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The aim of the present study was to assess prevalence and disease outcomes of arthritis in a nationwide cohort of pediatric patients with inflammatory bowel disease (IBD). We collected data of pediatric IBD patients experiencing arthritis from the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition IBD registry. We gathered baseline and one-year follow-up data on concomitant IBD and arthritis diagnosis. 150 patients [(99 Crohn's Disease (CD), 51 Ulcerative Colitis (UC) and Unclassified IBD (IBDU)] with arthritis out of 3061 (1301 CD and 1760 UC) patients were identified, with an overall prevalence of 4.9 %. Arthritis was more frequent in CD than in UC (7.6 % vs 2.9 %, p < 0.01). Peripheral arthritis was more frequently diagnosed in patients with active IBD than in those with quiescent disease (94.6 % vs 67.3 %, p < 0.01). At one-year follow-up, clinically active IBD was independently associated with lower peripheral arthritis remission rates, whereas it did not impact axial arthritis remission. The presence of additional EIMs was associated with lower IBD clinical remission rates. Clinically active IBD impacts peripheral arthritis but not axial one, whose activity appeared to be independent by intestinal disease. The presence of additional EIMs has a negative prognostic impact on IBD course. [ABSTRACT FROM AUTHOR]

The natural history of ulcerative proctitis (UP) has been poorly investigated in children. We aimed to compare the disease course of children with UP at diagnosis to the other locations and to identify extension predictors. This was a multicenter, observational study carried out from data prospectively entered in the SIGENP-IBD-Registry. Children with ulcerative colitis (UC) diagnosis and at least 1-year follow-up were included. On the basis of Paris classification UP patients were identified and compared with the other locations. 872 children were enrolled (median age at diagnosis: 11.2 years; M/F: 426/446), of whom 78 (9%) with UP. Kaplan–Meier analysis demonstrated increased cumulative probabilities of disease extension in the E1 group [1 year: 20.3%; 5 years: 52.7%; 10 years: 72.4%] compared to E3 group [1 year: 8.5%; 5 years: 24.9% and 10 years: 60.1%, p=0.001]. No differences were observed comparing E1 and E2 groups [p=0.4]. Cumulative probabilities of surgery at 1, 5 and 10 years were 1.3, 2.8 and 2.8% in the E1 group and 2.5, 8 and 12.8% in the E2–E3-E4 group, respectively (p=0.1). Cox regression analysis demonstrated that PUCAI>35 at diagnosis was associated with endoscopic extension (HR=4.9; CI 95% 1.5-15.2, p=0.006). UP is associated with similar short and long-term outcomes compared to other locations. [ABSTRACT FROM AUTHOR]

Although consistent data support the outpatient use of continuous glucose monitoring (CGM) to improve glycemic control and reduce hypoglycemic burden, and clinical outcomes, there are limited data regarding its use in the hospital setting, particularly in the non-intensive care unit (non-ICU) setting. The emerging use of CGM in the non-critical care setting may be useful in increasing the efficiency of hospital care and reducing the length of stay for patients with diabetes while improving glycemic control. The purpose of this Expert Opinion paper was to evaluate the state of the art and provide a practical model of how CGM can be implemented in the hospital. A patient's CGM journey from admission to the ward to the application of the sensor, from patient education on the device during hospitalization until discharge of the patient to maintain remote control. This practical approach for the implementation and management of CGM in patients with diabetes admitted to non-ICUs could guide hospitals in their diabetes management initiatives using CGM, helping to identify patients most likely to benefit and suggesting how this technology can be implemented to maximize clinical benefits. • Data regarding the use of CGM in the hospital setting are limited, particularly in the non-critical care wards. • Emerging use of CGM in the non-critical setting may increase the efficiency of hospital care and reduce the length of stay. • The CGM management team consists of CGM manager, nurses, the specialist of the wards eligible using the CGM. • This Expert Opinion paper evaluates the state of the art and provides a practical model to implement CGM in hospital setting. [ABSTRACT FROM AUTHOR]

Multi-sector variants of gravity models typically predict much larger gains from trade (losses from protectionism) than their one-sector counterparts. This result –corroborated by several model-based quantification studies and commonly ascribed to Jensen's inequality– has been recently questioned by studies that use micro price data to obtain sector-level estimates of the trade elasticity, a key parameter for the quantification of the gains. We reassess this issue by using a novel set of estimates of the trade elasticity at various levels of sectoral disaggregation, exploiting a recently proposed identification strategy based on tariffs. In our baseline 24-sector model specification, we find that the cross-country average size of the gains amounts to 12% and that this number is 21% larger than the one delivered by the one-sector specification. Overall, our results suggest that the effects of magnification of the gains associated with greater sectoral disaggregation (which we confirm to be mainly driven by cross-sector variation in trade elasticity) are significant, not negligible, but considerably smaller than generally quantified in the previous literature. [ABSTRACT FROM AUTHOR]

Papillary muscle rupture is usually caused by myocardial infarction although rare cases of non-ischemic etiology have also been described. Among these, infective endocarditis represents an important cause. Herein, we report a case due to Streptococcus agalactiae involving the posteromedial papillary muscle. Non-ischemic papillary muscle rupture should be suspected when there is no evidence of atherosclerotic coronary artery disease. In the febrile patient, infective endocarditis should be considered in the differential diagnosis. [ABSTRACT FROM AUTHOR]

The complex design of cannulas is a major challenge for reprocessing due to the retention and accumulation of fat residues. To evaluate the cleaning of liposuction cannulas and the protective effects of the remaining fat residues on Mycobacterium abscessus subspecies bolletii (MASB) and Geobacillus stearothermophilus inactivation during steam sterilization. In phase 1, six standard operating procedures were evaluated for cleaning of liposuction cannulas. In phase 2, the sectioned lumens of the liposuction cannulas were contaminated with the largest and smallest volume of human fat found in phase 1, with the addition of MASB. In phase 3, the same volumes of human fat from phase 2 were used to contaminate paper strips containing G. stearothermophilus. In phase 1 the residual amount of fat ranged from 6 to 52 mg. In phases 2 and 3, the minimum and maximum amounts of fat (6 and 50 mg) protected micro-organisms during steam sterilization at 134 °C for 1.5 and 3 min. Effective cleaning and sterilization of liposuction cannulas intentionally contaminated with human fat, MASB and G. stearothermophilus could not be performed. [ABSTRACT FROM AUTHOR]

