La ricerca e la messa a punto di nuove tecnologie per rendere più sostenibile l’industria lattiero-casearia , costituisce tema di attualità sempre più stringente nel ambito degli sforzi tesi al rispetto ed alla tutela ambientale. In particolare gli aspetti di inquinamento connessi agli allevamenti di bestiame domestico hanno ripercussioni sulle emissioni di CO2 e sull’effetto serra con ricadute sulle problematiche di riscaldamento del pianeta. Il presente articolo si propone di affrontare le caratteristiche connesse alle attività lattiero-casearie e di allevamento, ovvero focalizzando l’attenzione sulle linee di intervento e di controllo delle frazioni liquide, solide e aeriformi di scarto. In effetti i sieri caseari derivati dal processo produttivo quali (scotta, siero, latticello ,acque di lavaggio delle attrezzature e degli ambienti),sono liquidi ad alto contenuto di BOD5 e di sostanze nutrienti e pertanto risultano idonee a poter essere sottoposte a trattamenti biologici con possibilità di recupero dei fanghi. Come pure le frazioni solide di scarto del metabolismo animale possono essere assoggettate a recupero di materia sotto forma di compost, o in alternativa essere utilizzati per il recupero energetico negli impianti a biomassa. Obbiettivo del presente lavoro consiste nel partire dallo studio di realtà virtuose indicate nei vari casi studio, per indicare un percorso di realizzazione delle migliori soluzioni con le più avanzate tecnologie, volte al recupero e riuso degli scarti di allevamento e produzione nel pieno rispetto della tutela ambientale.

Risk stratification of pediatric febrile neutropenia (FN) is an established concept; the internal evaluation of a validated clinical decision rules (CDR) tool has not been well-described. In this study, restrictive criteria and procalcitonin were added to a recommended CDR for internal evaluation before implementation. Analysis of 577 FN episodes showed good sensitivity and negative predictive value in predicting blood stream infections (87.3%; 95.6%) and intensive care admissions (97.2%; 99.1%). There were no severe adverse events in low-risk patients with low procalcitonin; procalcitonin identified 3 low-risk patients with serious bacterial infections. The modified CDR with procalcitonin may assist in risk stratification.

Objectives We aim to seek expert opinion and gain consensus on the risks associated with a range of prescribing scenarios, preventable using e-prescribing systems, to inform the development of a simulation tool to evaluate the risk and safety of e-prescribing systems (ePRaSE). Methods We conducted a two-round eDelphi survey where expert participants were asked to score pre-designed prescribing scenarios using a five-point Likert scale to ascertain the likelihood of occurrence of the prescribing event, likelihood of occurrence of harm and the severity of the harm. Results Twenty four experts consented to participate with fifteen participants and thirteen participants completing rounds 1 and 2 respectively. Experts agreed on the level of risk associated with 136 out of 178 clinical scenarios with 131 scenarios categorised as high or extreme risk. Discussion We identified 131 extreme or high-risk prescribing scenarios that may be prevented using e-prescribing clinical decision support. The prescribing scenarios represent a variety of categories, with drug-disease contraindications, being the most frequent representing 37 (27%) scenarios and antimicrobial agents being the most common drug class representing 28 (21%) of the scenarios. Conclusion Our eDelphi study has achieved expert consensus on the risk associated with a range of clinical scenarios with most of the scenarios categorised as extreme or high risk. These prescribing scenarios represent the breadth of preventable prescribing error categories involving both basic and advanced clinical decision support. We will use the findings of this study to inform the development of the e-prescribing risk and safety evaluation tool.

Wound management, especially for chronic wounds, has emerged as a major healthcare challenge, which brings great pain and other negative impacts to patients, and accounts for significant portions of health care budgets. The common practice of covering wounds with dressings, owing to the lack of information about wound healing underneath, cannot provide insights into the status of the wound. Changing the dressings to inspect wounds not only disturbs normal healing process of wounds, but also causes pain to affected individuals. Therefore, it is necessary to rely on parameters in the wound microenvironment such as temperature, pH, moisture level, and etc., by continuously monitoring, to indicate the wound status and healing stages. Moreover, intelligent on-demand treatment systems also can be integrated into the smart dressing, called new-type skin bioelectronic systems to be applicated in wound repair. Besides monitoring, these kinds of skin bioelectronic systems can offer effective treatments automatedly when the wound deteriorates. It makes timely treatment possible and avoids delayed treatment and uncovering the dressing to give medicine. In this review, wound healing-related indexes in the wound microenvironment are discussed, applications of various smart dressings with functions of monitoring or/and treatment are summarized.

