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We exploit the increased sensitivity of the recently installed AO SOUL at the LBT to obtain new high-spatial-resolution NIR images of the massive young stellar object IRAS20126+4104 and its outflow. We aim to derive the jet proper motions and kinematics, as well as to study its photometric variability by combining the novel performances of SOUL together with previous NIR images. We used both broad-band ($K_{s}$, $K'$) and narrow-band (Br$\gamma$, H2) observations from a number of NIR cameras (UKIRT/UFTI,SUBARU/CIAO,TNG/NICS,LBT/PISCES,and LBT/LUCI1) to derive maps of the continuum and the H$_2$ emission in the 2.12 $\mu$m line. Three sets of images, obtained with AO systems (CIAO,2003; FLAO,2012; SOUL,2020), allowed us to derive the proper motions of a large number of H$_2$ knots along the jet. Photometry from all images was used to study the jet variability. We derived knot proper motions in the range of 1.7-20.3 mas yr$^{-1}$ (i.e. 13-158 km s$^{-1}$ at 1.64 kpc, avg. outflow tangential velocity $\sim$ 80 km s$^{-1}$). The derived knot dynamical age spans a $\sim$ 200-4000 yr interval. A ring-like H$_2$ feature near the protostar location exhibits peculiar kinematics and may represent the outcome of a wide-angle wind impinging on the outflow cavity. Both H$_2$ geometry and velocities agree with those inferred from proper motions of the H$_2$O masers, located at a smaller distance from the protostar. Although the total H$_2$ line emission from the knots does not exhibit time variations at a $\widetilde{>}$ 0.3 mag level, we have found a clear continuum flux variation (radiation scattered by the dust in the cavity opened by the jet) which is anti-correlated between the blue-shifted and red-shifted lobes and may be periodic (with a period of $\sim$ 12-18 yr). We suggest that the continuum variability might be related to inner-disc oscillations which have also caused the jet precession., Comment: 26 pages, 22 figures, 2 mpeg files, accepted by Astronomy & Astrophysics

Aim Parahiatal hernia is a rare type of diaphragmatic hernia, consisting in a adjacent but separated defect, lateral to the oesophageal hiatus and crus. It's not so familiar for surgeons, preoperative diagnosis is unlikely to be confirmed, and it is mostly found incidentally during intervention, leading to a complex and difficult repair. We present a case of parahiatal hernia robotically treated with the aim of emphasizing how robotic system can successfully help surgeons in performing even unexpected confusing and challenging anatomic dissections and procedures. Material and Methods A 65-year-old woman underwent robotic parahiatal hernia repair at our Institution. Four robotic trocars were positioned along the transverse umbilical line with the additional Air-seal port at the periumbilical left side for assistant's use. Dissection and isolation of both parahiatal defect and crural musculature were performed; the defect was closed with not absorbable barbed suture, conventional iatoplasty was also performed and a biosynthetic mesh was placed and fixed as a reinforcement. Results The duration of the intervention was of 100 minutes. No. intr- or post-operative complications occurred. Blood loss were inferior than 100 millilitres. The patient started oral intake at the second post-operative day and after discharged. At six months no recurrences were detected. Conclusions Parahiatal hernia are rare entities of which surgeons should be aware. Robotic treatment is safe and feasible and it represents a good tool for a successful management.

