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Adequate serum vitamin D levels correlate with a more favorable lipid profile compared to deficient levels. Despite the well-established prevalence of vitamin D deficiency in children with obesity, studies investigating its influence on lipid profiles in this population are scarce. We explored the impact of vitamin D status on lipid profiles and markers of atherogenic dyslipidemia in a cohort of children and adolescents with obesity. A total of 271 Caucasian children and adolescents with overweight/obesity and a control group of 54 pediatric patients with normal weight. All participants underwent outpatient visits for the assessment of clinical parameters and venous blood collection for biochemical analysis such as triglycerides (TG)/HDL-C ratio, LDL-C/HDL-C ratio, atherogenic index of plasma AIP), vitamin D level. Individuals with obesity displayed severe vitamin D deficiency (25-OH-D ≤10 ng/ml) at a higher frequency compared to those with normal weight (p = 0.03). In patients with overweight/obesity and low 25-OH-D levels show higher values of glycemia (p = 0.001), insulin resistance (HOMA-IR and TRYG p < 0.001), TG (p < 0.001), TG/HDL-C (p = 0.001), AIP (p < 0.001), SBP (p = 0.01), and DBP (p = 0.04). In normal-weight individuals with low 25-OH- D levels an increased values of glycemia (p = 0.01), insulin resistance (HOMA-IR p = 0.01 and TRYG p = 0.002), TG (p = 0.01), TG/HDL-C (p = 0.02), AIP (p = 0.01). A direct correlation between 25-OH-D levels and metabolic parameters is observed. A correlation between vitamin D levels and the lipid/atherosclerotic profile was recorded. Vitamin D deficiency may represent a preventable and easily treatable cardiometabolic risk factor, emphasizing the importance of early intervention and preventive measures. • Adequate serum vitamin D levels correlate with a favorable lipid profile. • We explored the impact of vitamin D status on atherogenic dyslipidemia in children with obesity. • A correlation between vitamin D levels and the lipid/atherosclerotic profile was recorded. • Vitamin D deficiency may represent a preventable and treatable cardiometabolic risk factor. [ABSTRACT FROM AUTHOR]

Schwannoma is a slow-growing benign encapsulated tumor that arises from Schwann cells. Ancient schwannoma is a rare histologic variant characterized by degenerative changes, usually in the context of a schwannoma with long evolution. Intraoral ancient schwannoma is extremely rare. A review of the literature revealed only thirty previously reported cases. This article aims to present and discuss the first case of ancient schwannoma of the anterior mandibular vestibule and to review the relevant literature on intraoral ancient schwannoma. [ABSTRACT FROM AUTHOR]

Industry 4.0 has supported and changed the way companies operate over the last decade. Today, the increasing focus on sustainability in all its pillars is initiating a critical process and revision about the Fourth Industrial Revolution. A new scenario characterized by human-centricity, resilience and social sustainability, named Industry 5.0, is emerging. In this transition process, new and old enabling technologies are appearing, among them the Metaverse. Although its actual functions are not yet fully investigated, from different perspective this tool could adequately support the definition of Industry 5.0 by creating a symbiotic ecosystem between companies, workers and consumers. Against this backdrop, the aim of this paper is to investigate, through a systematic literature review, the role of the Metaverse in the approach to sustainability in order to understand in which way this technology can be useful for the transition. The results may support policy makers, managers and practitioners in understanding the role of Metaverse in sustainability and in the new wave of Industrial Revolution. Limits and future research steps are also discussed. [ABSTRACT FROM AUTHOR]

Caval valve implantation (CAVI) represents a minimally invasive strategy for managing severe tricuspid regurgitation in high-risk patients unsuitable for surgical or transcatheter tricuspid valve implantation. This case series aimed to assess the anesthesia management challenges and outcomes associated with this procedure, seeking to generate insights that can inform and refine anesthesia protocols. A case series. At a cardiac catheterization laboratory of a teaching hospital. Eight patients undergoing CAVI with the Tricvalve system The anesthetic protocol included preprocedural planning, fast-track general anesthesia, and postprocedural debriefing. Intraoperative management involved anesthesia depth monitoring, real-time guidance via transesophageal echocardiography, and hemodynamic stability maintenance. Postoperative analgesia involved preemptive intravenous paracetamol and morphine as needed. No anesthesia-related or implantation-related complications were observed, with a mean procedure duration of 112 ± 44 minutes. The median hospital stay was 4 days, and only 1 patient required brief intensive care unit monitoring. Postoperative right shoulder pain was reported by half of the patients, and was managed with morphine bolus administration (average dose 4.75 ± 3.6 mg). All patients had the device correctly positioned, as confirmed by postoperative transthoracic echocardiograms. None of the patients required outpatient analgesic therapy upon discharge. The authors' study demonstrated the potential of TricValve implantation in effectively managing severe tricuspid regurgitation with no procedure-related complications and a 100% survival rate. A collaborative, interdisciplinary approach and targeted anesthesia management proved crucial for this success. Postoperative shoulder pain emerged as a frequent complication, whose pathogenesis is still not clear, and successfully was managed using targeted analgesic therapy. [ABSTRACT FROM AUTHOR]

