Relevant Discrepancies Research Articles

A Prediction Model to Identify Clinically Relevant Medication Discrepancies at the Emergency Department (MED-REC Predictor): Development and Validation Study.

Many patients do not receive a comprehensive medication reconciliation, mostly owing to limited resources. We hence need an approach to identify those patients at the emergency department (ED) who are at increased risk for clinically relevant discrepancies. The aim of our study was to develop and externally validate a prediction model to identify patients at risk for at least 1 clinically relevant medication discrepancy upon ED presentation. A prospective, multicenter, observational study was conducted at the University Hospitals Leuven and General Hospital Sint-Jan Brugge-Oostende AV, Belgium. Medication histories were obtained from patients admitted to the ED between November 2017 and May 2022, and clinically relevant medication discrepancies were identified. Three distinct datasets were created for model development, temporal external validation, and geographic external validation. Multivariable logistic regression with backward stepwise selection was used to select the final model. The presence of at least 1 clinically relevant discrepancy was the dependent variable. The model was evaluated by measuring calibration, discrimination, classification, and net benefit. We included 824, 350, and 119 patients in the development, temporal validation, and geographic validation dataset, respectively. The final model contained 8 predictors, for example, age, residence before admission, number of drugs, and number of drugs of certain drug classes based on Anatomical Therapeutic Chemical coding. Temporal validation showed excellent calibration with a slope of 1.09 and an intercept of 0.18. Discrimination was moderate with a c-index (concordance index) of 0.67 (95% CI 0.61-0.73). In the geographic validation dataset, the calibration slope and intercept were 1.35 and 0.83, respectively, and the c-index was 0.68 (95% CI 0.58-0.78). The model showed net benefit over a range of clinically reasonable threshold probabilities and outperformed other selection criteria. Our software-implemented prediction model shows moderate performance, outperforming random or typical selection criteria for medication reconciliation. Depending on available resources, the probability threshold can be customized to increase either the specificity or the sensitivity of the model.

Effectiveness of an Artificial Intelligence Software for Limb Radiographic Fracture Recognition in an Emergency Department.

Objectives: To assess the impact of an Artificial Intelligence (AI) limb bone fracture diagnosis software (AIS) on emergency department (ED) workflow and diagnostic accuracy. Materials and Methods: A retrospective study was conducted in two phases-without AIS (Period 1: 1 January 2020-30 June 2020) and with AIS (Period 2: 1 January 2021-30 June 2021). Results: Among 3720 patients (1780 in Period 1; 1940 in Period 2), the discrepancy rate decreased by 17% (p = 0.04) after AIS implementation. Clinically relevant discrepancies showed no significant change (-1.8%, p = 0.99). The mean length of stay in the ED was reduced by 9 min (p = 0.03), and expert consultation rates decreased by 1% (p = 0.38). Conclusions: AIS implementation reduced the overall discrepancy rate and slightly decreased ED length of stay, although its impact on clinically relevant discrepancies remains inconclusive. Key Point: After AI software deployment, the rate of radiographic discrepancies decreased by 17% (p = 0.04) but this was not clinically relevant (-2%, p = 0.99). Length of patient stay in the emergency department decreased by 5% with AI (p = 0.03). Bone fracture AI software is effective, but its effectiveness remains to be demonstrated.

SpadaHC: a database to improve the classification of variants in hereditary cancer genes in the Spanish population.