Background Vegetarians diets are characterized by the absence of some animal foods (e.g. red and processed meats), and a high consumption of plant-based foods. However, plant-based foods can include foods with varying nutritional value and health effects. We examined the association of three different pro-vegetarian (PVG) food patterns defined as general (gPVG), healthful (hPVG) and unhealthful (uPVG), with the risk of all-cause and cardiovascular disease (CVD) mortality in Italians. Methods Longitudinal analysis on 22,912 men and women (mean age 55±12 y) from the Moli-sani Study (2005-2010) followed up for 11.2 y (median). Food intake was assessed by a 188-item FFQ. A provegetarian food pattern (FP) was constructed by assigning positive scores to plant foods and reverse scores to animal foods. A healthful and an unhealthful pro-vegetarian FP, which distinguished between healthy (e.g. fruits, vegetables, legumes) and less-healthy plant foods (e.g. fruit juices, potatoes, sugary beverages), were also built up. Results In multivariable-adjusted analyses controlled for known risk factors, higher adherence to a gPVG was associated with lower all-cause (HR = 0.83; 95%CI 0.73-0.94) but not CVD mortality (HR = 0.90; 0.72-1.12). Increasing adherence to a hPVG was associated with reduced all-cause mortality risk (HR = 0.82; 0.72-0.95) as well as lower risk of CVD mortality (HR = 0.75; 0.59-0.95). Finally, the uPVG was directly associated with both all-cause (HR = 1.17; 1.03-1.33) and CVD mortality risks (HR = 1.23; 0.99-1.53). Conclusions A general pro-vegetarian food pattern was associated with longer survival in Italians. Preferring healthful vegetarian foods provided protection against CVD mortality too. Consistently, a large dietary share of unhealthful vegetarian foods, mostly highly processed, was associated with increased risk mortality. Thus the quality of the plant food consumed is paramount to achieve diet-related benefits on mortality. Key messages • A pro-vegetarian food pattern was associated with longer survival but preferring healthful vegetarian foods provided protection against CVD mortality too. • The quality of the plant food consumed is paramount to achieve diet-related benefits on mortality.

Background Ultra-processed food (UPF) is a major public health concern being reportedly associated with increased risk of non-communicable diseases and lower survival. However, most of the epidemiological evidence has been almost exclusively provided by research conducted in populations of youths or middle-aged adults. We tested the hypothesis that a large dietary share of UPF could be a risk factor also for vulnerable groups, as older adults (≥65 years). Methods Longitudinal analysis on 5,215 men and women (mean age 72±5 y) from the Moli-sani Study (2005-2010, Italy) followed up for 10.9 y (median). Food intake was assessed by a 188-item FFQ. UPF was defined using the NOVA classification according to degree of processing, and categorized as quartiles of the ratio (%) between UPF (g/d) and total food consumed (g/d; weight ratio). The overall nutritional quality of the diet was measured by the Food Standard Agency nutrient profiling system dietary index (FSAm-NPS DI). Results UPF contributed to 8% (min-max 0.0-58.4%) of the total food eaten daily and represented 14.4% (0.0-70.0%) of daily energy intake. In multivariable-adjusted analyses controlled for known risk factors, higher intake of UPF (Q4, ≥10.2% of total food), as opposed to the lowest (Q1, UPF Conclusions A large dietary share of UPF was associated with lower survival in older Italians consuming relatively low amounts of these foods. Expanding on previous studies on different age groups, these findings provide further justification to advise people to limit consumption of UPF even at older age. Key messages • A large dietary share of ultra-processed food was associated with lower survival in older Italians consuming relatively low amounts of these foods. • These findings provide further justification to advise people to limit consumption of ultra-processed food even at older age.

Aim With the recent evolution of minimally invasive hernia repairing techniques, robotic platform has exponentially gained consensus in the field of abdominal wall surgery, leading to the placement of retromuscolar synthetic meshes avoiding the need of extensive tissue dissection as the open approach. Our aim was to describe the introduction of Robotic Transabdominal Retromuscular Umbilical Prosthetic Hernia Repair (TARUP) at a referral centre for advanced mini-invasive surgery, by reporting the preliminary experience and the technical aspects of the procedure. Material & Methods We present a case of a 3 cm umbilical defect associated to supraumbilical diastasis in a young man undergoing TARUP with the Da Vinci Xi system. The robotic boom was placed on the patient's right side, with three trocars on the anterior axillary line. The outline for the mesh was marked by centering the hernia defect with transcutaneous needles to delineate the extent of dissection corresponding to mesh area. Intra-abdominal pressure was of 8–12 mmHg. A retromuscolar plane was created starting from the incision of the ipsilateral posterior rectus sheat. The hernia content was reduced. The junction between the anterior and posterior rectus fascia was incised to cross-over the linea alba and continue the dissection controlaterally. A 15×15 cm polypropylene mesh was positioned in the retrorectus space and fixed with cyanoacrylic glue tack. Results Intervention lenght was of 100 minutes. No intra- or post-operative complications occurred. At present, no early recurrences were observed. Conclusions Robotic TARUP represents a safe and reproducible alternative in selected cases where retromuscolar mesh is preferred.