Aim: We aim to determine the preoperative anxiety levels of patients with open-heart surgery and examine the relationship between anxiety levels and postoperative complications. Material and Methods: In our prospective study, 200 patients who will undergo open-heart surgery preoperative anxiety levels were measured using the Hamilton anxiety scale (HAM-A). Anxiety levels and the development of complications were investigated. Results: Preoperative anxiety was more common in females (p=0.001). The length of stay in the intensive care unit (p=0.006) and the hospital stay (p=0.005) were found to be longer in patients with high anxiety. It was observed that high preoperative anxiety severity increased the risk of developing postoperative complications (p=0.000024). Conclusion: We can say that preoperative anxiety, which is not considered very important, is seen more frequently than expected for patients who will undergo open-heart surgery. In our study, it was observed that high anxiety levels increased the risk of postoperative complications.

Coronavirus disease 2019 (COVID-19) is caused by Severe Acute Respiratory Syndrome- Coronavirus-2 (SARS-CoV-2) and has affected millions of individuals. Here, we report the case of a 57-year-old man, who had COVID-19 infection and was treated with favipravir. He came to our clinic with erosions in oral and anogenital region.

 Additively manufactured (AM) alloy usually inevitably contains defects during the manufacturing processor or service process. Defects, as a harmful factor, could significantly reduce the fatigue performance of materials. This paper shows that the location and introduced form of defects play an important role in high cycle and very high cycle fatigue (VHCF) behavior of selective laser melting Ti-6Al-4V alloy. S-N curve descends linearly for internal defects induced failure. While for artificial surface defects induced failure, S-N curve descends at first and then exhibits a plateau region feature. We also observed competition of interior crack initiation with the fine granular area feature in VHCF regime. The paper indicates that only the size or the stress intensity factor range of the defect is not an appropriate parameter describing the effect of defects on the fatigue crack initiation. Finally, the effect of artificial surface defects on high cycle and VHCF strength is modeled, i.e. the fatigue strength   \(\sigma\), fatigue life  N and defect size \(\sqrt{area}\) (square root of projection area of defect perpendicular to principal stress direction) is expressed as  σ = CN a( \(\sqrt{area}\)) n  for  N0 and  σ = CN0 a( \(\sqrt{area}\)) n  for  N≥N0, where  C,  a and  n are constants, N0 is the number of cycles at the knee point.

Rectal duplication cysts are extremely rare and account for only 4% of all gastrointestinal duplication cysts. They may become difficult for removal in the case of a large tumor in a narrow pelvis. Herein, we report a case of rectal duplication cysts excision via robotic-assisted laparoscopic surgery and its utility.

Title: Multiple nodules in the scrotal wall

Internal hernias are a rare phenomenon, and even rarer is a herniation through the foramen of Winslow. We report a rare case of an 81 year old female presenting with vague abdominal symptoms who was found to have a cecal bascule herniating through the foramen of Winslow treated with surgery.

Ectopia cordis (EC) is a rare congenital condition characterized by a partial or complete defect of the anterior chest wall. It is associated with ventricular and atrial septal defects (ASD),. This study aimed to explore the cardiac manifestations of EC complicated by coronavirus disease 2019 (COVID-19).

