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The COVID-19 pandemic and the related emergency have contributed to the push for innovative solutions applied to health care. In particular, robotics has shown huge potential for contributing to pandemic relief efforts and improving people's quality of life in several scenarios. In this article, a robotic system, characterized by interaction capabilities and autonomous navigation, is developed to be used in a COVID-19 health-care treatment center for logistics and disinfection purposes. The article describes the two-month use of the platform in the University Hospital Campus Bio-Medico (UCBM) COVID-19 treatment center in Rome, Italy, and presents experimental results for the robot's navigation capabilities in unstructured environments and collaborative activities with health-care operators in the clinical setting.

ObjectivePostacute COVID-19 syndrome (PACS) is an emerging entity characterised by a large array of manifestations, including musculoskeletal complaints, fatigue and cognitive or sleep disturbances. Since similar symptoms are present also in patients with fibromyalgia (FM), we decided to perform a web-based cross-sectional survey aimed at investigating the prevalence and predictors of FM in patients who recovered from COVID-19.MethodsData were anonymously collected between 5 and 18 April 2021. The collection form consisted of 28 questions gathering demographic information, features and duration of acute COVID-19, comorbid diseases, and other individual’s attributes such as height and weight. The American College of Rheumatology (ACR) Survey Criteria and the Italian version of the Fibromyalgia Impact Questionnaire completed the survey.ResultsA final sample of 616 individuals (77.4% women) filled the form 6±3 months after the COVID-19 diagnosis. Of these, 189 (30.7%) satisfied the ACR survey criteria for FM (56.6% women). A multivariate logistic regression model including demographic and clinical factors showed that male gender (OR: 9.95, 95% CI 6.02 to 16.43, pConclusionOur data suggest that clinical features of FM are common in patients who recovered from COVID-19 and that obesity and male gender affect the risk of developing post-COVID-19 FM.

Hepatic portal venous gas and pneumobilia (PB) are uncommon findings, indicating the accumulation of gas in the portal vein and its branches and in the biliary tree, respectively. Aims of this retrospective, descriptive study were to describe the computed tomographic (CT) features and visualization techniques of hepatic portal venous gas (HPVG) and PB in a group of small animal veterinary patients. The CT data of patients with HPVG and PB were retrospectively reviewed. Thin-section multiplanar reformatting and minimum intensity projection (MinIP) views were used to assess the acquired volume dataset. The CT features recorded were as follows: amount, aspect, distribution, and localization of the gas in the liver. Five patients were included (four dogs and one cat), two presenting HPVG and three with PB. Gas in HPVG presented a peripheral location, whereas in PB was characterized by a central location. The aspect of the gas was tubular in case of HPVG and mixed tubular and rounded in PB. An analogous number of animals between the two groups showed comparable amount (mild, moderate, and severe) and distribution (diffuse and focal). Thin-section CT can detect the presence of gas in the liver, and a combination of two-dimensional and thin-slab MinIP can differentiate between HPVG and PB in dogs and cats. The distinctive features are peripheral versus central location and tubular versus rounded aspect of the gas.

OBJECTIVECentral poststroke neuropathic pain is a debilitating syndrome that is often resistant to medical therapies. Surgical measures include motor cortex stimulation and deep brain stimulation (DBS), which have been used to relieve pain. The aim of this study was to retrospectively assess the safety and long-term efficacy of DBS of the posterior limb of the internal capsule for relieving central poststroke neuropathic pain and associated spasticity affecting the lower limb.METHODSClinical and surgical data were retrospectively collected and analyzed in all patients who had undergone DBS of the posterior limb of the internal capsule to address central poststroke neuropathic pain refractory to conservative measures. In addition, long-term pain intensity and level of satisfaction gained from stimulation were assessed. Pain was evaluated using the visual analog scale (VAS). Information on gait improvement was obtained from medical records, neurological examination, and interview.RESULTSFour patients have undergone the procedure since 2001. No mortality or morbidity related to the surgery was recorded. In three patients, stimulation of the posterior limb of the internal capsule resulted in long-term pain relief; in a fourth patient, the procedure failed to produce any long-lasting positive effect. Two patients obtained a reduction in spasticity and improved motor capability. Before surgery, the mean VAS score was 9 (range 8–10). In the immediate postoperative period and within 1 week after the DBS system had been turned on, the mean VAS score was significantly lower at a mean of 3 (range 0–6). After a mean follow-up of 5.88 years, the mean VAS score was still reduced at 5.5 (range 3–8). The mean percentage of long-term pain reduction was 38.13%.CONCLUSIONSThis series suggests that stimulation of the posterior limb of the internal capsule is safe and effective in treating patients with chronic neuropathic pain affecting the lower limb. The procedure may be a more targeted treatment method than motor cortex stimulation or other neuromodulation techniques in the subset of patients whose pain and spasticity are referred to the lower limbs.

Background Incidental radiographic findings, such as adrenal nodules, are commonly identified in imaging studies and documented in radiology reports. However, patients with such findings frequently do not receive appropriate follow-up, partially due to the lack of tools for the management of such findings and the time required to maintain up-to-date lists. Natural language processing (NLP) is capable of extracting information from free-text clinical documents and could provide the basis for software solutions that do not require changes to clinical workflows. Objectives In this manuscript we present (1) a machine learning algorithm we trained to identify radiology reports documenting the presence of a newly discovered adrenal incidentaloma, and (2) the web application and results database we developed to manage these clinical findings. Methods We manually annotated a training corpus of 4,090 radiology reports from across our institution with a binary label indicating whether or not a report contains a newly discovered adrenal incidentaloma. We trained a convolutional neural network to perform this text classification task. Over the NLP backbone we built a web application that allows users to coordinate clinical management of adrenal incidentalomas in real time. Results The annotated dataset included 404 positive (9.9%) and 3,686 (90.1%) negative reports. Our model achieved a sensitivity of 92.9% (95% confidence interval: 80.9–97.5%), a positive predictive value of 83.0% (69.9–91.1)%, a specificity of 97.8% (95.8–98.9)%, and an F1 score of 87.6%. We developed a front-end web application based on the model's output. Conclusion Developing an NLP-enabled custom web application for tracking and management of high-risk adrenal incidentalomas is feasible in a resource constrained, safety net hospital. Such applications can be used by an institution's quality department or its primary care providers and can easily be generalized to other types of clinical findings.

