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Resume La phacoemulsification est la chirurgie la plus frequemment pratiquee dans le monde. Depuis quelques annees, cette chirurgie semble avoir atteint un plateau et qu’il n’y a plus d’innovations de rupture. Dans cet article, nous faisons le point sur les techniques alternatives, les dernieres innovations et les voies de recherche et developpement dans ce domaine.

Gas injections at the bottom of the blast furnace create void regions in the coke matrix called the raceways which play a role in the gas distribution in the furnace and is directly linked to the iron production. In this region, complex physical phenomena occur, including particle-fluid with combustion, and, to our knowledge, there is no consensus on its shape and dynamics as well as its creation and stability. A better understanding of the raceway region could lead to a more efficient and stable blast furnace process. An unresolved CFD-DEM approach is used to study the gas-solid flows where coke particles are modelled as a discrete phase and the gas as continuous solving the RANS modelling of the turbulence. In order to clarify the main phenomena occurring in the raceway dynamics, we develop a CFD-DEM model of a 1/5 scale 2d slot pilot of the blast furnace for which alternative raceway collapses are monitored. First, DEM simulations are realized without the fluid contribution and shows that the pilot geometry influences the mechanical load applied on the raceway with a saturation of the granular stress inside the pilot. Also, dry raceway collapse shows a modification of this stress in a short characteristic time. Then, CFD-DEM model of the pilot permits to investigate the gas and granular flows when the raceway is imposed as in the experiment. The dynamics of the collapse with the coupling is solved and displays a complex particle-gas 3d flow. Further implementation in the model will allow coke particle combustion.

Objective: Sensory deficits are important risk factors for delirium but have been investigated in single-center studies and single clinical settings. This multicenter study aims to evaluate the association between hearing and visual impairment or bi-sensory impairment (visual and hearing impairment) and delirium. Design: Cross-sectional study nested in the 2017 "Delirium Day" project. Setting and participants: Patients 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes, and hospices in Italy. Methods: Delirium was assessed with the 4AT (a short tool for delirium assessment) and sensory deficits with a clinical evaluation. We assessed the association between delirium, hearing and visual impairment in multivariable logistic regression models, adjusting for: Model 1, we included predisposing factors for delirium (ie, dementia, weight loss and autonomy in the activities of daily living); Model 2, we added to Model 1 variables, which could be considered precipitating factors for delirium (ie, psychoactive drugs and urinary catheters). Results: A total of 3038 patients were included; delirium prevalence was 25%. Patients with delirium had a higher prevalence of hearing impairment (30.5% vs 18%; P < .001), visual impairment (24.2% vs 15.7%; P < .01) and bi-sensory impairment (16.2% vs 7.5%) compared with those without delirium. In the multivariable logistic regression analysis, the presence of bi-sensory impairment was associated with delirium in Model 1 [odds ratio (OR) 1.5, confidence interval (CI) 1.2-2.1; P = .00] and in Model 2 (OR 1.4; CI 1.1-1.9; P = .02), whereas the presence of visual and hearing impairment alone was not associated with delirium either in Model 1 (OR 0.8; CI 0.6-1.2, P = .36; OR 1.1; CI 0.8-1.4; P = .42) or in Model 2 (OR 0.8, CI 0.6-1.2, P = .27; OR 1.1, CI 0.8-1.4, P = .63). Conclusions and implications: Our findings support the importance of routine screening and specific interventions by a multidisciplinary team to implement optimal management of sensory impairments and hence prevention and the management of the patients with delirium.

