Measurement invariance of the driving inattention scale (ARDES) across 7 countries.

The Attention-Related Driving Errors Scale (ARDES) is a self-report measure of individual differences in driving inattention. ARDES was originally developed in Spanish (Argentina), and later adapted to other countries and languages. Evidence supporting the reliability and validity of ARDES scores has been obtained in various different countries. However, no study has been conducted to specifically examine the measurement invariance of ARDES measures across countries, thus limiting their comparability. Can different language versions of ARDES provide comparable measures across countries with different traffic regulations and cultural norms? To what extent might cultural differences prevent researchers from making valid inferences based on ARDES measures? Using Alignment Analysis, the present study assessed the approximate invariance of ARDES measures in seven countries: Argentina (n = 603), Australia (n = 378), Brazil (n = 220), China (n = 308). Spain (n = 310), UK (n = 298), and USA (n = 278). The three-factor structure of ARDES scores (differentiating driving errors occurring at Navigation, Manoeuvring and Control levels) was used as the target theoretical model. A fixed alignment analysis was conducted to examine approximate measurement invariance. 12.3 % of the intercepts and 0.8 % of the item-factor loadings were identified as non-invariant, averaging 8.6 % of non-invariance. Despite substantial differences among the countries, sample recruitment or representativeness, study results support resorting to ARDES measures to make comparisons across the country samples. Thus, the range of cultures, laws and collision risk across these 7 countries provides a demanding assessment for a cultural-free inattention while-driving. The alignment analysis results suggest that ARDES measures reach near equivalence among the countries in the study. We hope this study will serve as a basis for future cross-cultural research on driving inattention using ARDES.

Missense mutations in the membrane domain of PRRT2 affect its interaction with Nav1.2 voltage-gated sodium channels.

PRRT2 is a neuronal protein that controls neuronal excitability and network stability by modulating voltage-gated Na+ channel (Nav). PRRT2 pathogenic variants cause pleiotropic syndromes including epilepsy, paroxysmal kinesigenic dyskinesia and episodic ataxia attributable to loss-of-function pathogenetic mechanism. Based on the evidence that the transmembrane domain of PRRT2 interacts with Nav1.2/1.6, we focused on eight missense mutations located within the domain that show expression and membrane localization similar to the wild-type protein. Molecular dynamics simulations showed that the mutants do not alter the structural stability of the PRRT2 membrane domain and preserve its conformation. Using affinity assays, we found that the A320V and V286M mutants displayed respectively decreased and increased binding to Nav1.2. Accordingly, surface biotinylation showed an increased Nav1.2 surface exposure induced by the A320V mutant. Electrophysiological analysis confirmed the lack of modulation of Nav1.2 biophysical properties by the A320V mutant with a loss-of-function phenotype, while the V286M mutant displayed a gain-of-function with respect to wild-type PRRT2 with a more pronounced left-shift of the inactivation kinetics and delayed recovery from inactivation. The data confirm the key role played by the PRRT2-Nav interaction in the pathogenesis of the PRRT2-linked disorders and suggest an involvement of the A320 and V286 residues in the interaction site. Given the similar clinical phenotype caused by the two mutations, we speculate that circuit instability and paroxysmal manifestations may arise when PRRT2 function is outside the physiological range.

How are Brazilian university students coping with the COVID-19 pandemic? Results of an online survey on psychosocial well-being, perceived burdens, and attitudes toward social distancing and vaccination.