Sugarcane mono-sequencing is one of the prominent systems of Uttar Pradesh but wide variations in cane yields are the main cause of concern across the cane producing zones. Hence, 131, 198 and 122 composite soil samples (0-20 cm depth) were taken from cane producing Eastern zone (EZ), Central zone (CZ) and Western zone (WZ) of Uttar Pradesh, respectively to assess the causes of yield variations and impact of sugarcane mono-sequencing on nutrient index (NI), microbial activity and soil quality. Sugarcane mono-sequencing depleted soil organic carbon (SOC), available nitrogen (Na), potassium (Ka), sulphur (Sa) and Zn as 48.9, 98.2, 39.0, 43.3 and 26.4% soil samples falls in low categories, respectively. However, soil degradation aggregated more in EZ soils due to acute deficiency of macro-nutrients as well as high content of Cu, Fe and Mn in low-lying areas. Total microbial counts, microbial biomass of C and N, basal soil respiration, acid and alkaline phosphatase were highest in WZ, but Na, Pa, Ka, Sa, FDA, β-glucosidase and urease activity was greater in CZ soils. As a result, NI was greater in CZ (2.19) followed EZ (1.98) and WZ (1.97), but soil quality index (SQI) was found in the order of CZ (0.795) >WZ (0.785) > EZ (0.708). The sensitivity index (S) was lowest in CZ soils (1.420) indicated that WZ (1.810) and EZ (1.915) soils are more preferable and sensitive to perturbations and management practices. Na was the most vital indicator for sugarcane production followed by SOC, AZO and Sa.

The Jacobi polynomials $\hat{P}_n^{(\alpha,\beta)}(x)$ conform the canonical family of hypergeometric orthogonal polynomials (HOPs) with the two-parameter weight function $(1-x)^\alpha (1+x)^\beta, \alpha,\beta>-1,$ on the interval $[-1,+1]$. The spreading of its associated probability density (i.e., the Rakhmanov density) over the orthogonality support has been quantified, beyond the dispersion measures (moments around the origin, variance), by the algebraic $\mathfrak{L}_{q}$-norms (Shannon and R\’enyi entropies) and the monotonic complexity-like measures of Cram\’er-Rao, Fisher-Shannon and LMC (L\’opez-Ruiz, Mancini and Calbet) types. These quantities, however, have been often determined in an analytically highbrow, non-handy way; specially when the degree or the parameters $(\alpha,\beta)$ are large. In this work, we determine in a simple, compact form the leading term of the entropic and complexity-like properties of the Jacobi polynomials in the two extreme situations: ($n\rightarrow \infty$; fixed $\alpha,\beta$) and ($\alpha\rightarrow \infty$; fixed $n,\beta$). These two asymptotics are relevant \textit{per se} and because they control the physical entropy and complexity measures of the high energy (Rydberg) and high dimensional (pseudoclassical) states of many exactly, conditional exactly and quasi-exactly solvable quantum-mechanical potentials which model numerous atomic and molecular systems.

Systemic allergic reactions to vaccines are very rare. In this study we assessed the management and outcome suspected SARS-CoV-2 vaccine hypersensitivity. We present data of 219 individuals, who experienced symptoms suspicious for an allergic reaction after the first (n=214) or the second vaccination (n=5). 195 reactions occurred after the first application of mRNA-based vaccines (157 Comirnaty®, and 38 Spikevax®) and eighteen reactions were reported after first application of a vector vaccine (Vaxzevria®). Of these 162 experienced immediate symptoms. Skin symptoms occurred in 91 cases. The most frequent cutaneous symptom was angioedema (n=45), followed by generalized urticaria (n=36) and generalized erythema/flush (n=20). 70 patients had cardiovascular symptoms, 45 showed respiratory symptoms and gastrointestinal symptoms were recorded in 14 patients. The allergological assessment of 334 individuals (219 with reactions after COVID vaccination and 115 with a history of vaccine related reactions) showed in 17% a suspicion of sensitization against the SARS-CoV-2 vaccine and/or their ingredients defined as one positive skin test and/or BAT. The majority of the SPT/IDT with the vaccines were negative. Of the 214 patients with suspected allergic symptoms after the first vaccination, 67/67 patients tolerated the re-vaccination. In this study, 334 individuals of a cohort resembling >2000 persons presenting for an allergy workup regarding SARS-CoV-2 vaccination only 45 were diagnosed in concordance with the anaphylaxis definition of the Brighton collaboration with anaphylactic immediate hypersensitivity reaction after SARS-CoV-2 vaccination. Identifiable characteristics of these patients with suspected, but also diagnosed SARS-CoV-2 vaccine hypersensitivity were female gender and the symptom angioedema. Overall, IgE-mediated hypersensitivity towards SARS-CoV-2 vaccines is extremely low and not increased in comparison to the reported hypersensitivity for other vaccines.