[Display omitted] • Prevalence and consequences of MAD in children are unreported. • MAD is common in children with MVP. • Pickelhaube sign is a marker of MAD in children with MVP. • Pickelhaube sign is significantly related to VAs in children with MVP. • Myxomatous mitral valve is significantly related to VAs in children with MVP. • Myocardial fibrosis seen on CMR imaging in children with Pickelhaube sign and VAs. Mitral annular disjunction (MAD) and the Pickelhaube sign are identified as risk factors for malignant ventricular arrhythmias (VAs) and sudden cardiac death in adults with mitral valve prolapse (MVP); their prevalence and consequences in children have never been studied. To determine the proportion of MAD in children with MVP, and its potential link with VAs. A cohort of 49 consecutive children (mean age 12.8 ± 3.0 years; 33 females) with MVP and comprehensive clinical arrhythmia (24-hour monitoring) and Doppler echocardiographic characterization, including pulsed-wave tissue Doppler (PWTD) of the lateral mitral annulus, was identified. The relationship between clinical and echocardiographic data and presence of VAs was studied. MAD was common (n = 25; 51%). Only five patients had significant VAs (Lown grade > 2) characterized by polymorphic premature ventricular contractions or couplets. MAD was not associated with VAs on 24-hour Holter monitoring, but an association was found between VAs and spiked high-velocity midsystolic signal > 16 cm/s on PWTD (Pickelhaube sign) (P = 0.004), myxomatous mitral valve (P = 0.004) and left ventricular dilatation (P = 0.01). T-wave inversion in inferolateral leads on electrocardiogram was more frequent in patients with versus without the Pickelhaube sign (P = 0.03). No difference was found between patients with or without MAD regarding sex, history of palpitation, severity of mitral regurgitation, aortic root diameter and incidence of connective tissue disorders. Myocardial fibrosis was detected in two of three patients who underwent a complementary cardiac magnetic resonance examination. MAD is common in children with MVP; its presence was not associated with significant VAs on 24-hour Holter monitoring, but the Pickelhaube sign and presence of myxomatous mitral valve may help to detect patients prone to significant VAs. Myocardial fibrosis can be detected by cardiac magnetic resonance in children with significant VAs. [ABSTRACT FROM AUTHOR]

Local authorities play a key role in tackling climate change by implementing targeted adaptation and mitigation measures. The specific implementation of a mix of adaptation and mitigation strategies is the outcome of the interaction of policymakers through a political debate and their attitudes towards climate change. By concentrating on the political discourses occurring in the Assembly of an Italian region (Emilia-Romagna), we use a multi-method approach of Discourse Network Analysis and Concept Mapping to investigate local policymakers' positioning. Our investigation shows that actors are grouped not only according to their political affiliation, but also to the debated topics, and this relates to the preference for supporting adaptation or mitigation measures, which characterizes the local policy debate. • Local policymaking is relevant to address climate change. • Adaptation and mitigation measures characterise the local political debate. • Network of actors' coalitions and topics emerge from political discourses. • Political affiliation does not fully explain policy preferences. [ABSTRACT FROM AUTHOR]

Lung cancer remains the leading cause of cancer-related mortality for men and women in the United States. Screening for lung cancer with annual low-dose CT is saving lives, and the continued implementation of lung screening can save many more. In 2015, the CMS began covering annual lung screening for those who qualified based on the original United States Preventive Services Task Force (USPSTF) lung screening criteria, which included patients 55 to 77 year of age with a 30 pack-year history of smoking, who were either currently using tobacco or who had smoked within the previous 15 years. In 2021, the USPSTF issued new screening guidelines, decreasing the age of eligibility to 80 years of age and pack-years to 20. Lung screening remains controversial for those who do not meet the updated USPSTF criteria, but who have additional risk factors for the development of lung cancer. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]

Trapeziectomy with suspensionplasty is the most popular treatment for thumb carpometacarpal arthritis. However, carpometacarpal denervation has recently shown promise as an alternative treatment option. This study was designed to compare functional outcomes, pain reduction, and quality of life between denervation and suspension arthroplasty in patients treated for thumb carpometacarpal osteoarthritis. We conducted a prospective clinical trial between June 2020 and December 2021. Preoperative and postoperative evaluations were conducted on patients, including the evaluation of functional outcomes via the Michigan Hand Outcomes Questionnaire, pain with the visual analog score, quality of life with the EuroQol-5D, and the evaluation of time to return to function. Outcomes and complications were compared between patients undergoing denervation versus arthroplasty. Forty-eight patients were included in the study, 34 of whom underwent denervation and 14 underwent suspension arthroplasty of the thumb carpometacarpal joint. Patients in the denervation group were younger, with an average age of 59 years compared with 67 years in the arthroplasty group. All other patient characteristics were similar. Pain reduction, functional outcomes, and quality of life scores showed equal improvement in both groups. Denervation patients had a reduced time to return to function (3.3 weeks vs 4.5 months in the arthroplasty group). Carpometacarpal denervation appears to provide similar short-term outcomes as suspension arthroplasty for the treatment of thumb carpometacarpal arthritis. Treatment with denervation may offer a quicker return to function. The long-term outcomes of denervation remain unknown. Therapeutic IV. [ABSTRACT FROM AUTHOR]

Industry 4.0 (I4.0) has brought about profound changes in the management field but not only. Companies have embraced I4.0 innovations and enabling technologies in production and marketing, business models and human resources management. About 10 years after the introduction of I4.0, a recent intervention by the European Commission has drawn attention to a new paradigm, Industry 5.0 (I5.0), a new Industrial Revolution oriented to social and sustainability objectives. In this context of technological but even more social change and the coexistence of two Industrial Revolutions, using a systematic literature review, the paper aims to provide a holistic and comprehensive definition of I5.0 while analysing the enabling technologies and the challenges and opportunities related to the I4.0 transition to I50. The results show a growing interest in I5.0, in particular the transition from I4.0, and a strong link between the two industrial revolutions, emphasised, for instance, by the enabling technologies. The conclusions offer insights into future research trends and possible managerial implications. • After 10 years of Industry 4.0 we are in the era of a new industrial revolution. • Industry 5.0 is the new human-oriented paradigm. • There is no single, holistic definition of I5.0. • Transition from I4.0 to I5.0 involves technologies, challenges and opportunities. [ABSTRACT FROM AUTHOR]

