Sociodemographic profile, health-related behaviours and experiences of healthcare access in Italian transgender and gender diverse adult population.

PURPOSE: Information on the general health of transgender and gender diverse (TGD) individuals continues to be lacking. To bridge this gap, the National Institute of Health in Italy together with the National Office against Racial Discriminations, clinical centres, and TGD organizations carried out a cross-sectional study to define the sociodemographic profile, health-related behaviours, and experiences of healthcare access in Italian TGD adult population. METHODS: A national survey was conducted by Computer-Assisted Web Interviewing (CAWI) technique. Collected data were compared within the TGD subgroups and between TGD people and the Italian general population (IGP). RESULTS: TGD respondents were 959: 65% assigned female at birth (AFAB) and 35% assigned male at birth (AMAB). 91.8% and 8.2% were binary and non-binary TGD respondents, respectively. More than 20% of the TGD population reported to be unemployed with the highest rate detectable in AMAB and non-binary people. Cigarette smoking and binge drinking were higher in the TGD population compared with IGP (p < 0.05), affecting TGD subgroups differently. A significant lower percentage of AFAB TGD people reported having had screening for cervical and breast cancer in comparison with AFAB IGP (p < 0.0001, in both cases). Over 40% was the percentage of AFAB and non-binary TGD people accessing healthcare who felt discriminated against because of their gender identity. CONCLUSIONS: Our results are a first step towards a better understanding of the health needs of TGD people in Italy in order to plan the best policy choices for a more inclusive public health.

Multichannel Doppler fiber-imager spectrometer for spatiotemporal characterization of high-intensity laser-driven plasmas.

We demonstrate a flexible multichannel fiber-based imaging Doppler spectrometer to characterize plasmas in high intensity (≥1 × 1018 W/cm2) laser-plasma experiments at high repetition rates. This instrument collects data from ×21 different plasma locations combining optical fibers and a single imaging spectrometer. This diagnostic maps the plasma velocity evolution as a function of time with sub-pico-second resolution. Experimental results showing 2D velocity measurements of plasma with 20 µm spatial resolution are presented. Intensities of the order of 1018 W/cm2 were used to generate a plasma, while a much less intense, frequency doubled (400 nm), probe beam (1011 W/cm2) was used to measure the Doppler shift from the plasma critical surface. The instrument can be scaled to a larger number of channels (e.g., 100) still using a single spectrometer.

Time localized tilted beams in nearly-degenerate laser cavities.

We show that nearly-degenerate Vertical External-Cavity Surface-Emitting Lasers may emit a set of tilted beams of individually addressable mode-locked pulses. These time localized beams feature a Gaussian profile and they are emitted in pairs with opposite transverse k-vector. Because they are phase locked, their interference leads to a non homothetic pattern in the near-field emission of the laser. In the simplest situation, when a single pair is emitted, this is a stripe pattern. Our analysis discloses the role of third order (spherical) aberrations of the cavity in stabilizing this spatio-temporal mode-locked regime and in selecting the value of the transverse k-vector.

Estimate and needs of the transgender adult population: the SPoT study.

BACKGROUND: Despite the increasing interest in transgender health research, to date little is known about the size of the transgender and gender diverse (TGD) population. METHODS: A web-based questionnaire survey was developed, including a collection of socio-demographic characteristics and disseminated online through social media. Gender incongruence was evaluated by using a 2-item approach assessing gender recorded at birth and gender identity. The primary objective of the present population-based study was to estimate the proportion of TGD people across ages among a large sample of people who answered a web-based survey. The secondary endpoints were to identify gender-affirming needs and possible barriers to healthcare access. RESULTS: A total of 19,572 individuals participated in the survey, of whom 7.7% reported a gender identity different from the sex recorded at birth. A significantly higher proportion of TGD people was observed in the youngest group of participants compared with older ones. Among TGD people who participated in the study, 58.4% were nonbinary, and 49.1% experienced discrimination in accessing health care services. Nonbinary TGD participants reported both the need for legal name and gender change, along with hormonal and surgical interventions less frequently compared to binary persons. CONCLUSIONS: Being TGD is not a marginal condition In Italy. A large proportion of TGD persons may not need medical and surgical treatments. TGD people often experience barriers to healthcare access relating to gender identity.

Manipulation of temporal localized structures in a vertical external-cavity surface-emitting laser with optical feedback.

