First attempt to quantify microplastics in Mediterranean Sabellaria spinulosa (Annelida, Polychaeta) bioconstructions.

This work focuses on the arenaceous reefs by the polychaete Sabellaria spinulosa and addresses microplastics pollution. The main aim is to assess microplastics amount in a bioconstruction located in the Adriatic coast of Italy (Mediterranean Sea) through a comparative approach: sea-floor sediment and bioconstruction samples were analysed to quantify microplastics absolute abundance in both substrates. A total of 431 MPs were found in the investigated substrates: respectively 85 % fibers and 15 % fragments. Multivariate analysis indicates that MPs within bioconstruction occur in higher abundances and with different morphologies than in sediment samples. The analysis of bioconstruction polished sections allowed for observation of MPs agglutinated in their original position: higher concentration is reported in inter-tube areas. Results suggest that physical characteristics of MPs could play a key-role in bioconstruction inclusion processes and raise questions on effective role of sabellariid bioconstructions as a trap for this pollutant in the littoral environment.

Injury severity prediction of cyclist crashes using random forests and random parameters logit models.

Cycling provides numerous benefits to individuals and to society but the burden of road traffic injuries and fatalities is disproportionately sustained by cyclists. Without awareness of the contributory factors of cyclist death and injury, the capability to implement context-specific and appropriate measures is severely limited. In this paper, we investigated the effects of the characteristics related to the road, the environment, the vehicle involved, the driver, and the cyclist on severity of crashes involving cyclists analysing 72,363 crashes that occurred in Great Britain in the period 2016-2018. Both a machine learning method, as the Random Forest (RF), and an econometric model, as the Random Parameters Logit Model (RPLM), were implemented. Three different RF algorithms were performed, namely the traditional RF, the Weighted Subspace RF, and the Random Survival Forest. The latter demonstrated superior predictive performances both in terms of F-measure and G-mean. The main result of the Random Survival Forest is the variable importance that provides a ranked list of the predictors associated with the fatal and severe cyclist crashes. For fatal classification, 19 variables showed a normalized importance higher than 5% with the second involved vehicle manoeuvring and the gender of the driver of the second vehicle having the greatest predictive ability. For serious injury classification, 13 variables showed a normalized importance higher than 5% with the bike leaving the carriageway having the greatest normalized importance. Furthermore, each path from the root node to the leaf nodes has been retraced the way back generating 361 if-then rules with fatal crash as consequent and 349 if-then rules with serious injury crash as consequent. The RPLM showed significant unobserved heterogeneity in the data finding four normal distributed indicator variables with random parameters: cyclist age ≥ 75 (fatal prediction), cyclist gender male (fatal and serious prediction), and driver aged 55-64 (serious prediction). The model's McFadden Pseudo R2 is equal to 0.21, indicating a very good fit. Furthermore, to understand the magnitude of the effects and the contribution of each variable to injury severity probabilities the pseudo-elasticity was assessed, gaining valuable insights into the relative importance and influence of the variables. The RF and the RPLM resulted complementary in identifying several roadways, environmental, vehicle, driver, and cyclist-related factors associated with higher crash severity. Based on the identified contributory factors, safety countermeasures useful to develop strategies for making bike a safer and more friendly form of transport were recommended.

Ukrainian refugee crisis management in the Local Health Authority Roma 1: the challenges of implementing public health policies and lessons learned.

