The Invisible Pandemic: Domestic Violence and Health and Welfare Services in Italy and in the United Kingdom during Covid-19

Background: International research has shown how Domestic Violence (DV) can escalate during and after or large-scale crises or natural disaster. In many parts of the world, the introduction of lockdown, together with periods of global self-isolation in order to reduce the spread of SARS-CoV-2, has put families, women and children in abusive relationships more at risk, in terms of an “invisible pandemic”. Objective: The purpose of this paper is examining specific reports from Italy and the United Kingdom and analysing how there has been a surge in the pattern of DV cases, recorded globally during the Covid-19 pandemic. Methods: For this purpose, starting from an increased number of DV reports, we examine the typology of Health and Welfare Services, delivered in Italy and in the UK, by a qualitative data collection as a way to show the problematic impact of pandemic measures for those living in and surviving abusive relationships. Results: Our findings allow a comparison between the two different countries and their Welfare Services, highlighting how lockdown has resulted in a reduction of available support for some families, while many others have experienced significant changes in how this care is provided. Conclusions: Our discussion and conclusions focus on the challenges posed by Covid-19, as well as on concerns and considerations regarding Governmental policies and Community services between these two countries

Performance Improvement for SAR Tomography Based on Local Plane Model

Multilook approaches have been applied in synthetic aperture radar (SAR) tomography (TomoSAR), for improving the density and regularity of persistent scatterers reconstructed from multipass SAR images in both rural and urban regions. Multilook operations assume that all scatterers in a given neighborhood are similar in height, thereby providing additional data for recovering the position and reflectivity of a single scatterer, so that a higher signal-to-noise ratio can be achieved. This is equivalent to assuming that scatterers belonging to a local neighborhood of range-azimuth cells are located on horizontal planes. The present article generalizes this approach by adopting the so-called local plane (LP) model for TomoSAR imaging in urban areas, accounting for local variations in the height of scatterers that are not negligible. Furthermore, an LP-generalized likelihood ratio test (LP-GLRT) algorithm is developed to implement the previous idea. Compared with the multilook generalized likelihood ratio test algorithm, LP-GLRT shows better performance in the case of urban structures and terrains in experiments based on both simulated data and TerraSAR-X images

Symptomatic nonconvulsive status epilepticus erroneously suggestive of sporadic Creutzfeldt-Jakob disease

Nonconvulsive status epilepticus (NCSE) may have heterogeneous presentations and differential diagnosis may be particularly difficult because clinical signs coupled with periodic EEG pattern are most often subtle or non-specific. Moreover, few cases of NCSE have been previously described as the presenting symptom of sporadic Creutzfeldt–Jakob disease (sCJD) [1,4,5,7]. We describe a patient with a NCSE strongly, but erroneously, suggestive of a probable sCJD

Spinal vascular lesions: anatomy, imaging techniques and treatment

Vascular lesions of the spinal cord are rare but potentially devastating conditions whose accurate recognition critically determines the clinical outcome. Several conditions lead to myelopathy due to either arterial ischemia, venous congestion or bleeding within the cord. The clinical presentation varies, according with the different aetiology and mechanism of damage

Microalbuminuria and sRAGE in High-Risk Hypertensive Patients Treated with Nifedipine/Telmisartan Combination Treatment: A Substudy of TALENT

Some antihypertensive drugs have also renoprotective and anti-inflammatory properties that go beyond their effect on blood pressure. It has been suggested that microalbuminuria and glomerular filtration rate (GFR) are associated with circulating levels of the soluble form of the receptor, sRAGE (soluble receptor for advanced glycation ends-products). In the present analysis, we used data from the TALENT study to evaluate soluble receptor for advanced glycation end-products (sRAGE) plasma levels in patients with hypertension and high-cardiovascular risk-treated nifedipine and telmisartan in combination. Treatment with nifedipine-telmisartan significantly decreased mean systolic and diastolic ambulatory blood pressure and resulted in a significant increase in sRAGE plasma concentrations after 24 weeks of therapy. We concluded that in hypertensive patients with early-stage renal disease, sRAGE concentrations are not influenced by either microalbuminuria or GFR. Long-term treatment with a combination of nifedipine-telmisartan may have a beneficial effect increasing sRAGE plasma levels, thus exerting an atheroprotective and anti-inflammatory activity

