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OBJECTIVE Infradiaphragmatic craniopharyngiomas (ICs) represent a distinct subtype, harboring a sellar-suprasellar origin and generally growing in the extra-arachnoidal space contained by the diaphragma sellae. They have been considered ideal for surgical removal through the transsphenoidal approach since the 1960s. The authors present a multicentric national study, intending to selectively analyze IC behavior and the impact of the transsphenoidal endoscopic endonasal approach (EEA) on surgical outcomes. METHODS Craniopharyngiomas that were intraoperatively recognized as infradiaphragmatic and removed with standard EEA between 2000 and 2021 at 6 Italian neurosurgical departments were included in the study. Clinical, radiological, and surgical findings and outcomes were evaluated and reviewed. RESULTS In total, 84 patients were included, with 45.23% identified as pediatric cases and 39.28% as having recurrent tumors. The most common presenting symptoms were endocrine (75%), visual (59.52%), and hypothalamic (26.19%) disorders. ICs were classified as extending below (6 intrasellar and 41 occupying the suprasellar cistern) or above (26 obliterating the anterior recesses of the third ventricle and 11 extending up to the foramina of Monro) the chiasmatic cistern. Gross-total resection (GTR) was achieved in 54 cases (64.28%). Tumor extension above the chiasmatic cistern and calcifications were associated with lower likelihood of GTR. The cumulative rate of postoperative complications was 34.53%, with CSF leak being the most common (14.28%). Endocrine, visual, and hypothalamic functions deteriorated postoperatively in 41/78 patients (52.56%), 5/84 (5.95%), and 14/84 (16.67%), respectively. Twenty-eight patients (33.33%) had recurrence during follow-up (mean 63.51 months), with a mean 5-year progression-free survival (PFS) rate of 58%. PFS was greater in patients who achieved GTR than patients with other extent of resection. CONCLUSIONS This is the largest series in the literature to describe ICs removed with standard EEA, without the need for additional bone and dural opening over the planum sphenoidale. EEA provides a direct route to ICs, the opportunity to manage lesions extending up to the third ventricle without breaching the diaphragma, and high rates of GTR and satisfactory clinical outcomes. Increased surgical complexity and morbidity should be expected in patients with extensive suprasellar extension and involvement of the surrounding vital neurovascular structures.

Placental abruption is a common complication of preeclampsia. It is an obstetric emergency that occurs when the placenta partially or completely separates from the uterine wall. The diagnosis is usually made clinically or objectively. It is relatively rare but put a serious risk for both the fetus and the mother. We reported a case of a 32-year-old multigravid patient at 35-36 weeks gestation who presented with moderate vaginal bleeding and lower abdominal pain. Her obstetric history included one premature vaginal delivery. Her blood pressure started to rise in the second trimester of pregnancy. The examination revealed that her blood pressure was 190/120 mmHg, and she had pitting edema on her extremities and tender uterine fundus. The fetal heart rate was bradycardia at 100 beats per minute. Placental abruption and fetal distress were suspected. An emergency cesarean section was performed. Intraoperatively, the uterus showed intramural bleeding and was livid, with the beginning of Couvelaire-uterus. The uterus was left in situ. In conclusion, placental abruption interrupts the vital function of the placentae which leads to fetal hypoxia and even fetal death. It is an obstetric emergency that requires immediate intervention to save the fetus and reduce the risk of complications in the mother.

The Glasgow Benefit Inventory (GBI) is a generic patient recorded outcome measure assessing the quality of life of patients undergoing ear nose and troth surgery. Although largely used in the clinical practice, it has never been adapted and validated in the Italian language. The aim of the study was to translate the original GBI from English to Italian and to examine its reliability for use in the Italian adult population of patients undergoing endonasal endoscopic dacryocystorhinostomy. After translation and back-translation of the original English we evaluated the reliability of GBI for use in 79 Italian adults undergoing dacryocystorhinostomies. Reliability of GBI-IT was examined by the internal consistency of the scale (using the Cronbach’s alpha coefficient), and by the test–retest analysis. The GBI-IT showed adequate internal consistency (Cronbach’s alpha = 0.85 for the total scale). The total GBI-IT score showed a strong correlation in retests (CCC 0.87). In conclusion, our study showed that the GBI-IT has satisfactory internal consistency and reliability and is equivalent to the original English version. In addition, it can be considered a valuable measure for both clinical and research uses.