Early de-tethering procedures are performed on spinal dysraphisms to prevent neuro-urological deterioration caused by growth. Partial lipoma removal may cause delayed deterioration by re-tethering, while complete removal may increase the risk of postoperative worsening. The present study evaluates the risk of postoperative deterioration and the protective potential of intraoperative neurophysiological monitoring (IOM), with a special reference to the conus lipomas treated with the radical approach. Forty toddlers (

A patient’s conscious decision to voluntarily undergo a therapeutic treatment is called informed consent (IC). The aim of IC is to provide information about health and treatment options and increase patient’s participation in healthcare decision-making. IC therefore honors the ethical principles of human autonomy and self-determination. In the field of assisted reproductive technology (ART), the process of communication and mutual understanding between patient and doctor (the IC process) is a current and relevant issue due to its medical, ethical and psychological implications. This exploratory research aims to understand how couples with infertility problems relate to the ART IC, and it proposes the innovative experience of IC conversations with a psychologist. It also provides practical advice on a better use of IC process in ART centers.

The counting process is designed to prevent retained foreign bodies while providing optimal perioperative patient safety. Intraoperative distractions are prevalent and potentially contribute to patient safety risks. Counting is an important preventative measure that is a human process prone to error, especially in this busy environment where multiple things are happening simultaneously. We sought to evaluate the impact of distractions during the count process on patient safety. Trained, nationally certified registered nurses used a validated tool to observe the number of interruptions that occurred during the count process in cardiac surgery. Observation included the key personnel that lead the count process including the scrub person, circulating nurse, attending surgeons, fellows, and residents of all disciplines. Observation included scheduled cases in the cardiac specialty for the adult population including all shifts (24 hours). The predictor in this study was distraction. The primary measure of distraction was the total number of distraction for each case. There are different distraction levels for each distraction. Thus, weighted distraction score for each case was created as the summation of distraction level and it is the secondary measure of distraction. To detect a medium effect size with 80% power at 0.05 level, we needed a minimum sample size of 54. We correlated the relationship between the number of interruptions observed and sequelae. Working together as a cohesive team to minimize interruptions can enhance patient safety and decrease additional workload across departments.

Psoriatic arthritis (PsA) is burdened by an increased susceptibility to cardiovascular diseases. Comorbid diabetes may represent one of the key factors contributing to this risk. The aim of our medical records review study was to investigate the prevalence of type 2 diabetes (T2D) and type 1 diabetes (T1D) in an Italian PsA cohort.The clinical records of all patients consecutively seen at our clinic with a diagnosis of PsA during a 12-month period were reviewed to identify comorbid T2D or T1D. For comparison, a 1:1 age- and sex-matched group of individuals with noninflammatory diseases was recruited.The final study cohort comprised 408 patients. The prevalence of T2D was 7.8% (95% confidence interval, 5.6-10.8) in PsA and 4.4% in controls (95% confidence interval, 2.8-6.9; p = 0.04). Two cases (0.49%) of T1D were identified in the PsA cohort, whereas no cases were observed in controls. In a multivariate logistic regression model including age, disease duration, and body mass index (BMI) as covariates, increasing age (odds ratio [OR], 1.079; p = 0.006) and BMI (OR, 1.188; p = 0.011) but not PsA duration predicted being classified as having T2D. In a similar model accounting for age and BMI, average disease activity score including 28 joints and C-reactive protein showed a trend toward significance (OR, 1.639; p = 0.066).In conclusion, our data provide further support to the emerging evidence of an increased risk of T2D in PsA patients. Cardiometabolic comorbidity represents a significant aspect of integrated arthritis management to improve long-term cardiovascular outcomes and to provide a comprehensive treatment.

Current methods used to evaluate the effects of healthcare improvement efforts have limitations. Designs with strong causal inference—such as individual patient or cluster randomisation—can be inappropriate and infeasible to use in single-centre settings. Simpler designs—such as prepost studies—are unable to infer causal relationships between improvement interventions and outcomes of interest, often leading to spurious conclusions regarding programme success. Other designs, such as regression discontinuity or difference-in-difference (DD) approaches alone, require multiple assumptions that are often unable to be met in real world improvement settings. We present a case study of a novel design in improvement and implementation research—a hybrid regression discontinuity/DD design—that leverages risk-targeted improvement interventions within a hospital readmission reduction programme. We demonstrate how the hybrid regression discontinuity-DD approach addresses many of the limitations of either method alone, and represents a useful method to evaluate the effects of multiple, simultaneous heath system improvement activities—a necessary capacity of a learning health system. Finally, we discuss some of the limitations of the hybrid regression discontinuity-DD approach, including the need to assign patients to interventions based upon a continuous measure, the need for large sample sizes, and potential susceptibility of risk-based intervention assignment to gaming.

BACKGROUND Decompression and, when necessary, neurolysis in entrapment neuropathies of upper limbs are effective and safe procedures, but their correlation with the variation of compound muscle action potentials (CMAPs) is still unclear, based in particular on experimental models. In addition, there are few data regarding the efficacy of intraoperative neurophysiologic monitoring (IOM) to predict clinical early and late outcome after surgery in term of pain control and sensitive/motor recovery. We report about the association between the intraoperative anatomical and neurophysiological findings and the mid- and long-term postoperative clinical course in a surgical series. METHODS We retrospectively reviewed clinical data of 24 patients among 68 admitted at our Institution for upper limb neuropathies from September 2012 to May 2015. All patients completed two preoperative questionnaires for assessing the level of disability (DASH) and of pain/discomfort (NRS). CMAPs' amplitudes were intraoperatively detected, before and after decompression and neurolysis and the variations were then related to clinical outcome, evaluated through DASH and NRS questionnaires at 6-, 9- and 12-months follow-up. RESULTS A statistically significant difference was noted in CMAPs amplitudes before and after decompression (P

