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In this article, a fourth-order finite-difference ghost-point method for the Poisson equation on regular Cartesian mesh is presented. The method can be considered the high-order extension of the second-order ghost method introduced earlier by the authors. Three different discretizations are considered, which differ in the stencil that discretizes the Laplacian and the source term. It is shown that only two of them provide a stable method. The accuracy of such stable methods is numerically verified on several test problems.

We classify hypersurfaces with rotational symmetry and positive constant r-th mean curvature in Hn×R ${\mathbb{H}}^{n}{\times}\mathbb{R}$ . Specific constant higher order mean curvature hypersurfaces invariant under hyperbolic translation are also treated. Some of these invariant hypersurfaces are employed as barriers to prove a Ros–Rosenberg type theorem in Hn×R ${\mathbb{H}}^{n}{\times}\mathbb{R}$ : we show that compact connected hypersurfaces of constant r-th mean curvature embedded in Hn×[0,∞) ${\mathbb{H}}^{n}{\times}\left[0,\infty \right)$ with boundary in the slice Hn×{0} ${\mathbb{H}}^{n}{\times}\left\{0\right\}$ are topological disks under suitable assumptions.

Sectors of the Campania region (southern Italy), where pyroclastic airfall deposits cover carbonate slopes, have frequently experienced debris avalanches and debris flows. These landslides are triggered by heavy rainfall and in the last century caused severe destruction and hundreds of deaths. Their occurrence is controlled by the interaction of several factors, both natural and human induced. The initial failure is linked with the presence of morphological discontinuities such as rocky scarps and road cuts, which interrupt the stratigraphical continuity of an “infinite slope”. Here the main criteria for susceptibility analysis are defined trying to develop a procedure for identify highly-susceptible sources, runout and invasion areas.

An experimental investigation on the durability of Lightweight Cemented Soils (LWCS) after wetting and drying cycles was developed, focusing on the evolution of their mechanical response. Wetting and drying cycles were performed in climatic chamber to test their mechanical performance as function of number of cycles and the environmental conditions (50% and 90% of Relative Humidity). Unconfined compression tests and triaxial tests were performed on treated specimens after cycles in dry state. Suction of LWCS samples was measured after mechanical tests. Test results show that the wetting-drying cycles and the variations of suction are responsible for the evolution of LWCS mechanical behaviour. Moreover, strength and stiffness of the treated samples are related to the suction level induced by environmental conditions. The degradation of mechanical behaviour is linked to the number of cycles and to the amplitude of suction variation induced, being the latter responsible for mechanical cement bonding destructuration.

A geotechnical monitoring campaign and a site investigation have been recently planned and undertaken aiming at the preservation and protection of the “Palazzone” Etruscan necropolis, an archaeological site dated back to Hellenistic period located 4 km from the city of Perugia, along the southeastern margin of the hill where the town is settled. The site includes some beautiful and monumental cavities, among them, the Volumni Hypogeum. The majority of the graves are underground cavities excavated in partially saturated alluvial soil deposits. Their inspection reveals the geological features and the depositional structures. The groundwater table is located about 35 m below the ground surface. Due to the difficulties of soil-sampling inside the ancient cavities, only limited portions of the material were retrieved for conventional laboratory tests, although not enough for a geotechnical characterization. On the other hand, XRD analyses and MIP tests were performed. The obtained results allowed to recognize the relevant contribution of soil suction to the stability conditions of the lateral walls and the ceiling of the cavities, which is complementary to the weak cementation characterizing the soil mass. This important information supports the conservation strategy of the monument, which has as its primary tool the monitoring of environmental conditions, aimed at maintaining the unsaturated conditions of the soil mass.

