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Diagnosis of myeloid neoplasm is currently performed according to the presence of a predetermined set of clinical, morphological, and molecular diagnostic criteria agreed upon by a consensus of experts. Even strictly adhering to these criteria, it is possible to encounter patients who present features that are not easily ascribable to a single disease category. This is the case, e.g., of patients with de novo myeloid neoplasms with features intermediate between primary myelofibrosis (PMF) and chronic myelomonocytic leukemia (CMML). In this study, we retrospectively searched the pathological database of IRCCS Humanitas Research Hospital to identify cases of chronic myeloid neoplasm with monocytosis with a driver mutation of classic myeloproliferative neoplasms (MPN) and showing morphological MPN features. For each case, we assessed all epidemiological, clinical, histopathological, and molecular data. Then, we carried out a literature review, searching for cases with features similar to those of our patients. We retrieved a total of 13 cases presenting such criteria (9 from the literature review and 4 from our institution); in all of them, there was a coexistence of clinical, histopathological, and molecular myelodysplastic and myeloproliferative features. To date, according to current classifications (World Health Organization and International Consensus Classification), given the presence/absence of essential features for PMF or CMML, these patients should be formally diagnosed as myelodysplastic/myeloproliferative neoplasm unclassified/not otherwise specified (U/NOS). This review aims to summarize the features of these difficult cases and discuss their differential diagnosis and their classification according to the novel classifications and the existing literature on overlapping myeloid neoplasms.

Abstract BackgroundManaging noncommunicable diseases effectively requires continuous coordination and monitoring, often facilitated by eHealth technologies like mobile health (mHealth) apps. The end-user version of the Mobile Application Rating Scale is a valuable tool for assessing the quality of mHealth apps from the user perspective. However, the absence of a French version restricts its use in French-speaking countries, where the evaluation and regulation of mHealth apps are still lacking, despite the increasing number of apps and their strong relevance in health care. ObjectiveThis study aims to translate and culturally adapt a French version of the user Mobile Application Rating Scale (uMARS-F) and to test its overall and internal reliability. MethodsCross-cultural adaptation and translation followed the universalist approach. The uMARS-F was evaluated as part through a cohort study using the French mHealth app “MonSherpa” (Qare). Participants were French-speaking adults with Apple or Android phones, excluding those with difficulty understanding French, prior app use, or physical limitations. They assessed the app using the uMARS-F twice (T1 and T2) 1 week apart. Scores for each section and overall were assessed for normal distribution using the Shapiro-Wilk test and presented as mean (SD), and potential floor or ceiling effects were calculated accordingly. Overall reliability was evaluated using intraclass correlation coefficients and internal reliability using Cronbach α. Concordance between the 3 subscales (objective quality, subjective quality, and perceived impact), 4 sections, and 26 items at T1 and T2 was evaluated using the paired t ResultsIn total, 167 participants assessed the app at both T1 and T2 (100% compliance). Among them, 49.7% (n=83) were female, and 50.3% (n=84) were male, with a mean age of 43 (SD 16) years. The uMARS-F intraclass correlation coefficients were excellent for objective quality (0.959), excellent for subjective quality (0.993), and moderate for perceived impact (0.624). Cronbach α was good for objective quality (0.881), acceptable for subjective quality (0.701), and excellent for perceived impact (0.936). The paired tPrP ConclusionsThe uMARS-F is a valid tool for end users to assess the quality of mHealth apps in French-speaking countries. The uMARS-F used in combination with the French version of the Mobile Application Rating Scale could enable health care professionals and public health authorities to identify reliable, high-quality, and valid apps for patients and should be part of French health care education programs.

Abstract Lions and their prey are threatened across most of their range and especially in West and Central Africa. Prey availability influences carnivore densities, social structure, prey preference and home ranges, and changes in prey are important for carnivore management. Scarcity of large prey in many West and Central African ecosystems has been described as leading to a preference for hunting smaller prey in smaller groups. Here we investigated the changes in prey selection of lions in Zakouma National Park (Chad), a protected area in Central Africa that showed significant recovery in wildlife numbers, by collecting feeding data through observations of lions on kills during monitoring drives and GPS cluster points of lion collars. Compared to similar data collected prior to this significant recovery, lions preferred larger prey and fed in larger groups. Our results show that diet shifts due to prey losses can be reversed with restoration of prey populations thanks to improved management, and we speculate that this may be true across large carnivores and across regions.

El artículo indaga y reflexiona acerca del proceso que hace que los youtubers logren gran difusión, cuestión que lleva a concentrarnos en su dimensión mediática y significante. A partir de dicho propósito, analizamos la producción de Zekiel79 siguiendo el modelo de la circulación hipermediática elaborado por Carlón (2020), el cual permite comprender que el crecimiento de los youtubers no alcanza con estudiar las poéticas de sus videos, sino que deben atenderse al menos a tres niveles de circulación de sentido: 1) la circulación que se da en el sistema que conforma las interacciones entre el youtuber y el colectivo de comunicación hipermediática que conforma; 2) la circulación que se da en las relaciones de interpenetración entre dicho sistema y su entorno; y 3) la circulación que se da en las relaciones intersistémicas entre los medios de comunicación masiva y los medios soportados por Internet y la telefonía.