BACKGROUND: The conflict between Russia and Ukraine has strained the health systems of countries that welcome war refugees on all levels, from national to local. Despite the Public Health guidelines regarding assistance being published on the topic, the scientific literature currently lacks evidence on the experience of applying theory in practice. This study aims to describe evidence-based practices that were implemented and to provide a detailed description of emerging problems and solutions pertaining Ukrainian refugee assistance in the context of one of the biggest Local Health Authorities in Italy (LHA Roma 1). METHODS: LHA Roma 1 developed a strategic plan based on local expertise, national and international guidelines to ensure infectious disease prevention and control, as well as continuity of care for non-communicable diseases and mental health. RESULTS: The insertion of Ukrainian refugees in the National Health System through an identification code assignment and other services such as COVID-19 swab and vaccination were provided either in one of the three major assistance hubs or in local district level ambulatories spread throughout the LHA. Many challenges were faced during the implementation phase of the outlined practice guidelines, which required sensible and timely solutions. These challenges include the necessity of rapid resource provision, overcoming linguistic and cultural barriers, guaranteeing a standard of care across multiple sites and coordination of interventions. Public Private Partnerships, the creation of a centralized multicultural and multidisciplinary team and the mutually beneficial collaboration with the local Ukrainian community were essential to guarantee the success of all operations. CONCLUSIONS: The experience of LHA Roma 1 helps shed light on the importance of leadership in emergency settings and how a dynamic relationship between policy and practice would allow each intervention to be modulated according to the local environment, to better realize the potential of local realities to provide appropriate health interventions to all those in need.

Whole genome sequencing diagnostic yield for paediatric patients with suspected genetic disorders: systematic review, meta-analysis, and GRADE assessment.

BACKGROUND: About 80% of the roughly 7,000 known rare diseases are single gene disorders, about 85% of which are ultra-rare, affecting less than one in one million individuals. NGS technologies, in particular whole genome sequencing (WGS) in paediatric patients suffering from severe disorders of likely genetic origin improve the diagnostic yield allowing targeted, effective care and management. The aim of this study is to perform a systematic review and meta-analysis to assess the effectiveness of WGS, with respect to whole exome sequencing (WES) and/or usual care, for the diagnosis of suspected genetic disorders among the paediatric population. METHODS: A systematic review of the literature was conducted querying relevant electronic databases, including MEDLINE, EMBASE, ISI Web of Science, and Scopus from January 2010 to June 2022. A random-effect meta-analysis was run to inspect the diagnostic yield of different techniques. A network meta-analysis was also performed to directly assess the comparison between WGS and WES. RESULTS: Of the 4,927 initially retrieved articles, thirty-nine met the inclusion criteria. Overall results highlighted a significantly higher pooled diagnostic yield for WGS, 38.6% (95% CI: [32.6 - 45.0]), in respect to WES, 37.8% (95% CI: [32.9 - 42.9]) and usual care, 7.8% (95% CI: [4.4 - 13.2]). The meta-regression output suggested a higher diagnostic yield of the WGS compared to WES after controlling for the type of disease (monogenic vs non-monogenic), with a tendency to better diagnostic performances for Mendelian diseases. The network meta-analysis showed a higher diagnostic yield for WGS compared to WES (OR = 1.54, 95%CI: [1.11 - 2.12]). CONCLUSIONS: Although whole genome sequencing for the paediatric population with suspected genetic disorders provided an accurate and early genetic diagnosis in a high proportion of cases, further research is needed for evaluating costs, effectiveness, and cost-effectiveness of WGS and achieving an informed decision-making process. TRIAL REGISTRATION: This systematic review has not been registered.

Systematic literature review of 10 years of cyclist safety research.

Cyclist safety is a research field that is gaining increasing interest and attention, but still offers questions and challenges open to the scientific community. The aim of this study was to provide an exhaustive review of scientific publications in the cyclist safety field. For this purpose, Bibliometrix-R tool was used to analyse 1066 documents retrieved from Web of Science (WoS) between 2012 and 2021. The study examined published sources and productive scholars by exposing their most influential contributions, presented institutions and countries most contributing to cyclist safety and explored countries open towards international collaborations. A keywords analysis provided the most frequent author keywords in cyclist safety shown in a word cloud with E-bike, behaviour, and crash severity representing the primary keywords. Furthermore, a thematic map of cyclist safety field drafted from the author's keywords was identified. The strategic diagram is divided in four quadrants and, according to both density and centrality, the themes can be classified as follows: 1) motor themes, characterized by high value of both centrality and density; 2) niche themes, defined by high density and low centrality; 3) emerging or declining themes, featured by low value of both centrality and density; and 4) basic themes, distinguished by high centrality and low density. The motor themes (i.e., the main topics in cyclist safety field) crash severity and bike network were further explored. The research findings will be useful to develop strategies for making bike a safer and more confident form of transport as well as to guide researchers towards the future scientific knowledge.