Intracranial extension of acquired cholesteatoma is a rare occurrence that can develop secondary to trauma, chronic otitis media or acquired aural cholesteatoma. The most commonly observed symptoms are headache and hearing loss. The authors report on a rare case of intracranial cholesteatoma presenting with atypic symptoms: swelling and temporomandibular joint disorders.

This research aims to investigate the influence of female directors on Intellectual Capital Performance (ICP) using a sample of manufacturing-listed companies in China. Our study investigates the link between having two or more female directors and the Modified Value-Added Intellectual Coefficient (MVAIC) methodology, employing the critical mass theory from 2004–2017. We find that having a critical mass of female directors (three or more) shows a significant positive impact on MVAIC and its components, including human capital efficiency, structural capital efficiency, relational capital efficiency, and physical capital efficiency, with physical capital being the critical driver. Our study reveals that the critical mass participation of female directors substantially influences the IC efficiency of privately owned companies compared to state-owned companies. Moreover, the number of female directors also affects the IC performance of manufacturing companies in multiple regions. Our findings support the validity of group classification identified by Kanter and Critical Mass Theory. To the best of our knowledge, this is one of the few pieces of research that studies the role of female board directors in IC performance and Chinese manufacturing firms using MVAIC as an IC measure.

Background Placental abruption is a common complication of preeclampsia. It is an obstetric emergency which occurs when the placenta partially or completely separates from the uterine wall. The diagnosis is usually made clinically or objectively. It is relatively rare but put a serious risk for both the fetus and the mother. Case presentation We reported a case of a 32-year-old multigravida patient at 35-36 weeks gestation presented with moderate vaginal bleeding and lower abdominal pain. Her obstetric history included one premature vaginal delivery. Her blood pressure started to rise in the second trimester of pregnancy. The examination revealed that her blood pressure was 190/120 mmHg, she had pitting edema on her extremities and tender uterine fundus. The fetal heart rate was bradycardia at 100 beats per minute. Placental abruption and fetal distress were diagnosed. An emergency cesarean section was performed. Intraoperatively, the uterus showed intramural bleeding and was livid, with the beginning of Couvelaire-uterus. The uterus was left in situ. Conclusion As a conclusion, placental abruption interrupts the vital function of the placentae which leads to fetal hypoxia and even fetal death. It is an obstetric emergency that requires immediate intervention to save the fetus and reduce the risk of complications in the mother.

To describe the infants presenting to pediatric emergency departments (PEDs) and diagnosed with group B Streptococcus (GBS) late-onset disease (LOD) bacteremia and identify risk factors for severe infection and pediatric intensive care unit (PICU) admission.Observational study and subanalysis of a multicenter prospective registry. Setting: pediatric emergency department. Inclusion criteria: infants between 7 and 89 days of age with positive blood culture for GBS seen between 2011 and 2016 at any of 22 Spanish PEDs. Main outcome: risk factors (clinical and laboratory variables) for severe infection (sepsis/septic shock or meningitis) and PICU admission. Second, the prevalence of poor outcomes (acute complications, sequelae or death).Among 118 patients with LOD, 74 (62.7%) presented a severe infection: 66 sepsis/septic shock (11 with associated meningitis) and 8 meningitis. Thirty-five patients (29.7%) were admitted to a PICU. An altered Pediatric Assessment Triangle (PAT) upon arrival and leukopenia were the only independent risk factors for severe infection [odds ratio (OR): 43.6; 95% confidence interval (CI): 8.1-235.7, P0.01] and PICU admission (OR: 11.6; 95% CI: 1.5-91.4; P0.019), respectively. Six patients (5.1%) developed a poor outcome, including 2 deaths (1.7%); all had an altered PAT, elevated procalcitonin (range 4.7-100 ng/ml), and were diagnosed with sepsis/septic shock and admitted to a PICU. Four developed leukopenia.Infants with GBS LOD frequently develop sepsis/septic shock and bacterial meningitis, associated with non-negligible morbidity and mortality. Clinical appearance was the only risk factor for severe infection, whereas leukopenia was related to PICU admission.