Obstetrician-gynecologists can improve the learning environment and patient care by addressing implicit bias. Accumulating evidence demonstrates that racial and gender-based discrimination is woven into medical education, formal curricula, patient-provider-trainee interactions in the clinical workspace, and all aspects of learner assessment. Implicit bias negatively affects learners in every space. Strategies to address implicit bias at the individual, interpersonal, institutional, and structural level to improve the well-being of learners and patients are needed. The authors review an approach to addressing implicit bias in obstetrics and gynecology education, which includes: (1) curricular design using an educational framework of antiracism and social justice theories, (2) bias awareness and management pedagogy throughout the curriculum, (3) elimination of stereotypical patient descriptions from syllabi and examination questions, and (4) critical review of epidemiology and evidence-based medicine for underlying assumptions based on discriminatory practices or structural racism that unintentionally reinforce stereotypes and bias. The movement toward competency-based medical education and holistic evaluations may result in decreased bias in learner assessment. Educators may wish to monitor grades and narratives for bias as a form of continuous educational equity improvement. Given that practicing physicians may have little training in this area, faculty development efforts in bias awareness and mitigation strategies may have significant impact on learner well-being. [ABSTRACT FROM AUTHOR]

This study examines the aging of industrial crude oil to simulate the chemical transformations that occur when it is exposed to environmental conditions over time. It was triggered by the finding of plastitar — a mixture of tar and plastic waste — on the coast of Milazzo, Sicily. Research began with a chemical characterization of the tar component of plastitar, followed by aging experiments designed to simulate environmental conditions such as seawater, UV light and sunlight. Fourier transform infrared spectroscopy (FTIR) was used to analyze the chemical changes during the aging process and compare the results with local tar samples. The results showed significant chemical changes in the aged crude oil, including oxidation, degradation of hydrocarbons and the formation of oxygenated compounds. In particular, the FTIR spectra of the aged crude oil closely matched those of the local tar and provided valuable insights that could help address similar coastal pollution issues in other regions. [Display omitted] • Crude oil aging experiments simulate plastitar formation in laboratory conditions. • FTIR analysis enabled significant chemical changes during crude oil aging process. • Oxidation and hydrocarbon degradation observed in aged crude oil. • New insights into plastitar formation in coastal areas [ABSTRACT FROM AUTHOR]

As raw materials become increasingly scarce, it is important to efficiently recycle PV panels to recover the highest quantity and quality of secondary raw materials. This study evaluates the environmental impact and the related benefits of an innovative process for c-Si PV panels recycling, which permits to recover most of the raw materials contained in them. Life Cycle Assessment analysis was carried out with "grave-to-cradle" perspective. Inventory was supported by data from a pilot plant located in Venice (Italy). ReCiPe 2016 method was used for the impact assessment. The results showed that environmental benefits are due to the recovery of aluminium, copper, silicon, silver and glass. Normalization of impact assessment results demonstrates main relevant impact categories of this process, and gravity analysis underlines what steps in the recycling process mainly contribute to the environmental benefits. Sensitivity analysis showed that quality of recovered materials influences the environmental profile of recycling process. [Display omitted] [ABSTRACT FROM AUTHOR]

Health systems science addresses the complex interactions in healthcare delivery. At its core, health systems science describes the intricate details required to provide high-quality care to individual patients by assisting them in navigating the multifaceted and often complicated US healthcare delivery system. With advances in technology, informatics, and communication, the modern physician is required to have a strong working knowledge of health systems science to provide effective, low-cost, high-quality care to patients. Medical educators are poised to introduce health systems science concepts alongside the basic science and clinical science courses already being taught in medical school. Because of the common overlap of women's healthcare subject matter with health systems science topics, such as interprofessional collaboration, ethics, advocacy, and quality improvement, women's health medical educators are at the forefront of incorporating health systems science into the current medical school educational model. Here, the authors have described the concept of health systems science and discussed both why and how it should be integrated into the undergraduate medical education curriculum. Medical educators must develop physicians of the future who can not only provide excellent patient care but also actively participate in the advancement and improvement of the healthcare delivery system. [ABSTRACT FROM AUTHOR]

The present study aimed at evaluating Italian epidemiological trends of pediatric inflammatory bowel diseases (IBD) over the period 2009–2018. Data from 1969 patients enrolled in the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition Registry, by 49 pediatric IBD centers throughout the country, were analyzed, comparing three different time intervals (2009–2012, 2013–2015, 2016–2018). The number of new IBD diagnoses ranged from 175 to 219 per year, evenly distributed over the examined period of time. From 2009 to 2018, the minimal incidence ranged from 1.59 to 2.04 /105 inhabitants aged < 18 years, with an overall slight predominance of ulcerative colitis (UC) over Crohn's disease (CD) (ratio: 1.1). Mean diagnostic delay was 6.8 months for CD and 4.1 months for UC, with a significant reduction for CD when comparing the three-time intervals (p =0.008). The most frequent disease locations according to the Paris classification were ileocolonic for CD (41.3%) and pancolitis for UC (54.6%). The minimal incidence rate in Italy seems to have stabilized over the last two decades, even if it has increased when compared to previous reports. UC is still slightly more prevalent than CD in our country. Diagnostic delay significantly decreased for CD, reflecting an improved diagnostic capacity. [ABSTRACT FROM AUTHOR]

• Patients with higher tortuosity showed a greater incidence of aortic surgery. • A longer surgery-free survival was associated with lower tortuosity. • Arterial tortuosity can be easily quantified on brain MRA. The aim of our study was to evaluate the association between intracranial arterial tortuosity and cardiovascular outcome in patients with Loeys-Dietz syndrome (LDS). We performed a retrospective analysis of all patients with genetically confirmed LDS who underwent at least one brain MRA at our institution (n = 32); demographic and clinical features were evaluated in relation to the tortuosity of intracranial arteries as measured by tortuosity index (TI), which was calculated using the formula: [(centerline length) / (straight-line length)-1] × 100. Receiver operating characteristic curve analysis for intracranial TI and the binary end point of aortic surgery showed vertebrobasilar TI (VBTI) to be the best classifier among the examined arterial segments (AUC = 0.822). Patients with higher VBTI showed a greater incidence of aortic surgery (p < 0.001) and underwent more surgical and endovascular procedures (p = 0.006), with a higher rate of operations (p = 0.002). Kaplan-Meier analysis showed a significantly longer surgery-free survival in patients with lower arterial tortuosity (p < 0.001). At multivariate analysis, higher VBTI was associated with an increased risk of surgery (p < 0.001), which was independent of gene mutation and patient age. Increased VBTI is a marker of adverse cardiovascular outcome in patients with LDS, which can be easily measured on brain MRA, and may be useful in the management of this heterogeneous patient population. [ABSTRACT FROM AUTHOR]