Low-background gamma spectrometry and neutron diffraction in the study of stony meteorites.

Non-destructive characterisation of meteorites is here performed on a stony meteorite. The identification of the sample is performed by low-background γ-ray spectrometry in order to determine the presence of certain cosmogenic radionuclides, whereas a mineralogical phase quantitative analysis is carried out by Time-of-Flight Neutron Diffraction (ToF-ND) on the sample as-it-is. The protocol is then validated by applying micro-Raman Spectroscopy (µRS) and Energy Dispersive X-ray Spectroscopy (EDS). This paper is focused on γ-ray spectrometry, proving the meteoric origin of the sample, and it also presents some preliminary results of ToF-ND.

Analysis of contributory factors of fatal pedestrian crashes by mixed logit model and association rules.

Pedestrians are the most vulnerable road users and pedestrian crashes are a major concern both for their number and their severity. In Italy, pedestrians account for 34% of the road fatalities in urban area. To improve pedestrian safety, this study is aimed at analysing the roadway, environmental, vehicle, driver and pedestrian-related factors that are associated with fatal pedestrian crashes in Italy and providing insights for the development of effective countermeasures. This study used an econometric model, the mixed logit model, and a machine learning algorithm, the association rules, to analyse 101,032 pedestrian crashes that occurred in Italy. Study results identified several factors associated with fatal pedestrian crashes. The mixed logit identified 46 significant indicator variables (1 with random parameter), and the association rules provided 119 valid rules. F-measure and G-mean showed higher prediction performance of the mixed logit over the association rules. Study results recommend using both models as complementary approaches since their combination is effective in providing meaningful insights about pedestrian crash contributory factors and their interdependencies. To address the contributory factors identified by the study, behavioural/engineering pedestrian safety countermeasures are recommended. The findings provided new insights for transportation agencies to develop effective countermeasures for pedestrian safety improvement.

Cervical cancer elimination in Italy: Current scenario and future endeavors for a value based prevention.

Background: Cervical Cancer (CC) is a vaccine-preventable disease, and it is treatable if diagnosed early and managed properly. However, it is the fourth most common cancer in women worldwide with about 604,127 cases and 341,831 deaths in 2020. In Italy, it represents the fifth most common cancer in women under 50 years of age with about 2,400 new cases in 2020. The CC elimination is today a global public health goal published by the World Health Organization (WHO) in 2020 and a commitment of the European Union that has included it in Europe's Beating Cancer Plan. Therefore, urgent action is needed, at international and national level, to implement value-based interventions regarding vaccination, screening and timely management of the disease. Our study aims to describe the state of the art of Human Papilloma Virus (HPV) prevention in Italy and to get a consensus on indicators for monitoring the progress toward CC elimination at national level. Methods: The study envisaged the following activities: research and synthesis of the evidence on strategies and actions for CC elimination at regional Italian level; identification of indicators to monitor such strategies/actions; organization of a multi-stakeholder consensus to reach the agreement on main indicators to be used in Italy. Results: As for HPV vaccination coverage, the last Italian available data (December 31st, 2020) showed that it was way below the target (95%) with full cycle vaccination coverage ranging from 6 to 61.7% in female adolescents and from 5.4 to 55.4% in male adolescents (2008 birth cohorts). The coverage rate of CC screening is variable with a range of 61.7-89.6%. Furthermore, coverage rates due to organized screening programs (excluding out-of-pocket screening) shows a range from 20.7 to 71.8%. The mapping of the Italian Regions highlighted an important regional heterogeneity in respect to organizational/operational issue of HPV vaccination and CC screening. Indicators for monitoring CC elimination strategies have been drawn from the Australian experience and distinguished by disease outcomes, vaccination coverage, screening participation and treatment uptake. The highest consensus was reached for the following indicators: CC incidence; detection of high-grade cervical disease; CC mortality; full cycle vaccination coverage; screening participation; high-grade cervical disease treatment rates; CC treatment rates. Conclusions: The assessment of the current status of CC elimination as overarching goal beyond the achievement of vaccine, screening and treatment targets represents the first step for the identification of interventions to be implemented to accelerate the path toward CC elimination. Based on this and following the WHO call, a value-based approach is proposed to untangle the full benefit of HPV-related cancers elimination strategies and identify priority and best practices.

