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The United Nations Social Development Goals ensure the achievement of food security by 2030. Food security is characterized by various aspects, however in this study we focus on economic vulnerability to food insecurity. In particular, we compared two measures: food insecurity levels as defined by the Integrated food security phase classification Global-Partners quantitative scale and those defined by the Latin American and Caribbean Food Security qualitative scale. The qualitative scale only measures nutritional status using specific questions, regardless of food expenditures, while the quantitative scale is based on the share of consumer expenditure spent on food (the ratio between food expenditure and total expenditure). From our analysis on 2018 Mexico data—therefore unaffected by the pandemic—59% of discrepancies were found between the two measures. The qualitative scale does not classify people who spend too much on food as being food insecure, so they are economically vulnerable about housing, healthcare and other important aspects of social life (access to food generate insecurity). The quantitative scale does not identify people who do not have access to high-quality nutrition because they must pay for other fixed expenses, for example for housing or healthcare. These two measures depict two aspects of economic vulnerability to food insecurity, and here we quantify this difference in a developing country. Future research should be at integrating these two aspects into one single indicator based on food and non-food expenditures, so to take into account both the two aspects by using only consumption expenditure data. [ABSTRACT FROM AUTHOR]

Reducing food waste is essential if we want to create a more sustainable food system, which is why halving per capita food waste by 2030 has been included in the UN Sustainable Development Goals. The main aim of this paper is to demonstrate that by using digital tools to monitor food provisioning and management within canteens, it is possible to achieve a more sustainable food service management within industrial companies and to reduce the overall quantity and environmental impacts of food preparation and consumption thus achieving economic benefits. Longitudinal 2018 and 2019 data collected from the canteen of a major Italian food production company were analyzed. The results showed that the amount of food lost and wasted has decreased over time, reaping important environmental benefits and illustrating specific differences between the food lost in meal preparation and the food left on employees' plates. It is therefore important to implement education initiatives and to use digital tools to share food‐related data collected within companies among both employees and kitchen and catering staff in order to raise awareness of their behavioral strengths and weaknesses. From this perspective, new interventions at both kitchen and customer/worker levels are introduced and discussed. [ABSTRACT FROM AUTHOR]

Hazardous Natural events can cascade into Technological accidental scenarios (so called NaTech accidents). The occurrence of these accidents can degrade the performance of the preventive and mitigative safety barriers installed in the technological plants. Such performance degradation is typically assessed by expert judgement, without considering the effect of the magnitude of the natural hazard, nor its increasing frequency of occurrence in view of climate change. In this work, a novel sensitivity analysis framework is developed to identify the safety barriers whose performance degradation is most critical and thus needs careful modeling for realistic risk assessment. The framework is based on the calculation of a set of sensitivity measures, namely the Beta, the Conditional Value at Risk (CVaR) and the Value of Information (VoI), ● and their use to prioritize the safety barriers with respect to the need of: ● accounting for performance degradation during an accidental scenario; ● planning investments for further characterization of the safety barrier performance. An application is shown with respect to a case study of literature that consists of a chemical facility equipped with five safety barriers (of three different types, active, passive and procedural). NaTech scenarios can occur, triggered by floods and earthquakes. The results obtained with the Beta measure indicate that two-out-of-five barriers (one active and one passive) deserve accurate modelling of the performance degradation due to natural events. An additional outcome is that in the case study considered, both CVaR and VoI rank the passive barrier as the most effective in mitigating the scenarios escalation: therefore, this barrier is the one for which the decision maker could decide to invest resources for improving the characterization of its performance to obtain a more realistic assessment of the risk. [ABSTRACT FROM AUTHOR]

The UN Sustainable Development Goals have set clear targets on global poverty, hunger and malnutrition to be achieved by 2030, which have prompted academics and policymakers to identify useful strategies and drivers. Moreover, the COVID19 pandemic has exacerbated inequalities at national and sub-national levels thus hampering the achievement of these goals. On considering the multifaceted nature of poverty, a recent research strand focuses on food poverty and insecurity issues in terms of economic access to food and healthy diet consumption, with moderate and extreme food insecurity affecting almost 9% of the population in Europe and North America. This paper aims to analyse food poverty and insecurity at regional level in Italy. Using micro-data from the Italian Household Budget Survey carried out by ISTAT, an analytical approach was proposed to define and measure the different degree of food poverty and insecurity. Moreover, to obtain insights into whether food poverty and insecurity can afford population healthy nutrition, inequality of the distributions of food expenditure categories are estimated. The results provided us with information on other important aspects of the poverty. Indeed, in Italy individuals who are at-risk-of-food-poverty or food insecure amount to 22.3% of the entire population. Furthermore, the at-risk-of-food-poverty-rate varies at regional level from 14.6% (Umbria) to 29.6% (Abruzzo), with high levels of food consumption inequalities observed above all for vegetables, meat and fish. All these issues could help policy makers to define economic intervention policies aimed at reducing social exclusion and achieving more equitable and sustainable living conditions for the entire population. [ABSTRACT FROM AUTHOR]