El objetivo del artículo es describir las operaciones que transforman al meme en arte. Para ello, se da cuenta de los antecedentes artísticos y mediáticos del género y se analizan tres obras de la artista argentina, Luciana Ponte, que se apropian del meme. Con el estudio se pretende contribuir al conocimiento de los vínculos contemporáneos del arte argentino con el nuevo sistema mediático y lo risible. La perspectiva analítica se desarrolla en una lectura semiótica de las teorías del arte de Goodman y Danto.

Office of Social Innovation undertakes transformative initiatives that challenge systemic issues and create a space to imagine alternative pathways and perspectives. Our team of staff, students, and faculty has undertaken an intentional process to reflect on these initiatives and elaborate a scholarly approach: one that enters into dialogue with existing scholarship and identifies potential avenues of further research. We explore the guiding principles, areas of research focus, and knowledge mobilization to identify the values and distinguishing features of our approach to social innovation. Guided by our commitment to collaboration and transformation, we identify four research areas of interest: systems thinking pedagogy, community engagement, challenging institutional boundaries in knowledge generation, and the scholarship of teaching and learning. We reflect on each and explore ideas and methods for future research. Finally, we examine how we share research findings, expanding our understanding of staff, students, and faculty as key actors. Our reflection highlights the importance of collaboration and the expanded networks of belonging in research partnerships and knowledge mobilization. This entails positioning ourselves within the broader framework of action research and working from a place that centres community, collaboration, and openness.

BackgroundSince June 2021, patients with hemophilia A with antifactor VIII inhibitors and those with severe hemophilia A without antifactor VIII inhibitors treated with Hemlibra have had to choose between a community or hospital pharmacy. The French reference center for hemophilia developed the HEMOPHAR e-learning program for community pharmacists for dispensing emicizumab. ObjectiveThis study aims to evaluate the efficiency and safety of this new care pathway by assessing the HEMOPHAR e-learning program. MethodsThe methodology is based on Kirkpatrick’s model for evaluating the immediate reaction of trained community pharmacists (level 1), their level of acquired knowledge (level 2), and their professional practice after 3 months of dispensation (level 3). ResultsThe HEMOPHAR e-learning program reached a large audience, with 67% (337/502) of the eligible community pharmacists following it. The immediate reaction was overall satisfying. High rates of engagement were reported with 63.5% (214/337) to 73.3% (247/337) of completed training modules, along with high rates of success with quizzes of 61.5% (174/337) to 95.7% (244/337). We observed that 83.9% (193/230) of the community pharmacists needed less than 2 attempts to pass the quiz of the module related to professional practice, while the other quizzes required more attempts. Advice on compliance and drug interactions were most frequently provided to patients by the community pharmacists. ConclusionsThis study suggests ways to improve the training of community pharmacists and to optimize coordination with treatment centers. This study also reports on the feasibility of switching to a community pharmacy in a secure pharmaceutical circuit, including in the context of a rare bleeding disease. Trial RegistrationClinicalTrials.gov NCT05449197; https://clinicaltrials.gov/study/NCT05449197 International Registered Report Identifier (IRRID)RR2-10.2196/43091

IntroductionThe healthcare pathway is at the heart of public health organization concerns, but communication between the various players can be an obstacle. This work, produced by a French transdisciplinary team, offers a methodological approach based on formalized consensus to elaborate a glossary of healthcare pathways. A two-steps procedure was elaborated, including a double rounded Delphi method to formalize expert consensus, and two groups of experts: a workgroup and a review group.MethodsThe workgroup provided a list of words or expressions that, in their opinion, described, evaluated or compared the healthcare pathways for patients, caregivers or regulators. The review group checked this list and added or deleted words or expressions. Then, definitions were added by the workgroup based into account three dimensions: official, academic and from the field. The review group validated the definitions and provided complementary proposals if needed.ResultsAfter pooling the list of words proposed by each of the six members of the working group, 417 words/expressions were ranked. After the two rounds of evaluation, 294 words/expressions were rated “appropriate” and were analyzed by the review group. This group, after two rounds of evaluation, agreed on 263 words/expressions that were transmitted to the working group who defined them. These definitions were rated by the review group. The first round of evaluation established 195 definitions as being appropriated whereas 68 definitions were amended by the review group.ConclusionThis glossary supports transdisciplinary communication, reduces the extent of variations in practice and optimizes decision-making. International debate on all aspects might be strengthened by an improved understanding of the concept of health pathway.

Automated methods for rapidly purifying and concentrating bacteria from environmental interferents are needed in next-generation applications for anything from water purification to biological weapons detection. Though previous work has been performed by other researchers in this area, there is still a need to create an automated system that can both purify and concentrate target pathogens in a timely manner with readily available and replaceable components that could be easily integrated with a detection mechanism. Thus, the objective of this work was to design, build, and demonstrate the effectiveness of an automated system, the Automated Dual-filter method for Applied Recovery, or aDARE. aDARE uses a custom LABVIEW program that guides the flow of bacterial samples through a pair of size-based separation membranes to capture and elute the target bacteria. Using aDARE, we eliminated 95% of the interfering beads of a 5 mL-sample volume containing 107 CFU/mL of E. coli contaminated with 2 µm and 10 µm polystyrene beads at 106 beads/mL concentration., The target bacteria were concentrated to more than twice the initial concentration in 900 µL of eluent, resulting in an enrichment ratio for the target bacteria of 42 ± 13 in 5.5 min. These results show the feasibility and effectiveness of using size-based filtration membranes to purify and concentrate a target bacterium, in this case E. coli, in an automated system.