Safety Index for evaluation of urban roundabouts.

Recently, there is a growing interest in road safety assessments based on the examination of the characteristics of the road aimed at identifying the presence of risk factors. This approach, named road assessment program or network wide road safety assessment, is required by the EU Directive 2019/1936 on road infrastructure safety management. Reliable procedures for assessing the inherent safety of all the elements of the road network are required to conduct roadway safety assessments. To provide a contribution toward the development of procedures for network wide road safety assessment, this paper develops and validates a Safety Index (SI) for evaluating urban roundabouts. The SI is assessed both at the roundabout level as well as at the roundabout approach level. This procedure detects the safety issues that are the largest contributors to crash risk in order to identify the safety measures that provide the greatest crash reduction at roundabouts. The SI is formulated by combining two components: the exposure of road users to road hazards (Exposure) and the risk factors which increase the probability of involvement in crashes (Risk Index). The procedure considers 33 detailed safety issues and 5 general safety issues to compute the Risk Index. Criteria for identifying and ranking the safety issues are defined. The SI procedure was validated in a sample of 50 urban roundabouts located in Rome, Italy. The sample consisted of 12 single-lane roundabouts and 38 two-lane roundabouts, with a total number of approaches equal to 179. In these roundabouts, the SI scores and the EB crash estimates were compared with reference both to the whole roundabouts as well as to the single roundabout approaches. The correlation between the SI scores and EB estimates was highly significant both at the roundabout level (R2 = 0.85, t = 16.49, p-value < 0.001) as well as at the approach level (R2 = 0.56, t = 14.88, p-value < 0.001). The results from Spearman's rank-correlation analysis provided further validation for the SI indicating that rankings from the SI and the EB estimates agree at the 99.9 % confidence level both at the roundabout level (ρs = 0.80) as well as at the approach level (ρs = 0.70).

Health technology assessment of whole genome sequencing in the diagnosis of genetic disorders: a scoping review of the literature.

OBJECTIVE: The aim of this scoping review is to map the available evidence about the use of health technology assessment (HTA) in the assessment of whole genome sequencing (WGS). METHODS: A scoping review methodology was adopted. The population, concept, and context framework was used to build up the research question and to establish the eligibility criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews was adopted to implement a comprehensive search strategy. Evidence was retrieved from scientific databases and HTA organizations Web sites. Reports were classified as full HTA, mini-HTA, rapid reviews or other. RESULTS: The search strategy identified seven reports. Five HTA organizations from five countries elaborated the reports: one full HTA, four rapid reviews, and two classified as others. The reports were mainly focused on the evaluation of the clinical utility and cost-effectiveness of genome-wide sequencing as well as informing policy questions by providing analyses of organizational and ethical considerations. CONCLUSIONS: Few HTA organizations are drafting reports for WGS. It is essential to stimulate a critical reflection during the elaboration of HTA reports for WGS to steer choices of decision makers in the establishment of priorities for research and policy and reimbursement rates.

