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The Directive 2013/59/Euratom established a reduction of the occupational exposure limits to the lens. Since it is become crucial to estimate the lens absorbed dose, the individual variability of exposed worker's ocular conformations with respect to the data estimated with their personal dosimetry has been studied. The anterior eye conformation of 45 exposed workers was acquired with Scheimpflug imaging and classified according to eye vision conditions (emmetropia, myopia or hypermetropia). Three eye models were computed, with two lens reconstructions, and implemented in an interventional radiology scenario by using Monte Carlo (MC) code. The models were dosimetrically analysed simulating setup A, a theoretical monoenergetic and isotropic photon's source (10-150 keV) and setup B, a more realistic interventional conditions with an angiographic X-ray unit (50, 75, 100 kV-peak). Scheimpflug imaging provided an average anterior chamber depth of (6.4 ± 0.5) mm and a lens depth of (3.9 ± 0.3) mm, together with a reconstructed equatorial lens length of (7.1 - 10.1) mm. Using this data for model's reconstruction, the dose conversion coefficients (DCs) for all ocular structures were simulated. Regardless of the eye model used, DCs show a similar trend with radiation energy which highlights, for the same energy and setup used, no significant dependence on ocular morphology and worker's visual conditions. The maximum difference obtained does not exceed 1% for all eye models or structures analysed. Therefore, the individual variabilities of worker ocular anatomy do not require any additional correction compared to the personal dosimetry data measured with a dedicated lens dosimeter. To estimate the absorbed dose to the other eye structures, it is essential instead to know the spectrum of the source that has generated the irradiation since there are differences considering monoenergetic sources or more realistic angiographic units.

Traumatic brain injury (TBI) is a leading cause of neurologic disability; the most common deficits affect prefrontal cortex-dependent functions such as attention, working memory, social behavior, and mental flexibility. Despite this prevalence, little is known about the pathophysiology that develops in frontal cortical microcircuits after TBI. We investigated whether alterations in subtype-specific inhibitory circuits are associated with cognitive inflexibility in a mouse model of frontal lobe contusion in both male and female mice that recapitulates aberrant mental flexibility as measured by deficits in rule reversal learning. Using patch-clamp recordings and optogenetic stimulation, we identified selective vulnerability in the non-fast-spiking and somatostatin-expressing (SOM+) subtypes of inhibitory neurons in layer V of the orbitofrontal cortex 2 months after injury. These subtypes exhibited reduced intrinsic excitability and a decrease in their synaptic output onto pyramidal neurons, respectively. By contrast, the fast-spiking and parvalbumin-expressing interneurons did not show changes in intrinsic excitability or synaptic output, respectively. Impairments in non-fast-spiking/SOM+ inhibitory circuit function were also associated with network hyperexcitability. These findings provide evidence for selective disruptions within specific inhibitory microcircuits that may guide the development of novel therapeutics for TBI. SIGNIFICANCE STATEMENT TBI frequently leads to chronic deficits in cognitive and behavioral functions that involve the prefrontal cortex, yet the maladaptive changes that occur in these cortical microcircuits are unknown. Our data indicate that alterations in subtype-specific inhibitory circuits, specifically vulnerability in the non-fast-spiking/somatostatin-expressing interneurons, occurs in the orbitofrontal cortex in the context of chronic deficits in reversal learning. These neurons exhibit reduced excitability and synaptic output, whereas the other prominent inhibitory population in layer V, the fast-spiking/parvalbumin-expressing interneurons as well as pyramidal neurons are not affected. Our work offers mechanistic insight into the subtype-specific function of neurons that may contribute to mental inflexibility after TBI.

Rationale: Lung biopsy (LBx) has a relevant role in the prediction of prognosis of interstitial lung diseases (ILDs), but its impact on the clinical management of patients remains unexplored. Objectives: This study evaluates whether LBx may change the therapeutic strategy and assesses the effect of diagnostic reclassification after LBx on long-term prognosis. Methods: We evaluated the LBx of 426 consecutive patients with ILDs, without a definite usual interstitial pneumonia pattern on high-resolution computed tomographic imaging. A total of 266 patients underwent transbronchial lung cryobiopsy (TBLC), and 160 patients underwent surgical lung biopsy (SLB). The multidisciplinary team (MDT) determined a diagnosis with high or low confidence, and a management strategy, both before and after the LBx data. Results: Final MDT diagnoses were 189 idiopathic pulmonary fibrosis (IPF), 143 non-IPF fibrotic ILDs, and 94 nonfibrotic ILDs. LBx data changed the management strategy in 145 cases (34%), with similar results for TBLC and SLB (the treatment strategy changed in 31.5% of TBLC cases, 84/266, P

Pre-clinical models of disease have long played important roles in the advancement of new treatments. However, in traumatic brain injury (TBI), despite the availability of numerous model systems, translation from bench to bedside remains elusive. Integrating clinical relevance into pre-clinical model development is a critical step toward advancing therapies for TBI patients across the spectrum of injury severity. Pre-clinical models include in vivo and ex vivo animal work-both small and large-and in vitro modeling. The wide range of pre-clinical models reflect substantial attempts to replicate multiple aspects of TBI sequelae in humans. Although these models reveal multiple putative mechanisms underlying TBI pathophysiology, failures to translate these findings into successful clinical trials call into question the clinical relevance and applicability of the models. Here, we address the promises and pitfalls of pre-clinical models with the goal of evolving frameworks that will advance translational TBI research across models, injury types, and the heterogenous etiology of pathology.

Anemia is a common complication of chronic kidney disease, affecting the quality of life of patients. Among various factors, such as iron and erythropoietin deficiency, reduced red blood cell (RBC) lifespan has been implicated in the pathogenesis of anemia. However, mechanistic data on in vivo RBC dysfunction in kidney disease are lacking. Herein, we describe the development of chronic kidney disease-associated anemia in mice with proteinuric kidney disease resulting from either administration of doxorubicin or an inducible podocin deficiency. In both experimental models, anemia manifested at day 10 and progressed at day 30 despite increased circulating erythropoietin levels and erythropoiesis in the bone marrow and spleen. Circulating RBCs in both mouse models displayed altered morphology and diminished osmotic-sensitive deformability together with increased phosphatidylserine externalization on the outer plasma membrane, a hallmark of RBC death. Fluorescence-labelling of RBCs at day 20 of mice with doxorubicin-induced kidney disease revealed premature clearance from the circulation. Metabolomic analyses of RBCs from both mouse models demonstrated temporal changes in redox recycling pathways and Lands’ cycle, a membrane lipid remodeling process. Anemic patients with proteinuric kidney disease had an increased proportion of circulating phosphatidylserine-positive RBCs. Thus, our observations suggest that reduced RBC lifespan, mediated by altered RBC metabolism, reduced RBC deformability, and enhanced cell death contribute to the development of anemia in proteinuric kidney disease.