Hip fracture injury is one of the principal health problems affecting the elderly. Patients reporting hip fractures often show relevant comorbidities leading to prolonged hospital stay, significant complications and higher mortality rates. This study aims to assess the risk factors associated with prolonged hospitalization after hip fracture, in-hospital mortality and transfers to other facilities.Retrospective cross-sectional study.The study considered all admissions performed between 2006 and 2015 in Abruzzo region, Italy. Logistic regression analyses were performed to evaluate odds ratios for each risk factor as predictor of in-hospital mortality, length of stay, and transfer to other facilities.Age over 85 (OR=5.38) and cancer (OR=3.62) were identified as the strongest risk predictors for in hospital mortality; diabetes (OR=2.24) and heart failure (OR=1.57) were identified as predictors of prolonged length of stay and age over 85 (OR=1.38) and atrial fibrillation (OR=1.69) were identified as predictors of transfer to other facilities.With the rising incidence of hip fractures, identification of modifiable factors may help to reduce morbidity and mortality.

Quantifying heterogeneity in Alzheimer’s disease (AD) risk is critical for individualized care and management. Recent attempts to assess AD heterogeneity have used structural (magnetic resonance imaging (MRI)-based) or functional (Aβ or tau) imaging, which focused on generating quartets of atrophy patterns and protein spreading, respectively. Here we present a computational framework that facilitated the identification of subtypes based on their risk of progression to AD. We used cerebrospinal fluid (CSF) measures of Aβ from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) (n=544, discovery cohort) as well as the National Alzheimer’s Coordinating Center (NACC) (n=508, validation cohort), and risk-stratified individuals with mild cognitive impairment (MCI) into quartiles (high-risk (H), intermediate-high risk (IH), intermediate-low risk (IL), and low-risk (L)). Patients were divided into subgroups utilizing patterns of brain atrophy found in each of these risk-stratified quartiles. We found H subjects to have a greater risk of AD progression compared to the other subtypes at 2- and 4-years in both the discovery and validation cohorts (ADNI: H subtype versus all others, p < 0.05 at 2 and 4 years; NACC: H vs. IL and LR at 2 years, p < 0.05, and a trend toward higher risk vs. IH, and p < 0.05 vs. IH, and L risk groups at 48 months with a trend toward lower survival vs. IL). Using MRI-based neural models that fused various deep neural networks with survival analysis, we then predicted MCI to AD conversion. We used these models to identify subtype-specific regions that demonstrate the largest levels of atrophy-related importance, which had minimal overlap (Average pairwise Jaccard Similarity in regions between the top 5 subtypes, 0.25±0.05 (± std)). Neuropathologic changes characteristic of AD were present across all subtypes in comparable proportions (Chi-square test, p>0.05 for differences in ADNC, n=31). Our risk-based approach to subtyping individuals provides an objective means to intervene and tailor care management strategies at early stages of cognitive decline.

A good selection of the thermomechanical processing parameters will optimize the function of alloying elements to get the most of mechanical properties in Advanced High-Strength Steels for automotive components, where high resistance is required for passenger safety. As such, critical processing temperatures must be defined taking into account alloy composition, in order for effective thermomechanical processing schedules to be designed. These critical temperatures mainly include the recrystallization stop temperature (T5%) and the transformation temperatures (Ar1, Ar3, Bs, etc.). These critical processing temperatures were characterized using different thermomechanical conditions.T5%was determined through the softening evaluation on double hit tests and the observation of prior austenite grain boundaries on the microstructure. Phase transformation temperatures were measured by dilatometry experiments at different cooling rates. The results indicate that the strain per pass and the interpass time will influence the most on the determination ofT5%. The range of temperatures between the recrystallized and non-recrystallized regions can be as narrow as 30 °C at a higher amount of strain. The proposed controlled thermomechanical processing schedule involves getting a severely deformed austenite with a high dislocation density and deformation bands to increase the nucleation sites to start the transformation products. This microstructure along with a proper cooling strategy will lead to an enhancement in the final mechanical properties of a particular steel composition.