Abstract Background and Purpose: The autophagic degradation of lipid droplets (LDs), termed lipophagy, is the main mechanism contributing to lipid consumption in hepatocytes. The identification of effective and safe natural compounds that target lipophagy to eliminate excess lipids may be a potential therapeutic strategy for non-alcoholic fatty liver disease (NAFLD). Here, we investigated the effects of naringin on NAFLD and the underlying mechanism. Experimental Approach: The role of naringin was investigated in mice fed a high-fat diet (HFD) to induce NAFLD, as well as in AML12 cells and primary hepatocytes stimulated by palmitate (PA). Transcription factor EB (TFEB)-knockdown AML12 cells and hepatocyte-specific TFEB-knockout mice were also used for the mechanism study. In vivo and in vitro studies were conducted using transmission electron microscopy, immunofluorescence techniques and western blot analysis. Key Results: We found that naringin treatment effectively relieved HFD-induced hepatic steatosis in mice and inhibited palmitate (PA)-induced lipid accumulation in hepatocytes. The increased p62 and LC3-II levels observed with excess lipid-support autophagosome accumulation and impaired autophagic flux. Treatment with naringin restored TFEB-mediated lysosomal biogenesis, thereby promoting the fusion of autophagosomes and lysosomes, restoring impaired autophagic flux and further inducing lipophagy. However, the knockdown of TFEB in hepatocytes or the hepatocyte-specific knockout of TFEB in mice abrogated naringin-induced lipophagy, which eliminated the therapeutic effect of naringin on hepatic steatosis. Conclusion and Implications: These results demonstrate that TFEB-mediated lysosomal biogenesis and subsequent lipophagy play essential roles in the ability of naringin to mitigate hepatic steatosis and suggest that naringin is a promising drug for treating or relieving NAFLD.

Spontaneous bilateral intracerebral hemorrhage is an outstandingly infrequent context. Ensuing hypertension, trauma inflicted to the brain case is another common cause that out turn into the sequelae of bilateral intracerebral hemorrhage. Lately, a few cases of bilateral basal ganglia bleed have been revealed, as a repercussion of COVID-19 infection.

The commentary discusses the importance of developing Universal Health Coverage strategies through the lens of complex systems framework that evaluates policies not only in terms of the final desired outcome but also as an interplay of disparate views among diverse actors in the system. This view also confers a degree of agency and autonomy on the individual actors, whether they be patients or healthcare workers, and necessitates the inclusion of bottom-up participatory process in the development of UHC policies and interventions. These are consistent with the Primary Health Care principles articulated in the 1978 Alma Ata Declaration and will need to be integrated into the health system development framework to achieve UHC. Ultimately, this approach would encourage the creation of a more cooperative and adaptive policy environment in which each actor is encouraged to collaborate and are nudged toward a desirable outcome rather than through coercive means.

The Madrean Sky Islands Archipelago (MSIA) comprises mountain “islands” whose Pine-Oak forests appear in stark contrast to the surrounding “sea” of Sonoran Desert vegetation. Rhizopogon (Boletales) consists of obligate ectomycorrhizal (EcM) symbionts that form truffle sporocarps and associate exclusively with Pinaceae. The objectives of this project were to describe the diversity of species of Rhizopogon across the MSIA and to characterize whether community structure is determined by host diversity, island identity, geographic distance, or some interaction among these factors. We selected nine islands, two sites were sampled per island: one site dominated by Pinus species and the other by Pseudotsuga menziesii var. glauca. Rhizopogon diversity was characterized from sporocarps and from bioassay-based EcM root tips derived from P. muricata, Ps. menziesii var. menziesii, and Ps. menziesii var. glauca seedlings inoculated with soil samples collected along transects established at each site. The ITS rDNA fungal barcode was amplified, and sequences were used in community analyses. Twenty-one 99% OTUs in the genus Rhizopogon were identified across nine sky islands. While differential host association with Pinus and Pseudotsuga is a significant driver of community composition, our results supported a stronger island effect. Furthermore, Rhizopogon communities associated within hosts are characterized by random phylogenetic structures across sky islands and are not structured by geographic distance. These results are consistent with a strong isolation effect involving historical habitat fragmentation of sky islands in response to past climate changes, and that both niche partitioning and stochastic demographic processes function in shaping Rhizopogon communities of the MSIA.