Background: Health is becoming important today, especially during a pandemi situation. Everyone needs to take care of their health to avoid Covid-19. There are many information that students can use in maintaining their health from the internet. This is the basis for researchers to see student health information literacy. Research objectives: to determine the health information literacy of students from Faculty of Social and Political Sciences, University of Bengkulu and see the relationship between gender and study program with the dimensions of health information literacy. Research Methods: This study uses quantitative research using sample of 95 students of the Faculty of Social and Political Sciences, University of Bengkulu. The determination of the sample is based on the stratified sampling. Finding: Respondents already have health information literacy, especially information on Covid-19. The majority of respondents have an interest in finding information about Covid-19. Respondents already have health information literacy skills in the aspects of identifying, searching for, finding, and using the Covid-19 information they find. Female respondents have more health information literacy than men. In this type of education, Journalism study program students have information literacy compared to other study programs, especially in finding, evaluating and using Covid-19’s information. Conclusion: The results of this study indicate that students of the Faculty of Social and Political Sciences, University of Bengkulu have health information literacy skills in seeking information on Covid-19 during the pandemi season.

Indonesia is one of the countries that is prone to earthquakes. In addition to the dead loads, superimposed dead loads, and live loads, the design of buildings in Indonesia must be concerned with earthquake loads. Installing shear walls in the building structure as the Special Moment Frame Dual System is one of a solution to withstand earthquake loads. However, the location of shear walls must be considered, especially in buildings with horizontal irregularities. This study aims to determine the optimum location of the shear walls in a 10-storey building that has U-configuration with dynamic earthquake loads. This research is a numerical simulation ran by modelling the structure with software. To know the effect of the shear wall’s location on a building, several variations of the shear wall configuration with different positions have been conducted. It can be seen the lateral displacement of each floor and the shear force are the response structure to withstand the dynamic earthquake loads. Shear walls that are located close to the center of mass of the building are the optimum variation because the position of the shear wall is the closest to the core area of the building, which is the rotational axis of the building.

BACKGROUND: The flood disaster has had various impacts on the people in Aceh. One of the groups prone to flooding is mothers with toddlers. Efforts should be made to increase capacity, understanding, and knowledge through education and education for disaster preparedness to reduce the risk of occurring. AIM: Analyzing the effect of disaster management education on the Preparedness of mothers under five in Aceh. METHODS: This type of research is a quasi-experimental study using the One-Group Pretest-Posttest. The sample in this study was 51 mothers of children under five who were willing to sample and resided in two flood-affected villages. Data collection on the Preparedness of mothers under five in this study was carried out using pre-test and post-test questionnaires before and after the provision of disaster education. Data analysis using bivariate used dependent T-test and correlation analysis used Rank Spearman correlation. RESULTS: The results showed a significant difference in the mean value of knowledge, attitudes, and Preparedness of under-five mothers before and after receiving education about disasters, as evidenced by statistical tests using the dependent t-test p < 0.05. Measurement of the pre-test and post-test scores on the average increase in knowledge from before 89.45 to 94.53 after education provision. The attitude variable also increased on average from 39.43 to 48.40 after the provision of education. The preparedness variable also increased on average from 50.69 to 58.28 after the provision of education. CONCLUSION: Disaster management education has provided increased knowledge, attitudes, and Preparedness for mothers under five to flood disasters.

Perinatal (antenatal and postpartum) depression is increasingly becoming a global public health problem. Studies have shown that the presence of depression during the perinatal period impact on a mother’s ability to adequately provide nutritional care for herself and her infants and young children. This may thus negatively influence the nutritional status of these vulnerable children resulting in poor growth, such as stunting which is currently a public health problem in low- and middle-income countries (LMICs). The aim of this systematic review and meta-analysis was to determine the association between maternal postpartum depression and child growth in LMICs. Electronic databases were systematically reviewed by screening abstracts, titles, full text and additional data sources of eligible papers. Articles were eligible for inclusion if based on children aged 0 to 59 months, if reporting maternal postpartum depression as an exposure, if based on observational studies evaluating the relation between maternal postpartum depression and child growth, if reporting at least one physical growth indicator such as stunting as an outcome, and if published after 2000. Article selection was based on the PRISMA guidelines for reporting systematic reviews. Twelve articles were included in the quantitative synthesis (12 for stunting, 8 for underweight and 2 for wasting). Maternal postpartum depression was observed to be associated with an increased risk of child stunting (1.87 (95% CI: 1.52, 2.30; I2 = 41.6%, p = 0.064)) and underweight (1.81 (95% Cl: 1.25, 2.62; I2 = 70.7%, p = 0.001)). These results were confirmed after influence analyses, with publication bias being negligible. Conclusion: Maternal depression is a risk factor for poor child growth in LMICs. This study contributes to the knowledge on this topic and calls on policymakers to improve on its understanding, screening and treatment to alleviate the potential negative impact on child growth.

As of October 2021, coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains a global emergency, and novel therapeutics are urgently needed. Here we describe human single chain variable fragment (scFv) antibodies (76clAbs) that block an epitope of the SARS-CoV-2 spike protein essential for ACE2-mediated entry into cells. 76clAbs neutralize the delta variant and other variants being monitored (VBMs) and inhibit spike-mediated pulmonary cell-cell fusion, a critical feature of COVID-19 pathology. In two independent animal models, intranasal administration counteracted the infection. Due to high efficiency, remarkable stability, resilience to nebulization and low production cost, 76clAbs may become a relevant tool for rapid, self-administrable early intervention in SARS-CoV-2-infected subjects independently of their immune status.

Purpose To assess differences in referral and pathologic outcomes for uro-oncology cases prior to and during the COVID pandemic, comparing clinical and pathological data of cancer surgeries performed at an academic referral center between 2019 and 2020. Methods We collected data of 880 prostate biopsies, 393 robot-assisted radical prostatectomies (RARP) for prostate cancer (PCa), 767 trans-urethral resections of bladder tumor (TURB) and 134 radical cystectomies (RC) for bladder cancer (BCa), 29 radical nephro-ureterectomies (RNU) for upper tract urothelial carcinoma, 130 partial nephrectomies (PN) and 12 radical nephrectomies (RN) for renal cancer, and 41 orchifunicolectomies for testicular cancer. Data of patients treated in 2019 (before COVID-19 pandemic) were compared to patients treated in 2020 (during pandemic). Results No significant decline in uro-oncological surgical activity was seen between 2019 and 2020. No significant increase in time between diagnosis and surgery was observed for all considered cancers. No differences in terms of main pathologic features were observed in patients undergoing RARP, TURB, RNU, RN/PN, or orchifunicolectomy. A higher proportion of ISUP grade 3 and 4 PCa were diagnosed in 2020 at biopsy (p = 0.001), but this did not translate into worse pathological grade/stage at RARP. In 2020, more advanced disease features were seen after RC, including lymph node involvement (p = 0.01) and non-organ confined disease (p = 0.02). Conclusion Neither decline in uro-oncologic activity nor delay between diagnosis and treatment was observed at our institution during the first year of COVID-19 pandemic. No significant worsening of cancer disease features was found in 2020 except for muscle-invasive BCa. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03842-y.

