on gambling. Higher prices were consistently associated with lower demand, notwithstanding variation in the size of effect across commodities or populations. Reductions in demand were large enough to be considered meaningful for policy. Conclusions Increases in the price of alcohol, tobacco, unhealthy food, and SSBs are consistently associated with decreases in demand. Moreover, increasing taxes can be expected to increase tax revenue. There may be potential in joining up approaches to taxation across the harm-causing commodities.

Background and objective: The role of cytoreductive nephrectomy (CN) in the treatment of metastatic renal cell carcinoma (mRCC) has been called into question on the basis of clinical trial data from the tyrosine kinase inhibitor (TKI) era. Comparative analyses of CN for patients treated with immuno-oncology (IO) versus TKI agents are sparse. Our objective was to compare CN timing and outcomes among patients who received TKI versus IO therapy. Methods: This was a multicenter retrospective analysis of patients who underwent CN using data from the REMARCC (Registry of Metastatic RCC) database. The cohort was divided into TKI versus IO first-line therapy groups. The primary outcome was all-cause mortality (ACM). Secondary outcomes included cancer-specific mortality (CSM). Multivariable analysis was used to identify factors predictive for ACM and CSM. The Kaplan-Meier method was used to analyze 5-yr overall survival (OS) and cancer-specific survival (CSS) with stratification by primary systemic therapy and timing in relation to CN. Key findings and limitations: We analyzed data for 189 patients (148 TKI + CN, 41 IO +CN; median follow-up 23.2 mo). Multivariable analysis revealed that a greater number of metastases (hazard ratio [HR] 1.06; p = 0.015), greater primary tumor size (HR 1.10; p = 0.043), TKI receipt (HR 2.36; p = 0.015), and initiation of systemic therapy after CN (HR 1.49; p = 0.039) were associated with worse ACM. A greater number of metastases at diagnosis (HR 1.07; p = 0.011), greater primary tumor size (HR 1.12; p = 0.018), TKI receipt (HR 5.43; p = 0.004), and initiation of systemic therapy after CN (HR 2.04; p

For the Western Indian Ocean region, there is a significant knowledge gap regarding marine turtle nesting on the continental coast of East Africa. Here we present results from a long-term (2000–2020) community-based monitoring programme in and around Watamu Marine National Park, Kenya, covering 30 km of coastline (c. 6% of the national total). Conservation actions effectively protected nesting turtles and resulted in a near-total cessation of illegal egg harvesting in Watamu Marine National Park. Collected data indicate this is an important marine turtle nesting index site in Kenya and the wider region. Green turtle Chelonia mydas nests were most common (95%), followed by olive ridley turtles Lepidochelys olivacea (4%), with occasional nests of hawksbill Eretmochelys imbricata and leatherback turtles Dermochelys coriacea. Clutches per season increased significantly over the 20-year monitoring period for green turtles (50%) and showed a positive trend for olive ridley turtles. Watamu remains an area at risk from human pressures such as coastal development. Clutch distribution along the Watamu Marine National Park beach has shifted over time, probably because of coastal development and disturbance. Illegal take of adults and eggs continues in areas north and south of the Watamu Marine National Park, possibly slowing rates of recovery. Clutches deemed at risk were moved to a safe location within the National Park, and hatching success was high. Continued conservation efforts, including wider engagement with stakeholders to reduce human pressures, are needed to ensure the perpetuation of this nesting site.

Background and objective: Renal tumour biopsy (RTB) can help in risk stratification of renal tumours with implications for management, but its utilisation varies. Our objective was to report current practice patterns, experiences, and perceptions of RTB and research gaps regarding RTB for small renal masses (SRMs). Methods: Two web-based surveys, one for health care providers (HCPs) and one for patients, were distributed via the European Association of Urology Young Academic Urologist Renal Cancer Working Group and the European Society of Residents in Urology in January 2023. Key findings and limitations: The HCP survey received 210 responses (response rate 51%) and the patient survey 54 responses (response rate 59%). A minority of HCPs offer RTB to >50% of patients (14%), while 48% offer it in

Here, we introduce the EpiConnect Intelligence Platform (ECIP), a platform facilitating rapid, transparent data sharing and analysis to support researchers and public health officials in Europe, with a focus on Italy. ECIP provides reliable, concise, machine-readable data to aid in epidemiological understanding, standardize case characteristics, and estimate key parameters. The platform adheres to FAIR (findable, accessible, interoperable, reusable) principles, offering easily accessible and downloadable datasets for researchers’ endeavors. Future enhancements include involving national public health authorities, expanding data streams, and fostering collaboration between experts and users for improved epidemic risk monitoring. Shared standards among diverse surveillance systems are advocated to achieve common strategic goals, emphasizing the need for forward-looking policies to empower professionals to analyze disease dynamics in the context of evolving health crises. The recent emergencies underscore the importance of collective efforts towards shared strategic goals, highlighting the necessity for coordinated action to address mutual concerns affecting everyone’s lives.

The evolutionary dynamics of viruses, particularly exemplified by SARS-CoV-2 during the ongoing COVID-19 pandemic, underscore the intricate interplay between genetics, host adaptation, and viral spread. This paper delves into the genetic evolution of SARS-CoV-2, emphasizing the implications of viral variants on global health. Initially emerging from the Wuhan-Hu-1 lineage, SARS-CoV-2 rapidly diversified into numerous variants, each characterized by distinct mutations in the spike protein and other genomic regions. Notable variants such as B.1.1.7 (α), B.1.351 (β), P.1 (γ), B.1.617.2 (δ), and the Omicron variant have garnered significant attention due to their heightened transmissibility and immune evasion capabilities. In particular, the Omicron variant has presented a myriad of subvariants, raising concerns about its potential impact on public health. Despite the emergence of numerous variants, the vast majority have exhibited limited expansion capabilities and have not posed significant threats akin to early pandemic strains. Continued genomic surveillance is imperative to identify emerging variants of concern promptly. While genetic adaptation is intrinsic to viral evolution, effective public health responses must be grounded in empirical evidence to navigate the evolving landscape of the pandemic with resilience and precision.