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This mixed-methods study examined 220 teachers' responses from a new instrument, the Imagination, Creativity, and Innovation (ICI) Index. ICI Index scores represented teachers' predictions of how students would rate their school's support for student creativity, which was assumed to represent the teachers' perspective of the actual support for student creativity at the school. Teachers of grades 6-8 (n = 55) had significantly lower ICI Index scores than teachers of grades 3-5 (n = 155; p = 0.03, g = 0.35). Regular classroom teachers (n = 151) did not differ significantly from gifted and talented teachers (n = 49) on their ICI scores (p = 0.065). Qualitative analysis found that, when asked to give examples of products, performances, and services produced by students that were points of pride, most teachers discussed their own creative teaching practices rather than student-initiated projects. Most major content areas were represented, and many responses were interdisciplinary. The most common audience was the school community. Time, including scheduled special periods, was commonly discussed as a support for creativity. Teachers with high ICI Index scores usually wrote about how the school community collaborated to provide creative opportunities to all students, whereas teachers with low ICI Index scores reported that support for student creativity was absent or limited to specific groups.

In response to economic distress, schools are increasingly serving as providers and distributors of social service resources. However, even when schools offer resources that respond to needs, they struggle to attain high levels of uptake. We examine the family-level correlates of participation in school-sponsored resources during the early months of the COVID-19 pandemic and find that uptake increases with economic need. In addition, net of need, families who report maintaining communication with parents of their children's classmates take up more resources; and take-up of key meal and digital technology resources is associated with higher levels of take-up of other resources. These findings contribute to efforts to reposition schools as social service hubs by highlighting promising practices to improve resource uptake.

Academic disciplines and professional fields need to engage in ongoing evaluation of their purposes and conceptual frameworks. The complex field of gifted education can benefit from such evaluations, and the refinements that can emerge from them. This article is a discussion between two of the most prominent scholars in the field. The discussion is based on a set of questions that cover much of the field's conceptual and practical territory. While answering the questions, the scholars also respond to each other. They address a wide range of phenomena in the field, including concerns pertaining to identification of the gifted, program development, instructional goals and processes, underrepresentation and other social justice issues, and the need for expansion of ethical awareness, among other topics. The discussion also is framed with some interdisciplinary concepts.

Accurate identification of prostate cancer Gleason grade group remains an important component of the initial management of clinically localized disease. However, Gleason score upgrading (GSU) from biopsy to radical prostatectomy can occur in up to a third of patients treated with surgery. Concern for disease undergrading remains a source of diagnostic uncertainty, contributing to both over-treatment of low-risk disease as well as under-treatment of higher-risk prostate cancer. This review examines the published literature concerning risk factors for GSU from time of biopsy to prostatectomy final pathology. Risk factors identified for Gleason upgrading include patient demographic and clinical factors including age, body mass index, race, prostate volume, and biomarker based assays, including prostate-specific antigen (PSA) density, and testosterone values. In addition, prostate magnetic resonance imaging (MRI) findings have also been associated with GSU. Biopsy-specific characteristics associated with GSU include lower number of biopsy cores and lack of targeted methodology, and possibly increasing percent biopsy core positivity. Recognition of risk factors for disease undergrading may prompt confirmatory testing including repeat sampling or imaging. Continued refinements in imaging guided biopsy techniques may also reduce sampling error contributing to undergrading.

Joseph S. Renzulli believes the purpose of gifted education is to increase the reservoir of creative and productive young people who will make innovative contributions to the arts, sciences, and all other areas of human knowledge and productivity and that these contributions will be guided toward making the world a better place for all people. He makes a distinction between what he calls lesson-learning giftedness and creative productive giftedness. While lesson-learning giftedness is all about learning the prescribed material, be able to demonstrate your learning by taking a test or through oral, written, artistic, dramatic, or some other form of expression; creative-productive giftedness is defined as those aspects of human activity and involvement where a premium is placed on the development of original ideas, material, and products that are purposefully designed to have an impact on one or more target audiences. The pedagogy discussed in the article is based on the role that knowledge plays in developing an investigative mindset, high levels of creative productivity, and how the integrated use of three levels of knowledge contribute to the major goal of gifted education.