Pharmaceuticals are commonly detected at low concentrations in surface waters, where they disrupt biological and ecological processes. Despite their ubiquity, the annual mass of pharmaceuticals exported from watersheds is rarely quantified. We used liquid chromatography-mass spectroscopy to screen for 92 pharmaceuticals in weekly samples from an urban stream network in Baltimore, MD, USA, that lacks wastewater treatment effluents. Across the network, we detected 37 unique compounds, with higher concentrations and more compounds in streams with higher population densities. We also used concentrations and stream discharge to calculate annual pharmaceutical loads at the watershed outlet, which range from less than 1 kg to ∼15 kg and are equivalent to tens of thousands of human doses. By calculating annual watershed mass balances for eight compounds, we show that ∼0.05 to ∼42% of the pharmaceuticals consumed by humans in this watershed are released to surface waters, with the importance of different pathways (leaking sewage vs treated wastewater effluent) differing among compounds. These results demonstrate the importance of developing, maintaining, and improving sewage infrastructure to protect water resources from pharmaceutical contamination.

Poststroke pain (PSP) is a heterogeneous term encompassing both central neuropathic (ie, central poststroke pain [CPSP]) and nonneuropathic poststroke pain (CNNP) syndromes. Central poststroke pain is classically related to damage in the lateral brainstem, posterior thalamus, and parietoinsular areas, whereas the role of white matter connecting these structures is frequently ignored. In addition, the relationship between stroke topography and CNNP is not completely understood. In this study, we address these issues comparing stroke location in a CPSP group of 35 patients with 2 control groups: 27 patients with CNNP and 27 patients with stroke without pain. Brain MRI images were analyzed by 2 complementary approaches: an exploratory analysis using voxel-wise lesion symptom mapping, to detect significant voxels damaged in CPSP across the whole brain, and a hypothesis-driven, region of interest-based analysis, to replicate previously reported sites involved in CPSP. Odds ratio maps were also calculated to demonstrate the risk for CPSP in each damaged voxel. Our exploratory analysis showed that, besides known thalamic and parietoinsular areas, significant voxels carrying a high risk for CPSP were located in the white matter encompassing thalamoinsular connections (one-tailed threshold Z3.96, corrected P value0.05, odds ratio = 39.7). These results show that the interruption of thalamocortical white matter connections is an important component of CPSP, which is in contrast with findings from nonneuropathic PSP and from strokes without pain. These data can aid in the selection of patients at risk to develop CPSP who could be candidates to pre-emptive or therapeutic interventions.

The improvement of the sales system not only focuses on the advantage result of the sales transaction but also can use another parameter to improve it. One of a parameter used is commission. Giving commissions to the salesperson can improve their work performance and have an impact on increasing sales targets. Based on the study literature, the problem faced by the company is the discrepancy of commission. It can be affected by several factors such as the commission system are not integrated with the main system, improper formula, or there are many systems used in the company so it the staff are difficult to integrate the system. For example, the company using Odoo ERP to support sales transaction and use commission information system separately. The salesperson must integrate sales data into both of the systems. It can affect the time delay of decision commission. Based on the problem above, we propose a prototype commission system that integrates with Odoo12. The salesperson does not need to integrate data manually into the system because it automatically integrates into the system. This study uses a prototyping model as a software development method. The results show that the commission system can implement on the Odoo12 ERP to decide commission to the salesperson. 70% of respondent agree that system has able to use in order to setting up commission module on Odoo.

Objectives Peripheral neuropathic pain (pNeP) is prevalent, and current treatments, including drugs and motor cortex repetitive transcranial magnetic stimulation (rTMS) leave a substantial proportion of patients with suboptimal pain relief. Methods We explored the intensity and short-term duration of the analgesic effects produced in pNeP patients by 5 days of neuronavigated deep rTMS targeting the posterior superior insula (PSI) with a double-cone coil in a sham-controlled randomized cross-over trial. Results Thirty-one pNeP patients received induction series of five active or sham consecutive sessions of daily deep-rTMS to the PSI in a randomized sequence, with a washout period of at least 21 days between series. The primary outcome [number of responders (>50% pain intensity reduction from baseline in a numerical rating scale ranging from 0 to 10)] was significantly higher after real (58.1%) compared to sham (19.4%) stimulation (p = 0.002). The number needed to treat was 2.6, and the effect size was 0.97 [95% CI (0.6; 1.3)]. One week after the 5th stimulation day, pain scores were no longer different between groups, and no difference in neuropathic pain characteristics and interference with daily living were present. No major side effects occurred, and milder adverse events (i.e., short-lived headaches after stimulation) were reported in both groups. Blinding was effective, and analgesic effects were not affected by sequence of the stimulation series (active-first or sham-first), age, sex or pain duration of participants. Discussion PSI deep-rTMS was safe in refractory pNeP and was able to provide significant pain intensity reduction after a five-day induction series of treatments. Post-hoc assessment of neuronavigation targeting confirmed deep-rTMS was delivered within the boundaries of the PSI in all participants. Conclusion PSI deep-rTMS provided significant pain relief during 5-day induction sessions compared to sham stimulation.

Background Studies on age differences in emotional states during the COVID-19 pandemic showed that older adults experienced greater emotional wellbeing compared to younger adults. We hypothesized these age differences to be related to the perception of closeness to family/friends or the engagement in daily activities during the pandemic. Aim To investigate age differences in positive and negative emotional experiences and whether the perception of closeness to family/friends and the engagement in daily activities during pandemic explained such age-related differences. Methods Through a cross-sectional study, 1,457 adults aged 18–87 years old completed an online survey assessing positive and negative emotional experiences, the perception of more closeness to family/friends, and daily activities that participants started/re-started during the pandemic. Results Increasing age was associated with more positive and less negative emotional experiences. Age differences in positive emotional experience were explained by the perception of more closeness to friends and not by the engagement in daily activities. For negative emotional experience age, differences remained significant even after accounting for the perception of closeness to family/friends and engagements in daily activities. Discussion Older adults’ greater overall level of positive emotional experience was explained by their greater perception of more closeness to friends. We speculate that social closeness provides a coping mechanism to increase emotional wellbeing employed especially in older adults. Conclusion Our findings reinforce the link between perceived social closeness and emotional wellbeing especially in older adults. To cope with stressful situation, it is important to encourage older adults to increase the closeness to their social network.