BACKGROUND: The COVID-19 pandemic caused significant disruption to education systems worldwide, increasing pre-existing concerns regarding university students' mental health. Brazil was among the countries most affected by COVID-19 cases and deaths and was considered a pandemic epicenter. This study aimed to investigate Brazilian university students' mental health status and perceived burdens during the COVID-19 pandemic. MATERIAL AND METHODS: From November 2021 to March 2022, a cross-sectional and anonymous online survey was conducted among students of a Brazilian federal university. Mental health status (depressive symptoms, alcohol and drug consumption) and social and emotional aspects in the pandemic context (social support, perceived stress, loneliness, resilience, and self-efficacy) were assessed with standardized measures. Students' attitudes toward the COVID-19 pandemic and vaccination and perceived burdens of the pandemic were also investigated. RESULTS: A total of N = 2,437 students completed the online survey. The PHQ-9 mean sum score was 12.85 (SD = 7.40), while n = 1,488 (61.10%) participants reported a sum score of 10 or more, indicating clinically relevant depressive symptoms. Further, n = 808 (33.1%) of the total sample reported suicidal thoughts. Levels of depressive symptoms, perceived stress, and loneliness were higher among undergraduate/bachelor students than doctoral students. Almost all participants (97.3%) reported being fully vaccinated against COVID-19. Multiple regression analyses showed that being single, having an income decreased during the pandemic, having a previous mental illness, having a chronic somatic condition, not finding positive aspects in the pandemic, lower self-efficacy, lower social support, lower resilience, and higher experienced loneliness were significantly associated with higher levels of depression. CONCLUSIONS: The study showed high levels of depressive symptoms and suicidal ideation among Federal University of Parana students. Therefore, health care providers and universities need to recognize and address mental health issues; psychosocial policies must be enhanced to mitigate the impact of the pandemic on students' mental health and wellbeing.

"I Drive Well, the Problem is the Other Driver": A Study About the Self-Assessment of the Ability to Drive / "Yo Conduzco Bien, el Problema es el Otro": Un Estudio Sobre la Autoevaluación de la Capacidad de Conducir

Abstract This study aims to verify the self-evaluation that people make about their ability to drive and investigate whether there is a difference between self-evaluation and evaluation about their friends' abilities. To this end, 151 people answered three different questionnaires, one questionnaire about driving abilities (self-evaluation and evaluation of friends), the Driver's Behavior Questionnaire and a socio-demographic questionnaire The sample consisted of 50.3% of males with a mean age of 25.32 years (SD = 1.66). As a result, self-evaluation was positively correlated with age, evaluation of friend, weekly driving hours, Common Violations, and Aggressive Violations. In addition, there was significant difference between evaluation by sex: males carry out self-assessments in a more positive way. It was also found that people evaluate themselves better than they evaluate their friends. From this research, it is possible to think the target audience that would most benefit from an intervention to reduce self-evaluation, that is, men, people over 24 years old, and people who have more driving experience.

Resumen Este estudio tiene como objetivo verificar la autoevaluación que las personas hacen sobre su capacidad para conducir y si hay diferencia entre la autoevaluación y la evaluación de las habilidades de sus amigos. Fueron aplicados tres instrumentos, un cuestionario sobre habilidades de conducción (autoevaluación y evaluación de amigos), el Driver's Behavior Questionnaire y un cuestonario sociodemográfico. Participaron 151 personas (50.3% hombres) con una edad media de 25.32 años (DE=1.66). Hubo una correlación positiva entre la autoevaluación y la edad; evaluación de amigos; horas semanales de conducción; violaciones ordinarias y violaciones agresivas. Además, hubo una diferencia significativa entre la evaluación por sexo: los hombres realizan autoevaluaciones de una manera más positiva. También se descubrió que las personas evalúan mejor a sí mismas de lo que evalúan a sus amigos. Así, es posible pensar en el público que se beneficiaría más de una intervención para reducir la autoevaluación: hombres, personas mayores de 24 años y personas que tienen más experiencia de conducción.

Promoção de comportamento seguro no trânsito: relato de uma intervenção / Promoting safe behavior in traffic: an intervention report / Promoción de comportamiento seguro en el tránsito: relato de una intervención

Este artigo objetiva relatar uma intervenção em Psicologia do Trânsito, visando conscientizar jovens estudantes sobre aspectos importantes do trânsito que estão envolvidos no cotidiano. O projeto "Meu Primeiro Certificado UFPR" foi elaborado como projeto piloto para implementação durante a Feira de Profissões da Universidade Federal do Paraná, desenvolvendo quatro temáticas: o pedestre e uso do celular; cinto de segurança; mobilidade com a bicicleta; e entrar no carro com motorista alcoolizado. Estandes com os temas foram montados em pontos estrategicamente distribuídos na feira. Ao entrar na feira, os estudantes recebiam um material já no primeiro estande; ao visitarem os outros quatro estandes, recebiam carimbos de presença em cada um; e, ao final da feira, o estudante recebia um certificado mediante a apresentação do cartão carimbado. Ao todo, o projeto alcançou diretamente 2674 estudantes de Ensino Médio, 68,7% adolescentes mulheres. Os participantes tinham entre 14 e 19 anos (M = 16,59). Do total de jovens, 72,3% estudam em escola pública. Concluiu-se que a aplicação do piloto foi relevante, uma vez que houve grande alcance do público-alvo, que demonstrou interesse em visitar os estandes e dialogar sobre as temáticas apresentadas. O projeto foi bem avaliado pelos participantes, a maioria (75%) classificando-o como excelente.(AU)

