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Sewage sludge is a by-product of wastewater treatment processes, and may be employed in agriculture as a fertilizer or in forestry for land reclamation. It is an important source of nutrients but its reuse can arouse concern on account of the wide range of contaminants that are retained and may persist during treatments. Information on the emerging contaminants (ECs) in sewage sludge in Italy is limited. The present study developed and applied a reliable analytical method for the analysis of 44 ECs in sewage sludge. ECs were extracted by accelerated solvent extraction followed by a clean-up step on solid-phase cartridges. High performance liquid chromatography coupled to mass spectrometry was used for analysis. The ECs, selected on the basis of their use and documented presence in the environment, were 42 pharmaceuticals belonging to 12 therapeutic categories and 2 perfluorinated substances. The method performance was good, with recoveries higher than 70%, good repeatability (

Nutrition and metabolism are altered in patients with gastroenteropancreatic neuroendocrine tumors, which is related to excessive production of gastrointestinal hormones, peptides, and amines that can cause maldigestion, diarrhea, steatorrhea, and altered gastrointestinal motility. Patients with carcinoid syndrome are at risk of malnutrition due to tryptophan depletion, reduced intake of food, and loss of appetite because of diarrhea and/or flushing. To date, there is limited information on the nutritional issues faced by patients with neuroendocrine tumors, and on what specific recommendations should be made to patients concerning nutrition at various stages of the disease process. Dietary planning should therefore be an integral part of multidisciplinary management for patients with neuroendocrine tumors. Herein, we review current guidance for nutrition in patients with neuroendocrine tumors, focusing on intake of amines and foods to avoid, as well as concurrent medications. We also propose a new and practical food pyramid based on the principles of Mediterranean diet 4.0 that can be easily adapted according to the unmet needs of patients with neuroendocrine tumors at all stages of disease. The overarching goal of the present review is to create greater awareness of nutritional care and considerations that should be given to patients with neuroendocrine tumors.

In the last decades, decentralization reforms have often come to the fore of the policy debate in both OECD and non-OECD countries. In spite of the many theorised virtues, these reforms might fail to deliver when local institutions are too weak to guarantee higher accountability of local policy-makers to constituents. To support this argument, this paper analyses the political economics of decentralization reforms in three countries (Burundi, Brazil and Belgium) that differ in terms of their stage of development as well as the “intensity” of their decentralized institutions. In unstable political settings—like those characterising post-conflict countries—, decentralization may fail if leaders exploit entrenched rivalries to weaken local institutions and compete unfairly for power. In more stable settings, decentralization may entail coordination costs that prevent local leaders to jointly provide a decentralized public service and even create incentives for free-riding. Local political dynamics may exacerbate these coordination costs, with collusion among politically aligned leaders blurring their accountability to citizens and leading to lower-quality public services.

Introduction: Total knee replacement is the treatment of choice in knee osteoarthritis. Despite this, there is still a percentage of unsatisfied patients. Recently, prosthetic designs have been developed to improve the kinematics of the prosthetic knee. Materials and methods: Between June 2016 and November 2016 we enrolled 26 patients underwent to total knee arthroplasty divided in two groups (A and B) treated respectively with Journey 2 implant and the Attune impltant. Each patient was evaluated with functional scores (KOOS and KSS) and with kinematic analysis using the Bioval System. Results: In the group A, compared to the pre-operative, the flexion of the operated knees is significantly increased (31.27°±3.13° → 35.02°±2.1°) as well as that of the unoperated knee (34.34°±2.8° → 35.39°±3.5°). The pre/post-operative comparison of the muscles’ activation timing showed an improvement for the unoperated side, which is closed to the physiological pattern, while the operated side showed an incorrect activation of all the investigated muscles. Conclusions: The Journey 2 prosthesis seems to reach better results in rotational flexion, rotational freedom and muscles activation during free walking. Furthermore, it seems that with this prosthesis the patient can feel his “new prosthetic knee” more similar and closer to the physiological one. More studies are needed to confirm these results. (www.actabiomedica.it)

Lung ultrasound is increasingly used in emergency departments, medical wards, and critical care units—adult, pediatric, and neonatal. In vitro and in vivo studies show that the number and type of artifacts visualized change with lung density. This has led to the idea of a quantitative lung ultrasound approach, opening up new prospects for use not only as a diagnostic but also as a monitoring tool. Consequently, the multiple scoring systems proposed in the last few years have different technical approaches and specific clinical indications, adaptable for more or less time-dependent patients. However, multiple scoring systems may generate confusion among physicians aiming at introducing lung ultrasound in their clinical practice. This review describes the various lung ultrasound scoring systems and aims to clarify their use in different settings, focusing on technical aspects, validation with reference techniques, and clinical applications.