Background: Episodes of wet loads after steam sterilization are frequent; however, the factors related to these events are still unclear.Aim: To evaluate the strength of relationship of factors related to wet loads after steam sterilization.Methods: By adapting the Delphi technique, steam sterilization specialists assigned a score for the relation strength of a list of 37 factors (f.01-37) related to wet load, grouped into: cycle parameters, sterilizer, steam, load, and environment. Sixty-seven specialists distributed on five continents participated in all phases of this study.Findings: Certain factors related to wet loads are better established, such as vacuum depth in the drying phase, whereas others are still controversial, such as those related to the environment. The factor that obtained the highest average score was the vacuum depth in the drying phase (f.12), with a value of 4.28, and the lowest score of 2.66 was obtained in the delay time when the set reaches the value of vacuum or steam in the conditioning phase (f.05).Conclusion: Specialists' opinions diverge in most of the factors related to the occurrence of wet loads. The results obtained will enable further research and the establishment of normative requirements. [ABSTRACT FROM AUTHOR]

This paper presents an off-line programming approach for the automatic generation of trajectories and the printing program for a 6-axis robot in order to print accurate conductive paths on 3D objects using a silver microparticle solvent-based ink. The aim of this study was to develop a semi-predictive model in order to - Adapt the printing parameters of a 6-axis robot arm and a piezo jetting print head to the printing speed and substrate type. - Print 3D electronic circuits matching the targeted geometry and conductivity. For the jetting printing process, 2D patterns printed on substrates with different roughness and wettability were analysed as a function of the print head translation speed and jetting frequency which were used as base variables to develop correlations in order to predict line width, thickness and conductivity. The model was based on the assumption that the behaviour of a single drop impacting the printing substrate is close to that of a train of drops (i.e. lines). Thus, the diameter of individual drops on a specific substrate was used to account for support properties and jetting conditions. The study also proposes a methodology to tune the circuit morphology by adapting the jetting parameters as a function of the trajectory and the speed of the 6-axis robot. As a representative case study, a 3D circuit was printed on a disposable paper cup obtaining an excellent agreement between measured and predicted conductivity values. [ABSTRACT FROM AUTHOR]

Lake Neusiedl, the largest steppe lake in Europe, is particularly sensitive to climate variations due to its extreme shallowness (z max = 1.8 m) and low ratio of catchment to lake area (3.5 : 1). Changes in water budget, salinity and turbidity have key implications for the lake's ecology and management. Here, we present a multi-proxy palaeolimnological reconstruction of the evolution of Lake Neusiedl since the end of its last complete desiccation (1865–1868), based on an undisturbed radiometrically dated core taken from the open water portion of the lake. Geochemical and biological (algal) proxies outline the succession of three major ecological stages since 1873 ± 16 yrs, with the first major changes appearing already in the 1930s as driven by climate related hydrological variability. Subfossil diatoms proved to be reliable for tracking long-term changes in the trophic conditions of Lake Neusiedl while diatom-inferred lake conductivity revealed to be unreliable due to a combination of lake environmental settings and the absence of a site-specific training set. Nonetheless, multivariate statistical analyses and comparisons with limnological data confirm a great potential of subfossil diatoms for revealing past ecological changes and tipping points of shallow lakes, as long as studies rely on a multi-proxy approach. In agreement with limnological surveys, the sediment record corroborates the high vulnerability of Lake Neusiedl, both in present and past times, towards climate-driven changes in water level and salinity, and allows the prediction, by analogy with the past, of future ecological changes in a context of global warming and increasing nutrient inputs from non-point sources. [ABSTRACT FROM AUTHOR]

Metals pollution is a worldwide environmental issue due to their persistence in the ecosystems, non-degradability, and bioaccumulation in marine biota. Pacific Oysters (Crassostrea gigas) are highly nutritious bivalve representing an important dietary constituent but may accumulate metals through feeding on suspended sediments from surrounding water, then represent a suitable tool for biomonitoring. The occurrence of trace elements (Al, As, Cd, Co, Cr, Cu, Fe, Mn, Mo, Ni, Pb, Rb, Se, Sn, V, Zn) was investigated in Pacific Oysters (Cassostrea gigas) collected from Calich Lagoon in each season of 2019. Samples were homogenized and subjected to microwave acid digestion before being analyzed by inductively coupled plasma-mass spectrometer (ICP-MS). The results showed a significant seasonal variation for temperature, dissolved oxygen, chlorophyll, and pH. Moreover, high significant seasonal variation in concentrations of Cd, Mn, Ni, and V was recorded. The highest values were found for Fe (128 mg kg⁻1 w.w.), and Al (112 mg kg⁻1 w.w.) in October, for Zn (113 mg kg⁻1 w.w.) in March and May. Pacific Oysters were confirmed as suitable bioindicators of the health status of coastal lagoons; trace elements concentrations were highly affected by season of collection, and according to literature the highest values were recorded in autumn and summer. The EU legal limits for Cd and Pb were not exceeded, then the farmed oysters were safe to consumers. • Trace elements and metalloids were investigated in Pacific Oysters (Crassostrea gigas). • Physicochemical water parameters and metals concentrations are highly affected by seasonality. • Metals concentrations trend was autumn > spring > summer > winter. • Oysters from the Calich Lagoon (Sardinia, Italy) were safe for consumption. • Pacific Oysters are a suitable tool for biomonitoring of metals in the brackish environments. [ABSTRACT FROM AUTHOR]

[Display omitted] This study investigated the dynamics of reciprocal phenotypic plasticity entailing inducible defense and offense in freshwater ciliate communities in response to altered resource supply and the extent of intraspecific trait variation. Communities consisted of Euplotes octocarinatus (intraguild prey) capable of inducible defense to escape predation, Stylonychia mytilus (intraguild predator) capable of inducible offense to expand its prey spectrum, and Cryptomonas sp. (algal resource). The extent of inducible defense was tested in ten different Euplotes strains in response to freeze-killed Stylonychia concentrate, revealing significant differences in their width and length development. In a subsequent 30-day experiment, four strains were incubated in monoculture and mixture with Stylonychia under continuous and pulsed microalgae supply. The polyclonal Euplotes population outperformed the monoclonal populations, except one, which developed the most pronounced inducible defense and retained the highest biovolume. Stylonychia fluctuated in size, but dominated all communities irrespective of clonal composition. Pulsed resource supply promoted biovolume production of both species. However, periods of resource depletion resulted in more Stylonychia resting cysts, allowing Euplotes to resume growth. Our study provides new insights into interactions of induced defense and intraguild predation under variable environmental conditions, emphasizing the relevance of intraspecific trait variation for predator–prey interactions and community dynamics. [ABSTRACT FROM AUTHOR]