Aspects of the planetary Birkhoff normal form

The discovery in [G. Pinzari. PhD thesis. Univ. Roma Tre. 2009], [L. Chierchia and G. Pinzari, Invent. Math. 2011] of the Birkhoff normal form for the planetary many--body problem opened new insights and hopes for the comprehension of the dynamics of this problem. Remarkably, it allowed to give a {\sl direct} proof of the celebrated Arnold's Theorem [V. I. Arnold. Uspehi Math. Nauk. 1963] on the stability of planetary motions. In this paper, using a "ad hoc" set of symplectic variables, we develop an asymptotic formula for this normal form that may turn to be useful in applications. As an example, we provide two very simple applications to the three-body problem: we prove a conjecture by [V. I. Arnold. cit] on the "Kolmogorov set"of this problem and, using Nehoro{\v{s}}ev Theory [Nehoro{\v{s}}ev. Uspehi Math. Nauk. 1977], we prove, in the planar case, stability of all planetary actions over exponentially-long times, provided mean--motion resonances are excluded. We also briefly discuss perspectives and problems for full generalization of the results in the paper.Comment: 44 pages. Keywords: Averaging Theory, Birkhoff normal form, Nehoro{\v{s}}ev Theory, Planetary many--body problem, Arnold's Theorem on the stability of planetary motions, Properly--degenerate kam Theory, steepness. Revised version, including Reviewer's comments. Typos correcte

The ARCA Registry: A Collaborative Global Platform for Advancing Trial Readiness in Autosomal Recessive Cerebellar Ataxias.

Autosomal recessive cerebellar ataxias (ARCAs) form an ultrarare yet expanding group of neurodegenerative multisystemic diseases affecting the cerebellum and other neurological or non-neurological systems. With the advent of targeted therapies for ARCAs, disease registries have become a precious source of real-world quantitative and qualitative data complementing knowledge from preclinical studies and clinical trials. Here, we review the ARCA Registry, a global collaborative multicenter platform (>15 countries, >30 sites) with the overarching goal to advance trial readiness in ARCAs. It presents a good clinical practice (GCP)- and general data protection regulation (GDPR)-compliant professional-reported registry for multicenter web-based capture of cross-center standardized longitudinal data. Modular electronic case report forms (eCRFs) with core, extended, and optional datasets allow data capture tailored to the participating site's variable interests and resources. The eCRFs cover all key data elements required by regulatory authorities [European Medicines Agency (EMA)] and the European Rare Disease (ERD) platform. They capture genotype, phenotype, and progression and include demographic data, biomarkers, comorbidity, medication, magnetic resonance imaging (MRI), and longitudinal clinician- or patient-reported ratings of ataxia severity, non-ataxia features, disease stage, activities of daily living, and (mental) health status. Moreover, they are aligned to major autosomal-dominant spinocerebellar ataxia (SCA) and sporadic ataxia (SPORTAX) registries in the field, thus allowing for joint and comparative analyses not only across ARCAs but also with SCAs and sporadic ataxias. The registry is at the core of a systematic multi-component ARCA database cluster with a linked biobank and an evolving study database for digital outcome measures. Currently, the registry contains more than 800 patients with almost 1,500 visits representing all ages and disease stages; 65% of patients with established genetic diagnoses capture all the main ARCA genes, and 35% with unsolved diagnoses are targets for advanced next-generation sequencing. The ARCA Registry serves as the backbone of many major European and transatlantic consortia, such as PREPARE, PROSPAX, and the Ataxia Global Initiative, with additional data input from SPORTAX. It has thus become the largest global trial-readiness registry in the ARCA field

Clinico-Genetic, Imaging and Molecular Delineation of COQ8A-Ataxia: A Multicenter Study of 59 Patients.