Accurate classification of genetic variants is crucial for clinical decision-making in hereditary cancer. In Spain, genetic diagnostic laboratories have traditionally approached this task independently due to the lack of a dedicated resource. Here we present SpadaHC, a web-based database for sharing variants in hereditary cancer genes in the Spanish population. SpadaHC is implemented using a three-tier architecture consisting of a relational database, a web tool and a bioinformatics pipeline. Contributing laboratories can share variant classifications and variants from individuals in Variant Calling Format (VCF) format. The platform supports open and restricted access, flexible dataset submissions, automatic pseudo-anonymization, VCF quality control, variant normalization and liftover between genome builds. Users can flexibly explore and search data, receive automatic discrepancy notifications and access SpadaHC population frequencies based on many criteria. In February 2024, SpadaHC included 18 laboratory members, storing 1.17 million variants from 4306 patients and 16 343 laboratory classifications. In the first analysis of the shared data, we identified 84 genetic variants with clinically relevant discrepancies in their classifications and addressed them through a three-phase resolution strategy. This work highlights the importance of data sharing to promote consistency in variant classifications among laboratories, so patients and family members can benefit from more accurate clinical management. Database URL: https://spadahc.ciberisciii.es/.

Individual participant data analysis comparing acute stroke patients with anterior versus posterior circulation dissections

BackgroundCervical artery dissection (CAD) is a relevant etiology of transient ischemic attacks and strokes. Several trials explored the significance of specific antithrombotic treatments, i.e. oral anticoagulation (OAC) versus antiplatelet treatment (APT), on recurrent ischemic complications and clinical outcomes. As overall incidence rates of complications were low there is still controversy which antithrombotic treatment should be used. However, up to now there has been no systematic investigation among CAD-patients with ischemic stroke specifically comparing clinical course and outcome of patients with anterior versus posterior CAD. MethodsWe performed an individual participant data analysis of patients with CAD and ischemic stroke. Over a five-year period we pooled data from three sites (i.e. West China Hospital, Chengdu, China as well as Erlangen and Giessen University Hospitals, Germany) and enrolled patients with CAD-associated ischemic stroke. Patient demographics, clinical and in-hospital measures as well as radiological data were retrieved from institutional databases. Clinical follow-up was over 6 months and included data on recurrent ischemic strokes and hemorrhages as well as clinical functional outcome assessed by the modified Rankin Scale dichotomized into favourable (mRS=0–2) and unfavourable. ResultsA total of 203 patients with CAD were included of which n=112 had anterior and n=91 had posterior CAD. Patients with posterior CAD were younger (46.0 vs. 41.0 y; p<0.001) than patients with anterior CAD and showed less often arterial hypertension. (42.0 % vs. 28.6 %; p<0.048). Antithrombotic treatment with APT and OAC was similarily distributed among patients with anterior and posterior CAD and not significantly differently related to ischemic or hemorrhagic complications during follow-up (all p=n.s.). Main difference between Chinese and German patients were mode of antithrombotic treatment consisting predominantly of APT in China compared to OAC in Germany. Functional outcome overall was good, yet worse in patients with anterior CAD compared to posterior CAD (80.2 % favorable in anterior CAD vs. 92.2 % in posterior CAD (p=0.014). ConclusionThis study provides evidence that anterior and posterior CAD show baseline imbalances regarding age and comorbidity which may affect clinical outcome. There are no signals of superiority or harm of any specific mode of antithrombotic treatment nor relevant discrepancies in clinical outcome among Chinese and German CAD-associated stroke patients.

The Impact of Second Opinion Expert Pathology Review in Patient Management at the Time of Transurethral Resection of the Bladder