Aim The main aim of the project will be evaluating the effectiveness of an experimental structured didactic program in robotic surgery in filling the training gap caused by the pandemic. We intend to evaluate how establishing a training pathway could improve young surgeons’ robotic skills and implement their participation in robotic procedures during the COVID-19 pandemic. We will also evaluate the learning curve of robotic transabdominal preperitoneal inguinal hernia repair (TAPP) for young surgeons with limited experience as first operators at the dual console. Matherials and Methods We designed an experimental stepwise training program in robotic surgery that starts from a first step of theoretical and laboratory lessons, followed by a second phase of bedside assistance training, and finally the completion of low complexity procedures by the trainees proctored at the dual console by senior surgeons. Robotic TAPP was selected as training model. The performance of each trainee will be registered in an evaluation data sheet and Learning scores will be recorded by the tutor with the evaluation of 6 corner steps of the procedure. Results Preliminary results showed improved technical skills and increased team spirit and wellbeing. Conclusions TAPP is a good training model because involves technical steps useful for more complex procedures. The robotic dual console represent an extraordinary training tool and a structured training program positively impacts technical skills and could help filling the training gap caused by the pandemic.

Aim Orofacial clefts are the most common congenital anomaly to affect the craniofacial region. Surgical repair is usually performed in infancy; however, there are concerning inequalities in access to and quality of surgical care. Scoring aesthetic results after surgery is crucial when determining the success of a repair. A reliable and accurate scoring system utilising large numbers of unstandardised 2-dimentional (2D) photographs of ethnically diverse patients, which is inexpensive, widely accepted and easily applicable, does not exist. Artificial Intelligence (AI) has been applied in various surgical specialities with beneficial results; however, its advantages have not yet been harnessed in cleft care. We aimed to evaluate the potential use of routinely collected 2D photographs of patients with an orofacial cleft and determine if non-standardised data could be used for machine learning (ML) analysis in cleft research. Method A database comprising over 5 million photographs, collected over 20 years, and developed by the international non-governmental organisation Smile Train, was described, and analysed using RStudio and Microsoft Excel. Results Description and analysis of the dataset demonstrated that it is the largest and most ethnically inclusive and diverse dataset that currently exists. Preliminary AI analysis confirmed that ML could be used to analyse the data. Conclusion The quality of routinely collected data presents challenges for use in research. Addressing such challenges helps ensure that findings are more representative of global burden of disease and will deliver outcomes that are more relevant to a diverse global population. Evidence based minimum standards to optimise future data collection have been identified.