Assessing the potentiality of algorithms and artificial intelligence adoption to disrupt patient primary care with a safer and faster medication management: a systematic review protocol.

INTRODUCTION: In primary care, almost 75% of outpatient visits by family doctors and general practitioners involve continuation or initiation of drug therapy. Due to the enormous amount of drugs used by outpatients in unmonitored situations, the potential risk of adverse events due to an error in the use or prescription of drugs is much higher than in a hospital setting. Artificial intelligence (AI) application can help healthcare professionals to take charge of patient safety by improving error detection, patient stratification and drug management. The aim is to investigate the impact of AI algorithms on drug management in primary care settings and to compare AI or algorithms with standard clinical practice to define the medication fields where a technological support could lead to better results. METHODS AND ANALYSIS: A systematic review and meta-analysis of literature will be conducted querying PubMed, Cochrane and ISI Web of Science from the inception to December 2021. The primary outcome will be the reduction of medication errors obtained by AI application. The search strategy and the study selection will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the population, intervention, comparator and outcome framework. Quality of included studies will be appraised adopting the quality assessment tool for observational cohort and cross-sectional studies for non-randomised controlled trials as well as the quality assessment of controlled intervention studies of National Institute of Health for randomised controlled trials. ETHICS AND DISSEMINATION: Formal ethical approval is not required since no human beings are involved. The results will be disseminated widely through peer-reviewed publications.

Incremental net benefit of whole genome sequencing for newborns and children with suspected genetic disorders: Systematic review and meta-analysis of cost-effectiveness evidence.

BACKGROUND: The introduction of massive parallel sequencing has contributed to a decline in sequencing costs. In recent years, whole-exome sequencing (WES) and whole-genome sequencing (WGS) have been increasingly adopted for diagnostic purposes in individuals with suspected genetic diseases. However, a debate is still ongoing in the scientific community about the superiority of WGS over WES in terms of cost-effectiveness. The aim of this study is to assess whether WGS, for the pediatric population with suspected genetic disorders, is cost-effective with respect to WES and chromosomal microarray (CMA) by pooling incremental net benefits. MATERIALS AND METHODS: Articles were retrieved from PubMed, Web of Science, Embase and Scopus from 2015 to 2021. The dominance ranking matrix (DRM) tool was adopted to provide a qualitative synthesis of all the included studies. Incremental net benefits (INBs) were estimated and meta-analysis was implemented to pool INBs across studies. RESULTS: The database search identified 1600 publications of which four articles were considered eligible for the meta-analysis. The pooled INB of WGS over WES was estimated at I$4073 (95% CI I$2426 - I$5720). The pooled INB of WGS over CMA amounted to I$6003 (95% CI I$2863 - I$9143). CONCLUSIONS: WGS could be cost-effective in the diagnostic workup of affected infants and children. Further economic evaluations however are needed for comparing WGS versus WES and confirm the present conclusions.

Combining Micro-Raman Spectroscopy and Scanning Electron Microscopy Mapping: A Stony Meteorite Study.

Meteorite characterisation represents a privileged and unique opportunity to increase our knowledge about the materials composing the Universe and, particularly, the Proto Solar System. Moreover, meteorites studies evolve contextually with the development of analytical technologies. In the present paper, the results from an unclassified stony meteorite (chondrite) characterisation have been reported on the basis of the innovative analytical protocol presented here. Advanced Mapping by micro-Raman Spectroscopy and Scanning Electron Microscopy equipped with Energy Dispersive Spectroscopy have been combined to disclose molecular and elemental features on the same regions sample at a micrometric resolution. Thanks to their non-destructive properties, the mapping tools of both instruments have been applied to single chondrules analysis and the best match between the mineralogical information and the chemical composition has been obtained. This combined approach proved to be highly suitable in disclosing the crystallinity features of the phases, with in-depth spatial and morphological details too.