El artículo tiene por objetivo describir dos procedimientos del Humor Hipermediático en la generación y activación cotidiana de colectivos identitarios. Llamamos Humor Hipermediático a lo reidero producido en la interacción entre los medios de comunicación masiva y los medios con base en Internet y la telefonía (Fraticelli, 2023). El trabajo parte del abordaje semiótico del concepto de colectivo identitario de Verón (2013, 2012, 1997, 1994, 1987b) y su periodización del vínculo entre la conformación de colectivos y la mediatización. Luego, se hace foco en los cambios que trae el nuevo sistema mediático a la generación de colectivos, entre los que se encuentra la acción del Humor Hipermediático. De ella, nos concentramos en dos procedimientos básicos de la vida cotidiana: la producción de publicaciones risibles en las redes y la regulación de su circulación. Ambos producen la pertenencia a colectivos de identificación. Las maneras en que operan las describimos analizando dos casos. El primero es la producción de humor político hipermediatizado del primer discurso de apertura de las sesiones legislativas del presidente Alberto Fernández y del debate en el senado de la Ley de Interrupción Voluntaria del Embarazo. Y, el segundo es la regulación de la generación reidera del que fuera presidente de ArteBA, Juan Lynch, en la que actuaron distintos enunciadores hipermediáticos del mundo del arte y los medios informativos.

Gender-based violence (GBV) is a global issue deeply rooted that grows from gender inequality and represents one of the most severe human rights violations. GBV is violence directed against a person because of their gender. It may include both intimidation and manipulation in addition to sexual, physical, mental, and financial harm done in secret or in a public context. The consequences of GBV can be devastating, with life-long consequences for survivors, or even result in death. Although GBV affects both men and women, the burden belongs mainly to women and girls. According to the 2015 Italian National Institute of Statistics report, almost 1 out of 3 women in Italy have disclosed physical and/or sexual violence. Thirty-one percent of women aged 16—70 have experienced some form of violence (20% physical and 21% sexual violence).1 Up to December 3, 2023, 109 women had died in Italy, 90 of whom in domestic settings, and 58 had been killed by partners or former partners. Analysing the data from the first nine months of 2023 of calls to the national ‘Anti-violence and anti-stalking’ helpline (1522), approximately half of the victims (47.6%) were victims of physical violence. Psychological violence was the second most frequent reason for calling (36.9%). Most of them (79.4%) are victims of domestic violence. Only 15.8% reported the type of violence they suffered (1,311 victims),2 even if the Italian law ensures greater protection for victims and legal aid. [...]

The feeding activity of frugivorous birds is influenced by the selection criteria for berry size. European laurel (Laurus nobilis), a dioecious species with high lipid and protein content in its berries, is dispersed by blackbird (Turdus merula). This study aimed to investigate the relationship between berry size and feeding behavior of blackbird. Field data was collected in a botanical park near Rome (Italy) and included seed collection, observation of regurgitation events, and bird population surveys. The volume and shape index of berries and seeds were measured, and statistical analyses were performed. The results showed a positive linear correlation between berry and seed volume. Blackbird selectively consumed larger berries, resulting in a higher percentage of pericarp as an energy resource. The birds exhibited a bimodal strategy, feeding on both large ellipsoidal and large round berries, which had a higher percentage of pericarp. The shape index of berries and seeds showed a significant difference between the control collection and those consumed by blackbird. The findings suggest a case of coevolution, with the plant optimizing seed dispersal by offering berries of different sizes to accommodate the feeding behavior of blackbird. This study provides insights into the ecological relationship between frugivorous birds and plants, highlighting the role of berry size in seed dispersal strategies.

The pathogenic role of p-ANCA in eosinophilic granulomatosis with polyangiitis (EGPA) is a long-standing matter of debate. In this work, we report our real-life experience with EGPA patients, treated with biologics targeting type 2 (T2)-eosinophilic inflammation (Mepolizumab, Benralizumab, Dupilumab). Interestingly, we observed EGPA extrarespiratory relapses only in p-ANCA-positive patients (2/5 cutaneous vasculitis, 3/5 constitutional symptoms), with new rise of p-ANCA and normal eosinophil blood count. Notably, revising our cohort with the new ACR 2022 criteria, these five patients were the only ones to satisfy the entry criterion of vasculitis’ defined diagnosis at disease onset. These observations may suggest that biologics, selectively turning off T2 inflammation, may have unmasked p-ANCA exclusive role in the pathogenesis of vasculitis in EGPA. Therefore, we raise the question whether EGPA vasculitis exists only in p-ANCA-positive patients, and whether p-ANCA-negative disease is “only eosinophils without vasculitis”.