Diagnosing soft x-ray (SXR) emission from tokamaks represents a unique source of information, since it allows the study of several plasma parameters, such as the electron and ion temperature, the investigation of the ionization equilibrium, particle and impurities transport and the study of MHD fluctuations and disruptions. A new SXR diagnostic system called EXODUS (Enhanced X-ray Optimized Detector for Use in multiple Scenarios) is under development with the aim to obtain energy resolved SXR emission profiles from the plasma with a high time resolution (

Background Medullary rim sign (MRS) refers to a hyperechoic line in the renal medulla, reported on ultrasound examination (US) in both dogs and cats with and without kidney disease (KD). Objective To describe the different aspects of MRS in cats and to assess its association with KD. Animals Cats that underwent US examination, with MRS (study group) with and without KD and without MRS with and without KD (control groups). Methods Retrospective case-control study: cats with MRS, with or without KD (rim sign groups) and cats without MRS, with or without KD (control groups). Ultrasonographic images were blindly reviewed with attention given to the thickness and margins of the MRS recorded. Results Eighty-four cats with MRS were included and 60 cats recruited for each control group. The MRS had 2 distinct aspects: a thin hyperechoic line with well-defined margins (MRS-line) in 50/84 cats (59%) and a thick hyperechoic band with ill-defined margins (MRS-band) in 34/84 cats (41%). Twenty of 50 (40%) cats with MRS-line and 25/34 (74%) of cats with MRS-band had KD. The frequency of MRS-line was higher in cats without KD, whereas the presence of MRS-band was more frequent in cats with KD (P = .003). Conclusions and clinical importance A thick hyperechoic ill-defined band (for which the term medullary band sign is proposed) was more frequently associated with KD, whereas a thin hyperechoic well-defined line (true MRS) may be seen in cats with or without KD.

Studies have shown that a ventilator associated pneumonia (VAP) bundle significantly decreases VAP rates. In this study, we evaluated existing knowledge, practices, and adherence of nurses and infection control preventionists (ICP) to the VAP bundles of care in the intensive care unit (ICU) by using qualitative and quantitative tools. Of 60 participants (56 nurses and 4 ICPs), mean knowledge score regarding specific evidence-based VAP guidelines was 5 (range 3–8) out of 10 points. Self-reported adherence to the VAP bundle ranged from 38.5 to 100%, with perfect compliance to head of bed elevation, and poorest compliance with readiness to extubate. Overall VAP median bundle compliance was 84.6%. Knowledge regarding specific components of VAP prevention is lacking. Formal training and interactive educational sessions should be performed regularly to assess the competency of key personnel regarding the VAP bundle, especially in the context of rapid nurse turnover. Incentives for retention of nurses should also be considered, so that knowledge of hospital specific initiatives such as the VAP bundles of care can be cultivated over time. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-021-01027-1.

Anthropomorphic criteria are widely adopted for developing socially interactive robots since they can improve human capability to interpret and predict robot motion, with an impact on robot acceptability and human–robot interaction safety. Learning by demonstration approaches based on dynamic movement primitives are a suitable solution for planning the robot motion in human-like fashion and endow robots with generalization capabilities and robustness against perturbation. Objective of this work is to propose a new formulation of the learning by demonstration approach based on dynamic movement primitives (DMPs), called hybrid joint/Cartesian DMPs, for redundant robots with the twofold purpose of avoiding obstacles on the path and obtaining anthropomorphic motion in the joint as well as the task space. The proposed approach, suitable for assistive purposes, was experimentally validated on the anthropomorphic robot arm Kuka Light Weight Robot 4+. Trajectories recorded by an optoelectronic system (i.e. the BTS Smart D) from human demonstrators performing point-to-point reaching and pouring tasks were adopted to teach the robot how to move. A comparative analysis with current methods of learning by demonstration in the literature, i.e. Cartesian DMP and inverse kinematics, was performed. Performance indicators were introduced to (1) assess the robot accuracy of the motion performing, (2) evaluate the level of anthropomorphism of the computed motion, (3) measure the success rate in obstacle avoidance. Moreover, questionnaires were administered to ten human subjects who observed robot motion. The obtained results demonstrated that the proposed approach guarantees anthropomorphic motion of the robot both in the joint and in the task spaces ensuring obstacle avoidance along the robot kinematic chain. In particular, the anthropomorphic robot, while operating with the proposed method, exhibits behaviours in the joint space that are similar to the one recorded during the demonstration and has a level of anthropomorphism rather higher than the one obtained with Cartesian DMP and inverse kinematics (a configuration of the robot joints within the physiological limits is always ensured and the maximum convex hull created between the human and the robot arm is 0.0085 m$$^3$$). In presence of obstacles, an acceptable level of the Cartesian accuracy ($$Position~err

RESUMEN Este trabajo reflexiona sobre las particularidades que tiene la participación en materia ambiental. Las distintas maneras como los ordenamientos jurídicos la recogen y regulan fundamenta una cierta distancia teórica con el tratamiento general que se da a la participación en la gestión pública. No obstante, se indaga también en otros factores de distanciamiento con el debate general sobre participación, lo que involucra la existencia de variables que tensionan la participación ambiental, como los conceptos de riesgo, deliberación, justicia ambiental y acceso a la justicia. Lo anterior conduce a plantear la necesidad de construir un tratamiento teórico diferenciado, que integre miradas interdisciplinarias (derecho, ciencias políticas, sociología, entre otras) en orden a entender y regular adecuadamente el asunto. ABSTRACT This paper is a reflection over the singularities of public participation in environmental issues. The way in which the law deals with it in practice shows differences between public participation in this area, and public participation in general, that could imply a theoretical difference. Moreover, this difference can also be studied from the variables that justify public participation in environmental matters, such as risk management, environmental justice, deliberation and access to justice. Because of these differences, this article believes that public participation in environmental issues should be treated different from a theoretical point of view, integrating disciplines such as political science, sociology and law, to understand and regulate accurately the subject.