Responsible investments are considered one of the driving factors of revenues growth enhancing risk-adjusted returns. This paper investigates the effects of responsible investments on the volatility of European stock returns. First, we exploit an expectation–maximization (E–M) algorithm to cluster the companies into two groups according to the Environmental score (E), used as a proxy for responsible investments. Second, we build one global minimum variance (GMV) portfolio within each group and estimate its volatility using ARCH-type models. Finally, we forecast well-known risk measures such as the value-at-risk (VaR) and the expected tail loss (ETL) to assess market risks for investing green. Responsible portfolios composed of stocks with high E score outperform their Low E counterparts and are shown to be safer choices to mitigate risks, especially during periods of market distress. The results are remarkable for many sectors.

Sustainable and responsible finance incorporates Environmental, Social, and Governance (ESG) principles into business decisions and investment strategies. In recent years, investors have rushed to Sustainable and Responsible Investments in response to growing concerns about the risks of climate change. Asset managers look for some assessment of sustainability for guidance and benchmarking, for instance, $30 trillion of assets are invested using some ESG ratings. Several studies argue that good ESG ratings helped to prop up stock returns during the 2008 Global Financial Crisis (Lins et al. J Finance 72(4):1785–1824, 2017). The ESG score represents a benchmark of disclosures on public and private firms, it is based on different characteristics which are not directly related to the financial performance (Harvard Law School Forum on Corporate Governance, ESG reports and ratings:what they are, why they matter. https://corpgov.law.harvard.edu/2017/07/27/esg-reports-and-ratings-what-they-are-why-they-matter/ , 2017). The role of ESG ratings and their reliability have been widely discussed (Berg et al. Aggregate confusion: the divergence of ESG ratings, MIT Sloan Research Paper No. 5822-19, 2019). Sustainable investment professionals are unsatisfied with publicly traded companies’ climate-related disclosure. This negative sentiment is particularly strong in the USA, and within asset managers who do not believe that markets are consistently and correctly pricing climate risks into company and sector valuations. We believe that ESG ratings, when available, still affect business and finance strategies and may represent a crucial element in the company’s fundraising process and on shares returns. We aim to assess how structural data as balance sheet items and income statements items for traded companies affect ESG scores. Using the Bloomberg ESG scores, we investigate the role of structural variables adopting a machine learning approach, in particular, the Random Forest algorithm. We use balance sheet data for a sample of the constituents of the Euro Stoxx 600 index, referred to the last decade, and investigate how these explain the ESG Bloomberg ratings. We find that financial statements items represent a powerful tool to explain the ESG score.

In the past, the use of face masks in western countries was essentially limited to occupational health. Now, because of the COVID-19 pandemic, mask-wearing has been recommended as a public health intervention. As potential side effects and some contraindications are emerging, we reviewed the literature to assess the impact of them in daily life on patient safety and to provide appropriate guidelines and recommendations. We performed a systematic review of studies investigating physiological impact, safety, and risk of masks in predefined categories of patients, which have been published in peer-reviewed journals with no time and language restrictions. Given the heterogeneity of studies, results were analyzed thematically. We used PRISMA guidelines to report our findings. Wearing a N95 respirator is more associated with worse side effects than wearing a surgical mask with the following complications: breathing difficulties (reduced FiO

Secretory senescence of the upper and lower airway represents the most important risk factor for respiratory complication in the elderly. In most cases, patients present with high health care costs due to the relevant number of hospitalizations and medical cares. A growing evidence is accumulating on the role of immunosenescence in the pathogenesis of chronic rhinosinusal disorders, and on defect in the lubrication of the corneal, conjunctival and scleral mucosa, delicate structures of the external eye, and of trachea-bronchial diseases, dependent on a failure of the gland system and reduction of mucociliary clearance (MCC). The presence of multiple comorbidities in the elderly may significantly contribute to a systemic pro-inflammatory state which negatively affects the airway. Secretory senescence promotes systemic inflammation and exacerbates the pre-existing pathologies. The role of cytokines is associated to a pro-inflammatory state of breathing apparatus. Several observations support the hypothesis that the secretory senescence can act in a paracrine and vasocrine manner to influence the structure and function of glands, mucus and lacrimal secretions, thus contributing to fraility and hospitalizations in the elderly. Given the recognized role of secretory senescence in the pathophysiology of airway disease, it should be desirable to identify specific therapies targeting the nasal, lacrimal and tracheo- bronchial secretory system able to modulate its pro-inflammatory profile and the negative effect of the inflammatory burden on the elderly.

