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Clinical practice has benefited from new methodologies such as realistic simulation (RS). RS involves recreating lifelike scenarios to more accurately reflect real clinical practice, enhancing learners' skills and decision-making within controlled environments, and experiencing remarkable growth in medical education. However, RS requires substantial financial investments and infrastructure. Hence, it is essential to determine the effectiveness of RS in the development of skills among medical students, which will improve the allocation of resources while optimizing learning. This cross-sectional study was carried out in the simulation laboratory of a medical school, and the performance of students who underwent two different curriculum matrices (without RS and with RS, from 2021 to 2022) in the Advanced Cardiac Life Support (ACLS) course was compared. This test was chosen considering that the competencies involved in cardiac life support are essential, regardless of the medical specialty, and that ACLS is a set of life-saving protocols used worldwide. We observed that the impact of RS can be different for practical abilities when compared with the theoretical ones. There was no correlation between the general academic performance and students' grades reflecting the RS impact. We conclude that RS leads to less remediation and increased competence in practical skills. RS is an important learning strategy that allows repeating, reviewing, and discussing clinical practices without exposing the patient to risks.

Abstract Additional copies of chromosome 1 long arm (1q) are frequently found in multiple myeloma (MM) and predict high-risk disease. Available data suggest a different outcome and biology of patients with amplification (Amp1q, ≥4 copies of 1q) vs. gain (Gain1q, 3 copies of 1q) of 1q. We evaluated the impact of Amp1q/Gain1q on the outcome of newly diagnosed MM patients enrolled in the FORTE trial (NCT02203643). Among 400 patients with available 1q data, 52 (13%) had Amp1q and 129 (32%) Gain1q. After a median follow-up of 62 months, median progression-free survival (PFS) was 21.2 months in the Amp1q group, 54.9 months in Gain1q, and not reached (NR) in Normal 1q. PFS was significantly hampered by the presence of Amp1q (HR 3.34 vs. Normal 1q, P

Este estudo revisou intervenções terapêuticas e farmacológicas para o tratamento do transtorno por uso de Cannabis. Foram incluídos estudos de revisão que abordassem diretamente intervenções terapêuticas, farmacológicas ou psicossociais para a dependência de Cannabis. A busca identificou 430 artigos, dos quais 11 foram incluídos na revisão. Os resultados destacaram descobertas sobre farmacoterapia, intervenções mistas, psicoterapias e tratamentos digitais. Concluímos que, embora existam intervenções promissoras, como terapias comportamentais e programas digitais, são necessárias mais pesquisas rigorosas para enfrentar eficazmente o uso problemático de Cannabis.

Background: Simulation-Based Learning (SBL) has potential in health education, yet it remains underutilized at the undergraduate level. Active teaching methodologies, such as deliberate practice, are known to enhance skills like leadership, self-confidence, and teamwork. This study aimed to evaluate the medical students’ perception of deliberate practice in learning Human Physiology at a private medical school in Brazil. Methods: An observational qualitative and quantitative study was conducted in 2022 and 2023 using an online questionnaire, including 198 participants. An inferential statistical analysis was conducted, using Fisher's exact test at a 0.05 level of significance, to assess the association between categorical variables. Results: Overall, students had a positive perception of deliberate practice. A significant proportion (66.8%) strongly agreed that they developed teamwork skills through the scenarios. Additionally, 83.7% strongly agreed that access to realistic simulation environments enhanced their learning. In terms of emotions, 67.9% felt motivated, while 37.8% experienced anxiety during the scenarios. The statistical analysis revealed a significant association between the sum scores of each section and the binary response (“yes” or “no”) to the question “Do you like the practical classes of Human Physiology?” (p < 0.05), with the exception of the Negative Emotions sum. This indicates that higher section scores are associated with a greater likelihood of students liking the practical classes. Conclusion: The integration of deliberate practice into the Human Physiology curriculum has positively impacted students’ learning and skill development. However, enhancements are needed to create a safer emotional environment for students.