• In this systematic review the main neurosurgical hemostatics are described. • Hemostasis can be grouped as mechanical, chemical, and thermal. • Microfibrillar collagen, and platelet-rich plasma are considered novel hemostatics. Hemostasis represents a fundamental step in every surgical procedure. During neurosurgical procedures, proper and robust hemostasis into confined spaces can significantly reduce the odds of perioperative complications. Over the decades, multiple methods have been applied, and several medical devices have been developed to promote and guarantee proper hemostasis. This study presents a systematic review of the most used intraoperative hemostatic methods and devices in neurosurgery. Insightful research was performed on the PubMed database according to the PRISMA guidelines. This comprehensive review of scientific literature represents a synoptic panel where the most used intraoperative hemostatic methods and devices available today in neurosurgery are classified and described. [ABSTRACT FROM AUTHOR]

Aims: To evaluate efficacy, renal safety and tolerability of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in a cohort of patients with type 2 diabetes (T2DM) aged ≥65 years.Methods: We retrospectively evaluated 364 elderly individuals with T2DM starting SGLT2i from June 2015 to June 2018. Patients were divided into 2 subgroups based on median age (70 years). Linear mixed effect models were used to estimate changes in glycated hemoglobin (HbA1c), body mass index (BMI), and glomerular filtration rate (eGFR). SGLT2i discontinuation rate and causes of treatment interruption were also recorded.Results: A significantly higher percentage of patients achieved HbA1c <7.5% (46.7% vs. 31.6%, p < 0.01) and <8.0% (68.9% vs. 47.2%, p < 0.01) compared to baseline. Each year of therapy was associated with an average HbA1c decrease of 0.34% (p < 0.01) and BMI loss of 0.71 kg/m2 (p < 0.01), without significant interaction across age classes. In the younger group eGFR increased by 1.02 ml/min/year, while in the older group it declined by 0.42 ml/min/year (p = 0.08). Overall discontinuation rate during the follow-up period was similar across age groups (34.2% vs. 36.1%, long-rank p = 0.26). Genitourinary infections were the most frequent cause of treatment interruption (15.8% vs. 17.2%, p = 0.69) in both study groups, while persistent eGFR decline (4.4%) and orthostatic hypotension (1.7%) were only present in older age class.Conclusions: Efficacy, renal safety and tolerability of SGLT2i were similar in people >70 compared to 65-70 years of age, suggesting that a wider use should not be worried even in the elderly. However, some caution must be paid to the occurrence of persistent eGFR decline and orthostatic hypotension, especially in patients >70 years old. [ABSTRACT FROM AUTHOR]

Background and Aims: Low potassium intake, in addition to high sodium, has been associated with higher risk of hypertension and CVD. The Study assessed habitual potassium intake and sodium/potassium ratio of the Italian adult population from 2008 to 2012 to 2018-2019 based on 24-h urine collection, in the framework of the CUORE Project/MINISAL-GIRCSI/MENO SALE PIU' SALUTE national surveys.Methods and Results: Data were from cross-sectional surveys of randomly selected age-and-sex stratified samples of resident persons aged 35-74 years in 10 (out of 20) Italian regions. Urinary electrolyte and creatinine measurements were performed in a central laboratory. Analyses considered 942 men and 916 women, examined in 2008-2012, and 967 men and 1010 women, examined in 2018-2019. In 2008-2012, the age-standardized mean of potassium intake (urinary potassium accounts for 70% of potassium intake) was 3147 mg (95% CI 3086-3208) in men and 2784 mg (2727-2841) in women, whereas in 2018-2019, it was 3043 mg (2968-3118) and 2561 mg (2508-2614) respectively. In 2008-2012, age-adjusted prevalence of persons with an adequate potassium intake (i.e. ≥ 3510 mg/day) was 31% (95% CI 28-34%) for men and 18% (16-21%) for women; in 2018-2019, it was 26% (23-29%) and 12% (10-14%) respectively. The sodium/potassium ratio significantly decreased both in men and women.Conclusions: The average daily potassium intake of the Italian general adult population remains lower than the WHO and EFSA recommended level. These results suggest the need of a revision to strengthen initiatives for the promotion of an adequate potassium intake at the population level. [ABSTRACT FROM AUTHOR]

Background and Aims: The WHO Global Action Plan for the Prevention of non-communicable diseases (NCDs) recommends a 30% relative reduction in mean population salt/sodium intake. The study assessed the trend in the habitual salt intake of the Italian adult population from 2008 to 2012 to 2018-2019 based on 24-h urinary sodium excretion, in the framework of the CUORE Project/MINISAL-GIRCSI/MENO SALE PIU' SALUTE national surveys.Methods and Results: Data were from cross-sectional surveys of randomly selected age and sex-stratified samples of resident persons aged 35-74 years in 10 (out of 20) Italian Regions distributed in North, Centre and South of the Country. Urinary sodium and creatinine measurements were carried out in a central laboratory. The analyses included 942 men and 916 women examined in 2008-2012, and 967 men and 1010 women examined in 2018-2019. The age-standardized mean daily population salt (sodium chloride) intake was 10.8 g (95% CI 10.5-11.1) in men and 8.3 g (8.1-8.5) in women in 2008-2012 and respectively 9.5 g (9.3-9.8) and 7.2 g (7.0-7.4) in 2018-2019. A statistically significant (p<0.0001) salt intake reduction was thus observed over 10 years for both genders, and all age, body mass index (BMI) and educational classes.Conclusions: The average daily salt intake of the Italian general adult population remains higher than the WHO recommended level, but a significant reduction of 12% in men and 13% in women has occurred in the past ten years. These results encourage the initiatives undertaken by the Italian Ministry of Health aimed at the reduction of salt intake at the population level. [ABSTRACT FROM AUTHOR]

This article, from the "To the Point" series by the Undergraduate Medical Education Committee of the Association of Professors of Gynecology and Obstetrics, is a guide for advising medical students applying to Obstetrics and Gynecology residency programs. The residency application process is changing rapidly in response to an increasingly complex and competitive atmosphere, with a wider recognition of the stress, expense, and difficulty of matching into graduate training programs. The coronavirus disease 2019 pandemic and societal upheaval make this application cycle more challenging than ever before. Medical students need reliable, accurate, and honest advising from the faculty in their field of choice to apply successfully to residency. The authors outline a model for faculty career advisors, distinct from mentors or general academic advisors. The faculty career advisor has detailed knowledge about the field, an in-depth understanding of the application process, and what constitutes a strong application. The faculty career advisor provides accurate information regarding residency programs within the specialty, helping students to strategically apply to programs where the student is likely to match, decreasing anxiety, expense, and overapplication. Faculty career advisor teams advise students throughout the application process with periodic review of student portfolios and are available for support and advice throughout the process. The authors provide a guide for the faculty career advisor in Obstetrics and Gynecology, including faculty development and quality improvement. [ABSTRACT FROM AUTHOR]

