Fungal community composition predicts forest carbon storage at a continental scale

Forest soils harbor hyper-diverse microbial communities which fundamentally regulate carbon and nutrient cycling across the globe. Directly testing hypotheses on how microbiome diversity is linked to forest carbon storage has been difficult, due to a lack of paired data on microbiome diversity and in situ observations of forest carbon accumulation and storage. Here, we investigated the relationship between soil microbiomes and forest carbon across 238 forest inventory plots spanning 15 European countries. We show that the composition and diversity of fungal, but not bacterial, species is tightly coupled to both forest biotic conditions and a seven-fold variation in tree growth rates and biomass carbon stocks when controlling for the effects of dominant tree type, climate, and other environmental factors. This linkage is particularly strong for symbiotic endophytic and ectomycorrhizal fungi known to directly facilitate tree growth. Since tree growth rates in this system are closely and positively correlated with belowground soil carbon stocks, we conclude that fungal composition is a strong predictor of overall forest carbon storage across the European continent.

Precipitating factors in patients with spontaneous coronary artery dissection: Clinical, laboratoristic and prognostic implications

BACKGROUND

Spontaneous coronary artery dissection (SCAD) often presents with acute coronary syndrome and underlying pathophysiology involves the interplay between predisposing factors and precipitating stressors, such as emotional and physical triggers. In our study we sought to compare clinical, angiographic and prognostic features in a cohort of patients with SCAD according to the presence and type of precipitating stressors.

METHODS

Consecutive patients with angiographic evidence of SCAD were divided into three groups: patients with emotional stressors, patients with physical stressors and those without any stressor. Clinical, laboratoristic and angiographic features were collected for each patient. The incidence of major adverse cardiovascular events, recurrent SCAD and recurrent angina was assessed at follow-up.

RESULTS

Among the total population (64 subjects), 41 [64.0%] patients presented with precipitating stressors, including emotional triggers (31 [48.4%] subjects) and physical efforts (10 [15.6%] subjects). As compared with the other groups, patients with emotional triggers were more frequently female (p = 0.009), had a lower prevalence of hypertension (p = 0.039] and dyslipidemia (p = 0.039), were more likely to suffer from chronic stress (p = 0.022) and presented with higher levels of C-reactive protein (p = 0.037) and circulating eosinophils cells (p = 0.012). At a median follow-up of 21 [7; 44] months, patients with emotional stressors experienced higher prevalence of recurrent angina (p = 0.025), as compared to the other groups.

CONCLUSIONS

Our study shows that emotional stressors leading to SCAD may identify a SCAD subtype with specific features and a trend towards a worse clinical outcome.

In-vivo evaluations of bone regenerative potential of two novel bioactive glasses

Due to the aging of population, materials able to repair damaged tissues are needed. Among others, bioactive glasses (BGs) have attracted a lot of interest due to their outstanding properties both for hard and soft tissues. Here, for the first time, two new BGs, which gave very promising results in preliminary in vitro-tests, were implanted in animals in order to evaluate their regenerative potential. The new BGs, named BGMS10 and Bio_MS and containing specific therapeutic ions, were produced in granules and implanted in rabbits' femurs for up to 60 days, to test their biocompatibility and osteoconduction. Additionally, granules of 45S5 Bioglass® were employed and used as a standard reference for comparison. The results showed that, after 30 days, the two novel BGs and 45S5 displayed a similar behavior, in terms of bone amount, thickness of new bone trabeculae and affinity index. On the contrary, after 60 days, 45S5 granules were mainly surrounded by wide and scattered bone trabeculae, separated by large amounts of soft tissue, while in BGMS10 and Bio_MS the trabeculae were thin and uniformly distributed around the BG granules. This latter scenario could be considered as more advantageous, since the features of the two novel BG granules allowed for the neo-formation of a uniformly distributed bony trabeculae, predictive of more favorable mechanical behavior, compared to the less uniform coarse trabeculae, separated by large areas of soft tissue in 45S5 granules. Thus, BGMS10 and Bio_MS could be considered suitable products for tissue regeneration in the orthopedic and dental fields.

220 MANAGING CARDIAC ARREST SECONDARY TO SPONTANEOUS CORONARY ARTERY DISSECTION: SHOULD WE ROUTINELY CONSIDER ICD IMPLANTATION?

Introduction

Cardiac arrest secondary to a spontaneous coronary artery dissection (SCAD) represents a challenging scenario. It deserves specific considerations due to the dramatic presentation and the need for secondary sudden cardiac death prevention.

Methods

We collected clinical data of four women admitted during the last two years in the Coronary Care Unit of Parma University Hospital, whose presentation of SCAD were cardiac arrest due to ventricular fibrillation.

Results

Three patients survived the acute phases. One patient, being considered at high risk of SCAD recurrence, received a subcutaneous implantable cardioverter-defibrillator (S-ICD). Acute management of cardiac arrest related to SCAD deserves specific considerations. Our case series illustrates the importance of prompt resuscitation manoeuvres and early defibrillation. We propose a flow chart of management of cardiac arrest in patient with suspect of SCAD. Evaluating risk of SCAD recurrence and sudden cardiac death The management of SCAD patients complicated by malignant ventricular arrhythmias and cardiac arrest is challenging. Looking at published registries, it appears that SCAD patients are more likely to suffer from ventricular arrythmia or sudden cardiac death than non-SCAD MI patients. The risk-benefit ratio of ICD implantation in these patients remain uncertain . Evaluation of scar burden with CMR can help stratify the global arrhythmic risk, especially as extensive myocardial scar with a residual impaired LVEF increases the risk of future arrhythmic events. In our series, only one patient underwent S-ICD implantation, and the decision was mainly driven by the finding of underlying arteriopathy affecting other vascular territories, suggesting a potentially higher rate of SCAD recurrence. For this particular subset of patients, we propose an algorithm that combines predisposing factors and myocardia injury quantification data that could be useful for the estimate of the risk of malignant arrythmias, as well as the risk of recurrence of SCAD, but needs to be validated in larger case studies.

