Sketching sound with voice and gesture

Insights: In product and interaction design, sounds should be included in the early stages of the design process. Voice and gestures are natural sketching tools that we can exploit to communicate sonic interactions

Extreme—Super obesity and panniculectomy: bipolar radiofrequency scalpel assisted surgery as a valuable option for the most challenging cases

Background In Italy, with a cohort of 6.3 million morbidly obese patients, panniculectomy is often necessary both in relation to bariatric surgery and as the sole treatment to reduce excess lower abdominal tissues. At first glance, the procedure could be misjudged as technically simple; however, when considering patients with Extreme obesity or worse (BMI > 40 kg/m(2)), the surgical risks increase significantly, patients are often inoperable, and few studies are available in the literature. Most surgeons actually avoid this job and related risks. Recent research has highlighted a potential role of the Bipolar Radiofrequency Scalpel (BRS) in various fields as a promising tool to reduce surgical complications. With this paper, the authors report their experience in the management of panniculectomy in Extreme (BMI > 40 kg/m2) and Super (BMI > 50 kg/m(2)) obese patients through the technique of BRS assisted panniculectomy. Methods A retrospective study was conducted on Extreme / Super obese patients who underwent BRS assisted panniculectomy between June 2013-June 2022. The panniculectomy involved lower abdomen excess skin and soft tissues removal, assisted by BRS, minimal undermining, and eventual abdominal hernia repair. Surgical procedures, and complications rate are discussed. Results Fourteen patients matched the selection criteria and were included in the study. Minor and major complications occurred in 28,6% and 14,3%, respectively. No flap necrosis, infections, cellulitis or decubitus ulcer occurred. Seroma 28,6% (4/14) and hematoma 7,1% (1/14) were the most relevant complications in the study population. Conclusions BRS assisted panniculectomy with minimal undermining is a valuable option for patients with extreme or super obesity. At the time of dissection, minimizing undermining and using BRS could make the operation safer and therefore extendable to a larger cohort of patients

Shaping Mediterranean landscapes:The cultural impact of anthropogenic fires in Tyrrhenian southern Tuscany during the Iron and Middle Ages (800–450 BC / AD 650–1300)

Charcoal analysis, applied in sediment facies analysis of the Pecora river palaeochannel (Tyrrhenian southern Tuscany, Italy), detected the occurrence of past fire events in two different fluvial landforms at 800–450 BC and again at AD 650–1300. Taking place in a central Mediterranean district adequately studied through palaeoenvironmental and archaeological research, the investigation determined land changes, time phases and socio-economic driving forces involved in dynamic processes of fire. The fire sequences had purely anthropogenic origins and were linked to forest opening and reduction by local communities. Introduced by the Etruscans, fires dated to 800–450 BC involved mainly the forest cover on the hilly slopes, ensuring agricultural exploitation. From AD 650, fires contributed to Medieval upstream reclamation and vegetation clearing of flat swamplands. From AD 850 to 1050, the use of fire spread over a wider area in the river valley, increasing arable lands. Between AD 1150 and 1300, fires belonged to a regional forest clearance phase. Medieval fire episodes had a paramount importance in shaping and determining the character of the Tuscan Mediterranean landscape. From AD 850, Medieval fire clearing influenced regional vegetation history contributing to the decline of the dominant deciduous Quercus woodland. Open habitats became the new form of a clearly detectable agricultural landscape from AD 950. The use of fire clearing and the resulting landscape changes in the Pecora river valley depended on the political strategies adopted by Medieval authorities and marked, in fact, the progression of a cultural landscape still characterizing central Tyrrhenian Italy

Formation processes at a high resolution Middle Paleolithic site: Cueva Antón (Murcia, Spain)

Cueva Antón is a Middle Paleolithic rockshelter located in the valley of the River Mula (Murcia, Spain). The archeological investigation of the site, which began with salvage work in 1991, resumed in 2006 and is still ongoing, uncovered a succession spanning most of MIS 3 and MIS 4 (ca. 75e36 ka) and featuring a well preserved human occupation record. This paper presents the first information about site stratigraphy and site formation processes. Geoarcheological data collected in the field and through micromorphological observation show that the archeological succession at Cueva Antón is mainly composed of alluvial sediments, with thin intercalations of gravitational and slope material. The sedimentary characteristics of the alluvial succession are well preserved as the result of a rapid accumulation rate and the protective effect of the rockshelter. Several sedimentary facies produced by the shifting of distinct fluvial sub-environments (channel, bar and floodplain) are recognized. With the exception of a few units (II-u, a thin buried alluvial soil, and the archeologically richest units at the base of the succession), postdepositional modification is rare. The site was occupied within a framework of infrequent, short-term visits, resulting in a relatively low overall density of finds and the formation of well-defined archeological lenses that correspond to synchronous paleosurfaces preserving the spatial distribution of finds and features. This pattern explains the limited anthropogenic evidence observed in thin sections, even those from units where archeological excavation uncovered significant remains of human occupation

Stool Xpert MTB/RIF as a possible diagnostic alternative to sputum in Africa: a systematic review and meta-analysis

