The Impact of COVID-19 on Plastic Surgery Residency Training

Abstract: Nowadays didactic and surgical activities for residents in the surgery field are less and less due to an increasing burden of documentation and \u201cnon-educational work.\u201d Considering the current lockdown due to the COVID-19 pandemic, it has never been so important to find different ways to allow residents to improve their knowledge. We asked all plastic and esthetic surgery residents in our country to fill out a questionnaire to investigate changes in their didactical activity and analyze problems about their professional growth in the last few months. From the results of such questionnaires, we found that most of the residents feel the decrease in surgical activities during this time is a detrimental factor for their training and that even if all the schools have changed their didactical activities no school has introduced the use of virtual simulators to compensate for the decrease in surgical practice. Actually, the majority of residents use webinars to keep updated, stating that such technologies are useful but not sufficient to analyze plastic surgery topics in depth during COVID-19 lockdown. Virtual interactive tools are well known in different clinical and surgical specialties, and they are considered as a valid support, but it seems that in plastic surgery they are not so used. According to the most recent studies about residents\u2019 didactical program, we have investigated the potential of Anatomage Table in combination with Touch Surgery application as physical and mental aids to bypass the decreased number and kind of surgical interventions performed in this particular time. Anatomage is an academic user-friendly touch screen table; it is used by both medical students and residents to learn human anatomy and to master surgical anatomy. Touch Surgery is an application available on smartphones and tablets that gives the possibility to watch real and virtually designed surgical videos, accompanied by explanatory comments on the surgical phases; they are interactive and give the possibility to check what you have learned through tests administered after virtual classes. In our opinion, these tools represent reliable solutions to improve plastic residents\u2019 training, mostly during the COVID-19 pandemic. Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266

Evaluating the Maximum Likelihood Method for Detecting Short-Term Variability of AGILE gamma-ray Sources

The AGILE space mission (whose instrument is sensitive in the energy ranges 18-60 keV, and 30 MeV - 50 GeV) has been operating since 2007. Assessing the statistical significance of time variability of gamma-ray sources above 100 MeV is a primary task of the AGILE data analysis. In particular, it is important to check the instrument sensitivity in terms of Poisson modeling of the data background, and to determine the post-trial confidence of detections. The goals of this work are: (i) evaluating the distributions of the likelihood ratio test for "empty" fields, and for regions of the Galactic plane; (ii) calculating the probability of false detection over multiple time intervals. In this paper we describe in detail the techniques used to search for short-term variability in the AGILE gamma-ray source database. We describe the binned maximum likelihood method used for the analysis of AGILE data, and the numerical simulations that support the characterization of the statistical analysis. We apply our method to both Galactic and extra-galactic transients, and provide a few examples. After having checked the reliability of the statistical description tested with the real AGILE data, we obtain the distribution of p-values for blind and specific source searches. We apply our results to the determination of the post-trial statistical significance of detections of transient gamma-ray sources in terms of pre-trial values. The results of our analysis allow a precise determination of the post-trial significance of {\gamma}-ray sources detected by AGILE.Comment: 12 pages, 13 figures, 8 tables, accepted to A&

Fabrication of photothermally active poly(vinyl alcohol) films with gold nanostars for antibacterial applications.

The unique photothermal properties of non-spherical gold nanoparticles under near-infrared (NIR) irradiation find broad application in nanotechnology and nanomedicine. The combination of their plasmonic features with widely used biocompatible poly(vinyl alcohol) (PVA) films can lead to novel hybrid polymeric materials with tunable photothermal properties and a wide range of applications. In this study, thin PVA films containing highly photothermally efficient gold nanostars (GNSs) were fabricated and their properties were studied. The resulting films displayed good mechanical properties and a pronounced photothermal effect under NIR irradiation. The local photothermal effect triggered by NIR irradiation of the PVA-GNS films is highly efficient at killing bacteria, therefore providing an opportunity to develop new types of protective antibacterial films and coatings

Business cycles, international trade and capital flows: Evidence from Latin America

This paper adopts a flexible framework to assess both short- and long-run business cycle linkages between six Latin American (LA) countries and the four largest economies in the world (namely the US, the Euro area, Japan and China) over the period 1980:I-2011:IV. The result indicate that within the LA region there are considerable differences between countries, success stories coexisting with extremely vulnerable economies. They also show that the LA region as a whole is largely dependent on external developments, especially in the years after the great recession of 2008 and 2009. The trade channel appears to be the most important source of business cycle comovement, whilst capital flows are found to have a limited role, especially in the very short run