We analyze the effect of optical feedback on the dynamics of an external-cavity passively mode-locked surface-emitting laser operating in the regime of temporal localized structures. Depending on the ratio between the cavity round trip time and the feedback delay, we show experimentally that feedback acts as a solution selector that either reinforces or hinders the appearance of one of the multistable harmonic arrangements of pulses. Our theoretical analysis reproduces well the experiment and allows us to evidence asymmetrical resonance tongues due to the parity symmetry-breaking induced by gain depletion.

Testing Critical Slowing Down as a Bifurcation Indicator in a Low-Dissipation Dynamical System.

We study a two-dimensional low-dissipation nonautonomous dynamical system, with a control parameter that is swept linearly in time across a transcritical bifurcation. We investigate the relaxation time of a perturbation applied to a variable of the system and we show that critical slowing down may occur at a parameter value well above the bifurcation point. We test experimentally the occurrence of critical slowing down by applying a perturbation to the accessible control parameter and we find that this perturbation leaves the system behavior unaltered, thus providing no useful information on the occurrence of critical slowing down. The theoretical analysis reveals the reasons why these tests fail in predicting an incoming bifurcation.

Experimental study of speckle patterns generated by low-coherence semiconductor laser light.

Speckle is a wave interference phenomenon that has been studied in various fields, including optics, hydrodynamics, and acoustics. Speckle patterns contain spectral information of the interfering waves and of the scattering medium that generates the pattern. Here, we study experimentally the speckle patterns generated by the light emitted by two types of semiconductor lasers: conventional laser diodes, where we induce low-coherence emission by optical feedback or by pump current modulation, and coupled nanolasers. In both cases, we analyze the intensity statistics of the respective speckle patterns to inspect the degree of coherence of the light. We show that the speckle analysis provides a non-spectral way to assess the coherence of semiconductor laser light.

Third Order Dispersion in Time-Delayed Systems.

Time-delayed dynamical systems materialize in situations where distant, pointwise, nonlinear nodes exchange information that propagates at a finite speed. However, they are considered devoid of dispersive effects, which are known to play a leading role in pattern formation and wave dynamics. We show how dispersion may appear naturally in delayed systems and we exemplify our result by studying theoretically and experimentally the influence of third order dispersion in a system composed of coupled optical microcavities. Dispersion-induced pulse satellites emerge asymmetrically and destabilize the mode-locking regime.

Hybrid procedures and femoral endarterectomy in diabetic patients.

OBJECTIVE: The aim of the study is to evaluate the safety and effectiveness of common femoral endarterectomy (CFE) in critical limb ischemia (CLI) associated with proximal and distal endovascular (EV) revascularization in diabetic (type 1 and type 2) and non-diabetic patients. PATIENTS AND METHODS: We analyzed patients from January 2008 to December 2011 who underwent one-staged hybrid procedures. Patients were divided into three groups: group 1 = EV reconstruction proximal to the CFE, group 2 = EV procedures distal to the CFE, group 3 = both proximal and distal EV procedures. Patients were evaluated at 6 and 36 months after the procedures, and the mean follow-up was 42 ± 20.3 months. RESULTS: A total of 43 (79% men; aged 74.4 ± 8.6 years) out of 635 (5.5%) patients operated for CLI fulfilled the inclusion criteria; 23 (53.5%) had type 1 or type 2 diabetes mellitus (DM). DM patients were younger than controls (p = 0.048). The patient distribution was 14 in Group 1 (32.5%), 24 in Group 2 (55.8%) and 5 in Group 3 (11.7%). CFE was successful in all cases, while associated EV procedures were successful in 90.7% of patients. Peri-operative morbidity and mortality were 11.6% and 2.3%, respectively. Survival rates at 6 and 36 months were 93% and 71.9%, respectively. Three patients (6.98%) underwent a major amputation. The cumulative limb salvage was 95.2% at 6 months and 92.1% at 36 months. No recurrent CFE stenosis was observed. No differences in survival, amputation or patency rates emerged between DM and non-DM patients or among the three EV revascularization groups. CONCLUSIONS: Hybrid procedures are safe and effective both in CLI patients with or without DM, and they should be taken into consideration whenever indications are present.

Nonlocality Induces Chains of Nested Dissipative Solitons.