Background: The risk concerning the presence of non-condensable gases (NCGs) has already been demonstrated, but routine monitoring still requires further research to be implemented in each sterilization cycle.Aim: Performance evaluation of the physical, chemical and biological indicators used in monitoring in comparison with a sterilizer integrated detector for NCG in the Sterilization Process.Methods: Chemical indicators (type 2 Bowie-Dick test, type 5 and type 6 models), self-contained biological indicators and physical indicators (temperature, pressure, thermal qualification and a patented integrated air detector) were used to monitor the steam sterilization process in two situations of controlled failure: chamber leakage and door seal failure. This controlled failure was obtained by the presence of a known amount of air: 0-30 L/min for chamber leakage and 0-30% for the door seal failure. Evaluation tests were carried out with and without the use of process challenge devices (PCDs).Findings: In both studies, the Bowie-Dick Test showed different results, according to the manufacturer. The biological, physical or chemical indicators without a PCD were unable to detect small volumes of NCGs in both simulations.Conclusion: The integrated air detector can be considered an option for the detection of NCGs in each cycle. [ABSTRACT FROM AUTHOR]

No real-life study on the comparative effectiveness of Vedolizumab (VDZ), Adalimumab (ADA), and Golimumab (GOL) in ulcerative colitis (UC) is currently available. To compare the effectiveness of the three biologics in consecutive patients with UC. A three-arms propensity score-adjusted analysis was performed using the Inverse Probability of Treatment Weighting method. 463 treatments (VDZ: n = 187; ADA: n = 168; GOL: n = 108) were included (median follow-up: 47.6 weeks). At 12 weeks (n = 463), a steroid-free remission was reported in 24.1% patients in the VDZ group, in 33.3% patients in the ADA group, and in 30.6% patients in the GOL group (p = n.s. for all comparisons). At 52 weeks (n = 377), a steroid-free remission was reported in 51.5% patients in the VDZ group, in 31.2% patients in the ADA group, and in 29.4% patients in the GOL group (p = 0.002 for VDZ vs. ADA, p = 0.001 for VDZ vs. GOL, p = n.s. for ADA vs. GOL). Cox survival analysis demonstrated that patients treated with VDZ had reduced probability of treatment discontinuation compared to those treated with ADA (HR: 0.42, 95% CI 0.28–0.64, p < 0.001) and GOL (HR: 0.30, 95% CI 0.19–0.46, p < 0.001), while patients treated with ADA had reduced risk of treatment discontinuation compared to those treated with GOL (HR: 0.71, 95% CI 0.50–1.00, p = 0.048). VDZ was superior to ADA and GOL at 52 weeks and as treatment persistence, while ADA showed a superior treatment persistence compared to GOL. [ABSTRACT FROM AUTHOR]

• Seven categories of social impacts were identified in the literature review. • Most important negative impacts are on human rights and social equity. • Most important positive impacts are on wellbeing and livelihoods. • There is need to increase subjective assessment of impacts in protected areas. • Coordination of policies across sectors is needed to meet future biodiversity targets. Effective designation of Protected Areas (PAs) requires the careful consideration of their social impacts as these are perceived by people. These refer to a variety of issues such as the distribution of power, social equity, social relations and more importantly the impact of PAs on human wellbeing. A number of studies have emerged in the past decade aiming to capture social impacts of PAs across the world through non-monetary assessments taking into consideration people's perceptions. Although Europe is the region with the largest in proportion number of Protected Areas across the world it is also a region with very limited scientific evidence on this topic. As the European Union is preparing to implement its new Biodiversity Strategyto ipkmplement this paper aims to provide the first comprehensive review of the literature regarding social impacts of European PAs and highlight new directions for current policy frameworks in the region. The paper focuses on the perceived non-economic social costs and benefits of PAs and identifies 7 key categories of social impacts. We propose that policy planning for biodiversity conservation in Europe should incorporate subjective assessments of social costs and benefits with the aim to achieve an increase of benefits for people and their equal distribution across social groups. [ABSTRACT FROM AUTHOR]

The second part of this JPD Digital presentation focused on the treatment planning, treatment coordination, and execution of implant therapy. The clinical application of the evidence-based criteria in implant therapy was emphasized including the surgical parameters, restorative parameters, and implant features reviewed in part 1. The objective was to achieve predictable results that improve the longevity of the implant and restoration, maintain peri-implant health, and optimize the esthetic outcome. Examples of several clinical scenarios of single tooth replacement treatment in the esthetic zone were reviewed by using options that included immediate placement, immediate loading, and resin-bonded interim restoration. In addition, patients requiring multiple implants, combinations of tooth-supported and implant-supported restorations, and a complete arch prosthesis supported by implants were presented. Many clinically challenging patients can be treated more effectively by using a digital workflow to plan and execute implant therapy. [ABSTRACT FROM AUTHOR]

As dental implants have evolved into a universally accepted treatment option, it is essential to identify nuances of the peri-implant complex and their impact on treatment given the increasing evidence of peri-implantitis and implant loss. A thorough knowledge of anatomy and biology, careful treatment planning, correct placement, prosthetic and occlusal design, and proper long-term maintenance all play a role in dental implant therapy. The goal of this part 1 presentation is to review evidence-based criteria in implant treatment including the surgical and restorative parameters, and the desired implant features, with the objective of achieving predictable results that improve the longevity of the implant and restoration, maintain peri-implant health, and optimize the esthetic outcome. By following science-based guidelines, implant treatment can be improved and simplified with more predictable results, especially in the esthetic zone, where demands are greater and there is less room for error. [ABSTRACT FROM AUTHOR]

This article is from the "To The Point" series prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee. The purpose of this review was to provide an overview of the importance of well-being in medical education. A literature search was performed by a Reference Librarian who used Ovid/MEDLINE to identify scholarly articles published in English on learner well-being, using the search terms "burnout," "resilience," "wellness," and "physicians" between 1946 and January 11, 2019. The accreditation expectations and standards, available assessment tools for learner well-being, existing programs to teach well-being, and some key elements for curriculum development are presented. This is a resource for medical educators, learners, and practicing clinicians from any field of medicine. [ABSTRACT FROM AUTHOR]

This article, from the To the Point series prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, is an overview of issues to consider regarding learner mistreatment and its effects on the undergraduate medical education learning environment in the United States. National data from the American Association of Medical Colleges Graduate Questionnaire and local data regarding learner mistreatment provide evidence that the learning environment at most medical schools needs to be improved. The American Association of Medical Colleges' definition of learner mistreatment focuses on active mistreatment, but data on passive mistreatment also contribute to a negative learning environment. The lack of tolerance for active mistreatment issues such as public humiliation and sexual and racial harassment need to be made transparent through institutional and departmental policies. Additionally, reporting mechanisms at both levels need to be created and acted upon. Passive mistreatment issues such as unclear expectations and neglect can also be addressed at institutional and departmental levels through training modules and appropriate communication loops to address these concerns. To fully confront and solve this challenging issue regarding learner mistreatment at the undergraduate medical education level, solutions to need to be implemented for faculty, residents, and students in the institutional, departmental, and clerkship settings. [ABSTRACT FROM AUTHOR]