Background: To describe the infants presenting to pediatric emergency departments (PEDs) and diagnosed with group B Streptococcus (GBS) late-onset disease (LOD) bacteremia and identify risk factors for severe infection and pediatric intensive care unit (PICU) admission. Methods: Observational study and subanalysis of a multicenter prospective registry. Setting: pediatric emergency department. Inclusion criteria: infants between 7 and 89 days of age with positive blood culture for GBS seen between 2011 and 2016 at any of 22 Spanish PEDs. Main outcome: risk factors (clinical and laboratory variables) for severe infection (sepsis/septic shock or meningitis) and PICU admission. Second, the prevalence of poor outcomes (acute complications, sequelae or death). Results: Among 118 patients with LOD, 74 (62.7%) presented a severe infection: 66 sepsis/septic shock (11 with associated meningitis) and 8 meningitis. Thirty-five patients (29.7%) were admitted to a PICU. An altered Pediatric Assessment Triangle (PAT) upon arrival and leukopenia were the only independent risk factors for severe infection [odds ratio (OR): 43.6; 95% confidence interval (CI): 8.1-235.7, P < 0.01] and PICU admission (OR: 11.6; 95% CI: 1.5-91.4; P < 0.019), respectively. Six patients (5.1%) developed a poor outcome, including 2 deaths (1.7%); all had an altered PAT, elevated procalcitonin (range 4.7-100 ng/ml), and were diagnosed with sepsis/septic shock and admitted to a PICU. Four developed leukopenia. Conclusions: Infants with GBS LOD frequently develop sepsis/septic shock and bacterial meningitis, associated with non-negligible morbidity and mortality. Clinical appearance was the only risk factor for severe infection, whereas leukopenia was related to PICU admission.

First-time home buyers have many considerations to choose their house after leaving the parental house. One of the determinant roles is culture. Culture influences activities, the meaning of home perspectives, and parental support system. Indonesia has a strong family culture, one of which is the Batak tribe. As one of the largest populations in Jakarta, this study focuses on the next-generation Batak process of selecting the first house. This study using case studies and qualitative research with in-depth interviews. We found that culture influenced the moving stage and parental support role. The parents play two essential parts: they are mindset formers as well as providers of financial support. Although the housing preferences tend to be similar to the firsttime homebuyers in urban areas, culture influences the spatial arrangement process. The finding can contribute to how parental support affects the next generation of migrants while adapts to the housing market. Keywords: Batak family; culture; housing preferences; parental support

Introduction: The loss of voice after total laryngectomy is one of the main impairments in personal and social life. In order to prevent potential psycho-social consequences in the patient and his family, the restoration of phonatory function is the main objective of post-laryngectomy rehabilitation. The aim of this study was to assess quality of life in patients who received prosthetic voice after total laryngectomy. Materials and Methods: Over a one-year period, 51 patients with voice prostheses after total laryngectomy were recruited. 32 patients (62.74%) were administered radiation therapy and 9 patients (17.64%) underwent to surgical reconstruction with flaps. Each patient was administered the VHI-10 and V-RQOL self-assessment questionnaires. Results: The study showed that vocal restoration with voice prosthesis allows patients to recover a significant degree of quality of life after total laryngectomy. The average score on the V-RQOL questionnaire was 75.9 and on the VHI-10 questionnaire was 13.5. It has not been shown a statistically significant correlation between quality of life after tracheoesophageal prosthesis and radiation therapy, chemotherapy or reconstruction flaps. Younger patients showed, on average, a higher score at V-RQOL. These results allow to state that, after prosthetic rehabilitation, at least 75% of patients experienced an increase in quality of life. Moreover, the prosthetic technique (primary vs secondary) does not affect the long-term outcome and radiotherapy, chemotherapy or reconstruction flaps are not absolute contraindications to rehabilitation with voice prosthesis. Conclusion: After total laryngectomy, rehabilitation with tracheoesophageal prosthesis is a satisfactory choice to restore the patient’s ability to communicate verbally.