Conclusions

The acute management of cardiac arrest related to SCAD deserves specific consideration. The residual myocardial damage, predisposing and precipitants factors should be evaluated in order to estimate the SCAD recurrence and sudden cardiac death risks.

Did the 2018 megadrought change the partitioning of growth between tree sizes and species? A Swiss case-study

By killing or weakening trees, drought could change the partitioning of growth between tree sizes or species, thereby altering stand structure. Growth partitioning, often quantified using the growth dominance coefficient (DC) or the shape of tree size versus growth relationships (SGR), indicates the relative contribution of differently sized trees to the total stand growth. Changes in growth partitioning due to droughts are rarely examined but provide valuable information that links tree- and stand-level responses to droughts. The objective of this study was to test whether the 2018 European megadrought altered the growth partitioning among tree sizes and species. For this purpose, we first evaluated whether DC or SGR can be calculated from small sample sizes of trees typical of individual forest inventory plots. DC, and particularly SGR, were sensitive to sample size, forest type (even-aged and uneven-aged), target variable (tree diameter, basal area or stem mass) and range of tree sizes within the sample. SGR could therefore not be used for our analyses. We found no differences in DC prior to and during the 2018 drought. However, when considering only beech (Fagus sylvatica)-dominated stands, DC was lower during post-drought years than during the 2018 drought. The growth of larger trees, especially beech, was more negatively affected during post-drought years. Therefore, an extreme drought event can indeed alter the growth partitioning within forest stands. The DC indicates such changes in partitioning and, hence, which trees can be selected for commercial thinning, or released from competition, to minimize potential impacts of droughts.

Data from Multiple Portable XRF Units and Their Significance for Ancient Glass Studies

X-ray fluorescence spectroscopy is a non-destructive technique employed for elemental analysis of a wide range of materials. Its advantages are especially valued in archaeometry, where portable instruments are available. Considering ancient glass, such instruments allow for the detection of some major, minor, and trace elements linked to the deliberate addition of specific components or to impurities in the raw materials of the glass batch. Besides some undoubted advantages, portable XRF (p-XRF) has some limitations that are addressed in this study. The performance assessment of four different p-XRF units and the reconciling of their output were conducted. The results show the limitations in cross-referencing the data obtained from each unit and suggest procedures to overcome the issues. The p-XRF units were tested on the set of Corning reference glasses and on a small set of archaeological glasses with known composition. The compatibility of the output was assessed using multivariate statistical tools. Such a workflow allows us to consider data from multiple sources in the same frame of reference.

Total quality service in digital era

Purpose

Total quality management is a valuable approach to continuously improve the quality of organizations; however, scholars debate its applicability to services, which require specific best practices that are different from those related to manufacturing. Moreover, digitization is pervading all kinds of services, but little has been written about total quality service practices in digital-based companies. For this purpose, the authors provide a holistic model of total quality service that reflects the peculiarities of such companies, guided by the question: how do total quality service practices change in digital-based service organizations?

Design/methodology/approach

The authors conduct an illustrative case study on Healthware Group, a global integrated digital health organization, to evaluate theoretical assumptions about total quality service practices in the digital environment.

Findings

The findings allow to validate the model provided. In addition, the study enables them to observe the changes the authors are witnessing in service provision in the digital era and the consequent transformation of best practices. To be accurate, the authors cannot refer to a full transformation in digital-based companies but rather to the enrichment and extension of TQS practices. The best illustration of these conclusions has been summarized in a set of propositions corresponding to seven of the key levers of a TQS model.

Originality/value

The paper represents the first attempt to discuss the relationship between total quality service and digitalization, offering a set of propositions for academics and insights for practitioners. The model can be used as a tool to visualize the different levers that successful implementation of TQS in digital-based services companies can rely on.

Leaf trait plasticity and site-specific environmental variability modulate the severity of visible foliar ozone symptoms in Viburnum lantana

The assessment of Visible Foliar Symptoms (VFS) is commonly adopted by forest monitoring programs to evaluate ozone impact on vegetation. The occurrence of ozone VFS may differ among individuals of the same species at the same site, and within leaves of the same individual. The aim of this study was to identify site and plant characteristics as well as functional leaf traits associated with the occurrence and severity of VFS in Viburnum lantana (an ozone-sensitive species) and at the scale of an individual site. V. lantana plants growing at one site of the ViburNeT monitoring network (Trentino, North Italy) experiencing high ozone levels were surveyed in relation to 1) sun exposure, 2) shading effect from neighbor vegetation, 3) plant height and 4) presence and severity of VFS. Leaves from three different sections of each plant were subjected to a phenotypic characterization of leaf area, dry weight, specific leaf area (SLA), chlorophyll content (Chl_SPAD), percentage of VFS, and adaxial and abaxial trichome density (Tr). We showed that plants at high irradiation levels had significantly lower SLA (p<0.05), higher Tr (p<0.01) and greater Chl_SPAD (p<0.01) when compared to shaded and/or west- and north-exposed plants, thus indicating a strong influence of site-specific characteristics on leaf trait plasticity. Similar differences were observed for taller vs. shorter plants and apical vs. basal branches (p<0.05). Ozone-induced VFS at leaf level were associated with lower SLA (p<0.001) and higher Tr in the abaxial leaf surface (p<0.05). Both leaf traits showed significant differences also within the south and east exposed plant category, thus suggesting the increase in leaf thickness and Tr as a potential adaptive strategy under multiple stress conditions. Our results provide evidence of a strong relationship between VFS, leaf traits and site-specific variables, offering new insights for interpreting data on the impact of ozone on vegetation.