Background and objectivePathological features in non–muscle-invasive bladder cancer specimens are pivotal in determining correct patients’ therapeutic management. Sparse data exist regarding the importance of second opinion performed by an expert uropathologist. This study aimed to assess the importance of a second opinion by an expert uropathologist in the management of bladder cancer. MethodsThe study relied on 272 bladder cancer specimens from 231 patients seeking a pathology second opinion after transurethral resection of the bladder for a clinical suspicion of bladder cancer, relapse, or second-look procedure. Pathology second opinion was offered by an experienced fellowship-trained uropathologist. Discrepancies were recorded considering primary tumor staging, the presence of muscularis propria, and the presence of histological variants. Cases were categorized as no significant discordance, major discordance without management change, and major discordance with management change according to the European Urology Association (EAU) guidelines. Key findings and limitationsAmong 272 second opinion cases, 39% (108/272) had major discordance and 28% (75/272) had major discordance with change in management according to the EAU guidelines. Upstaging and downstaging were reported in 66 (24%) patients. Improper identification of the presence of muscularis propria was found in 46 (17%) cases, of which 11 (4%) were deemed clinically relevant. Differences regarding the presence of histological variants were diagnosed in 40 cases (15%), resulting in eight (3%) changes in clinical management. In ten specimens (4%), multiple clinically relevant discrepancies were found. Conclusions and clinical implicationsThe second opinion evaluation changed the clinical management in 25% of the cases. These results support the importance of specimen review by an expert uropathologist as a major driver in the correct bladder cancer management. Patient summaryWe investigated the importance of a second opinion performed by an expert uropathologist in the management of bladder cancer. We found that 25% had their treatment plan changed due to the revised pathological report.

Evaluating the effects of soil grain roughness and rill cross‐section shape on flow resistance

AbstractThe knowledge of the hydraulic characteristics of rill flows is needed to improve the understanding and the accurate modelling of upland erosion processes. Flume investigations are developed to schematize conditions useful to analyze the influence of a unique variable significant for modelling rill hydraulics, while field investigations are used to simulate morphological and hydraulic conditions of natural cases. The main aim of this investigation is to compare flow resistance measurements carried out using a rectangular rill channel (flume data) and manually generated and naturally shaped rills (plot data) for the same soils and hydraulic conditions. The two data sets allowed for establishing how the soil grain roughness and rill cross‐section shape affect flow resistance using a theoretical equation deduced by applying dimensional analysis and self‐similarity theory. The analysis developed for a fixed‐bed channel with a rectangular cross‐section demonstrated that the influence of different soil roughness on the Darcy‐Weisbach friction factor is approximately equal to ±1%, while for a rill with an irregular cross‐section the same effect is almost equal to ±2%. Therefore, for an open‐channel flow on a fixed bed, the effect of the grain size roughness on the friction factor is limited. For each examined soil, the investigation also demonstrated that the rill cross‐section shape leads to a variability of the friction factor from −20% to +30%. This result highlights that, for a fixed‐bed channel, the effect of the cross‐section shape on the Darcy‐Weisbach friction factor is much greater than that due to the soil grain size roughness. The main implication of this work is that the results deduced by laboratory measurements with regular cross‐sections, thus neglecting a complex geometry, can be affected by relevant discrepancies from those obtained by the field measurements, which better simulate natural conditions.

Discordance of Biomarker Expression Profile between Primary Breast Cancer and Synchronous Axillary Lymph Node Metastasis in Preoperative Core Needle Biopsy

Background: Breast cancer (BC) is a heterogeneous disease made up of clones with different metastatic potential. Intratumoral heterogeneity may cause metastases to show divergent biomarker expression, potentially affecting chemotherapy response. Methods: We investigated the immunohistochemical (IHC) and FISH profile of estrogen receptors (ER), progesterone (PR) receptors, Ki67, and HER2 in a series of BC-matched primary tumors (PTs) and axillary lymph node (ALN) metastases in pre-operative core needle biopsies (CNBs). Phenotypical findings were correlated to morphological features and their clinical implications. Results: Divergent expression between PTs and ALNs was found in 10% of the tumors, often involving multiple biomarkers (12/31, 39%). Most (52%) displayed significant differences in ER and PR staining. HER2 divergences were observed in almost three-quarters of the cases (23/31, 74%), with five (16%) switching from negativity to overexpression/amplification in ALNs. Roughly 90% of disparities reflected significant morphological differences between PTs and ALN metastases. Less than half of the discrepancies (12/31, 39%) modified pre/post-operative treatment options. Conclusions: We observed relevant discrepancies in biomarker expression between PTs and metastatic ALNs in a noteworthy proportion (10%) of preoperative BC CNBs, which were often able to influence therapies. Hence, our data suggest routine preoperative assessment of biomarkers in both PTs and ALNs in cases showing significant morphological differences.