Microplastics make up a significant amount of the overall quantity of plastic debris that is present in seawater. However, their detection and monitoring at sea is cost-inefficient and challenging; typically, it consists of water sampling with special manta nets, followed by long (i.e., weeks) laboratory analysis to obtain valid results. The analysis of the state-of-the-art technologies capable of monitoring/detecting microplastics in the sea (typically in coastal areas) presented in this paper shows that there are currently no specific tools to obtain quick measurements. The classic multiparametric probes are useless and the contribution of their relative chemical–physical parameters to determine the presence of microplastics in water is insignificant. The evolution in the last decade of hardware and software tools for capturing hologram images and related post-processing seems to be one of the most effective methods available currently for the rapid detection of microplastics in seawater. In particular, some results of monitoring campaigns carried out in the Adriatic Sea using this type of technology are reported. The acquired data are analyzed and discussed, highlighting their strengths and weaknesses, with indications of the possible methodologies that could be used to improve these systems.

Immune system function declines with age, a consequence of defects in hematopoietic stem cells (HSCs). Here the authors show that TAZ buffers age-related loss of PU.1 activity to maintain HSC functionality and identify the surface protein Clca3a1 as a marker of “young-like” HSCs, even in old mice.

The brutal murder of 55-year-old Italian psychiatrist Barbara Capovani in April 2023, at the hands of a man she had assisted during a hospitalization four years prior, produced a wave of emotion within Italian psychiatry, with important echoes in the media. It is the death of a woman at work, a doctor, a psychiatrist, a professional of the National Health Service who has been taking care of serious mental illnesses for years. She was beaten to death by the attacker at the end of her shift at the psychiatric ward of the Santa Chiara Hospital in Pisa as she was untying her bicycle to go home. The man is now in jail on premeditated murder accusations. The day before he had gone to look for her in the hospital without success; the day of the crime he returned, dressed in dark clothes, masked with a hat on his head and a backpack on his shoulders. During his arrest, officers discovered a crossbow and some bolts in his home.

This short report describes two cases of predation carried out by Merlin Falco columbarius in open sea, highlighting the ability of this species to feed during active migration.

BackgroundCommercialized since 2019, emicizumab (Hemlibra) was available only in French hospital pharmacies for prophylaxis of hemophilia A with or without inhibitors. Since June 15, 2021, patients can choose between a hospital and community pharmacy. These changes in the care pathway have important organizational consequences for patients, their relatives, and health professionals. Two training programs are available for community pharmacists: the “HEMOPHAR” training program proposed by the national reference center for hemophilia and the Roche training program proposed by the laboratory that markets the product. ObjectiveThe PASODOBLEDEMI study aims to evaluate the direct impact of the training programs provided to community pharmacists in the context of the dispensing of emicizumab, and to evaluate patients’ satisfaction with their treatment whether they choose dispensation from a community pharmacy or retained dispensation from the hospital pharmacy. MethodsWe designed a cross-sectional study based on the 4-level Kirkpatrick evaluation model: the immediate reaction of community pharmacists following training (Reaction), the knowledge acquired during the training (Learning), the professional practice of community pharmacists during dispensing of the product (Behavior), and patients’ satisfaction related to the treatment whether it is dispensed from a hospital or from a community pharmacy (Results). ResultsConsidering that single outcome measures cannot adequately reflect the complexity of this new organization, the Kirkpatrick evaluation model provides 4 distinct outcomes: the immediate reaction after the HEMOPHAR training program, the level of knowledge acquired after the HEMOPHAR training program, the impact of training on professional practice, and patient satisfaction with access to emicizumab. We developed specialized questionnaires for each of the 4 levels of the Kirkpatrick evaluation model. All community pharmacists involved in dispensing emicizumab, whether they have followed the HEMOPHAR or the Roche training program or neither, were eligible for inclusion. All patients with severe hemophilia A were eligible, irrespective of inhibitor use, age, treatment with emicizumab, and whether they chose dispensation from a community pharmacy or retained dispensation from a hospital pharmacy. ConclusionsThe new organization for dispensing emicizumab to patients with hemophilia A in French community pharmacies must be accompanied by optimal safety and quality conditions due to the risk of serious and urgent bleeding situations in the management of rare bleeding diseases. The elaboration of the PASODOBLEDEMI protocol has already a positive impact with the commitment of all health professionals, physicians, hospital and community pharmacists, and the patient community. The results will be disseminated among the French authorities and will enable, if necessary, proposing this access model to other rare diseases. Trial RegistrationClinicalTrials.gov NCT05449197, https://clinicaltrials.gov/ct2/show/NCT05449197?term=NCT05449197; ClinicalTrials.gov NCT05450640, https://clinicaltrials.gov/ct2/show/NCT05450640?term=NCT05450640 International Registered Report Identifier (IRRID)DERR1-10.2196/43091

The aim of the study was to estimate the effect of the COVID- 19 pandemic and response policies on the psychiatric ward admissions in the hospitals referring to the ASST Lariana (province of Como, Italy) and the Hospital of Mendrisio (Canton of Ticino, Switzerland), two similar territories that belong to countries that dealt differently with the pandemic. We compared the two territories for type of admission (voluntary vs. compulsory), the Stringency Index (SI) and the country’s number of admission in Intensive Care Units (ICU). We found a significant reduction in the psychiatric ward admission in the lockdown period in both territories, even in periods with milder lockdown measures. The admission rate’s reduction in the ASST Lariana was significantly associated with the ICU admissions (p