Dissipative solitons often behave as quasiparticles, and they may form molecules characterized by well-defined bond distances. We show that pointwise nonlocality may lead to a new kind of molecule where bonds are not rigid. The elements of this molecule can shift mutually one with respect to the others while remaining linked together, in a manner similar to interlaced rings in a chain. We report experimental observations of these chains of nested dissipative solitons in a time-delayed laser system.

Extracellular matrix characterization in plaques from carotid endarterectomy by a proteomics approach.

Extracellular matrix (ECM) is a fundamental component of multicellular organisms. Alteration of its structure and/or molecular composition are associated with several pathologies, among the others with atherosclerosis. To determine how the overall ECM architecture of a tissue as complex as the atheroma may change under varying pathological conditions constitutes a great technical challenge. This entails removing cell components and solubilisation of fibrillar proteins in order to allow enzymatic digestion and mass spectrometry analyses. This work aimed at testing and assessing an easy to use, standardized and reproducible proteomics protocol to map ECM proteins in carotid plaque specimens. To this end, plaques from endarterectomies were incubated in different buffers and the resulting solutions and tissue homogenates after incubation were processed for mass spectrometry. Comparison of the different workflows showed that 4M Guanidine treatment (following 0.5M NaCl and 0.08% SDS incubations) is the most promising in terms of ECM enrichment. The protocol can also be used to identify different and complementary classes of proteins both in plaque extracts and homogenates.

Correlation between peak systolic velocity and diameter of cavernosal arteries in flaccid versus dynamic state for the evaluation of erectile dysfunction.

Previous studies have suggested that parameters measured in the flaccid state (FS) by penile duplex Doppler ultrasound (PDDU) may predict the outcome after intracavernosal injection (ICI). The aim of this study was to evaluate the association between peak systolic velocity (PSV) and cavernosal artery diameter (CAD) in the FS with PSV and clinical assessment of erection hardness (CAEH) after ICI. Fifty patients who underwent PDDU for erectile dysfunction were prospectively enrolled. PSV and CAD were measured in FS and then correlated with PSV and CAEH after ICI of 20 µg of e1 prostaglandin (PGe1). Even though PSV in FS demonstrated a significant correlation with PSV after ICI (P=0.04, r=0.21), none of the cutoff values tested (10, 13 and 15 cm s-1 in FS) had a combined sensitivity and specificity >80% to predict a PSV after ICI ⩾30 cm s-1. No correlation was observed between CAD in FS and PSV after ICI. Also, no association was observed between PSV in FS and development of a complete full rigid erection after ICI. Although PSV in FS statistically correlates with PSV after ICI, predictive values are low, making it non-reliable to predict accurately the response to ICI of 20 µg PGe1.

Asymmetric mode scattering in strongly coupled photonic crystal nanolasers.

We investigate the basic mechanism of nonlinear mode competition in two semiconductor-coupled nanocavities operating in the laser regime. For this, we study energy transfer between bonding (in-phase) and anti-bonding (out-of-phase) modes of the system formed by two strongly coupled photonic crystal nanolasers. We experimentally observe mode switching from the blue-detuned to the red-detuned mode as the pump power is increased. A semi-classical description in terms of mean-field equations allows us to explain this phenomenon as stimulated scattering due to carrier population oscillations in the cavities at the mode splitting frequency. We predict such asymmetrical mode interaction to be universal in arrays of optically coupled semiconductor micro and nanocavities.

Dynamics of Localized Structures in Systems with Broken Parity Symmetry.

A great variety of nonlinear dissipative systems are known to host structures having a correlation range much shorter than the size of the system. The dynamics of these localized structures (LSs) has been investigated so far in situations featuring parity symmetry. In this Letter we extend this analysis to systems lacking this property. We show that the LS drifting speed in a parameter varying landscape is not simply proportional to the parameter gradient, as found in parity preserving situations. The symmetry breaking implies a new contribution to the velocity field which is a function of the parameter value, thus leading to a new paradigm for LSs manipulation. We illustrate this general concept by studying the trajectories of the LSs found in a passively mode-locked laser operated in the localization regime. Moreover, the lack of parity affects significantly LSs interactions which are governed by asymmetrical repulsive forces.

Tailored ultrasound learning for acute care surgeons: a review of the MUSEC (Modular UltraSound ESTES Course) project.