Telescope detectors have long been studied for their capability of discriminating the type of radiation detected. Silicon is the most widely used material for solid-state detectors. However, in many nuclear physics experiments and medical applications, diamond offers significant advantages due to its outstanding features, such as a near tissue equivalence, high radiation hardness and reliable operation in harsh environments. A monolithic ΔE–E diamond-based telescope was fabricated. The thicknesses of the two detection stages were 2.5 μm and 500 μm for the ΔE and E stage, respectively. The device was characterised by means of IBIC (Ion Beam Induced Charge) analysis at the Ruđer Bošković Institute ion microbeam. The detector, irradiated with different low energy ions ranging from helium to oxygen, showed good homogeneity of the response on a well-defined sensitive volume with a charge collection efficiency close to 100%. The ΔE stage showed a very good linear response on a wide range of LET values in diamond (170–3140 keV/μm). Due to its relatively low thickness, it can be successfully used as a microdosimeter. Time coincidence measurements have demonstrated the diamond telescope capability of discriminating and identifying the impinging ions. However, when the ratio between the energy deposited by the particle in the E stage and in the ΔE stage is small, the response of the E stage was observed to be affected by a cross-talk between the two stages of the device. A method to correct the E response for such effect was developed and successfully applied to the acquired data.

Objective. A calibration service based on a primary standard calorimeter for the direct determination of absorbed dose for proton beams does not exist. A new Code of Practice (CoP) for reference dosimetry of proton beams is being developed by a working party of the UK Institute of Physics and Engineering in Medicine (IPEM), which will recommend that ionisation chambers are calibrated directly in their clinical beams against the proposed Primary Standard Proton Calorimeter (PSPC) developed at the National Physical Laboratory (NPL). The aim of this work is to report on the use of the NPL PSPC to directly calibrate ionisation chambers in a low-energy passively scattered proton beam following recommendations of the upcoming IPEM CoP. Approach. A comparison between the dose derived using the proposed IPEM CoP and the IAEA TRS-398 protocol was performed, and k Q values were determined experimentally for three types of chambers. In total, 9 plane-parallel and 3 cylindrical chambers were calibrated using the two protocols for two separate visits. Main results. The ratio of absorbed dose to water obtained with the PSPC and with ionisation chambers applying TRS-398 varied between 0.98 and 1.00, depending on the chamber type. The new procedure based on the PSPC provides a significant improvement in uncertainty where absorbed dose to water measured with a user chamber is reported with an uncertainty of 0.9% (1 σ ), whereas the TRS-398 protocol reports an uncertainty of 2.0% and 2.3% (1 σ ) for cylindrical and plane-parallel chambers, respectively. The k Q values found agree within uncertainties with those from TRS-398 and Monte Carlo calculations. Significance. The establishment of a primary standard calorimeter for the determination of absorbed dose in proton beams combined with the introduction of the associated calibration service following the IPEM recommendations will reduce the uncertainty and improve consistency in the dose delivered to patients.

Cystic lung diseases (CLDs) are a heterogeneous group of pathophysiological entities comprising gas-filled lesions with imperceptible walls, which can occur throughout lung parenchyma. CLDs can arise from different mechanisms and may often have an unpredictable progression. As CLDs are infrequent and may be associated to many different processes, they pose a diagnostic challenge to the radiologist and referring physician. CLDs require a comprehensive diagnostic approach. An essential tool in the evaluation of CLDs is high-resolution computed tomography (HRCT). The first step is in distinction from true cysts, from other cysts mimicking entities, as emphysema, honeycombing, pneumatocoele, cavitate nodules, or bronchiectasis. Thereafter the identification of number, distribution, wall size, and other systemic manifestations provides an accurate characterisation of CLD, often avoiding further evaluation with lung biopsy. Features of pulmonary lucencies, classification of CLDs based on pathophysiological mechanisms, and radiological criteria, the less common aetiologies, and a multidisciplinary approach in pulmonary cysts are reported. Finally, a systematic diagnostic algorithm to guide radiologists in the evaluation of CLDs is discussed.