While the benefits of early antiretroviral therapy (ART) initiation in perinatally infected infants are well documented, early initiation is not always possible in postnatal pediatric HIV infections. The timing of ART initiation is likely to affect the size of the latent viral reservoir established, as well as the development of adaptive immune responses, such as the generation of neutralizing antibody responses against the virus. How these parameters impact the ability of infants to control viremia and the time to viral rebound after ART interruption is unclear and has never been modeled in infants. To investigate this question we used an infant nonhuman primate Simian/Human Immunodeficiency Virus (SHIV) infection model. Infant Rhesus macaques (RMs) were orally challenged with SHIV.C.CH505 375H dCT and either given ART at 4-7 days post-infection (early ART condition), at 2 weeks post-infection (intermediate ART condition), or at 8 weeks post-infection (late ART condition). These infants were then monitored for up to 60 months post-infection with serial viral load and immune measurements. To gain insight into early after analytic treatment interruption (ATI), we constructed mathematical models to investigate the effect of time of ART initiation in delaying viral rebound when treatment is interrupted, focusing on the relative contributions of latent reservoir size and autologous virus neutralizing antibody responses. We developed a stochastic mathematical model to investigate the joint effect of latent reservoir size, the autologous neutralizing antibody potency, and CD4+ T cell levels on the time to viral rebound for RMs rebounding up to 60 days post-ATI. We find that the latent reservoir size is an important determinant in explaining time to viral rebound in infant macaques by affecting the growth rate of the virus. The presence of neutralizing antibodies can also delay rebound, but we find this effect for high potency antibody responses only. Finally, we discuss the therapeutic implications of our findings. • Latent reservoir size is an important determinant in explaining time to viral. • Latent reservoir size affects the growth rate of the virus. • Neutralizing antibodies can delay viral rebound for high neutralization potency. [ABSTRACT FROM AUTHOR]

The aim of this multicenter study was to evaluate the effectiveness and safety of electrochemotherapy (ECT) for the treatment of mucosal tumors in the head and neck. A total of 71 patients with 84 nodules of different histologies in the oral cavity, pharynx and larynx treated by ECT were evaluated. The data were collected from the InspECT database from 10 participating centers throughout Europe. Primary and recurrent/secondary tumors of different histologies were treated. The overall response rate was 65 %, with a 33 % complete response rate with limited side effects. The response rates of the primary and secondary tumors were not different. However, smaller tumors responded better than tumors larger than 3 cm in diameter. Furthermore, the tumors that were treated with curative intent responded significantly better than those treated with palliative intent. This study demonstrated the feasibility, safety and effectiveness of ECT in a larger cohort of patients with mucosal lesions in the head and neck region. Based on the available data, ECT can be used for the treatment of recurrent and, in some cases, primary mucosal tumors located in the oral cavity, larynx, and pharynx. A better response was obtained in patients with smaller primary tumors treated with curative intent. [ABSTRACT FROM AUTHOR]

The effect of obesity on lung function in children stratified by asthma status is not fully elucidated. We evaluated the impact of adiposity indices, including Body Mass Index (BMI) and estimated fat mass (eFT), on lung changes in asthmatic and non-asthmatic children with rhinitis. We performed a retrospective review of 400 pediatric patients, classified into an asthma group (n = 200) and a no-asthma group (n = 200). According to the BMI z-score all subjects were classified into normal-weight patients (NW; −2 ≤ BMI z-score <1) and overweight patients/patients with obesity (OW/OB; BMI z-score ≥1). Lung function parameters were measured by spirometry. BMI and eFM were considered as adiposity indices. Excess weight/obesity was present in 37 % of patients. The OW/OB group showed higher basal forced expiratory vital capacity (FVC) and lower forced expiratory volume in 1 s (FEV 1), FEV 1 /FVC ratio compared to the NW group (p ≤ 0.01). FVC and FEV 1 were correlated with the BMI z-score, and FEV 1 /FVC with eFT (p ≤ 0.01). No differences were noted between the NW and the OW/OB groups in terms of respiratory parameters except for FVC (p < 0.01). In the OW/OB group, asthma patients were significantly different based on FEV 1 , FEV 1 /FVC, and forced expiratory flow at 25–75 % of FVC (FEF 25/75) (p < 0.01). The BMI z-score was correlated with FVC and FEV 1 in both the no-asthma and asthma groups (p ≤ 0.01 and p ≤ 0.05, respectively), while eFM was correlated with FEV 1 /FVC (p = 0.007) in the asthma group only. Obesity seems to have a significant impact on lung function in children with respiratory allergic diseases. BMI and eFM may be used to evaluate the impact of adiposity on lung function. [ABSTRACT FROM AUTHOR]

Making a diagnosis of neurodegenerative diseases at an early stage is one of the most significant challenges of modern neuroscience. Although this family of diseases remains without a cure, the effectiveness of their medical treatment largely relies on the timing of their detection. For certain groups of diseases, such as Fronto-Temporal Dementia (FTD), trained professionals can effectively reach a correct diagnosis through the visual analysis of Magnetic Resonance Imaging, in its functional (fMRI) or raw (MRI) version. However, this operation is time-consuming and may be subject to personal interpretation. In this paper, we explore the performance of a group of machine learning algorithms to formulate a correct FTD diagnosis, in order to provide medical professionals with a supporting tool. The dataset consists of MRI data acquired on 30 subjects, and the experiments are carried out by investigating different fMRI techniques based on a Multi-Voxel Pattern Analysis (MVPA) approach. The results obtained show high accuracy in identifying FTD in elderly patients when Support Vector Machine and Random Forest techniques are used, with outcomes varying based on the fMRI methods. [ABSTRACT FROM AUTHOR]

• We defined a new composite Municipal Indicator (MICE) for Circular economy (CE). • MICE is based on 14 strictly environmental variables. • MICE is tested on the 329 municipalities of Emilia- Romagna region (Italy). • Regressions show small cities are slower than large ones in adopting CE practices. • Albeit focused on ecological dimension, MICE performs consistently with literature. The multidimensional nature of Circular Economy (CE) has been investigated by using composite indicators including variables that sometimes can be assumed only indirectly related to the concept of CE. This paper defines a new composite indicator based exclusively on environmental variables, grouped into the five areas of green enterprise, sustainable mobility, sustainable energy, biodiversity, emissions and pollution and applicable to local territories such as municipalities. Our Municipal Indicator of Circular Economy (MICE) is then tested on the 329 municipalities of Emilia- Romagna region (Italy). Based on our results, MICE detects circularity patterns at local level; moreover, we observe that small municipalities tend to be slower in adopting CE practices, while large municipalities are more proactive and perform better under the different environmental dimensions of CE. Our results confirm what has been found in previous studies, i.e. that CE is linked with industrial specialization [ABSTRACT FROM AUTHOR]