Background and Aim: There is no agreement about which index of adiposity and/or body composition is the most accurate in identifying the metabolic syndrome (METS). The aim of our study was to compare the accuracy of the different indexes in order to recognize the most reliable.Methods and Results: We evaluated 1332 obese children and adolescents (778 females and 554 males), aged 14.4 ± 1.8 yrs, Body Mass Index (BMI) standard deviation scores (SDS) 2.99 ± 0.55, followed at the Istituto Auxologico Italiano, a tertiary center for childhood obesity. For each subject the following indexes were assessed: BMI, BMI SDS, Fat-Free Mass Index (FFMI), Fat Mass Index (FMI), Tri-Ponderal Mass Index (TMI), Waist-to-Height ratio (WtHR) and a new one, the Body Mass Fat Index (BMFI), which normalizes the BMI for percentage of body fat and the waist circumference. Thereafter we calculated for each index a threshold value for age and sex, in order to compare their accuracy, sensitivity and specificity in identifying the METS. There was a good correlation among indexes (p < 0.0001 for all). However, when the area under the curve (AUC) was compared, some of them, in particular the BMFI and the BMI, performed better than the other ones, although the differences were small.Conclusions: BMI, which neither considers body composition nor fat distribution, performs as good as other indexes, and should therefore be the preferred one, also because of the easiness of its calculation. [ABSTRACT FROM AUTHOR]

Background: The dispersal of airborne norovirus (NoV) particles from the floor after contamination with faeces or vomit is a challenge for infection control, as this pathogen is infectious at low doses. Therefore, it is imperative to establish a safe protocol for floor decontamination.Aim: To assess the presence of residual NoV-GII particles on floors and airborne particles following various floor decontamination procedures.Methods: Two types of floor (vinyl and granite) were contaminated intentionally with 10% human faeces, positive for NoV-GII. Two decontamination protocols were implemented: cleaning followed by disinfection using 1% sodium hypochlorite, and cleaning followed by disinfection using a manual ultraviolet C (UV-C) light device. Swab samples were taken from the floors, and air samples were obtained using an air sampler. The TaqMan method for real-time reverse transcription-quantitative polymerase chain reaction was employed for analysis.Findings: The disinfection protocol using 1% sodium hypochlorite after cleaning proved to be more effective than cleaning followed by UV-C light exposure (P<0.001). Viral particles were detected in 27 of 36 air samples after cleaning, with no significant difference between the two floor types. On average, 617 genome copies/sample were identified in air samples after cleaning, but the number decreased gradually after disinfection.Conclusion: NoV-GII can be aerosolized during floor cleaning, and its particles may be inhaled and then swallowed or can settle on surfaces. Therefore, residual viral particles on floors must be fully eliminated. Cleaning followed by 10 min of 1% sodium hypochlorite disinfection proved to be the superior decontamination protocol. [ABSTRACT FROM AUTHOR]

The objective of this article is to analyze the effect of dynamic price variability on revenue maximization. While dynamic pricing is a common practice in tourism, this is the first comprehensive study on the relationship between price variability and revenue maximization. Within the framework provided by the literature on intertemporal price discrimination, price fairness, inventory controls and organizational culture, this research proposes and applies a new hedonic revenue model on a sample of 21,687 observations. The findings suggest that higher dynamic price variability leads to higher hotel revenues. Strategic room unavailability and review rating also exert a clear positive revenue impact. Overall, the benefits from charging different prices for the same service (intertemporal price discrimination) and limiting the number of units available before the demand is known (inventory control) outweigh the potential negative effects of price unfairness and organizational culture. The paper concludes by providing actionable levers for hospitality managers. • The paper offers a comprehensive analysis on the effect of dynamic price variability on revenue maximization. • Measuring whether or not tourism players are applying the right extent of dynamic price variability. • A new hedonic revenue model is applied to sample of 21687 hotel observations coming from 17 European cities. • Tourism and hospitality players use dynamic price variability at sub-optimal levels. [ABSTRACT FROM AUTHOR]

Pediatric patients with Prader-Willi syndrome (PWS) can be treated with recombinant human GH (rhGH). These patients are highly sensitive to rhGH and the standard doses suggested by the international guidelines often result in IGF-1 above the normal range. We aimed to evaluate 1 the proper rhGH dose to optimize auxological outcomes and to avoid potential overtreatment, and 2 which patients are more sensitive to rhGH. In this multicenter real-life study, we recruited 215 patients with PWS older than 1 year, on rhGH at least for 6 months, from Italian Centers for PWS care. We collected auxological parameters, rhGH dose, IGF-1 at recruitment and (when available) at start of treatment. The rhGH dose was 4.3 (0.7/8.4) mg/m2/week. At recruitment, IGF-1 was normal in 72.1% and elevated in 27.9% of the patients. In the group of 115 patients with IGF-1 available at start of rhGH, normal pretreatment IGF-1 and uniparental disomy were associated with elevated IGF-1 during the therapy. No difference in height and growth velocity was found between patients treated with the highest and the lowest range dose. The rhGH dose prescribed in Italy seems lower than the recommended one. Normal pretreatment IGF-1 and uniparental disomy are risk factors for elevated IGF-1. The latter seems to be associated with higher sensitivity to GH. In case of these risk factors, we recommend a more accurate titration of the dose to avoid overtreatment and its potential side effects. • Height, growth velocity and BMI of the lowest rhGH dose quartile are similar to those of the highest one • In our study, PWS patients are on 4.3 mg/m2/week of rhGH and IGF-1 is above the normal range in about 28% of the patients • Low pretreatment IGF-1 and deletion of the paternal 15q11.2–q13 region predict normal IGF-1 during the rhGH treatment • Patients with PWS due to uniparental disomy seem to feature a higher sensitivity to rhGH than patients with deletion [ABSTRACT FROM AUTHOR]