ASD is a lifelong multifaceted condition with considerable impact and costs to the single patients, their family and wider society, hence emphasizing the need of tailoring services for ASD subjects and their families. In Italy, recent efforts have been made to harmonize and promote the appropriateness of interventions for ASD people. At present, scattered information on services for people with ASD is available. The aim of this study was to survey the presence and distribution of child and adolescent mental health services (CAMHs) in Italy, devoting a specific focus on their capacity to provide care to ASD patients. CAMHs based on local health services, public and university hospitals, and care/research institutions, as well as private (INHS-accredited) units were invited to participate to present investigation filling in a questionnaire assessing relevant dimensions for public health, namely overall structural capacity and ASD care processes. Heterogeneity of the results among geographical macro-areas in CAMHs provision was found. Specifically, for ASD care, diagnosis and intervention strategies resulted to be unevenly distributed across the Italian territory, and the level of service integration throughout transition into adulthood resulted to be low. Results from this survey contribute to increase the knowledge on services provided in Italy to people with ASD, and suggest potential targets to improve ASD management. The final aim is to ensure that the conditions are in place to achieve the adequate capacity to respond to the needs of individuals affected and their families over time and across the whole country.

ObjectiveTo evaluate whether a quantitative speech measure is effective in identifying and monitoring motor speech impairment (MSI) in patients with primary progressive aphasia (PPA) and to investigate the neuroanatomical basis of MSI in PPA.MethodsSixty-four patients with PPA were evaluated at baseline, with a subset (n = 39) evaluated longitudinally. Articulation rate (AR), a quantitative measure derived from spontaneous speech, was measured at each time point. MRI was collected at baseline. Differences in baseline AR were assessed across PPA subtypes, separated by severity level. Linear mixed-effects models were conducted to assess groups differences across PPA subtypes in rate of decline in AR over a 1-year period. Cortical thickness measured from baseline MRIs was used to test hypotheses about the relationship between cortical atrophy and MSI.ResultsBaseline AR was reduced for patients with nonfluent variant PPA (nfvPPA) compared to other PPA subtypes and controls, even in mild stages of disease. Longitudinal results showed a greater rate of decline in AR for the nfvPPA group over 1 year compared to the logopenic and semantic variant subgroups. Reduced baseline AR was associated with cortical atrophy in left-hemisphere premotor and supplementary motor cortices.ConclusionsThe AR measure is an effective quantitative index of MSI that detects MSI in mild disease stages and tracks decline in MSI longitudinally. The AR measure also demonstrates anatomic localization to motor speech–specific cortical regions. Our findings suggest that this quantitative measure of MSI might have utility in diagnostic evaluation and monitoring of MSI in PPA.

Background Obstructive Sleep Apnea (OSA) is associated with pathological changes of cerebral β-amyloid dynamics. Orexin has been demonstrated interfering with β-amyloid metabolism in Alzheimer's Disease (AD) pathology. The present study investigated cerebrospinal-fluid (CSF) β-amyloid40 (Aβ40), β-amyloid42 (Aβ42) and orexin levels in OSA patients compared to AD patients and controls. Methods OSA and AD patients were included in this study and compared to a group of controls. Patients and controls underwent lumbar puncture for the assessment of CSF Aβ40, Aβ42, tau proteins, orexin levels, and polysomnography to measure nocturnal sleep architecture. Results 20 OSA patients, 20 AD patients, and 15 controls were included in our study. OSA patients showed higher CSF orexin levels than AD patients and controls, and AD patients showed higher CSF orexin levels than controls. Moreover, CSF Aβ40 and Aβ42 were lower in OSA patients than controls, but higher in OSA patients compared to AD patients. However, AD patients showed lower CSF Aβ42 levels but comparable CSF Aβ40 levels than controls. Sleep macrostructure was similarly altered in OSA and AD patients compared to controls. Finally, the apnea-hypopnea index (AHI) was related to the ratio Aβ42/Aβ40 and CSF orexin levels in OSA patients. Conclusion This study proved the alteration of CSF orexin levels and β-amyloid isoforms 40 and 42 in OSA patients. We suppose that sleep disruption and intermittent hypoxia, the two core features of OSA, may induce orexinergic system and cerebral β-amyloid metabolism dysregulation. This evidence further supports the current hypothesis that OSA may possibly start AD neuropathological processes.

Background: Depressive symptoms in the postpartum period are a highly prevalent mental health problem. COVID-19 restrictions have increased maternal clinical symptoms during the postpartum period, leading to a high demand for mental health assistance and the need for cost-effective care adjusted to this new context. Video feedback (VF) has been a particularly cost-effective strategy in early interventions focused on maternal sensitivity. However, these interventions usually do not include mentalization as one of the critical elements involved in sensitive and attachment relationships. Also, these interventions are generally carried out in face-to-face settings. This study's main goal is to evaluate the feasibility and acceptability of a brief internet mentalization informed with VF to improve the sensitive response in mother-baby dyads with postpartum depressive symptoms attended in primary health centers.Methods/design: This randomized feasibility trial will include 60 mother-baby dyads. Participants will be randomized and allocated in a 1:1 ratio. A random number sequence will be computer-generated in varying block sizes (2&4) and stratified by center. The intervention aims to improve maternal sensitivity and mentalizing by using a model based on video-feedback methodology in a virtual modality. The intervention consists of four sessions plus one pre-intervention assessment session and psychoeducational cards. Control dyads will receive only psychoeducational cards once a week. Additionally, dyads from both groups will receive the health center’s treatment as usual. A MI-VF manual guides each intervention session, but its application is tailored to each dyad, VF therapists will receive one weekly group supervision session. Data will be collected at baseline, 4 weeks and 3 months follow-up. The main goal of this trial is to assess feasibility outcomes (recruitment rate and data completion) and change in maternal sensibility.Discussion: This study will inform parameters for the future implementation of a large randomized controlled clinical trial, contributing to the current scarce evidence on mentalization informed interventions that use VF as their primary intervention strategy. Also, this study will provide a cost-effective internet-based intervention model, feasible to be implemented in public health settings.Trial registration: NCT04748731