In museums, poor indoor air quality combined with unsuitable thermal and hygrometric conditions can affect the visitors and staff wellbeing as well as cause the deterioration processes of the exhibit objects. In order to assess indoor air quality of the museum, a survey was carried out in some rooms of the Uffizi Gallery of Florence by the researchers of the Laboratory of Environmental Physics of the University of Florence. Indoor temperature, relative humidity, chemical and microbiological pollutants were sampled, and the results analyzed and discussed. To do that a general methodology of investigation and evaluation of the results was defined and applied to several rooms of the Gallery. The presence of critical pollutant concentration was underlined and proper investigations on the HVAC system were scheduled. In this paper the results regarding a representative room are shown and discussed.

The possibility to use a special class of heavy-ion induced direct reactions, such as double charge exchange reactions, is discussed in view of their application to extract information that may be helpful to determinate the nuclear matrix elements entering in the expression of neutrinoless double beta decay half-life. The strategies adopted in the experimental campaigns performed at INFN - Laboratori Nazionali del Sud are briefly described, emphasizing the advantages of the multi-channel approach to nuclear reaction data analysis.

In soil stabilisation, the use of alternative products to lime or cement has been proposed. However, the effects of these additives, of various origins, on soil behaviour and stabilizing mechanisms are not well understood. Thus, the aim of this paper is to characterize the modification of the mechanical behaviour and microstructure of two soils after treatment with one of those product, a vinyl based copolymer. After treatment, both materials were compacted up to their maximum dry density. The mechanical behaviour of the materials as a function of the curing conditions, suction and water content was first determined. In a second step, the alteration of the microstructure by the treatment product was assessed. The results showed that the treatment permitted to significantly improve the strength of the tested soils. Moreover, the efficiency of the product increases when the soil is dried. However, the Young modulus is not significantly modified by the treatment. Microstructural reorganization after co-polymer addition has been detected by SEM technique for kaolin samples, whereas no modification have been observed for silt samples.

The geotechnical construction industry is a major component of the overall construction sector and is strategically important in infrastructure development (transportation, flood and landslide protection, building foundations, waste disposal). Although industry and research in the overall construction sector have been investing significantly in recent years to produce innovative low-carbon technologies, little innovation has been created in geotechnical construction industry, which is lagging behind other construction industry sectors. This paper discusses the interplay between low-carbon geotechnical engineering and unsaturated soil mechanics based on the research carried out within the project TERRE (Marie Skłodowska-Curie Innovative Training Networks funded by the European Commission, 2015-2019,H2020-MSCA-ITN-2015-675762).

An experimental investigation on the mechanical improvement induced by alkali-activated binder based on the activation of a fluidal bed combustion fly ash on a clayey soil has been developed. The use of these binders for geotechnical applications is a promising issue in terms of sustainability since it reduces the carbon footprint and allows reusing secondary by-products such as artificial pozzolans. Treated samples were prepared by mixing soil and fly ash with water and alkaline solution and dynamically compacted. Mechanical behaviour has been investigated by means of triaxial tests performed on treated samples compacted at optimum water content. Addition of alkali activated binder increased stiffness and shear strength of treated samples, whose extent depends on binder content and curing time. Macroscopic behaviour of treated soil has been linked to the experimental evidences at microscale. Microstructural analyses highlighted a high reactivity of alkali-activated fly ashes as alumino-silicate source promoting the precipitation of new mineralogical phases with cementitious properties. Amorphous alumino-silicate gels produced from alkali-activation of fly ash bound particles aggregates leading to a decrease of cumulative pore volume and porosity of treated samples and modification of the modal pore size.

In the present paper an experimental investigation on water retention properties of lightweight cemented soils (LWCS) taking into account the effects of air foam content and curing time is presented. This experimental study, aimed at determining the suction range corresponding to significant changes in water content, is preliminary to future investigations devoted to durability properties of LWCS systems against wetting and drying cycles. Test results showed that water retention capacity is slightly affected by the curing time for the considered time interval (i.e. 30 and 90 days). Furthermore, the addition of air foam does not affect water retention properties of treated samples. Large voids are present in the samples as footprints of air bubbles added upon mixing, leading to an increase of the porosity of samples without altering the microstructure of the matrix.