International co-operation, with the aim to facilitate research in the Antarctic, plays a pivotal role for logistic support and for the deployment of scientific projects run by multiple cou...

We aim at understanding the triggers of electoral violence, which spoiled 80% ofelections in Africa during the last decades. We focus on Burundi, a country wherepolls were organized in 2010, only few months after the end of a long-lasting civilwar. We find that an acute polarization between ex-rebels’ groups is highly conduciveto electoral violence. In particular, we predict a five-fold increase in electoralviolence between the lowest- and highest-polarized municipality. However, neitherethnic nor political cleavages significantly determine such electoral malpractices.These results are robust to numerous specifications. We therefore argue that policiessupporting the transition of ex-rebel groups from warfare to the political arenashould be reinforced., info:eu-repo/semantics/published

This study aimed to determine if dietary modifications using a nutritional regimen could prevent or reduce the incidence of cancer therapy-induced diarrhea in patients with metastatic colorectal cancer and to evaluate the relationship of Vitamin D blood levels with diarrhea severity. Patients with metastatic colorectal cancer were enrolled. A Mediterranean diet, containing some special limitations aiming to reduce the risk of diarrhea, was administered before and during the entire chemotherapy program. Enrolled patients numbering 60/137 (44%) had diarrhea during chemotherapy. Adherence to the diet was high in 36 (26.3%) patients, medium in 94 (68.6%), and low in 7 (5.1%). Mean adherence to the diet was significantly lower in patients who experienced diarrhea with maximum grade 2–3 compared to those who had no diarrhea or grade 1 diarrhea (score = 5.4 ± 1.9 vs. 7.1 ± 1.5, p < 0.001). Patients with higher adherence to the diet had a lower risk of grade 2–3 diarrhea (odds ratio: 0.5 (95% CI: 0.3–0.7, p < 0.001)). In addition, patients who completed a higher number of chemotherapy cycles had an increased risk of grade 2–3 diarrhea (odds ratio: 1.2 (95% CI: 1.0–1.5, p = 0.02)). Of note, a lower level of Vitamin D correlated with an increased risk of G2-G3 diarrhea (p = 0.03). A diet based on vegetables with a controlled fiber content, Mediterranean Modified Healthy Diet (MMHD), is useful to control the incidence of cancer therapy-induced diarrhea.

Summary In recent decades, a significant number of developing countries have implemented fiscal incentives programs for the tourism industry as part of their regional development policies. The main objective of these programs is to increase local investment and employment, as tourism activities are labor intensive. Little evidence is available, however, to assess the effect of these policies on job creation in emerging markets. In this paper, we analyze a program of fiscal incentives introduced by the Brazilian federal government in the SUDENE area in 2002 and in which tourism firms were eligible to participate. Through a difference-in-difference estimation, we compare the change in the logarithm of local employment in the SUDENE municipalities before and after 2002 to the change in the same outcome in a group of municipalities that were not affected by the program. Although our empirical analysis does not measure the efficiency of a similar fiscal policy, it is the first one in the literature to show its effectiveness. It provides evidence that the fiscal incentives led to a substantial increase in tourism employment in the SUDENE area. We find that, over the period 2002–09, municipal tourism employment was on average 30% higher than in the absence of the intervention. This result is robust and is not the consequence of either displacement effects or job destruction in neighboring municipalities that had not been targeted by the tax incentives. We finally discuss some limitations of our analysis that might open avenues for future research in the field.

Ultrasound is a useful tool for integrating clinical assessment with a bedside reliable imaging technique, but it requires adequate training. Ultrasonographic training involves examination performed on human models, in which many pathologic findings are not always readily available for the trainee to observe. The possibility of creating test objects that reproduce pathologic images allows the provision of training courses with those elements that are not always available. Our aims were to describe how to create a urinary bladder test object and to test its image quality and usefulness. Thus, we compared computed volume with the actual filling volume for five different devices to assess their reliability in volume estimation. Moreover, we evaluated the image quality and teaching utility using a 5-point Likert-type questionnaire among a group of learners. Computed bladder volume had excellent correlation with actual filling volume (p