International students have been a growing presence in U.S. higher education institutions for over a decade. Feelings of belonging play a crucial role in the adjustment of these students to campus life in American universities, and their conationals play a significant role in facilitating this adjustment process. However, the role of belonging and co-national communities in facilitating the persistence of international students toward and beyond degree attainment remains understudied. In our examination of the aspirations of 642 international students across 9 U.S. universities, we establish that stronger feelings of academic and social belonging are associated with a higher likelihood of aspiring to stay in the United States after graduation. In particular, we demonstrate the presence of an academic enclave effect wherein larger communities of co-nationals have a stronger influence on the aspirations of international students with low social belonging but does not affect the aspirations of socially well-integrated international students.

Introduction: Although the clinical benefits of pelvic lymph node dissection (PLND) at the time of radical prostatectomy for prostate cancer remain uncertain, major guidelines recommend PLND based on risk profile. Thus, the objective of this study was to examine the association between PLND and survival among patients undergoing RP stratified by Gleason grade group (GG) with the aim of allowing patients and physicians to make more informed care decisions about the potential risks and benefits of PLND. Materials and methods: From the SEER-17 database, we examined overall (OS) and prostate cancer-specific (PCSS) survival of prostate cancer patients who underwent RP from 2010 to 2015 stratified by GG. We applied propensity score matching to balance pre-operative characteristics including race, age, PSA, household income, and housing status (urban/rural) between patients who did and did not undergo PLND for each GG. Statistical analyses included log-rank test and Kaplan-Meier curves. Results: We extracted a matched cohort from 80,287 patients with GG1-5 who underwent RP. The median PSA value was 6.0 ng/mL, and the median age was 62-years-old. 49,453 patients underwent PLND (61.60%), while 30,834 (38.40%) did not. There was no difference in OS and PCSS between patients who received PLND and those who did not for all Gleason GG (OS–GG1: P = 0.20, GG2: P = 0.34, GG3: P > 0.05, GG4: P = 0.55, GG5: P = 0.47; PCSS–GG1: P = 0.11, GG2: P = 0.96, GG3: P = 0.81, GG4: P = 0.22, GG5: P = 0.14). Conclusions: In this observational study, PLND at the time of RP was not associated with improved OS or PCSS among patients with cGS of 3 + 3, 3 + 4, 4 + 3, 4 + 4, 4 + 5, and 5 + 4. These findings suggest that until definitive clinical trials are completed, prostate cancer patients who have elected RP should be appropriately counseled on the potential risks and lack of proven survival benefit of PLND.

Abstract Background Fermented soy products have shown to possess inhibitory effects on prostate cancer (PCa). We evaluated the effect of a fermented soy beverage (Q-Can®), containing medium-chain triglycerides, ketones and soy isoflavones, among men with localized PCa prior to radical prostatectomy. Methods We conducted a placebo-controlled, double-blind randomized trial of Q-Can®. Stratified randomization (Cancer of the Prostate Risk Assessment (CAPRA) score at diagnosis) was used to assign patients to receive Q-Can® or placebo for 2–5 weeks before RP. Primary endpoint was change in serum PSA from baseline to end-of-study. We assessed changes in other clinical and pathologic endpoints. The primary ITT analysis compared PSA at end-of-study between randomization arms using repeated measures linear mixed model incorporating baseline CAPRA risk strata. Results We randomized 19 patients, 16 were eligible for analysis of the primary outcome. Mean age at enrollment was 61, 9(56.2%) were classified as low and intermediate risk, and 7(43.8%) high CAPRA risk. Among patients who received Q-Can®, mean PSA at baseline and end-of-study was 8.98(standard deviation, SD 4.07) and 8.02ng/mL(SD 3.99) compared with 8.66(SD 2.71) to 9.53ng/mL(SD 3.03), respectively, (Difference baseline – end-of-study, p = 0.36). There were no significant differences in Gleason score, clinical stage, surgical margin status, or CAPRA score between treatment arms (p > 0.05), and no significant differences between treatment arms in end-of-study or change in lipids, testosterone and FACT-P scores (p > 0.05). Conclusions Short exposure to Q-Can® among patients with localized PCa was not associated with changes in PSA levels, PCa characteristics including grade and stage or serum testosterone. Due to early termination from inability to recruit, study power, was not achieved.

Providing challenging and engaging learning opportunities is one way to motivate students to learn. In this article, we discuss the contributions of the gifted education field to the development of enrichment pedagogy and identify several different types of these engaging instructional strategies, including interest-based learning pedagogy, differentiation and curriculum compacting, project-based learning, open-ended choice, and the application of creative productivity to students learning. We identify this specialized pedagogy and give examples of how these exciting pedagogical strategies can be implemented in classrooms and by enrichment specialists and school counselors, both for academically talented and for all students. We conclude with a brief overview of research that demonstrates longitudinal benefits for students who are exposed to this type of teaching, suggesting positive outcomes.