Neutral pion emission from accelerated protons in the supernova remnant W44

We present the AGILE gamma-ray observations in the energy range 50 MeV - 10 GeV of the supernova remnant (SNR) W44, one of the most interesting systems for studying cosmic-ray production. W44 is an intermediate-age SNR (20, 000 years) and its ejecta expand in a dense medium as shown by a prominent radio shell, nearby molecular clouds, and bright [SII] emitting regions. We extend our gamma-ray analysis to energies substantially lower than previous measurements which could not conclusively establish the nature of the radiation. We find that gamma-ray emission matches remarkably well both the position and shape of the inner SNR shocked plasma. Furthermore, the gamma-ray spectrum shows a prominent peak near 1 GeV with a clear decrement at energies below a few hundreds of MeV as expected from neutral pion decay. Here we demonstrate that: (1) hadron-dominated models are consistent with all W44 multiwavelength constraints derived from radio, optical, X-ray, and gamma-ray observations; (2) ad hoc lepton-dominated models fail to explain simultaneously the well-constrained gamma-ray and radio spectra, and require a circumstellar density much larger than the value derived from observations; (3) the hadron energy spectrum is well described by a power-law (with index s = 3.0 \pm 0.1) and a low-energy cut-off at Ec = 6 \pm 1 GeV. Direct evidence for pion emission is then established in an SNR for the first time.Comment: accepted for publication on ApJ

Autologous tooth graft after endodontical treated used for socket preservation: A multicenter clinical study.

The aim of the study was to evaluate the tooth extracted use as autologous tooth graft after endodontic root canal therapies used for socket preservation. To this purpose, the Tooth Transformer shredding and decontamination machine has been used. The graft obtained in this way, was inserted at the time of the extraction or at a second surgery altogether with the chosen regenerative therapy. This clinical trial enrolled patients with post-estractive defects requiring the restoration bone dimension and shape in the maxillary and mandibular zone. In addition, 98 patients with 119 extraction sockets were enrolled across 10 standardized centers. An innovative preparation method, using the dedicated automated device Tooth Transformer, able to transform autologous teeth in suitable grafting material, has been used. The extracted tooth was cleaned and treated using a Tooth Transformer and made a socket preservation. Thirteen Biopsies were realized to analyze the histologic outcomes at the average time of four months to demonstrate that the autologous tooth graft made from root after endodontic therapy should be used in human bone regeneration as graft for dental implant placement

Calibration of AGILE-GRID with In-Flight Data and Monte Carlo Simulations

Context: AGILE is a gamma-ray astrophysics mission which has been in orbit since 23 April 2007 and continues to operate reliably. The gamma-ray detector, AGILE-GRID, has observed Galactic and extragalactic sources, many of which were collected in the first AGILE Catalog. Aims: We present the calibration of the AGILE-GRID using in-flight data and Monte Carlo simulations, producing Instrument Response Functions (IRFs) for the effective area A_eff), Energy Dispersion Probability (EDP), and Point Spread Function (PSF), each as a function of incident direction in instrument coordinates and energy. Methods: We performed Monte Carlo simulations at different gamma-ray energies and incident angles, including background rejection filters and Kalman filter-based gamma-ray reconstruction. Long integrations of in-flight observations of the Vela, Crab and Geminga sources in broad and narrow energy bands were used to validate and improve the accuracy of the instrument response functions. Results: The weighted average PSFs as a function of spectra correspond well to the data for all sources and energy bands. Conclusions: Changes in the interpolation of the PSF from Monte Carlo data and in the procedure for construction of the energy-weighted effective areas have improved the correspondence between predicted and observed fluxes and spectra of celestial calibration sources, reducing false positives and obviating the need for post-hoc energy-dependent scaling factors. The new IRFs have been publicly available from the Agile Science Data Centre since November 25, 2011, while the changes in the analysis software will be distributed in an upcoming release

Direct Evidence for Hadronic Cosmic-Ray Acceleration in the Supernova Renmant IC 443

The Supernova Remnant (SNR) IC 443 is an intermediate-age remnant well known for its radio, optical, X-ray and gamma-ray energy emissions. In this Letter we study the gamma-ray emission above 100 MeV from IC 443 as obtained by the AGILE satellite. A distinct pattern of diffuse emission in the energy range 100 MeV-3 GeV is detected across the SNR with its prominent maximum (source "A") localized in the Northeastern shell with a flux F = (47 \pm 10) 10^{-8} photons cm^{-2} s^{-1} above 100 MeV. This location is the site of the strongest shock interaction between the SNR blast wave and the dense circumstellar medium. Source "A" is not coincident with the TeV source located 0.4 degree away and associated with a dense molecular cloud complex in the SNR central region. From our observations, and from the lack of detectable diffuse TeV emission from its Northeastern rim, we demonstrate that electrons cannot be the main emitters of gamma-rays in the range 0.1-10 GeV at the site of the strongest SNR shock. The intensity, spectral characteristics, and location of the most prominent gamma-ray emission together with the absence of co-spatial detectable TeV emission are consistent only with a hadronic model of cosmic-ray acceleration in the SNR. A high-density molecular cloud (cloud "E") provides a remarkable "target" for nucleonic interactions of accelerated hadrons: our results show enhanced gamma-ray production near the molecular cloud/shocked shell interaction site. IC 443 provides the first unambiguous evidence of cosmic-ray acceleration by SNRs.Comment: 5 pages, 2 figures; accepted by ApJLetters on Jan 21, 201