Primary cutaneous B-cell lymphomas (PCBCLs) account for 25% of all primary cutaneous lymphomas. Three major types are currently recognized by the WHO classification: primary cutaneous marginal zone B-cell lymphoma (PCMZL), primary cutaneous follicle centre lymphoma (PCFCL) (both considered indolent lymphomas) and primary cutaneous diffuse large B-cell lymphoma, leg-type (PCDLBCL-LT), which is, instead, a very aggressive disease. Nowadays, the PCBCL’s category also includes some rare entities such as intravascular B-cell lymphoma (IVBL) and the EBV+ mucocutaneous ulcer (EBVMCU). Furthermore, controversies still exist concerning the category of primary cutaneous diffuse large B-cell lymphoma (PCDLBCL), because some cases may present with clinical and histological features between PCFCL and PCDLBCL-LT. Therefore, some authors proposed introducing another category called PCDLBCL, not otherwise specified (NOS). Regardless, PCBCLs exhibit distinct features and differ in prognosis and treatment from their nodal/systemic counterparts. Therefore, clinicopathologic analysis is a key diagnostic element in the work-up of these lymphomas.

El tuiteo de humor político sobre transmisiones televisivas es una práctica habitual que debe atenderse si quiere comprenderse cómo se construyen los acontecimientos en las sociedades actuales. Su existencia implica complejos procedimientos de apropiación colaborativa por parte de los internautas y también de los medios informativos que editorializan los eventos con sus memes. Aquí nos ocuparemos de describir de qué manera opera ese humor político enfocándonos en cómo actúan sus enunciadores, qué clases discursivas y tipos de circulaciones genera. Los eventos analizados son el primer discurso de apertura de las sesiones legislativas del presidente argentino Alberto Fernández, en marzo del 2020, y el debate en el Senado argentino de la Ley de Interrupción Voluntaria del Embarazo, en diciembre del mismo año. Su análisis nos posibilitó observar que el humor político del live tweeting tiene más retuiteos y likes que los tuits serios y que sus intercambios no se agotan en lo risible, sino que fomentan debates entre los internautas. A su vez, distinguimos cuatro clases discursivas (la sátira política, la burla, la situación cómica y el humor del colectivo) que implican modos diferentes de contactarse con el evento transmitido y circunscribimos modalidades de apropiación de las instituciones informativas.

BackgroundApproximately 800 million people, representing 11% of the world’s population, are affected by mental health problems. The COVID-19 pandemic exacerbated problems and triggered a decline in well-being, with drastic increase in the incidence of conditions such as anxiety, depression, and stress. Approximately 20,000 mental health apps are listed in mobile app stores. However, no significant evaluation of mental health apps in French, spoken by approximately 300 million people, has been identified in the literature yet. ObjectiveThis study aims to review the mental health mobile apps currently available on the French Apple App Store and Google Play Store and to evaluate their quality using Mobile App Rating Scale–French (MARS-F). MethodsScreening of mental health apps was conducted from June 10, 2022, to June 17, 2022, on the French Apple App Store and Google Play Store. A shortlist of 12 apps was identified using the criteria of selection and assessed using MARS-F by 9 mental health professionals. Intraclass correlation was used to evaluate interrater agreement. Mean (SD) scores and their distributions for each section and item were calculated. ResultsThe highest scores for MARS-F quality were obtained by Soutien psy avec Mon Sherpa (mean 3.85, SD 0.48), Evoluno (mean 3.54, SD 0.72), and Teale (mean 3.53, SD 0.87). Mean engagement scores (section A) ranged from 2.33 (SD 0.69) for Reflexe reussite to 3.80 (SD 0.61) for Soutien psy avec Mon Sherpa. Mean aesthetics scores (section C) ranged from 2.52 (SD 0.62) for Mental Booster to 3.89 (SD 0.69) for Soutien psy avec Mon Sherpa. Mean information scores (section D) ranged from 2.00 (SD 0.75) for Mental Booster to 3.46 (SD 0.77) for Soutien psy avec Mon Sherpa. Mean Mobile App Rating Scale subjective quality (section E) score varied from 1.22 (SD 0.26) for VOS – journal de l’humeur to 2.69 (SD 0.84) for Soutien psy avec Mon Sherpa. Mean app specificity (section F) score varied from 1.56 (SD 0.97) for Mental Booster to 3.31 (SD 1.22) for Evoluno. For all the mental health apps studied, except Soutien psy avec Mon Sherpa (11/12, 92%), the subjective quality score was always lower than the app specificity score, which was always lower than the MARS-F quality score, and that was lower than the rating score from the iPhone Operating System or Android app stores. ConclusionsMental health professionals assessed that, despite the lack of scientific evidence, the mental health mobile apps available on the French Apple App Store and Google Play Store were of good quality. However, they are reluctant to use them in their professional practice. Additional investigations are needed to assess their compliance with recommendations and their long-term impact on users.