Background and aim: The aim of this research was to review the articles published by the Ear, Nose and Throat (ENT) departments of the Italian University Hospitals in 2019 and in 2020 to analyze the impact of the COVID-19 pandemic on the academic production. Methods: PubMed and Scopus were searched for the articles published by the ENT departments of the Italian Universities in 2019 and in 2020. The main eligibility criteria were English-language articles, while there were no exclusion criteria related to topic. The articles were classified into seven domains corresponding to the main ENT subspecialties. Results: There was an overall increase in the number of articles by the 42.2% in 2020. Publications pertaining Rhinology and Laryngology increased more significantly in 2020, respectively by the 50.5% and 72.2%. Additionally, there was an increase in the number of articles concerning topics of general interest, by the 95.2% in 2020. Also, the citation trends of the articles published by the Italian University Hospitals increased remarkably in 2020. Conclusions: These results evidenced an overall increase in the number of ENT articles. Although 2020 is going to be remembered as a year to forget, it should be acknowledged for being the “golden year of research”. However, the scientific community needs quality more than quantity and it is now more important than ever to provide optimal medical indications and clear answers to patients’ questions. (www.actabiomedica.it)

Adverse childhood experiences (ACEs) disproportionately impact African Americans because of profound subjection to historical-systemic oppression in addition to personal and intergenerational trauma exposure. This article utilizes a biopsychosocial-cultural framework to understand the correlates of ACE exposure in African Americans and attends to the cultural factors that contribute to resilience. We review the evidence base for culturally informed, preventive-interventions, as well as strategies for bolstering this work by capitalizing on cultural strengths that are salient in the African American community. We also highlight pertinent policy initiatives guided by recent strategic outlines by the Centers for Disease Control and Prevention. These policies provide the backdrop for the recommendations offered to facilitate the healthy biopsychosocial development of individuals and families. These recommendations can contribute to the expansion and creation of new policies that aim to strengthen individual coping in the face of adversity, enhance family bonds and resilience, and promote community capacity to reduce ACE exposure in African Americans. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Background The medical community has been deeply involved in fighting the Coronavirus disease 2019 (COVID-19) pandemic and, as a consequence, the care of non-COVID-19 patients has been impacted. However, the treatment of head and neck cancer patients is not deferrable, and an integrated strategy is required. The aim of the current article is to present the experience in the management of head and neck patients during the COVID-19 pandemic at the research hospital “Casa Sollievo della Sofferenza”. This review contains replicable and widely usable instructions on how to avoid delays in the diagnosis and treatment of head and neck tumors and to ensure a gradual return to elective procedures. Main text The Head and Neck Department of the research hospital “Casa Sollievo della Sofferenza” includes an Otolaryngology and a Maxillofacial Surgery Unit, both of which deal with the diagnosis and treatment of benign and malignant pathologies of the head and neck, as well as urgent/emergent consultations and surgical procedures that necessitate time sensitive operative management, such as cochlear implantation (CI). Given these premises and the complexity of the Department, the “COVID-19 organizing protocol” of the research hospital “Casa Sollievo della Sofferenza” was divided into two phases in accordance with the different stages of the pandemic and the priority of treatment. Special attention was given to the medical surveillance of health care workers and hospitalized patients, to the organization of the outpatient clinic and the operating setting as well as to the implementation of telehealth systems. Conclusions The COVID-19 pandemic is going to be a long-term situation with lasting effects on the public health and the entire society. Therefore, an efficient health care system has to adopt a double strategy: always being ready for a “new wave” of the pandemic and not forgetting non-COVID-19 patients, among whom head and neck cancer patients represent a priority. More than 1 year since the first outbreak in Wuhan, this review offers a unique and helpful perspective that incorporates awareness of the disease.

Energy return on investment (EROI) is a ratio of the energy obtained in relation to the energy used to extract/produce it. The EROI of fossil fuels is globally decreasing. What do the declining EROIs of energy sources imply for society as a whole? We answer this question by proposing a novel EROI measure that describes, through one parameter, the efficiency of a society in managing energy resources over time. Our comprehensive societal EROI measure was developed by (1) expanding the boundaries of the analysis up to the useful stage; (2) estimating the amount of energy embodied in the energy-converting capital; (3) considering non-conventional sources such as the muscle work of humans and draught animals; and (4) considering the influence of imported and exported energy. We computed the new EROI for Portugal as a case study. We find a considerably lower EROI value, at around 3, compared to those currently available, which is stable over a long-time range (1960–2014). This suggests an independence of EROI from economic growth. When estimated at the final stage, using conventional methods (i.e., without applying the four novelties here introduced), we find a declining societal EROI. Therefore, our results imply that the production of new and more efficient final-to-useful energy converting capital has historically kept societal EROI around a stable value by offsetting the effects of the changing returns of energy sources at the primary and final stages. This will be crucial in the successful transition to renewables.