Study question Is failure mode and effects analysis (FMEA) a useful and effective method of risk assessment in a gamete donor program? Summary answer The analysis of the potential failures, their causes and effects significantly improved the safety strategies previously adopted in our gamete donor program. What is known already At present, in Italy, the donation of fresh gametes is possible, but almost unmanageable due to the lack of donors and the refund to donors forbidden by law. As a result, many IVF Italian Centers established agreements with foreign gametes cryo-banks in order to meet the huge demand for donation treatments. The exchange of personal sensitive data and gametes between the sending and receiving centers represents a crucial aspect in a donor cycle. Each stage of this process, from gamete request to gamete thawing, is not error-free. FMEA represents a strategy to identify and mitigate potential failures before they occur. Study design, size, duration Fifty-eight oocyte and 4 sperm donation cycles were performed at our IVF facility from September 2019 to January 2021. Gametes came from a single Spanish cryo-bank. FMEA represents a proactive risk evaluation tool useful to identify real or potential failures and to develop actions to minimize risks. FMEA was conducted, in January 2021, by a team consisting of 2 gynaecologists, 3 embryologists and 2 quality managers and repeated 8 months later. Participants/materials, setting, methods Processes were analyzed to identify and score the potential failure modes using the risk priority number (RPN) scoring system. The calculation has been obtained by multiplying 3 factors: severity, occurrence and detectability scored from 1-5. After calculating the criticality of each failure mode, an action plan was prepared and then effectiveness of new process was monitored. Finally, FMEA was repeated and the improved RPN after the corrective actions was calculated. Main results and the role of chance In our gamete donation program, we mapped four phases: gamete request, donor-recipient matching, gamete delivery and gamete thawing. All the steps presented multiple failures and 11 different potential failure modes had been identified. Failure modes as the incorrect transcription of the recipient data, the acceptance of a donor proposal not well-matched with recipients and the receipt of gametes unsuitable for the couple correlate to high-risk scores with 30 RPN. These events may have severe consequences such as an incorrect matching between donor and recipient, and the subsequent birth of a child from a mismatched donor. Although gamete request, donor-recipient matching and receiving gametes phases are mainly characterized by document checking, the introduction of witnessing by another physician or embryologist, reduced the risk by 50%. Therefore, the introduction of double checking by a second operator represents an essential control measure to avoid errors. Limitations, reasons for caution This study is influenced by the general limitations of the FMEA approach, such as different personal experiences and skills of the participants since failures may be unrecognized, underestimated or overstated. Wider implications of the findings Performing a risk assessment in a donor program represents a valid strategy to mitigate risks of incorrect matching and loss of traceability. Since errors in data record and acceptance of donor proposal may cause important down streaming consequences, the double witnessing is strongly encouraged. Trial registration number NA

Study question How many retracted papers are there in the medically assisted reproduction (MAR) literature and, more importantly, what are their particulars? Summary answer Article retraction within MAR literature is increasing and the most common reasons for retraction are errors in data and duplicate publications. What is known already Article retraction accounts for one of the most serious consequences of research misconduct. Articles may be subject to retraction whenever the findings are found to be unreliable, redundant, plagiarised or the authors are found to have performed unethical research or hidden Trial registration number N/A

BACKGROUND: Tuberculosis (TB) preventive therapy (TPT) decreases the risk of developing TB disease and its associated morbidity and mortality. The aim of these clinical standards is to guide the assessment, management of TB infection (TBI) and implementation of TPT.METHODS: A panel of global experts in the field of TB care was identified; 41 participated in a Delphi process. A 5-point Likert scale was used to score the initial standards. After rounds of revision, the document was approved with 100% agreement.RESULTS: Eight clinical standards were defined: Standard 1, all individuals belonging to at-risk groups for TB should undergo testing for TBI; Standard 2, all individual candidates for TPT (including caregivers of children) should undergo a counselling/health education session; Standard 3, testing for TBI: timing and test of choice should be optimised; Standard 4, TB disease should be excluded prior to initiation of TPT; Standard 5, all candidates for TPT should undergo a set of baseline examinations; Standard 6, all individuals initiating TPT should receive one of the recommended regimens; Standard 7, all individuals who have started TPT should be monitored; Standard 8, a TBI screening and testing register should be kept to inform the cascade of care.CONCLUSION: This is the first consensus-based set of Clinical Standards for TBI. This document guides clinicians, programme managers and public health officers in planning and implementing adequate measures to assess and manage TBI.

An exhaustive analysis of the leaky tank car problem is presented, pointing out its intriguing physical properties, which well serve to students and teachers for illustrating standard Newtonian mechanics in a highly non-standard fashion. Calculus (at a leading undergraduate level) is effectively required only to examine some details concerning the solution of the equation of motion and interesting limiting cases. Instead we let any student to appreciate all the physical content of the problem, within a proper simple model and its generalization, ranging from the motion of the leaky tank car to that of the water flowing from the car with their peculiarities. Generalizations of the problem to more than one draining hole (even with different sizes), as well as to "two-dimensional" geometries, reveal further intriguing results, culminating into a no-rotation theorem and its corollaries, thus rendering unique the problem at hand for allowing students to fully recognize the power of physical analysis., Comment: Revtex, 15 pages, 10 figures

