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Septic non-union (SNU) represents an insidious complication of open fractures. SNU is defined as a clinical and radiological evidence of cessation of fracture healing after 6-8 months of treatment, associated with persistence of clinical, laboratoristic and radiological signs of infection. The infection is mostly caused by bacteria and when it occurs at the bone fracture site, the healing process slows down and generally the treatment takes place in multiple phases. First a surgical debridement, often with the use of polymethylmethacrylate and local antibiotics, associated with specific systemic antibiotic therapy and a temporary stabilization of the septic non-union. Once the infection is cleared up, the final definitive synthesis is performed. Recently the use of implantable antibiotic medical devices in one step surgery has been introduced with encouraging results and have shown numerous advantages both in terms of management and morbidity for the patient. There are several "pre-formed" devices on the market, which however must be approved by the institution and often have the limit of a high cost in addition to the impossibility of using specific antibiotics. We want to report our experience with a clinical case of a tibial SNU successfully treated by one-step surgery procedure using a custom-made intramedullary antibiotic cement-coated carbon nail. We focus on surgical technique, advantages and pitfalls related to the use of these devices.

Road accidents are the eighth cause of death worldwide and the first among young people, and, in turn, distraction is considered one of the main determinants of road accidents. One of the most important factors of distraction while driving appears to be the use of a mobile phone. This paper aims at simultaneously analyzing individual Knowledge, Attitudes, and Behaviors toward the use of mobile phones while driving in one of the largest and most populous metropolitan areas of Italy, Naples. The study analyzes a sample of 774 questionnaires which consist of 39 questions each. Several socio-demographic characteristics (i.e., gender, age, profession, and others) are considered within this study. A Structural Equation Model displays that the relationship between Knowledge and Behavior is not direct and it passes through the Attitude. The results of this study might be used for the creation of targeted educational programs, community-based interventions, and legal regulations.

The UN Sustainable Development Goals have set clear targets on global poverty, hunger and malnutrition to be achieved by 2030, which have prompted academics and policymakers to identify useful strategies and drivers. Moreover, the COVID19 pandemic has exacerbated inequalities at national and sub-national levels thus hampering the achievement of these goals. On considering the multifaceted nature of poverty, a recent research strand focuses on food poverty and insecurity issues in terms of economic access to food and healthy diet consumption, with moderate and extreme food insecurity affecting almost 9% of the population in Europe and North America. This paper aims to analyse food poverty and insecurity at regional level in Italy. Using micro-data from the Italian Household Budget Survey carried out by ISTAT, an analytical approach was proposed to define and measure the different degree of food poverty and insecurity. Moreover, to obtain insights into whether food poverty and insecurity can afford population healthy nutrition, inequality of the distributions of food expenditure categories are estimated. The results provided us with information on other important aspects of the poverty. Indeed, in Italy individuals who are at-risk-of-food-poverty or food insecure amount to 22.3% of the entire population. Furthermore, the at-risk-of-food-poverty-rate varies at regional level from 14.6% (Umbria) to 29.6% (Abruzzo), with high levels of food consumption inequalities observed above all for vegetables, meat and fish. All these issues could help policy makers to define economic intervention policies aimed at reducing social exclusion and achieving more equitable and sustainable living conditions for the entire population.

Composite indicators (CIs) are frequently employed to measure complex, multidimensional phenomena such as well-being, sustainability, or work quality. It is nowadays well studied, that the multiple decisions made in the construction process of building the CI strongly affect the result. These construction decisions range from the selection of a set of sub-indicators, to the standardization method, the weighting and the choice of the aggregation function. Sensitivity analysis is an established tool to analyze and quantify the impact of the choices made in this regard. Less attention has been paid to the impact of data quality on CIs: CIs are usally based on sub-indicators that are estimated from sample surveys and the resulting aggregated measure can only be as good as the underlying data. The uncertainty in the CI due to sampling and possible non-sampling errors is, however, frequently neglected. With this report we aim to fill this gap. To do so, we perform a sensitivity analysis for an example CI for working quality, that includes the selection of a sampling design and the sampling itself as possible sources of variability. Further, we propose a parametric bootstrap-based apporach to estimate the standard error of a CI and apply it to the illustrating example of a CI on environmental perfomance.