Small area estimation is receiving considerable attention due to the high demand for small area statistics. Small area estimators of means and totals have been widely studied in the literature. Moreover, in the last years also small area estimators of quantiles and poverty indicators have been studied. In contrast, small area estimators of inequality indicators, which are often used in socio-economic studies, have received less attention. In this article, we propose a robust method based on the M-quantile regression model for small area estimation of the Theil index and the Gini coefficient, two popular inequality measures. To estimate the mean squared error a non-parametric bootstrap is adopted. A robust approach is used because often inequality is measured using income or consumption data, which are often non-normal and affected by outliers. The proposed methodology is applied to income data to estimate the Theil index and the Gini coefficient for small domains in Tuscany (provinces by age groups), using survey and Census micro-data as auxiliary variables. In addition, a design-based simulation is carried out to study the behaviour of the proposed robust estimators. The performance of the bootstrap mean squared error estimator is also investigated in the simulation study. [ABSTRACT FROM AUTHOR]

• A Multi-Objective Optimization of safety barriers performance parameters is developed. • The solution suggests the design improvements to guarantee the best mitigation at the minimum cost. • A chemical facility exposed to NaTech is considered as case study. • The facility is equipped with active, passive, and procedural safety barriers. • Meaningful insights on the budget to be allocated and on the actions to be performed are collected. Safety barriers are to be designed to bring the largest benefit in terms of accidental scenarios consequences mitigation at the most reasonable cost. In this paper, we formulate the problem of the identification of the optimal performance parameters of the barriers that can at the same time allow for the consequences mitigation of Natural Technological (NaTech) accidental scenarios at reasonable cost as a Multi-Objective Optimization (MOO) problem. The MOO is solved for a case study of literature, consisting in a chemical facility composed by three tanks filled with flammable substances and equipped with six safety barriers (active, passive and procedural), exposed to NaTech scenarios triggered by either severe floods or earthquakes. The performance of the barriers is evaluated by a phenomenological dynamic model that mimics the realistic response of the system. The uncertainty of the relevant parameters of the model (i.e., the response time of active and procedural barriers and the effectiveness of the barriers) is accounted for in the optimization, to provide robust solutions. Results for this case study suggest that the NaTech risk is optimally managed by improving the performances of four-out-of-six barriers (three active and one passive). Practical guidelines are provided to retrofit the safety barriers design. [ABSTRACT FROM AUTHOR]

Background: With over 1 million HIV-related deaths annually, quality end-of-life care remains a priority. Given strong public preference for home death, place of death is an important consideration for quality care. This 11 country study aimed to i) describe the number, proportion of all deaths, and demographics of HIV-related deaths; ii) identify place of death; iii) compare place of death to cancer patients iv), determine patient/health system factors associated with place of HIV-related death.Methods: In this retrospective analysis of death certification, data were extracted for the full population (ICD-10 codes B20-B24) for 1-year period: deceased's demographic characteristics, place of death, healthcare supply.Results: i) 19,739 deaths were attributed to HIV. The highest proportion (per 1000 deaths) was for Mexico (9.8‰), and the lowest Sweden (0.2‰). The majority of deaths were among men (75%), and those aged <50 (69.1%). ii) Hospital was most common place of death in all countries: from 56.6% in the Netherlands to 90.9% in South Korea. The least common places were hospice facility (3.3%-5.7%), nursing home (0%-17.6%) and home (5.9%-26.3%).iii) Age-standardised relative risks found those with HIV less likely to die at home and more likely to die in hospital compared with cancer patients, and in most countries more likely to die in a nursing home. iv) Multivariate analysis found that men were more likely to die at home in UK, Canada, USA and Mexico; a greater number of hospital beds reduced the likelihood of dying at home in Italy and Mexico; a higher number of GPs was associated with home death in Italy and Mexico.Conclusions: With increasing comorbidity among people ageing with HIV, it is essential that end-of-life preferences are established and met. Differences in place of death according to country and diagnosis demonstrate the importance of ensuring a "good death" for people with HIV, alongside efforts to optimise treatment. [ABSTRACT FROM AUTHOR]

Household consumption expenditure represents a crucial measure to be used for assessing individuals' material living conditions and well-being. Indeed, the analysis of household conditions can provide policy makers with a clear picture of the economic and social situation of the area in which they are operating. However, official sample surveys which are generally used for this purpose, such as the Household Budget Survey in Italy carried out by the National Institute of Statistics, do not allow for reliable disaggregated estimates thus hindering appropriate and effective planning and evaluation of political interventions at local level. By referring to the 2012 Italian Household Budget Survey, this paper aims at obtaining reliable provincial estimates of household consumption expenditure in Italy. We use Small Area Estimation methods and we adjust the estimates for spatial differences in price levels by computing and using sub-national Purchasing Power Parities, thus obtaining 'real' estimates of consumption expenditure to be used for intra-national comparisons. [ABSTRACT FROM AUTHOR]