This article aims to report a Traffic Psychology intervention that sought to raise awareness about important traffic features involved in everyday life among young students. Developed to be implemented in the Career Expo at the Universidade Federal do Paraná, the pilot project Meu Primeiro Certificado UFPR (My first UFPR Certificate) consisted of four stands strategically positioned along the expo, each approaching one of the following themes: pedestrian's use of mobile phone, seat belt, bicycle use, and travelling with a drunk driver. The students received the material to participate in the activity upon entering the expo; for each visited stand, they received a stamp and, after completing the four stands, they received a certificate. The project was offered to 2674 high school students (68.7% female; 72.3% of whom studied in public schools) aged between 14 and 19 years (M = 16.59); among these, 924 visited all stands and received the certificate. The intervention program was relevant due to its wide reach, as a considerable amount of students showed interest in visiting the stands and talking about the presented topics, with 75% of them rating the project as excellent.(AU)

Este artículo tiene como objetivo relatar una intervención en Psicología del Tránsito con el fin de concientizar a jóvenes estudiantes sobre los aspectos importantes de esta involucrados en el día a día. El proyecto Meu Primeiro Certificado UFPR ("Mi Primer Certificado UFPR") se elaboró como un proyecto piloto y fue desarrollado durante la Feria de Profesiones de la Universidade Federal do Paraná, teniendo en cuenta cuatro temáticas: el peatón y uso del celular; el cinturón de seguridad; la movilidad con la bicicleta y el manejo del coche con conductor alcohólico. Los estudiantes recibían el material en el primero de los stands, junto con un sello de presencia por cada visita a los cuatro stands, y obtenían el certificado al final de la feria mediante la presentación de la tarjeta sellada. En total, el proyecto llegó directamente a 2.674 estudiantes de la secundaria, siendo el 68,7% mujeres. Los participantes tenían edades entre los 14 y los 19 años (media = 16,59). Del total de jóvenes, el 72,3% estudiaban en escuelas públicas. Se concluye que la aplicación piloto se mostró relevante debido al gran alcance dentro del público objetivo, que durante la aplicación se mostró interesado por la visita a los stands y el diálogo con respecto a las temáticas presentadas. En cuanto al nivel de satisfacción, el 75% de los participantes clasificaron el proyecto como excelente.(AU)

Circulating biomarkers and cardiac function over 3 years after chemotherapy with anthracyclines: the ICOS-ONE trial.

AIMS: A multicentre trial, ICOS-ONE, showed increases above the upper limit of normality of cardiac troponin (cTn) in 27% of patients within 12 months after the end of cancer chemotherapy (CT) with anthracyclines, whether cardiac protection with enalapril was started at study entry in all (prevention arm) or only upon first occurrence on supra-normal cTn (troponin-triggered arm). The aims of the present post hoc analysis were (i) to assess whether anthracycline-based treatment could induce cardiotoxicity over 36 month follow-up and (ii) to describe the time course of three cardiovascular biomarkers (i.e. troponin I cTnI-Ultra, B-type natriuretic peptide BNP, and pentraxin 3 PTX3) and of left ventricular (LV) function up to 36 months. METHODS AND RESULTS: Eligible patients were those prescribed first-in-life CT, without evidence of cardiovascular disease, normal cTn, LV ejection fraction (EF) >50%, not on renin-angiotensin aldosterone system antagonists. Patients underwent echocardiography and blood sampling at 24 and 36 months. No differences were observed in biomarker concentration between the two study arms, 'prevention' vs. 'troponin-triggered'. During additional follow-up 13 more deaths occurred, leading to a total of 23 (9.5%), all due to a non-cardiovascular cause. No new occurrences of LV-dysfunction were reported. Two additional patients were admitted to the hospital for cardiovascular causes, both for acute pulmonary embolism. No first onset of raised cTnI-Ultra was reported in the extended follow-up. BNP remained within normal range: at 36 months was 23.4 ng/L, higher (N.S.) than at baseline, 17.6 ng/L. PTX3 peaked at 5.2 ng/mL 1 month after CT and returned to baseline values thereafter. cTnI-Ultra peaked at 26 ng/L 1 month after CT and returned to 3 ng/L until the last measurement at 36 months. All echocardiographic variables remained stable during follow-up with a median LVEF of 63% and left atrial volume index about 24 mL/m2 . CONCLUSIONS: First-in-life CT with median cumulative dose of anthracyclines of 180 mg/m2 does not seem to cause clinically significant cardiac injury, as assessed by circulating biomarkers and echocardiography, in patients aged 51 years (median), without pre-existing cardiac disease. This may suggest either a 100% efficacy of enalapril (given as preventive or troponin-triggered) or a reassuringly low absolute cardiovascular risk in this cohort of patients, which may not require intensive cardiologic follow-up.