Clustering approaches are pivotal to handle the many sequence variants obtained in DNA metabarcoding datasets, therefore they have become a key step of metabarcoding analysis pipelines. Clustering often relies on a sequence similarity threshold to gather sequences in Molecular Operational Taxonomic Units (MOTUs) that ideally each represent a homogeneous taxonomic entity, e.g. a species or a genus. However, the choice of the clustering threshold is rarely justified, and its impact on MOTU over-splitting or over-merging even less tested. Here, we evaluated clustering threshold values for several metabarcoding markers under different criteria: limitation of MOTU over-merging, limitation of MOTU over-splitting, and trade-off between over-merging and over-splitting. We extracted sequences from a public database for eight markers, ranging from generalist markers targeting Bacteria or Eukaryota, to more specific markers targeting a class or a subclass (e.g. Insecta, Oligochaeta). Based on the distributions of pairwise sequence similarities within species and within genera and on the rates of over-splitting and over-merging across different clustering thresholds, we were able to propose threshold values minimizing the risk of over-splitting, that of over-merging, or offering a trade-off between the two risks. For generalist markers, high similarity thresholds (0.96-0.99) are generally appropriate, while more specific markers require lower values (0.85-0.96). These results do not support the use of a fixed clustering threshold (e.g. 0.97). Instead, we advocate a careful examination of the most appropriate threshold based on the research objectives, the potential costs of over-splitting and over-merging, and the features of the studied markers.

We studied the population genetic structure of Cobitis vettonica, an endangered freshwater fish species endemic to the Iberian Peninsula in order to propose a biogeographic model of the responses of species to the multiple changes that occurred in the Iberian hydrological system during the Quaternary period. We also deciphered the relationship of C. vettonica with its sister species C. paludica, particularly in sympatric areas and provide genetic information for conservation purposes. To achieve this end, we analysed both mitochondrial and nuclear data (the cytochrome b and the nuclear recombination activating 1 genes) and a battery of single nucleotide polymorphisms (SNPs) of 248 individuals of C. vettonica or C. paludica from 38 localities, including some sympatric ones, covering the entire distribution area of C. vettonica. We highlight the important role played by the hydrogeomorphological processes and climatic changes that occurred in the Iberian Peninsula during the Quaternary on both the population structure of C. vettonica and its relationship with its sister species C. paludica. Our results support the genetic introgression of populations at the eastern limit of the distribution of C. vettonica. Furthermore, we postulate genetic introgression in sympatric areas. Finally, we propose the establishment or expansion of four OCUs for C. vettonica, and highlight the threat faced by its populations due to the low level of genetic diversity detected for some of its populations and genetic introgression with C. paludica, which could eventually displace C. vettonica, resulting in a loss of diversity in this species.

Background: Guidelines for management of patients with allergic conditions are available, but the added value of nurses, allied health care professionals (AHPs) and general practitioners (GPs), in the management of allergic disease has not been fully clarified. The European Academy of Allergy and Clinical Immunology (EAACI) appointed a task force to explore this issue. Aim: To investigate the added value of nurses, AHPs and GPs in management of allergic diseases, in an integrated model of care. Methods: A search was made of peer-reviewed literature published between 2010 and December 2020 (Cochrane Library, PubMed, and CINAHL) on the involvement of the various specific health care providers (HCPs) in the management of allergic diseases. Results: Facilitative models of care for patients with allergies can be achieved if HCP collaborate in the diagnosis and management. Working in multidisciplinary teams (MDT) can increase patients’ understanding of the disease, adherence to treatment, self-care capabilities, and ultimately improve quality of life. The MDT competencies and procedures can be improved and enhanced in a climate of mutual respect and shared values, and with inclusion of patients in the planning of care. Patient-centered communication among HCPs and emphasis on the added value of each profession can create an effective integrated model of care for patients with allergic diseases. Conclusion: Nurses, AHPs, and GPs, both individually and in collaboration, can contribute to the improvement of the management of patients with allergic disease. The interaction between the HCPs and the patients themselves can ensure maximum support for people with allergies.