[es] Con el siguiente artículo esperamos demostrar la necesidad de estudiar la enunciación para aprehender lo risible en las redes sociales mediáticas. En los estudios sobre el tema, se ha expandido la práctica de realizar análisis internos de memes y videos cómicos suponiendo que así se explica cómo producen lo reidero. Sin embargo, con este tipo de análisis no se alcanza ese objetivo porque lo risible se instituye en lo enunciativo, por lo que es necesario estudiar los memes y videos emplazados en las cuentas que los publicaron. Para probar esto, abordaremos lo reidero desde una perspectiva comunicacional y semiótica construyendo herramientas que sirvan para su estudio. Luego presentaremos un modelo analítico que dé cuenta de la enunciación en las redes sociales y, finalmente, analizaremos algunos productos risibles con el fin de verificar nuestros postulados. [en] With the following paper we hope to demonstrate the need to study the enunciation to apprehend the laughable in the social media networks. In the studies on the subject, the practice of internal analysis of memes and funny videos has been expanded assuming that this explains how they produce the laughable. However, as we will argue, with these internal analyzes that objective is not achieved because the laughable is instituted in the enunciation, so it is necessar y to analyze the memes and videos placed in the accounts that published them. To prove this, we will approach the laughable from a communicational and semiotic perspective, building tools that serve to study it. Then we will develop an analytical model that accounts for the enunciation in social networks and, finally, we will analyze some laughable products in order to verif y our postulates.

Abstract Background We hypothesized that monitoring the volume of activity and overall performance indicators is not sufficient to understand the underlying differences between emergency departments. We aimed to understand the underlying common characteristics of emergency departments and map their typology in order to propose adaptive solutions, that would take into account territorial specificities and manage existing resources. Methods We applied a multifactorial analysis based on input data at three levels; 1) the health care available in the area surrounding the emergency departments, 2) the level of medical technicality of the hospitals and 3) the profile of emergency department visits. Results We included 73 emergency departments in this study, representing 93.6% of the emergency departments in our region and seven groups were retained. The smallest group (n = 5) included both public and private structures with low volumes of activity. These medical structures were associated with the shortest length of stay and one of the lowest hospitalisation rates. The largest group (n = 21) included only public structures in peri-urban areas, which were associated with the highest rate of hospitalization in the region. The surrounding population was representative of the regional population, but the patients were older. Conclusions This approach represents a systemic response to target the organisational needs and constraints, propose appropriate solutions and adjust the financial resources allocated to hospitals. Future policies to improve care delivery may benefit from stratifying solutions and performance objectives depending on these groups.

Gastrointestinal (GI) involvement of plasma cell neoplasms is extremely rare. Herein, we describe the case of a 74-year-old Caucasian woman who came to our attention with abdominal pain, food vomiting, and weight loss of 10 kg over 1 year. A computed tomography scan of the abdomen revealed circumferential thickening of terminal ileum, for which the patient underwent an urgent 20-cm-long ileal resection. Histopathological and immunophenotypic analysis revealed a plasma cell neoplasm of the ileum. Subsequent investigations found a serum monoclonal immunoglobulin A component, an osteolytic lesion of the left jaw, and a clonal bone marrow plasma cell infiltrate carrying 1q21 amplification. Given the final diagnosis of plasma cell myeloma (PCM), the patient underwent a VMD (bortezomib, melphalan, and dexamethasone) chemotherapy regimen, achieving a complete remission after a 12-month treatment. For disease relapse, two further chemotherapy regimens were later attempted. At the last follow-up 4 years after the diagnosis, the patient is still alive. This case draws attention to the extramedullary presentation of plasma cell neoplasms, even if rare, as a prompt diagnosis seems to result in a better prognosis. In addition, it highlights the relevance of a multidisciplinary approach, involving gastroenterologists, hematologists, and pathologists, to the diagnosis and management of these neoplasms.

The phenomenon of acute behavioral disturbance is an underrecognized and potentially life-threatening syndrome, and sometimes an emergency in psychiatric settings. Patients presenting to the Italian emergency department (ED) with acute behavioral disturbances account for approximately 3.2% of all ED visits. The spectrum of behaviors and signs overlap with many clinical disease processes. In addition to patients with behavioral problems related to mental disorders or substance abuse, there is also a large group whose behavioral emergencies directly result from medical illness. The complexity of these patients, as well as the interdisciplinary nature of their care, requires a clear and consensual framework for care. A network of Italian scientific societies developed ten reccomendations for good clinical practice. The main purpose is to draw up a document that presents a standardized method for the organization of the care of patients with acute behavioral disorders in ED