Additional file 1. Allelic profiles chracterizing the 11 varieties on trial.

Small area estimation is receiving considerable attention due to the high demand for small area statistics. Small area estimators of means and totals have been widely studied in the literature. Moreover, in the last years also small area estimators of quantiles and poverty indicators have been studied. In contrast, small area estimators of inequality indicators, which are often used in socio-economic studies, have received less attention. In this article, we propose a robust method based on the M-quantile regression model for small area estimation of the Theil index and the Gini coefficient, two popular inequality measures. To estimate the mean squared error a non-parametric bootstrap is adopted. A robust approach is used because often inequality is measured using income or consumption data, which are often non-normal and affected by outliers. The proposed methodology is applied to income data to estimate the Theil index and the Gini coefficient for small domains in Tuscany (provinces by age groups), using survey and Census micro-data as auxiliary variables. In addition, a design-based simulation is carried out to study the behaviour of the proposed robust estimators. The performance of the bootstrap mean squared error estimator is also investigated in the simulation study.

Background and aim of the work: Patellar tendon rupture is a rare complication after Total Knee Arthroplasty (TKA) which always requires surgical treatment. Patients with chronic lesions or tendon degenerations showed good results at short-term follow-up (FU) when treated using autografts or allografts, but these techniques showed poor outcomes at long-term FU. Moreover, allografts have high costs and limited availability, not to mention the increased risk of immune reactions and infections. Recently, the use of synthetic ligaments for patellar tendon reconstruction has taken hold with encouraging results. We report our experience in the treatment of patellar tendon ruptures after TKA using the Ligament Advanced Reinforcement System-LARS®. Methods: Clinical evaluation was performed using the Knee Society Score and recording extensor lag. Instrumental evaluation was performed using ultrasound imaging to assess patellar tendon thickness and using conventional x-rays to assess prosthesis’ mobilization signs and patella’s height. Results: At the final FU, 6 knees were included in our study. Patient’s mean age was 66.7. Patellar tendon reconstruction occurred after a mean time of 4 months from the previous surgery. The mean FU was 44,2 months. The mean Knee Score was 63.3 and the mean Function Score was 35. In 4 knees the extensor lag was < 10° while in 2 knees it was > 20°. The mean ISI was 1.16, while the average increment in tendon thickness was 127.12%. Conclusions: In our opinion, synthetic ligaments can be successfully employed for the reconstruction of patellar tendon breakage after TKA and rTKA in selected patients, in order to quickly return them to their activity of daily living. (www.actabiomedica.it)

Background and aim of the work: since 2003, a series of so called ‘micro-posterior’ approaches have been developed in the orthopaedic surgery to perform total hip replacement. These techniques present several theoretical advantages compared to the classic postero-lateral approach: reduction in blood loss, post-operative pain, and length of stay but also improving functional outcomes. In our hypothesis these goals could also be obtained in patients with femoral neck fractures, especially in the elderly with several comorbidities. Methods: In our series we performed 50 consecutive cemented hemiarthroplasties through SuperPATH approach. At the latest follow-up (FU) 41 patients were included in the study. Clinical and radiological evaluation was performed before the surgery and at the latest FU using VAS score, Harris Hip Score (HHS) and conventional AP and LL X-rays. Results: We didn’t report any intra-operative complication (i.e. periprosthetic fractures, vasculo-nervous injuries or dislocations) or any case with a dysmetria greater than 1 cm. Mean blood transfusion units were 0.8 during surgery (0 – 4) and 1,6 after surgery (0-4). We reported a mean length of stay of 9.7 days (range 7-15) mainly due to our patients’ high comorbidity rate. At the last one-year FU no cases of dislocation, infection and clinical or radiographical signs of prosthetic loosening were recorded. All our patients returned to the same activity level before femoral fracture occurred, according to HHS. Conclusion: The SuperPATH is a real minimally invasive approach with a low rate of intra- and post-operative complications. It is related to a reduced dislocation rate and potentially to a reduced infection rate compared to the conventional surgical approaches, allowing, furthermore, a faster functional recovery. According to our experience the advantages of this type of approach can be obtained in the trauma field too. (www.actabiomedica.it)

