Variability of adenoidectomy/tonsillectomy rates among children of the Veneto Region, Italy

<p>Abstract</p> <p>Background</p> <p>Despite national guidelines in 2003 aimed at limiting the recourse to tonsillectomy and/or adenoidectomy (A/T), the latter are among the most frequent pediatric surgeries performed in Italy. Aim of the study is to investigate variability of A/T rates among children of the Veneto Region, Italy.</p> <p>Methods</p> <p>All discharges of Veneto residents with Diagnosis-Related Groups 57–60 and ICD9-CM intervention codes 28.2 (tonsillectomy), 28.3 (adenotonsillectomy), 28.6 (adenoidectomy) were selected in the period 2000–2006 for a descriptive analysis. A multilevel Poisson regression model was applied to estimate Incidence Rate Ratios (IRR) with 95% Confidence Intervals (CI) for A/T surgery among children aged 2–9 years in 2004–2006, while taking into account clustering of interventions within the 21 Local Health Units.</p> <p>Results</p> <p>Through 2000–2006, the overall number of A/T surgeries decreased (-8%); there was a decline of adenoidectomies (-20%) and tonsillectomies (-8%), whereas adenotonsillectomies raised (+18%). Analyses on children aged 2–9 resulted in an overall rate of 14.4 surgeries per 1000 person-years (16.1 among males and 12.5 among females), with a wide heterogeneity across Local Health Units (range 8.1–27.6). At random intercept Poisson regression, while adjusting for sex and age, intervention rates were markedly lower among foreign than among Italian children (IRR = 0.57, CI 0.53–0.61). A/T rates in the 10–40 age group (mainly tonsillectomies) computed for each Local Health Unit and introduced in the regression model accounted for 40% of the variance at Local Health Unit level of pediatric rates (mainly adenoidectomies and adenotonsillectomies).</p> <p>Conclusion</p> <p>A/T rates in the Veneto Region, especially adenoidectomies among children aged 2–9 years, remain high notwithstanding a decrease through 2000–2006. A wide heterogeneity according to nationality and Local Health Units is evident. The propensity to A/T surgery of each Local Health Unit is similar in different age groups and for different surgical indications.</p

Esterase Cleavable 2D Assemblies of Magnetic Iron Oxide Nanocubes: Exploiting Enzymatic Polymer Disassembling to Improve Magnetic Hyperthermia Heat Losses

Here, we report a nanoplatform based on iron oxide nanocubes (IONCs) coated with a bioresorbable polymer that, upon exposure to lytic enzymes can be disassembled increasing the heat performances in comparison with the initial clusters. We have developed bi-dimensional (2D) clusters by exploiting benchmark iron oxide nanocubes as heat mediators for magnetic hyperthermia and a polyhydroxyalkanoate (PHA) copolymer, a biodegradable polymer produced by bacteria that can be digested by intracellular esterase enzymes. The comparison of magnetic heat performance of the 2D assemblies with 3D centro-symmetrical assemblies or single iron oxide nanocubes emphasize the benefit of the 2D assembly. On one hand, the heat losses of 2D assemblies dispersed in water are better than the 3D assemblies, but worse than for single nanocubes. On the other hand, when the bi-dimensional magnetic beads (2D-MNBs) are incubated with the esterase enzyme at a physiological temperature, their magnetic heat performances began to progressively increase. After 2 hours of incubation, specific absorption rate values of the 2D assembly double the ones of individually coated nanocubes. Such an increase can be mainly correlated to the splitting of the 2D-MNBs into smaller size clusters with a chain- like configuration containing few nanocubes. Moreover, 2D-MNBs exhibited non-variable-heat performances even after intentionally inducing their aggregation. Magnetophoresis measurements indicate a comparable response of 3D and 2D clusters to external magnets (0.3T) that is by far faster than that of single nanocubes. This feature is crucial for a physical accumulation of magnetic materials in the presence of magnetic field gradients. This system is the first example of a nanoplatform that, upon exposure to lytic enzymes, such as those present in a tumor environment, can be disassembled from the initial 2D-MNB organization to chain-like assemblies with clear improvement of the heat magnetic losses resulting in better heat dissipation performances. The potential application of 2D nano-assemblies based on the cleavable PHAs for preserving their magnetic losses inside cells will benefit hyperthermia therapies mediated by magnetic nanoparticles under alternating magnetic fields

Goal frames and sustainability transitions: how cognitive lock-ins can impede crop diversification

This is the final version. Available on open access from Springer via the DOI in this record. Transitions towards more sustainable agricultural systems are often characterised by ‘lock-ins’, understood as self-reinforcing mechanisms that reproduce the status quo and impede change. While socioeconomic, technological and institutional lock-ins have been widely used to understand processes of sustainable transitions in agri-food systems, the role of so-called cognitive lock-ins is still under-investigated. In this study, we focus on how institutional settings create cognitive lock-ins in farmers’ decision-making related to the adoption of sustainable agricultural practices. We apply goal framing for environmental behaviour and transition theory in explaining how socio-technical conditions may shape farmer’s decision-making. Empirically, we focus on the example of diversifying crop rotations with legumes as an established strategy to increase biodiversity and soil health, and reduce agrochemical use, emissions and pollution, which still remains rare in European agriculture. We use two cases in the Atlantic pedo-climatic region, Cornwall, UK, and Gelderland, Netherlands. Using in-depth interview data with farmers and extensive supplementary secondary data, we explore how context-specific socio-technical settings interact with farmers’ normative, gain-oriented and hedonic goal frames to shape the (un-)desirability of crop diversification with legumes. This creates conditions recognisable as cognitive lock-ins: the context of farmers’ decision-making creates cognitive processes that drastically reduce the perceived viability of alternative agricultural practices. Our findings in this case suggest the framework developed for this study may help to identify regionally specific, as well as common, barriers and solutions to crop diversification and comparable practices that are relevant to transitions towards sustainability in agri-food systems.European Union Horizon 202