Data-Driven Harmonization of 2022 Who and ICC Classifications of Myelodysplastic Syndromes/Neoplasms (MDS): A Study By the International Consortium for MDS (icMDS)

Background. The inclusion of gene mutations and chromosomal abnormalities in the 2022 WHO and ICC Classifications of MDS has enhanced diagnostic precision and is expected to improve clinical decision-making process. Although these two systems share similarities, clinically relevant discrepancies still exist and potentially cause inconsistency in their adoption in a clinical setting. In this study on behalf of the International Consortium for MDS (icMDS), we adopted a data-driven approach to provide a harmonization roadmap between the 2022 WHO and ICC classification for MDS. A modified Delphi Process consensus approach is currently ongoing among icMDS experts to finalize a harmonized MDS classification scheme. Methods. We analyzed retrospective international cohorts of patients with a diagnosis of MDS (n=7017) and AML (n=1002) according to WHO 2016 criteria. Hierarchical Dirichlet Processes were applied to define clusters capturing broad dependencies among all gene mutations and cytogenetic abnormalities. To investigate the features of importance and their impact on the clustering process, we employed the SHapley Additive exPlanations approach (SHAP). This allowed to define harmonized labels for each clinical entity. The clinical relevance of the unsupervised clustering was assessed through the analysis of phenotypic features and outcomes among each group. ( Blood 2022;140: 9828-9830) Results. Patients' characteristics are summarized in Table 1. We identified 9 clusters, defined by specific genomic features. The cluster of highest hierarchical importance was characterized by biallelic inactivation of TP53 (biTP53). According to SHAP analysis, bi TP53 was defined as 2 or more TP53 mutations, or 1 mutation with copy number loss or cnLOH. Most patients assigned to bi TP53 cluster had TP53 VAF&amp;gt;10% (77.9%) and complex karyotype (70.1%). Assignment to bi TP53 cluster was irrespective of blast count. Patients with monoallelic TP53 mutation segregated into other clusters. Hierarchically, the second cluster included patients with del(5q). SHAP analysis highlighted 5q deletion alone, or with one other chromosomal abnormality other than -7, and absence of bi TP53, as the most relevant features. Most of these patients had blast counts &amp;lt;5% (88.1%). The third distinct cluster included patients with SF3B1 mutations (in the absence of concurrent del(7q), abn3q26.2, complex karyotype or RUNX1 mutation). Most patients with MDS and SF3B1 mutation had &amp;lt;5% blasts (94.2%). Common co-mutated variants in the SF3B1 cluster included mutant DNMT3A (25.2%) and TET2 (38.3%). Morphologically defined MDS cases (i.e., not meeting criteria for bi TP53, del(5q) or SF3B1) were preferentially assigned to the following additional clusters: SF3B1 and concurrent higher-risk mutations (e.g., RUNX1 and ASXL1); SRSF2 and concomitant TET2 mutations; U2AF1 mutations with del(20q), del(7q) or -7; SRSF2 with TET2 mutations and co-mutational patterns including RUNX1 and ASXL1; and AML-like genomic signatures. Our analyses suggest that morphologically defined MDS is characterized by a large heterogeneity in terms of mutation profiles, not entirely captured by the presence of unilineage versus multilineage dysplasia, percentage of bone marrow blasts, and presence of hypocellularity and fibrosis. To better investigate the continuum between high risk MDS (i.e., patients with ≥10% blasts) and AML, an exploratory comparison was made using a cohort of AML (defined according to WHO 2016) patients analyzed using the same statistical methods. Only a partial overlap in genetic signatures was observed between MDS with ≥10% blasts and AML. However, similarities were observed between the AML-like MDS clusters (characterized by mutant NPM1, bZIP CEBPA, and Core Binding Factor abnormalities) and AML clusters defined by the same genetic signature, thus supporting the classification of these entities as AML, irrespective of blast count. Conclusion. Our study demonstrated the utility of a data-driven approach based on advanced statistical methods to generate a harmonized classification for MDS. Table 2 shows a provisional, hierarchical classification algorithm. Further refinement of entity labels and classification criteria is the subject of the ongoing modified Delphi Process consensus approach among icMDS experts.