The examination of children suspected of being abused poses a great challenge for forensic pathologists. The risk of misjudgment is high and can have serious consequences for the child and the family. In unclear cases, an assessment should always be carried out on an interdisciplinary basis with the involvement of the relevant disciplines such as pediatrics, dermatology, or radiology. We present the case of a 2.5-year-old boy who was presented by his parents at the Pediatric Emergency Department of a Swiss University Hospital due to fever and weight loss. During the physical examination, conspicuous findings on the abdomen were present, and the responsible emergency physicians informed the child protective services. A clinical forensic examination occurred on behalf of the child protection services. The abdomen of the child showed several symmetrical scars. The initial questioning of the parents did not provide clear information about the origin of the injuries. Further professional questioning of the family by the child protective services concluded that the injuries were the result of a traditional medical treatment in Somalia, which occurred several weeks before.

The main purpose of this paper is to quantitatively study the possibility of delivering dose distributions of clinical relevance with laser-driven proton beams. A Monte Carlo application has been developed with the Geant4 toolkit, simulating the ELIMED (MEDical and multidisciplinary application at ELI-Beamlines) transport and dosimetry beam line which is being currently installed at the ELI-Beamlines in Prague (CZ). The beam line will be used to perform irradiations for multidisciplinary studies, with the purpose of demonstrating the possible use of optically accelerated ion beams for therapeutic purposes. The ELIMED Geant4-based application, already validated against reference transport codes, accurately simulates each single element of the beam line, necessary to collect the accelerated beams and to select them in energy. Transversal dose distributions at the irradiation point have been studied and optimized to try to quantitatively answer the question if such kind of beam lines, and specifically the systems developed for ELIMED in Prague, will be actually able to transport ion beams not only for multidisciplinary applications, such as pitcher-catcher nuclear reactions (e.g. neutrons), PIXE analysis for cultural heritage and space radiation, but also for delivering dose patterns of clinical relevance in a future perspective of possible medical applications.

Preclinical studies represent an important step towards a deep understanding of the biological response to ionizing radiations. The effectiveness of proton therapy is higher than photons and, for clinical purposes, a fixed value of 1.1 is used for the relative biological effectiveness (RBE) of protons considered 1.1. Recent in vitro studies have reported that the RBE along the spread-out Bragg peak (SOBP) is not constant and, in particular, the RBE value increases on the distal part of SOBP. The present work has been carried-out in the perspective of a preclinical hadrontherapy facility at LNS-INFN and was focused on the experimental preparation of an in vivo study concerning the RBE variation along the SOBP. The main purpose of this work was to determine, using GEANT4-based Monte Carlo simulations, the best configuration for small animal treatments. The developed GEANT4 application simulates the proton-therapy beam line of LNS-INFN (CATANA facility) and allows to import the DICOM-CT images as targets. The RBE will be evaluated using a deterministic radiation damage like myelopathy as end-point. In fact, the dose at which the 50% of animals will show the myelopathy is supposed to be LET-dependent. In this work, we studied different treatment configurations in order to choose the best two that maximize the LET difference reducing as much as possible the dose released to healthy tissue. The results will be useful to plan hadrontherapy treatments for preclinical in vivo studies and, in particular, for the future in vivo RBE studies.

Background: Geant4 is a Monte Carlo code extensively used in medical physics for a wide range of applications, such as dosimetry, micro- and nanodosimetry, imaging, radiation protection, and nuclear medicine. Geant4 is continuously evolving, so it is crucial to have a system that benchmarks this Monte Carlo code for medical physics against reference data and to perform regression testing. Aims: To respond to these needs, we developed G4-Med, a benchmarking and regression testing system of Geant4 for medical physics. Materials and Methods: G4-Med currently includes 18 tests. They range from the benchmarking of fundamental physics quantities to the testing of Monte Carlo simulation setups typical of medical physics applications. Both electromagnetic and hadronic physics processes and models within the prebuilt Geant4 physics lists are tested. The tests included in G4-Med are executed on the CERN computing infrastructure via the use of the geant-val web application, developed at CERN for Geant4 testing. The physical observables can be compared to reference data for benchmarking and to results of previous Geant4 versions for regression testing purposes. Results: This paper describes the tests included in G4-Med and shows the results derived from the benchmarking of Geant4 10.5 against reference data. Discussion: Our results indicate that the Geant4 electromagnetic physics constructor G4EmStandardPhysics_option4 gives a good agreement with the reference data for all the tests. The QGSP_BIC_HP physics list provided an overall adequate description of the physics involved in hadron therapy, including proton and carbon ion therapy. New tests should be included in the next stage of the project to extend the benchmarking to other physical quantities and application scenarios of interest for medical physics. Conclusion: The results presented and discussed in this paper will aid users in tailoring physics lists to their particular application. Ministerio de Economía y Competitividad FPA2016-77689-C2-1-R National Institutes of Health U24CA215123 France-Greece PICS 8235 European Space Agency 4000126645/19/NL/BW Australian Research Council ARC DP170100967, DP170102423 Susan G Komen Foundation for the Cure IIR13262248