Management of symptomatic focal cartilage defects of the hip can be challenging. Cells, scaffold therapies, and injectable agents have emerged as an adjunctive modality to improve clinical outcomes. Long and malleable needles that can be bent are used to release these kinds of biological products. Distance between the tip of the needle and the area to be filled should be minimal to ensure full contact with the chondral lesion to avoid losing material inside the hip cavity and to increase the efficiency of the release of the product. Nevertheless in many cases the accessibility is not easy, and the distance between the tip of the needle and the area to be treated is such that the efficiency of the release is difficult, if not impossible. We aim to describe a simple, inexpensive, and reproducible technique to facilitate the implantation of biologic and injectable materials in hip chondral defects during arthroscopy: the use of a combination of a curette and a needle inside the tip of the curette. Additionally we describe the use of ChondroFiller liquid, a liquid cell-free collagen matrix, for the treatment of symptomatic full-thickness chondral defects of the hip in a 1-step arthroscopic procedure., Technique Video Video 1 The patient lies supine on a traction table with the feet well padded and placed into traction boots. A 70° arthroscope is used to perform a diagnostic arthroscopy. The procedure is begun by establishing standard anterolateral (AL), midanterior (MA), and distal anterolateral (DALA) portals. Evaluation and specific quantification of the size, location, depth, and severity of the chondral lesion is performed. Chondral flaps are debrided to a stable edge using motorized shavers and a 45° curved open arthroscopic rectangular curette to generate a stable, well-defined, and well-contained lesion bordered by healthy cartilage and labrum circumferentially and to completely remove the calcified cartilage layer over the subchondral bone in preparation for the injection. The inflow of irrigation is stopped, and the fluid is extravasated from the hip joint, and the patient is placed in Trendelenburg positioning of 10° to ensure gravity-dependent flow away from the implantation site. Neurosurgery swabs are used during the drying process. At this point ChondroFiller Liquid is inserted into the defect zone with a needle and the aid of a curette to guide it to ensure full contact with the chondral lesion, because the needle alone does not allow easy direct application or implantation. The needle or “delivery portal” is percutaneously created and checked until good position is achieved. This portal must be located just 2 to 3 cm superior and anterior from the “curette portal.” The curette portal is chosen on the basis of the lesion site. Acetabular chondral lesions are usually located anterosuperior, so most of the time the curette portal is the DALA portal. For femoral head lesions the curette portal is again chosen on the basis of the site of the lesion and rotation of the extremity so it can help achieve better access. Once inside the joint thread the needle through the hole/eye of the curette with the bevel facing the femoral head, pass through the curette and then rotate the needle and face the labrum. The curette is used as a guide for the needle to travel around the defect. Pressure, rotation, and small up and medial lateral movements of the curette assist in optimal, consistent, and controlled delivery of the collagen gel into the defect in a drop-wise manner until the defect is filled completely up to the native cartilage level.

Anabolic-androgenic steroids (AASs) are a large group of molecules including endogenously produced androgens, such as testosterone, as well as synthetically manufactured derivatives. AAS use is widespread due to their ability to improve muscle growth for aesthetic purposes and athletes’ performance, minimizing androgenic effects. AAS use is very popular and 1–3% of US inhabitants have been estimated to be AAS users. However, AASs have side effects, involving all organs, tissues and body functions, especially long-term toxicity involving the cardiovascular system and the reproductive system, thereby, their abuse is considered a public health issue. The aim of the proposed review is to highlight the most recent evidence regarding the mechanisms of action of AASs and their unwanted effects on organs and lifestyle, as well as suggesting that AAS misuse and abuse lead to adverse effects in all body tissues and organs. Oxidative stress, apoptosis, and protein synthesis alteration are common mechanisms involved in AAS-related damage in the whole body. The cardiovascular system and the reproductive system are the most frequently involved apparatuses. Epidemiology as well as the molecular and pathological mechanisms involved in the neuropsychiatric side-effects of AAS abuse are still unclear, further research is needed in this field. In addition, diagnostically reliable tests for AAS abuse should be standardized. In this regard, to prevent the use of AASs, public health measures in all settings are crucial. These measures consist of improved knowledge among healthcare workers, proper doping screening tests, educational interventions, and updated legislation.

Acute Lymphoblastic Leukemia (ALL) is a type of leukemia that is related to a large number of lymphoblast cells in the peripheral blood and bone marrow. The initial step in diagnosing the disease is an individual immature White Blood Cells (WBC) assessment by the hematologists. Visual interpretation and detection of immature WBC is a time-consuming and burdensome task for hematologists. The reliable and confident examination of the ALL blood specimen relies on a valid classification of lymphoblast cells. In this paper, we proposed two-stages Artificial Neural Networks integrated with the Particle Swarm Optimization method to classify the immature WBC in ALL patients. The proposed method includes binary classification of lymphoid cells in the first stages and binary classification of lymphoblast cells in the second stages. In this study, we have used five peripheral blood specimen samples obtained from Sardjito Hospital ALL dataset to develop the proposed model. The proposed model consists of data preprocessing, features selection, features extraction, and two-stage classification. The performance of our approach is compared with the common backpropagation neural networks classification (multiclass NN-BP) and multiclass neural networks particle swarm optimization (multiclass NN-PSO). The results show that the proposed method has better accuracy than other compared models with 86.92% accuracy and should be developed and applied in other cases.

The aim of this paper is to analyze the roles and profiles of military leaders required in the context of the Brazilian Army's peacekeeping mission in Haiti. Qualitative research is conducted in the context of the "United Nations Stabilization Mission in Haiti", from interviews with leaders of the Brazilian Army. The results reveal that the investigated context requires a relational and people-oriented leadership profile, including sensitive to emotional aspects, as well as leaders capable of recovering of collective. Therefore, the leadership authority derives more from the ability of social interaction than from the formal power.

The science and technology application activities are planned to be carried out with the partner of the women farmer group located in Kediri Village, Karanglewas District. The problems faced by partners are not having adequate knowledge about natural pest management and the correct use of organic fertilizers; do not have skills in making and using vegetable pesticides, liquid organic fertilizers, and proper organic vegetable cultivation techniques. The purpose of applying science and technology is to provide knowledge about the functions and ways of using vegetable pesticides and liquid organic fertilizers, improving skills in making and using vegetable pesticides, POC, technical complete package of organic vegetable cultivation. Methods for achieving the goal are socialization and learning by doing, which are complemented by guiding and piloting techniques. The output of the service activities is in the form of articles in dedication journals, and articles on appropriate technology (TTG).

Public service is one of the most important things to ensure the goal of creating good government in a work arrangement between all components. One of the most important parts in an institution is often measured by the community through the success or failure of an event that is held and every event or event held must have infrastructure or infrastructure and facilities that are sufficiently supportive or qualified, currently at the West Jakarta Youth and Sports Office. still managing infrastructure and facilities data manually, this is what results in infrastructure management being less effective and efficient, for that by making the design of the Infrastructure and Facilities Management system is an effective way of managing infrastructure to be stored in the database This system is designed using the prototype method. This system can search for data on complaints about existing problems in infrastructure to be faster and can present data to be effective and efficient because it is website-based.

Coronary computed tomographic angiography (CTA) is a non-invasive procedure that makes it very convenient to imagine the anatomical ability to remove coronary artery disease in patients with chest pain in a population at low to moderate risk. For plaque identification and physiological assessment, coronary CTA may be used, facilitating thorough diagnostic and prognostic assessment of primary prevention in patients. Overall plaque load is assessed by the coronary CTA, plaque subtypes are distinguished and high-risk plaque is identified. The purpose of this article is to review existing applications and practices related to the use of automatic techniques in coronary CTA analysis and interpretation.

This article addresses a topic that has rarely been addressed in the available scientific literature, according to our knowledge. It comprehensively defines citizens’ trust in the services, identifies the factors influencing this type of trust, and proposes a model for establishing and maintaining holistic trust. The research described in the article is based on the analysed publicly available literature in the field of trust (in general and specific types of trust) and intelligence services, while offering its definition of trust (in general) and holistic trust.

The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, is creating an unprecedented global public health emergency with the continuous growth of infected individuals worldwide. Italy was one of the first European country to face the first wave of infection outside mainland China. The first case of COVID-19 was confirmed in Lombardy on February 20th , 2020, and subsequently, a rapid increase in the number of detected cases was observed, spreading through Italy and the rest of Europe.3 As of April 22nd , confirmed COVID-19 cases in Italy were 183,957.

