Environmental reporting in Italian thermal power plants: insights from a comprehensive analysis of EMAS environmental statements.

The global energy sector heavily relies on fossil fuels, significantly contributing to climate change. The ambitious European emissions' reduction targets require sustainable processes and alternatives. This study presents a comprehensive analysis of 73 Italian thermal power plants registered to the European Eco-Management and Audit Scheme (EMAS) aimed at assessing EMAS effectiveness in addressing and quantifying the environmental impacts of this relevant industrial sector. The analysis was based on EMAS environmental statements, publicly disclosing verified and certified data, with the secondary objective of evaluating if EMAS could be an efficient tool to improve the plants' environmental performances. An inventory of technical and environmental aspects, adopted indicators, and allocated budgets was based on 2023 data. A strong correlation was found between the significance of the environmental aspects and the number of adopted indicators. Gaps were observed in describing aspects like "biodiversity" and "local issues". Improvement objectives and budget allocation showed discrepancies and lacked correlation with the significance of the related environmental aspects. "Energy production" accounted for 68% of the total allocated budget; "environmental risks", "emissions to air", "electricity consumption", and "local issues" were also key focus areas. Insufficient information on emission control technologies and progress tracking of improvement objectives was detected. This study highlights the need for thermal power installations to improve the selection of appropriate indicators and to better relate allocated budget to improvement objectives when implementing EMAS. Such measures would facilitate the quantification of the effective environmental impacts of the energy production sector, supporting future research on this topic, allowing stakeholders a better comparison among plants, and driving industry-wide improvements.

Does testosterone influence the association between sleep and frailty in men: results from the European Male Aging Study.

BACKGROUND: Previous studies have suggested an association between sleep disturbance and frailty. The mechanism is unknown, although it has been suggested that hormonal factors may play a role. METHODS: The aim was to determine the association between sleep duration, sleep quality and frailty, and to determine whether testosterone influenced this association. Males aged 40-79 years were recruited from eight European centres to the European Male Aging Study (EMAS). Subjects completed an interviewer-assisted questionnaire including questions regarding sleep quality and duration. Sleep quality was scored 0-20 and categorised as 0-4, 5-9, 10-14, and 15-20, with higher scores indicating poorer quality. A 39-component frailty index (FI) was constructed. Total testosterone levels were measured. The association between sleep duration, sleep quality and the FI was assessed using negative binomial regression, with adjustment for putative confounders including testosterone level. RESULTS: Two thousand three hundred ninety-three participants contributed data to the analysis. The mean age was 63.3 years and mean sleep duration was 7.01 h. The mean frailty index was 0.15. Mean testosterone levels declined with decreasing sleep quality. After adjustment, compared to those with a sleep score of 0-4, the FI was 57% (95% CI 38%, 78%) higher among those with a sleep score of 15-20. After adjustment compared to those with normal sleep duration (6-9 h), those with a short (< 6 h) and long (≥ 9 h) sleep duration had a 16% (95% CI 6%, 28%) and 11% (95% CI 0%, 23%) higher FI, respectively. Adjustment for testosterone did not influence the strength of either association. CONCLUSION: Frailty is associated with impaired sleep quality and sleep duration. The association cannot, however, be explained by variation in testosterone levels.

The Use of Mobile Assessments for Monitoring Mental Health in Youth: Umbrella Review.

BACKGROUND: Improving mental health in youth is a major concern. Future approaches to monitor and intervene in youth mental health problems should rely on mobile tools that allow for the daily monitoring of mental health both actively (eg, using ecological momentary assessments [EMAs]) and passively (eg, digital phenotyping) by capturing individuals' data. OBJECTIVE: This umbrella review aims to (1) report the main characteristics of existing reviews on mental health and young people, including mobile approaches to mental health; (2) describe EMAs and trace data and the mental health conditions investigated; (3) report the main results; and (4) outline promises, limitations, and directions for future research. METHODS: A systematic literature search was carried out in 9 scientific databases (Communication & Mass Media Complete, Psychology and Behavioral Sciences Collection, PsycINFO, CINAHL, ERIC, MEDLINE, the ProQuest Sociology Database, Web of Science, and PubMed) on January 30, 2022, coupled with a hand search and updated in July 2022. We included (systematic) reviews of EMAs and trace data in the context of mental health, with a specific focus on young populations, including children, adolescents, and young adults. The quality of the included reviews was evaluated using the AMSTAR (Assessment of Multiple Systematic Reviews) checklist. RESULTS: After the screening process, 30 reviews (published between 2016 and 2022) were included in this umbrella review, of which 21 (70%) were systematic reviews and 9 (30%) were narrative reviews. The included systematic reviews focused on symptoms of depression (5/21, 24%); bipolar disorders, schizophrenia, or psychosis (6/21, 29%); general ill-being (5/21, 24%); cognitive abilities (2/21, 9.5%); well-being (1/21, 5%); personality (1/21, 5%); and suicidal thoughts (1/21, 5%). Of the 21 systematic reviews, 15 (71%) summarized studies that used mobile apps for tracing, 2 (10%) summarized studies that used them for intervention, and 4 (19%) summarized studies that used them for both intervention and tracing. Mobile tools used in the systematic reviews were smartphones only (8/21, 38%), smartphones and wearable devices (6/21, 29%), and smartphones with other tools (7/21, 33%). In total, 29% (6/21) of the systematic reviews focused on EMAs, including ecological momentary interventions; 33% (7/21) focused on trace data; and 38% (8/21) focused on both. Narrative reviews mainly focused on the discussion of issues related to digital phenotyping, existing theoretical frameworks used, new opportunities, and practical examples. CONCLUSIONS: EMAs and trace data in the context of mental health assessments and interventions are promising tools. Opportunities (eg, using mobile approaches in low- and middle-income countries, integration of multimodal data, and improving self-efficacy and self-awareness on mental health) and limitations (eg, absence of theoretical frameworks, difficulty in assessing the reliability and effectiveness of such approaches, and need to appropriately assess the quality of the studies) were further discussed. TRIAL REGISTRATION: PROSPERO CRD42022347717; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=347717.