Endoscopic placement of SEMSs for malignant hilar biliary strictures (MHBS) is well-established palliative treatment for inoperable patients. Objectives of this study were evaluation of survival and stents patency after placement of multiple SEMS for palliation of complex MHBS. Retrospective review of patients with MHBS that underwent ERCP with insertion of multiple SEMSs for palliation. Survival-associated factors and stents patency were analyzed by Cox multivariate analysis. Between January 1998 and January 2015, 740 patients with nonoperable MHBS that underwent ERCP were identified and only 18.2% of these received multiple SEMSs. Complications were observed in 7.5% of the patients with no procedure-related mortality. Palliative therapies (chemotherapy, external beam radiotherapy and high dose rate brachytherapy) were done in some patients, and outcomes were evaluated. Overall mean survival of the 134 patients was 323 days. Of these, 59% did not had stents malfunction while 41% patients had episodes of SEMSs malfunction and mean survival after re-interventions was 502.9 days. Survival was not influenced by type of tumor, sex or age. Endoscopic multiple SEMSs placement is safe and effective in patients with complex MHBS. Survival is independent from the type and complexity of MHBS while is prolonged in patients undergoing HDR brachytherapy. Prompt recognition of SEMSs malfunction is fundamental for survival. [ABSTRACT FROM AUTHOR]

• All symptomatic paraesophageal hiatal hernias should be repaired, particularly those with acute obstructive symptoms or which have undergone volvulus. • Laparoscopic hiatal hernia repair is as effective as open transabdominal repair, with a reduced rate of perioperative morbidity and with shorter hospital stays. It is the preferred approach for the majority of hiatal hernias. • Robotic Assisted Giant-Paraesophageal Hernia repair remain technically challenging predominantly in the dissecation of the hernia sac from the posterior mediastinum. • The robotic platform have the same benefits of the laparoscopic approach in terms of complication rate, total surgical time, and hospital length of stay and in particular case is superior. Giant hiatus hernia is defined as migration of >30% of the stomach with or without other intra-abdominal organs into the chest. Situs Viscerum Inversus is a rare congenital condition in which the major visceral organs are reversed from their normal arrangement; they are translated (completely or partially) on the opposite side of the body. Diagnosis is often incidental. We report a Robot-assisted Toupet fundoplication for a giant hiatal hernia with gastro oesophageal reflux disease and cholelithiasis, in a 63-years-old woman with situs viscerum inversus. A 63-year-old woman with Situs Viscerum Inversus was diagnosed with giant sliding hiatus hernia. We performed a Robot-assisted procedure of reduction of hiatal hernia in abdomen and Toupet fundoplication with Bio A mesh placement and gastropexy procedure associated to cholecystectomy. The operation time was of 190 min. The patient was discharged on third postoperative day after X-ray check and he tolerated a solid food. Minimally invasive surgery represents, nowadays, the standard approach for hiatal hernia and cholelithiasis. In challenging cases as the giant hernias ad rare anomaly as situs viscerum inversus, the surgical treatment can be facilitated by the use of robotic technology. [ABSTRACT FROM AUTHOR]

Heavy metal contamination is widespread in Bangladesh. Previous studies have observed lead increases blood pressure over time. However, the role of other metal contaminants and essential micronutrients, which could also adversely affect blood pressure or act as protective factors, is understudied. We therefore evaluated the associations of lead, manganese, and selenium with blood and pulse pressure trajectories. We prospectively followed placebo-assigned participants nested within a randomized trial for the prevention of arsenic-related skin cancer (n = 255). Blood lead, manganese, and selenium were measured at baseline; blood pressure was measured at baseline and at 3 biennial follow-up examinations. Mixed-effect linear regression models were used to estimate associations with average annual changes in systolic, diastolic, and pulse pressure. In models simultaneously adjusted for baseline blood lead, manganese, and selenium concentrations in addition to other potential confounders, lead was linearly associated with increases in systolic blood pressure, but not with diastolic blood pressure or pulse pressure. A non-linear association was observed for manganese, such that mid-range concentrations were associated with decreases in systolic, diastolic, and pulse pressure. Baseline selenium concentrations in the highest quartile were also associated with longitudinal decreases in both systolic and diastolic blood pressure, while null associations were observed with pulse pressure. In exploratory analyses, the combination of mid-range manganese and high selenium concentrations completely offset lead-associated increases in blood and pulse pressure. The results indicate a direct, linear association of lead exposure with systolic blood pressure, and manganese and selenium exposures within certain ranges may have a blood pressure-lowering effect in this population. • Metal contamination is endemic in Bangladesh where elevated exposure to certain toxic metals can result in hypertension. • Epidemiologic research on other metals, including essential nutrients, in relation to blood pressure has been sparse. • ILead was related to higher blood pressure, whereas manganese and selenium within certain ranges were associated with declines. • This study highlights the potential for manganese and selenium as anti-hypertensive agents in a lead-exposed population. The findings of this study suggest toxic lead exposures remain a significant public health problem in Bangladesh where high levels are associated with high blood pressure; however, the nutritionally essential micronutrients manganese and selenium appear to confer protection from the hypertensive effects of lead. [ABSTRACT FROM AUTHOR]

Abstract The immune system seems to play a fundamental role in breast cancer responsiveness to chemotherapy. We investigated two peripheral indicators of immunity/inflammation, i.e. neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR), in order to reveal a possible relationship with pathological complete response (pCR) in patients with early or locally advanced breast cancer treated with neoadjuvant chemotherapy (NACT). We retrospectively analyzed 373 consecutive patients affected by breast cancer and candidates to NACT. The complete blood cell count before starting NACT was evaluated to calculate NLR and PLR. ROC curve analysis determined threshold values of 2.42 and 104.47 as best cut-off values for NLR and PLR, respectively. The relationships between NLR/PLR and pCR, along with other clinical-pathological characteristics, were evaluated by Pearson's χ 2 or Fisher's exact test as appropriate. Univariate and multivariate analyses were performed using a logistic regression model. NLR and PLR were not significantly associated with pCR if analyzed separately. However, when combining NLR and PLR, patients with a NLRlow/PLRlow profile achieved a significantly higher rate of pCR compared to those with NLRhigh and/or PLRhigh (OR 2.29, 95% CI 1.22–4.27, p 0.009). Importantly, the predictive value of NLRlow/PLRlow was independent from common prognostic factors such as grading, Ki67, and molecular subtypes. The combination of NLR and PLR may reflect patients' immunogenic phenotype. Low levels of both NLR and PLR may thus indicate a status of immune system activation that may predict pCR in breast cancer patients treated with NACT. [ABSTRACT FROM AUTHOR]