The loggerhead sea turtle Caretta caretta has been chosen as bioindicator to monitor the amount of litter ingested by marine animals within the European Marine Strategy Framework Directive and the Barcelona Regional Sea Convention. European Member States and Contracting Parties are committed to achieve the Good Environmental Status (GES), which is reached when the quantity of ingested litter does not adversely affect the health of the species concerned. Although the monitoring strategy has been outlined for more than a decade, to date no threshold values have been adopted to verify GES achievement. After five years of extensive monitoring along the Italian coasts, this study evaluates the suitability of five different GES scenarios and proposes a new threshold value (i.e. , "there should be less than 33% of sea turtles having more than 0.05 g of ingested plastic in the GI") for its implementation in the European seas and the Mediterranean basin. • C. caretta is a good bioindicator of marine litter ingestion at subregional scale. • Two GES scenarios are suitable to monitor the health of the species concerned. • Marine litter ingestion rates seem to be affected by food availability. • C. caretta cannot be considered as a marine litter passive sampler for GES. • No lethal impact has been observed in individuals with ≤0.05 g of ingested litter. [ABSTRACT FROM AUTHOR]

Lung cancer screening (LCS) decreases lung cancer mortality; however, that reduction depends upon screening adherence. The purpose of this study was to determine factors associated with adherence rate for LCS among patients with negative baseline CT results in a multi-integrated health care network. A retrospective analysis was conducted among patients with negative baseline CT results in a multi-integrated health care network LCS program between January 2015 and January 2020. The two outcomes were adherence for the first and second subsequent LCS studies. Negative baseline result was defined as a Lung CT Screening Reporting and Data System score 0, 1, or 2. Adherence was defined as undergoing a follow-up study within 11 to 15 months of a prior scan. Multivariable logistic regression was used to determine significant predictors of adherence, adjusting for patient demographics, median household income (on the basis of geocoding ZIP codes from the US Census Bureau), smoking history, screening sites, and provider specialty. A total of 30.7% (512 of 1,668) and 16.3% (270 of 1,660) of patients were adherent for the first two annual subsequent screens, respectively. First-year adherence was higher among former smokers and varied by site and provider specialty. Second-year adherence was higher among former smokers and varied by site, provider specialty, and pack-years smoked. Adherence to LCS in a multihospital integrated health care network was poor and even lower at year 2. The identified factors associated with adherence may serve as targets to increase LCS adherence and decrease lung cancer mortality. [ABSTRACT FROM AUTHOR]

This paper deals with the dissimilar friction stir lap welding of AA2198 and AA6082 thin sheets. The influence of processing parameters, namely welding speed and tool rotational speed on joint features, microstructure, and mechanical properties were investigated by implementing a full factorial design of experiments. During the welding process, axial and transversal forces were continuously measured using a dedicated fixture equipped with sensors aiming at the correlation of this processing parameter with the quality of the achieved joints. The microstructural analysis provided a detailed view of the metallurgical features such as hook, and its relative influence exhibited on the welded joints. Microhardness distribution and lap shear behavior were assessed and correlated with the metallurgical analysis. [ABSTRACT FROM AUTHOR]

• Linear Friction Welding (LFW) demonstrated for hybrid additive manufactured (AM) parts. • Microstructure evolution compared between conventional and AM parts. • Temperature history predicted by finite element models correlated well with the microstructure changes. • The effects of process parameters on metallurgical evolution have been explained. Hybrid additive manufacturing combining bulk components from traditional manufacturing route can overcome the size limitation in typical metal additive process. Investigating the joining process of bulk and additive components is crucial in hybrid processes. In the present work, a comprehensive study, including both experiments and simulations, has been carried out to describe the linear friction welding of electron beam melted Ti6Al4V. Three different welding configuration have been considered: conventional-conventional, EBMelted to EBMelted and the dissimilar conventional-EBMelted. Successive weld joints were achieved in all the three configurations. The mechanical behavior and the phase transformation in the weld region is highly influenced by the base material microstructure. The thermo mechanical behaviour during the friction welding is simulated using finite element method. The temperature history is predicted with very good accuracy in all the three configurations. The experimental data along with the simulation results are used to further explain and understand the phenomena occurring during the welding. [ABSTRACT FROM AUTHOR]

Myotonic dystrophy type 1 (DM1) is a rare inherited neuromuscular disease associated with insulin resistance, and its association with metabolically associated fatty liver disease (MAFLD) has never been explored in prospective studies. The aim of this study was to assess the clinical features of MAFLD in DM1 patients. We investigated the prevalence and the diagnostic features of MAFLD in a cohort of 29 outpatient fully characterized DM1 patients; afterward, we compared the selected cohort of DM1-MAFLD individuals with a propensity-matched cohort of non-DM1-MAFLD 13/29 (44.83%) DM1 patients received a clinical diagnosis of MAFLD. Compared to DM1 patients with normal liver, DM1-MAFLD individuals showed a higher male prevalence (p = 0.008), BMI (p = 0.014), HOMA score (p = 0.012), and GGT levels (p = 0.050). The statistical comparison showed that the DM1-MAFLD group had a more severe MAFLD according to the FIB4 score than non-DM1-MAFLD patients. This association of a more severe form of liver disease with DM1 remained significant after logistic regression analysis (OR: 6.12, 95% CI 1.44- 26.55). [ABSTRACT FROM AUTHOR]