Cerebrospinal fluid (CSF) analysis supports diagnosis of neurodegenerative diseases (NDs), however a number of issues limits its potentialities in clinical practice. Here, a newly developed technique for fluid voltammetry, relying on a simple sensor (BIOsensor-based multisensorial system for mimicking Nose, Tongue and Eyes, BIONOTE), was used to test the applicability for CSF analysis. BIONOTE was initially calibrated on an artificial CSF-like solution and then applied on human CSF, either immediately after collection or after refrigerated storage. Following optimization, it was used to evaluate 11 CSF samples correlating the electrochemical dataset with CSF routine parameters and biomarkers of neurodegeneration. Multivariate data analysis was performed for model elaboration and calibration using principal component analysis and partial least squares discriminant analysis. BIONOTE presented a high capacity to predict both physiological and pathological constituents of artificial CSF. It differentiated distinct fresh human CSF samples well but lost accuracy after refrigerated storage. The electrochemical analysis-derived data correlated with either CSF routine cytochemical indexes or a biomarker of neurodegeneration. BIONOTE resulted as being a reliable system for electrochemical analysis of CSF. The CSF fingerprint provided by the sensor has shown itself to be sensitive to CSF modification, thus it is potentially representative of CSF alteration. This result opens the way to its testing in further study addressed at assessing the clinical relevance of the methodology. Because of its advantages due to the ease and rapidity of the methodology, a validation study is now required to translate the technique into clinical practice and improve diagnostic workup of NDs.

Despite ever-increasing multicultural and multilingual diversity in Australia, the learning of languages, as a curriculum area, has long struggled to achieve recognition and stability. This could not be more true than in the state of Queensland, where despite mandatory language learning in the middle years, the percentage of high school students graduating with a language has consistently hovered around 8% for the last three decades. In this chapter, we draw on analysis of 18 semi-structured interviews with School Principals and Heads of Languages departments in ten metropolitan state high schools whose language programmes may be considered counter-examples to the current state of play in the Australian languages education landscape. These interviews explored participants’ views regarding the factors that may contribute to enabling the development and maintenance of language teaching in their schools as well as potential deterrents leading to discontinuation of programmes in other school contexts. The data provide evidence that resistance to the prevalent ‘monolingual mindset’ in these specific contexts is achieved through the interaction of several elements within the ecology of the school community, and specifically, through key stakeholders’ exercise of agency in a concerted effort to ensure the sustainability of languages programmes.

International audience; This study aims to detect peanut flour adulteration in chocolate powder using near-infrared (NIR) hyperspectral imaging. Fifteen samples were prepared by mixing both food products in different proportions (0%, 0.1%, 1%, 10% and 100% of peanut) and measured using the hyperspectral camera. A preliminary Principal Component Analysis (PCA) was performed to investigate the structure of the data. Next, the Multivariate Curve Resolution - Alternating Least Squares (MCR-ALS) chemometric method combined with a selectivity constraint in the concentration matrix was applied to untangle the spectral data into a set of components representative of the main constituents found in the samples. Moreover, a detection algorithm based on the calculation of the Mahalanobis distance for every pixel to the model distribution of chocolate powder was implemented. This analysis revealed the complexity of the unmixing problem, allegedly due to the spectral signature overlap in the pixel field of view and because the pure products presented similar spectral signatures. MCR-ALS results were improved after the application of a selectivity constraint, which resulted in a higher performance of the detection algorithm. MCR-ALS detected from 0% to 2.2% of adulterated pixels in mixed samples. On the other hand, the selectivity-constrained MCR-ALS method provided detections from 0.03% to 17.0% in those samples. This pipeline showed that peanut adulteration can be detected even for the lowest concentration level tested (0.1% of peanut). This work highlights the potential of NIR hyperspectral imaging combined with chemometrics for detection purposes.

Populated coastal areas are exposed to emissions from harbour-related activities (ship traffic, loading/unloading, and internal vehicular traffic), posing public health issues and environmental pressures on climate. Due to the strategic geographical position of Italy and the high number of ports along coastlines, an increasing concern about maritime emissions from Italian harbours has been made explicit in the EU and IMO (International Maritime Organization, London, UK) agenda, also supporting the inclusion in a potential Mediterranean emission control area (MedECA). This work reviews the main available outcomes concerning shipping (and harbours’) contributions to local air quality, particularly in terms of concentration of particulate matter (PM) and gaseous pollutants (mainly nitrogen and sulphur oxides), in the main Italian hubs. Maritime emissions from literature and disaggregated emission inventories are discussed. Furthermore, estimated impacts to air quality, obtained with dispersion and receptor modeling approaches, which are the most commonly applied methodologies, are discussed. Results show a certain variability that suggests the necessity of harmonization among methods and input data in order to compare results. The analysis gives a picture of the effects of this pollution source, which could be useful for implementing effective mitigation strategies at a national level.

Chromosome 21 trisomy or Down syndrome (DS) is the most common genetic cause of intellectual disability (ID). DS is also associated with hypotonia, muscle weakness, autoimmune diseases, and congenital heart disease. C-C chemokine receptor type 3 (CCR3) plays a role in inflammatory, autoimmune, and neuronal migration mechanisms. The present study aimed to evaluate the expression of the CCR3 gene by NGS and qRT-PCR in patients with DS and normal controls (NC). The CCR3 gene was over-expressed in DS patients compared to NC. These data suggest that an over-expression of the CCR3 gene is associated with the phenotype of patients with DS.

Public sector organizations literature has addressed the influence of AI on decision-making process, looking mainly at rationalization and efficiency. However, recent adoptions of AI have been challenged because of their discriminatory nature. As a result, questions emerged on the accountability of AI supported decision-making processes in the public sector. This research sheds light on how AI transforms decision-making processes in the public sector and hence on their accountability. The paper illustrates that AI adoptions lead to the emergency of techno-legal entanglements - assemblages - which might impact upon AI accountability. Building on the findings of some of the most controversial and discussed cases of AI adoption in the public sector - COMPAS in the US and UKVI in the UK - the paper makes the case for a new approach to AI supported public sector decision-making accountability.