Hamdan Intelligence Scale (HIS) is the first intelligence scale that has been developed and normed in the United Arab Emirates (UAE). This study aimed to examine the refinement, validity, and reliability of HIS in upper elementary grades using the Rasch model. A total of 4,301 students (34.3% Male; 65.7% Female) from grade 4 to 6 (32.1% grade 4; 33.7% grade 5; 34.2% grade 6) were administered to the HIS. The confirmatory factor analysis was first conducted to verify the fitness of the one-factor model of the HIS. The results of validity showed strong correlation coefficients between the HIS and the Aurora-g battery (0.83) and the Raven’s Standard Progressive Matrices (RSPM; 0.86). Moreover, the results of the developmental trends demonstrated that raw scores of the HIS increase with age and grade relatively constantly across composite scores. Unidimensionality was confirmed through the Confirmatory Factor Analysis and Principal Component Analysis of Residuals (PCAR). The low eigenvalues of the first contrast were below 2, and additionally, the infit and outfit mean squares ranged from 0.88 to 1.14 and 0.84 to 1.14. Rasch’s person reliability result of 0.62 was acceptable reliability. The results provided strong support for the validity and reliability of using the Hamdan Intelligence Scale in the UAE environment.

Background & Aims: Sarcopenia is associated with increased morbidity and mortality in patients with cirrhosis, but its definition in current literature is very heterogeneous. We performed a systematic review and meta-analysis to assess the association between mortality and sarcopenia evaluated by computed tomography (CT) in patients with cirrhosis, both overall and stratified for the criteria used to define sarcopenia. Methods: Medline, Embase, Scopus, and Cochrane Library were searched up to January 2023. We included studies assessing sarcopenia presence with CT scans and providing data on the risk of mortality. Adjusted hazard ratios (HRs) and 95% CIs were pooled using a random-effects model. Results: Thirty-nine studies comprising 12,827 patients were included in the meta-analysis. The summary prevalence of sarcopenia was 44% (95% CI 38-50%). The presence of sarcopenia (any definition) was an independent predictor of mortality with an adjusted HR of 2.07 (95% CI 1.81-2.36), and the result was consistent in all subgroup analyses. The prognostic role of the EASL/AASLD criteria was confirmed for the first time with an HR of 1.86 (95% CI 1.53-2.26) (n = 14 studies). The cut-offs used to define sarcopenia based on psoas muscle parameters varied among studies, thus, a subgroup analysis was not feasible. There was no substantial heterogeneity for the main estimates and no significant risk of publication bias. Conclusions: Sarcopenia on CT is associated with a 2-fold higher risk of mortality in patients with cirrhosis. The cut-offs proposed by EASL/AASLD are prognostically relevant and should be the recommended criteria used to define sarcopenia in clinical practice. Impact and implications:: Sarcopenia assessed by the reference standard (computed tomography scan) is an independent predictor of mortality in patients with cirrhosis, with a 2-fold increase in the risk of death in all sensitivity analyses. This finding is particularly valid in patients from Europe and North America, and in transplant candidates. Stratifying for the parameters and cut-offs used, we confirmed for the first time the prognostic impact of the definition proposed by EASL/AASLD, supporting their use in clinical practice. Psoas muscle assessment is promising, but data are still limited and too heterogeneous to recommend its routine use at present.

Abstract Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Most people infected with the virus experience mild to moderate respiratory illness. However, some might become seriously ill and may develop acute respiratory distress syndrome (ARDS), thus requiring non-invasive or invasive mechanical ventilation. Furthermore, COVID-19 disease can involve also other organs and systems, causing several extra-pulmonary manifestations and, thus, negatively influencing the patient’s outcome. Imaging studies play a pivotal role in the monitoring of severely ill patients, especially those admitted to the intensive care unit (ICU), who can develop several potentially life-threatening complications, both from the infection itself and the mechanical supporting system. This widespread utility of imaging modalities calls for a deeper understanding of potential radiologic findings in this disease and the need for multidisciplinary collaboration between radiologists and anesthesiologists to provide actionable guidance to appropriate interventions under such conditions.