Poliklinik KIA merupakan salah satu jenis pelayanan kesehatan yang ada di Puskesmas X. Pada Poliklinik KIA memiliki program-program kerja sebagai ukuran pencapaiankinerja. Salah satu program kerja adalah Antenatal Care (ANC) yang merupakan pelayanan pemeriksaan kehamilan untuk ibu hamil. Data dan rekapitulasi data ibu hamil yang menerimapelayanan ANC merupakan kebutuhan penting guna pelaporan, namun memiliki kendala sering terjadi duplikasi data dan lamanya rekapitulasi data perbulan. Selain itu pelayanan yangkurang maksimal karena ibu hamil memeriksa kehamilannya hanya jika ada masalah dan tidak berdasarkan jadwal yang sudah ditetapkan. Aplikasi Pendataan dan Remainder Pelayanan ANC akan dikembangkan dengan menggunakan metodologi Rapid Application Development (RAD). Aplikasi ini dapat membantu Poliklinik KIA pada Puskesmas X untuk pendataan danrekapitulasi serta memberikan remainder pada ibu hamil sehingga meningkatkan pelayanan program kerja ANC.

Introducción Las infecciones por adenovirus tienen una presentación clínica variable y son una importante causa de morbilidad en la infancia. Frecuentemente reciben tratamiento antibiótico de forma innecesaria. Este estudio busca analizar las características de los pacientes con infección por adenovirus y ver si difieren de aquellos con infección bacteriana. Pacientes y métodos Se estudiaron 174 pacientes ingresados en un hospital terciario desde enero de 2009 hasta agosto de 2017 a los que se les detectó adenovirus. Se analizaron las variables clínicas y analíticas y se compararon con las de una muestra de pacientes diagnosticados de infección bacteriana confirmada en el mismo centro en 2016. Resultados La tasa de pacientes con infección por adenovirus fue de 1,58/100 ingresos. El 64% eran varones, siendo la edad media de 17 meses. Los que solo presentaban síntomas gastrointestinales tenían una menor edad y resultados analíticos más favorables que los que solo mostraban síntomas respiratorios. Un 24,5% presentaban coinfección por otro virus, observándose en este grupo una mayor estancia hospitalaria (7,93 frente a 6,17 días, p = 0,006). Los criterios analíticos de infección bacteriana grave no mostraron diferencias significativas al comparar entre los pacientes infectados por adenovirus y los que tenían una infección bacteriana confirmada, excepto una diferencia mínima, aunque estadísticamente significativa, al comparar las cifras de proteína C reactiva. Conclusiones Las variables analíticas y clínicas estudiadas no son suficientes para discriminar entre infección bacteriana y por adenovirus. Sería adecuado descartar infección por adenovirus sistemáticamente antes de instaurar tratamiento antibiótico.

Crude oil is a major driver of the global economy and its price dynamics are a key indicator for producers, consumers and investors. The increasing volatility of crude oil prices in the last decade has encouraged many researchers to model its dynamics. Recent studies have tried to explain this dynamics by taking into account the role of various market participants many of whom have increasingly used crude oil for portfolio diversification. We propose a modified supply–demand framework which assumes that the real price of crude oil is affected not only by fundamental shocks but also by financial shocks. We assess the role of what we define as the financial shock component when describing the dynamics of the real crude oil price and endeavor to measure a possible equilibrium relationship between standard supply/demand variables and our financial shock component. Using a Dynamic Ordinary Least Squares (DOLS) approach and an ECM framework we are able to empirically assess the significant role of “hedging pressure” on the real price of oil and find evidence that the impact of the “hedging pressure” is not only affecting quick reverting short-term deviations but also the structural long-run equilibrium of the oil price.

BackgroundThe World Health Organization (WHO) reported in 2013 that approximately 360 million people have disabling hearing loss, of which 32 million are children. A major consequence of hearing loss is a disability in communication: development of spoken language is often delayed in children with hearing loss, or absent in total deafness. Such children can benefit from a range of interventions such as hearing aids, cochlear implants, and educational and social support. Hearing screening can prevent the most severe consequences of hearing loss, but it is preferable first to consider populations with a high probability of developing hearing impairment. The present study assessed the incidence of hearing impairment through ABR in infants at high risk at Casa Sollievo della Sofferenza Hospital in southern Italy.Material and MethodsThe paper reports the results of auditory brain stem response (ABR) testing over a period of 3 years on infants born with a history of infantile respiratory distress syndrome (IRDS), otoacoustic emission failure at hearing screening, low birth-weight (ResultsOf 549 infants tested, 469 (85.4%) showed normal hearing, 51 (9.3%) suffered mild hearing impairment, 6 (1.1%) had moderate hearing impairment, 8 (1.5%) had severe hearing loss, and 15 (2.7%) failed to show any response at maximum intensity levels in both ears. For the hearing loss categories, the most important risk factors were found to be (in order of importance): craniofacial malformation, CMV infection, and familial factors.ConclusionsABR is an important clinical tool in the identification and quantification of hearing impairment. In neonatal screening it is preferable first to consider populations with a high probability of developing hearing losses.