The timely, accurate monitoring of social indicators, such as poverty or inequality, on a finegrained spatial and temporal scale is a crucial tool for understanding social phenomena and policymaking, but poses a great challenge to official statistics. This article argues that an interdisciplinary approach, combining the body of statistical research in small area estimation with the body of research in social data mining based on Big Data, can provide novel means to tackle this problem successfully. Big Data derived from the digital crumbs that humans leave behind in their daily activities are in fact providing ever more accurate proxies of social life. Social data mining from these data, coupled with advanced model-based techniques for fine-grained estimates, have the potential to provide a novel microscope through which to view and understand social complexity. This article suggests three ways to use Big Data together with small area estimation techniques, and shows how Big Data has the potential to mirror aspects of well-being and other socioeconomic phenomena. [ABSTRACT FROM AUTHOR]

Small-area estimation techniques have typically relied on plug-in estimation based on models containing random area effects. More recently, regression M-quantiles have been suggested for this purpose, thus avoiding conventional Gaussian assumptions, as well as problems associated with the specification of random effects. However, the plug-in M-quantile estimator for the small-area mean can be shown to be the expected value of this mean with respect to a generally biased estimator of the small-area cumulative distribution function of the characteristic of interest. To correct this problem, we propose a general framework for robust small-area estimation, based on representing a small-area estimator as a functional of a predictor of this small-area cumulative distribution function. Key advantages of this framework are that it naturally leads to integrated estimation of small-area means and quantiles and is not restricted to M-quantile models. We also discuss mean squared error estimation for the resulting estimators, and demonstrate the advantages of our approach through model-based and design-based simulations, with the latter using economic data collected in an Australian farm survey. [ABSTRACT FROM AUTHOR]

Focuses on the combined percutaneous internal and external fixation of type-C tibial plafond fractures. Treatment options for the fractures; Overview of the technique used for the fracture fixation; Disadvantage of the technique.

Italy was severely hit by COVID-19 during 2020 and great concern about the possible increase of suicide rates in the population has arisen since early pandemic phases. Analyses limited to March–April have shown a drop in suicides in both sexes. This study aims to analyze suicide mortality in Italy during the whole 2020 making comparisons with the pre-pandemic period 2015–19, by sex, age and geographic area. Official cause-of-death data with national coverage were used to analyze suicide mortality by sex, month, age class and geographic area in the population aged ≥10 years (54,595,179). The monthly number of suicide deaths in 2020 was compared to the average number in 2015–19. Age-specific and age-adjusted suicide rates in 2020 and in 2015–19 were compared using rate-ratios with 95 % confidence intervals. Compared to 2015–19 a non-significant reduction of the overall suicide rate was observed during 2020, both in males (−3 %) and females (−7 %). Suicide rates non-significantly decreased in most age groups; an increase, although not statistically significant, was found among males aged ≥75 years and females aged ≥85 years. Suicide deaths reduced mainly in Central-Southern areas and the Islands, while they slightly increased in the North especially among males. Study limitations include accuracy of death certification and the relatively brief observation period. The study contributes to the analysis of early effects of the COVID-19 pandemic on suicide mortality in the whole population highlighting sex, age and territorial differences and suggesting to monitor possible increases in a longer observation period. • In Italy, compared to 2015-19 a non-significant reduction of the overall suicide rate was observed in 2020, in both sexes • An increase in suicide rates, although non-significant, was found among males aged ≥75 years and females aged ≥85 years • The variation in the number of suicide deaths during 2020 is not uniform across the country [ABSTRACT FROM AUTHOR]

Food waste is a significant problem within public catering establishments in any normal situation. During spring 2020 the Covid-19 pandemic placed the public catering system under greater pressure, revealing weaknesses within the system and generation of food waste due to rapidly changing consumption patterns. In times of crisis, it is especially important to conserve resources and allocate existing resources to areas where they can be of most use, but this poses significant challenges. This study evaluated the potential of a forecasting model to predict guest attendance during the start and throughout the pandemic. This was done by collecting data on guest attendance in Swedish school and preschool catering establishments before and during the pandemic, and using a machine learning approach to predict future guest attendance based on historical data. Comparison of various learning methods revealed that random forest produced more accurate forecasts than a simple artificial neural network, with conditional mean absolute prediction error of < 0.15 for the trained dataset. Economic savings were obtained by forecasting compared with a no-plan scenario, supporting selection of the random forest approach for effective forecasting of meal planning. Overall, the results obtained using forecasting models for meal planning in times of crisis confirmed their usefulness. Continuous use can improve estimates for the test period, due to the agile and flexible nature of these models. This is particularly important when guest attendance is unpredictable, so that production planning can be optimized to reduce food waste and contribute to a more sustainable and resilient food system. • A machine learning approach can help kitchens to predict guest attendance. • Forecast of demand during extreme events is hard. • There is a savings potential compared to a business as usual scenario. [ABSTRACT FROM AUTHOR]