Teste Palográfico: desafios para formação em avaliação psicológica / Palographic test: challenges for training in psychological evaluation / Test Palográfico: retos para la formación en evaluación psicológica

O Teste Palográfico é um teste de personalidade muito utilizado no Brasil. Objetivou-se na presente pesquisa realizar uma análise sobre o modo que a correção deste vem sendo realizada por psicólogos que trabalham cotidianamente com avaliação psicológica. Para tanto, foram aplicados questionários em 295 psicólogos. Estes tinham entre 26 e 66 anos (média = 40,34; DP = 9,91), 94,9% eram do sexo feminino. Os resultados indicam uma falta de padronização na correção do teste, o que gera a possibilidade de uma mesma pessoa receber diferentes pareceres, dependendo do critério utilizado. Além disso, três problemas foram encontrados: a rapidez na correção do teste; o não uso dos materiais necessários para corrigi-lo e o erro de significado atribuído aos indicadores. A partir dos erros de correção do teste e do pouco tempo utilizado nesse processo, discute-se a necessidade de que seja dada atenção à formação do psicólogo em avaliação psicológica. (AU)

The teste Palográfico (Palographic test) is a personality test used a lot in Brazil. The aim of this study was to perform an analysis on the way that correction of this test has been performed by psychologists that work daily with psychological evaluation. For this, questionnaires were applied to 295 licensed psychologists. These were aged between 26 and 66 years (M=40.34, SD=9.91); with 94.9% females. The results highlight the lack of standardization in the correction process of the test, which generates the possibility of the same person receiving different results depending on the criteria used. In addition, three problems were found: the time spent during the correction process; lack of application of proper methods to evaluate the tests and the incorrect interpretation of test items. From the errors in the correction of the test, we discuss the need to consider the psychologist's training regarding psychological assessment. (AU)

El Test Palográfico es un test de personalidad muy utilizado en Brasil. El objetivo de la presente investigación fue realizar un análisis sobre el modo en que la corrección de este test viene siendo efectuada por los psicólogos que trabajan diariamente con evaluación psicológica. Para ello, 295 psicólogos contestaron al cuestionario. Estos tenían entre 26 y 66 años (media = 40,34, DS = 9,91), siendo 94,9% mujeres. Los resultados indican una falta de estandarización en la corrección del test, lo que genera la posibilidad de que, dependiendo del criterio utilizado, una misma persona pueda recibir diferentes resultados. Además, se encontraron tres problemas: la rapidez en la corrección del test; los materiales necesarios para su corrección no fueron utilizados y el error de significado atribuido a los indicadores. A partir de esos resultados, se discute la necesidad fomentar la formación del psicólogo en evaluación psicológica. (AU)

Brazilian adaptation of the driving anger expression inventory: testing its psychometrics properties and links between anger behavior, risky behavior, sensation seeking, and hostility in a sample of Brazilian undergraduate students.