P56 SPONTANEOUS CORONARY ARTERY DISSECTIONS: ANALYSIS OF NON TRADITIONAL RISK FACTORS

 

The etiology of spontaneous coronary dissection (SCAD) is not well defined and Non traditional risk factors (NT–RF) have assumed increasing interest, but few data are available. NT–RF include three categories: Sex–related (SR–NT–FR), Sex–predominant (SP–NT–RF) and Gender–related (GR–NT–RF). (Table 1)

Aim of the Study

The objective of our analysis was to evaluate the incidence of NT–RF in Parma SCAD registry population.

Material and methods

We reviewed 62 patients with SCAD enrolled between January 2013 through November 2021

Results

Traditional risk factors were less common: hypertension was the most prevalent (39 pts, 62.9%). When considering NT–RF, 51 patients (82%) had at least one of all, with at least one SR–RF (66%) or GR–RF (64,5%). Patients with NT–RF were younger at time of SCAD (mean age 53 vs 66; p = 0.027) and they were predominantly females (48 vs 7 pts, p = 0.004) (Table 2). No differences were found among NT–RF SCAD and nNT–RF SCAD patients by fibromuscular dysplasia, peripheral arterial disease and chronic kidney disease. Patients with SCAD more often presented with non ST–segment elevation myocardial infarction (43 pts, 72.6%) vs ST–segment elevation (17 pts, 27.4%). No differences in clinical presentation and angiographic characteristics were found among NT–RF and nNT–RF patients group. MACE occurred in 17.7% of patients of the overall study population, at a median follow–up of 23 (interquartile range: 11;57) months. When comparing the incidence of cardiovascular events in the 2 study groups there was a trend toward a higher prevalence of MACE in NT–RF group without statistical significance (NT–RF SCAD 19.6% – nNT–RF SCAD 9.1%; p = 0.4). (Table 3)

Conclusion

SCAD is an emerging cause of myocardial infarction in young and middle–aged women without the traditional cardiovascular risk profile. Although overall survival seems good, SCAD is a potentially malignant disease which can present with ventricular arrhythmias and sudden cardiac death. Risk estimation is difficult in women, due to the scarce validity of prediction models, therefore a great effort must be made by the clinical community for the widespread diffusion and use of models incorporating NT–RF. Acknowledgement of peculiar features of this disease could help clinicians and researchers to establish targeted interventions for cardiovascular primary prevention, early diagnosis and secondary prevention in women, including rehabilitation and stress management programmes.

Characterization of Castellani nineteenth-century gold jewellery by in situ micro-XRF spectroscopy

The material characterization of nineteenth-century artifacts is of great interest, due both to the breakthrough technological advances and to the unprecedented spread of forgeries of antiquities which took place in that period. However, this type of artifacts has been largely overlooked in the past. In this paper we present the compositional analysis of gold jewels by the Castellani, one of the most important families of goldsmiths in nineteenth-century Europe. The use of a portable micro-XRF spectrometer, specifically developed for jewellery analysis at the Centro Nacional de Aceleradores (Seville), allowed us to analyse, in a completely non-invasive way, the alloys, joining techniques and surface treatments of the jewels of the Castellani collection at the National Etruscan Museum of Villa Giulia in Rome. The addition to the spectrometer of a second X-rays detector with a zinc filter allowed us to check the possible presence of low amounts of cadmium, a metal added to gold soldering only from the nineteenth century and often used in authenticity studies. Moreover, the relative intensities of the Au X-ray lines were studied in order to check non-invasively the presence of surface enrichments in gold.

Echocardiographically defined haemodynamic categorization predicts prognosis in ambulatory heart failure patients treated with sacubitril/valsartan

AIM

Echo-derived haemodynamic classification, based on forward-flow and left ventricular (LV) filling pressure (LVFP) correlates, has been proposed to phenotype patients with heart failure and reduced ejection fraction (HFrEF). To assess the prognostic relevance of baseline echocardiographically defined haemodynamic profile in ambulatory HFrEF patients before starting sacubitril/valsartan.

METHODS AND RESULTS

In our multicentre, open-label study, HFrEF outpatients were classified into 4 groups according to the combination of forward flow (cardiac index; CI:< or ≥2.0 L/min/m2 ) and early transmitral Doppler velocity/early diastolic annular velocity ratio (E/e': ≥ or <15): Profile-A: normal-flow, normal-pressure; Profile-B: low-flow, normal-pressure; Profile-C: normal-flow, high-pressure; Profile-D: low-flow, high-pressure. Patients were started on sacubitril/valsartan and followed-up for 12.3 months (median). Rates of the composite of death/HF-hospitalization were assessed by multivariable Cox proportional-hazards models. Twelve sites enrolled 727 patients (64 ± 12 year old; LVEF: 29.8 ± 6.2%). Profile-D had more comorbidities and worse renal and LV function. Target dose of sacubitril/valsartan (97/103 mg BID) was more likely reached in Profile-A (34%) than other profiles (B: 32%, C: 24%, D: 28%, P < 0.001). Event-rate (per 100 patients per year) progressively increased from Profile-A to Profile-D (12.0%, 16.4%, 22.9%, and 35.2%, respectively, P < 0.0001). By covariate-adjusted Cox model, profiles with low forward-flow (B and D) remained associated with poor outcome (P < 0.01). Adding this categorization to MAGGIC-score and natriuretic peptides, provided significant continuous net reclassification improvement (0.329; P < 0.001). Intermediate and high-dose sacubitril/valsartan reduced the event's risk independently of haemodynamic profile.