Food waste is a significant problem within public catering establishments in any normal situation. During spring 2020 the Covid-19 pandemic placed the public catering system under greater pressure, revealing weaknesses within the system and generation of food waste due to rapidly changing consumption patterns. In times of crisis, it is especially important to conserve resources and allocate existing resources to areas where they can be of most use, but this poses significant challenges. This study evaluated the potential of a forecasting model to predict guest attendance during the start and throughout the pandemic. This was done by collecting data on guest attendance in Swedish school and preschool catering establishments before and during the pandemic, and using a machine learning approach to predict future guest attendance based on historical data. Comparison of various learning methods revealed that random forest produced more accurate forecasts than a simple artificial neural network, with conditional mean absolute prediction error of < 0.15 for the trained dataset. Economic savings were obtained by forecasting compared with a no-plan scenario, supporting selection of the random forest approach for effective forecasting of meal planning. Overall, the results obtained using forecasting models for meal planning in times of crisis confirmed their usefulness. Continuous use can improve estimates for the test period, due to the agile and flexible nature of these models. This is particularly important when guest attendance is unpredictable, so that production planning can be optimized to reduce food waste and contribute to a more sustainable and resilient food system. • A machine learning approach can help kitchens to predict guest attendance. • Forecast of demand during extreme events is hard. • There is a savings potential compared to a business as usual scenario. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed at investigating gender differences in the relationship between sociodemographic factors and suicide mortality, as well as in the method used for suicide and the presence of comorbidities in an older population in Italy.Methods/design: We conducted a historical cohort study based on individual record linkage across the 15th Italian Population Census, the Italian Population Register, and the National Register of Causes of Death. Suicides among people aged 75 years or older from 2012 to 2017 were analyzed. Crude mortality rates were computed, and cause-specific mortality rate ratios were estimated using negative binomial regression models. Chi-square tests were used to evaluate significant gender differences in suicide methods and comorbidities associated with suicide.Results: The study included 9,686,698 individuals (41% men, 59% women). Compared to living alone, living with children or partners reduced suicide mortality, especially among men. Having high or medium educational levels was associated with lower mortality than low educational levels among men. Foreign citizens had lower mortality among men, but not among women. Living in urban areas was associated with lower suicide rates in men and higher rates in women. Methods of suicide significantly differed by gender: leading methods were hanging, strangulation, and suffocation in men, and falling from height in women. Mental comorbidity was significantly more frequent among women, especially at ages 75-84 years.Conclusions: We believe that our findings might help to promote public health strategies taking gender differences in old age into account to improve social support and quality of life of older men and women. [ABSTRACT FROM AUTHOR]

Drug driving represents a public safety concern, and the size of this issue in Italy is not fully known. Drug testing is composed of two steps: 1) screening and 2) confirmatory analysis. The second step, and the associate medical examination to assess the state of impairment, usually are not performed right after the screening as they require specialized personnel and instrumental equipment that are not historically available at roadblocks. These pitfalls make this process both complicated and time-consuming. A mobile laboratory was set up in 2019 by the Forensic Lab Service S.r.l. (limited liability company) to improve roadblock timing, planning, as well as to shed light on the extent of the drug driving issue in Italy. Drug screenings were performed using DrugWipe® Saliva testing. Confirmatory analysis was performed on oral fluids by liquid chromatography coupled with tandem mass spectrometry. A dedicated room of the mobile laboratory was also designed for drug driving medical assessment. 2082 samples were collected during 88 road safety services held in different locations across Italy. In total, 9 % of the tested subjects were positive to both the screening and the confirmatory analysis. The most prevalent illicit drugs found in this study were THC (72 %), followed by cocaine (41 %). Drug drivers were mostly male (93 %) and younger than 30 years of age (58 %). The prevalence of drivers testing positive for illicit drugs resulted to be higher compared to the results obtained in the DRUID project and to other surveys previously performed in Italy. These data demonstrate the need for control services to improve road safety in regards to drug driving. • A mobile laboratory was set up in 2019 to support road safety services. • These services included screening and confirmation tests and medical assessment. • 2082 samples were collected and 9 % of the drivers tested positive for illicit drugs. • The rate of drug drivers was higher than that reported in DRUID and other studies. • The most prevalent illicit drugs found were THC (72 %) and cocaine (41 %). [ABSTRACT FROM AUTHOR]

Different strategies have been used to overcome the difficulties to produce antimicrobial peptides. Here we used Intein Mediated Purification with an Affinity Chitin-binding Tag (IMPACT-System, New England Biolabs) for the expression of the antimicrobial peptide cecropin to reduce its sensitivity to intracellular proteases and use its inducible self-cleaving capability to remove the carrier. Cecropin was cloned into suitable expression vector pTYB11, and expression induced by IPTG in Escherichia coli ER2566. The use of 22°C induction allowed the expression of cecropin with its intein carrier in soluble form. Cell extracts were purified by chitin affinity chromatography and intein-mediated splicing of the target protein was achieved by thiol addition, obtaining a final yield of 2.5 mg cecropin/l. Cecropin cleaved from the intein had its proper biologically active form, showing a micromolar antimicrobial activity against Vibrio ordalii, Vibrio alginolyticus and Escherichia coli. [ABSTRACT FROM AUTHOR]