Both GRACE and GOCE have proven to be very successful missions, providing a wealth of data which are exploited for geophysical studies such as climate changes, hydrology, sea level changes, solid Earth phenomena, with benefits for society and the whole world population. It is indispensable to continue monitoring gravity and its changes from space, so much so that a GRACE follow-on mission has been launched in 2018. In this paper, a new satellite mission concept named MOCASS is presented, which can be considered as a GOCE follow-on, based on an innovative gradiometer exploiting ultra-cold atom technology and aimed at monitoring Earth mass distribution and its variations in time. The technical aspects regarding the payload will be described, illustrating the measurement principle and the technological characteristics of a cold atom interferometer that can measure gravity gradients. The results of numerical simulations will be presented for a one-arm and a two-arm gradiometer and for different orbit configurations, showing that an improvement with respect to GOCE could be obtained in the estimate of the static gravity field over all the harmonic spectrum (with an expected error of the order of 1 mGal at degree 300 for a 5-year mission) and that estimates are promising also for the time-variable gravity field (although GRACE is still performing better at very low degrees). Finally, the progress achievable by exploiting MOCASS observations for the detection and monitoring of geophysical phenomena will be discussed: the results of simulations of key geophysical themes (such as mass changes due to hydrology, glaciers and tectonic effects) with expected gravity change-rates, time constants and corresponding wavelengths, show that an improvement is attainable and that signals invisible to past satellites could be detected by exploiting the cold atom technology.

This study aims to comprehend: 1) the obstacles confronted by high school students in East Java in implementing study from home; 2) Readiness of learning facilities for high school students in East Java in undertaking study from home; 3) The platform or application used for the implementation of study from home for high school students in East Java; 4) The advantages and disadvantages of implementing study from home for high school students in East Java. This study uses a descriptive method with a quantitative approach. In addition, primary data was obtained by using a questionnaire with google form in 354 student respondents from East Java. The result of this research was found that the biggest obstacles confronted by students in implementing study from home 46.3% were limited availability of internet access; 24.6% signal difficulty; 11.3% there are differences in the learning platforms used by each teacher. The level of readiness of students to confront study from home showed that 88.4% of students were ready because their cellphones or devices had supported the online learning. Platforms used for students in East Java to access online learning are: Whatsapp Group 70.6%;Zoom 5.1% and Google Classroom 4%. The advantages of implementing study from home are time efficiency, more diverse learning materials, flexible places to study, while the disadvantage of implementing study from home is that the technology used in learning is difficult and ineffective in teaching and learning activities. Keywords: Online learning; Students perception; Covid-19 pandemic

This study aims to put forward some considerations on the Common National Curriculum Base (CNCB) and the Teaching and Learning of Environmental Education (EE) in the field of Professional and Technological Education (PTE). It is a documental study, which involves the analysis of the existing policy texts that regulate EE and the insertion of it in the CNCB, with emphasis on technical and technological education. The CNCB, in terms of High School education, gives autonomy to teaching networks and schools. Young people may choose technical-professional training, within the regular academic workload. It was observed that, in the CNCB, EE is considered an "integrating theme", prevailing in it the division into subjects, with possible reinsertion conditioned to the autonomy of schools. In this context, the CNCB has limitations that should be recognized considering it as a public policy that aims to attend to the interests of all citizens. In technical and technological education there have been efforts to integrate environmental education in many activities and the opportunity to acquire knowledge, however, the great challenge is to develop environmental education and at the same time integrate it with as many subjects as possible, taking into account that the current educational system still reproduces the traditional teaching methodology. For that, thinking about changing this reality, EE should be seen as a way of contribution, so that trained technicians would be, besides good professionals, critical citizens, and aware of their roles.

Sierra Leone is one of the least developed low-income countries (LICs), slowly recovering from the effects of a devastating civil war and an Ebola outbreak. The health care system is characterized by chronic shortage of skilled human resources, equipment, and essential medicines. The referral system is weak and vulnerable, with 75% of the country having insufficient access to essential health care. Consequently, Sierra Leone has the highest maternal and child mortality rates in the world. This manuscript describes the implementation of a National Emergency Medical Service (NEMS), a project aiming to create the first prehospital emergency medical system in the country. In 2017, a joint venture of Doctors with Africa (CUAMM), Veneto Region, and Research Center in Emergency and Disaster Medicine (CRIMEDIM) was developed to support the Ministry of Health and Sanitation (MOHS) in designing and managing the NEMS system, one of the very few structured, fully equipped, and free-of-charge prehospital service in the African continent. The NEMS design was the result of an in-depth research phase that included a preliminary assessment, literature review, and consultations with key stakeholders and managers of similar systems in other African countries. From May 27, 2019, after a timeframe of six months in which all the districts have been progressively trained and made operational, the NEMS became operative at national level. By the end of March 2020, the NEMS operation center (OC) and the 81 ambulances dispatched on the ground handled a total number of 36,814 emergency calls, 35,493 missions, and 31,036 referrals.

Fusiform intracranial aneurysms (FIA) are associated with significant morbidity and mortality. We carried out a systematic review and meta-analysis of individual participant data with propensity score adjustment to compare the functional and angiographic outcomes between surgical and endovascular approaches to FIA. We conducted a systematic review for articles on the treatment of FIA with individual patient-level detailing. Data from patients treated for FIA in our institution from 2010 to 2018 were also collected. The primary studied outcome was morbidity, and secondary outcomes were angiographic results and retreatment. Propensity score–adjusted mixed-effects logistic regression models evaluated treatment options, stratified by anatomical location. Compiling original and published data, there were 312 cases, of which 79 (25.3%) had open surgery, and 233 (74.5%) were treated with endovascular procedures. There were no differences between treatment groups, for neither cavernous ICA (OR 1.04, 95% CI 0.05–23.6) nor supraclinoid aneurysms (OR 7.82, 95% CI 0.65–94.4). Both size (OR 1.11, 95% CI 1.03–1.19) and initial mRS (OR 2.0, 95% CI 1.2–3.3) were risk factors for morbidity, independent of location. Neither age nor rupture status influenced the odds of posterior morbidity. Unfavorable angiographic outcomes were more common in the endovascular group for supraclinoid and vertebrobasilar aneurysms (χ2, P

OBJECTIVE Multiple intracranial aneurysms (MIA) account for 30% of all intracranial aneurysms, while mirror aneurysms, a subgroup of MIA, are present in 5% of all patients with cerebral aneurysms. We investigated the risk factors associated with the presence of multiple and mirror intracranial aneurysms. METHODS 1404 patients, 314 males (22.4%) and 1090 female (77.6%) were enrolled for this study. Diagnosis was performed with a digital subtraction angiography (DSA). Multiplicity was defined as the presence of two or more aneurysms and mirror aneurysms as one pair of aneurysms involving bilateral corresponding arteries. Patients were followed-up from September 2009 till August 2018. Individuals' characteristics such as sex, age, smoking, hypertension and use of contraceptives were evaluated. RESULTS Five hundred and twelve patients (36.4%) were diagnosed with MIA, approximately 4%/year. We observed 203 pairs of mirror aneurysms, accounting for 406 aneurysms (13% of the population). There was an increased frequency of females with multiple (p 25 mm) were most found in patients with only one aneurysm (p

Pancreatic injury following blunt trauma abdomen is presentation with significant morbidity and mortality. Our first case here is the American Association for the Surgery of Trauma Organ Injury Scale (AAST-OIS) Grade V pancreaticoduodenal injuries following penetrating injury managed with pancreaticoduodenectomy and the second case is blunt trauma to the abdomen with pancreatic tail transection which is American Association for the Surgery of Trauma Organ Injury Scale (AAST-OIS) Grade III that was managed with Endoscopic Retrograde Cholangiopancreaticography (ERCP) and pancreatic duct stenting. The outcome depends on early diagnosis and needs a high index of suspicion due to subtle clinical and radiological findings initially. Hemodynamically unstable patients may have other associated visceral and vascular injuries, and damage control strategy will be a suitable option. Same sitting resection procedures like pancreaticoduodenectomy are rarely performed. Pancreatic injuries can often be managed non-operatively with percutaneous drainage and pancreatic duct stenting.