Esterase-Cleavable 2D Assemblies of Magnetic Iron Oxide Nanocubes: Exploiting Enzymatic Polymer Disassembling to Improve Magnetic Hyperthermia Heat Losses

Here, we report a nanoplatform based on iron oxide nanocubes (IONCs) coated with a bioresorbable polymer that, upon exposure to lytic enzymes, can be disassembled increasing the heat performances in comparison with the initial clusters. We have developed two-dimensional (2D) clusters by exploiting benchmark IONCs as heat mediators for magnetic hyperthermia and a polyhydroxyalkanoate (PHA) copolymer, a biodegradable polymer produced by bacteria that can be digested by intracellular esterase enzymes. The comparison of magnetic heat performance of the 2D assemblies with 3D centrosymmetrical assemblies or single IONCs emphasizes the benefit of the 2D assembly. Moreover, the heat losses of 2D assemblies dispersed in water are better than the 3D assemblies but worse than for single nanocubes. On the other hand, when the 2D magnetic beads (2D-MNBs) are incubated with the esterase enzyme at a physiological temperature, their magnetic heat performances began to progressively increase. After 2 h of incubation, specific absorption rate values of the 2D assembly double the ones of individually coated nanocubes. Such an increase can be mainly correlated to the splitting of the 2D-MNBs into smaller size clusters with a chain-like configuration containing few nanocubes. Moreover, 2D-MNBs exhibited nonvariable heat performances even after intentionally inducing their aggregation. Magnetophoresis measurements indicate a comparable response of 3D and 2D clusters to external magnets (0.3 T) that is by far faster than that of single nanocubes. This feature is crucial for a physical accumulation of magnetic materials in the presence of magnetic field gradients. This system is the first example of a nanoplatform that, upon exposure to lytic enzymes, such as those present in a tumor environment, can be disassembled from the initial 2D-MNB organization to chain-like assemblies with clear improvement of the heat magnetic losses resulting in better heat dissipation performances. The potential application of 2D nanoassemblies based on the cleavable PHAs for preserving their magnetic losses inside cells will benefit hyperthermia therapies mediated by magnetic nanoparticles under alternating magnetic fields

Toward a Comprehensive and Integrated Strategy of the European Marine Research Infrastructures for Ocean Observations

Research Infrastructures (RIs) are large-scale facilities encompassing instruments, resources, data and services used by the scientific community to conduct high-level research in their respective fields. The development and integration of marine environmental RIs as European Research Vessel Operators [ERVO] (2020) is the response of the European Commission (EC) to global marine challenges through research, technological development and innovation. These infrastructures (EMSO ERIC, Euro-Argo ERIC, ICOS-ERIC Marine, LifeWatch ERIC, and EMBRC-ERIC) include specialized vessels, fixed-point monitoring systems, Lagrangian floats, test facilities, genomics observatories, bio-sensing, and Virtual Research Environments (VREs), among others. Marine ecosystems are vital for life on Earth. Global climate change is progressing rapidly, and geo-hazards, such as earthquakes, volcanic eruptions, and tsunamis, cause large losses of human life and have massive worldwide socio-economic impacts. Enhancing our marine environmental monitoring and prediction capabilities will increase our ability to respond adequately to major challenges and efficiently. Collaboration among European marine RIs aligns with and has contributed to the OceanObs’19 Conference statement and the objectives of the UN Decade of Ocean Science for Sustainable Development (2021–2030). This collaboration actively participates and supports concrete actions to increase the quality and quantity of more integrated and sustained observations in the ocean worldwide. From an innovation perspective, the next decade will increasingly count on marine RIs to support the development of new technologies and their validation in the field, increasing market uptake and produce a shift in observing capabilities and strategies.Peer reviewe

Advancements in decadal climate predictability: the role of nonoceanic drivers

We review recent progress in understanding the role of sea ice, land surface, stratosphere, and aerosols in decadal-scale predictability and discuss the perspectives for improving the predictive capabilities of current Earth system models (ESMs). These constituents have received relatively little attention because their contribution to the slow climatic manifold is controversial in comparison to that of the large heat capacity of the oceans. Furthermore, their initialization as well as their representation in state-of-the-art climate models remains a challenge. Numerous extraoceanic processes that could be active over the decadal range are proposed. Potential predictability associated with the aforementioned, poorly represented, and scarcely observed constituents of the climate system has been primarily inspected through numerical simulations performed under idealized experimental settings. The impact, however, on practical decadal predictions, conducted with realistically initialized full-fledged climate models, is still largely unexploited. Enhancing initial-value predictability through an improved model initialization appears to be a viable option for land surface, sea ice, and, marginally, the stratosphere. Similarly, capturing future aerosol emission storylines might lead to an improved representation of both global and regional short-term climatic changes. In addition to these factors, a key role on the overall predictive ability of ESMs is expected to be played by an accurate representation of processes associated with specific components of the climate system. These act as “signal carriers,” transferring across the climatic phase space the information associated with the initial state and boundary forcings, and dynamically bridging different (otherwise unconnected) subsystems. Through this mechanism, Earth system components trigger low-frequency variability modes, thus extending the predictability beyond the seasonal scale