• Aggregated composite indexes (Cis) are likely to be affected by sampling variability. • We show how uncertainty about indicators due to sampling error affects final scores. • Our method is applied to real indicators of a CI for environmental performance. • Our method could be used for non-response issues or other non-sampling errors. In recent decades, the measurement and evaluation of important social and natural phenomena has significantly evolved, with many traditional measurements based on single variables increasingly being replaced by multidimensional approaches. One key aspect of these approaches is the development of composite indexes, usually real-value functions of multiple achievements of a group of units. The achievements in each of the selected dimensions are generally synthesised through one or more variables, often referred to as indicators. When indicators are obtained through an estimation process, it is crucial to understand if and how their estimation error – for example, sampling error – affects the resulting composite index. This paper presents a methodology based on a parametric bootstrap technique that evaluates to what extent uncertainty in indicators affects the reliability of the aggregate composite index. The method is applied to four composite indexes measuring the environmental performances of Italian regions based on real population and survey data. To our knowledge, this is the first attempt to measure the impact of indicators' sampling error on composite indexes. If adequately generalised, our methodology could be used in the presence of measurement errors, non-response issues, or other kinds of non-sampling errors. [ABSTRACT FROM AUTHOR]

Background: Achieving adequate fixation strength in osteoporotic bone is a challenge. In this study, we examined the use of hydroxyapatite-coated tapered external-fixation pins for the fixation of wrist fractures in patients with osteoporosis.Methods: Twenty female patients with osteoporosis and a fracture of the wrist were divided into two paired groups and randomized to receive either standard tapered pins or hydroxyapatite-coated tapered pins. Two pins were inserted in the distal part of the radius, two pins were inserted in the second metacarpal, and an external fixation device was mounted. All fixation devices were removed six weeks after surgery.Results: The mean pin-insertion torque (and standard deviation) was 461 +/- 254 Nmm in the group managed with standard pins and 332 +/- 176 Nmm in the group managed with hydroxyapatite-coated pins (p = 0.01). The mean pin-extraction torque was 191 +/- 155 Nmm in the group managed with standard pins and 600 +/- 214 Nmm in the group managed with hydroxyapatite-coated pins (p < 0.0001, power 95%). The mean extraction torque was lower than the corresponding insertion torque at each pin position in the group managed with standard pins (p < 0.05), whereas the mean extraction torque was higher than the corresponding insertion torque at each pin position in the group managed with hydroxyapatite-coated pins (p = 0.001). Two patients managed with standard pins and no patient managed with hydroxyapatite-coated pins had a pin-track infection. Pain during pin removal did not differ between the two groups.Conclusions: The present study showed that hydroxyapatite-coated tapered external-fixation pins provided improved fixation in the treatment of wrist fractures in patients with osteoporosis. [ABSTRACT FROM AUTHOR]

Suicide is a leading cause of death among adolescents and is recognized as a serious public health problem. This study aimed to investigate the relationship between family characteristics and the risk of suicide among adolescents in Italy using nationwide official data. We carried out a cohort study based on the record linkage between the 15th Italian Population Census, the Italian Population Register, and the National Register of Causes of Death. Suicides in adolescents aged 10–19 years from 2012 to 2016 were analyzed. Hazard ratios of mortality from suicide were estimated through a multivariable Cox regression model using time-on-study as the time scale. We included 8,284,359 children and adolescents (51% males, 49% females). Over the 5-year follow-up, we registered 330 deaths from suicides (74% males), mostly occurred in the age class 15–19 years (86%). The suicide rate was 1.71 per 100,000 person-years among males and 0.65 among females. We found some familial characteristics associated with a higher risk of dying by suicide, including: living in single-parent or reconstructed families (among boys), a 40-year or more age gap between mother and child (among girls), having highly educated parents, an age difference between parents greater than 5 years. Furthermore, the study showed a lower risk for boys living in urban areas and for both boys and girls living in South Italy. Our results could help in identifying adolescents at high risk of suicide who could benefit from the planning of targeted intervention strategies. [ABSTRACT FROM AUTHOR]