A new machine learning approach for price modeling is proposed. The use of neural networks as an advanced signal processing tool may be successfully used to model and forecast energy commodity prices, such as crude oil, coal, natural gas, and electricity prices. Energy commodities have shown explosive growth in the last decade. They have become a new asset class used also for investment purposes. This creates a huge demand for better modeling as what occurred in the stock markets in the 1970s. Their price behavior presents unique features causing complex dynamics whose prediction is regarded as a challenging task. The use of a Mixture of Gaussian neural network may provide significant improvements with respect to other well-known models. We propose a computationally efficient learning of this neural network using the maximum likelihood estimation approach to calibrate the parameters. The optimal model is identified using a hierarchical constructive procedure that progressively increases the model complexity. Extensive computer simulations validate the proposed approach and provide an accurate description of commodities prices dynamics.

This paper investigates the role of CDS volatility in providing information concerning the credit quality of a company. In Castellano and D’Ecclesia (J. Financ. Decis. Mak. 2:27, 2011) a first analysis of how CDS quotes respond to rating announcements is provided and it showed that market participants do not rely much on Rating Agencies, especially during periods characterized by very high volatility, i.e. during a financial crisis. Here, a more accurate analysis of the CDS’s ability to provide timely information on the creditworthiness of reference entities is performed, estimating the volatility of CDS quotes by using Exponential GARCH(1,1) models. The event study methodology is applied to a sample of CDS quotes for US and European markets, over the period 2004–2009. Results provide an accurate understanding of market behavior in the presence of news released by Rating Agencies. Overall, market participants seem to provide timely reactions around the event date and we show that the key element of signaling is represented by the changing volatility in CDS quotes, before and after the rating event.

This paper aims to explain crude oil price volatility and its relationship respect to some macroeconomic and financial variables. Finding the main drivers of oil price dynamics is a crucial element for the definition of adequate monetary policies and risk management purposes. The role of macroeconomic and financial variables is analyzed in a Vector Error Correction Model framework, in order to test the existence of a long run equilibrium in the oil price dynamics. We use monthly data for crude oil prices, the Dollar/Euro exchange rate, the US interest rate, the crude oil Futures open interest, the US oil imports and the gold price over the period 1993–2009. One cointegrating relationship is found which allows to identify a long run equilibrium between the variables.

The recent complex dynamics observed in financial and commodity markets require continuous updates, implementation and backtesting of mathematical models aimed to provide an efficient representation of a real world situation. The aim of the scholars who attended the 50th Meeting of the EuroWorking Group for Financial Modelling is to provide “new” tools for, and answers to, the challenges issued by more complex markets dynamics and interactions. Financial modelling may mean different things to different users; we usually refer either to accounting and corporate finance applications, or to quantitative finance applications. Recent complexmodelling tools havebeendeveloped to translate a set of hypotheses about the behaviour of markets or agents into numerical predictions in order to provide effective risk management strategies. The financial crisis which followed the Lehman crash highlighted the need to provide accurate measures of market, credit, operational, liquidity and funding risk measurement and management, for the practitioner and academic world. Traditional market, credit, operational, liquidity and funding risk measures (including the interplay between them) have to be adequately estimated and monitored by firms, banks and financial intermediaries using proper mathematical models. These models must allow the user to assess the correlated risks and risk concentrations, to implement statistical models for the identification of risks or to run stress-based measures. Although mathematical modelling and the quantitative approach are clearly important, common sense and an appreciation of a wide range of potential outcomes, includ