We present the results of an experimental study of multiple scattering of positively charged high energy particles in bent samples of monocrystalline silicon. This work confirms the recently discovered effect of a strong reduction in the rms multiple scattering angle of particles channeled in the silicon (111) plane. The effect is observed in the plane orthogonal to the bending plane. We show in detail the influence of angular constraints on the magnitude of the effect. Comparison of the multiple scattering process at different energies indicates a violation of the law of inverse proportionality of the rms angle of channeled particles with energy. By increasing the statistics, we have improved the results of multiple scattering measurements for particles moving, but not channeled, in silicon crystals., arXiv admin note: text overlap with arXiv:1910.00250 minor fixes

The Chopper Dump in the Linac4 accelerator at CERN is a beam-intercepting device responsible for the absorption of the 3 MeV H− ion beam produced by the Linac4 source and deflected upstream by an electromagnetic chopper. It allows a portion of the beam, which would otherwise fall into the unstable region of the radiofrequency buckets in the Proton Synchrotron Booster, to be dumped at low energy with minimal induced radiation. It may also be used to absorb the entire beam. With peak currents of 25 to 45 mA and shallow penetration, this results in large deposited energy densities, thermal gradients and mechanical stresses. Additional constraints arise from geometric integration, vacuum and radiation protection requirements. Material selection, beam-matter interaction studies and thermo-structural analyses are important aspects of the design process. The Chopper Dump underwent modification in 2019 following observed material degradation in the original version of the device. The experience gained, modifications made and observations noted since then are detailed herein. Against this background, the design and analysis of an upgraded device, intended to cope with future operational conditions, is outlined and discussed.

Crusted scabies (CS) is a severe form of scabies caused by hyper-infestation of mites in the horny layer of the epidermis that thickens and forms warty crusts.1 Although it has been described mainly in immunosuppressed individuals, it has been also observed in otherwise healthy patients.1 We are living the coronavirus disease 2019 (COVID-19) outbreak, that is a mild/moderate disease in children.2-4 However, SARS-CoV-2 infection may induce significant changes in the host's immune response.5,6.

Background Data on milk and other dairy products intake with health outcomes are inconsistent. We investigated the association of milk and total dairy consumption with the risk of all-cause and cause-specific mortality in a Mediterranean population. Methods We performed a longitudinal analysis on 22,889 men and women (mean age 55.4±11.7 y; 52.3% women), from the Moli-sani Study cohort (enrollment 2005-2010) followed-up for a median of 11 years. Dietary data were collected through a 188-item food frequency questionnaire. Total dairy consumption (g/d) was calculated as the sum of milk (whole and partially-skimmed, g/d), yogurt (whole and partially skimmed, g/d) and cheese (fresh and hard, g/d). Hazard ratio (HRs) with 95% confidence interval (CI) were calculated by multivariable Cox regression, modelled by spline curves. Results In multivariable-adjusted analysis controlled for sociodemographic, clinical and dietary factors, cheese, yogurt or whole milk intake were not associated with either all-cause or cause-specific mortality (p for overall association >0.38), as well as was total diary intake (p > 0.18). On the contrary, non-linear J-shaped curves were observed for the association of partially skimmed milk intake with all-cause and cancer mortality (p value for total and non-linear association=0.0072 and 0.035, and 0.097 and 0.049, respectively; magnitude of the relative reduction =16% and 18% at nadir of 128 and 114 g/d, respectively). A linear association between partially skimmed milk intake and CVD mortality was observed (p for association =0.047; p for non-linearity= 0.41), with HR = 0.82 (95%CI: 0.68-0.98) at 125 g/d and a window of statistically significant protection ranging from 100 to 250 g/d. Conclusions In a large Mediterranean population of adults, consumption of 1 standard cup of partially skimmed milk was associated with lower all-cause, cancer and CVD mortality. Other dairy sources were not associated with mortality. Key messages In a large Mediterranean population, total dairy intake did not predict mortality. Daily consumption of 1 standard cup of partially skimmed milk lowers the risk of all-cause, cardiovascular and cancer mortality.