An adequate calcium and vitamin D intake may play a role in preventing osteoporosis, but the contribution of the different food sources of calcium with regards to the risk of osteoporosis been barely explored. This observational study evaluated the calcium intake through a food frequency questionnaire in 126 adult women with not previously diagnosed osteoporosis undergoing Dual-energy X-ray Absorptiometry (DXA) to screen for osteoporosis, and to correlate the calcium intake with parameters of bone density, measured by DXA. Total daily calcium intake and daily intake from food were similar among women found to have osteoporosis, osteopenia or normal condition. The main food source was milk and dairy products, while calcium supplementation was consumed by only 14% of subjects, irrespectively from osteoporosis conditions. DXA parameters were not significantly correlated with total daily calcium intake and calcium from food. The present study highlighted no qualitative and quantitative differences in the consumption of food groups contributing to calcium intakes in women with and without osteoporosis.

Objective:The present study aimed at surveying the nutritional quality of prepacked biscuits and sweet snacks sold on the Italian market, and at identifying whether the product type and other information reported on the pack could discriminate the overall quality of products analysed.Design:Data on energy, nutrient and salt content of the products from two different categories of prepacked sweet cereal products (i.e. biscuits and sweet snacks) were collected from thirteen retailers present on the Italian market. Based on the product type, nutrition and health claim (NHC) and gluten-free (GF) declaration, a comparison of nutrient profile within each category was performed.Setting:This work is part of the Food Labelling of Italian Products (FLIP) study that aims at systematically investigating the overall quality of the prepacked foods sold on the Italian market.Results:A total of 1290 products were analysed (63 % biscuits and 37 % sweet snacks). After comparing different product types within each category, a high intra-type product variability was evidenced, which was more pronounced for biscuits. Overall, NHC-carrying products seemed to have a better nutrition profile than those without claims, except for salt content. Conversely, a comparison between GF and gluten-containing products did not show consistent results within the two categories analysed.Conclusions:Due to the high intra-type variability within each category, the different characteristics and regulated information reported on the pack do not seem to be a clear marker of the overall nutritional quality of biscuits and snacks.

Background In patellofemoral replacement (PFR) coronal alignment is mostly influenced by local condylar anatomy. However, there is still a lack of consensus regarding references to follow intraoperatively for the optimal positioning of the trochlear component. The aim of this study was to assess whether aiming for the anatomical femoral axis on the coronal plane leads to improved clinical outcomes and whether coronal alignment correlates with clinical outcomes. Methods Forty-two patients who underwent PFR were retrospectively evaluated at a minimum one-year follow-up using Kujala and Knee Society Score (KSS). Moreover, patients underwent an anteroposterior hip-to-knee X-ray to evaluate the coronal alignment of the trochlear component with respect to the femoral anatomic and mechanical axis. Prosthesis coronal alignment, Kujala, and KSS were assessed for possible correlation. Results Mean follow-up time: 29.1 months. Mean KSS for pain: 90 (± 8.9), for function: 93.7 (± 15.9); mean Kujala: 89.2 (± 13.6). Mean prosthesis coronal alignment was 3.3 ± 2.3° in valgus with respect to the femoral anatomic axis and 7.4 ± 2.6° in valgus with respect to the femoral mechanical axis. No correlations were found between coronal alignment and KSS or Kujala scores. Conclusions Results from the current study showed that PF replacement with a third-generation implant led to good-to-excellent outcomes. In addition, the surgical technique used for aligning femoral component in this study resulted in reduced coronal alignment variability and achieved good short-term clinical outcomes.

Background & aims The effect of pasta consumption within a low-energy Mediterranean diet on body weight regulation has been scarcely explored. This paper investigates the effect of two Mediterranean diets, which differed for lower or higher pasta intake, on body weight change in individuals with obesity. Methods & Results Forty-nine volunteers finished a quasi-experimental 6-month two–parallel group dietary intervention. Participants were assigned to a low-energy high pasta (HP) or to a low-energy low Pasta (LP) group on the basis of their pasta intake (HP ≥ 5 or LP ≤ 3 times/week). Anthropometrics, blood pressure and heart rate were measured every month. Weight maintenance was checked at month 12. Body composition (bioelectrical impedance analysis, BIA), food intake (24-h recall plus a 7-day carbohydrate record) and the perceived quality of life (36-item short-form health survey, SF-36) were assessed at baseline, 3 and 6 months. Blood samples were collected at baseline and month 6 to assess glucose and lipid metabolism. After 6-month intervention, body weight reduction was −10 ± 8% and −7 ± 4% in HP and LP diet, respectively, and it remained similar at month 12. Both dietary interventions improved anthropometric parameters, body composition, glucose and lipid metabolism, but no significant differences were observed between treatment groups. No differences were observed for blood pressure and heart rate between treatments and among times. HP diet significantly improved perception of quality of life for the physical component. Conclusions Independent of pasta consumption frequency, low-energy Mediterranean diets were successful in improving anthropometrics, physiological parameters and dietary habits after a 6-month weight-loss intervention. This trial was registered at clinicaltrials.gov as NCT03341650.

Problems in communication may happen not only with EFL learners but also with EFL teachers. Those problems happen wherefore the teachers inadequate of communicative competence. When teachers face difficulties in finishing their communication, and they initiate to use such gesture, pausing their words in making their communication run smoothly, it means they use communicative strategies. This study aimed to find out the types of CSs used by the English teacher during the teaching process at the Aviation class and to describe CSs which are dominantly used by the English teacher. By implementing Celce-Murcia’s taxonomy, the data was classified into five strategies and eleven sub-strategies. A qualitative research was used as the method in this study and the data was collected by doing observation and video recording the teacher in Cruise ship and Aviation Course, Central Java. The result showed that five strategies were used by the English teacher included eleven sub-type strategies that appeared during teaching process. Based on the result, Filler ( 32,8%) was the highest number of strategies used by the teacher in the classroom. Meanwhile the least number of strategies used was retrieval (0,9%) and clarification request (0,9%). Thus, by conducting this study, the teacher was expected to use the best strategies to solve the communication problems during teaching and learning process.