INTRODUCTION: In Brazil, driver aggressiveness in road traffic is a critical issue and could be an important contributing factor to the high number of traffic accidents. Because no instruments are available in Portuguese to register driving aggressiveness or driving anger in Brazil, we adapted English instruments into the Brazilian context. The aims of this study were to provide a Brazilian adaptation of the Driving Anger Expression Inventory (DAX) and to try to validate it by testing its psychometric properties and investigating its relationships with risky driving behaviors (DBQ), road accidents, driving sensation seeking, and hostility. METHOD: The Brazilian adaptations of the DAX, DBQ, the Driving Sensation Seeking Scale (DSSS) and the hostility Scale were administered to a sample of 512 undergraduate students (with a mean age of 23.7 years, 52.1% men). RESULTS: Confirmatory factor analysis of the Brazilian DAX (DAX-BR) items yielded a four-factor solution with 43 items, which obtained the best goodness-of-fit to the data. Cronbach's alpha for the DAX-BR factors ranged from 0.69 to 0.88. Other results on validity were a positive correlation (range 0.39-0.59) between the factors of the DAX-BR, DSSS, and DBQ. CONCLUSION: DAX-BR as the same structure as the original and is a reliable instrument for use with young drivers. Other studies should be conducted to further validate the DAX-BR in different types of populations such as older and more experienced drivers, professional drivers, and traffic regulation offenders whose driver's license has been taken away. Practical applications: This Brazilian version can be recommended for the assessment of driving anger expression in Brazil among young drivers in view of helping them driver more safely, and in particular to reduce traffic violations.

HARCI-EU, a harmonized gridded dataset of critical infrastructures in Europe for large-scale risk assessments.

Critical infrastructures (CIs) are assets, systems, or parts thereof that are essential for the maintenance of socioeconomic functions, health, safety and well-being of people. The exposure of CIs to natural and man-made hazards poses a risk to the economy and society. The spatial distribution of CIs and their economic value are a prerequisite for quantifying risk and planning suitable protection and adaptation measures. However, the incompleteness and inconsistency of existing information on CIs hamper their integration into large-scale risk frameworks. We present here the 'HARmonized grids of Critical Infrastructures in EUrope' (HARCI-EU) dataset. It represents major CIs in the transport, energy, industry and social sectors at 1 km2 expressed in sector-specific, economically-relevant units. The HARCI-EU grids were produced by integrating geospatial and statistical data from multiple sources. Correlation analysis performed against independent metrics corroborates the approach showing average Pearson coefficients ranging between 0.61 and 0.95 across the sectors. HARCI-EU provides a consistent mapping of CIs in key sectors that can serve as exposure information for large-scale risk assessments in Europe.

Juvenile recurrent parotitis: Diagnostic and therapeutic effectiveness of sialography. Retrospective study on 110 children.

INTRODUCTION: Juvenile recurrent parotitis (JRP) is characterized by recurrent episodes of painful parotid swelling, generally associated with non-obstructive sialectasia of the parotid gland. The aim of this study was to evaluate the diagnostic and therapeutic effectiveness of sialography in children affected by JRP. METHODS: Clinical records of 110 outpatients with a diagnosis of JRP followed up from 2008 to 2017 at the Unit of Paediatric Otorhinolaryngology, Surgery Department of the Bambino Gesù Children's Hospital of Rome, were retrospectively reviewed. Data on demographics, number of acute episodes/year, course of disease, site of symptoms and duration of follow up were collected. The inclusion criteria were: at least two or more episodes of intermittent swelling of the parotid glands on one side or both sides during the last 6 months, age <16 years. Exclusion criteria were: obstructive lesions, dental malocclusion, Sjogren syndrome, congenital IgA immunodeficiency, and relevant systemic diseases. Outcome of the procedure was measured by evaluating number and degree of episodes of parotid swelling before and after sialography. RESULTS: Sialography has been shown in all cases to be a valid method in the diagnosis of JRP. Following the execution of the sialography, in 98 patients (89% of cases) there was a statistically significant improvement of disease with a mean reduction of 67.4% of episodes of parotid swelling (p < 0.05). In 75 patients there was marked improvement of the symptomatology (p < 0.05). In 23 patients partial resolution occurred (p < 0.05); in 12 patients there was no resolution or a reduction less than 30% of episodes (p > 0.05). There was a statistically significant relationship between the number of attacks/year and the degree of glandular function, pre and post-sialography in 2-way ANOVA test (p < 0.05). CONCLUSION: Sialography is effective method not only as a diagnostic procedure but also as a therapeutic procedure in treatment of JRP. It is a method that can be carried out in ambulatory setting, without anaesthesia, with a minimum cost and with a very low rate of complications. In a disease with tendency to spontaneous resolution like JRP, sialography represent a therapeutic option alternative to more invasive treatment.