1. Dietary studies in birds of prey involve direct observation and examination of food remains at resting and nesting sites. Although these methods accurately identify diet in raptors, they are time-consuming, resource-intensive, and associated with biases from the feeding ecology of raptors like Gyps vultures. Our study set out to estimate diet composition in Gyps vultures informed by stable isotopes that provide a good representation of assimilated diet from local systems. 2. We hypothesized that differences in Gyps vulture diet composition is a function of sampling location, and that these vultures move between Serengeti National Park and Selous Game Reserve protected areas to forage. We also, theorised that grazing ungulates are the principal items in Gyps vulture diet. 3. Through combined linear and Bayesian modelling, diet-derived from 13C in Gyps vultures consisted of grazing herbivores across sites, with those in Serengeti National Park consuming higher proportions of grazing herbivores (> 87%). 13C differences in vulture feather subsets did not indicate shifts in vulture diet and combined with blood 13C, vultures fed largely on grazers for ~159 days before they were sampled. Similarly, 15N values indicated Gyps vultures fed largely on herbivores. 34S ratios separated where vultures fed when the two sites were compared. 34S variation in vultures across sites resulted from baseline differences in plant 34S values, though it is not possible to match 34S to specific locations. 4. Our findings highlight the relevance of repeated sampling that considers tissues with varying isotopic turnover and emerging Bayesian techniques for dietary studies using stable isotopes. Findings also suggested limited vulture movement between the two local systems. However, more sampling coupled with telemetry is required to fully comprehend this observation and its implications to Gyps vulture ecology and conservation.

Key Points 1. COVID-19 associated mucormycosis (CAM) is a life-threatening fungal disease that has become an epidemic and notifiable disease after the second wave of COVID-19 in India 2. The target group for CAM includes severely immunocompromised individuals either by COVID-19, or corticosteroid therapy, or uncontrolled glycemic index. 3. With an intention to find out the sensitivity and specificity of diagnostic nasal endoscopy (DNE) and contrast-enhanced magnetic resonance imaging (CEMRI), one hundred two consecutive patients of target group with clinical features of CAM were enrolled in the study. 4. The sensitivity and specificity of DNE as compared to KOH mount were 73.4% and 94.7% respectively. The sensitivity and specificity of CEMRI as compared to KOH mount were 87.5% and 50% respectively. 5. CEMRI misses fewer cases than DNE. In cases of normal endoscopy in the target group, imaging and biopsy should be advised to reduce false-negative results. Nasal endoscopy, biopsy, and imaging can reliably detect the majority of cases of CAM.

Multimeric protein complexes are molecular apparatuses to regulate biological systems and often determine their fate. Among proteins forming such molecular assemblies, amyloid proteins have drawn attention over a half-century since amyloid fibril formation of these proteins is supposed to be a common pathogenic cause for neurodegenerative diseases. This process is triggered by the accumulation of fibril-like aggregates, while the microscopic mechanisms are mostly elusive due to technical limitation of experimental methodologies in individually observing each of diverse aggregate species in the aqueous solution. We then addressed this problem by employing atomistic molecular dynamics simulations for the paradigmatic amyloid protein, amyloid-β (1-42) (Aβ 42). Seven different dimeric forms of oligomeric Aβ 42 fibril-like aggregate in aqueous solution, ranging from tetramer to decamer, were considered. We found additive effects of the size of these fibril-like aggregates on their thermodynamic stability and have clarified kinetic suppression of protomer-protomer dissociation reactions at and beyond the point of pentamer dimer formation. This observation was obtained from the specific combination of the Aβ 42 protomer structure and the physicochemical condition that we here examined, while it is worthwhile to recall that several amyloid fibrils take dimeric forms of their protomers. We could thus conclude that the stable formation of fibril-like protomer dimer should be involved in a turning point where rapid growth of amyloid fibrils is triggered.