A 4-year-old nulliparous Labrador Retriever bitch and a 7-year-old nulliparous crossbreed bitch were referred for weakness and vomiting. Ultrasonographic examination revealed in both cases a large abdominal mass-lesion with corpuscular fluid content; computed tomography examination revealed in both cases the uterine origin of the lesions, with findings consistent with torsion. Surgery confirmed the uterine torsion upon the ovarian pedicle in both cases, and at histological examination both presented a uterine polyp associated with haemorrhage and necrosis of the uterine wall. Both patients were released in good clinical conditions.

PURPOSE The etiology of azoospermia in patients with Klinefelter syndrome (KS) is still unknown. The protein codified by the G protein-couple receptor 56 (GPR56) belongs to the adhesion family of G protein-coupled receptors (GPRs). Its mutations are involved in the pathogenesis of intellectual disability and, according to animal studies, infertility. As the expression of GPR56 in patients with KS has not been investigated so far, this study was undertaken with the purpose of evaluating its expression in peripheral blood mononuclear cells (PBMCs) of patients with KS and normal controls. MATERIALS AND METHODS This age-matched case-control study was performed in 10 patients with KS and 10 controls. Patients and controls underwent to blood sampling for next-generation sequencing (NGS) analysis, and differentially expressed mRNAs were identified using DESeq2 v.1.12. QRT-PCR was used to validate the results obtained by NGS analysis. TaqMan Gene Expression Assay primers were used to carry out the Realtime PCR analysis for GPR56. RESULTS GPR56 was down-regulated by -2,081-fold (q-value

International audience; This work presents an innovative usage of the GEMpix detector for soft X-rays (SXR) measurements aimed to make an estimate of the electron temperature of a Laser Produced Plasma (LPP). The GEMpix is a proportional gas detector based on three Gas Electron Multipliers (GEMs) with a Front-End Electronics (FEE) based on four Timepix chips. This FEE provides the Time over Threshold (ToT) acquisition mode pixel by pixel and then a digital measure of the released charge in the gas mixture. In addition, the charge can be amplified through the GEM foils with 4 orders of magnitude spanning gain offering, in this way, a big dynamic range and adjustable sensitivity. Chip design provides a threshold for each channel. All the thresholds are set in order to cut electronic noise and detect X-rays. In this configuration, a cut on the low amplitude signals is set, but the gain has been tuned in order to observe the main signal due to the soft X-rays reaching the detector. This detector works in an energy range between 2 to 15 keV . It offers good imaging properties, high efficiency and absolute calibration. It offers a good immunity to Electromagnetic Pulse (EMP), as checked at VEGA-2 laser facility (hundreds of TW in about 30 fs). In these experiments, where the formation of warm dense matter produced by blast waves has been studied, a measure of the plasma temperature was required. This measurement was realized applying some filters on the active area of the detector, in correspondence of three chips. With this configuration a study of the GEMpix response due to the photons coming from the coronal plasma produced by the laser on the target has been done for each single shot. GEMpix revealed innovative and attractive features, compared to the state of the art where passive films or detectors based on indirect conversion are used, for SXR imaging and spectral analysis to infer the electron temperature.

The present retrospective study evaluated the progression of osteoarthritis in stifle joints based on the radiographic grade of osteoarthritis (OA) scored in dogs with cranial cruciate ligament rupture. The aim of the study was to search for a correlation between the stage of radiographic osteoarthritis prior to surgery and the osteoarthritis progression occurring after the tibial tuberosity advancement (TTA) procedure. It was hypothesized that the procedure carried out in dogs in the early stages of OA could reduce the OA changes. A total of 190 X-ray images obtained from the medical records of 38 dogs were evaluated. The radiographic signs of osteoarthritis of 38 stifle joints were scored from 0 to 3 in 10 specific anatomic locations. The radiographs were divided into 4 groups based on the global scores: A) no-OA, B) mild-OA, C) moderate-OA, D) severe-OA; they were assessed prior to surgery, and 1, 2, 3 and 6 months post-operatively (T0, T1, T2, T3 and T6). There were no differences in osteoarthritis progression in Groups A and C at any time. Osteoarthritis changes from T0 to T6 were statistically significant in Group B. The OA changes in the anatomic locations were investigated. The most common anatomic sites for OA changes were the patella apex, the proximal and distal trochlear ridges, and the caudal aspect of the tibial plateau assessed before surgery. After surgery, the score increased in the first three locations in 10, 9 and 11 joints, respectively; instead, the progression of osteoarthritis in the caudal aspect of the tibial plateau occurred in 23 out of 38 stifle joints. The results indicated that the TTA procedure could be effective in slowing down the OA progression when carried out in the absence of or in the early stages of disease. Therefore, an early intervention may be suggested in clinical practice to obtain minimal or no progression 6 months postoperatively.

Guided wave (GW) testing is regularly used for finding defect locations through long-range screening using low-frequency waves (from 5 to 250 kHz). By using magnetostrictive sensors, some issues, which usually limit the application to nuclear power plants (NPPs), can be fixed. The authors have already shown the basic theoretical background and simulation results concerning a real steel pipe, used for steam discharge, with a complex structure. On the basis of such theoretical framework, a new campaign has been designed and developed on the same pipe, and the obtained experimental results are now here presented as a useful benchmark for the application of GWs as nondestructive techniques. Experimental measures using a symmetrical probe and a local probe in different configurations (pulse-echo and pitch-catch) indicate that GW testing with magnetostrictive sensors can be reliably applied to long-term monitoring of NPPs components.

A six-year-old intact male Chihuahua dog was referred for vomiting, diarrhoea and weight loss. Ultrasonographic (US) and computed tomographic examination revealed a focal thickening in the jejunum, with no signs of gross metastatic disease. Histology and immunohistochemistry performed after surgical resection revealed a presumed large granular lymphocytic lymphoma. Treatment with chlorambucil was started, and no signs of recurrence were noticed at serial US follow-up for the following months. Six months after surgery, several lesions were seen in the ventrolateral aspect of the peritoneal cavity both on ultrasonography and CT, and cytology confirmed the suspicion of peritoneal lymphomatosis.