CONCLUSIONS

Echocardiographically-derived haemodynamic classification identifies ambulatory HFrEF patients with different risk profiles. In real-world HFrEF outpatients, sacubitril/valsartan is effective in improving outcome across different haemodynamic profiles.

Climatic and stand drivers of forest resistance to recent bark beetle disturbance in European coniferous forests

Bark beetle infestation is a major driver of tree mortality that may be critical for forest persistence under climate change and the forecasted increase of extreme heat and drought episodes. Under this context, the environmental position of host tree populations within the species' climatic niche (central vs. marginal populations) is expected to be a determinant in the dynamics of insect-host systems. Here, we analyzed the recent patterns of bark beetle disturbance and forest resistance across European coniferous forests during the 2010-2018 period. We obtained bark beetle attack and tree mortality data from successive continental-scale forest condition surveys on 130 plots including five host trees and five bark beetle species, and characterized the climatic niche of each species. Then, we analyzed the overall forest resistance and species-specific responses, in terms of bark beetle attack and induced tree mortality, in relation to the distance to the niche optimum of both host tree and beetle species, previous drought events, and plot characteristics. Regional patterns of recent disturbance revealed that forests in central, north, and east of Europe could be at risk under the attack of multivoltine bark beetle species. We found that overall forest resistance to beetle attack was determined by several driving factors, which varied among species responses. Particularly, the environmental position of the affected forest within the host and beetle species' climatic niche and plot characteristics mediated the influence of drought on the resistance to beetle attack. In turn, forest resistance to induced tree mortality was determined exclusively by the maximum intensity and duration of drought events. Our findings highlight the importance of disturbance interactions and suggest that the joint influence of drought events and bark beetle disturbance will threaten the persistence of European coniferous forests, even in those tree populations close to their species' climatic optimum.

Benefit from sacubitril/valsartan is associated with hemodynamic improvement in heart failure with reduced ejection fraction: An echocardiographic study

BACKGROUND

Sacubitril/valsartan improves outcome in patients with heart failure (HF) with reduced left ventricular (LV) ejection fraction (EF, HFrEF). However, little is known about possible mechanisms underlying this favourable effect.

PURPOSE

To assess changes in echocardiographically-derived hemodynamic profiles induced by sacubitril/valsartan and their impact on outcome.

METHODS

In this multicenter, open-label study, 727 HFrEF outpatients underwent comprehensive echocardiography at baseline (before starting sacubitril/valsartan) and after 12 months. Estimated LV filling pressure (E/e') and cardiac index (CI, l/min/m²) were combined to determine 4 hemodynamic profiles: profile-A (normal-flow/normal-pressure); profile-B (low-flow/normal-pressure); profile-C: (normal-flow/high-pressure); profile-D: (low-flow/high-pressure). Changes among categories were recorded, and their associations with rates of the composite of death/HF-hospitalization were assessed by multivariable Cox analysis.

RESULTS

At baseline, 29% had profile-A, 15% had profile-B, 32% profile-C, and 24% profile-D. After 12 months, the hemodynamic profile improved in 53% of patients (all profile-A achievers, or profile-D patients achieving either C or B profile), while it remained unchanged in 39% patients and worsened in 9%. Prevalence of improved profile progressively increased with increasing dose of sacubitril/valsartan (P < 0.0001). After the second echocardiography, patients were followed up 12.6 ± 7.6 months: event-rate was lower in patients with improved profile (12.3%, 95%CI: 9.4-16.1) compared to patients in whom hemodynamic profile remained unchanged (29.9%, 24.0-37.3) or worsened (31.2%, 20.7-46.9, P < 0.0001). Improved hemodynamic profile was associated with favourable outcome independent of LVEF and other covariates (HR 0.65, 95%CI: 0.45-0.95, P < 0.05).

CONCLUSION

In HFrEF patients, the beneficial prognostic effects of sacubitril/valsartan are associated with improvement in hemodynamic conditions.

Sacubitril/ Valsartan in Advanced Heart Failure: Is it Just a Matter of Contractility or are there Effects on the Pulmonary Circulation? A Real Life Monocentric Experience

Background: Sacubitril/valsartan (S/V), an angiotensin receptor neprilysin inhibitor (ARNI), is the first drug to demonstrate a mortality benefit in patients with chronic heart failure and reduced ejection fraction. S/v had a 20% reduction in the primary composite endpoint of cardiovascular death or heart failure hospitalization, compared with subjects receiving enalapril.  However, the mechanisms are not clear.  The aim of this prospective, non-randomized study was to assess the clinical and instrumental effects of this agent in patients with HFrEF and pulmonary hypertension. Methods: To investigate the effects of S/V in HFrEF, we selected 40 consecutive patients (31 males, 9 females, mean age 64±19 years) in the NYHA class II-III, because they had left ventricular ejection fraction ≤35% at echocardiography. Etiology: 22 CHD, 3 Myocarditis, 15 IDCM. Results: 2 patients took the maximum dose of 97/103 mg, 2 stopped the therapy due to a creatinine increase, all the others took the dose of 49/52 mg. During a mean ± SD follow-up of 24±6 months, no patients died. PASP decreased from 42.71 to 36 mm/Hg (p <0.0001); 6MWT improved from 402 m to 453 m (p <0.0001). Mean LVEF increased from 28.9% to 31.5% p <0.005); NYHA mean class improved from 1.95 to 1.70.  An AICD was implanted in 20 patients. Conclusion: These preliminary data suggest that in patients with severe heart failure, S/V is able to improve 6MWT and PASP, even in the absence of a significant improvement of ventricular contractility. S/v may reduce the fluid retention and pulmonary vasoconstriction that contribute to heart failure symptoms.