Objective: Particularly for pediatric patients presenting with acute conditions or challenging diagnoses, identifying variation in emergency radiology staffing models is essential in establishing a standard of care. We conducted a cross-sectional survey among radiology departments at academic pediatric hospitals to evaluate staffing models for providing imaging interpretation for emergency department imaging requests.Methods: We conducted an anonymous telephone survey of academic pediatric hospitals affiliated with an accredited radiology residency program across the United States. We queried the timing, location, and experience of reporting radiologists for initial and final interpretations of emergency department imaging studies, during weekday, overnight, and weekend hours. We compared weekday with overnight, and weekday with weekend, using Fisher's exact test and an α of 0.05.Results: Surveying 42 of 47 freestanding academic pediatric hospitals (89%), we found statistically significant differences for initial reporting radiologist, final reporting radiologist, and final report timing between weekday and overnight. We found statistically significant differences for initial reporting radiologist and final report timing between weekday and weekend. Attending radiologist involvement in initial reports was 100% during daytime, but only 33.3% and 69.0% during overnight and weekends. For initial interpretation during overnight and weekend, 38.1% and 28.6% use resident radiologists without attending radiologists, and 28.6% and 2.4% use teleradiology. All finalized reports as soon as possible during weekdays, but only 52.4% and 78.6% during overnight and weekend.Discussion: A minority of hospitals use 24-hour in-house radiology attending radiologist coverage. During overnight periods, the majority of academic pediatric emergency departments rely on resident radiologists without attending radiologist supervision or outside teleradiology services to provide initial reports. During weekend periods, over a quarter rely on resident radiologists without attending radiologist supervision for initial reporting. This demonstrates significant variation in staffing practices at academic pediatric hospitals. Future studies should look to determine whether this variation has any impact on standard of care. [ABSTRACT FROM AUTHOR]

Recent evidence suggests that brain activity following the offset of a stimulus during encoding contributes to long-term memory formation, however the exact mechanisms underlying offset-related encoding are still unclear. Here, in three repetitive transcranial magnetic stimulation studies (rTMS) we investigated offset-related activity in the left ventrolateral prefrontal cortex (VLPFC). rTMS was administered at different points in time around stimulus offset while participants encoded visually-presented words or pairs of words. The analyses focused on the effects of the stimulation on subsequent memory performance. rTMS administered at the offset of the stimuli, but not during online encoding, disrupted subsequent memory performance. In Experiment 1 we found that rTMS specifically disrupted encoding mechanisms initiated by the offset of the stimuli rather than general, post-stimulus processes. Experiment 2 showed that this effect was not dependent upon rTMS-induced somatosensory effects. In a third rTMS experiment we further demonstrated a robust decline in associative memory performance when the stimulation was delivered at the offset of the word pairs, suggesting that offset-related encoding may contribute to the binding of information into an episodic memory trace. The offset of the stimulus may represent an event boundary that promotes the reinstatement of the previously experienced event and episodic binding. • The administration of rTMS over the left VLPFC at the offset of to-be-remembered words impairs later memory for those words. • Offset-related brain activity is crucial for long-term memory formation. • Offset-related encoding may contribute to the binding of information into an episodic memory trace. [ABSTRACT FROM AUTHOR]

Industrial market is becoming increasingly competitive and companies need even more advanced resources to advantage over competitors. As an example, simulation is part of Industry 4.0 technologies and a key tool for lay out re-configuration, in order to realize a flexible product customization but also to optimize manufacturing processes. For these reasons Computational Fluid Dynamics (CFD) simulation can determine a competitive advantage for smart factories in the light of possibilities offered by new technologies. The research is focused on a conceptual solution to integrate CFD simulation with technologies of the Industry 4.0, in order to open new opportunities for companies in terms of in terms of growth and competitiveness. [ABSTRACT FROM AUTHOR]

Industry 4.0 technologies are transforming the factory in an "intelligent" or "smart" factory. In a such context, a greater efficiency and innovative relationship is basically demanded within the whole production chain, including suppliers, producers, and customers. To be more competitive, companies are becoming increasingly aware that maintenance plays a key role during the digital transformation from the perspective of both technology and management. In this work, we perform a literature review of published cases to investigate how maintenance is changing through technologies of Industry 4.0 currently used in maintenance. We found 34 papers in literature involved in analyzing relations between maintenance and Industry 4.0 technology. The analysis of such studies let us to establish the current technology state-of-art and identify the most suited technology that today is employed in maintenance tasks. In particular Industrial Internet of Things and Cloud Computing are more common in the analyzed studies, confirming how these concepts and technologies are at the basis of Industry 4.0 [ABSTRACT FROM AUTHOR]

Industry 4.0 is a popular topic in management literature, but it is also an interdisciplinary subject, maintaining a strong engineering connotation. Firm decision-making processes are more and more affected by Industry 4.0 which has introduced numerous tools that benefit and greatly support business activities. In this domain, the focus of this paper is the information made available to stakeholders on Industry 4.0 tools in use through a content analysis of the Annual Reports of the main European innovative firms (from the top ten of the Boston Consulting Group ranking). The analysis seeks to highlight how firms describe and qualify these tools in terms of impact (risk, strategy or environmental), the perspective used in illustrating them (managerial or engineering) as well as the temporal orientation of the information provided (present, past, future or none). Results show that innovative European firms pay attention and use these tools, in different ways and for different purposes. The paper has both theoretical and managerial implications. From a theoretical point of view, it contributes to study and further the literature on Industry 4.0 and its instruments, while from a managerial perspective, it gives a better understanding of how these innovative tools can be communicated to external stakeholders, especially investors. [ABSTRACT FROM AUTHOR]

Lean production and Industry 4.0 are two concepts that have been studied in recent years, focusing mainly on the relationship that exist between them. Several authors state that lean manufacturing cannot be efficient without the implementation of Industry 4.0 technologies. For this reason, the aim of this paper is to understand how these concepts can be implemented in a company. Results show that the academic research is divided between two different clusters: (1) strategic/managerial and (2) techniques/implementation. [ABSTRACT FROM AUTHOR]

The present article focuses its attention on the tools of the Industry 4.0 with the purpose to analyze how these tools can be useful for the companies to increase factors like efficiency and productivity. In the age of the fourth industrial revolution, companies try to know how they can approach to the Industry 4.0, keeping attention on the tools which will be able to increase their results over time. This it will be possible if the companies will be able to integrate, not only the concept of Industry 4.0 with Lean Production, but even the human factor with the tools of the fourth industrial revolution. This integration will allow to increase companies' performance and to get higher results than competitors, increasing even their productivity and flexibility. The aim of the study is to know what tools of the Industry 4.0 are used by the companies, what are the reasons that push companies to use these tools and what advantages are from their use. The results achieved will show that the most important I4.0 tools integrated with lean production will be IoT and Big Data, which will allow companies to improve their flexibility and productivity. Finally, the human factor, as reported from some authors in the section 7, will be another important element which will allow companies to get great results. [ABSTRACT FROM AUTHOR]