The effects of various hypertonic solutions on the intraventricular conduction, ventricular repolarization and the arrhythmias caused by the intravenous (iv) injection of bupivacaine (6.5 mg/kg) were studied in sodium pentobarbital-anesthetized mongrel dogs. Hypertonic solutions, given iv 5 min before bupivacaine, were 7.5% (w/v) NaCl, 5.4% (w/v) LiCl, 50% (w/v) glucose (2,400 mOsm/l, 5 ml/kg), or 20% (w/v) mannitol (1,200 mOsm/l, 10 ml/kg). Bupivacaine induced severe arrhythmias and ventricular conduction and repolarization disturbances, as reflected by significant increases in QRS complex duration, HV interval, IV interval and monophasic action potential duration, as well as severe hemodynamic impairment. Significant prevention against ventricular electrophysiologic and hemodynamic disturbances and ventricular arrhythmias was observed with 7.5% NaCl (percent increase in QRS complex duration: 164.4 ± 21.8% in the non-pretreated group vs 74.7 ± 14.1% in the pretreated group, P

In times of multiple crises, embracing alternative and sustainable solutions for materials, products, and manufacturing systems becomes increasingly crucial and urgent. Constant improvements and innovations in technology and science, together with consumer demand for the new, encourage an ever-growing production of electronic goods, consequently leading to a broad and multi-levelled scope of problems. While incremental growth follows unsustainable production patterns, the democratisation of technology on the contrary gives rise to contrasting paradigms and ways of production that could shift the power back to the consumer. Starting from the principles of transparency and openness, the Do-It-Yourself-Revolution (DIYR) project aims for a more sustainable product world, where environmentally conscious production raises the value and care for things while at the same time formulating a new contemporary product language. This project aims to create novel products and product ecosystems with a localised production focus, wherein users are motivated to transition into proDusers (producer-users). This transformation is facilitated through instruction, acquiring additional knowledge, and cultivating skills via immersion in the worlds of making, crafting, and design.

Background: The dynamics of global, state-dependent reconfigurations in brain connectivity are yet unclear. We aimed at assessing reconfigurations of the global signal correlation coefficient (GSCORR), a measure of the connectivity between each voxel timeseries and the global signal, from resting-state to a stop-signal task. The secondary aim was to assess the relationship between GSCORR and blood-oxygen-level-dependent (BOLD) activations or deactivation across three different trial-conditions (GO, STOP-correct, and STOP-incorrect). Methods: As primary analysis we computed whole-brain, voxel-wise GSCORR during resting-state (GSCORR-rest) and stop-signal task (GSCORR-task) in 107 healthy subjects aged 21–50, deriving GSCORR-shift as GSCORR-task minus GSCORR-rest. GSCORR-tr and trGSCORR-shift were also computed on the task residual time series to quantify the impact of the task-related activity during the trials. To test the secondary aim, brain regions were firstly divided in one cluster showing significant task-related activation and one showing significant deactivation across the three trial conditions. Then, correlations between GSCORR-rest/task/shift and activation/deactivation in the two clusters were computed. As sensitivity analysis, GSCORR-shift was computed on the same sample after performing a global signal regression and GSCORR-rest/task/shift were correlated with the task performance. Results: Sensory and temporo-parietal regions exhibited a negative GSCORR-shift. Conversely, associative regions (ie. left lingual gyrus, bilateral dorsal posterior cingulate gyrus, cerebellum areas, thalamus, posterolateral parietal cortex) displayed a positive GSCORR-shift (FDR-corrected p < 0.05). GSCORR-shift showed similar patterns to trGSCORR-shift (magnitude increased) and after global signal regression (magnitude decreased). Concerning BOLD changes, Brodmann area 6 and inferior parietal lobule showed activation, while posterior parietal lobule, cuneus, precuneus, middle frontal gyrus showed deactivation (FDR-corrected p < 0.05). No correlations were found between GSCORR-rest/task/shift and beta-coefficients in the activation cluster, although negative correlations were observed between GSCORR-task and GO/STOP-correct deactivation (Pearson rho=-0.299/-0.273; Bonferroni-p < 0.05). Weak associations between GSCORR and task performance were observed (uncorrected p < 0.05). Conclusion: GSCORR state-dependent reconfiguration indicates a reallocation of functional resources to associative areas during stop-signal task. GSCORR, activation and deactivation may represent distinct proxies of brain states with specific neurofunctional relevance.