Direct or indirect damages due to foreign object impacts on aeronautical structures, represent a major concern. The problem potentially intensifies with the adoption of composite materials, especially due to Barely Visible Impact Damage (BVID). In this context, understanding whether an impact event gives rise to delamination or debonding is highly desirable in view of the optimization of the maintenance strategies and, at the same time, of the safety margins associated to the operation of the structures. One possible method to achieve this goal is that of integrating damage monitoring systems within the vehicle architecture itself. By doing so, in fact, the enhanced structural health state awareness allows the implementation of Predictive Maintenance philosophies and the possibility to detect damage with size/severity and indentation smaller than the BVID currently applied by design and certification. In this work, a simple and a stiffened carbon fiber panel are subjected to Low Velocity Impacts using falling masses to generate a structural damage. A sensor network made of Piezoelectric elements (PZT) allows the application of Ultrasonic techniques, to monitor the damaged structure and calculate signal related features called Damage Indexes (DIs). The DI capability to identify the damage is then thoroughly investigated, with specific reference to: (i) effect of signal averaging, (ii) effect of reduced sensor network configurations and (iii) effect of sensor faults.

Purpose: Introduction of cyclin-dependent inhibitors was a milestone in therapeutics for patients with estrogen receptor+/HER2− metastatic breast cancer. Despite the wide use of such agents and remarkable improvement of survival rates, drug-related adverse events are not yet fully characterized. We describe vitiligo-like lesions as a new adverse event occurring in patients with advanced breast cancer treated with cyclin-dependent inhibitors. Methods: We performed an international retrospective study including patients with advanced breast cancer who developed vitiligo-like lesions during treatment with cyclin-dependent kinases 4 and 6 inhibitors, in the period January 2018–December 2019. Patients > 18 years, both males and females, were recruited at six Dermatology Departments located in Italy (3), France (1) and Greece (2). We evaluated epidemiological and clinical characteristics, impact on quality of life and outcome of vitiligo-like lesions in patients treated with cyclin-dependent 4 and 6 inhibitors. The percentage of skin involved by vitiligo-like lesions was assessed using the Body Surface Area (BSA) score. Changes in patients’ quality of life were investigated through the evaluation of the Dermatology Life Quality Index (DLQI) questionnaire. Results: Sixteen women (median age: 62.5 years; range 40–79 years) treated with cyclin-dependent kinases 4 and 6 inhibitors for advanced breast cancer presented with vitiligo-like lesions during follow-up visits. Cutaneous lesions consisted of white, irregular macules and patches located mainly on sun-exposed areas in 11/16 patients or diffuse to the entire body surface in 5/16. Cutaneous lesions clearly impaired the quality of life of patients tested (DLQI ≥ 10). Conclusions: We present for the first time, to our knowledge, a case series of vitiligo-like lesions developing in patients with advanced breast cancer treated with cyclin-dependent kinases 4 and 6 inhibitors. We showed that such lesions further impair the patients’ quality of life and their treatment is challenging. © 2020, Springer Science+Business Media, LLC, part of Springer Nature.