Introduction: Joint prosthesis survival is associated with the quality of surrounding bone. Dual-energy X-ray absorptiometry (DXA) is capable to evaluate areal bone mineral density (BMD) around different prosthetic implants, but no studies evaluated periprosthetic bone around total ankle replacement (TAR). Our aim is to determine the precision of the DXA periprosthetic BMD around TAR. Methodology: Short-term precision was evaluated on 15 consecutive patients. Each ankle was scanned 3 times both in the posteroanterior (PA) and lateral views with a dedicated patient positioning protocol. Up to four squared regions of interest (ROIs) were placed in the periprosthetic bone around tibial and talar implants, with an additional ROI to include the calcaneal body in the lateral scan. Coefficient of variation (CV%) and least significant change were calculated according to the International Society for Clinical Densitometry. Results: The lateral projection showed lower mean CV values compared to the PA projection, with an average precision error of 2.21% (lateral scan) compared to 3.34% (PA scans). Overall, the lowest precision error was found at both "global" ROIs (CV = 1.25% on PA and CV = 1.3% on lateral). The highest CV value on PA was found at the medial aspect of talar side (ROI 3; CV = 4.89%), while on the lateral scan the highest CV value was found on the posterior aspect of talar side (ROI 2; CV = 2.99%). Conclusions: We found very good reproducibility BMD values of periprosthetic bone around TAR, that were comparable or even better compared to other studies that evaluated periprosthetic BMD around different prosthetic implants. DXA can be used to precisely monitor bone density around ankle prostheses, despite further long-term longitudinal studies are required to assess the clinical utility of such measurements. [ABSTRACT FROM AUTHOR]

ECHS1 encodes for short-chain enoyl-CoA hydratase, a key component in b-oxidation. This enzyme is also involved in the isoleucine and valine catabolic pathways. The literature contains reports of scattered cases of ECHS1 mutation, which show a wide clinical spectrum of presentation. Despite that the clinical spectrum of the disease has not been defined so far due to the absence of previous systematic reviews and descriptions of large series of patients. We performed a systematic literature review of so far reported ECHS1 mutated patients and we reported two additional cases. We pointed out clinical and neuroradiological features of all patients. 45 patients were included in the analysis. Based on clinical and neuroradiological feature we were able to distinguish four main phenotypes of ECHS1deficiency: a severe neonatal presentation with a rapid and fatal course and significant white matter abnormalities; a severe infantile variant with slower neurological deterioration, developmental delay, pyramidal and extrapyramidal signs, optic atrophy, feeding difficulties, and degeneration of the deep gray nuclei; a slowly progressive infantile form, qualitatively similar to the previous phenotype, but less severe with mainly basal ganglia involvement; and a final phenotype, present in only few cases, characterized by paroxysmal exercise-induced dystonic attacks, normal neurological examination between these episodes, and isolated pallidal degeneration on MRI. ECHS1 mutations cause metabolic encephalopathy with a wide range of clinical presentations that can be grouped into four main phenotypes, each with a distinct profile in terms of severity on clinical presentation, disease course and MRI involvement. • ECHS1 mutations cause a metabolic encephalopathy with a wide range of clinical presentations. • Our study, on the basis of clinical and neuroradiological features, distinguish four main forms of ECHS1 deficiency. • The differences in phenotypes predict differences in clinical outcomes. [ABSTRACT FROM AUTHOR]

• Emergency care model had significant reduction in unplanned hospital admissions. • Model had 25% decrease in ancillary testing costs compared to control facilities. • Utilizing model nationwide could save $10+ billion in health care costs annually. The population of individuals age 65 and older is increasing in the United States. One third of these individuals will utilize nursing home care before death. Nursing home residents ("NHR") average 1.8 emergency department visits annually. Improving the quality of nursing home care is of vital importance. This project describes a new paradigm for the management of acute emergent health issues affecting NHR. The model features a multidisciplinary team coordinated by emergency providers resulting in a 55% reduction in unplanned hospital admissions compared to skilled nursing facility regional data. Additionally, a reduction in ancillary lab costs was observed. Implementation of this paradigm on a national scale could result in a projected cost savings in excess of $10 billion per year for the Center for Medicare and Medicaid Services ("CMS"). [ABSTRACT FROM AUTHOR]

One of the most important problems in the early years of engineering programs is the difficulty that students have to understand Basic Sciences concepts, their application in technology and, particularly, in engineering. One of the ways to solve this situation is by implementing methodologies that promote an "Active and Student-Centered Learning" (ASCL). There are many techniques to develop this kind of approach, some of them are facilitated and/or enhanced through the use of technology. One of the most developed technologies in recent times and with greater expectations for the near future is Virtual and Augmented Reality (VAR). Our objective with this project is to develop and test VAR applications for improving the understanding of Basic Sciences concepts in freshmen courses. [ABSTRACT FROM AUTHOR]