Energy piles are an innovative technology that couples the role of the structural foundation to the role of the heat exchanger to satisfy the energy needs of buildings and infrastructures. In the last decade insight into the mechanisms governing the thermo-mechanical response of single energy piles have been gained via full-scale in-situ tests, numerical analyses and model-scale experiments. The numerical approaches allow testing a large variety of configurations, geometries, materials, thermo-mechanical loadings and boundary conditions in a rather controlled but relatively easy and cost-effective manner. As a widespread habit it should be remarked that the temperature changes adopted in the piles have been only rarely justified based on realistic heating and cooling demands of live buildings. This numerical study investigates the effects of combination of mechanical and thermal loads on the mechanical behaviour of a single energy pile embedded in a typical pyroclastic soil deposit of Campania region, in Southern Italy. Thermal loads over one year have been determined by means of Design Builder software analysing a building in Napoli; the intermittent operation of the heat pump over daily time scale is properly modelled in the coupled thermo-hydro-mechanical axisymmetric FE analyses. A sensitivity analysis has been carried out to investigate the effects of the surface thermal boundary conditions.

One of the main problems encountered in civil engineering is the management of large amounts of excavated soil, especially when the mechanical properties of this soil are not suitable for its reuse as a construction material. However, the excavated soil could represent a resource if appropriately improved. A suitable solution is the addition of cement and foam to produce lightweight cemented soils (LWCS). In this paper, an insight into the influence of foam on chemo-mineralogical and microstructural features of soil-cement-water system is presented. Time dependent mineralogical and microstructural changes have been monitored by means of X-Ray Diffraction, Thermo-gravimetric analysis and Mercury Intrusion Porosimetry. The present study shows that addition of foam does not alter the chemo-physical evolution of the soil-cement-water system. Large voids are present in the samples as footprint of air bubbles upon mixing, thus increasing porosity. Macroscopic behaviour of treated samples has been investigated by direct shear and oedometric tests. Chemo-physical evolution induced by cement addition is the major responsible for mechanical improvement showed by treated samples. Porosity of samples induced by foam addition plays a key role in the mechanical response of LWCS, inducing a transition of stress-strain behaviour from brittle and dilative to ductile and contractive as a function of increasing foam content.

In the present paper, the use of alkali activated binders to improve engineering properties of clayey soils is presented as an alternative to traditional binders such as lime or cement. An alkali-activated fly ash and its chemo-physical evolution has been monitored at increasing curing times by means of X-Ray Diffraction and Scanning Electron Microscopy. Alkali-activated binder has been mixed with soil for evaluating the improvement of its mechanical behaviour. One-dimensional compression tests on treated samples have been performed with particular reference to effects induced by binder content and curing time. Test results showed a high initial reactivity of the alkali activated systems promoting formation of new mineralogical phases responsible of the mechanical improvement of the treated soil.

The possibility to use a special class of heavy-ion induced direct reactions, such as double charge exchange reactions, is discussed in view of their application to extract information that may be helpful to determinate the nuclear matrix elements entering in the expression of neutrinoless double beta decay half-life. The methodology of the experimental campaign presently running at INFN - Laboratori Nazionali del Sud is reported andthe experimental challenges characterizing such activity are described.