Liver lobe torsion (LLT) is an uncommon condition of unknown origin in dogs. Several reports describe the clinical features and outcome, but only few of them include the imaging characteristics of this disease. The aim of this descriptive case series was to describe the ultrasonographic (US) and multidetector-row computed tomographic (MDCT) features of LLT in a group of dogs. Five dogs were included in this single-center descriptive study, having both US, CT and surgical and histological confirmation of LLT available for review. Different US appearances have been found, both hypoechoic and hyperechoic liver lobes and heterogeneous mass-like lesions, with fluid and gas content. At three-phase MDCT examination, LLT appeared as fluid- and gas-filled lesions (consistent with abscess transformation), or as hypoattenuating hypovascular lobes. Two different vascular signs were also described: whirl sign or vascular interruption were seen in all cases, allowing a correct pre-surgical diagnosis in all the cases presented. Multiphase MDCT was a helpful imaging method for the correct pre-surgical diagnosis of LLT in dogs, and its use in the suspected cases is therefore advisable.

PurposeDespite having distinct etiologies, acquired apraxia of speech (AOS) and childhood apraxia of speech (CAS) share the same central diagnostic challenge (i.e., isolating markers specific to an impairment in speech motor planning/programming). The purpose of this review was to evaluate and compare the state of the evidence on approaches to differential diagnosis for AOS and CAS and to identify gaps in each literature that could provide directions for future research aimed to improve clinical diagnosis of these disorders.MethodWe conducted a scoping review of literature published between 1997 and 2019, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. For both AOS and CAS, literature was charted and summarized around four main methodological approaches to diagnosis: speech symptoms, quantitative speech measures, impaired linguistic–motor processes, and neuroimaging.ResultsResults showed that similar methodological approaches have been used to study differential diagnosis of apraxia of speech in adults and children; however, the specific measures that have received the most research attention differ between AOS and CAS. Several promising candidate markers for AOS and CAS have been identified; however, few studies report metrics that can be used to assess their diagnostic accuracy.ConclusionsOver the past two decades, there has been a proliferation of research identifying potential diagnostic markers of AOS and CAS. In order to improve clinical diagnosis of AOS and CAS, there is a need for studies testing the diagnostic accuracy of multiple candidate markers, better control over language impairment comorbidity, more inclusion of speech-disordered control groups, and an increased focus on translational work moving toward clinical implementation of promising measures.

mTOR dysregulation has been described in pathological conditions, such as cardiovascular and overgrowth disorders. Here we report on the first case of a patient with a complex congenital heart disease and an interstitial duplication in the short arm of chromosome 1, encompassing part of the mTOR gene. Our results suggest that an intragenic mTOR microduplication might play a role in the pathogenesis of non-syndromic congenital heart defects (CHDs) due to an upregulation of mTOR/Rictor and consequently an increased phosphorylation of PI3K/AKT and MEK/ERK signaling pathways in patient-derived amniocytes. This is the first report which shows a causative role of intragenic mTOR microduplication in the etiology of an isolated complex CHD.

Extramedullary hematopoiesis (EMH) is the formation and development of blood cells outside the bone marrow, and in dogs it frequently occurs in the spleen. Although splenic EMH is a relatively common condition, data regarding its appearance in veterinary medicine are lacking. Our aim was to describe different multidetector computed tomographic (MDCT) features of splenic EMH in dogs. In this descriptive retrospective study, dogs with cytological diagnosis of splenic EMH and three-phase MDCT study of the abdomen were included. Multi-detector CT findings recorded were splenomegaly, appearance of the parenchyma, and mean attenuation of the spleen and lesions. Out of 89 dogs included, 55 (62%) presented multifocal nodular aspect, 14 (16%) mass, 12 (13%) diffuse heterogeneous parenchyma, and eight (9%) normal spleen. Most lesions were hyperattenuating to the parenchyma in the arterial (57/89, 64%) and portal (59/89, 66%) phases; whereas in the interstitial phase only 40 of 89 (45%) were hyperattenuating. The mean attenuations of the lesions were higher compared to the values of the adjacent spleen, and the difference of the mean attenuation between the hyperattenuating lesions and the parenchyma was significantly higher in arterial and portal phases than in interstitial phase (P < .0001). The most frequent MDCT aspect of splenic extramedullary hematopoiesis consists of multiple nodules hyperattenuating to the normal spleen, best visualized in the arterial and portal phases.

Recent progress in tissue engineering has led to increasingly complex approaches to investigate human neurodegenerative diseases in vitro, such as Alzheimer’s disease, aiming to provide more functional and physiological models for the study of their pathogenesis, and possibly the identification of novel diagnostic biomarkers and therapeutic targets. Induced pluripotent stem cell-derived cortical and retinal organoids represent a novel class of in vitro three-dimensional models capable to recapitulate with a high similarity the structure and the complexity of the native brain and retinal tissues, thus providing a framework for better mimicking in a dish the patient’s disease features. This review aims to discuss progress made over the years in the field of in vitro three-dimensional cell culture systems, and the benefits and disadvantages related to a possible application of organoids for the study of neurodegeneration associated with Alzheimer’s disease, providing a promising breakthrough toward a personalized medicine approach and the reduction in the use of humanized animal models.

Trisomy 21, also known as Down Syndrome (DS), is the most common chromosome abnormality and causes intellectual disability. Long non-coding RNA (lncRNA) growth arrest-specific 5 (GAS5), whose differential expression has recently been reported in patients with Klinefelter syndrome, has been addressed to play a role in the development of inflammatory and autoimmune diseases, vascular endothelial cells apoptosis and atherosclerosis, all being common features in patients with DS. Therefore, the aim of this study was to assess the lncRNA GAS5 expression profile in DS patients and in controls. lncRNA GAS5 levels were evaluated by qRT-PCR assay in 23 patients with DS and 23 age-matched controls. A significant lncRNA GAS5 down-regulation was observed in patients with DS by RT-PCR analysis, The RNA sequencing experiments confirmed the qRT-PCR data. LncRNA GAS5 down-expression may play a role in the development of some typical features of the patients with DS and, particularly, in inflammatory and autoimmune diseases.