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• The point of care ultrasound: a diagnostic tool for the assessment of volume status. • The reference pediatric ranges for the measurement of inferior vena cava (IVC), aorta (AO) and IVC/AO ratio. • Age can be used as an independent variable in emergency conditions. The pediatric ultrasound measurement of the inferior vena cava (IVC) and aorta (AO) with the study of the collapsibility index (CI) and of IVC-to-AO ratio (IVC/AO) can provide clinicians in the acute care setting with information on abnormal volume status but one of the major limitations is a lack of reference normal values by body surface area (BSA) and age. The aim of this study was to provide reference ranges for the sonographic measurement of IVC, AO, and IVC/AO ratio in healthy Caucasian Italian children. We enrolled prospectively 516 healthy Caucasian Italian children aged between 1 month and 16 years. Echocardiographic IVC and AO diameters were collected and presented separately for children aged ≤1 year and for children aged over 1 year. For children >1 year we categorized subjects into 3 years classes. CI and IVC/AO for the systolic aortic diameter were then calculated. For children over 1 year, age reference ranges were age-related or BSA-related; for children of ≤1 year, reference ranges were determined with their 90% confidence intervals regardless of age and of BSA. Tables and charts with reference ranges for all the echocardiographic measurements are presented for children aged >1 year according to age and BSA. The equations to obtain percentile and Z -score for each echocardiographic measurement are provided. The reference ranges for children aged ≤1 year are shown considering the small 90% confidence intervals for upper and lower limits. CI was 30% (SD 17%) in children >1 year and 36% (SD 16%) in children <1 year. IVC/AOs showed age-dependent values from 0.83 (SD 0.20) age <1 year to 1.22 (SD 0.31) in older subjects. We report reliable reference ranges for echocardiographic measurement of IVC, AO, CI, and IVC/AO for a Caucasian Italian healthy pediatric population. [ABSTRACT FROM AUTHOR]

This study analyzes microplastic ingestion by three deep-water elasmobranch species (Galeus melastomus , Scyliorhinus canicula and Etmopterus spinax) from the Tyrrhenian Sea, discriminating between stomach and intestine contents. The absence of significant differences in frequency and abundance of plastic items into stomachs seems to suggest that ecological diversity among the three sharks does not strongly influence the probability of plastic ingestion in the study area. On the other hand, the detected differences in the microplastic content into the intestine might be due to a different retention time of microplastics, suggesting how feeding habits could influence metabolic features, and therefore affect the recovery of ingested plastic items. This information would improve the future development of marine micro-litter monitoring systems, following the MSFD requirements. Moreover, this study shows that all the three examined elasmobranch species can give important information even with relatively small sample sizes (N ≈ 30), and they could be used as target species for monitoring micro-litter ingestion in deep-water habitats. Image 1 • New proposal for study microplastic presence into stomach and intestine separately. • Deep-water sharks are exposed to microplastic ingestion. • First evidence of plastic ingestion by S. canicula in the Mediterranean Sea. • Retention time affect the recovery of ingested microplastics. • Elasmobranchs could be used for monitoring micro-litter ingestion. Feeding habits could influence the retention time of ingested microplastics, and therefore affect their recovery. [ABSTRACT FROM AUTHOR]

The classification of natural language texts has gained a growing importance in many real world applications due to its significant implications in relation to crucial tasks, such as Information Retrieval, Question Answering, Text Summarization, Natural Language Understanding. In this paper we present an analysis of a Deep Learning architecture devoted to text classification, considering the extreme multi-class and multi-label text classification problem, when a hierarchical label set is defined. The paper presents a methodology named Hierarchical Label Set Expansion (HLSE), used to regularize the data labels, and an analysis of the impact of different Word Embedding (WE) models that explicitly incorporate grammatical and syntactic features. We evaluate the aforementioned methodologies on the PubMed scientific articles collection, where a multi-class and multi-label text classification problem is defined with the Medical Subject Headings (MeSH) label set, a hierarchical set of 27,775 classes. The experimental assessment proves the usefulness of the proposed HLSE methodology and also provides some interesting results relating to the impact of different uses and combinations of WE models as input to the neural network in this kind of application. • Deep Neural Network architecture for extreme multilabel text classification. • Multi-label classification problem with a huge label space hierarchically organized. • Comparison among different word-embeddings methods for text representation. • Definition of a method for label set expansion exploiting the label hierarchy. • Experimental assessment based on flat and hierarchical measures. [ABSTRACT FROM AUTHOR]

Abstract The presence of marine litter is a complex, yet persistent, threat to the health and biodiversity of the marine environment, and plastic is the most abundant, and ubiquitous type of marine litter. To monitor the level of plastic waste in an area, and the prospect of it entering the food chain, bioindicator species are used extensively throughout Northern European Seas, however due to their distribution ranges many are not applicable to the Mediterranean Sea. Guidance published for the Marine Strategy Framework Directive suggests that the contents of fish stomachs may be analyzed to determine trends of marine plastic ingestion. In order to equate transnational trends in marine plastic ingestion, the use of standardized fish species that widely occur throughout the basin is favoured, however for the Mediterranean Sea, specific species are not listed. Here we propose a methodology to assess how effective Mediterranean fish species, that are known to have ingested marine plastic, are as bioindicators. A new Bioindicator Index (BI) was established by incorporating several parameters considered important for bioindicators. These parameters included species distribution throughout the Mediterranean basin, several life history traits, the commercial value of each species, and the occurrence of marine litter in their gut contents. By collecting existing data for Mediterranean fish, ranked scores were assigned to each trait and an average value (BI value) was calculated for each species. Based on their habitat preferences, Engraulis encrasicolus (pelagic), Boops boops (benthopelagic), three species of Myctophidae (Hygophum benoiti , Myctophum punctatum and Electrona risso) (mesopelagic), Mullus barbatus barbartus (demersal) and Chelidonichthys lucerna (benthic), were identified as currently, the most suitable fish for monitoring the ingestion of marine plastics throughout the Mediterranean basin. The use of standardized indicator species will ensure coherence in the reporting of marine litter ingestion trends throughout the Mediterranean Sea. Graphical abstract Image 1 Highlights • An index describes suitable marine plastic fish bioindicators in the Mediterranean. • European anchovy is well suited to monitor plastic trends in pelagic environments. • Boops boops appears the most adept plastic bioindicator for benthopelagic habitats. • For marine demersal habitats, Mullus barbatus barbatus is a suitable bioindicator. • The work contributes to standardization of Mediterranean monitoring protocols. Using a novel index, seven species of fish were identified as the most suitable to monitor marine plastic ingestion trends in the Mediterranean Sea. [ABSTRACT FROM AUTHOR]