Dealing with COVID-19 Epidemic in Italy: Responses from Regional Organizational Models during the First Phase of the Epidemic.

As the COVID-19 outbreak traveled through various Italian regions, all national and local administrations issued measures to counter the spread of the contagion and organize healthcare. The Italian healthcare system is, indeed, a decentralized system with 21 regional health systems (RHSs), with different models of healthcare service delivery and organization. This study investigates whether a different organization of RHSs would have led to different management of the COVID-19 epidemic, and evaluates the effect of different approaches in epidemic management on the COVID-19 epidemiological trend. A set of indicators is identified by conducting an online synchronous Focus Group, involving an experts panel. A Pearson's correlation test was performed on the values assumed by the historical series of indicators investigate correlations among the trends represented by the indicators or between them and external factors. The comparison between the experiences of the different Italian regions, regarding the management of the epidemic, has helped to confirm and emphasize the importance of a community-based approach in health care-integrated with the hospital's functions for the care of complex conditions and the need for specialized assistance.

Rule discovery to identify patterns contributing to overrepresentation and severity of run-off-the-road crashes.

The main objective of this paper was to analyse the roadway, environmental, and driver-related factors associated with an overrepresentation of frequency and severity of run-off-the-road (ROR) crashes. The data used in this study refer to the 6167 crashes occurred in the section Naples-Candela of A16 motorway, Italy in the period from 2001 to 2011. The analysis was carried out using the rule discovery technique due to its ability of extracting knowledge from large amounts of data previously unknown and indistinguishable by investigating patterns that occur together in a given event. The rules were filtered by support, confidence, lift, and validated by the lift increase criterion. A two-step analysis was carried out. In the first step, rules discovering factors contributing to ROR crashes were identified. In the second step, studying only ROR crashes, rules discovering factors contributing to severe and fatal injury (KSI) crashes were identified. As a result, 94 significant rules for ROR crashes and 129 significant rules for KSI crashes were identified. These rules represent several combinations of geometric design, roadside, barrier performance, crash dynamic, vehicle, environmental and drivers' characteristics associated with an overrepresentation of frequency and severity of ROR crashes. From the methodological point of view, study results show that the a priori algorithm was effective in providing new information which was previously hidden in the data. Finally, several countermeasures to solve or mitigate the safety issues identified in this study were discussed. It is worthwhile to observe that the study showed a combination of factors contributing to the overrepresentation of frequency and severity of ROR crashes. Consequently, the implementation of a combination of countermeasures is recommended.

A data mining approach to investigate patterns of powered two-wheeler crashes in Spain.

Powered two-wheelers (PTWs) are growing globally each year as they are considered an attractive alternative to cars (flexible, small, affordable, fast and easy to park), especially on congested traffic situations. However, PTWs represent an important challenge for road safety. In fact, in 2016, Spain ranked fifth in terms of PTW fatalities among EU 28. For this reason, this paper aims to investigate which are the patterns among crash characteristics contributing to PTW crashes in Spain. Data from 78,611 crashes involving PTWs occurred in Spain in the period 2011-2013 were analyzed. The analysis was performed by using classification trees and rules discovery which are suitable models aimed at extracting knowledge and identifying valid and understandable patterns from large amounts of data previously unknown and indistinguishable. The response variables assessed in this study were severity and crash type. As a result, several combinations of road, environmental and drivers' characteristics associated with severity and typology of PTW crashes in Spain were identified. Based on the analysis results, several countermeasures to solve or mitigate the safety issues identified in the study were proposed. From the methodological point of view, study results show that both the classification trees and the a priori algorithm were effective in providing non-trivial and unsuspected relations in the data. Classification trees structure allowed a simpler understanding of the phenomenon under study while association discovery provided new information which was previously hidden in the data. Given that the results of the two different techniques were never contradictory, we recommend using classification trees and association discovery as complementary approaches since their combination is effective in exploring data providing meaningful insights about PTW crash characteristics and their interdependencies.