Background: Identification of outcome predictors is one of the unmet needs in chronic HDV infection. Until recently, no reliable quantitative assays for HDV RNA were available. Aims: To evaluate the impact of baseline viremia on natural history of HDV infection in a cohort of patients whose serum samples were stored at their first visit 15 years ago. Methods: Quantitative HBsAg, HBeAg, HBeAb, HBV DNA, HDV RNA, genotypes, and liver disease severity were assessed at baseline. Patients who were no longer on active follow-up were recalled and re-evaluated in August 2022. Results: The majority of patients were male (64.9%); the median age was 50.1 years; and all patients were Italian, with only three born in Romania. All were HBeAg negative with HBV genotype D infection. Patients were subdivided three groups: 23 were in active follow-up (Group 1), 21 were recalled due to no longer being in follow-up (Group 2), and 11 died (Group 3). Liver cirrhosis was diagnosed in 28 subjects at the first visit; 39.3% of diagnosed patients were in Group 3, 32.1% were in Group 1 and 28.6% were in Group 2 (p = 0.001). Baseline HBV DNA IU/mL Log10 were 1.6 (1.0–5.9) in Group 1, 1.3 (1.0–4.5) in Group 2, and 4.1 (1.5–4.5) in Group 3; median baseline HDV RNA Log10 levels were 4.1 (0.7–6.7) in Group 1, 3.2 (0.7–6.2) in Group 2, and 5.2 (0.7–6.7) in Group 3, resulting significantly higher rates among patients in Group 3 compared to the other groups (p = 0.038). Eighteen patients in Group 2, as compared to 7 in Group 1, had undetectable HDV RNA at the follow-up evaluation (p = 0.001). Conclusions: HDV chronic infection is a heterogeneous disease. It may not only progress but also improve over time in patients, who eventually become HDV RNA-undetectable. HDV RNA levels may help identify the subgroup of patients with less progressive liver disease.

Castleman disease (CD) is a rare lymphoproliferative disorder that includes various clinico-pathological subtypes. According to clinical course, CD is divided into unicentric CD (UCD) and multicentric CD (MCD). MCD is further distinguished based on the etiological driver in herpes virus-8-related MCD (that can occur in the setting of HIV); in MCD associated with POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes); and idiopathic MCD (iMCD). The latter can also be divided in iMCD-TAFRO (thrombocytopenia, anasarca, fever, myelofibrosis, organomegaly) and iMCD not otherwise specified. To date, CD pathogenesis is still uncertain, but CD may represent the histological and clinical result of heterogeneous pathomechanisms. Transcriptome investigations in CD lymph nodes have documented the expression and up-regulation of different cytokines; furthermore, few recent studies have shown alterations of different T-cell subsets in CD patients, suggesting a possible role of the nodal microenvironment in CD development. On this basis, our study aimed to investigate the distribution of T-cell subsets in the clinico-pathological spectrum of CD. We evaluated the CD4/CD8 ratio and the number of T-regulatory (T-reg) FOXP3+ cells in 28 CD cases. In total, 32% of cases showed a decreased CD4/CD8 ratio due to increased CD8+ T-cells, including both UCD, iMCD, and HHV8+ MCD cases. The T-reg subset analysis revealed a statistically significant (p < 0.0001) lower mean number of FOXP3+ T-reg cells in CD cases when compared with non-specific reactive lymph nodes. We did not find statistically significant differences in T-reg numbers between the different CD subtypes. These findings may suggest that alterations in T-cell subpopulations that can lead to disruption of immune system control may contribute to the numerous changes in different cellular compartments that characterize CD.

BackgroundThe global burden of disease attributes 20% of deaths to poor nutrition. Although hundreds of nutrition-related mobile apps have been created, and these have been downloaded by millions of users, the effectiveness of these technologies on the adoption of healthy eating has had mixed ObjectiveThe aim of this study was to review which nutrition-related mobile apps are currently available on the French market and assess their quality. MethodsWe screened apps on the Google Play Store and the French Apple App Store, from March 10 to 17, 2021, to identify those related to nutritional health. A shortlist of 15 apps was identified, and each was assessed using the French version of the Mobile App Rating Scale: 8 dietitians and nutritionists assessed 7 apps, and the remaining apps were randomly allocated to ensure 4 assessments per app. Intraclass correlation was used to evaluate interrater agreement. Means and standard deviations of scores for each section and each item were calculated. ResultsThe top scores for overall quality were obtained by Yazio - Régime et Calories (mean 3.84, SD 0.32), FeelEat (mean 3.71, SD 0.47), and Bonne App (mean 3.65, SD 0.09). Engagement scores ranged from a mean of 1.95 (SD 0.5) for iEatBetter: Journal alimentaire to a mean of 3.85 (SD 0.44) for FeelEat. Functionality scores ranged from a mean of 2.25 (SD 0.54) for Naor to a mean of 4.25 (SD 0.46) for Yazio. Aesthetics scores ranged from a mean of 2.17 (SD 0.34) for Naor to a mean of 3.88 (SD 0.47) for Yazio. Information scores ranged from a mean of 2.38 (SD 0.60) for iEatBetter to a mean of 3.73 (SD 0.29) for Yazio. Subjective quality scores ranged from a mean of 1.13 (SD 0.25) for iEatBetter to a mean of 2.28 (SD 0.88) for Compteur de calories FatSecret. Specificity scores ranged from a mean of 1.38 (SD 0.64) for iEatBetter to a mean of 3.50 (SD 0.91) for FeelEat. The app-specific score was always lower than the subjective quality score, which was always lower than the quality score, which was lower than the rating from the iOS or Android app stores. ConclusionsAlthough prevention and information messages in apps regarding nutritional habits are not scientifically verified before marketing, we found that app quality was good. Subjective quality and specificity were associated with lower ratings. Further investigations are needed to assess whether information from these apps is consistent with recommendations and to determine the long-term impacts of these apps on users.

