[Younger medical specialists and longer waiting time: cohort study of the duration of medical training]. / Jongere specialisten en langere wachttijd.

OBJECTIVE: To describe trends and developments in the total duration of training medical specialists in the Netherlands, including their ages upon completion of the components of medical education: undergraduate medical program, waiting time and further post-graduate specialist training. DESIGN: Population cohort study. METHOD: From the combined data from Statistics Netherlands and the Registration Committee for Medical Specialists for the period 1986 to 2018 relevant populations were selected and training trajectories were mapped. The population size was 40,604 individuals for undergraduate medical programs, 41,885 for the duration of post-graduate specialist training, 31,915 for the waiting periods and 21666 for the total duration of the trajectory from the start of medical school until registration as a specialist. RESULTS: The median duration of undergraduate medical programs was 7.1 years, which is longer than the nominal duration and this remained unchanged over the observation period. The average waiting time between graduating medical school and postgraduate specialist training has increased from 2010 onwards to 3.7 years in 2018. The average duration of postgraduate specialist training is increasing. The average age at graduation of medical school fell by 1.7 years to 26.1. The average age at the start of post-graduate specialist training decreased, as did the average age at registration as a specialist. CONCLUSION: The total duration of training of medical specialists is stable. Changes such as "dedicated transition year" and flexible arrangements for postgraduate training have had no discernible influence on the total duration of medical training. Because the average age at start of postgraduate specialist training has decreased, medical specialists are on average younger upon registration.

Surface ruptures database related to the 26 December 2018, MW 4.9 Mt. Etna earthquake, southern Italy.

We provide a database of the surface ruptures produced by the 26 December 2018 Mw 4.9 earthquake that struck the eastern flank of Mt. Etna volcano in Sicily (southern Italy). Despite its relatively small magnitude, this shallow earthquake caused about 8 km of surface faulting, along the trace of the NNW-trending active Fiandaca Fault. Detailed field surveys have been performed in the epicentral area to map the ruptures and to characterize their kinematics. The surface ruptures show a dominant right-oblique sense of displacement with an average slip of about 0.09 m and a maximum value of 0.35 m. We have parsed and organized all observations in a concise database, with 932 homogeneous georeferenced records. The Fiandaca Fault is part of the complex active Timpe faults system affecting the eastern flank of Etna, and its seismic history indicates a prominent surface-faulting potential. Therefore, this database is essential for unravelling the seismotectonics of shallow earthquakes in volcanic areas, and contributes updating empirical scaling regressions that relate magnitude and extent of surface faulting.

The October 23, 2011, Van (Turkey) earthquake and its relationship with neighbouring structures.

The present work reports the analysis of a possible relationship due to stress transfer between the two earthquakes that hit the province of Van, Eastern Turkey, on October 23, 2011 (Mw = 7.2) and on November 9, 2011 (Mw = 5.6). The surface displacement field of the mainshock has been obtained through a combined data set made up of differential interferograms from COSMO-SkyMed and ENVISAT satellites, integrated with continuous GPS recordings from the Turkish TUSAGA-AKTIF network. This allowed us to retrieve the geometry and the slip distribution of the seismic source and to compute the Coulomb Failure Function (CFF) variation on the aftershock plane, in order to assess a possible causal relationship between the two events. Our results show that the November 9 earthquake could have been triggered by the October 23 shock, with transferred stress values largely exceeding 1 bar.

[Experience with 5% lidocaine medicated plaster in the treatment of localized neuropathic pain]. / Esperienza con lidocaina cerotto 5% nel trattamento del dolore neuropatico localizzato.

AIM: The aim of this paper is to confirm the efficacy and safety in clinical practice of 5% lidocaine medicated plaster (LMP) in the treatment of localized neuropathic pain. METHODS: Retrospective, observational study carried out in the period 2006-2012, in patients with various forms of localized peripheral neuropathic pain treated with LMP. Only patients with at least one follow-up visit after prescription of the drug were assessed. RESULTS: One hundred and one patients were assessable, 60.4% of whom suffered from postherpetic neuralgia (PHN), while the remainder reported mainly post-traumatic/post-surgical neuropathic pain and other superficial localized neuralgias. In baseline conditions, the mean pain intensity measured on the NRS was 6.1. The median treatment time with LMP was 41 days, at the end of which there was a 64% fall in NRS, with no significant differences between the patients with PHN or other localized neuralgias. A better NRS reduction trend was also observed in those patients who, in our study, started treatment with LMP from the first visit, compared with those patients to whom LMP was prescribed later. The tolerability was good, with few adverse events at the application site, which led to suspension of treatment in just three cases. CONCLUSION: In our experience, LMP proved to be an effective and well-tolerated drug in the treatment of PHN and other superficial localized neuralgias. This observation is in agreement with the international guidelines, which suggest LMP as first line treatment for the management of localized peripheral neuropathic pain.