Study question Does ejaculatory abstinence period in male affect embryological and pregnancy outcomes following fresh embryo transfers in ICSI cycles? Summary answer Shorter ejaculatory abstinence period is associated with lower triploid zygotes rate per ICSI cycle but it does not affect clinical outcomes after fresh embryo transfers. What is known already Lower sperm quality may negatively impact on fertilisation rate and embryo morphokinetic parameters after ICSI and the effect of the ejaculatory abstinence period before semen collection on seminal parameters and sperm quality has been widely reported. However, the impact of ejaculatory abstinence on clinical outcomes is still controversial. WHO (World Health Organization) guideline recommended that abstinence period should be 2–7 days. Even so, there are no larger prospective trials determining the optimal timing for ejaculatory abstinence period for infertile couples. Study design, size, duration This is a single center retrospective observational study of 3,353 fresh cycles from January 2017 to December 2020. Semen analysis was done according to the WHO criteria. Exclusion criteria for this study were frozen gametes and cycles with no retrieved oocytes. Primary outcomes were fertilization rate and triploid zygotes rate. Secondary outcomes were blastulation rate, ongoing pregnancy rate and live birth rate per fresh embryo transfer. Participants/materials, setting, methods The correlation between ejaculatory abstinence and continuous outcomes was evaluated by Spearman’s correlation analysis in order to detect potential non-linear associations. Generalized linear model and logistic regression were used, respectively for continuous and binary outcomes, in order to adjust for confounders such as female age, male age, number of retrieved oocytes, percentage of mature oocytes, infertility causes, seminal volume, sperm concentration and total progressive sperm motility. A p value Main results and the role of chance The male mean age was 40.3±5.5 and mean duration of abstinence was 2.9±1.7 days. The mean age of female patients was 38.2±4.0. Higher ejaculatory abstinence period was associated with a higher sperm concentration (Spearman p = 3.1x10–6) but not with a higher total sperm progressive motility. Even so, no significant correlation with EA were observed when considering fertilization rate, blastulation rate, ongoing pregnancy and live birth rate per transfer in analyzed cycles. Triploid zygote rate was positively associated with a higher ejaculatory abstinence period. For the ejaculatory abstinence period of 1 day (n = 64), 2 days (n = 1523), 3 days (n = 1032), 4 days (n = 408), 5 days (n = 174), 6 days (n = 47) and ≥7 days (n = 105) the mean triploid rate was 2.4%, 2.4%, 2.5%, 4.1%, 3.6%, 5.4% and 4.3%, respectively (Spearman p = 9x10–3). Triploid zygote rate was independent of semen volume, concentration and total progressive motility. Limitations, reasons for caution This is a large observational study with a retrospective data collection. Despite our methodological approach, the presence of biases related to retrospective design can not be excluded and it may be a reason for caution. Wider implications of the findings: Our results demonstrate that ejaculatory abstinence period do not affect blastulation, ongoing pregnancy and live birth rates. The current findings discourage an abstinence time longer than 3 days due to its association with a higher abnormal fertilization rate. Trial registration number Not applicable

Background Prejudices and negative attitudes towards intellectual disabilities (IDs) may hinder social inclusion of ID individuals, limiting their well-being. This study investigated the psychometric characteristics of the Italian Modern and Classical Prejudices Scale (MCPS-IT) towards people with ID and the effects of gender, age and socio-economic status (SES) on prejudices. Method The MCPS-IT was administered to 474 adults (69% women, age range 18-70 years, M = 33.13) in conjunction with a questionnaire evaluating socio-demographic information (SES), the contact and the education about ID people and the social dominance orientation. Results Results confirmed that Italian MCPS has a two-factor structure that measures in a reliable and valid way prejudice towards people with ID. Multivariate analyses of variance confirmed a weak gender difference in both scales and age differences in modern scale. No SES differences were found. Conclusion The Italian MCPS represents a valid scale that can be used to monitor the social context of people with ID.