There have been great advancements in cardiac surgery over the last two decades; the widespread use of off-pump aortocoronary bypass surgery, minimally invasive cardiac surgery, and robotic surgery have also changed the face of cardiac anaesthesia. The concept of "Fast-track anaesthesia" demands the use of nondepolarising neuromuscular blocking drugs with short duration of action, combining the ability to provide (if necessary) sufficiently profound neuromuscular blockade during surgery and immediate re-establishment of normal neuromuscular transmission at the end of surgery. Postoperative residual muscle paralysis is one of the major hurdles for immediate or early extubation after cardiac surgery. Nondepolarising neuromuscular blocking drugs for cardiac surgery should therefore be easy to titrate, of rapid onset and short duration of action with a pathway of elimination independent from hepatic or renal dysfunction, and should equally not affect haemodynamic stability. The difference between repetitive bolus application and continuous infusion is outlined in this review, with the pharmacodynamic and pharmacokinetic characteristics of vecuronium, pancuronium, rocuronium, and cisatracurium. Kinemyography and acceleromyography are the most important currently used neuromuscular monitoring methods. Whereas monitoring at the adductor pollicis muscle is appropriate at the end of surgery, monitoring of the corrugator supercilii muscle better reflects neuromuscular blockade at more central, profound muscles, such as the diaphragm, larynx, or thoraco-abdominal muscles. In conclusion, cisatracurium or rocuronium is recommended for neuromuscular blockade in modern cardiac surgery.

INTRODUCTION: la fistule obstétricale est un orifice entre le vagin et la vessie ou le rectum, voire les deux. Ses impacts sont des conséquences anatomo-fonctionnelles et sociales. On estime à plus de 19 000 le nombre de femmes qui souffrent de fistule obstétricale au Cameroun. METHODES: il s'agissait d'une étude transversale descriptive conduite dans trois districts de santé de la région de l'Extrême-nord. Vingt-huit femmes victimes de fistules obstétricales, quarante-deux membres de leur entourage et vingt-quatre agents de santé ont été interviewés entre Novembre et Décembre 2013. Trois types de questionnaires ont été utilisés. Les données ont été analysées dans Epi Info version 7.1.4.0. Les moyennes et les fréquences ont été calculées avec un intervalle de confiance à 95%. RESULTATS: 46,4% des femmes victimes de fistule obstétricales interviewées avaient subi une intervention chirurgicale réparatrice parmi lesquelles, 61,5% bénéficiaient de la réintégration. Le fonds de commerce (62,5%) était l'aide la plus reçue. Vingt-deux membres de l'entourage savaient pourquoi on fait la réintégration. Selon eux, les considérations socioculturelles (68,2%), sont la principale barrière de la réintégration. D'après les agents de santé, le suivi psychosocial (58,3%) est la principale activité de la réintégration dans les centres de prise en charge de la fistule. CONCLUSION: la prise en charge des fistules obstétricales au Cameroun souffre de manque de réintégration sociale. Ceci expliquerait en partie la persistance de cette pathologie. Un accent devrait être mis sur l'appui matériel, financier et sur le suivi psychosocial des femmes victimes de fistule obstétricale.

The paper presents and discusses some results of an experimental research aimed at analysing the influence of compaction variables (w and energy) and method on the resulting microstructure of a compacted silty soil. In particular, the experimental data here discussed allow to compare the microstructure induced by different dynamic compaction techniques, comparing that characterising specimens obtained by two laboratory methods (Proctor standard and Harvard) and that of samples compacted in-situ during the construction of an embankment built for river regimentation purposes. Both undisturbed and disturbed samples have been retrieved from the embankment, the latter one with the purpose of collecting the soil subsequently used for laboratory compaction. Microstructural analyses (SEM, MIP) performed on laboratory and in-situ compacted samples evidenced a substantial similarity of the texture induced by the various compaction techniques, highlighting that laboratory compaction is suitable to provide soil samples representative of earth in-situ compacted soil.

In the paper some results on the effects of chemo-physical evolution of clay-lime-water suspensions on the microstructure of a lime treated kaolin have been presented. A multi-scale investigation on the sedimentation behaviour of clay suspensions under different pore water chemistry has been developed highlighting the chemo-physical mechanisms controlling particle arrangement and the soil fabric formation. The results evidenced the key role of ionic exchange in the short term on the microstructure features of the lime treated soil.