Role of EDTA, citrate and phthalate on Cs, Sr, Eu and U adsorption by smectite and evaluation by geochemical modeling

The presence of organic ligands may exacerbate the mobility of contaminants by stabilizing them in the aqueous phase and reducing their retention on the solid phases, representing an additional environmental hazard.We investigated the impact of EDTA, citrate and phthalate on the adsorption of four different radionuclides (RN = 137Cs, 85Sr, 152Eu and 233U) by a well-characterized smectite clay and evaluated the capability of sorption modeling to incorporate the impact of these organic ligands.We analyzed the effect of ligand concentration (from 1·10−6 to 1·10−3 M) on RN retention at two different pH values (approximately 5 and 9) to contemplate the occurrence of different adsorption mechanisms in clays (cation exchange or surface complexation) as well as the RN and organic speciation.The results suggested that phthalate had a minimal effect on the retention of the studied RNs, while EDTA and citrate significantly decreased the adsorption of Eu, Sr and U, even making it drop to zero in some cases. The simulation outcomes demonstrated that, in most cases, the variation in the distribution coefficient (Kd) as a function of the organic concentration could be accurately replicated with the available thermodynamic data, but few relevant discrepancies were identified.The importance of the possible competitive effects of trace ions in the equilibrium water (notably Ca) for the overall assessment of the role of organic matter on RN retention was highlighted.

White Collars and Blue Collars in Tourism Industry: Could Tourism Establish Equal Opportunities?

The study presents a theoretical reflection of work divisions and the possibilities for equal labor and social environment inclusion in tourism. Through empirical methods the relevant discrepancies are outlined and discussed in relation to the contemporary tourism challenges. The study indicated that there were clear correlations between collar color and visions of the present and the future. The tourism sector will maintain the need for the presence of both working classes. At the same time, it will be the factor that can reduce the differences between them and provide conditions for decent performance according to the capabilities of each of the collars studied.

The eclectic landscape: examining Spanish secondary school teachers’ beliefs on literary education

Literary education aims to promote the teaching of reading from an academic, social, and personal perspective. At present there is a consensus on the central role that the school institution plays, which can be translated into explicit and implicit approaches. The objective of this article is to explore Spanish Secondary school teachers’ beliefs about literary education to determine their proximity to each of these two approaches, as well as the coherence within such beliefs, unpacking the relationships between adherence to principles and declared practices. To obtain the data that supports the study, the Beliefs About Literary Education of Secondary School Teachers (BALESST) scale has been elaborated. 1,544 Secondary Education teachers from the 17 Spanish communities and the autonomous cities of Ceuta and Melilla have responded to the scale. For the analysis of the data, the statistical packages of IBM SPSS Statistics, 24.0 and G* Power 3 have been used. The results suggest that Spanish Secondary school teachers are in an eclectic position in the debate between explicit and implicit literary education, reveal relevant discrepancies between the two factors that make up the scale (adherence to principles and declared practices), and allow identify majority and minority representations and practices among teachers.

Breast Cancer in Brazil: Screening Program and Surgical Approach

Breast cancer is the most common female cancer, and Screening mammography is a current strategy that reduces mortality among women. In Brazil, more recent data show an increasing number of mammograms but unequal geographic access to the exam nationwide. Breast surgery is essential to the current oncological treatment and management of breast cancer. Conservative breast techniques have been established as an effective treatment option; however, mastectomies are still widely used in Brazil. The increase in breast cancer screening programs nationwide should increase the number of breast-conserving surgeries over total mastectomies. However, these expectations may be compromised in developing countries such as Brazil, where there are relevant discrepancies in the public health system.