• In the winter seasons from 2013/14 to 2016/17, an estimated average of 5,290,000 ILI cases occurred in Italy, corresponding to an incidence of 9%. • More than 68,000 deaths attributable to flu epidemics were estimated in the study period. • Italy showed a higher influenza attributable excess mortality compared to other European countries. especially in the elderly. In recent years, Italy has been registering peaks in death rates, particularly among the elderly during the winter season. Influenza epidemics have been indicated as one of the potential determinants of such an excess. The objective of our study was to estimate the influenza-attributable contribution to excess mortality during the influenza seasons from 2013/14 to 2016/17 in Italy. We used the EuroMomo and the FluMomo methods to estimate the annual trend of influenza-attributable excess death rate by age group. Population data were provided by the National Institute of Statistics, data on influenza like illness and confirmed influenza cases were provided by the National Institutes of Health. As an indicator of weekly influenza activity (IA) we adopted the Goldstein index, which is the product of the percentage of patients seen with influenza-like illness (ILI) and percentage of influenza-positive specimens, in a given week. We estimated excess deaths of 7,027, 20,259, 15,801 and 24,981 attributable to influenza epidemics in the 2013/14, 2014/15, 2015/16 and 2016/17, respectively, using the Goldstein index. The average annual mortality excess rate per 100,000 ranged from 11.6 to 41.2 with most of the influenza-associated deaths per year registered among the elderly. However children less than 5 years old also reported a relevant influenza attributable excess death rate in the 2014/15 and 2016/17 seasons (1.05/100,000 and 1.54/100,000 respectively). Over 68,000 deaths were attributable to influenza epidemics in the study period. The observed excess of deaths is not completely unexpected, given the high number of fragile very old subjects living in Italy. In conclusion, the unpredictability of the influenza virus continues to present a major challenge to health professionals and policy makers. Nonetheless, vaccination remains the most effective means for reducing the burden of influenza, and efforts to increase vaccine coverage and the introduction of new vaccine strategies (such as vaccinating healthy children) should be considered to reduce the influenza attributable excess mortality experienced in Italy and in Europe in the last seasons. [ABSTRACT FROM AUTHOR]

The purpose was to establish a ranking of the 50 most cited articles about wrist surgery and analyse their features. Science Citation Index Expanded was used to identify the 50 most frequently cited orthopaedic journal articles written in English, searching for the topic "wrist surgery" in the subject category ''Orthopaedics''. Then, we analysed the number of citations, citation density, authorship, article institution, the year of publication, the country of origin of the article, name and impact factor of the journal, and publication type of the article. The 50 most cited articles were published in only 6 of the 74 journals included under the category "orthopaedics". Citation count ranged from 256 for the first one to 67 for the 50th article. Most of them were written by American authors. These articles were published between 1991 and 2011. "Distal Radius Fractures" was the most common issue. This type of bibliographic analysis could be particularly useful for other young Authors who would like to improve their research in wrist and hand surgery and make their publications more citable and appreciated by the scientific community. [ABSTRACT FROM AUTHOR]

Purpose. The implantation of a hip prosthesis determines changes in the joint biomechanics and it alters distribution of the loads on the surrounding bone. Proximal bone resorption around femoral stems is commonly seen after cementless total hip arthroplasty. The aim of this study was to evaluate the effects of a tapered single wedge HA coated Stem on periprosthetic bone density in the seven Gruen areas to define the pattern of bone remodelling associated with this stem's design. Methods. 25 patients (11 men and 14 women) were selected in this study in accordance with specific inclusion and exclusion criteria. Patients underwent total hip replacement with Accolade I® TMZF® hip stem. They were all preoperative evaluated using the Harris Hip Score and a standard radiology examination. Clinical, radiological and bone density evaluations were performed on each patient within 6 months and at 12, 24 and 36 months after surgery. Results. The results at 36 months show a statistically significant increase (p < 0.001) of the HHS scores, from 64 during preoperative phase to 93 at 36 months. No patients underwent to revision surgery and no peri-implant radiolucency was found during radiological assessments. The bone mineral density changes in the seven Gruen zones seen with DXA scan showed a decrease of 2.9% only at the level of the calcar region (R7), a moderate increase at the level of R1, R2 and R3 and a statistically significant increase of BMD (p < 0,05) at 24 and 36 months after surgery at the level of R4 (+ 6.2%), R5 (+ 7.2%) and R6 (+ 8.15%). Conclusion. Our study showed that the use of the Accolade I® TMZF® uncemented stem after 36 months of followup is associated to a good load transfer to the preriprosthetic bone avoiding the stress shielding phenomena. It showed a definitely positive BMD evolution at the level of all Gruen's zones and especially at the level of the medial region (R5, R6). The only exception was at the level of the calcar region where there was a BMD mildly decrease (from 1.03 to 1.00) most likely due to the stem philosophy (metaphyseal fixation) and to the consequent load transfer to the metaphyseal medial regions (R5, R6). [ABSTRACT FROM AUTHOR]