Abstract Background To identify the predictive factors for malignancies using basic clinical and laboratory information in children presenting with musculoskeletal pain and eventually diagnosed with juvenile idiopathic arthritis (JIA) or malignancy. Methods A retrospective case–control chart review research examining laboratory data from patients referred for musculoskeletal pain in 2001–2010 and diagnosed with malignancy or JIA was performed. The validity of each test for the diagnosis of neoplasia was assessed by calculating the sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV) and likelihood ratios. Results A total of 134 patients were enrolled. Statistically significant differences were found in neutrophil count, Hb, LDH, IgA and C4 values, ANA, anti-EA EBV IgG and anti-CMV IgG titres. High LDH value and anti-CMV IgG were the most predictive factors for neoplasia. High specificity factors for neoplasia were abnormal values of neutrophil count, Hb, IgA and C4, and the presence of anti-EA EBV and anti-CMV IgG. High PPV were recorded for abnormal neutrophil count, Hb value and anti-CMV titre. A low NPV was found only for anti-EA EBV and anti-CMV titres. Conclusions In this setting of patients, minimum changes in neutrophil count, particularly if associated with low Hb and high LDH levels, are to be thoroughly considered, because they appear as the most predictive factors for the diagnosis of tumour.

Abstract Background This study investigates the use of TomoDirectTM 3DCRT for whole breast adjuvant radiotherapy (AWBRT) that represents a very attractive treatment opportunity, mainly for radiotherapy departments without conventional Linacs and only equipped with helical tomotherapy units. Methods Plans were created for 17 breast cancer patients using TomoDirect in 3DCRT and IMRT modality and field-in-field 3DCRT planning (FIF) and compared in terms of PTV coverage, overdosage, homogeneity, conformality and dose to OARs. The possibility to define patient-class solutions for TD-3DCRT employment was investigated, correlating OARs dose constraints to patient specific anatomic parameters. Results TD-3DCRT showed PTV coverage and homogeneity significantly higher than TD-IMRT and FIF. PTV conformality was significantly better for FIF, while no differences were found between TD-3DCRT and TD-IMRT. TD-3DCRT showed mean values of the OARs dosimetric endpoints significantly higher than TD-IMRT; with respect to FIF, TD-3DCRT showed values significantly higher for lung V20Gy, mean heart dose and V25Gy, while contralateral lung maximum dose and contralateral breast mean dose resulted significantly lower. The Central Lung Distance (CLD) and the maximal Heart Distance (HD) resulted as useful clinical tools to predict the opportunity to employ TD-3DCRT: positive correlations were found between CLD and both V20Gy and mean lung dose and between HD and both V25Gy and the mean heart dose. TD-3DCRT showed a significantly shorter mean beam-on time than TD-IMRT. Conclusions The present study showed that TD-3DCRT and TD-IMRT are two feasible and dosimetrically acceptable treatment approach for AWBRT, with an optimal PTV coverage and adequate OARs sparing. Some concerns might be raised in terms of dose to organs at risks if TD-3DCRT is applied to a general population. A correct patients clusterization according to simple quantitative anatomic measures, would help to correctly allocate patients to the appropriate treatment planning strategy in terms of target coverage, but also of normal tissue sparing.

Abstract Introduction Antiphospholipid syndrome (APS) is characterized by recurrent arterial and venous thrombosis and detection of antiphospholipid antibodies (aPLs). This syndrome may be associated with connective tissue disorders, or with malignancies, but it may also appear in isolated form (primary APS). We report on a pediatric patient presenting with acute adrenal failure as the first manifestation of primary APS. Case report A previously healthy 11-year-old boy developed fever, abdominal pain, and vomiting. An abdominal computed tomography scan showed nodular lesions in the adrenal glands. He was referred to our Department and a diagnosis of APS and acute adrenal failure was considered, based on positive aPLs (IgG and IgM), elevated ACTH levels and low cortisol levels. Other features were anemia, thrombocytopenia, elevated inflammatory parameters, hypergammaglobulinemia, prolonged partial thromboplastin time, positive antinuclear, anticardiolipin, anti-platelet antibodies, with negative double-stranded DNA antibodies. Lupus anticoagulant and Coomb’s tests were positive. MRI revealed a bilateral adrenal hemorrhage. A treatment with intravenous metylprednisolone, followed by oral prednisone and anticoagulant, was started, resulting in a progressive improvement. After 2 months he also showed hyponatremia and elevated renine levels, indicating a mineralcocorticoid deficiency, requiring fludrocortisones therapy. Conclusion The development of acute adrenal failure from bilateral adrenal haemorrhage in the context of APS is a rare but life-threatening event that should be promptly recognized and treated. Moreover, this case emphasizes the importance of the assessment of aPLs in patients with acute adrenal failure in the context of an autoreaction.