La malattia metastatica in oncologia testa-collo.Il distretto testa e collo rappresenta una delle più comuni sedi di insorgenza di malattie oncologiche, con una percentuale di disseminazioni metastatiche elevata tanto a livello loco-regionale quanto a distanza. La prognosi di questi tumori è strettamente legata ad alcuni fattori principali: a) lo stadio della malattia; b) le recidive loco-regionali; c) le metastasi a distanza. Nei tumori della testa e del collo le metastasi a distanza sono presenti in circa il 10% dei casi al momento della prima diagnosi e si rendono evidenti nel corso della malattia in un ulteriore 20%-30% dei casi. Quando una metastasi a distanza a partenza da un tumore della testa e del collo si rende evidente, la prognosi viene usualmente considerata infausta, con una sopravvivenza media stimabile intorno ai 10 mesi. Scopo del presente lavoro è quello di fornire un up-todate aggiornato ed esaustivo in tema di metastasi a distanza in oncologia cervico-cefalica alla luce delle più recenti conoscenze. Concetti di recente acquisizione quali l’assetto molecolare dei tumori, le possibili interazioni tra cellule tumorali e tessuti, le peculiarità della malattia oligometastatica, il ruolo dell’immunoterapia… stanno profondamente cambiando l’approccio terapeutico in questi pazienti, con interessanti ricadute in tema di controllo di malattia. I primi capitoli sono dedicati alla storia naturale ed all’epidemiologia delle metastasi a distanza nei tumori della testa e del collo ed al loro inquadramento diagnostico anatomo-patologico e radiologico. Nei capitoli successivi vengono focalizzate le più rilevanti peculiarità cliniche con particolare attenzione agli argomenti di recente attualità quali le metastasi a distanza da tumori EBV ed HPV positivi ed il concetto di malattia oligometastatica. Ampio spazio viene destinato alle varie opzioni terapeutiche con particolare attenzione al sempre più rilevante ruolo dell’immunoterapia ed allo sviluppo di nuove tecnologie terapeutiche. In conclusione, vengono focalizzate le problematiche etico-cliniche legate al concetto di fragilità del paziente oncologico e le crescenti difficoltà di una sostenibile governance socio-economica.The head and neck district represents one of the most frequent sites of cancer, and the percentage of metastases is very high in both loco-regional and distant areas. Prognosis refers to several factors: a) stage of disease; b) loco-regional relapses; c) distant metastasis. At diagnosis, distant metastases of head and neck cancers are present in about 10% of cases with an additional 20-30% developing metastases during the course of their disease. Diagnosis of distant metastases is associated with unfavorable prognosis, with a median survival of about 10 months. The aim of the present review is to provide an update on distant metastasis in head and neck oncology. Recent achievements in molecular profiling, interaction between neoplastic tissue and the tumor microenvironment, oligometastatic disease concepts, and the role of immunotherapy have all deeply changed the therapeutic approach and disease control. Firstly, we approach topics such as natural history, epidemiology of distant metastases and relevant pathological and radiological aspects. Focus is then placed on the most relevant clinical aspects; particular attention is reserved to tumours with distant metastasis and positive for EBV and HPV, and the oligometastatic concept. A substantial part of the review is dedicated to different therapeutic approaches. We highlight the role of immunotherapy and the potential effects of innovative technologies. Lastly, we present ethical and clinical perspectives related to frailty in oncological patients and emerging difficulties in sustainable socio-economical governance.

Background: lung ultrasound(LUS) score allows reliable quantification of loss of aeration[1] and was applied to monitor lung aeration[2]. Aims: To determine if LUS score early identifies responders to non-invasive respiratory support. Methods: prospective observational multicenter study. Hypoxemic patients(PaO2/FiO2 Results: 18 enrolled supports in 16 patients (males 7, age 71.5[62.5-73.5]year-old, BMI 25.6[24.2-29.8]kg/m2, SAPS2 38.5[29.0-48.0]) admitted to ICU for respiratory failure(7), abdominal(4) and vascular(2) surgery, neurological issues(2), HELLP syndrome(1). They required non-invasive support for weaning failure(6), community-acquired pneumonia(4), cardiogenic edema(3), aspiration pneumonia(3). The support was delivered by helmet CPAP(83.3%) and HFNC(16.7%); 4 were non-responders(22.2%). LUS score, PaO2/FiO2 and respiratory rate(RR) before(T0) and after 2hours(T1) of treatment are in Tab1. LUS score and PaO2/FiO2 after 2 hours predicted respiratory support failure with AUC 0.875 and 0.750 respectively. Conclusions: LUS score may early identify responders to non-invasive respiratory support. References: 1. Chiumello D., Crit Care Med 2018 2. Mojoli F., Am J Resp Crit Care Med 2018