In this article, I describe a few personal favorite contributions of Dr. Marcia Gentry, one of the most successful graduates from our doctoral program at the University of Connecticut, as well as a dear friend and collaborator. Marcia focused her life's work on the need to serve underserved and often-neglected populations in our field and implemented programs for these students, focusing on positive change in schools and on reservations. She also developed innovative identification and programming practices to be used in schools as well as summer programs. Marcia's personalized boots-on-the-ground activities, research, and advocacy for numerous Native American students across the country helped develop gifts and talents in diverse groups. Her success in this area resulted in recent years in the application of the same know-how to leadership and change strategies with other diverse groups. Marcia's life's work earned her a place among the top leaders in our field and in this special issue, we celebrate her work and life.

First-generation immigrants (FGIs) are eager to achieve the American dream and acquire the advantages a bachelor's degree affords. FGIs compared to their second-generation, third-generation and native peers fare better educationally. But, this comparison obscures across racial variation within a single-nativity status. As such, it is important to understand what mechanisms might produce inequality in college access among FGIs. One mechanism may be differences in how schools support students for college-going. The content of support may vary if racial stereotypes affect how support is given. Such variations could be decisive for FGIs' educational trajectories. We find that Latinx and black FGIs are less likely than other FGIs to enroll in bachelor-degree programs. The content of school support is a mechanism that can help partially explain this differential for black FGIs. Our findings indicate that how schools support black FGIs for college-going is different and is likely at least implicitly racially biased.

In this article, I describe a series of Five Core Competencies that gifted education specialists should consider integrating into their teaching to respond to the many changes that are taking place in technology, work, and career preparation. Although the focus of this theory is on high- level jobs usually pursued by college graduates and advanced degree students, this work also has relevance for the general-education community because future employment at all levels will require various degrees of proficiency in the Core Competencies discussed below. Students who will pursue college degrees and professional level jobs will need to attain advanced levels of these skills, have the opportunity to explore a wide range of skills, and be able to learn them more rapidly. Students should be placed in learning situations that require the adaptability that is the theme of this article so that they will learn to apply the skills in ways that will lead to success in job-transformational situations. Leadership and advanced-level positions require high levels of both performance and flexibility in the competencies that will be discussed below. The Catch-A-Wave Theory of Adaptability will be introduced with the presentation of background information and a rationale for the theory. The theory itself along with the five Core Competencies included in the theory will follow and then be supplemented with a section that provides strategies and resources for developing those competencies.

Background: Traumatic pelvic injuries are associated with high injury severity scores and significant morbidity and mortality. Active bleeding is the most common cause of death among those patients. Due to limitations of surgery for pelvic hematomas, angiographic treatment is at the forefront of pelvic trauma management. Objective: The present article aims to discuss the available endovascular treatment modalities, and common angiographic treatment strategies and techniques. Conclusion: Interventional radiologists plays a key role in the management of patients with pelvic trauma. New standardized protocols are needed to minimize the time spent on deciding the correct treatment for each patient.

A man in his 40s presented to our Hospital with abdominal pain, jaundice, and pruritus. He had a history of Alagille Syndrome treated with cholecystojejunostomy in the neonatal period because of initial misdiagnosis of biliary atresia. Laboratory investigations showed hyperbilirubinemia (total bilirubin 1.76 mg/dL [

