The DUNDRUM ToolKit, Italian version and its potenzial use in the italian forensic treatment model

The legislative process that led to the closure of the Judicial Psychiatric Hospitals (OPG), replaced by theResidences for the Execution of Security Measures (REMS), constituted a significant step forward towardsthe establishment of a community model of care of offenders with severe socially dangerous mental disordersmore respectful of human rights. Among the main criticalities that had been identified in the previous forensicpsychiatric treatment system, based on OPGs, were considered the overcrowding, the problematic hygienic-sanitary conditions, the inexistence of treatment programs that were adequate to the levels of social danger that changed over time, the non-therapeutic-rehabilitative nature of the internment in OPG, the“anti-therapeutic” presence of the Penitentiary Police personnel, the hypothetically unlimited duration ofthe internment. The new model has certainly remedied these critical issues, but other issues have arisen thatneed to be worked on. The authors report here the first data of a multicenter research project that developedon the national territory during the years 2021 and 2022 aimed at validating the DUNDRUM Toolkit, a toolfor evaluating the effectiveness of forensic treatment and recovery, in validation course also in other Europeancountries, particularly adaptable to the treatment model that has been developing in Italy with the establishment of REMS.Il processo legislativo che ha portato alla chiusura degli Ospedali Psichiatrici Giudiziari (OPG), sostituitidalle Residenze per l’Esecuzione delle Misure di Sicurezza (REMS), ha costituito un significativo passo inavanti verso l’istituzione di un modello comunitario di cura degli autori di reato affetti da gravi disturbi mentali socialmente pericolosi più rispettoso dei diritti umani. Tra le principali criticità che erano state ravvisatenel precedente sistema trattamentale psichiatrico forense, basato sugli OPG, sono state considerate il sovraffollamento, le condizioni igienico-sanitarie problematiche, l’insussistenza di programmi trattamentaliche fossero adeguati ai livelli di pericolosità sociale modificantisi nel tempo, la natura non terapeutico-riabilitativa dell’internamento in OPG, la presenza “anti-terapeutica” del personale di Polizia Penitenziaria, ladurata ipoteticamente senza termine dell’internamento. A queste criticità il nuovo modello ha certamenteposto rimedio, ma sono sorte altre problematicità su cui bisognerà lavorare. Gli autori riportano in questasede i primi dati di un progetto di ricerca multicentrico che si è sviluppato sul territorio nazionale nel corsodegli anni 2020-2022 teso a validare il DUNDRUM Toolkit, strumento di valutazione dell’efficacia del trattamento forense e della recovery, in corso di validazione anche in altri Paesi europei, particolarmente adattabile al modello trattamentale che si è andato sviluppando in Italia con l’istituzione delle REMS

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

The James Webb Space Telescope Mission

Twenty-six years ago a small committee report, building on earlier studies, expounded a compelling and poetic vision for the future of astronomy, calling for an infrared-optimized space telescope with an aperture of at least $4m$. With the support of their governments in the US, Europe, and Canada, 20,000 people realized that vision as the $6.5m$ James Webb Space Telescope. A generation of astronomers will celebrate their accomplishments for the life of the mission, potentially as long as 20 years, and beyond. This report and the scientific discoveries that follow are extended thank-you notes to the 20,000 team members. The telescope is working perfectly, with much better image quality than expected. In this and accompanying papers, we give a brief history, describe the observatory, outline its objectives and current observing program, and discuss the inventions and people who made it possible. We cite detailed reports on the design and the measured performance on orbit.Comment: Accepted by PASP for the special issue on The James Webb Space Telescope Overview, 29 pages, 4 figure

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals &lt;1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P &lt; 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men