Background: Most people prefer to receive end-of-life care in familiar surroundings rather than in hospital. This study examines variation in place of death for people dying from Parkinson's disease (PD) across 11 European and non-European countries. Methods: Using death certificate data of 2008 for Belgium, France, Italy, Hungary, Czech Republic, New Zealand, USA, Canada, Mexico, South Korea and Spain for all deaths with PD as an underlying cause (ICD-10 code: G20) cross-national differences in place of death were examined. Associations between place of death and patient socio-demographic and regional characteristics were evaluated using multivariable binary logistic regression analyses. Results: The proportion of deaths in hospital ranged from 17% in the USA to 75% in South Korea. Hospital was the most prevalent place of death in France (40%), Hungary (60%) and South Korea; nursing home in New Zealand (71%), Belgium (52%), USA (50%), Canada (48%) and Czech Republic (44%); home in Mexico (73%), Italy (51%) and Spain (46%). The chances of dying in hospital were consistently higher for men (Belgium, France, Italy, USA, Canada), those younger than 80 years (Belgium, France, Italy, USA, Mexico), and those living in areas with a higher provision of hospital beds (Italy, USA). Conclusions: In several countries a substantial proportion of deaths from PD occurs in hospitals, although this may not be the most optimal place of terminal care and death. The wide variation between countries in the proportion of deaths from PD occurring in hospital indicates a potential for many countries to reduce these proportions. [ABSTRACT FROM AUTHOR]

Background: Although cementless implants are increasing in popularity, the use of cementless femoral stems for total hip arthroplasty (THA) and hip hemiarthroplasty (HH) in elderly patients remains controversial. The aim of this study was to report the outcomes of a cementless stem used in a large multicentric cohort of elderly patients receiving elective THA and HH for displaced femoral neck fracture. Methods: A total of 293 patients (301 hips) aged 70 years or older (mean age, 78 years; range, 70–93) who received the same cementless plasma-sprayed porous titanium–hydroxyapatite stem were retrospectively evaluated after primary THA and HH to investigate stem survival, complications, and clinical and radiographic results. Results: Cumulative stem survival was 98.5% (95% CI, 96.4–99.4%; 91 hips at risks) with revision due to any reason as the end-point at 10-year follow-up (mean 8.6 years, range 4–12). No stem was revised due to aseptic loosening. The mean Forgotten Joint Score was 98.7. Radiographically, the implants showed complete osseointegration, with slight stress-shieling signs in less than 10% of the hips. Conclusion: The use of cementless stems was proven to be a reliable and versatile option even in elderly patients for elective THA and HH for femoral neck fracture. [ABSTRACT FROM AUTHOR]

Abstract: In this work, the intein fusion approach was used for expression and purification of cathelicidin-like peptide SMAP-29 from Escherichia coli cultures. To overcome the high toxicity of the antimicrobial peptide against host cells, both C- and N-terminal fusions with Sce VMA intein were evaluated. The fusion of SMAP-29 with the N-terminus of intein had a dramatic lethal effect. In contrast, chimeric constructs harboring SMAP-29 linked to the C-terminus of intein displayed no significant inhibition of bacterial growth. Expression of intein-SMAP fusion protein was then induced in ER2566 E. coli strain by IPTG addition and different experimental conditions were tested in order to optimize the recovery of the soluble protein complex. Peptide purification was carried out by affinity chromatography: the chitin binding domain linked to intein was used to immobilize the chimeric protein on a chitin column and intein-mediated splicing of target peptide was obtained by thiol addition. Microbroth dilution assay showed that recombinant SMAP-29 displayed a high, dose-dependent bactericidal activity. These data demonstrate that the fusion of SMAP-29 with C-intein was able to inactivate the antimicrobial properties of the cathelicidin peptide allowing the expression of fusion protein in the host cell. The intein-mediated purification supplied an effective way to recover the fusion partner in its proper biologically active form. [Copyright &y& Elsevier]

The aim of the study was to assess the safety and efficacy of CT-guided percutaneous radiofrequency (RF) ablation of osteoid osteoma (OO). From 1997 to 2001, RF ablation was performed on 38 patients with OO, diagnosed clinically and by radiography, scintigraphy, contrast-enhanced MRI, and CT. Treatment was performed via percutaneous (n=29) or surgical (n=9) access, under CT guidance in all cases, with an 18-gauge straight electrode. Patients were discharged within 24 h and followed up clinically (at 1 week and every 6-12 months) and with MRI (at 6 months) and scintigraphy (after 1 year). The technical success rate was 100%. Complications occurred in two patients, consisting in local skin burns. The follow-up range was 12-66 months (mean +/- SD, 35.5+/-7.5 months). Prompt pain relief and return to normal activities were observed in 30 of 38 patients. Persistent pain occurred in eight patients; two patients refused further RF ablation and were treated surgically; RF ablation was repeated in six cases achieving successful results in five. One patient reported residual pain and is being evaluated for surgical excision. Primary and secondary clinical success rates were 78.9 (30/38 patients) and 97% (35/36 patients), respectively. CT-guided RF ablation of OO is safe and effective. Persistent lesions can be effectively re-treated. Several imaging modalities are needed for the diagnosis of OO and for the follow-up after treatment, particularly in patients with persistent symptoms. [ABSTRACT FROM AUTHOR]