Abstract Background The debate over physicians’ geographical distribution has attracted the attention of the economic and public health literature over the last forty years. Nonetheless, it is still to date unclear what influences physicians’ location, and whether foreign physicians contribute to fill the geographical gaps left by national doctors in any given country. The present research sets out to investigate the current distribution of national and international physicians in Portugal, with the objective to understand its determinants and provide an evidence base for policy-makers to identify policies to influence it. Methods A cross-sectional study of physicians currently registered in Portugal was conducted to describe the population and explore the association of physician residence patterns with relevant personal and municipality characteristics. Data from the Portuguese Medical Council on physicians’ residence and characteristics were analysed, as well as data from the National Institute of Statistics on municipalities’ population, living standards and health care network. Descriptive statistics, chi-square tests, negative binomial and logistic regression modelling were applied to determine: (a) municipality characteristics predicting Portuguese and International physicians’ geographical distribution, and; (b) doctors’ characteristics that could increase the odds of residing outside the country’s metropolitan areas. Results There were 39,473 physicians in Portugal in 2008, 51.1% of whom male, and 40.2% between 41 and 55 years of age. They were predominantly Portuguese (90.5%), with Spanish, Brazilian and African nationalities also represented. Population, Population’s Purchasing Power, Nurses per capita and Municipality Development Index (MDI) were the municipality characteristics displaying the strongest association with national physicians’ location. For foreign physicians, the MDI was not statistically significant, while municipalities’ foreign population applying for residence appeared to be an additional positive factor in their location decisions. In general, being foreigner and male resulted to be the physician characteristics increasing the odds of residing outside the metropolitan areas. However, among the internationals, older doctors were more likely to reside outside metropolitan areas. Being Spanish or Brazilian (but not of African origin) was found to increase the odds of being based outside the Lisbon and Oporto metropolitan areas. Conclusions The present study showed the relevance of studying one country’s physician population to understand the factors driving national and international doctors’ location decisions. A more nuanced understanding of national and foreign doctors’ location appears to be needed to design more effective policies to reduce the imbalance of medical services across geographical areas.

Abstract Background The aim of this study was to investigate cytochrome P450 2C8*2 (CYP2C8*2) distribution and allele frequency in three populations from West and East Africa exposed to Plasmodium falciparum malaria. CYP2C8 enzyme is involved in the metabolism of the anti-malarials amodiaquine and chloroquine. The presence of the CYP2C8*2 defective allele has been recently associated to higher rate of chloroquine-resistant malaria parasites. Methods A total of 503 young subjects were genotyped for the single nucleotide polymorphism rs11572103 (A/T). Eighty-eight were from southern Senegal, 262 from eastern Uganda and 153 from southern Madagascar. The PCR-RFLP technique was used to discriminate the wild-type (A) from the defective allele (T). Results A CYP2C8*2 (T) allele frequency of 0.222 ± 0.044 was detected in Senegal, 0.105 ± 0.019 in Uganda and 0.150 ± 0.029 in Madagascar. Conclusions This study demonstrated that CYP2C8*2 allele is widespread in Africa. This allele occurs at different frequency in West and East Africa, being higher in Senegal than in Uganda and Madagascar. These data indicate that an important fraction of the populations analysed has a decreased enzymatic activity, thus being at higher risk for drug accumulation with two possible consequences: i) an exacerbation of drug-associated adverse side effects; ii) an increase of drug-resistance selection pressure on P. falciparum parasites.