This paper investigates the informational content of the yield curve in the European market using data on the Italian term structures. According to the expectation hypothesis theory (EHT) the current forward rate equals the future short rate plus a constant risk premium that is time invariant but maturity dependent. This theory has been widely tested in the empirical literature providing various findings according to the country where it has been applied and to the segment of the yield curve examined or the period under study. The standard approach to test the EHT uses the regression techniques assuming data on spot rates and their first differences to be stationary. Recently an increasing number of studies evidenced the non stationarity of interest rates time series and some tests of the EHT are formulated using term spread and forward-spot spread which are stationary. A new strand of literature suggests to investigate the EHT using a restricted VAR framework. In this paper, following [Jondeau, E., Ricart, R., 1999. The expectations hypothesis of the term structure: tests on us, german, french and uk euro-rates. Journal of International Money and Finance 18, 725–750, Ghazali, N.A. Low, S.W., 2002. The expectations hypothesis in emerging financial markets: the case of malaysia. Applied Economics 34, 1147–1156 and Seo, B., 2003. Non linear mean reversion in the term structure of interest rates. Journal of Economic Dynamics and Control 27, 2243–2265], we test if the expectation hypothesis holds using cointegration and error correction analysis. For the period under study results suggest that the long and short term interest rates are cointegrated and therefore subject to a long equilibrium path, providing evidence that the EHT holds for the Italian and the European market.

Simulation methods are extensively used in Asset Pricing and Risk Management. The most popular of these simulation approaches, the Monte Carlo, requires model selection and parameter estimation. In addition, these approaches can be extremely computer intensive. Historical simulation has been proposed as a non-parametric alternative to Monte Carlo. This approach is limited to the historical data available. In this paper, we propose an alternative historical simulation approach. Given a historical set of data, we define a set of standardized disturbances and we generate alternative price paths by perturbing the first two moments of the original path or by reshuffling the disturbances. This approach is either totally non-parametric when constant volatility is assumed; or semi-parametric in presence of GARCH(1, 1) volatility. Without a loss in accuracy, it is shown to be much more powerful in terms of computer efficiency than the Monte Carlo approach. It is also extremely simple to implement and can be an effective tool for the valuation of financial assets. We apply this approach to simulate pay off values of options on the S&P 500 stock index for the period 1982–2003. To verify that this technique works, the common back-testing approach was used. The estimated values are insignificantly different from the actual S&P 500 options payoff values for the observed period.

We present our experience in endoscopic laser assisted dacryocystorhinostomy (DCR) analyzing the results obtained with a new technique that involves placing bicanalicolar silicone stent more Teflon tube, in combination with paraseptal silastic sheet.In our study 49 of 57 patients (85%) at a mean follow up of at least 12 months have not reported epiphora or more episodes of acute dacryocystitis.49 out of the 57 patients (85%) in our group reported no additional epiphora or episodes of acute dacryocystitis.Endoscopic DCR is currently the gold standard for sac and post-sac stenosis given the minimal invasiveness of the procedure and the long-term results that appear comparable to those obtained with extrinsic DCR. The principal problem is cicatricial stenosis that can occlude the stoma over time.

Myasthenia gravis (MG) induces a reduction of transient evoked otoacoustic emissions (TEOAEs) and distortion product otoacoustic emissions (DPOAEs) that reverses partially after administration of an acetylcholinesterase (AChE) inhibitor. In normal subjects a contralateral acoustic stimulation (CAS) produces an amplitude reduction of TEOAEs and DPOAEs. This effect, called contralateral suppression (CS), is mediated by the efferent auditory system. Twenty subjects affected by MG underwent DPOAE recording with and without contralateral white noise in a drug-free baseline period ('basal') and 1 h ('post') after administration of a reversible AChE inhibitor. In 'basal' condition CAS did not induce significant DPOAE amplitude changes but a paradoxical slight increase was observed. After drug administration, CAS produced a significant decrease of DPOAE amplitudes for middle frequencies (f(2) between 1306 and 2600 Hz). In normal controls CAS caused a significant decrease (P

The accumulation of chyle into the mediastinum after surgical intervention is considered an extremely rare event, which has been previously described only in adulthood. We report on a 9-month-old boy who developed a cervicomediastinal chyloma after excision of a large left-sided supraclavicular cystic hygroma. Notwithstanding considerable tracheal deviation, the infant remained asymptomatic and was successfully treated by nonoperative treatment. Professionals should be aware of such an unusual condition, which may benefit from expectant management when evaluation establishes a high likelihood of clinical diagnosis, and patient's general condition remains stable. This approach may avoid, with little risk, unnecessary early surgical intervention in some of these patients.