Analyzing the Performance of Thermoelectric Generators with Inhomogeneous Legs: Coupled Material–Device Modelling for Mg2X-Based TEG Prototypes

Thermoelectric generators (TEGs) possess the ability to generate electrical power from heat. As TEGs are operated under a thermal gradient, inhomogeneous material properties—either by design or due to inhomogeneous material degradation under thermal load—are commonly found. However, this cannot be addressed using standard approaches for performance analysis of TEGs in which spatially homogeneous materials are assumed. Therefore, an innovative method of analysis, which can incorporate inhomogeneous material properties, is presented in this study. This is crucial to understand the measured performance parameters of TEGs and, from this, develop means to improve their longevity. The analysis combines experimental profiling of inhomogeneous material properties, modelling of the material properties using a single parabolic band model, and calculation of device properties using the established Constant Property Model. We compare modeling results assuming homogeneous and inhomogeneous properties to the measurement results of an Mg2(Si,Sn)-based TEG prototype. We find that relevant discrepancies lie in the effective temperature difference across the TE leg, which decreases by ~10%, and in the difference between measured and calculated heat flow, which increases from 2–15% to 9–16% when considering the inhomogeneous material. The approach confirms additional resistances in the TEG as the main performance loss mechanism and allows the accurate calculation of the impact of different improvements on the TEG’s performance.

Multiphase Flow Simulation of ITTC Standard Cavitator for Underwater Radiated Noise Prediction

This work focuses on the main issues related to noise measurements in cavitation tunnels. The scope of the paper is to twofold: to obtain a better understanding on the main phenomena underlying experiments and to define consistent cavitation tunnel measurement corrections for background noise, wall reflections, and distance normalisation. To this aim, the acoustic field generated by the ITTC standard cavitator model inside a cavitation tunnel is predicted by Lighthill’s acoustic analogy and solved through a finite element method that inherently accounts for the presence of the walls. Sources of sound detection relies on two multiphase CFD solvers, namely, the homogeneous mixture model—Volume of Fluid method and the Euler–Euler formulations. Starting from the computation of the sound pressure level in the free field with the assumption of spherical spreading without absorption, corrections from losses and spreading are detected by the above approach. Background-corrected sound pressure levels are identified and then compared with the source levels measured in the cavitation tunnel of the Potsdam Model Basin (SVA). It is found that free-field computations corrected by tunnel-induced effects match well with experiments up to 100 Hz (in the one-third octave band), whereas relevant discrepancies arise out of this range that need further investigations.

Impact of age on indication for chemotherapy in early breast cancer patients: results from 104 German institutions from 2008 to 2017

PurposeToday, the decision to treat patients with chemotherapy for early breast cancer (EBC) is made based on the patient’s individual risk stratification and tumor biology. In cases with chemotherapy indication, the neoadjuvant application (NACT) is the preferred option in comparison with primary surgery and adjuvant chemotherapy (ACT). Age remains a relevant factor in the decision-making process. The aim of the present study was to illustrate the impact of age on the use of systemic therapy in clinical routine.MethodsThe study separately analyzed chemotherapy use among six age cohorts of EBC patients who had been treated at 104 German breast units between January 2008 and December 2017.ResultsIn total, 124,084 patients were included, 46,279 (37.3%) of whom had received chemotherapy. For 44,765 of these cases, detailed information on treatment was available. Within this cohort, chemotherapy was administered as NACT to 14,783 patients (33.0%) and as ACT to 29,982 (67.0%) patients. Due to the higher prevalence of unfavorable tumor subtypes, younger patients had a higher rate of chemotherapy (≤ 29y: 74.2%; 30–39y: 71.3%) and a higher proportion of NACT administration ( ≤ 29y: 66.9%; 30–39y: 56.0%) in comparison with elderly patients, who had lower rates for overall chemotherapy (60–69y: 37.5%; ≥ 70y: 17.6%) and NACT (60–69y: 25.5%; ≥ 70y: 22.8%). Pathologic complete response was higher in younger than in older patients (≤ 29y: 30.4% vs. ≥ 70y: 16.7%), especially for HER2− subtypes.ConclusionThe data from the nationwide German cohort reveal relevant age-dependent discrepancies concerning the use of chemotherapy for EBC.