Publicado en junio de 2020, el Livro de vozes e sombras de João de Melo se inserta en una fértil corriente literaria que en los últimos años ha proporcionado nuevas posibles lecturas del periodo revolucionario de 1974. Las tres historias que componen el eje argumental de la novela, intrínsecamente relacionadas entre sí, suponen un hito en la narrativa contemporánea, por la capacidad del autor de dar una voz tanto a las víctimas como a los verdugos de los sucesos del Verano Caliente de 1975. Ambientado en las Azores, en Lisboa y en Angola, el Livro de João de Melo desvela e interpreta los orígenes del independentismo del Frente de Libertação dos Açores, las acciones violentas perpetradas contra la población contraria a sus posiciones ideológicas, así como las consecuencias de la descolonización portuguesa en África a través del testimonio de una niña ciega que se convierte de forma repentina en una retornada. La ficción literaria se postula así como una sólida base para la configuración de una memoria colectiva que incluya todas las sensibilidades, cada una con sus fisuras y sus contradicciones.

Abstract Background Decisions of withholding or withdrawing life sustaining-treatments in emergency department are part of current practice but the decision-making process remains poorly described in the literature. Study objective We conducted a study in two phases, the first comprising a retrospective chart review study of patients dying in the ED and the second comprising survey study of health care workers at 10 urban emergency departments in France. Method In a first step, we analyzed medical records based on fifteen criteria of the decision-making process grouped into four categories: the collegiality, the traceability, the management and the communication as recommended by the international guidelines. In a second step, we conducted an auto-administrated survey to assess how the staff members (medical, paramedical) feel with the decision-making process. Results There were 273 deaths which occurred in the ED over the study period and we included 145 (53.1%) patients. The first-step analysis revealed that the traceability of the decision and the information given to patient or the relatives were the most reported points according to the recommendations. Three of the ten emergency departments had developed a written procedure. The collegial discussion and the traceability of the prognosis assessment were significantly increased in emergency department with a written procedure as well as management of pain, comfort care, and the communication with the patient or the relatives. In the second-step analysis, among the 735 staff members asked to take part in the survey, 287 (39.0%) answered. The medical and paramedical staff expressed difficult experience regarding the announcement and the communication with the patient and the relatives. Conclusion The management of the decision to withhold or withdraw life-sustaining treatments must be improved in emergency departments according to the guidelines. A standard written procedure could be useful in clinical practice despite the lack of experienced difference between centers with and without procedures.

Abstract Objectives To analyze the temporal trends in thrombolysis rates after implementation of a regional emergency network for acute ischemic stroke (AIS). Methods We conducted a retrospective study based on a prospective multicenter observational registry. The AIS benefited from reperfusion therapy included in 1 of the 5 primary stroke units or 1 comprehensive stroke center and 37 emergency departments were included using a standardized case report form. The population covers 3 million inhabitants. Results In total, 32,319 AIS was reported in the regional hospitalization database of which 2215 thrombolyzed AIS patients were included in the registry and enrolled in this study. The annual incidence rate of thrombolysis continuously and significantly increased from 2010 to 2018 (10.2% to 17.3%, P‐trend = 0.0013). The follow‐up of the onset‐to‐door and the door‐to‐needle delays over the study period showed stable rates, as did the all‐cause mortality rate at 3‐months (13.2%). Conclusion Although access to stroke thrombolysis has increased linearly since 2010, the 3‐month functional outcome has not evolved as favorably. Further efforts must focus on reducing hospital delays.

Subcutaneous (SC) rituximab may be beneficial in terms of convenience and tolerability, with potentially fewer and less severe administration-related reactions (ARRs) compared to the intravenous (IV) form. This report presents the results of a phase IIIb study conducted in Italy. The study included adult patients with CD20+ DLBCL or FL having received at least one full dose of IV RTX 375 mg/m2 during induction or maintenance. Patients on induction received ≥4 cycles of RTX SC 1400 mg plus standard chemotherapy and FL patients on maintenance received ≥6 cycles of RTX SC. Overall, 159 patients (73 DLBCL, 86 FL) were enrolled: 103 (54 DLBCL, 49 FL) completed induction and 42 patients with FL completed 12 maintenance cycles. ARRs were reported in 10 patients (6.3%), 3 (4.2%) with DLBCL and 7 (8.1%) with FL, all of mild severity, and resolved without dose delay/discontinuation. Treatment-emergent adverse events (TEAEs) and serious adverse events occurred in 41 (25.9%) and 14 patients (8.9%), respectively. Two patients with DLBCL had fatal events: Klebsiella infection (related to rituximab) and septic shock (related to chemotherapy). Neutropenia (14 patients, 8.9%) was the most common treatment-related TEAE. Two patients with DLBCL (2.8%) and 6 with FL (7.0%) discontinued rituximab due to TEAEs. 65.2% and 69.7% of patients with DLBCL and 67.9% and 73.6% of patients with FL had complete response (CR) and CR unconfirmed, respectively. The median time to events (EFS, PFS, and OS) was not estimable due to the low rate of events. At a median follow-up of 29.5 and 47.8 months in patients with DLBCL and FL, respectively, EFS, PFS, and OS were 70.8%, 70.8%, and 80.6% in patients with DLBCL and 77.9%, 77.9%, and 95.3% in patients with FL, respectively. The switch from IV to SC rituximab in patients with DLBCL and FL was associated with low risk of ARRs and satisfactory response in both groups. This trial was registered with NCT01987505.