Abstract Background Polycystic ovary syndrome (PCOS) is the most prevalent, chronic endocrine-metabolic disorder of adolescents and young women (AYAs), affecting 5–10% of AYAs worldwide. There is no approved pharmacological therapy for PCOS. Standard off-label treatment with oral contraceptives (OCs) reverts neither the underlying pathophysiology nor the associated co-morbidities. Pilot studies have generated new insights into the pathogenesis of PCOS, leading to the development of a new treatment consisting of a fixed, low-dose combination of two so-called insulin sensitisers [pioglitazone (PIO), metformin (MET)] and one mixed anti-androgen and anti-mineralocorticoid also acting as an activator of brown adipose tissue [spironolactone (SPI)], within a single tablet (SPIOMET). The present trial will evaluate the efficacy, tolerability and safety of SPIOMET, on top of lifestyle measures, for the treatment of PCOS in AYAs. Methods In this multicentre, randomised, double-blind, placebo-controlled, four-arm, parallel-group, phase II clinical trial, AYAs with PCOS will be recruited from 7 clinical centres across Europe. Intention is to randomise a total of 364 eligible patients into four arms (1:1:1:1): Placebo, PIO, SPI + PIO (SPIO) and SPI + PIO + MET (SPIOMET). Active treatment over 12 months will consist of lifestyle guidance plus the ingestion of one tablet daily (at dinner time); post-treatment follow-up will span 6 months. Primary endpoint is on- and post-treatment ovulation rate. Secondary endpoints are clinical features (hirsutism, menstrual regularity); endocrine-metabolic variables (androgens, lipids, insulin, inflammatory markers); epigenetic markers; imaging data (carotid intima-media thickness, body composition, abdominal fat partitioning, hepatic fat); safety profile; adherence, tolerability and acceptability of the medication; and quality of life in the study participants. Superiority (in this order) of SPIOMET, SPIO and PIO will be tested over placebo, and if present, subsequently the superiority of SPIOMET versus PIO, and if still present, finally versus SPIO. Discussion The present study will be the first to evaluate—in a randomised, double-blind, placebo-controlled way—the efficacy, tolerability and safety of SPIOMET treatment for early PCOS, on top of a lifestyle intervention. Trial registration EudraCT 2021–003177-58. Registered on 22 December 2021. https://www.clinicaltrialsregister.eu/ctr-search/search?query=%092021-003177-58 .

The aim of the present study was to test a new oral contrast medium composed of natural components for the magnetic resonance (MR) imaging of small bowel diseases. Between January 2018 and June 2019, 35 patients affected by ileocolic Crohn’s disease (CD) were enrolled in the present study. Each patient underwent two sequential MR enterographies, first with the standard polyethylene glycol (PEG) water solution and, after 3 weeks, with the new natural beverage designed by our team. At the end of the administration of each oral contrast, a satisfaction survey was given to the patients to assess the palatability of both beverages. The intestinal distention and the quality of images were evaluated by two expert radiologists for both studies and the interreader agreement was calculated. According to the satisfaction questionnaire, 97.1% of patients expressed positive judgments regarding the natural beverage (71.4% very good and 25.7% good) whereas only 8.6% of them appreciated the PEG water solution (8.6% good) (p = 0.0001). The degree of intestinal distention was excellent and good in 97.1% of patients after the administration of PEG and in 94.3% of the patients after the administration of the natural beverage, without significant differences between the two products and with almost perfect (k = 0.821) and substantial (k = 0.754) inter-observer variability, respectively. No statistical differences were observed between the two expert radiologists regarding the evaluation of the imaging quality; in particular, they were considered good and excellent in 100% of patients after the administration of PEG water solution and in 97.2% of those who took the natural beverage, with substantial (k = 0.618) and almost perfect (k = 0.858) inter-observer variability, respectively. The new natural beverage demonstrated the same intestinal distension and excellent image quality compared to the synthetic standard oral contrast administered during MRE for small bowel diseases, proving to be a valid alternative with better palatability.

Objective: Multiple endocrine neoplasia type 4 (MEN4) is caused by a CDKN1B germline mutation first described in 2006. Its estimated prevalence is le ss than one per million. The aim of this study was to define the disease characteristics. Methods: A systematic review was performed according to the PRISMA 2020 criteria. A literature search from January 2006 to August 2022 was done using MEDLINE® and Web of ScienceTM. Results: Forty-eight symptomatic patients fulfilled the pre-defined eligi bility criteria. Twenty-eight different CDKN1B variants, mostly missense (21/48, 44%) and frameshift mutations (17/48, 35%), were reported. The majority of patients were women (36/48, 75%). Men became symptomatic at a median age of 32.5 years (ran ge 10–68, mean 33.7 ± 23), whereas the same event was recorded for women at a media n age of 49.5 years (range 5–76, mean 44.8 ± 19.9) (P = 0.25). The most frequently affected endocrine organ was the parathyroid gland (36/48, 75%; uniglandular disease 31/36, 86%), followed by the pituitary gland (21/48, 44%; hormone-secreting 16/21, 76%), the endocrine pancreas (7/48, 15%), and the thyroid gland (4/48, 8%). Tumors of the ad renal glands and thymus were found in three and two patients, respectively. The present ing first endocrine pathology concerned the parathyroid (27/48, 56%) and the pituit ary gland (11/48, 23%). There were one (27/48, 56%), two (13/48, 27%), three (3/48, 6%), or four (5/48, 10%) syn-or metachronously affected endocrine organs in a single patient, respectively. Conclusion: MEN4 is an extremely rare disease, which most frequently affect s women around 50 years of age. Primary hyperparathyroidism as a unigla ndular disease is the leading pathology.