Total and partial digestion of sediments for the evaluation of trace element environmental pollution.

Four different sample treatment methods for the determination of trace elements have been compared: a total digestion with HNO3-H2O2-HF using microwave, and three different standardized methods of fractionation: BCR three-steps sequential extraction, USEPA standard 3050B and ISO standard 11466. The four treatment methods were applied to the determination of Cu and Ni in four samples collected in different areas of Cienfuegos Bay (Cuba). The location of samples and the analytes were selected on the basis of results obtained by previous studies. Analyses following total digestion and BCR three-steps procedure were performed by inductively coupled plasma mass spectroscopy whereas analyses following EPA and ISO procedures were performed by flame atomic absorption spectroscopy. The results obtained have been compared with an estimated anthropic fraction evaluated in each sampling point as the difference between the total concentration and an estimated background concentration level. The BCR three-steps provided the best approximation of the estimated anthropic fraction and was therefore applied also in the determination of Pb and Cd for further consideration.

A kinetic study of trace element leachability from abandoned-mine-polluted soil treated with SS-MSW compost and red mud. Comparison with results from sequential extraction.

The effect of adding treated red mud, a by-product of alumina production, to soil polluted by an abandoned mine and characterised by high concentrations of heavy metals, relatively low reaction grade, and low organic carbon content, was investigated. Also studied was addition of both red mud and compost (produced from source-separated municipal solid waste)--the synergistic action of red mud and compost could be exploited to achieve both metal trapping and an increase in organic carbon content. Leaching batch tests were performed on four different systems: soil, soil and treated red mud, soil and compost, soil and compost plus treated red mud. Dilute sulfuric acid and EDTA solution (liquid/solid ratio 10:1) were used in the tests--sulfuric acid to "mimic" acid rain and EDTA in accordance with general methods for estimating "plant-available" metals. Sequential extraction was also applied to the same samples. The use of relatively non-specific extractant reagents in the leaching tests led to a kinetic approach (already proposed in literature), because measurements of trace elements extracted at equilibrium cannot be related to their speciation. Comparison of information obtainable by the kinetic approach to evaluation of data from leaching tests with results from sequential extraction enabled evaluation whether the "kinetic fractionation method", a relatively rapid and simple procedure, furnishes adequate information about the mobility and bioavailability of trace elements. Especially interesting results were obtained for Mn, Zn, and Ni, present in large amounts in the soil studied--their leachability was significantly reduced by addition of red mud and compost, suggesting interesting perspectives in soil-remediation activity.

Evaluation of performance of time-saving extraction devices in the BCR three-step sequential extraction procedure.

Two alternative extraction methods--a routine ultrasonic bath and a microwave oven--were developed and optimized for their eventual exploitation in the three-stage sequential extraction procedure proposed by the European Standards, Measurements and Testing (S, M & T) Programme, formerly Bureau Communitaire de Reference (BCR), for the operationally defined speciation of Cd, Cr, Cu, Ni and Zn. The conventional BCR three-stage sequential extraction procedure was modified at each stage, applying ultrasonic or microwave devices in order to shorten the required 16 h of shaking in all three steps. The experimental tests and the optimization of the operating parameters were carried out on a highly homogenized estuarine sediment reference material (RM S7) prepared by the Joint Research Centre (JRC) of ISPRA. Extractable metal contents were measured by inductively coupled plasma-mass spectrometry (ICP-MS) and the results obtained in each fraction by all three methods were statistically compared for all the studied elements. The conventional and newly developed alternative extraction methods were finally compared by the analysis of BCR 601, which is certified for the three-step BCR sequential extraction procedure. According to the statistical evaluation of the results, the proposed accelerated sequential extraction methods are valid alternatives to conventional shaking, with much shorter extraction times.

Comparison between different leaching tests for the evaluation of metal release from fly ash.

Comparison of three different leaching tests, each characterized by different conditions, e.g. liquid/solid ratio, pH, leachant, stirring conditions, duration time, has been performed within the activities of Analeach, financed by the European Union in the "Cooperation with third Countries" programme (INCO). The comparison was performed on four highly homogenized fly ash reference materials, of different origin, provided by the Joint Research Centre of Ispra. Seven different elements (Cd, Cr, Cu, Ni, Pb, V, and Zn) were considered in this study. The influence of the main experimental conditions and of the matrix on metal release was studied. Basic characterization of the materials was also performed.

[Improved survival in the treatment of ruptured abdominal aortic aneurysm]. / Miglioramento degli indici di sopravvivenza nel trattamento degli aneurismi rotti dell'aorta addominale.

Personal experience in the management of 70 ruptured abdominal aortic aneurysm over the past 5 years is reported dividing patients into 2 groups, before and after establishment of intensive care unit: survival was 30.76% on the first, 66.66% in the second. Factors that allowed that result are discussed.