The FutureS of healthcare

This editorial for the special issue of FutureS is not intended to provide a comprehensive, analytical overview of the future of health care; rather, it collects the perspectives on which scholars have focused most. There is a danger that what we report will quickly become obsolete for numerous reasons; think of the speed of current technological progress or the fact that the Covid-19 pandemic could further stress health care systems around the world. However, we would like to outline some of the current topics explored in the literature and focus on the scenarios envisioned by practitioners. We write this piece being interested in the innovative impulses of all the actors belonging to the "renewed" health care ecosystem, aware of the fact that there are significant differences between the countries of the North and South of the world and, consequently, between their health care systems. What we can say with certainty is that the healthcare and life sciences are the protagonists of an unparalleled revolution. The aging population and changing needs, the increasingly common occurrence of chronic disorders, and digitization are some of the challenges facing the sector. The technological change of the fourth industrial revolution is disruptive and changes the logic of the market, not only that of healthcare but also that of adjacent markets. Because of the intensity with which insiders have to face these new trends, the topic has been the focus of interest of scholars and practitioners in recent years. The big players in consulting, as well as the scholars, have deepened the issues of healthcare of the future, focusing on what will be the major challenges in 10 years and imagining potential scenarios that will reconfigure the way health care is delivered and used. In the next 10 years, there will be profound demographic changes and the healthcare system will necessarily have to reconfigure the supply of the necessary services and the methods of delivery (KPMG, 2018). Due to the aging of the population, there has already been a dramatic increase in chronic and degenerative diseases requiring complex treatment in recent years. In addition, the Covid-19 pandemic that has been sweeping the world since 2019 has strained global health systems, revealed already existing weaknesses, even in the most advanced countries, and is representing an important moment of reflection for all policymakers. The whole world is questioning what will need to be done to foster greater effectiveness of national systems as well as better capacity to cope with shocks of such magnitude. In this document we explore what practitioners and scholars consider the main future challenges and the major changes that need to be made in the healthcare sector in order to embrace a new paradigm of care, based on the centrality of the patient, on prevention and not on cure, on technologies at the side of humans.

Assessing the response of forest productivity to climate extremes in Switzerland using model-data fusion

The response of forest productivity to climate extremes strongly depends on ambient environmental and site conditions. To better understand these relationships at a regional scale, we used nearly 800 observation years from 271 permanent long-term forest monitoring plots across Switzerland, obtained between 1980 and 2017. We assimilated these data into the 3-PG forest ecosystem model using Bayesian inference, reducing the bias of model predictions from 14% to 5% for forest stem carbon stocks and from 45% to 9% for stem carbon stock changes. We then estimated the productivity of forests dominated by Picea abies and Fagus sylvatica for the period of 1960-2018, and tested for productivity shifts in response to climate along elevational gradient and in extreme years. Simulated net primary productivity (NPP) decreased with elevation (2.86 ± 0.006 Mg C ha-1  year-1  km-1 for P. abies and 0.93 ± 0.010 Mg C ha-1  year-1  km-1 for F. sylvatica). During warm-dry extremes, simulated NPP for both species increased at higher and decreased at lower elevations, with reductions in NPP of more than 25% for up to 21% of the potential species distribution range in Switzerland. Reduced plant water availability had a stronger effect on NPP than temperature during warm-dry extremes. Importantly, cold-dry extremes had negative impacts on regional forest NPP comparable to warm-dry extremes. Overall, our calibrated model suggests that the response of forest productivity to climate extremes is more complex than simple shift toward higher elevation. Such robust estimates of NPP are key for increasing our understanding of forests ecosystems carbon dynamics under climate extremes.

Pervasive decreases in living vegetation carbon turnover time across forest climate zones

Forests play a major role in the global carbon cycle. Previous studies on the capacity of forests to sequester atmospheric CO2 have mostly focused on carbon uptake, but the roles of carbon turnover time and its spatiotemporal changes remain poorly understood. Here, we used long-term inventory data (1955 to 2018) from 695 mature forest plots to quantify temporal trends in living vegetation carbon turnover time across tropical, temperate, and cold climate zones, and compared plot data to 8 Earth system models (ESMs). Long-term plots consistently showed decreases in living vegetation carbon turnover time, likely driven by increased tree mortality across all major climate zones. Changes in living vegetation carbon turnover time were negatively correlated with CO2 enrichment in both forest plot data and ESM simulations. However, plot-based correlations between living vegetation carbon turnover time and climate drivers such as precipitation and temperature diverged from those of ESM simulations. Our analyses suggest that forest carbon sinks are likely to be constrained by a decrease in living vegetation carbon turnover time, and accurate projections of forest carbon sink dynamics will require an improved representation of tree mortality processes and their sensitivity to climate in ESMs.