Abstract Background Special services within public hospitals are becoming increasingly common in low and middle income countries with the stated objective of providing higher comfort services to affluent customers and generating resources for under funded hospitals. In the present study expenditures, outputs and costs are analysed for the Maputo Central Hospital and its Special Clinic with the objective of identifying net resource flows between a system operating two-tier charging, and, ultimately, understanding whether public hospitals can somehow benefit from running Special Clinic operations. Methods A combination of step-down and bottom-up costing strategies were used to calculate recurrent as well as capital expenses, apportion them to identified cost centres and link costs to selected output measures. Results The results show that cost differences between main hospital and clinic are marked and significant, with the Special Clinic's cost per patient and cost per outpatient visit respectively over four times and over thirteen times their equivalent in the main hospital. Discussion While the main hospital cost structure appeared in line with those from similar studies, salary expenditures were found to drive costs in the Special Clinic (73% of total), where capital and drug costs were surprisingly low (2 and 4% respectively). We attributed low capital and drug costs to underestimation by our study owing to difficulties in attributing the use of shared resources and to the Special Clinic's outsourcing policy. The large staff expenditure would be explained by higher physician time commitment, economic rents and subsidies to hospital staff. On the whole it was observed that: (a) the flow of capital and human resources was not fully captured by the financial systems in place and stayed largely unaccounted for; (b) because of the little consideration given to capital costs, the main hospital is more likely to be subsidising its Special Clinic operations, rather than the other way around. Conclusion We conclude that the observed lack of transparency may create scope for an inequitable cross subsidy of private customers by public resources.

Abstract Introduction In the context of the current human resources for health (HRH) crisis, the need for comprehensive Human Resources Development Plans (HRDP) is acute, especially in resource-scarce sub-Saharan African countries. However, the financial implications of such plans rarely receive due consideration, despite the availability of much advice and examples in the literature on how to conduct HRDP costing. Global initiatives have also been launched recently to standardise costing methodologies and respective tools. Methods This paper reports on two separate experiences of HRDP costing in Mozambique and Guinea Bissau, with the objective to provide an insight into the practice of costing exercises in information-poor settings, as well as to contribute to the existing debate on HRH costing methodologies. The study adopts a case-study approach to analyse the methodologies developed in the two countries, their contexts, policy processes and actors involved. Results From the analysis of the two cases, it emerged that the costing exercises represented an important driver of the HRDP elaboration, which lent credibility to the process, and provided a financial framework within which HRH policies could be discussed. In both cases, bottom-up and country-specific methods were designed to overcome the countries' lack of cost and financing data, as well as to interpret their financial systems. Such an approach also allowed the costing exercises to feed directly into the national planning and budgeting process. Conclusions The authors conclude that bottom-up and country-specific costing methodologies have the potential to serve adequately the multi-faceted purpose of the exercise. It is recognised that standardised tools and methodologies may help reduce local governments' dependency on foreign expertise to conduct the HRDP costing and facilitate regional and international comparisons. However, adopting pre-defined and insufficiently flexible tools may undermine the credibility of the costing exercise, and reduce the space for policy negotiation opportunities within the HRDP elaboration process.