This article describes the development of an instrument for examining schools as institutions where teaching practices and school structures provide opportunities and support for student imagination, creativity, and innovation, as well as initial comparisons using the instrument, using a sample of n = 5020 students and n = 268 teachers (n = 161 classes of students nested within teachers). The three five-item subscales show acceptable reliability across groups (0.73-0.90). Paired sample t tests indicate that, on average, students reported significantly more opportunities for creativity as compared to imagination or innovation. There were also significant differences between actual student reports and teachers' predictions only for creativity and innovation. Students reported more opportunities for creativity and innovation than their teachers predicted. However, students reported significantly less opportunity for imagination, creativity, and innovation than their teachers' ideals. Implications for subsequent research and practice are also discussed.

This article describes current attempts and steps to expand both services and research about gifted education and talent development programs and educational opportunities for academically talented students in Italy. The laws, procedures, and policies that have been essential to this process are described, as is the outcome, which is the implementation and use of the Schoolwide Enrichment Model as one viable method for developing students' talents and gifts in Italian schools.

Celem niniejszego artykułu jest przegląd badań naukowych dotyczących problematyki dobrostanu (well-being) uzdolnionych dzieci i młodzieży. Przyjęto procedurę przeglądu systematycznego w oparciu o protokół Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Page et al. 2021). Analizie poddano 15 artykułów opublikowanych w latach 2005–2022 w recenzowanych czasopismach naukowych. Analizy pokazały, że nie można jednoznacznie stwierdzić, czy uzdolnienia są czynnikiem ryzyka, czy też czynnikiem chroniącym dla subiektywnego poczucia dobrostanu dzieci i młodzieży uzdolnionej. Jednocześnie wyniki badań publikowane w większości analizowanych tekstów nie wskazały istotnych statystycznie różnic między poczuciem dobrostanu subiektywnego, jak i psychicznego uczniów uzdolnionych w porównaniu do uczniów o przeciętnych zdolnościach. W badaniach subiektywnego poczucia dobrostanu uzdolnionych dzieci i młodzieży wykorzystuje się szereg skal odnoszących się do różnych obszarów psychofizycznego funkcjonowania człowieka, np. nastroju, stresu, poczucia własnej skuteczności, zainteresowań, poczucia samotności, poczucia humoru, klimatu szkolnego, co pozwala na holistyczne spojrzenie na analizowane zjawisko.

This study is addressed at the cultural heritage of the UNESCO historical centre of Urbino (Italy) through the focus on a very peculiar building and ornamental carbonate porous (spongy) stone also found in the opus quadratum Roman dry walls. For these rocks, the mathematician and historian Bernardino Baldi (16th century AD) and the mineralogist Francesco Rodolico (middle of the 20th century AD) introduced, respectively, the popular terms of Tufo spugnoso or Pietra Spugna. Physical observations and stable isotope data (δ13C and δ18O) of these rocks allowed, for the first time, their classification as calcareous tufas, thus contributing to the valorization of the stone heritage of the city. This carbonate lithotype was formed by the chemical precipitation of CaCO3, driven by the CO2 degassing of supersaturated calcium-bicarbonate-rich waters, coupled with the passive encrustations of organic material in continental environments. Radiocarbon analyses dated these stones mostly between 9100 and 4700 yr. BP when a maximum growth of these carbonate continental deposits occurred in Mediterranean regions and northern Europe, i.e., during the Holocene Atlantic climatic optimum. Work is still in progress on a perched springline of calcareous tufas found along the Metauro Valley (a few km from Urbino), being good candidates for provenance, at least for those blocks exploited by the Romans and successively reused in the architectural framework of Urbino.