Bi-layered collagen nano-structured membrane prototype collagen matrix CM-10826 for oral soft tissue regeneration: an in vivo ultrastructural study on 13 patients

A new developed collagen matrix CM-10826 (CM) of porcine origin designed to be used as oral soft tissue substitute was investigated before and after implantation by light microscopy (LM), scanning electron microscopy (SEM), and transmission electron microscopy (TEM). In a case series biopsy specimens were harvested from thirteen patients at 10, 20, 30, 43 days after abutment surgery for uncovering dental implants. The in vivo histological evaluations of each patient were performed via micro-coring of newly formed oral mucosa in the area covered by CM (test side) or left uncovered (control). Results showed that CM can be integrated in connective and epithelial tissues within 10 days, can be completely resorbed within 20 days and it is able to reduce inflammatory infiltrates and to stimulate both fibroblast/epithelial cell proliferation and neo-angiogenesis. Generally it seems to be superior in promoting soft tissue healing compared to that induced by secondary intention healing. Furthermore, it is able to act as a scaffold for soft-tissue regeneration, allowing the proliferation of keratinocytes from the wound edges and favoring neovascularization and growth of connective tissue in the mesh of porous layer. It appears that a CM might function in oral surgery as a substitute for autologous grafts and to avoid secondary intention healing in soft tissue defects.

The future of quantum biology

Biological systems are dynamical, constantly exchanging energy and matter with the environment in order to maintain the non-equilibrium state synonymous with living. Developments in observational techniques have allowed us to study biological dynamics on increasingly small scales. Such studies have revealed evidence of quantum mechanical effects, which cannot be accounted for by classical physics, in a range of biological processes. Quantum biology is the study of such processes, and here we provide an outline of the current state of the field, as well as insights into future directions.

Combined Malignant Hemangiopericytoma and Deep Venous Thrombosis. A Case Report

Malignancies, antiproliferative drug treatment, cancer-related conditions like immobilization, perioperative status and radiotherapy are risk factors for hypercoagulability. Setting aside mass or invasion-related venous thrombosis, the differential diagnosis regarding the etiopathogenesis (paraneoplastic syndrome or antiproliferative treatment) is usually problematic. The authors report a case of combined malignant hemangiopericytoma and recurrent deep venous thrombosis in the right inferior limb.

Through a literature review, the following issues are discussed: 1) the criteria for cyto-histopathologic assessment; 2) the involvement of pericytes both in coagulation and platelet aggregation; 3) the importance of discriminating true paraneoplastic syndromes from other tumor-related clinical manifestations; 4) the response to external radiotherapy of malignant hemangiopericytoma as limited disease; 5) the poor results of doxorubicin-ifosfamide polychemotherapy and dacarbazine monochemotherapy in metastatic disease.

Although doxorubicin-ifosfamide treatment was in progress in the reported case, the authors conclude that the recurrent deep venous thrombosis is likely to be paraneoplastic, even if such a diagnosis has not been previously reported in the literature.

Scarce evidence of ozone effect on recent health and productivity of alpine forests-a case study in Trentino, N. Italy

We investigated the significance of tropospheric ozone as a factor explaining recent tree health (in terms of defoliation) and productivity (in terms of basal area increment, BAI) in 15 ICP Forests level I and one level II plots in alpine forests in Trentino (N. Italy). Mean daily ozone summer concentrations varied between 30 and 72 parts per billion (ppb) leading to large exceedance of concentration-based critical levels set to protect forest trees. Phytoxic ozone dose (POD₀) estimated at the level II plot over the period 1996-2009 was 31-61 mmol m^-2 projected leaf area (PLA). The role of ozone was investigated taking into account other site and environmental factors. Simple linear regression, multiple linear regression (MLR, to study mean periodical defoliation and mean periodical BAI), and linear mixed models (LMM, to study annual defoliation data) were used. Our findings suggest that-regardless of the metric adopted-tropospheric ozone is not a significant factor in explaining recent status and trends of defoliation and BAI in the alpine region examined. Both defoliation and BAI are in turn driven by biotic/abiotic damage, nutritional status, DBH (assumed as a proxy for age), and site characteristics. These results contrast with available ozone-growth dose response relationships (DRRs) and other observational studies. This may be due to a variety of concurrent reasons: (i) DRRs developed for individual saplings under controlled condition are not necessarily valid for population of mature trees into real forest ecosystems; (ii) some observational studies may have suffered from biased design; and (iii) since alpine forests have been exposed to high ozone levels (and other oxidative stress) over decades, possible acclimation mechanisms cannot be excluded.

In search for evidence: combining ad hoc survey, monitoring, and modeling to estimate the potential and actual impact of ground level ozone on forests in Trentino (Northern Italy)

A 5-year project was carried out over the period 2007-2011 to estimate the potential and actual ozone effect on forests in Trentino, Northern Italy (6207 km²) (Ozone EFFORT). The objective was to provide explicit answers to three main questions: (i) is there a potential risk placed by ozone to vegetation? (ii) are there specific ozone symptoms on vegetation, and are they related to ozone levels? (iii) are there ozone-related effects on forest health and growth? Different methods and techniques were adopted as follows: monitoring ozone levels, ad hoc field survey for symptoms on vegetation and chlorophyll-related measurements, modeling to upscale ozone measurements, ozone flux estimation, statistical analysis, and modeling to detect whether a significant effect attributable to ozone exists. Ozone effects were assessed on an ad hoc-introduced bioindicator, on spontaneous woody species, and on forest trees. As for question (i), the different ozone-risk critical levels for both exposure and stomatal flux were largely exceeded in Trentino, evidencing a potentially critical situation for vegetation. As for question (ii), specific ozone foliar symptoms related to ozone exposure levels were observed on the introduced supersensitive Nicotiana tabacum L. cv Bel-W3 and on the spontaneous, ozone-sensitive Viburnum lantana L., but not on other 33 species surveyed in the field studies. Regarding question (iii), statistical analyses on forest health (in terms of defoliation) and growth (in terms of basal area increment) measured at 15 forest monitoring plots and tree rings (at one site) revealed no significant relationship with ozone exposure and flux. Instead, a set of factors related to biotic and abiotic causes, foliar nutrients, age, and site were identified as the main drivers of forest health and growth. In conclusion, while ozone levels and fluxes in the investigated region were much higher than current critical levels, evidence of impact on vegetation-and on forest trees in particular-was limited.