A cross-sectional study on the response abilities of clinical and preventive medical students in public health emergency.

Inconsistent training programs for public health emergency (PHE) have been criticized as a contributing factor in PHE's managerial weak points. In response, to analyze the relevant discrepancies among the medical students in the class of 2021 from Xiangya School of Medicine of Central South University, the present study conducted an online questionnaire survey using convenience sampling. The questionnaire comprised four sections, including the basic information, the subjective cognition in PHE, the rescue knowledge and capabilities of PHE, and the mastery of PHE regulations and psychological intervention abilities. To compare the abovementioned aspects, related data were collected from 235 medical students divided into two groups, namely, clinical medical students (Group A) and preventive medical students (Group B). We found a more positive attitude in PHE (P = 0.014) and a better grasp of the PHE classification (P = 0.027) and the reporting system in group B compared with group A. In addition, even if group B showed the same response capability in communicable diseases as group A, the former had less access to clinical practice, resulting in poorer performance in the noncommunicable diseases during a fire, flood, and traffic accidents (P = 0.002, P = 0.018, P = 0.002). The different emphasis of each training program contributed to the uneven distribution of abilities and cognition. Meanwhile, the lack of an integrated PHE curriculum led to unsystematic expertise. Hence, to optimize the PHE management system, equal attention should be paid to medical students with diverse majors along with a complete integrated PHE curriculum.

NOTES ON AGAPANTHIA (SYNTHAPSIA) KIRBYI (GYLLENHAL, 1817) WITH DESCRIPTION OF A NEW SUBSPECIES AND THE CONFIRMATION OF ITS OCCURRENCE IN ITALY (COLEOPTERA CERAMBYCIDAE LAMIINAE)

Rapuzzi P., Parisi F. - Notes on Agapanthia (Synthapsia) kirbyi (Gyllenhal, 1817) with description of a new subspecies and the confirmation of its occurrence in Italy (Coleoptera Cerambycidae Lamiinae). In this paper, we investigated hundreds of specimens within the Agapanthia kirbyi (Gyllenhal, 1817) with the aim of finding relevant discrepancies in the Western and Southeastern populations. Amongst the species, the most diverse characters are body shape and pubescence color; however, based on the different geographical distribution it is possible to classify it into three different subspecies. One of these subspecies is new and is described below as Agapanthia (Synthapsia) kirbyi samai new subspecies. We also consider the characters used to create the Genus Synthapsia by Pesarini &amp; Sabbadini (2004) not sufficient for a genus rank but at least for a subgenus rank (new status) due to the fact that other species close to A. kirbyi (Agapanthia hirsuticornis) shows intermediate characters between Synthapsia and Agapanthia. We also formalize the following new synonym: A. kirbyi ssp. zawadskyi Fairmaire, 1866 (name resurrected, new combination) = A. kirbyi ssp. valandoensis Sláma 2015 (new synonym) on the base of many specimens studied from the type localities of both the Taxon. In addition, the occurrence of A. kirbyi (Gyllenhal, 1817) is ascertained in Italy; in fact, eleven specimens were reported in the Matese Mountains, central-southern Apennines, between the years 2019 and 2021. This extends its known distribution into southern Europe and further confirms the important biogeographical role of this mountainous territory. Key Words: Longhorn beetles, Geographical range, Holotype, Matese mountain, central-southern Apennine.