Postnatal survival after endoscopic equatorial laser for the treatment of twin-to-twin transfusion syndrome.

BACKGROUND: Endoscopic laser coagulation of placental anastomoses is the first-line treatment for severe twin-to-twin transfusion syndrome. A recent randomized controlled trial reported that laser coagulation along the entire vascular equator was associated with a similar dual survival and survival of at least 1 twin compared with the group that was treated with the selective technique. In addition, there was a significantly lower incidence of postoperative recurrence of twin-to-twin transfusion syndrome and the development of twin anemia-polycythemia sequence in the equatorial group. OBJECTIVE: The purpose of this study was to report on neonatal survival in twin-to-twin transfusion syndrome pregnancies that were treated with endoscopic laser therapy with the use of the equatorial technique and to examine the relationship between preoperative factors and twin loss. STUDY DESIGN: Endoscopic equatorial laser therapy was carried out as the primary treatment for twin-to-twin transfusion syndrome in all consecutive monochorionic diamniotic twin pregnancies that were referred at a single fetal surgery Center over a 4-year period. All visible placental anastomoses were coagulated; additional laser ablation of the placental tissue between the coagulated vessels was carried out. Pre-laser ultrasound data, periprocedural complications, pregnancy outcome, and postnatal survival at hospital discharge were recorded and analyzed. RESULTS: A total of 106 pregnancies were treated during the study period. Median gestational age at laser therapy was 19.7 weeks (range, 15.1-27.6 weeks). There was postoperative recurrence of twin-to-twin transfusion syndrome or the development of twin anemia-polycythemia sequence in 2 (1.9%) and 2 (1.9%) cases, respectively. The survival rates of both and at least 1 twin were 56.6% and 83.0%, respectively. Donor survival was significantly lower compared with the recipient co-twin (64.2% vs 75.5%, respectively; P < .05). The rate of fetal death, which was the most common cause of twin loss, was significantly higher in donors compared with recipient fetuses (23.6% vs 10.4%, respectively; P < .05). In cases with absent or reversed end-diastolic velocity in the donor umbilical artery, dual and donor survival rates were significantly lower compared with the remaining twin-to-twin transfusion syndrome pregnancies (40.0% vs 64.8% and 40.0% vs 76.1%, respectively; P < .05). There were no significant differences between the 2 groups in the survival of at least 1 twin and in the recipient survival. CONCLUSIONS: Endoscopic equatorial laser therapy was associated with a survival of both and at least 1 twin of approximately 55% and 83%, respectively, with a low rate of recurrent twin-to-twin transfusion syndrome and twin anemia-polycythemia sequence. In addition, the preoperative finding of abnormal donor umbilical artery Doppler on ultrasound identified a subgroup of twin-to-twin transfusion syndrome pregnancies with a lower dual survival rate caused by increased intrauterine deaths of donor twins.

Obesity can influence children's and adolescents' airway hyperresponsiveness differently.