Evidence for coherent mixing of excited and charge-transfer states in the major plant light-harvesting antenna, LHCII

LHCII, the major light harvesting antenna from plants, plays a dual role in photosynthesis. In low light it is a light-harvester, while in high light it is a quencher that protects the organism from photodamage. The switching mechanism between these two orthogonal conditions is mediated by protein dynamic disorder and photoprotective energy dissipation. The latter in particular is thought to occur in part via spectroscopically 'dark' states. We searched for such states in LHCII trimers from spinach, at both room temperature and at 77 K. Using 2D electronic spectroscopy, we explored coherent interactions between chlorophylls absorbing on the low-energy side of LHCII, which is the region that is responsible for both light-harvesting and photoprotection. 2D beating frequency maps allow us to identify four frequencies with strong excitonic character. In particular, our results show the presence of a low-lying state that is coupled to a low-energy excitonic state. We assign this to a mixed excitonic-charge transfer state involving the state with charge separation within the Chl a603-b609 heterodimer, borrowing some dipole strength from the Chl a602-a603 excited states. Such a state may play a role in photoprotection, in conjunction with specific and environmentally controlled realizations of protein dynamic disorder. Our identification and assignment of the coherences observed in the 2D frequency maps suggests that the structure of exciton states as well as a mixing of the excited and charge-transfer states is affected by coupling of these states to resonant vibrations in LHCII.

Bi-layered collagen nano-structured membrane prototype collagen matrix 10826® for soft tissue regeneration in rabbits: an in vivo ultra-structural study of the early healing phase

Collagen Matrix (CM) 10826 is a nanostructured bi-layered collagen membrane obtained from type I and III porcine collagen, which in vitro has shown to have the potential to be a substitute and/or stimulant for soft oral tissue regeneration. The objective of this study was to evaluate the in vivo potential and safety of this membrane for soft tissue regeneration in the early stage of wound healing. Two soft tissue wounds (test and control) were created on the back skin of 5 rabbits (female New Zealand White Rabbits specific pathogen free). All wounds were protected by a special poly-tetra-fluoro-ethylene (PTFE) healing camera. On each rabbit on the test side CM-10826 was used, while on the control side conventional treatment (an autologous pedicle graft) was performed. The healing process was observed clinically after 2 and 6 days, and Magnetic Resonance Imaging (MRI) was performed after this period. After 7 days, animals were sacrificed and specimens were analyzed with light optic microscopy (LM), Transmission Electron Microscopy (TEM) and Scanning Electron Microscopy (SEM). These in vivo trials on rabbits confirmed that CM-10826 is well tolerated, without signs of histological inflammatory reaction and proved to be able to accelerate the spontaneous repair of the skin defect taken as the control. The light-optic and ultra-microscopy of serial biopsies showed that the new matrix is biocompatible and is able to function as a scaffold inducing soft tissue regeneration. In conclusion this study demonstrates that CM-10826 promote early soft tissue regeneration and suggests it is a potential constituent for human autologous keratinocytes seeded derma bioequivalent. It protects the wound from injuries and bacterial contamination accelerating healing process. As a clinical relevance, we consider that the quality of life of patients will be improved avoiding the use of major autologous grafts, reducing the hospitalization time and morbidity.

Defective Function of the Fas Apoptotic Pathway in Type 1 Diabetes Mellitus Correlates with Age at Onset

The Fas death receptor triggers lymphocyte apoptosis through an extrinsic and an intrinsic pathway involving caspase-8 and -9 respectively. Inherited defects of Fas function are displayed by a proportion of patients with Type 1 diabetes mellitus (T1DM) especially those with a second autoimmunity (T1DM-p). This study assesses activation of both pathways in Fas-resistant (FasR) patients to localize the defect. 21/28 (75%) T1DM-p, 14/50 (38%) T1DM, and 7/150 (5%) controls were FasR. Analysis of the 35 FasR patients and 20 Fas-sensitive (FasS) controls showed that caspase-9 activity was lower in T1DM-p and T1DM than in controls, whereas caspase-8 activity was lower in T1DM-p than in T1DM and the controls. Single patient analysis showed that 16/35 patients displayed defective activity of one (FasR1), whereas 19 displayed normal activity of both caspases (FasR2) Ages at onset of diabetes mellitus in T1DM and the second autoimmune disease in T1DM-p were lower in FasR than in FasS patients. All FasR1 patients developed diabetes mellitus before the age of 9 years, whereas a later onset was displayed by 26% FasR2 and 53% FasS patients. These data show that defective Fas function may involve both the extrinsic and intrinsic pathway in T1DM and severity correlates with the precocity of the autoimmune attack and its tissue polyreactivity.

Dark States in the Light-Harvesting complex 2 Revealed by Two-dimensional Electronic Spectroscopy

Energy transfer and trapping in the light harvesting antennae of purple photosynthetic bacteria is an ultrafast process, which occurs with a quantum efficiency close to unity. However the mechanisms behind this process have not yet been fully understood. Recently it was proposed that low-lying energy dark states, such as charge transfer states and polaron pairs, play an important role in the dynamics and directionality of energy transfer. However, it is difficult to directly detect those states because of their small transition dipole moment and overlap with the B850/B870 exciton bands. Here we present a new experimental approach, which combines the selectivity of two-dimensional electronic spectroscopy with the availability of genetically modified light harvesting complexes, to reveal the presence of those dark states in both the genetically modified and the wild-type light harvesting 2 complexes of Rhodopseudomonas palustris. We suggest that Nature has used the unavoidable charge transfer processes that occur when LH pigments are concentrated to enhance and direct the flow of energy.