Adaptação Brasileira da Escala Clima Familiar para Segurança no Trânsito / Brazilian adaptation of the Family Climate Scale for Road Safety / Adaptación brasileña de la Escala Clima Familiar para la seguridad vial

Resumo (analítico): Esta pesquisa visa verificar evidências de validade da adaptação brasileira da Escala Clima Familiar para Segurança no Trânsito (Taubman-Ben-Ari & Katz-Ben- Ami, 2013), que avalia a percepção de jovens condutores sobre valores, prioridades, e práticas dos pais e da família em relação à condução segura. Participaram da pesquisa 420 universitários (63% homens), com idade entre 18 e 22 anos (média=19,7 anos; DP=1,3 anos). A análise fatorial indicou uma solução de cinco fatores: Comunicação/Mensagem (α=0,87), Monitoramento/Limites (α=0,87), Falta de Compromisso com a Segurança (α=0,70), Modelagem (α=0,79) e Feedback (α=0,80). Os dados mostram que a versão brasileira da escala apresentou resultados adequados e pode ser utilizada em estudos futuros sobre clima familiar em relação à condução.

Abstract (analytical): This research has the objective of verifying the evidence of the validity of the Brazilian version of the Family Climate Scale for Road Safety (Taubman-Ben-Ari & Katz-Ben- Ami, 2013), which evaluates the perception of young drivers of their values and priorities and the practices of parents and relatives in relation to safe driving. The participants were 420 university students (63% men) aged between 18 and 22 (mean=19.7 years, SD=1.3 years). Factor analysis indicated a five-factor solution: Communication / Message (α=0.87), Monitoring / Limits (α=0.87), Lack of Commitment to Safety (α=0.70), Modeling (α=0.79) and Feedback (α=0.80). The data show that the Brazilian version of the scale achieved suitable results and can be used in future studies of family environments in relation to driving.

Resumen (analítico): Esta investigación tiene como objetivo buscar evidencias de la validez de la versión brasileña de la Escala Clima Familiar para la Seguridad Vial (Taubman Ben-Ari y Katz-Bien-Ami, 2013), la cual evalúa la percepción de los conductores jóvenes sobre los valores, las prioridades y las prácticas de sus padres y de la familia con respecto a la conducción segura. Los participantes fueron 420 estudiantes universitarios (63% hombres) con edades comprendidas entre 18 y 22 años (media=19,7 años, DS=1,3 años). El análisis factorial indicó una solución en cinco factores: Comunicación/Mensaje (α=0,87), Monitoreo/Límites (α=0,87), Falta de Compromiso con la Seguridad (α=0,70), el Modelado (α=0,79) y Feedback (α=0,80). Los datos indican que la versión brasileña de la Escala Clima Familiar para la Seguridad Vial es adecuada y puede ser utilizada en futuros estudios que quieran evaluar el impacto del ambiente familiar en la formación de los conductores jóvenes.

Neoplastic Pericardial Effusion: A Monocentric Retrospective Study.

Background: Neoplastic pericardial effusion (NPE) is a life-threatening condition that can worsen clinical outcome in cancer patients. The optimal management of NPE has yet to be defined because randomized studies are lacking. Objective: We report a retrospective monoinstitutional experience describing characteristics, management and prognostic factors in NPE patients. Design: We reviewed clinical, pathological, and echocardiographic features, therapeutic strategies, and outcome in NPE patients referred to our institute from August 2011 to December 2017. Measurements: Twenty-nine patients with NPE from solid tumors have been identified: 21 lung, 5 breast, and 3 other cancer patients. Results: Median age was 62 years. Most of the patients had Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≥2 (69%) and a symptomatic NPE (69%). In 52% of patients NPE was detected at first diagnosis of metastatic disease, and in 20% of patients pericardium was the only site of metastases. Most of the patients (62%) received systemic therapy, 28% received combined locoregional and systemic therapy, and 10% received locoregional therapy alone. Median overall survival (OS) from NPE diagnosis was 3.9 months. Patients with PS ≥2 had worse OS than patients with better PS <2 (hazard ratio [HR] 3.56, IC 95% 1.19-10.65, p 0.02). Older age, extrapericardial disease, and NPE at progression showed a trend of association with worse OS. Patients treated with locoregional therapy alone showed the shortest median OS (p 0.05). Conclusions: NPE is related to dismal prognosis. Poor PS significantly worsens survival and influences therapeutic approaches. Randomized studies are required to investigate prognostic factors and appropriate clinical management for patients with NPE.