Objective:The aim of this study was to assess the validity and reliability of a self-administered nutrition knowledge (NK) questionnaire for Italian university students.Design:The NK questionnaire included ninety questions on experts’ nutritional recommendations, nutritional content of food, health aspects of food and diets, relationship between diet and diseases, and proper food choices. It was administered to the same population under the same conditions on two different occasions with a time interval of 3 weeks between the two administrations.Setting:The survey was carried out at the University of Parma (Italy) during the 2018–2019 academic year.Participants:Data were collected for 132 bachelor and master degree students attending the University of Parma, either attending or not nutrition classes during their studies (19–30 years, 29·5 % males, 57·6 % with an academic nutrition background).Results:The questionnaire revealed high overall internal consistency reliability (Cronbach’s α > 0·8) and a good temporal stability with high correlation of the total score (r = 0·835, P < 0·001). Moreover, it showed a good ability to discriminate between subjects with potentially different NK.Conclusions:This NK questionnaire proved to be a reliable, valid and easy-to-use tool for assessing the NK of Italian university students, either with or without nutrition background.

The diagnostic reference level (DRL) is a useful tool for the optimisation of medical exposures. Thus, a Working Party coordinated by the Italian National Institute of Health and the National Workers Compensation Authority has been formed to provide Italian DRLs, for both diagnostic and interventional procedures, to be used as appropriate for the implementation of the 2013/59 European Directive into the national regulation. The multidisciplinary Working Party was formed by professionals involved in diagnostic and interventional radiology medical exposures and started from a critical revision of both the literature and the results of previous Italian surveys. The procedures were divided into five sections for adult (projection radiography, mammography, diagnostic fluoroscopy, CT and interventional radiology) and two sections for paediatric patients (projection radiography and CT). The provided DRL values have been identified for “normal” adult patients and for age-classes of paediatric patients. Some of the DRL values provided by the Working Party are reported in this study as an example, divided by adult/paediatric patients, radiological technique and examination: specifically, DRLs for new radiological practices and new dose quantities as DRLs metric were introduced. The median value (rather than the mean) for each procedure, derived from a sample of patients, has to be compared with the corresponding DRL value, and dosimetric data related to a minimum number of patients should be collected for each examination. The approach to the definition and use of DRLs through guidelines of national Authorities in collaboration with scientific Associations should simplify the periodical updating and could be useful for keeping the optimisation of medical exposures faithful to the development of radiological practice.

Intisari— Menghadapi persaingan industri yang semakin ketat, perusahaan penghasil produk kemasan plastik berusaha meningkatkan daya saingnya dengan meningkatkan performansinya. Performansi perusahaan penghasil produk kemasan plastik dalam hal peningkatan value ke customer dapat diukur melalui key performance indicators bagian quality assurance. Pencapaian key performance indicators quality assurance perlu dibuat sebuah model yang tepat untuk meningkatkan key performance indicators quality assurance melalui pendekatan lean manufacturing Penelitian ini bertujuan untuk merancang model lean manufacturing untuk meningkatkan key performance indicators quality assurance. Tahapan awal dimulai dari studi literatur lean manufacturing tools dan survei ke berbagai perusahaan kemasan plastik sehingga diperoleh data yang dibutuhkan dalam rancangan model. Rancangan model harus dilakukan validasi pada perusahaan penghasil produk kemasan plastik. Setiap model memberikan manfaat dan dapat digunakan untuk memecahkan masalah mengenai tidak tercapainya key performance indicators quality assurance. Hasil rancangan model terdiri dari sub model 1 (current key performance indicators quality assurance), sub model 2 (current defect customer complaint), sub model 3 (lean manufacturing tools ) dan sub model 4 (future total complaint, future reject retur, future repeat issue, future resolution time dan future key performance indicators quality assurance). Diharapkan rancangan model lean manufacturing dapat menjadi solusi bagi perusahaan penghasil produk kemasan plastik untuk meningkatkan key performance indicators quality assurance.Abstract— Facing increasingly fierce industry competition, companies that produce plastic packaging products try to improve their competitiveness by increasing their performance. The performance of companies producing plastic packaging products in terms of increasing value to customers can be measured through the key performance indicators of the quality assurance section. Achievement of key performance indicators of quality assurance needs to be made an appropriate model to improve key performance indicators of quality assurance through a lean manufacturing approach. This study aims to design a lean manufacturing model to achieve key performance indicators of quality assurance. The initial stage starts from the study of lean manufacturing tools literature and surveys to various plastic packaging companies in order to obtain the data needed in the design of the model. The design of the model must be validated at the companies producing plastic packaging products. Each model provides benefits and can be used to solve problems regarding not achieving key performance indicators of quality assurance. The results of the model design consist of sub model 1 (current key performance indicators quality assurance), sub model 2 (current defect customer complaints), sub model 3 (lean manufacturing tools) and sub model 4 (future total complaints, future reject returns, future repeat issue, future resolution time and future key performance indicators quality assurance). It is hoped that the design of lean manufacturing models can be a solution for companies producing plastic packaging products to achieve key performance indicators of quality assurance.

Background The susceptibility of patients with chronic plaque psoriasis and the risks or benefits related to the use of biological therapies for COVID-19 are unknown. Few data about prevalence, clinical course and outcomes of COVID-19 among psoriatic patients were reported. The aims of this study were 1) to assess the prevalence and severity of COVID-19 in psoriatic patients treated with biologic agents during the first phase of the emergency (22 February to 22 April 2020) in Italy, and 2) to report the clinical outcomes of patients who have been exposed to individuals with confirmed SARS-CoV-2 infection. Methods Patients with moderate-to-severe chronic plaque psoriasis, aged ≥18 years and undergoing treatment with biologic agents as of 22 February 2020, were eligible to be included in PSO-BIO-COVID study. Demographic and clinical characteristics of patients using any biologic for psoriasis treatment between 22 February and 22 April 2020 were registered. For all confirmed or suspected cases of COVID-19, data about concomitant disease, ongoing therapies, and comorbidities were also reported. Results A total of 12,807 psoriatic patients were included in the PSO-BIO-COVID study. In this cohort twenty-six patients (0.2%) had a swab confirmation of SARS-CoV-2 infection. Eleven patients required hospitalization and two died. 125 of 12807 patients (1.0%) with exposure to a patient with COVID-19 under quarantine or active health surveillance, were reported. Conclusion The incidence of COVID-19 observed in our cohort of psoriatic patients (0.2%) is similar to that seen in the general population (0.31%) in Italy. However, the course of the disease was mild in most patients. Biological therapies may likely lessen "cytokine storm" of COVID-19, which sometimes lead to multiple organ failure, ARDS, and death.

Introduction: Smart drugs are among the most common drugs used by students. It is estimated that they are second in incidence after cannabis. Although they are usually used for diseases such as attention deficit hyperactivity disorder (ADHD) and dementia, in most cases the use of smart drugs is illegal and without a prescription. Methodological issues: A systematic review was conducted according to PRISMA guidelines. SCOPUS, Medline (using PubMed as a search engine), Embase, Web of Sciences, and Google Scholar were used as search engines from January 1, 1980 to June 1, 2021 to evaluate the association between smart drugs and neuro-enhancement. A total of 4715 articles were collected. Of these, 295 duplicates were removed. A total of 4380 articles did not meet the inclusion criteria. In conclusion, 48 articles were included in the present systematic review. Results: Most of the studies were survey studies, 1 was a prospective longitudinal study, 1 was a cross-over study, and 1 was an experimental study in an animal model (rats). The largest group of consumers was school or university students. The most frequent reasons for using smart drugs were: better concentration, neuro enhancement, stress reduction, time optimization, increased wake time, increased free time, and curiosity. There are conflicting opinions, in fact, regarding their actual functioning and benefit, it is not known whether the benefits reported by consumers are due to the drugs, the placebo effect or a combination of these. The real prevalence is underestimated: it is important that the scientific community focus on this issue with further studies on animal models to validate their efficacy.