On the relationship between lightning superbolts and TLEs in Northern Europe

Lightning occurrence at higher latitudes in northwestern Europe is by far less frequent than mainland continental and the Mediterranean during most of the year. Yet, as recent studies suggest, this region harbors a large fraction of the most energetic lightning flashes on Earth, commonly referred to as superbolts. In this study, we examine the time/locations of intense cloud-to-ground (CG) strokes (>200 kA in absolute value), provided by Météorage for the 10.5-year period (from Jan 2010 to Jul 2020), to present a high-resolution map of their distribution, pointing out relevant discrepancies observed between -CG and + CG, respectively. We additionally investigate the potential of superbolts to result in short-lived optical phenomena above thunderstorms, collectively known as transient luminous events (TLEs). Observations in the region indicate that isolated superbolts with substantial charge moment change can produce sprites during low active marginal winter thunderstorms, in the absence of concurrent IC/CG activity several minutes before and after the event. An example is described when 3 sprites were captured in a similar context during the night of 7th/8th February 2016. We suggest that: i) convergence and aerosols advection from sea surface and busy shipping lanes may favour deep convection and cloud electrification on the English Channel with respect to surrounding areas. Inherent differences in cloud charge structure of sea based storms could lead to faster negative leader vertical velocity than those for storms over land, on average, and hence in larger peak currents, determining the winter peak of negative superbolts in the area; ii) areas occupied by the most populated superbolt clusters can be used to conduct future research in the region, aimed at better characterising microphysical properties of superbolts and their potential in generating TLEs.

Proximal femur anatomy-implant geometry discrepancies.

Objectives: Due to ongoing concern about femur anatomy-implant mismatches, this cross-sectional study aimed to create a geometric femur profile and used it to identify and quantify possible mismatches between femur anatomy and cephalomedullary nail dimensions. The work further aimed to assess whether patient demographics affect anatomy-implant coherence. Methods: One hundred skeletally mature complete femur computer tomography (CT) scans were collected and exported to software enabling landmark placement and measures with multiplanar reconstruction techniques. Results: Clinically relevant anatomy-implant discrepancies included the femur neck and shaft axis offset 6.1 ± 1.7 mm (95% CI [5.7–6.4]), femur radius of curvature 1.2 ± 0.3 m (95% CI [1.1–1.2]), femur anteversion 18.8 ± 9.2 (95% CI [16.9–20.6]). The implants reviewed in this study did not compensate for the femur neck and shaft axis offset and had a larger radius of curvature than the studied population. Clinically significant demographic geometry differences were not identified. Conclusion: There were discrepancies between femur anatomy and cephalomedullary nail implant design; however, no clinically significant femur feature inconsistency was identified among the demographic subgroups. Due to the identified anatomy-implant discrepancies, including the femur neck and shaft axis offset, we suggest that these measurements be considered for future implant design and surgical technique.

The Heer K&amp;#252;ste Artillerie Abteilung 1161

This article presents the history of the German H.K.A.A. (Heer Küste Artillerie Abteilung—Army Coastal Artillery Group) 1161 during the WWII in the Finistère (FR). The emplacements Stps Av 34 or Av 55, Av 64, Av 66a, Av 67 of its four companies 1./H.K.A.A. 1161, 2./H.K.A.A. 1161, 3./H.K.A.A. 1161 and 4./H.K.A.A. 1161 have been visited and the preservation state of the remaining components, at about 77 years from the end of the WWII, ascertained. The problem of inhomogeneities between the information from different historical sources has been addressed by not altering the information from a source also in case of partial agreement with information from other sources and to discuss the information from different sources in case of relevant discrepancies in order to obtain the correct information. The preservation of the emplacements in the future is not assured, in fact, no classification as monuments or architectural heritage is foreseen and they are menaced by the expansion of the urbanization of the nearby cities.