Abstract Volcanic rocks were among the most sought-after materials to produce grinding tools in antiquity because lavas lithologies, either mafic or felsic, ensured good wear resistance and grinding capacity with respect to many other kinds of rocks. The interest in findings made of vesciculated lavas, referable to parts of querns, mortars, and/or pestles of the Final Bronze Age site of Monte Croce Guardia (Arcevia) lies in the fact that this settlement was built upon limestones belonging to the sedimentary sequence of the Marche-Umbria Apennines (central Italy) and far away from potential raw materials of volcanic rocks. A petrologic study of 23 grinding tool fragments clearly indicates a provenance from the volcanic provinces of central Italy: Latium and Tuscany Regions. Few leucite tephrites (5) and one leucite phonolite lavas have a clear magmatic affinity with the high-K series of the Roman Volcanic Province (Latium) whereas the most abundant volcanic lithotype (17 samples) is represented by shoshonites (K-series) whose thin section texture, modal mineralogy and major-trace elements contents closely match with the shoshonite lavas from the Radicofani volcanic centre in the Tuscan Magmatic Province. At Radicofani (a volcanic neck in the eastern sector of Tuscany) a Final Bronze Age site coeval to that of Arcevia is present and a potential pathway corridor from that site towards Arcevia (air-line distance of ca. 115 km) is dotted with many settlements of the same age. Through analytical algorithms based on the slope and the different human-dependent cost-functions which can be applied to determine non-isotropic accumulated cost surface, least-cost paths and least-cost corridors, the best route from Radicofani to Monte Croce Guardia, approximately 140 km long, was simulated, with a walking time of 25–30 h, possibly using pack animals and wheel chariots. Three thousand years ago the Apennine Mountains did not thus constitute a barrier for human movements. This study also shed light on some other possible patterns of interactions between Final Bronze Age communities of central Italy through the present-day regions of Tuscany, Umbria and Marche, aimed towards the best performance of strategic economic activities at that time such as that of the transformation of cereals, and accompanied to cultural and social reasons.

Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver malignancy and its incidence is rising in Western countries. Although surgical resection is considered the only curative treatment, up to 70% of patients are diagnosed at an advanced stage, which precludes surgical intervention. Those who are inoperable become candidates for systemic treatment. Currently, the combination of gemcitabine and cisplatin is the first-line chemotherapy, with a median overall survival (OS) of about one year. Recently, there has been a notable increase in evidence regarding chemotherapy for biliary tract cancer; however, the effectiveness of the new chemotherapy drugs still needs to be evaluated. Today, intra-arterial therapies (IAT), especially trans-arterial chemoembolization (TACE) and trans-arterial radioembolization (TARE), are widely used. Both TACE and TARE have demonstrated good efficacy in controlling localized disease and in improving survival. However, current literature does not conclusively show whether TACE is superior to TARE or vice versa. As recent meta-analyses have indicated, both TACE and TARE offer suboptimal objective response rates but yield similar positive outcomes. It’s important to note that these findings are based on single-center studies, which often include a small number of patients and lack a comparative design. Therefore, when comparing such studies, there’s an inevitable selection bias among the treatment groups (TACE or TARE) and significant heterogeneity. This review outlines the current evidence on the use of interventional IAT in managing ICC.

Background and aims: Sarcopenia has been associated with poor outcomes in patients with cirrhosis and hepatocellular carcinoma. We investigated the impact of sarcopenia on survival in patients with advanced hepatocellular carcinoma treated with Sorafenib. Methods: A total of 328 patients were retrospectively analyzed. All patients had an abdominal CT scan within 8 weeks prior to the start of treatment. Two cohorts of patients were analyzed: the “Training Group” (215 patients) and the “Validation Group” (113 patients). Sarcopenia was defined by reduced skeletal muscle index, calculated from an L3 section CT image. Results: Sarcopenia was present in 48% of the training group and 50% of the validation group. At multivariate analysis, sarcopenia (HR: 1.47, p = 0.026 in training; HR 1.99, p = 0.033 in validation) and MELD > 9 (HR: 1.37, p = 0.037 in training; HR 1.78, p = 0.035 in validation) emerged as independent prognostic factors in both groups. We assembled a prognostic indicator named “SARCO-MELD” based on the two independent prognostic factors, creating three groups: group 1 (0 prognostic factors), group 2 (1 factor) and group 3 (2 factors), the latter with significantly worse survival and shorter time receiving treatment.

The increased detection of pancreatic cysts in recent years has triggered extensive diagnostic investigations to clarify their potential risk of malignancy, resulting in a large number of patients undergoing numerous imaging follow-up studies for many years. Therefore, there is a growing need for optimization of the current surveillance protocol to reduce both healthcare costs and waiting lists, while still maintaining appropriate sensibility and specificity. Imaging is an essential tool for evaluating patients with intraductal papillary mucinous neoplasms (IPMNs) since it can assess several predictors for malignancy and thus guide further management recommendations. Although contrast-enhanced magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP) has been widely recommended by most international guidelines, recent results support the use of unenhanced abbreviated-MRI (A-MRI) protocols as a surveillance tool in patients with IPMN. In fact, A-MRI has shown high diagnostic performance in malignant detection, with high sensitivity and specificity as well as excellent interobserver agreement. The aim of this paper is, therefore, to discuss the current available evidence on whether the implementation of an abbreviated-MRI (A-MRI) protocol for cystic pancreatic lesion surveillance could improve healthcare economics and reduce waiting lists in clinical practice without significantly reducing diagnostic accuracy.