The impact of regional policies on emergency department management and performance: the case of the regional government of Sicily

BACKGROUND

Improvement in healthcare, seeking the correct balance between quality and costs, is an ongoing concern in many countries. Many countries have developed and implemented improvement programmes in health care, particularly in emergency departments (ED), which play a key role in terms of hospital resources and planning. The regional government of Sicily implemented a project 2010-2012 to improve ED care quality and patient safety.

PURPOSE

This paper aims to evaluate improvements implemented by the Regional Health Authority of Sicily in the 20 main EDs.

METHOD

Performance analysis of EDs was conducted on three levels: care quality (standard Joint Commission International evaluation), efficiency in terms of resources and output (by way of interviews and document analysis) and the role of management in efficiently promoting change (presence of a performance monitoring system).

FINDINGS

The results show improvements in all areas and improved performance in all EDs. There is, however, room for improvement in certain areas, and improvement was not uniformly distributed.

PRACTICAL IMPLICATIONS

The quality of local policy and management are key aspects of efficient promotion of performance improvement. Copyright © 2015 John Wiley & Sons, Ltd.

On the tracks of Nitrogen deposition effects on temperate forests at their southern European range - an observational study from Italy

We studied forest monitoring data collected at permanent plots in Italy over the period 2000-2009 to identify the possible impact of nitrogen (N) deposition on soil chemistry, tree nutrition and growth. Average N throughfall (N-NO3 +N-NH4 ) ranged between 4 and 29 kg ha(-1)  yr(-1) , with Critical Loads (CLs) for nutrient N exceeded at several sites. Evidence is consistent in pointing out effects of N deposition on soil and tree nutrition: topsoil exchangeable base cations (BCE) and pH decreased with increasing N deposition, and foliar nutrient N ratios (especially N : P and N : K) increased. Comparison between bulk openfield and throughfall data suggested possible canopy uptake of N, levelling out for bulk deposition >4-6 kg ha(-1)  yr(-1) . Partial Least Square (PLS) regression revealed that - although stand and meteorological variables explained the largest portion of variance in relative basal area increment (BAIrel 2000-2009) - N-related predictors (topsoil BCE, C : N, pH; foliar N-ratios; N deposition) nearly always improved the BAIrel model in terms of variance explained (from 78.2 to 93.5%) and error (from 2.98 to 1.50%). N deposition was the strongest predictor even when stand, management and atmosphere-related variables (meteorology and tropospheric ozone) were accounted for. The maximal annual response of BAIrel was estimated at 0.074-0.085% for every additional kgN. This corresponds to an annual maximal relative increase of 0.13-0.14% of carbon sequestered in the above-ground woody biomass for every additional kgN, i.e. a median value of 159 kgC per kgN ha(-1)  yr(-1) (range: 50-504 kgC per kgN, depending on the site). Positive growth response occurred also at sites where signals of possible, perhaps recent N saturation were detected. This may suggest a time lag for detrimental N effects, but also that, under continuous high N input, the reported positive growth response may be not sustainable in the long-term.

Ozone risk and foliar injury on Viburnum lantana L.: a meso-scale epidemiological study

A stratified random sampling design was adopted to contrast sites with different ozone exposure levels (≤ 18,000 and >18,000 μg m(-3) h) in order to define whether and to what extent a relationship exists between potential risk (estimated by exposure to ozone) and the response of Viburnum lantana L. in terms of foliar symptoms. The study was designed over a meso-scale (6200 km(2)), carried out in 2010 and repeated in 2012 on a subset of sites. No difference was found between the occurrences of symptoms in relation to soil moisture or plant size. Although no direct significant exposure-response function could be identified, when data were aggregated according to ozone exposure levels the symptoms (in terms of number of symptomatic plants and symptomatic leaves per plant) were found to be significantly more frequent at sites with higher exposure (AOT40>18,000 μg m(-3) h), especially at high elevations (>700 ma.s.l.). The 2012 results confirmed the 2010 findings. Although ozone levels in the region were almost similar between 2010 and 2012, symptoms were significantly less frequent in 2012. This was likely due to drier conditions in 2012 (+1.1 °C; -23% precipitation), a situation that may have prevented in part ozone uptake and therefore the expression of symptoms. These results are useful in several respects: (i) for identifying areas where ozone is likely to impact vegetation; (ii) for testing the appropriateness of EU standards to protect vegetation from ozone; and (iii) for designing biomonitoring surveys. We suggest that V. lantana is a suitable indicator for assessing qualitatively (but not quantitatively) the potential risk of ozone damage to vegetation over remote, large areas.

Quantum Coherence in Photosynthesis for Efficient Solar Energy Conversion

The crucial step in the conversion of solar to chemical energy in Photosynthesis takes place in the reaction center where the absorbed excitation energy is converted into a stable charge separated state by ultrafast electron transfer events. However, the fundamental mechanism responsible for the near unity quantum efficiency of this process is unknown. Here we elucidate the role of coherence in determining the efficiency of charge separation in the plant photosystem II reaction centre (PSII RC) by comprehensively combining experiment (two-dimensional electronic spectroscopy) and theory (Redfield theory). We reveal the presence of electronic coherence between excitons as well as between exciton and charge transfer states which we argue to be maintained by vibrational modes. Furthermore, we present evidence for the strong correlation between the degree of electronic coherence and efficient and ultrafast charge separation. We propose that this coherent mechanism will inspire the development of new energy technologies.