OBJECTIVE: To foster trial-readiness of coenzyme Q8A (COQ8A)-ataxia, we map the clinicogenetic, molecular, and neuroimaging spectrum of COQ8A-ataxia in a large worldwide cohort, and provide first progression data, including treatment response to coenzyme Q10 (CoQ10). METHODS: Cross-modal analysis of a multicenter cohort of 59 COQ8A patients, including genotype-phenotype correlations, 3D-protein modeling, in vitro mutation analyses, magnetic resonance imaging (MRI) markers, disease progression, and CoQ10 response data. RESULTS: Fifty-nine patients (39 novel) with 44 pathogenic COQ8A variants (18 novel) were identified. Missense variants demonstrated a pleiotropic range of detrimental effects upon protein modeling and in vitro analysis of purified variants. COQ8A-ataxia presented as variable multisystemic, early-onset cerebellar ataxia, with complicating features ranging from epilepsy (32%) and cognitive impairment (49%) to exercise intolerance (25%) and hyperkinetic movement disorders (41%), including dystonia and myoclonus as presenting symptoms. Multisystemic involvement was more prevalent in missense than biallelic loss-of-function variants (82-93% vs 53%; p = 0.029). Cerebellar atrophy was universal on MRI (100%), with cerebral atrophy or dentate and pontine T2 hyperintensities observed in 28%. Cross-sectional (n = 34) and longitudinal (n = 7) assessments consistently indicated mild-to-moderate progression of ataxia (SARA: 0.45/year). CoQ10 treatment led to improvement by clinical report in 14 of 30 patients, and by quantitative longitudinal assessments in 8 of 11 patients (SARA: -0.81/year). Explorative sample size calculations indicate that ≥48 patients per arm may suffice to demonstrate efficacy for interventions that reduce progression by 50%. INTERPRETATION: This study provides a deeper understanding of the disease, and paves the way toward large-scale natural history studies and treatment trials in COQ8A-ataxia. ANN NEUROL 2020;88:251-263

Recurrent Ischemic Stroke and Bleeding in Patients With Atrial Fibrillation Who Suffered an Acute Stroke While on Treatment With Nonvitamin K Antagonist Oral Anticoagulants: The RENO-EXTEND Study

Background: In patients with atrial fibrillation who suffered an ischemic stroke while on treatment with nonvitamin K antagonist oral anticoagulants, rates and determinants of recurrent ischemic events and major bleedings remain uncertain. Methods: This prospective multicenter observational study aimed to estimate the rates of ischemic and bleeding events and their determinants in the follow-up of consecutive patients with atrial fibrillation who suffered an acute cerebrovascular ischemic event while on nonvitamin K antagonist oral anticoagulant treatment. Afterwards, we compared the estimated risks of ischemic and bleeding events between the patients in whom anticoagulant therapy was changed to those who continued the original treatment. Results: After a mean follow-up time of 15.0±10.9 months, 192 out of 1240 patients (15.5%) had 207 ischemic or bleeding events corresponding to an annual rate of 13.4%. Among the events, 111 were ischemic strokes, 15 systemic embolisms, 24 intracranial bleedings, and 57 major extracranial bleedings. Predictive factors of recurrent ischemic events (strokes and systemic embolisms) included CHA2DS2-VASc score after the index event (odds ratio [OR], 1.2 [95% CI, 1.0–1.3] for each point increase; P=0.05) and hypertension (OR, 2.3 [95% CI, 1.0–5.1]; P=0.04). Predictive factors of bleeding events (intracranial and major extracranial bleedings) included age (OR, 1.1 [95% CI, 1.0–1.2] for each year increase; P=0.002), history of major bleeding (OR, 6.9 [95% CI, 3.4–14.2]; P=0.0001) and the concomitant administration of an antiplatelet agent (OR, 2.8 [95% CI, 1.4–5.5]; P=0.003). Rates of ischemic and bleeding events were no different in patients who changed or not changed the original nonvitamin K antagonist oral anticoagulants treatment (OR, 1.2 [95% CI, 0.8–1.7]). Conclusions: Patients suffering a stroke despite being on nonvitamin K antagonist oral anticoagulant therapy are at high risk of recurrent ischemic stroke and bleeding. In these patients, further research is needed to improve secondary prevention by investigating the mechanisms of recurrent ischemic stroke and bleeding

Defining the causes of sporadic Parkinson’s disease in the global Parkinson’s genetics program (GP2)

\ua9 2023, Springer Nature Limited. The Global Parkinson’s Genetics Program (GP2) will genotype over 150,000 participants from around the world, and integrate genetic and clinical data for use in large-scale analyses to dramatically expand our understanding of the genetic architecture of PD. This report details the workflow for cohort integration into the complex arm of GP2, and together with our outline of the monogenic hub in a companion paper, provides a generalizable blueprint for establishing large scale collaborative research consortia