International audience; The detection of adulterations in food powder products represents a high interest especially when it concerns the health of the consumers. The food industry is concerned by peanut adulteration since it is a major food allergen often used in transformed food products. Near-infrared hyperspectral imaging is an emerging technology for food inspection. It was used in this work to detect peanut flour adulteration in wheat flour. The detection of peanut particles was challenging for two reasons: the particle size is smaller than the pixel size leading to impure spectral profiles; peanut and wheat flour exhibit similar spectral signatures and variability. A Matched Subspace Detector (MSD) algorithm was designed to take these difficulties into account and detect peanut adulteration at the pixel scale using the associated spectrum. A set of simulated data was generated to overcome the lack of reference values at the pixel scale and to design appropriate MSD algorithms. The best designs were compared by estimating the detection sensitivity. Defatted peanut flour and wheat flour were mixed in eight different proportions (from 0.02% to 20%) to test the detection performances of the algorithm on real hyperspectral measurements. The number and positions of the detected pixels were investigated to show the relevancy of the results and validate the design of the MSD algorithm. The presented work proved that the use of hyperspectral imaging and a fine-tuned MSD algorithm enables to detect a global adulteration of 0.2% of peanut in wheat flour.

To report feasibility, safety, and technical advantages of flat-detector computed tomography perfusion (FD-CTP) during balloon test occlusion (BTO) angiography studies, 10 patients patients scheduled for BTO were evaluated. Cerebral blood volume maps were extracted from FD-CTP images acquired during the test. The FD-CTP perfusion combined with BTO is feasible and safe in intracranial tumor, and aneurysm cases in which vessel sacrifice should be considered.

Infertility-related psychological research is traditionally oriented to analyze the wellbeing of couples undergoing Assisted Reproductive Technologies (ART), than to study the job-related effects on the healthcare fertility staff. This piece of research aims at understanding the subjective perspective of the fertility professionals and contribute to identify their emotional dynamics in their work environment. An in-depth explorative research study was conducted on 12 healthcare professionals of an Italian ART hospital clinic. Structured interviews with open-ended questions were administered to explore their deep feelings about their professional experience. Emotional text analysis was then conducted to analyze the textual corpus of their narratives to grasp their affective symbolizations. Statistical multidimensional techniques were used to detect some thematic domains (cluster analysis) and latent factors organizing the contraposition between them (multiple correspondence analysis). Five thematic domains were detected which refer to different emotional dimensions, as follows: performance anxiety (Cluster 1), ambivalence between omnipotence and powerlessness (Cluster 2), care burden (Cluster 3), feeling of duty (Cluster 4), and sense of interdependence (Cluster 5). Then, four latent factors were identified dealing with the laborious attempt to remedy, the realistic sense of limitation, the incumbent feeling of pressure and the restorative sense of justice, respectively. The results are discussed based on the existing literature and some useful recommendations for staff education, training and clinical supervision are provided accordingly.

This study reports on a novel Smart-Fabric based wireless Body Area Sensor Network for assessing psychological and physiological work risk levels. The combination of smart-sensing fabrics advantages, high electronic miniaturization, and the latest machine learning enables the system to assess the risk level of the worker. The body area sensor network includes a smartphone, an artificial intelligence algorithm for risk assessment, and a set of sensor-nodes integrated into a textile substrate (i.e., activity detection, electrocardiogram (ECG), sweat rate, body temperature, and textile integrated respiration sensors). Preliminary and encouraging results are shown in terms of physiological signals and physical activity detection.

AIMS A recent double-blind placebo-controlled crossover 70-day trial demonstrated that a fixed combination of dextromethorphan and quinidine (DM/Q) improves speech and swallowing function in most patients with amyotrophic lateral sclerosis. In this study, a subset of participants, many of whom did not substantially improve while on DM/Q, were re-evaluated using computer-based speech analyses and expert clinician ratings of the overall severity of speech impairment. METHODS Speech samples were recorded from the subset of 10 patients at four visits made at approximately 30-day intervals. The recordings were analysed by automated computer-based analysis of speech pausing patterns. Severity of speech impairment was rated by three experienced speech-language pathologists using direct magnitude estimation. Scores on patient-reported and clinician-administered scales of bulbar motor involvement were obtained at each visit. RESULTS The effects of DM/Q were detected on several of the objective speech measures, including total pause duration (s) (Cohen's d = 0.73, 95% confidence interval (CI) -1.70, 0.24), pause time (%) (d = 0.77, 95% CI -1.75, 0.21), and mean speech event duration (s) (d = 0.52, 95% CI -0.44, 1.47), but not on clinician ratings of speech or the speech components of the self-report or clinician-administered scales. CONCLUSIONS These findings suggest that even patients with modest improvement while on DM/Q may experience quantifiable improvements in speech when assessed using sensitive and objective measures. This study provides additional evidence of the positive impact of DM/Q on one or more of the neural systems that control bulbar motor function and production of speech.

This paper presents a model of bank risk taking and government guarantees. Levered banks take excessive risk, as their actions are not fully priced at the margin by debt holders. The impact of government guarantees on bank risk taking depends critically on the portion of bank investors that can observe bank behavior and hence price debt at the margin. Greater guarantees increase risk taking (moral hazard) when informed investors hold a sufficiently large fraction of liabilities. Otherwise, greater guarantees reduce risk taking by increasing the profits of the bank (franchise value effect). The results extend to the case in which information disclosure, and thus the portion of informed investors, is endogenous but costly. The model also shows that when bank capital is endogenous, public guarantees lead unequivocally to an increase in bank leverage and an associated increase in risk taking. The analysis points to a complex relationship between prudential policy and the institutional framework governing bank resolution and bailouts.

Background The estimation of body core temperature (CT) is a central issue in the study of the human thermoregulation response in the occupational field. The objective of this systematic review was to identify the real-time CT estimation methods based on physiological measurements acquired through wearable devices. Methods According to the eligibility criteria, the articles published until 24th March 2020 were selected from Scopus, Pubmed and Web of Science and the potential risk of bias was assessed. Results 16 studies were included, which enrolled a total of 353 above all young males, with tests performed mainly in the laboratory under warm/hot environmental conditions. Several CT estimation methods were found, for which performance was evaluated with different approaches. Conclusion Promising solutions appear to be emerging from the literature to enable real-time CT estimation with a small number of wearable and non-invasive sensors for application in the occupational field.