A liquid Li vapour-box divertor is an attractive heat exhaust solution for future fusion reactors. Previous works have established the ability of vapour shielding to protect the wall, but it has not been possible to directly determine the effects of Li vapour on the plasma parameters. Experiments to investigate this were carried out in Magnum-PSI, which is able to generate a plasma with DEMO-divertor relevant conditions. 3D printed tungsten capillary porous structures filled with Li have been used as targets. A reciprocating Langmuir probe was used to determine electron temperature and density close to the target, while the power reduction to the coolant due to vapour shielding was increased from 0% to 50%. The Langmuir probe measurements directly determined an increase of density by up to 50% while electron temperature could be inferred to have dropped by up to 33% compared to the solid target reference case.

La patologia infettiva del tratto vulvovaginale

Summary As part of a research project aimed at drawing up a restoration project for the church of San Paolo, the monument was investigated with georadar surveys. The investigations were followed in a targeted manner by archaeological excavations, under the supervision of the Superintendence of Cultural and Environmental Heritage of Palermo. The San Paolo church is located in the oldest part of the city. The geophysical investigations will be useful to identify any pre-existing structures on which the church could be founded. The georadar investigations focused on the central nave and one of the side aisles to identify buried structures and crypts. The data showed several anomalies. One of these, located in the middle of the central nave, has been verified with an excavation. The entrance to a crypt, not yet explored, and several bone fragments were then found. Finally, some high-frequency profiles were acquired in the walls and columns of the church, which highlighted numerous anomalies that will be verified with exploratory tests.

Highlights • AEA and 2-AG play part in different stages of IFN-α induced immune response. • AEA might be acting in the immunoregulation of chronic inflammation. • 2-AG may be involved in the initial stages of inflammatory response. • Targeting eCB signalling may be of interest as an anti-inflammatory treatment., The endocannabinoid (eCB) system is one of the key players in immunoregulation, and reduced activity of the eCB system has been linked with depressive-like behaviours in animal studies and depression in clinical samples. There is a well-established link between immune activation and depression, such as following the administration of the pro-inflammatory cytokine, interferon-α (IFN-α), used to treat hepatitis C viral (HCV) infection. However, the role of peripheral endocannabinoids (eCBs), anandamide (AEA) and 2-arachidonoylglycerol (2-AG), following immunotherapy with IFN-α and in IFN-α -induced depression, have not been examined yet. In this study, we investigated whether circulating AEA and 2-AG were modified by treatment with IFN-α and whether they were involved in the development of IFN-α-induced depression. We also explored whether circulating eCBs were associated with peripheral cytokines during and after IFN-α treatment. We measured serum concentrations of AEA and 2-AG using High Performance Liquid Chromatography with Tandem Mass Spectrometry, and serum concentrations of cytokines using Meso Scale Discovery electrochemiluminescence V-PLEX assay, in 70 patients with HCV infection and 41 healthy subjects. We assessed HCV patients at baseline, IFN-α-treatment weeks (TW) 4 and 24, end of treatment (END) and at six months follow-up (FU). We assessed depression using M.I.N.I. International Neuropsychiatric Interview. We found a different pattern of change in peripheral AEA and 2-AG during and after IFN-α treatment. Whilst 2-AG increased earlier in immunotherapy (TW4), remained elevated throughout treatment, and reduced at six months follow-up (FU), AEA increased later in treatment (TW24) and remained elevated six months post-treatment. We also found that baseline levels of AEA were lower in HCV patients compared with healthy controls, whereas there were no differences in 2-AG levels. Interestingly, AEA, but not 2-AG, was significantly, negatively correlated with interleukin (IL)-2 and IL-17a at six months follow-up. We did not find any difference in both eCBs between patients with and without IFN-α-induced depression, at any time point. Our findings suggest that AEA and 2-AG are involved in different stages of immunoregulation following IFN-α treatment, where AEA might be involved in chronic inflammation. Lack of association between peripheral eCBs and IFN-α-induced depression suggests that different biological mechanisms may underpin inflammation-induced depression compared with classic “psychiatric” depression, or that any changes in the eCB system in depression may not be captured by peripheral AEA and 2-AG.