Evacuation planning and management represents a key aspect of volcanic crises because it can increase people protection as well as minimize the potential impact on the economy, properties, and infrastructure of the affected area. Assessment of evacuation scenarios that consider human and economic impact is best done in a pre-disaster context as it helps authorities develop evacuation plans and make informed decisions outside the highly stressful time period that characterizes crises. We present an agent-based simulation tool that assesses the effectiveness of different evacuation scenarios using Vulcano island (Italy) as a case study. Simulation results show that the overall time needed to evacuate people should be analysed together with the percentage of people evacuated as a function of time and that a simultaneous evacuation on Vulcano is more efficient than a staged evacuation. We also present a model to assess the economic impact of evacuation as a function of evacuation duration and starting period that reveals that an evacuation of Vulcano would cause significant economic impact to the tourism industry if lasting more than 3 months (in case it was initiated at the beginning of the visitor season) to 1 year (in case it was initiated at the end of the visitor season).

The COVID 19 disease is frequently associated with significant disability related to intensive care unit-acquired weakness, decontitioning, myopathies and neuropathies. However there are no data on the results of a specific rehabilitative treatment in this group of patients. The aim of our work was to evaluate the effectiveness f a personalized rehabilitative therapy in group of post-COVID patients (A, 47 patients, average age 65.3±11.6 y, 27 M,) comparing the results with a group of post-cardiosurgical patients COVID 19 negative (B, 47 patients, average age 63.5±10.3 y, 29 M) evaluating the degree of clinical complexity (Rehabilitation Complexity Scale, RCS-E V13) and the degree of autonomy recovery (Six-minute walking test SMWT, Barthel Index, BI) pre and post-treatment. In Group A patients the Rehabilitation program is associated with a significant improvement in autonomy recovery (BI admission 29.7±20 vs discharge 72.7±28.6 p At admission the comparison between Group A vs B has show: 1. a reduced pre-rehabilitation hospital stay (days) in Group Vs A (B 8.2±2 vs 31±5 0.005) 2. a similar degrre of clinical complexity (RCS scale A 10.9±1.1 vs 1.6±11.2 p ns) 3. a greater loss autonomy in post-COVID patients (BI scale A 29.7±20 vs B 47.7±19, p 0.05; SMWT A 145±25 m vs B 255±18 m, p 0.05) After a similar period of rehabilitation (A 29.7±12.8 days vs B 29.6±10 days, p ns) we observed in both Groups: 1. a reduction of clinical complexity ((RCS scale A 5.3±2 vs 6.6±2 p ns 2. an improvement of degree of autonomy recovery ((BI scale A 72.7±28 vs B 47.7±19, p ns; SMWT A 385±18 m vs B 410±25m, p ns) Conclusions Post-COVID patients show a greater loss of autonomy than post-cardiosurgery patients. Rehabilitative treatment has proven effective in ensuring adequate functional recovery with similar results to those obtained in the population of cardiological subjects COVID 19 negative. Funding Acknowledgement Type of funding sources: None.

Background and Objectives: Androgens play a significant role in the development of male reproductive organs. The clinical use of synthetic testosterone derivatives, such as nandrolone, is focused on maximizing the anabolic effects and minimizing the androgenic ones. Class II anabolic androgenic steroids (AAS), including nandrolone, are rapidly becoming a widespread group of drugs used both clinically and illicitly. The illicit use of AAS is diffused among adolescent and bodybuilders because of their anabolic proprieties and their capacity to increase tolerance to exercise. This systematic review aims to focus on side effects related to illicit AAS abuse, evaluating the scientific literature in order to underline the most frequent side effects on AAS abusers’ bodies. Materials and Methods: A systematic review of the scientific literature was performed using the PubMed database and the keywords “nandrolone decanoate”. The inclusion criteria for articles or abstracts were English language and the presence of the following words: “abuse” or “adverse effects”. After applying the exclusion and inclusion criteria, from a total of 766 articles, only 148 were considered eligible for the study. Results: The most reported adverse effects (found in more than 5% of the studies) were endocrine effects (18 studies, 42%), such as virilization, gynecomastia, hormonal disorders, dyslipidemia, genital alterations, and infertility; cardiovascular dysfunctions (six studies, 14%) such as vascular damage, coagulation disorders, and arteriosus hypertension; skin disorders (five studies, 12%) such as pricking, acne, and skin spots; psychiatric and mood disorders (four studies, 9%) such as aggressiveness, sleep disorders and anxiety; musculoskeletal disorders (two studies, 5%), excretory disorders (two studies, 5%), and gastrointestinal disorders (two studies, 5%). Conclusions: Based on the result of our study, the most common adverse effects secondary to the abuse of nandrolone decanoate (ND) involve the endocrine, cardiovascular, skin, and psychiatric systems. These data could prove useful to healthcare professionals in both sports and clinical settings.

Background and objectives: Anabolic-androgenic steroids (AASs) are a group of synthetic molecules derived from testosterone and its related precursors. AASs are widely used illicitly by adolescents and athletes, especially by bodybuilders, both for aesthetic uses and as performance enhancers to increase muscle growth and lean body mass. When used illicitly they can damage health and cause disorders affecting several functions. Sudden cardiac death (SCD) is the most common medical cause of death in athletes. SCD in athletes has also been associated with the use of performance-enhancing drugs. This review aimed to focus on deaths related to AAS abuse to investigate the cardiac pathophysiological mechanism that underlies this type of death, which still needs to be fully investigated. Materials and Methods: This review was conducted using PubMed Central and Google Scholar databases, until 21 July 2020, using the following key terms: “((Sudden cardiac death) OR (Sudden death)) AND ((androgenic anabolic steroid) OR (androgenic anabolic steroids) OR (anabolic-androgenic steroids) OR (anabolic-androgenic steroid))”. Thirteen articles met the inclusion and exclusion criteria, for a total of 33 reported cases. Results: Of the 33 cases, 31 (93.9%) were males while only 2 (61%) were females. Mean age was 29.79 and, among sportsmen, the most represented sports activity was bodybuilding. In all cases there was a history of AAS abuse or a physical phenotype suggesting AAS use; the total usage period was unspecified in most cases. In 24 cases the results of the toxicological analysis were reported. The most detected AASs were nandrolone, testosterone, and stanozolol. The most frequently reported macroscopic alterations were cardiomegaly and left ventricular hypertrophy, while the histological alterations were foci of fibrosis and necrosis of the myocardial tissue. Conclusions: Four principal mechanisms responsible for SCD have been proposed in AAS abusers: the atherogenic model, the thrombosis model, the model of vasospasm induced by the release of nitric oxide, and the direct myocardial injury model. Hypertrophy, fibrosis, and necrosis represent a substrate for arrhythmias, especially when combined with exercise. Indeed, AAS use has been shown to change physiological cardiac remodeling of athletes to pathophysiological cardiac hypertrophy with an increased risk of life-threatening arrhythmias.