Kawasaki disease (KD) is an acute vasculitis that mainly affects children under 5 years of age, leading to coronary artery alterations (CAAs) in 25% of untreated patients. Macrophage activation syndrome (MAS) is a secondary hemophagocytic lymphohistiocytosis (HLH) that can complicate the acute, subacute, and chronic phases of KD. We retrospectively reviewed three cases of children affected by KD complicated with MAS hospitalized in two pediatric units in Emilia Romagna, a northern region of Italy. Case 1: a previously healthy 23-month-old female with full clinical criteria of KD and a hemorrhagic rash due to MAS during the acute phase of the illness. This patient responded promptly to a high dose of intravenous immune globulin (IVIG) and three pulses of high doses of methylprednisolone (MPD) with improvement in clinical signs and laboratory tests without the development of CAA at any phase of illness. Case 2: a previously healthy 10-month-old female with incomplete KD with persistent fever and maculopapular rash. This patient did not respond to IVIG and developed MAS during the subacute phase, characterized by persistent fever, hypertransaminasemia, hyperferritinemia, and hypofibrinogenemia after two high doses of IVIG and boluses of MPD. The patient responded to the addition of IL-1 blocker and anakinra and did not present CAA alterations during any phase of the illness. Case 3: a previously healthy 26-month-old male with incomplete KD with fever, maculopapular rash, cheilitis, and hyperemic conjunctivitis. This patient developed gallbladder hydrops and CAA in the acute phase and did not respond to two high doses of IVIG and a high dose of MPD. In the subacute phase, this patient was complicated with MAS and responded to intravenous anakinra. During the subacute phase, the patient developed transient aneurysms that regressed during the chronic phase. These cases reiterate that prompt diagnosis and aggressive immunomodulatory treatment can limit the most severe complications of MAS complicating KD. High doses of IVIG and MPD may result in a favorable outcome or more aggressive adjunctive treatment may be needed. Anakinra, cyclosporine, monoclonal antibodies, and plasmapheresis can be used as adjunctive treatment in the case of unresponsive MAS in KD. Notably, MAS, present during the subacute phase in cases 2 and 3, promptly responded to anakinra, an IL-1 blocker, without the use of cyclosporine. Our experience confirms that the IL-1 blocker can be considered an optimal choice after non-response to IVIG and MPD in KD complicating with MAS, avoiding over-treatment with cytotoxic drugs.

