A portable wireless-based architecture for solving minimum digital divide problems.

In today's society digital services have become the key to the success of anyone. Hence, for being competitive it is important that these services are available, employ the latest technology and are low cost. Unfortunately, it often happens that these good intentions do not correspond to reality. In this paper an information system is proposed, targeted at those small realities affected by the digital divide and at those companies that employ out of date, high cost technologies, that provides data and voice services in a unified manner using heterogeneous devices. The system utilizes innovative technologies, in particular wireless technology, to deliver low cost solutions. The distinctive feature is that it does not depend on the network hardware infrastructure and the underlying platform. Furthermore, it deals with the configuration, accounting, security, management, and monitoring aspects while maintaining its flexibility and simplicity of use both for the administrator and end user

Management of cryptorchidism: a survey of clinical practice in Italy

<p>Abstract</p> <p>Background</p> <p>An evidence-based Consensus on the treatment of undescended testis (UT) was recently published, recommending to perform orchidopexy between 6 and 12 months of age, or upon diagnosis and to avoid the use of hormones. In Italy, current practices on UT management are little known. Our aim was to describe the current management of UT in a cohort of Italian children in comparison with the Consensus guidelines. As management of retractile testis (RT) differs, RT cases were described separately.</p> <p>Methods</p> <p>Ours is a retrospective, multicenter descriptive study. An online questionnaire was filled in by 140 Italian Family Paediatricians (FP) from <it>Associazione Culturale Pediatri </it>(ACP), a national professional association of FP. The questionnaire requested information on all children with cryptorchidism born between 1/01/2004 and 1/01/2006. Data on 169 children were obtained. Analyses were descriptive.</p> <p>Results</p> <p>Overall 24% of children were diagnosed with RT, 76% with UT. Among the latter, cryptorchidism resolved spontaneously in 10% of cases at a mean age of 21.6 months. Overall 70% of UT cases underwent orchidopexy at a mean age of 22.8 months (SD 10.8, range 1.2-56.4), 13% of whom before 1 year. The intervention was performed by a paediatric surgeon in 90% of cases, with a success rate of 91%. Orchidopexy was the first line treatment in 82% of cases, while preceded by hormonal treatment in the remaining 18%. Hormonal treatment was used as first line therapy in 23% of UT cases with a reported success rate of 25%. Overall, 13 children did not undergo any intervention (mean age at last follow up 39.6 months). We analyzed the data from the 5 Italian Regions with the largest number of children enrolled and found a statistically significant regional difference in the use of hormonal therapy, and in the use of and age at orchidopexy.</p> <p>Conclusions</p> <p>Our study showed an important delay in orchidopexy. A quarter of children with cryptorchidism was treated with hormonal therapy. In line with the Consensus guidelines, surgery was carried out by a paediatric surgeon in the majority of cases, with a high success rate.</p

Genome-wide Analyses Identify KIF5A as a Novel ALS Gene

To identify novel genes associated with ALS, we undertook two lines of investigation. We carried out a genome-wide association study comparing 20,806 ALS cases and 59,804 controls. Independently, we performed a rare variant burden analysis comparing 1,138 index familial ALS cases and 19,494 controls. Through both approaches, we identified kinesin family member 5A (KIF5A) as a novel gene associated with ALS. Interestingly, mutations predominantly in the N-terminal motor domain of KIF5A are causative for two neurodegenerative diseases: hereditary spastic paraplegia (SPG10) and Charcot-Marie-Tooth type 2 (CMT2). In contrast, ALS-associated mutations are primarily located at the C-terminal cargo-binding tail domain and patients harboring loss-of-function mutations displayed an extended survival relative to typical ALS cases. Taken together, these results broaden the phenotype spectrum resulting from mutations in KIF5A and strengthen the role of cytoskeletal defects in the pathogenesis of ALS.Peer reviewe

Global wealth disparities drive adherence to COVID-safe pathways in head and neck cancer surgery

Peer reviewe

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

La gestione del bambino con testicolo ritenuto

Background: The aims of our study were to describe the current management of cryptorchidism among Italian family paediatricians (FP) and detect any difference from the recently published Nordic Consensus guidelines. Methods: An online questionnaire was filled in by 140 Italian FP from 18/20 Italian regions. The questionnaire requested information on all children with cryptorchidism born between 1/01/2004 and 1/01/2006, their characteristics and management. Results: Data on 169 children with undescended testis were obtained. Among those, 24% had at diagnosis a retractile testis, while 76% had a true cryptorchidism. Mean age at diagnosis was 9.6 months (SD 13.2; range 0-52.8). In 16% of cases cryptorchydism resolved spontaneously at a mean age of 25.2 months (SD 12; range 6-46.8). On the overall cases, 99 subjects (59%) underwent orchiopexy at mean age of 22.8 months (SD 10.8; range 1.2-56.4), 13% of which before 1 year of age. The intervention was performed by a paediatric surgeon in 89% of cases, with a success rate of 91%. Orchiopexy was the first line treatment in 82/99 cases (83%), while preceded by hormonal treatment in the other 17 cases. Hormonal treatment was used as first line in 20% of cases with a reported success rate of 25% (n=8/32). Overall, 18 children did not undergo any intervention (mean age at last follow up 44.4 months; SD 12; range 20.4-62.4). Conclusions: Our study showed an important delay in orchiopexy. Moreover, a high percentage of children with undescended testis was treated with hormonal therapy, although it is not recommended by the recent guidelines

Assessing priorities for enhancing adaptive capacity of agricultural systems to climate change using fuzzy logic-based approaches

This study outlines the development of a composite indicator of the adaptive capacity (ACI) toclimate change of rural communities in the Oristanese district (Sardinia, Italy). Farming systemsinclude intensive dairy cattle, rainfed dairy sheep, cereals and irrigated horticulture. Twenty-oneindicators of AC were derived from an array of several priorities, initially identified by aninterdisciplinary team of scientists and then extended and scored (on a rank from 1 to 5) by 31experts (agronomic scientists, farmers, advisors and consumers). The extended list of prioritieswas reduced to a set of indicators that could be quantified using data from different sources. Theindicators were organized into seven determinants (Infrastructure, Technology, Economicpower, Flexibility, Knowledge, Sensitivity, Social capital), in turn organized in three components:Ability, Action and Awareness. AC calculations required that 1) scores for each basic indicator benormalized and aggregated to a determinant value, 2) determinants aggregated to a componentvalue, 3) components aggregated to an AIC (best, 0≤ACI≤1, worst). A fuzzy logic inferring systemwas used based on the importance of the basic indicators and their aggregation intodeterminants and components. Favourable/unfavourable thresholds for each indicator were setfollowing expert knowledge and/or survey/census/literature data, while the priority scores wereused to assign weighting factors. Results for the Oristanese district indicate a low-medium AC(ACI=0.61) with social capital (0.27) being the strongest determinant and economic power (0.80)the weakest. These findings provide insights for enhancing effective, locally meaningful andfeasible strategies by increasing the AC of Oristanese rural communities