Abstract We provide an overview on the current knowledge about the association between epilepsy and type 1 diabetes mellitus (T1DM). People with T1DM have a 2–6-fold higher risk of epilepsy than the general population. The onset of T1DM anticipates the onset of epilepsy by a mean period between 1,5 and 2,8 years. These two disorders share four potential distinct pathogenic factors: a) genetic predisposition; b) factors involved in autoimmune responses (i.e. anti-glutamic acid decarboxylase antibodies-GADAbs); c) effects of hypo/hyperglycaemia; d) cerebrovascular damages resulting in ischaemic processes. Seizures semiology prominently includes focal (up to patterns of epilepsia partialis continua) or secondarily generalized seizures but also reflex seizures and various forms of generalized seizures. EEG abnormalities are more common in people with an inappropriate metabolic control with a prominent involvement of fronto-temporal regions. Epilepsy management does not differ between patients with and without diabetes and insulin, nutritional recommendations and physical activity may also produce significant benefits on seizures control. Possible therapeutic alternatives in selected cases include immunosuppressive drugs (in patients with GADAbs) and ketogenic diet. [ABSTRACT FROM AUTHOR]

Highlights • Cardiovascular comorbidities may complicate pregnancy. • Pregnancy carries a 25-fold relative risk for aortic dissection. • Dissection may occur in pregnancies without known genetic or anatomical risk factors (non syndromic sporadic aortic dissection). • Dissection may occur in the postpartum period. • Given the high mortality for both mother and foetus, a high clinical suspicion for aortic dissection is needed in an emergency setting in postpartum. Abstract Introduction Aortic dissection is a rare cardiovascular complication in pregnancy. Most of the cases occur during the third trimester of pregnancy, whilst 33% of cases are reported during the postpartum period. Presentation of case We report the case of a multiparous 35-year-old patient with gestational hypertension treated for a type A aortic dissection on the second postpartum day. A review of literature on non-syndromic sporadic aortic dissection during the postpartum period is presented. Discussion Aortic complications in pregnancy have been described in genetic syndromes or congenital aortic malformations but may also be non -syndromic and occur in the absence of any other risk factor. Pregnancy carries a 25-fold increase in relative risk for dissection. A review of the 16 cases published in literature from 1995 to December 2016 of non-syndromic, sporadic aortic dissections in pregnancy showed that the event may occur more frequently in the first week post-partum, be symptomatic for thoracic pain or dyspnoea. Type A aortic dissection accounts to 75% of cases. Mortality, despite surgical treatment, has been reported in 4 cases. Conclusions Even though rarely reported, given the increasing incidence and the high mortality of aortic dissection in pregnancy, along with the potential challenge for two lives, clinician must consider aortic dissection in post-partum while dealing with differential diagnosis in post-partum patients in the emergency setting. [ABSTRACT FROM AUTHOR]

Objective: To determine if prehospital identification of sepsis will affect time to Centers for Medicare and Medicaid services (CMS) sepsis core measures and improve clinical outcomes.Methods: We conducted a retrospective cohort study among septic patients who were identified as "sepsis alerts" in the emergency department (ED). Metrics including time from ED registration to fluid resuscitation, blood cultures, serum lactate draws, and antibiotics administration were compared between those who had pre-arrival notification by EMS versus those that did not. Additionally, outcomes such as mortality and intensive care unit (ICU) admission were recorded.Results: Of the 272 total patients, 162 had pre-arrival notification (prehospital sepsis alerts) and 110 did not. The prehospital sepsis alert group had significantly lower times to intravenous fluid administration (6 min 95%CI 4-9 min vs 41 min 95%CI 24-58 min, p < 0.001), blood cultures drawn (12 min 95%CI 10-14 min vs 34 min 95%CI 20-48 min, p = 0.003), lactate levels drawn (12 min 95%CI 10-15 min vs 34 min 95%CI 20-49 min, p = 0.003), and administration of antibiotics (33 min 95%CI 26-40 min vs 61 min 95%CI 44-78 min, p = 0.004). Patients with prehospital sepsis alerts also had a higher admission rate (100% vs 95%, p = 0.006), and a lower ICU admission rate (33% vs 52%, p = 0.003). There was no difference in mortality (11% vs 14%, p = 0.565) between groups.Conclusions: Prehospital sepsis alert notification may decrease time to specific metrics shown to improve outcomes in sepsis. [ABSTRACT FROM AUTHOR]

The potential toxicity of microplastics is a growing concern for the scientific community. The loggerhead sea turtle (Caretta caretta) is particularly inclined to accidently ingest plastic and microplastic due to its long-life cycle features. The possible transfer of microplastics from the female to the eggs should be investigated. The present study investigated the presence of microplastics in yolk and liver samples evaluating the number of melanomacrophages in the hepatic tissue as a possible biomarker of microplastics impact on the embryonic health status. The biometric parameters and liver histological analysis of 27 and 48 embryos (from two different nests respectively) at the 30 stage of development were analyzed. Raman Microspectroscopy was performed to identify the microplastics after alkaline digestion (10% KOH) of yolk and portion of liver from 5 embryos at the 30 developmental stage per nest. Microplastics were found in yolk and liver of loggerhead sea turtles at late embryonic stage for the first time. All microplastics were smaller than 5 μm and were made of polymers and colors suggesting their diverse origins. A total number of 21 microplastics, with dimensions lower than 5 μm, were found between the two nests (11 and 10 microplastics respectively). Only two shape categories were identified: spheres and fragments. The most frequent polymers observed were polyethylene, polyvinyl chloride and acrylonitrile butadiene styrene (31.5%, 21.1% and 15.8% respectively). Despite the eggs showing a higher number of microplastics in yolk samples than liver (15 and 6 microplastics in yolk and liver respectively), a positive correlation was observed only between the number of melanomacrophages (r = 0.863 p < 0.001) and microplastics in the liver. This result may suggest that microplastics could exert some effects on the hepatic tissues. Future studies should investigate this aspect and the possible relation between microplastics and other stress biomarkers. [Display omitted] • Female sea turtles may possibly transfer microplastics to the eggs during oogenesis. • Microplastics were detected in embryos' yolk and liver. • Embryos' structural integrity and biometries were not affected by the presence of microplastics. • In liver samples, microplastics presence positively correlate with melanomacrophages number. [ABSTRACT FROM AUTHOR]