Escalating impacts of climate extremes on critical infrastructures in Europe.

Extreme climatic events are likely to become more frequent owing to global warming. This may put additional stress on critical infrastructures with typically long life spans. However, little is known about the risks of multiple climate extremes on critical infrastructures at regional to continental scales. Here we show how single- and multi-hazard damage to energy, transport, industrial, and social critical infrastructures in Europe are likely to develop until the year 2100 under the influence of climate change. We combine a set of high-resolution climate hazard projections, a detailed representation of physical assets in various sectors and their sensitivity to the hazards, and more than 1100 records of losses from climate extremes in a prognostic modelling framework. We find that damages could triple by the 2020s, multiply six-fold by mid-century, and amount to more than 10 times present damage of €3.4 billion per year by the end of the century due only to climate change. Damage from heatwaves, droughts in southern Europe, and coastal floods shows the most dramatic rise, but the risks of inland flooding, windstorms, and forest fires will also increase in Europe, with varying degrees of change across regions. Economic losses are highest for the industry, transport, and energy sectors. Future losses will not be incurred equally across Europe. Southern and south-eastern European countries will be most affected and, as a result, will probably require higher costs of adaptation. The findings of this study could aid in prioritizing regional investments to address the unequal burden of impacts and differences in adaptation capacities across Europe.

Anthracycline-induced cardiotoxicity: A multicenter randomised trial comparing two strategies for guiding prevention with enalapril: The International CardioOncology Society-one trial.

BACKGROUND: Troponin changes over time have been suggested to allow for an early diagnosis of cardiac injury ensuing cancer chemotherapy; cancer patients with troponin elevation may benefit of therapy with enalapril. It is unknown whether a preventive treatment with enalapril may further increase the benefit. METHODS: The International CardioOncology Society-one trial (ICOS-ONE) was a controlled, open-label trial conducted in 21 Italian hospitals. Patients were randomly assigned to two strategies: enalapril in all patients started before chemotherapy (CT; 'prevention' arm), and enalapril started only in patients with an increase in troponin during or after CT ('troponin-triggered' arm). Troponin was assayed locally in 2596 blood samples, before and after each anthracycline-containing CT cycle and at each study visit; electrocardiogram and echocardiogram were done at baseline, and at 1, 3, 6 and 12-month follow-up. Primary outcome was the incidence of troponin elevation above the threshold. FINDINGS: Of the 273 patients, 88% were women, mean age 51 ± 12 years. The majority (76%) had breast cancer, 3% had a history of hypertension and 4% were diabetic. Epirubicin and doxorubicin were most commonly prescribed, with median cumulative doses of 360 [270-360] and 240 [240-240] mg/m2, respectively. The incidence of troponin elevation was 23% in the prevention and 26% in the troponin-triggered group (p = 0.50). Three patients (1.1%) -two in the prevention, one in the troponin-triggered group-developed cardiotoxicity, defined as 10% point reduction of LV ejection fraction, with values lower than 50%. INTERPRETATION: Low cumulative doses of anthracyclines in adult patients with low cardiovascular risk can raise troponins, without differences between the two strategies of giving enalapril. Considering a benefit of enalapril in the prevention of LV dysfunction, a troponin-triggered strategy may be more convenient.

Audiological findings in a de novo mutation of ANKRD11 gene in KBG syndrome: Report of a case and review of the literature.

KBG syndrome is a rare genetic disorder, due to a mutation of ANKRD11, characterized by specific craniofacial dysmorphism, short stature and macrodontia of upper central incisors, intellectual disability and skeletal anomalies. We report a de novo mutation of ANKRD11 gene in a 7-years old girl, affected by KBG syndrome with bilateral conductive hearing loss. The aim of this article was to review the audiological findings of this syndrome.

Opacification patterns of cardiac masses using low-mechanical index contrast echocardiography: comparison with histopathological findings.