Purpose: Open lung strategy during ARDS aims to decrease the ventilator-induced lung injury by minimizing the atelectrauma and stress/strain maldistribution. We aim to assess how much of the lung is opened and kept open within the limits of mechanical ventilation considered safe (i.e., plateau pressure 30cmH2O, PEEP 15cmH2O). Methods: Prospective study from two university hospitals. Thirty-three ARDS patients (5 mild, 10 moderate, 9 severe without extracorporeal support, ECMO, and 9 severe with it) underwent two low-dose end-expiratory CT scans at PEEP 5 and 15cmH2O and four end-inspiratory CT scans (from 19 to 40cmH2O). Recruitment was defined as the fraction of lung tissue which regained inflation. The atelectrauma was estimated as the difference between the intratidal tissue collapse at 5 and 15cmH2O PEEP. Lung ventilation inhomogeneities were estimated as the ratio of inflation between neighboring lung units. Results: The lung tissue which is opened between 30 and 45cmH2O (i.e., always closed at plateau 30cmH2O) was 10±29, 54±86, 162±92, and 185±134g in mild, moderate, and severe ARDS without and with ECMO, respectively (p&nbsp

Air quality is a major point in current health policies in force globally to protect human health and ecosystems. Cardiovascular and lung diseases are the pathologies most commonly associated with air pollution and it has been estimated that exposure to particulate matters and ground-level ozone and nitric oxides caused > 500.000 premature deaths in Europe. Although air quality was generally improved in the recent years, further efforts are required to reduce the impact of air pollution on humans. The present study applied a multidisciplinary approach to estimate the adverse effects on the health of the inhabitants of the Olona Valley in the north of Italy. Chemical analyses quantified the air levels of metals, dioxins, PCBs, PAHs and some macropollutants, including total, fine and coarse airborne particles. These results were used as input for the health risk assessment and in vitro bioassays were used to evaluate possible adverse effects on the respiratory tract due to the organic pollutants adsorbed on the airborne particulate matter. Critical alerts were identified from the air characterization and from the chemical-based risk assessment in view of the levels of arsenic, nickel, benzene, fine and coarse particulate matters found in the investigated zone, which can induce severe adverse effects on human health. These findings were confirmed by bioassays with A549 and BEAS-2B cells. We also used the cell transformation assay with BALB/c 3T3 cells to assess the carcinogenicity of the organic extracts of collected particles as an innovative tool to establish the possible chronic effects of inhaled pollutants. No significant changes in morphological transformation were found suggesting that, although the extracts contain compounds with proven carcinogenic potential, in our experimental conditions the levels of these pollutants were too low to induce carcinogenesis as resulted also by the chemical-based risk assessment.

The assessment of lung recruitability in patients with acute respiratory distress syndrome (ARDS) may be important for planning recruitment maneuvers and setting positive end-expiratory pressure (PEEP).To determine whether lung recruitment measured by respiratory mechanics is comparable with lung recruitment measured by computed tomography (CT).In 22 patients with ARDS, lung recruitment was assessed at 5 and 15 cm H2O PEEP by using respiratory mechanics-based methods: (1) increase in gas volume between two pressure-volume curves (P-Vrs curve); (2) increase in gas volume measured and predicted on the basis of expected end-expiratory lung volume and static compliance of the respiratory system (EELV-Cst,rs); as well as by CT scan: (3) decrease in noninflated lung tissue (CT [not inflated]); and (4) decrease in noninflated and poorly inflated tissue (CT [not + poorly inflated]).The P-Vrs curve recruitment was significantly higher than EELV-Cst,rs recruitment (423 ± 223 ml vs. 315 ± 201 ml; P 0.001), but these measures were significantly related to each other (R(2) = 0.93; P 0.001). CT (not inflated) recruitment was 77 ± 86 g and CT (not + poorly inflated) was 80 ± 67 g (P = 0.856), and these measures were also significantly related to each other (R(2) = 0.20; P = 0.04). Recruitment measured by respiratory mechanics was 54 ± 28% (P-Vrs curve) and 39 ± 25% (EELV-Cst,rs) of the gas volume at 5 cm H2O PEEP. Recruitment measured by CT scan was 5 ± 5% (CT [not inflated]) and 6 ± 6% (CT [not + poorly inflated]) of lung tissue.Respiratory mechanics and CT measure-under the same term, "recruitment"-two different entities. The respiratory mechanics-based methods include gas entering in already open pulmonary units that improve their mechanical properties at higher PEEP. Consequently, they can be used to assess the overall improvement of inflation. The CT scan measures the amount of collapsed tissue that regains inflation. Clinical trial registered with www.clinicaltrials.gov (NCT00759590).