PURPOSE: The European Society for Trauma and Emergency Surgery (ESTES) identified the need for general and trauma surgeons involved in the management of critically ill surgical patients to embrace and learn both basic and advanced US skills. A steering group was created to address this deficit. METHODS: Modular UltraSound ESTES Course (MUSEC) is a modular blended-learning course. It incorporates pre-test/post-test examinations, pre-course online materials, didactic and interactive lectures, interactive case scenarios discussion with pathological US clips, hands-on practice on healthy volunteer models, and on original phantoms for simulating both pathological US findings and practicing US-guided interventional maneuvers. Four independent modules were provided. Surgical decision-making didactics were also included in the course curriculum. Learning gain (Δ of the rating of pre-test and post-test) was calculated for each module. An anonymous post-course satisfaction survey was also administered (16 questions with a Likert's 5-point scale of evaluation). RESULTS: Twenty-three MUSEC Courses were run in a 30 months period, training 416 doctors from 29 countries. A total of 52 modules were delivered. The mean pre-test and post-test grades were 8.3/12 and 10.7/12, respectively, yielding a significant mean learning gain of 28.9 % (p = 0.001). Post-course satisfaction survey got an overall ranking of 4.5/5. CONCLUSIONS: MUSEC is an effective and original educational format, enjoyed by candidates, that fills an educational gap for tailored US education as a procedural skill to acute care surgeons. Ongoing revisions should reduce the current limitations and increase the educational value, in terms of number of modules and post-course credentialing.

PCDD/Fs in the soils in the province of Trento: 10 years of monitoring.

This paper presents a 10-year overview of the dioxins and furans (PCDD/Fs) content in soils in the province of Trento (Italy). The aim was to compare the results found in the Valsugana valley where there is a steel-making plant with other locations within the province. During 2002 and from 2005 to 2010, campaigns were carried out in order to obtain a background reference in terms of micropollutants, in view of the possible construction of a municipal solid waste (MSW) incinerator in Trento. In 2009, a campaign was performed for the environmental characterization of the Valsugana valley, the town of Trento and its surroundings, in order to help assess the impact of the steel-making plant. In 2012, another campaign was carried out by the Department of Civil and Environmental Engineering of Trento, in order to monitor the soils in the area around the steel mill. All the campaigns showed relatively low concentrations of PCDD/Fs, both in protected areas and in the areas close to the industrial plants. No critical situations were identified, as also confirmed by an estimation of the potential daily PCDD/F intake by children subject to accidental ingestion of soil.

Invited Article: Progress in coherent lithography using table-top extreme ultraviolet lasers.

Compact (table top) lasers emitting at wavelengths below 50 nm had expanded the spectrum of applications in the extreme ultraviolet (EUV). Among them, the high-flux, highly coherent laser sources enabled lithographic approaches with distinctive characteristics. In this review, we will describe the implementation of a compact EUV lithography system capable of printing features with sub-50 nm resolution using Talbot imaging. This compact system is capable of producing consistent defect-free samples in a reliable and effective manner. Examples of different patterns and structures fabricated with this method will be presented.

Basic Endovascular Skills Trainer: A surgical simulator for the training of novice practitioners of endovascular procedures.

In recent years the clinical interest for structured training in endovascular procedures has increased. Such procedures respect the physical integrity of the patient and at the same time ensure good therapeutic results. This study describes the development and testing of the B.E.S.T. (Basic Endovascular Skills Trainer) simulator. The B.E.S.T is an innovative physical endovascular simulator to learn basic skills of endovascular surgery. The simulator was tested by 25 clinicians with different levels of experience: novices, intermediates, and experts. All clinicians agree on affirming the importance of training in endovascular surgery; in particular they consider the B.E.S.T a valid simulator to learn specific basic skills of vascular surgery.

How lasing localized structures evolve out of passive mode locking.

We investigate the relationship between passive mode locking and the formation of time-localized structures in the output intensity of a laser. We show how the mode-locked pulses transform into lasing localized structures, allowing for individual addressing and arbitrary low repetition rates. Our analysis reveals that this occurs when (i) the cavity round-trip is much larger than the slowest medium time scale, namely the gain recovery time, and (ii) the mode-locked solution coexists with the zero intensity (off) solution. These conditions enable the coexistence of a large quantity of stable solutions, each of them being characterized by a different number of pulses per round-trip and with different arrangements. Then, each mode-locked pulse becomes localized, i.e., individually addressable.