Significant challenges in the detection of laser-accelerated ions result from the high flux (1010-1012 ions/pulse) and the short bunch duration which are intrinsic to laser-driven sources. The development of diagnostic techniques able to operate in real-time and on a high-rep basis is a key step towards multidisciplinary applications of such non-conventional beams. Real time diagnosis of the main beam parameters for high-energy protons accelerated by the Vulcan Petawatt (VULCAN-PW) laser system has been performed using an on line diagnostics based on the Time of Flight (TOF) technique and the use of diamond detectors. Proton energy spectra have been measured for energies exceeding 30 MeV. The results show that the TOF method employing state-of-the-art detectors is a robust real-time diagnostics, able to operate efficiently under the harsh conditions occurring with kJ-class, PW laser systems, and offering the possibility to monitor on a shot-by-shot basis the main beam parameters of high intensity proton bunches for energies up to the 100 MeV level.

Detailed characterisation of the Roos secondary standard plane-parallel ionisation chamber has been conducted in a novel 200 MeV Very High Energy Electron (VHEE) beam with reference to the standard 12 MeV electron calibration beam used in our experimental work. Stopping-power-ratios and perturbation factors have been determined for both beams and used to calculated the beam quality correction factor using the Geant4 general purpose MC code. These factors have been calculated for a variety of charged particle transport parameters available in Geant4 which were found to pass the Fano cavity test. Stopping-power-ratios for the 12 MeV electron calibration beam quality were found to agree within uncertainties to that quoted by current dosimetry protocols. Perturbation factors were found to vary by up-to 4% for the calibration beam depending on the parameter configuration, compared with only 0.8% for the VHEE beam. Beam quality correction factors were found to describe an approximately 10% lower dose than would be originally calculated if a beam quality correction were not accounted for. Moreover, results presented here largely resolve unphysical chamber measurements, such as collection efficiencies greater than 100%, and assist in the accurate determination of absorbed dose and ion recombination in secondary standard ionisation chambers.

The objective of the ACONIT project is to design, manufacture and test actuators for flow control for an implantation in an aircraft engine. The actuators will fulfil aeronautics requirement in order to increase the Technology Readiness Level (TRL) in this domain. In particular, for the present proposal, one plans to focus on the extension of the stable operating range of axial compressor, allowing thus a reduction of the surge margin through postponing the stall onset. To do so, the first objective of the work is to improve the knowledge of the flow physics of an efficient flow control system by joint numerical and experimental analyses performed in a low speed, single stage axial compressor. The results of this analysis will be used to derive the fluidic specifications for high-TRL actuators and control systems. These specifications will be the base for the design and manufacturing of amplified piezo-electric actuator prototypes whose fluidic performance and operational performance in an environment with vibration and controlled level of temperature will be precisely evaluated before manufacturing final actuators that will be integrated in a full-scale engine test facility. Their performance will be evaluated in terms of Surge Margin Improvement (SMI) as well as in terms of energy balance between the induced consumption and the machine performance improvements. The consortium grouped for carrying out this project is composed of a SME (CTEC), two academic institutions (Bundeswehr University Munich and ENSAM) and a Research Centre (ONERA). It groups skills ranging from internal flow analysis in turbomachinery, to flow control or actuators design, manufacturing and characterisations. This project (ACONIT Project) has received funding from the Clean Sky 2 Joint Undertaking under the European Union’s Horizon 2020 research and innovation programme under grant agreement No. 886352