BACKGROUND: Two-dimensional echocardiography is the main noninvasive imaging tool to identify cardiac masses but is unable to provide detailed tissue characterization. AIM: The aim of the study was to assess the ability of low mechanical index (MI) contrast echocardiography to detect presence and amount of tissue vascularization as validated by histopathology study of cardiac masses. METHODS AND RESULTS: Twelve consecutive patients (5 females and 7 males, age range 51-82 years) underwent conventional and contrast two-dimensional echocardiography with low MI. By contrast echocardiography, mass enhancement was classified as absent (suggesting thrombus), partial, or complete (suggesting vascularized mass, both with early or late >20 cycles of opacification) as compared to the adjacent myocardium. The precise nature of the cardiac masses was provided by histopathology examination and/or by resolution after anticoagulation therapy during follow-up. Presence, type, and degree of mass vascularization were assessed by histology, immunohistochemistry, and morphometric analysis. Among the 12 cases, mass enhancement was absent, late and peripheral, late and partial, and early and complete in three cases each. Cardiac masses consisted of thrombus (three), secondary malignant cardiac tumor (three), myxoma (three), papillary fibroelastoma (two), and cavernous hemangioma (one). At histology, cardiac hemangioma had the highest degree of vascularization, at difference from thrombi which were not vascularized, and data were in keeping with contrast echocardiography findings. CONCLUSIONS: Low MI contrast echocardiography is an easy, noninvasive cardiac imaging tool to assess cardiac mass vascularization. The degree of contrast enhancement and time to opacification are highly variable among cardiac masses and correspond to different extent of vascularization.

Formalising multidisciplinary peer review: developing a haematological malignancy-specific electronic proforma and standard operating procedure to facilitate procedural efficiency and evidence-based clinical practice.

BACKGROUND: Multidisciplinary team (MDT) meetings aimed at facilitating peer review have become standard practice in oncology. However, there is scant literature on the optimal structure and conduct of such meetings. AIMS: To develop a process for formal peer review of patients with haematological malignancies and to audit any resulting changes made to the management recommendations of the treating physician. METHODS: A standard operating procedure (SOP) for MDT meetings was developed essentially to integrate clinical peer review with weekly pathology and radiology meetings. The centrepiece is the electronic submission of a patient-specific proforma (Microsoft InfoPath) prior to the meeting. It serves as the template for presentation, discussion and recording of recommendations and conclusions. The final verified document is stored in the electronic patient record, and a copy is sent to the general practitioner. The proposed management plans were compared to the consensus recommendations of the meeting for the first 4 years since inception. RESULTS: Both SOP and proforma underwent continual improvements. These provided the framework for the conduct of a robust weekly MDT meeting for peer review of the management of patients with haematological malignancies. On 20% of occasions, patient management plans were altered to optimise patient care as a direct consequence on peer review at the MDT. CONCLUSION: Our streamlined process, in its ultimate format, has provided a mature and efficient forum for formal peer review in a genuine multidisciplinary environment. Both initial data and informal feedback support its ongoing activity as an integral component of delivering quality patient care.

Patient satisfaction after auditory implant surgery: ten-year experience from a single implanting unit center.

CONCLUSIONS: The satisfaction rate of the subjects with an auditory implant appears strictly related to the resulting auditory improvement, and the surgical variables would play a prevailing role in respect to the esthetic factors. OBJECTIVES: To assess the rate of satisfaction in subjects who underwent the surgical application of an auditory device at a single Implanting Center Unit. METHOD: A series of validated questionnaires has been administered to subjects who underwent the surgical application of different auditory devices. The Glasgow Benefit Inventory (GBI), the Visual Analog Scale (VAS), and the Abbreviated Profile of Hearing Aid Benefit (APHAB) have been used to compare the implanted situation with the hearing-aided one; a percutaneous bone conductive implant (pBCI) with an active middle ear implant (AMEI) on the round window in mixed hearing loss; and an invisible, fully-implantable device with a frankly and bulky semi-implantable device. RESULTS: The mean GBI scores were higher in Vibrant Soundbridge (VSB)® and Bonebridge® subjects, without significant differences among the various devices. The mean VAS score increased for all the devices in comparison with the conventional hearing aid. The mean APHAB score was similarly better in the implanted condition as total and partial scores.