Purpose: This study examines differences in the mechanisms that charter schools and traditional public schools use to facilitate parental school involvement and the degree to which these differences account for the high levels of involvement among charter school parents. Data and Research Methods: We merge data from principals and teachers from the nationally representative Schools and Staffing Survey and National Teacher and Principal Survey with nonprofit tax data from the National Center for Charitable Statistics. We use ordinary least squares regression to explain how charter and traditional public schools involve parents in communal, public-good activities, and individualistic, private-good activities within schools. Findings: Charters are less likely than traditional public schools to use bureaucratic structures, like parent-teacher organizations, and more likely to use nontraditional and less bureaucratic structures, like parent workshops and compacts. The use of such structures mediates a portion of the charter advantage; however, they only partially explain the association between being a charter and parent involvement. Additionally, we find some of the outreach structures that are most common in charter schools, including compacts, are also more strongly associated with parent involvement in charter schools than in traditional public schools. Implications: While charters have more public-good and private-good parent involvement than traditional public schools, our results suggest that the uncritical adoption of outreach strategies from one sector to another is unlikely to result in equal gains in parental involvement.

One of the biggest challenges facing gifted education is how to balance the need to provide students with enrichment opportunities within the context of an overly prescribed or required curriculum. The emergence of standards in individual states and the new Common Core State Standards coupled with the almost overpowering influence of standardized testing has had the effect of squeezing highly engaging enrichment activities out of the curriculum. Many teachers have become so accustomed to requirements for "teaching-the-text" and overusing worksheets to grind up standardized test scores that they no longer have the opportunity or, in some cases, the know-how to deviate from prescribed material. Few would argue that standards-driven curriculum is not important; however, research has clearly and unequivocally shown that high engagement enrichment experiences do in fact, contribute to higher achievement scores "and" they also make school more meaningful and enjoyable for students (Dotterer & Lowe, 2011; Greenwood, 1991; Reyes et al., 2012, & Wang & Holcombe, 2010). In this article we present a strategy that teachers can use for achieving some balance between the required curriculum and a way of infusing enrichment activities into standards driven material. Teachers who have used this technique have commented about how it has made them feel more creative about their teaching and more like professionals rather than mere purveyors of other people's material. Some examples of exciting ideas developed by teachers are provided to illustrate how the technique has been used.

The diversity of skills, talents, and interests of students that we serve in our schools requires a remarkable range of teachers' skills, time, and resources. This brief article focuses on differentiation and the ways that teachers can adapt and differentiate the regular curriculum to meet the academic needs of all of their students. Challenges and solutions about how differentiation can be implemented will be discussed, as will a variety of strategies that can be used to differentiate, challenge, and engage all students. Defined simply, differentiation is matching a required curriculum with the learning styles, expression styles, interests and abilities of students. It is predicated on the simple belief that engaged and motivated students score higher, are easier to manage, and enjoy learning more. Both research and current practice illustrate the importance of differentiated instruction for meeting every child's needs as well as raising achievement-- and some of that research is summarized in this article.

Background & Aims: Alcohol abuse and metabolic disorders are leading causes of hepatocellular carcinoma (HCC) worldwide. Alcohol-related aetiology is associated with a worse prognosis compared with viral agents, because of the lower percentage of patients diagnosed with HCC under routine surveillance and a higher burden of comorbidity in alcohol abusers. This study aimed to describe the evolving clinical scenario of alcohol-related HCC over 15 years (2006–2020) in Italy. Methods: Data from the Italian Liver Cancer (ITA.LI.CA) registry were used: 1,391 patients were allocated to three groups based on the year of HCC diagnosis (2006–2010; 2011–2015; 2016–2020). Patient characteristics, HCC treatment, and overall survival were compared among groups. Survival predictors were also investigated. Results: Approximately 80% of alcohol-related HCCs were classified as cases of metabolic dysfunction-associated fatty liver disease. Throughout the quinquennia,