BACKGROUND: Literature is still arguing about a possible relationship between airway hyperresponsiveness (AHR) and body mass index (BMI). This study aimed at evaluating the influence of BMI on AHR and pulmonary function in children and adolescents that performed a methacholine test for suggestive asthma symptoms. METHODS: 799 consecutive children/adolescents (535 M; mean age: 15 ± 3 yrs; median FEV1% predicted: 101.94% [93.46-111.95] and FEV1/FVC predicted: 91.07 [86.17-95.38]), were considered and divided into underweight, normal, overweight and obese. Different AHR levels were considered as moderate/severe (PD20 ≤ 400 µg) and borderline (PD20 > 400 µg). RESULTS: 536 children/adolescents resulted hyperreactive with a median PD20 of 366 µg [IQR:168-1010.5]; 317 patients were affected by moderate/severe AHR, whereas 219 showed borderline hyperresponsiveness. Obese subjects aged > 13 years showed a lower (p = 0.026) median PD20 (187µg [IQR:110-519]) compared to overweight (377 µg [IQR:204-774]) and normal-weight individuals' values (370.5 µg [IQR:189-877]). On the contrary, median PD20 observed in obese children aged ≤ 13 years (761 µg [IQR:731-1212]) was higher (p = 0.052) compared to normal-weight children's PD20 (193 µg [IQR:81-542]) and to obese adolescents' values (aged > 13 years) (p = 0.019). Obesity was a significant AHR risk factor (OR:2.853[1.037-7.855]; p = 0.042) in moderate/severe AHR adolescents. Females showed a higher AHR risk (OR:1.696[1.046-2.751] p = 0.032) compared to males. A significant relationship was found between BMI and functional parameters (FEV1, FVC, FEV1/FVC) only in hyperreactive females. CONCLUSIONS: Obesity seems to influence AHR negatively in female but not in male adolescents and children. In fact, AHR is higher in obese teenagers, in particular in those with moderate/severe hyperresponsiveness, and may be mediated by obesity-associated changes in baseline lung function.

A plant's perspective of extremes: terrestrial plant responses to changing climatic variability.

We review observational, experimental, and model results on how plants respond to extreme climatic conditions induced by changing climatic variability. Distinguishing between impacts of changing mean climatic conditions and changing climatic variability on terrestrial ecosystems is generally underrated in current studies. The goals of our review are thus (1) to identify plant processes that are vulnerable to changes in the variability of climatic variables rather than to changes in their mean, and (2) to depict/evaluate available study designs to quantify responses of plants to changing climatic variability. We find that phenology is largely affected by changing mean climate but also that impacts of climatic variability are much less studied, although potentially damaging. We note that plant water relations seem to be very vulnerable to extremes driven by changes in temperature and precipitation and that heat-waves and flooding have stronger impacts on physiological processes than changing mean climate. Moreover, interacting phenological and physiological processes are likely to further complicate plant responses to changing climatic variability. Phenological and physiological processes and their interactions culminate in even more sophisticated responses to changing mean climate and climatic variability at the species and community level. Generally, observational studies are well suited to study plant responses to changing mean climate, but less suitable to gain a mechanistic understanding of plant responses to climatic variability. Experiments seem best suited to simulate extreme events. In models, temporal resolution and model structure are crucial to capture plant responses to changing climatic variability. We highlight that a combination of experimental, observational, and/or modeling studies have the potential to overcome important caveats of the respective individual approaches.

Thin agar layer- versus most probable number-PCR to enumerate viable and stressed Escherichia coli O157:H7 and application in a traditional raw milk pasta filata cheese.

A mid-log phase broth culture of Escherichia (E.) coli O157:H7 381 (final concentration 10(4) cfu/mL) was monitored by conventional liquid- and solid-based enumeration techniques combined with PCR while it was subjected to thermal stress in gradually more complex systems (i.e., Tryptone Soya Broth, pasteurized milk and during lab-scale productions of a pasta filata fior di latte cheese obtained from raw or pasteurized milk). Our results highlighted: i) the incapability of the selective medium, ii) the effectiveness of the thin agar layer-PCR method, and iii) the effectiveness of the most probable number (MPN)-PCR method (in comparison with both plating-based methods) in recovering and selectively counting viable and stressed or injured E. coli O157:H7. Moreover, MPN-PCR was superior to both plating-based methods in terms of speed and easiness to get results. The thermal stresses herein applied (heating at 55 °C for 5 and 8 min) were less effective on the pasteurized milk than on the Tryptone Soya Broth and the pathogen was more protected in the raw milk-based matrices than in the pasteurized ones. Moreover, given the contamination level (10(4) cfu/mL of milk) of the strain, the temperature/time of stretching and the hardening and brining conditions herein used, the complete inactivation of the pathogen is not achievable.