Naples is the most densely populated Italian city (7744 inhabitants per km2). It is located in a particular geological context: the presence of Mt Vesuvius characterizes the eastern part, and the western part is characterized by the presence of the Phlegrean Fields, making Naples a high-geothermal-gradient region. This endogenous heat, combined with the anthropogenic heat due to intense urbanization, has defined Naples as an ideal location for Surface Urban Heat Island (SUHI) analysis. SUHI analysis was effectuated by acquiring the Land Surface Temperature (LST) over Naples municipality by processing Landsat 8 (L8) Thermal Infrared Sensor (TIRS) images in the 2013–2023 time series by employing Google Earth Engine (GEE). In GEE, two different approaches have been followed to analyze thermal images, starting from the Statistical Mono Window (SMW) algorithm, which computes the LST based on the brightness temperature (Tb), the emissivity value, and the atmospheric correction coefficients. The first one is used for the LST retrieval from daytime images; here, the emissivity component is derived using, firstly, the Normalized Difference Vegetation Index (NDVI) and then the Vegetation Cover Method (VCM), defining the Land Surface Emissivity (LSɛ), which considers solar radiation as the main source of energy. The second approach is used for the LST retrieval from nighttime images, where the emissivity is directly estimated from the Advance Spaceborne Thermal Emission Radiometer database (ASTER-GED), as, during nighttime without solar radiation, the main source of energy is the energy emitted by the Earth’s surface. From these two different algorithms, 123 usable daytime and nighttime LST images were downloaded from GEE and analyzed in Quantum GIS (QGIS). The results show that the SUHI is more concentrated in the eastern part, characterized by intense urbanization, as shown by the Corine Land Cover (CLC). At the same time, lower SUHI intensity is detected in the western part, defined by the Land Cover (LC) vegetated class. Also, in the analysis, we highlighted 40 spots (10 hotspots and 10 coldspots, both for daytime and nighttime collection) that present positive or negative temperature peaks for all the time series. Due to the huge amount of data, this work considered only the five representative spots that were most representative for SUHI analysis and determination of thermal anomalies in the urban environment.

High-dose melphalan plus autologous stem cell transplantation (ASCT) is a standard of care for transplant-eligible patients with newly diagnosed multiple myeloma (NDMM), and adequate hematopoietic stem cell (HSC) collection is crucial to ensure hematologic recovery after ASCT. In this prospective, observational study we evaluated HSC mobilization with granulocyte colony-stimulating factor (G-CSF), cyclophosphamide, and ‘on-demand’ plerixafor (in patients with 60% (odds ratio [OR]=4.14), lenalidomide use (OR=4.45), and grade 3-4 hematologic toxicities during induction (OR=3.53) were independently associated with a higher risk of mobilization failure or plerixafor need. Cyclophosphamide plus G-CSF and ‘on-demand’ plerixafor is an effective strategy in NDMM patients treated with novel agents, resulting in a high rate of HSC collection and high HSC yield (clinicaltrials gov. identifier: NCT03406091).

This research aimed to segment the market of visitors who practise outdoor activities in the North region of Portugal based on their motivations. An online survey was conducted between June to September of 2021, with a sample of 200 tourists who realised the region's outdoor activities during this period. The data collected allowed determining factor analysis and the clusters. Two factors: services/hospitality and nature experiences, and three clusters: soft practitioners, radicals, and enthusiasts were delimited. The results show that these groups differ in motivations and practised activities. Segmentation of outdoor tourism demand in North of Portugal should set out marketing and promotion strategies in different destinations, attracting demand from outside the region, and according to their preferences.

Abstract The global increase in drug consumption exposes the growing need to develop new systems for the detection, capture, and treatment of bioactive molecules. Carbamazepine is one instance of such contaminants at the top of the ranking commonly found in sewage treatment systems. This work, therefore, presents a theoretical study of fullerene C60 and its derivatives with substitutional doping with B, Al, Ga, Si, Ge, N and P, for the detection and capture of carbamazepine is aqueous medium. Solvation effects were included by means of the Polarizable Continuum Solvent method. The results indicate that doped fullerenes are sensitive for the detection of carbamazepine both in gaseous and aquatic environments. Investigation on the intermolecular interactions between the drug and the fullerene molecule were carried out, allowing the characterization of the interactions responsible for stabilizing the adsorption of carbamazepine to the fullerenes. The theoretical survey revealed that fullerenes doped with Al, Ga, Si and Ge chemically adsorb carbamazepine whereas for the case of fullerenes doped with other heteroatoms physisorption is responsible for the molecular recognition. Relying on DFT calculations, the fullerene derivatives C59Al, C59Si and C59Ga are the most suitable to act both as a sensor and to uptake carbamazepine in aquatic environments.