IntroductionWorldwide, COVID-19 pandemic lead to a large fall in the number of newly reported TB cases. In sub-Saharan Africa, microbiological diagnosis of TB is generally based on smear microscopy and Xpert MTB/RIF on sputum samples, but good quality sputum samples are often difficult to obtain, leading clinicians to rely on more invasive procedures for diagnosis. Aim of this study was to investigate pooled sensitivity and specificity of Xpert MTB/RIF on stool samples compared to respiratory microbiological reference standards in African countries.MethodsFour investigators independently searched PubMed, SCOPUS, and Web of Science until 12th October 2022, then screened titles and abstracts of all potentially eligible articles. The authors applied the eligibility criteria, considered the full texts. All the studies reported the data regarding true positive (TP), true negative (TN), false positive (FP) and false negative (FN). Risk of bias and applicability concerns were assessed with the Quadas-2 tool.Resultsoverall, among 130 papers initially screened, we evaluated 47 works, finally including 13 papers for a total of 2,352 participants, mainly children. The mean percentage of females was 49.6%, whilst the mean percentage of patients reporting HIV was 27.7%. Pooled sensitivity for Xpert MTB/RIF assay for detecting pulmonary tuberculosis was 68.2% (95%CI: 61.1–74.7%) even if characterized by a high heterogeneity (I2=53.7%). Specificity was almost 100% (99%, 95%CI: 97–100%; I2 = 45.7%). When divided for reference standard, in the six studies using sputum and nasogastric aspirate the accuracy was optimal (AUC = 0.99, SE = 0.02), whilst in the studies using only sputum for tuberculosis detection the AUC was 0.85 (with a SE = 0.16). The most common source of bias was exclusion of enrolled patients in the analysis.ConclusionsOur study confirms that, in Africa, stool Xpert MTB/RIF may be a useful rule-in test for children above and below 5 years of age under evaluation for pulmonary tuberculosis. Sensitivity increased substantially when using both sputum and nasogastric aspirate as reference samples

Geoarcheologia ed approccio Multiscala per lo studio delle variazioni del paesaggio storico altomedievale ed implicazioni paleoambientali dell’Olocene recente nella Toscana meridionale

La presente Tesi di Dottorato riguarda lo studio geoarcheologico condotto all’interno di un contesto territoriale della Toscana centro-meridionale compreso tra i rilievi delle Colline Metallifere, i bacini idrografici dei fiumi Pecora e Cornia, e l’area costiera tirrenica tra Piombino e Follonica (Toscana centro-meridionale). La ricerca si è svolta nell’ambito di un progetto ERC multidisciplinare riguardante la caratterizzazione storica, archeologica e ambientale del territorio sotto esame durante i secoli altomedievali (VII-XIII sec AD). Per gli scopi del progetto, la ricerca ha proposto l’integrazione di metodi geoarcheologici (analisi geomorfologica, Remote Sensing, sedimentologia, stratigrafia sia di superficie che di sottosuolo e analisi micromorfologica) in un approccio basato sull’analisi Multiscala (Macroscala, Mesoscala e Microscala). L’impostazione della ricerca su questi tre livelli di risoluzione ha permesso di selezionare un ampio spettro di dati utili per ricostruire, in alto dettaglio, sia la cronologia degli eventi occorsi nella modellazione del paesaggio fisico storico sia le complesse interazioni con le attività antropiche. Inoltre, questo approccio ha consentito di analizzare le dinamiche insediative ed i processi di formazione, occupazione ed abbandono del sito altomedievale di Vetricella, ubicato nella pianura costiera del fiume Pecora, e considerato un unicum nell’area di studio sia per la sua posizione sia per le sue caratteristiche insediative. In particolare, i risultati della Macroscala suggeriscono come, alla scala del singolo bacino idrografico e delle aree costiere, l’evoluzione delle dinamiche di modellazione del paesaggio fisico e biologico durante l’Altomedioevo non fosse influenzata dalle supposte variazioni climatiche, che pure sono contraddittoriamente note in letteratura per il periodo storico in analisi, ma sia piuttosto il risultato di profonde modificazioni delle dinamiche superficiali ad opera dell’azione antropica, determinandone l’assetto odierno. La definizione degli effetti sul paesaggio delle attività umane fornisce quindi nuove informazioni circa le capacità gestionali e pianificatorie e tecnologiche del land use e quindi della loro importanza in ottica storica e socio-economica. Le analisi alla Mesoscala, invece, evidenziano come il sito archeologico di Vetricella fosse localizzato all’interno di un contesto dove la scelta dell’insediamento, e di conseguenza le sue funzioni, era stata pianificata allo scopo di mitigare la pericolosità associata allo scorrimento delle acque superficiali e dei rischi associati. Infine, le analisi alla Microscala delineano un quadro in cui l’adattamento al contesto geomorfologico è stato frutto di una accurata e continua pianificazione di opere di costruzione/distruzione di piani d’uso e di sistemazioni idrauliche. In particolare, quest’ultime sono relative alla presenza di tre fossati concentrici i cui riempimenti restituiscono un record sedimentologico e stratigrafico che suggerisce il loro utilizzo per scopi diversi legati ad attività produttive, difensive e domestiche. Nel complesso, l’approccio Multiscala si è rivelato decisivo per definire un quadro di riferimento cronologico dell’evoluzione del paesaggio all’interno dei sistemi vallivi nonché delle profonde modificazioni apportate dalle attività antropiche e delle loro relazioni con l’evoluzione a lungo, medio e breve termine degli ambienti umidi costieri. Per la prima volta, quindi, è stato possibile determinare come questi contesti, ritenuti per l’Altomedioevo difficilmente colonizzabili od esclusi dalla rete insediativa, fossero in realtà gestiti attraverso una precisa volontà di pianificazione delle opere di sistemazione idraulica e di sfruttamento delle risorse agricole e forestali