Several social, economic and political factors have contributed to the global spread of alcohol and other drugs. Drug addiction represents a huge expense for the society in terms of direct and indirect health and social consequences, as it is associated with numerous medical issues such as HIV, other infections and psychiatric disturbances.The aim of this study was the assessment of the hospital admissions among drug addicted patients in Abruzzo Region, central Italy, from 2006 to 2015, in order to clarify the specific causes of hospitalization.Data were collected from all hospital discharge records, taking into account only the hospital discharge registrations coded 304 (drug dependence). Multivariate logistic regression was performed to evaluate factors associated with main causes of the admission.Between 2006 and 2015, an amount of 2,159 drug-addicted subjects, aged 38.0±9.7 years, were admitted to hospital. Most of the admissions occurred in public hospitals (2,039, 94.4%), through the emergency room access (1,503, 69.6%) From an amount of 2,159 hospitalizations, 1,178 (54.6%) were first and 981 (45.4%) were subsequent admissions. The most frequent cause of hospitalization was "Psychosis" (419, 19.4%). The trend by range of age showed a progressive reduction in hospital admissions for patients aged45 y. Further, an increase in the hospitalization rate was estimated over recent years among drug addict subjects aged 25-45 years. Cannabis consumption was associated with mental disorder admissions (OR: 3.16, p0.001), opioid consumption was associated with hepatic disorder admission (OR:2.16, p0.001) and cardiovascular admissions (OR: 1,78, p0.001), and cocaine was associated with cardiovascular admissions (OR:1,55, p:0.001).Mental disorders result to be the leading cause of hospitalization among drug-addicts, principally associated with cannabis abuse. Opioid and cocaine abuse was associated with hepatic and cardiovascular disorders.

High dose-rate radiotherapy, known as FLASH, has been shown to increase the differential response between healthy and tumour tissue. Moreover, Very High Energy Electrons (VHEEs) provide more favourable dose distributions than conventional radiotherapy electron and photon beams. Plane-parallel ionisation chambers are the recommended secondary standard systems for clinical reference dosimetry of electrons, therefore chamber response to these high energy and high dose-per-pulse beams must be well understood. Graphite calorimetry, the UK primary standard, has been employed to measure the dose delivered from a 200 MeV pulsed electron beam. This was compared to the charge measurements of a plane-parallel ionisation chamber to determine the absolute collection efficiency and infer the ion recombination factor. The dose-per-pulse measured by the calorimeter ranged between 0.03 Gy/pulse and 5.26 Gy/pulse, corresponding to collection efficiencies between 97% and 4%, respectively. Multiple recombination models currently available have been compared with experimental results. This work is directly applicable to the development of standard dosimetry protocols for VHEE radiotherapy, FLASH radiotherapy and other high dose-rate modalities. However, the use of secondary standard ionisation chambers for the dosimetry of high dose-per-pulse VHEEs has been shown to require large corrections for charge collection inefficiency.

Testicular torsion is a known cause of morbidity in pediatric patients, but the burden in the adult population is poorly understood. We sought to determine the incidence of testicular torsion and risk factors for orchiectomy in a population encompassing all ages. A cohort analysis of 1625 males undergoing surgery for torsion was performed using the 2011 and 2012 Healthcare Cost and Utilization Project Nationwide Emergency Departments Sample. Patient and hospital factors were examined for association with orchiectomy vs. testicular salvage. The estimated yearly incidence of testicular torsion was 5.9 per 100,000 males ages 1-17 years and 1.3 per 100,000 males ≥18 years. Among those undergoing surgical intervention, orchiectomy was performed in 33.6%. The risk of orchiectomy was highest in patients 1-11 years of age and patients over 50 years of age (46.0% and 69.7% of patients, respectively). Orchiectomy was also associated with public insurance (Medicaid/Medicare) or self-pay as primary payer. While testicular torsion is less common in the adult population, the rate of orchiectomy is high. Those with disadvantaged payer status are also at increased risk for testicular loss.

Phacoemulsification is the most frequently performed surgery in the world. Over the past few years, this surgery seems to have reached a plateau with no further innovative breakthroughs. In this paper, we focus on alternatives techniques, the latest innovations, and the research and development pipeline in this field.