Abstract Background The Italian and European Best Practice Guidelines (EBPG) recommend a target haemoglobin value greater than 11 g/dl in most patients with Chronic Kidney Diseases. However, it is still difficult to maintain these values at a steady rate. Thus, the main aim of the study was to evaluate, throughout 2005, how many patients steadily maintained the performance targets related to anaemia treatment. Methods The survey was conducted on 3283 patients on haemodialysis (HD) and peritoneal dialysis (PD) at 20 Italian dialysis centres. 540 patients were randomly selected; each centre provided a statistically significant sample proportional to its total number of patients. Maintenance of the following target levels was assessed over time: Haemoglobin (HB) 11-12 gr/dl; Iron: 60-160 mcg/dl; Ferritin: 30-400 mcg/l; Transferrin: 200-360 mg/dl; Transferrin saturation percentage (TSAT %):> 25 1.2 1.5 1.8 Outcome included: 1- Percentage of target maintenance for each parameter. 2- Erythropoietin dose in relation to dialysis techniques, presence of cancer or myeloma, diabetic status, Vitamin B therapy. 3- Erythropoietin dose (International Units/kg/week) (IU/kg/wk) depending on: haemoglobin values, hospitalization of more than 3 days. Results Mean age was 65.1; mean haemoglobin concentration over the whole population was 11.3 gr/dl (Standard Deviation (SD): 0.91). The clinical performance targets were maintained over time as follows: HB: 4.3% (Mean 11.43 gr/dl) (SD: 0.42); Ferritin: 71.1% (Mean: 250.23 mcg/L (SD:104.07); Iron: 95.0% (Mean 59.79 mcg/dl)(SD:16.76); Transferrin: 44.8% (Mean 216.83 mg/dl) (SD: 19,50); TSAT %: in 8.4% (Mean: 34.33% (SD: 6.56); HD KT/V: 61.0% (Mean:1.46) (SD: 0.7); PD KT/V:31.4% (Mean: 2.10) (SD: 0.02). The average weekly dose of Erythropoietin (IU/Kg/Wk) was significantly lower for the peritoneal dialysis technique; the higher haemoglobin values, the lower the Erythropoietin dose (IU/Kg/Wk). Conclusion A very low percentage of patients maintained haemoglobin target values over time. We need to identify precise criteria to evaluate the stability over time of clinical performance targets proposed by the guidelines.

Abstract Background DNA microarrays are among the most widely used technical platforms for DNA and RNA studies, and issues related to microarrays sensitivity and specificity are therefore of general importance in life sciences. Compatible solutes are derived from hyperthermophilic microorganisms and allow such microorganisms to survive in environmental and stressful conditions. Compatible solutes show stabilization effects towards biological macromolecules, including DNA. Results We report here that compatible solutes from hyperthermophiles increased the performance of the hybridization buffer for Affymetrix GeneChip® arrays. The experimental setup included independent hybridizations with constant RNA over a wide range of compatible solute concentrations. The dependence of array quality and compatible solute was assessed using specialized statistical tools provided by both the proprietary Affymetrix quality control system and the open source Bioconductor suite. Conclusion Low concentration (10 to 25 mM) of hydroxyectoine, potassium mannosylglycerate and potassium diglycerol phosphate in hybridization buffer positively affected hybridization parameters and enhanced microarrays outcome. This finding harbours a strong potential for the improvement of DNA microarray experiments.

Erectile Dysfunction (ED) is defined as the persistent inability to obtain and maintain an erection that enables satisfactory sexual intercourse. ED prevalence vary across age groups, affecting approximately 1-9% of men under 40, 2-9% of those aged 40-59, and increasing to 20-40% for those aged 60-69. However, it remains a frequently untreated or insufficiently treated condition. Especially due to the feeling of discomfort and guilt, patients often avoid consulting their physicians; in this context, digital innovation could potentially play a pivotal role in the diagnosis and management of ED. This narrative review depicts the ongoing status of digital innovations in ED focusing on websites, social media platforms and mobile health applications (MHA). We examined Google, social media platforms (Facebook, Twitter, YouTube, and TikTok), and the recently developed MHA apps on Google Play Store and Apple App Store. Websites provide readily available but sometimes difficult to understand information, while social media is easy to understand and act on. MHA apps are the most complete and trustworthy tool for self-care management. In conclusion, digital innovations are a continuously growing source of information and therapeutic tools., Competing Interests: Competing interests MF is a speaker for Boston Scientific. The remaining authors declare no conflict of interest., (© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)