Background: Death certificates are considered the most reliable source of information to compare cause-specific mortality across countries. The aim of the present study was to examine death certificates of persons who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to (a) quantify the number of deaths directly caused by coronavirus 2019 (COVID-19), (b) estimate the most common complications leading to death, and (c) identify the most common comorbidities. Methods: Death certificates of persons who tested positive for SARS-CoV-2 provided to the National Surveillance system were coded according to the 10th edition of the International Classification of Diseases. Deaths due to COVID-19 were defined as those in which COVID-19 was the underlying cause of death. Complications were defined as those conditions reported as originating from COVID-19, and comorbidities were conditions independent of COVID-19. Results: A total of 5311 death certificates of persons dying in March through May 2020 were analysed (16.7% of total deaths). COVID-19 was the underlying cause of death in 88% of cases. Pneumonia and respiratory failure were the most common complications, being identified in 78% and 54% of certificates, respectively. Other complications, including shock, respiratory distress and pulmonary oedema, and heart complications demonstrated a low prevalence, but they were more commonly observed in the 30–59 years age group. Comorbidities were reported in 72% of certificates, with little variation by age and gender. The most common comorbidities were hypertensive heart disease, diabetes, ischaemic heart disease, and neoplasms. Neoplasms and obesity were the main comorbidities among younger people. Discussion: In most persons dying after testing positive for SARS-CoV-2, COVID-19 was the cause directly leading to death. In a large proportion of death certificates, no comorbidities were reported, suggesting that this condition can be fatal in healthy persons. Respiratory complications were common, but non-respiratory complications were also observed.

Supplementary Material for Place of death for people with HIV: a population-level comparison of eleven countries across three continents using death certificate data. About different data sources and the levels of linkage of data. Table S2. Descriptive data on HIV prevalence and ART coverage for each country, drawn from UNAIDS Global Report 2008. Description of HIV prevalence and ART coverage for each participating country. (DOCX 28Â kb)

Small area estimation is conventionally concerned with the estimation of small area averages and totals. More recently emphasis has been also placed on the estimation of poverty indicators and of key quantiles of the small area distribution function using robust models for example, the M-quantile small area model (Chambers and Tzavidis, 2006). In parallel to point estimation, Mean Squared Error (MSE) estimation is an equally crucial and challenging task. However, while analytic MSE estimation for small area averages is possible, analytic MSE estimation for quantiles and poverty indicators is extremely difficult. Moreover, one of the main criticisms of the analytic MSE estimator for M-quantile estimates of small area averages proposed by Chambers and Tzavidis (2006) and Chambers et al. (2009) is that it can be unstable when the area-specific sample sizes are small.

Plant regeneration via somatic embryogenesis and organogenesis was achieved in leaf base and ovary culture of the Croatian endemic Iris adriatica Trinajstić ex Mitić. Callus induction from leaf base explants occurred in the dark on three media with MS mineral solution containing 4.52 μM dichlorophenoxyacetic acid (2, 4-D), 4.83 μM naphthaleneacetic acid (NAA), 0.46 μM kinetin (Kin), 5% sucrose and 200 mg L-1 casein hydrolysate. The media differed only in vitamin and/or proline content. Calli from ovary culture were achieved on MS medium containing 45.25 μM 2, 4-D. The mean percentage of callus induction from leaf base explants was 18.9%, with no significant differences between media, and 27.3% from ovary sections. All embryogenic calli were formed on MS media containing 0.45 μM 2, 4-D, 4.44 μM benzyladenine (BA) and 0.49 μM indole-3-butyric acid (IBA) under low light intensity (25 μE m-2s-1). Transfer of embryogenic calli to hormone-free medium enabled the development of mature somatic embryos on the surface of 6.0% of induced calli produced from leaf base explants and 4.0% of those from ovary sections. Genotype had the main effect on plant regeneration efficiency in Iris adriatica.