In the process of programmed cell death (PCD), a key role has been attributed to endonucleases capable to cleave nuclear DNA at internucleosomal sites. In barley (Hordeum vulgare L.), two such nucleases (Bnuc1 and BEN1) were individually identified in unrelated tissues. In the present work, we demonstrate that their genes are also expressed in immature anthers at different stages of pollen development. Further experiments carried out on RNA extracted from immature barley anthers led to discover a novel endonuclease gene, namely Bnuc2 (AJ311603 in the EMBL/GenBank/DDBJ databases), eventually found up-regulated at the tetrad stage. The protein encoded was found to conserve large sequence portions of Bnuc1 and BEN1 endonucleases, including the domain regions involved in secretion and DNA/RNA binding. A survey conducted on barley EST libraries showed that Bnuc2 and BEN1 mRNAs are jointly present also in the transcriptome of 20 DAP spike and that other endonuclease ESTs are co-expressed with Bnuc1 or BEN1 in tissues where PCD has been recorded. Therefore, it can be concluded that during the PCD process, a set of S1-type endonucleases is synthesised regardless of the tissue considered. [Copyright &y& Elsevier]

Tobacco plants were engineered to express SMAP-29, a mammalian antimicrobial peptide of innate immunity, as fusion protein with modified vacuolar membrane ATPase intein. The peptide was purified taking advantage of the intein-mediated self-cleaving mechanism. SMAP-29 was immunologically detected in the chromatographic eluate and appeared tightly bound to copurified plant proteins. Electrophoretic separation under disaggregating conditions indicated that the recombinant peptide was cleaved off by intein at the expected site and an overlay gel assay demonstrated that the peptide retained antimicrobial activity. These results indicate that a modified intein expression system can be used to produce pharmaceutical peptides in transgenic plants. [Copyright &y& Elsevier]

Abstract. We report here the results of a validation study of the avidin/indium-111 biotin approach in patients with skeletal lesions. This study involved 54 patients with orthopaedic conditions: 20 patients with intermediate suspected osteomyelitis of the trunk, 19 patients with infection/inflammation of prosthetic joint replacements, and 15 patients with suspected osteomyelitis of appendicular bones. Avidin (3 mg) was injected as an i.v. bolus, followed 4 h later by Illin-biotin; imaging was acquired 30 min and 16-18 h after administration of [sup 111]In-biotin. Technetium-99m hexamethylpropylene amine oxime ([sup 99m]Tc-HMPAO)-labelled leucocyte scintigraphy was performed in 39/54 patients. The overall sensitivity of the avidin/[sup 111]In-biotin scan was 97.7% (versus 88.9% for [sup 99m]Tc-HMPAO leucocyte scintigraphy). While the diagnostic performance of avidin/[sup 111]Inbiotin scintigraphy was similar to that of [sup 99m]Tc-HMPAO leucocyte scintigraphy in patients with prosthetic joint replacements or osteomyelitis of appendicular bones, the avidin/[sup 111]In-biotin approach clearly performed better than 99mTc-HMPAO leucocyte scintigraphy in patients with suspected osteomyelitis of the trunk (100% sensitivity, specificity and accuracy versus 50% sensitivity, 100% specificity and 66.7% accuracy for 99mTcHMPAO-leucocyte scintigraphy). These results demonstrate the feasibility of the avidin/[sup 111]In-biotin approach for imaging sites of infection/inflammation in the clinical setting. Although no systematic advantages of avidin/[sup 111]In-biotin scintigraphy were found versus [sup 99m]TcHMPAO leucocyte scintigraphy, the newer scintigraphic method is more practicable and involves lower biological risk for the operators. [ABSTRACT FROM AUTHOR]

Background: Death certificates are considered the most reliable source of information to compare cause-specific mortality across countries. The aim of the present study was to examine death certificates of persons who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to (a) quantify the number of deaths directly caused by coronavirus 2019 (COVID-19); (b) estimate the most common complications leading to death; and (c) identify the most common comorbidities. Methods: Death certificates of persons who tested positive for SARS-CoV-2 provided to the National Surveillance system were coded according to the 10th edition of the International Classification of Diseases. Deaths due to COVID-19 were defined as those in which COVID-19 was the underlying cause of death. Complications were defined as those conditions reported as originating from COVID-19, and comorbidities were conditions independent of COVID-19. Results: A total of 5311 death certificates of persons dying in March through May 2020 were analysed (16.7% of total deaths). COVID-19 was the underlying cause of death in 88% of cases. Pneumonia and respiratory failure were the most common complications, being identified in 78% and 54% of certificates, respectively. Other complications, including shock, respiratory distress and pulmonary oedema, and heart complications demonstrated a low prevalence, but they were more commonly observed in the 30–59 years age group. Comorbidities were reported in 72% of certificates, with little variation by age and gender. The most common comorbidities were hypertensive heart disease, diabetes, ischaemic heart disease, and neoplasms. Neoplasms and obesity were the main comorbidities among younger people. Discussion: In most persons dying after testing positive for SARS-CoV-2, COVID-19 was the cause directly leading to death. In a large proportion of death certificates, no comorbidities were reported, suggesting that this condition can be fatal in healthy persons. Respiratory complications were common, but non-respiratory complications were also observed. [ABSTRACT FROM AUTHOR]