International audience; We evaluate in this paper different strategies for the construction of a statistical shape model (SSM) of the left ventricle (LV) to be used for segmentation in cardiac magnetic resonance (CMR) images. From a large database of LV surfaces obtained throughout the cardiac cycle from 3D echocardiographic (3DE) LV images, different LV shape models were built by varying the considered phase in the cardiac cycle and the registration procedure employed for surface alignment. Principal component analysis was computed to describe the statistical variability of the SSMs, which were then deformed by applying an active shape model (ASM) approach to segment the LV endocardium in CMR images of 45 patients. Segmentation performance was evaluated by comparing LV volumes derived by ASM segmentation with different SSMs and those obtained by manual tracing, considered as a reference. A high correlation (r2 > 0.92) was found in all cases, with better results when using the SSM models comprising more than one frame of the cardiac cycle.

The present study shows the results of perfuorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA), brominated dioxins (PBDDs) and furans (PBDFs) measured in several marine fish and seafood of commercial interest at different trophic levels of the food chain. The aims were to investigate the level of the contamination in Mediterranean aquatic wildlife, and in farmed fish, to assess human exposure associated to fishery products consumption. Samples of wild fish were collected during three different sampling campaigns in different Food and Agriculture Organization (FAO) 37 areas of the Mediterranean Sea. In addition, farmed fish (gilthead sea bream and European sea bass) from off-shore cages from different marine aquaculture plants. Results showed contamination values of PFOS and PFOA were lower than those detected in sea basins other than the Mediterranean Sea. Concentration values of PFOS were generally higher than those of PFOA, moreover, levels in farmed fish were lower than in wild samples from the Mediterranean Sea. Intake of PFOS and PFOA through fishery products consumption was estimated to be 2.12 and 0.24 ng/kg&middot, BW&middot, day, respectively, for high consumers (95th percentile). Results of 2,3,7,8-substituted congeners of PBDDs and PBDFs were almost all below the limit of detection (LOD), making it difficult to establish the contribution of these compounds to the total contamination of dioxin-like compounds in fish and fishery products.

BACKGROUND The leading cause of early mortality after lung transplantation is Primary graft dysfunction (PGD). We assessed the lung inflammation, inflation status and inhomogeneities after lung transplantation. Our purpose was to investigate the possible differences between patients who did or did not develop PGD. METHODS We designed a prospective observational study enrolling patients who underwent a CT-PET study within 1 week after lung transplantation. Twenty-four patients (10 after double- and 14 after single-lung) were enrolled. Respiratory and hemodynamic data were collected before, during and after lung transplantation. Each patient underwent computed tomography-positron emission tomography (CT-PET) scan early after surgery. Broncho-alveolar lavage (BAL) fluid collection was performed to analyze inflammatory mediators. RESULTS The grafts showed a [18F]fluoro-2-deoxy-D-glucose ([18F]FDG) uptake rate of 26[18-33]*10-4 mLblood/mLtissue/min (reference values 11[7-15]*10-4). Three double- and six single-lung recipients developed PGD. The grafts of patients who developed PGD had similar [18F]FDG uptake than grafts of patients who did not (28[18-26]*10-4 versus 26[22-31]*10-4, P=0.79). Not-inflated tissue fraction was significantly higher (28[20-38]% versus 14[7-21]%, P=0.01) while well-inflated fraction was significantly lower (29[25-41]% versus 53[39-65]%, P

The Peace pillar of the 2030 Agenda for Sustainable Development encompasses a diverse range of issues including stability and effective governance. Reforming the public sector is high on the government’s agenda, but involves a number of challenges: the gap between planning and implementation of policy objectives remains large; insufficient public participation in policy making is undermining the efficient allocation of resources toward public needs and development goals; under-development of evidence-based regulations is hampering the creation of a business-friendly environment essential to high value-added activities; and high levels of perceived corruption are weakening business confidence and public trust in the government. Thailand’s 12th Economic and Social Development Plan emphasises the importance of public sector reform. It sets out measures to strengthen co-ordination across ministries and agencies aimed at improving implementation of policy programmes, boosting public participation in policy making, improving online access to government services and combating corruption by strengthening integrity measures. The upcoming 20-year National Strategy and the accompanying National Reform Plan are expected to pave the way for future development. However, an inclusive and consultative process will be essential to ensure the success of reform efforts. This Working Paper relates to the Initial Assessment report of the Multi-dimensional Country Review of Thailand. (http://www.oecd.org/eco/surveys/multi-dimensional-review-thailand.htm)