Ordinary Portland cement (OPC) is a cost-effective and conventional binder that is widely adopted in brownfield site remediation and redevelopment. However, the substantial carbon dioxide emission during OPC production and the concerns about its undesirable retention capacity for potentially toxic elements strain this strategy. To tackle this objective, we herein tailored four alternative binders (calcium aluminate cement, OPC-activated ground-granulated blast-furnace slag (GGBFS), white-steel-slag activated GGBFS, and alkaline-activated GGBFS) for facilitating immobilization of high Pb content pyrite ash, with the perspectives of enhancing Pb retention and mitigating anthropogenic carbon dioxide emissions. The characterizations revealed that the incorporation of white steel slag efficiently benefits the activity of GGBFS, herein facilitating the hydration products (mainly ettringite and calcium silicate hydrates) precipitation and Pb immobilization. Further, we quantified the cradle-to-gate carbon footprint and cost analysis attributed to each binder-Pb contaminants system, finding that the application of these alternative binders could be pivotal in the envisaged carbon-neutral world if the growth of the OPC-free roadmap continues. The findings suggest that the synergistic use of recycled white steel slag and GGBFS can be proposed as a profitable and sustainable OPC-free candidate to facilitate the management of lead-contaminated brownfield sites. The overall results underscore the potential immobilization mechanisms of Pb in multiple OPC-free/substitution binder systems and highlight the urgent need to bridge the zero-emission insights to sustainable in-situ solidification/stabilization technologies. [Display omitted] • Waste-derived binders offer a low-carbon and affordable way to enhance Pb retention. • Underlying Pb retention mechanisms for different waste-derived binders are clarified. • Expense and CO 2 emissions for multiple binder scenarios are quantified. • Carbonation-induced sponge effect significantly mitigates the overall CO 2 emissions. • White steel slag efficiently activated GGBFS, leading to more amorphous precipitation. [ABSTRACT FROM AUTHOR]

The transformative possibilities of smart manufacturing, which is defined by digitization, enhanced connectivity, advanced analytics, and integrated cyber-physical systems in manufacturing processes and systems, have been extensively discussed in the literature. Potential benefits underscored include cost reduction, production flexibility, shorter product times-to-market, energy efficiency, environmental impact reduction, and increased productivity. Scant attention has been given to formal methods for quantifying and analyzing energy productivity to aid a broad range of manufacturing industries in evaluating the merits of adoption. Here we present a strategic analysis framework to estimate cost-effective improvements in energy efficiency and productivity that may be realized through smart manufacturing. The framework uses the cost of conserving energy (CCE) as a complementary measure to determine the feasibility of a set of smart manufacturing interventions in the context of a specific factory, firm, or entire industry. Guided by a function-driven approach based on key performance indicators, the CCE measure accounts for system-wide changes in direct and indirect costs and total energy use relative to the same manufacturing system without smart manufacturing interventions. These changes include cost of cyber-physical systems, which include components such as sensors, controllers, smart equipment, and information and communication technology (ICT) equipment. Additionally, cost and savings are accounted from changes in primary and intermediate inputs, production time, off-spec production, and waste. Energy calculations include upstream energy use of the cyber-physical systems. For complex processes with significant circularity and/or feedbacks, we propose the use of input-output models to characterize elements of the CCE. The framework is discussed in the context of recent efforts in craft breweries to use smart manufacturing for reducing energy intensity and increasing product yield. [ABSTRACT FROM AUTHOR]

This article, from the "To the Point" series prepared by the Association of Professors of Gynecology and Obstetrics (APGO) Undergraduate Medical Education Committee (UMEC), provides educators with an overview of the use of simulation in undergraduate medical education in the field of obstetrics and gynecology. Simulation plays an important role in the education of medical students. Students are increasingly serving as clinical observers and providing less direct patient care. Simulation can help standardize education and ensure quality and comparability across an enlarging educational environment. This article summarizes the expanding role of simulation in undergraduate medical education in obstetrics and gynecology and its effect on important learner outcomes such as confidence, knowledge, skills, workplace behaviors, and translation to patient care. [ABSTRACT FROM AUTHOR]

Gender differences in performance on the obstetrics and gynecology clerkship have been reported, with female students outperforming male students. Male students report that their gender negatively affects their experience during the clerkship. Additionally, there are fewer male students applying for obstetric/gynecology residency. This "To The Point" article by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee will describe the gender differences that have been found, examine factors that could be contributing to these issues, and propose measures to correct these disparities. [ABSTRACT FROM AUTHOR]

Tyrosine kinase inhibitors (TKIs) have emerged as first-line treatment for the management of epidermal growth factor receptor (EGFR)-mutated advanced non-small cell lung cancer (NSCLC). Erlotinib and gefitinib were the initial TKIs to be approved for lung cancer and showed improved response rates compared with chemotherapy. Afatinib is an irreversible ErbB family blocker that has also been shown to be active in EGFR-mutated NSCLC. Afatinib has been tested as first-line treatment of advanced NSCLC in the LUX-Lung trial program, as well as in the second- and third-line settings. In this article, we will review the data from the 8 reported LUX-Lung trials. [ABSTRACT FROM AUTHOR]

Abstract Introduction In non-endemic countries, one of the most important routes of transmission of Trypanosoma cruzi is vertical transmission. The objective of this work is to report the results of the screening activities for the control of congenital Chagas Disease (CD) implemented in Bergamo province between January 2014 and December 2016. Methods The programme addressed Bolivian pregnant women settled in Bergamo province. All the eight hospitals offering antenatal and delivery care in that area were involved. We retrospectively calculated the coverage rate of the screening programme, the prevalence of CD in this population, as well as transmission rate to their offspring. Results During the study period, 376 Bolivian women accounted for 387 deliveries. The coverage rate of serologic screening was 85.6%. Confirmed seropositive women were 28, accounting for a prevalence of CD of 8.7% (95% IC 5.9–11.5). Among 29 children born to positive mothers, one infected child was detected (transmission rate of 4.3%, 95% IC 0–12.6) and treated accordingly. Other 13 children previously born from the same mothers were retrieved and tested for CD: no additional congenital cases were diagnosed. Discussion Our screening programme presented a high coverage, although widely variable in the different birthing facilities. National guidelines recommending CD testing in pregnant women would help to increase case detection countrywide. [ABSTRACT FROM AUTHOR]

Climate change can have significant impacts on the survival of plant species. However, it is seldom included in the assessment of the extinction risk according to IUCN Red List criteria. Lack of data and uncertainties of predictions make difficult such inclusion. In our paper we present an approach, in which the effect of climate change on plant species spatial distribution is used to prioritize conservation within IUCN categories. We used, as a case study, 37 Italian policy species, relevant for conservation, and listed in the Habitat Directive and Bern Convention, and for which a Red List (RL) assessment was available. A stochastic SDM incorporating data on plant dispersal, generation length, and habitat fragmentation was used to predict a range shift due to climate change according to two climatic scenarios (RCP 2.6 and 8.5). No species was predicted to become extinct in the considered timespans (2050 and 2070) due to climate change, and only two were characterized by critical decline probabilities. However, all taxa were potentially affected by climate change through a reduction of their range. In all RL categories, species with the highest predicted reduction of range were those from lowlands, where fragmentation of natural habitats has occurred in the last decades. In these cases, despite some limitations, assisted migration can be considered a suitable conservation option. [ABSTRACT FROM AUTHOR]