Number of CAG repeats and mortality in middle aged and older men.

DESIGN: The androgen receptor (AR) mediates peripheral effects of testosterone. Previous data suggests an association between the number of CAG repeats in exon-1 of the AR gene and AR transcriptional activity. The aim of this analysis was to determine the association between the number of AR CAG repeats and all-cause mortality in men and the influence of testosterone level on the association. PATIENTS AND MEASUREMENTS: Follow-up data to 27 January 2018 were available for men aged 40-79 years recruited across six countries of the European Male Aging Study between 2003 and 2005. Cox proportional hazards modelling was used to determine the association between CAG repeat number/mortality. Results were expressed as hazard ratios (HR)/95% confidence intervals (CI). RESULTS: One thousand nine hundred and seventy-seven men were followed up. Mean baseline age was 60 ± 11.1 years. Mean duration of follow-up was 12.2 years. At follow up 25.1% of men had died. CAG repeat length ranged from 6 to 39, with the highest proportion of CAG repeat number at 21 repeats (16.4%). In a multivariable model, compared to men with 22-23 AR CAG repeats: for men with <22 and >23 AR CAG HR, 95% CI for mortality were, <22 CAG repeats 1.17 (0.93-1.49) and >23 CAG repeats 1.14 (0.88-1.47). In a post-hoc analysis, the association was significant for men in the lowest tertile of baseline testosterone (<14.2 nmol/L) with >23 CAG repeats: in the adjusted model for <22 and >23 CAG repeats, respectively, 1.49 (0.97-2.27) and 1.68 (1.06-2.67) versus 22-23 repeats. CONCLUSIONS: Our European-wide cohort data overall found no association of androgen receptor CAG repeat number and mortality in men. However, post hoc analysis suggested that an association might be present in men with lower baseline testosterone concentrations, which merits further investigation.

Multi-objective optimization configuration of redundant electromagnetic actuators in fault-tolerant control of active magnetic bearing system.

Fault-tolerant control of active magnetic bearing (AMB) systems with redundant electromagnetic actuators (EMAs) based on generalized bias current linearization has become a practical technique to address EMA/amplifier faults. In this method, the configuration of multi-channel EMAs involves solving a high-dimensional and nonlinear problem containing complex constraints offline. This article develops a general framework for the EMAs multi-objective optimization configuration (MOOC) by combining the non-dominated sorting genetic algorithm III (NSGA-III) and the sequential quadratic programming (SQP) with the designing of objectives, handling of constraints, consideration of the iterative efficiency and the diversity of solutions. The numerical simulation results confirm the feasibility of the framework for searching the non-inferior configurations and reveal the function mechanism that intermediate variables of the nonlinear optimization model on AMB performance. Finally, the best configurations identified using the technique for order preference by similarity to an ideal solution (TOPSIS) are applied to the 4-DOF AMB experimental platform. Experiments further indicate that the work in this paper provides a novel way with good performance and high reliability for solving the EMAs MOOC problem in fault-tolerant control of AMB systems.

Reinventing mental health care in youth through mobile approaches: Current status and future steps.

In this perspective, we aim to bring together research on mobile assessments and interventions in the context of mental health care in youth. After the COVID-19 pandemic, one out of five young people is experiencing mental health problems worldwide. New ways to face this burden are now needed. Young people search for low-burden services in terms of costs and time, paired with high flexibility and easy accessibility. Mobile applications meet these principles by providing new ways to inform, monitor, educate, and enable self-help, thus reinventing mental health care in youth. In this perspective, we explore the existing literature reviews on mobile assessments and interventions in youth through data collected passively (e.g., digital phenotyping) and actively (e.g., using Ecological Momentary Assessments-EMAs). The richness of such approaches relies on assessing mental health dynamically by extending beyond the confines of traditional methods and diagnostic criteria, and the integration of sensor data from multiple channels, thus allowing the cross-validation of symptoms through multiple information. However, we also acknowledge the promises and pitfalls of such approaches, including the problem of interpreting small effects combined with different data sources and the real benefits in terms of outcome prediction when compared to gold-standard methods. We also explore a new promising and complementary approach, using chatbots and conversational agents, that encourages interaction while tracing health and providing interventions. Finally, we suggest that it is important to continue to move beyond the ill-being framework by giving more importance to intervention fostering well-being, e.g., using positive psychology.

Characteristics of development and dissemination of environmental management systems in the area of production of medicines in Ukraine.

The article presents the results of a study based on an expert survey of senior management and leading experts of enterprises for the production of medicines in Ukraine and typical problematic aspects of implementing environmental management systems (EMS). It was found that among the enterprises whose respondents took part in the survey, only 25% implemented EMS and passed the certification procedure following the requirements of ISO 14001. A significant problem identified is the lack of influential information tools and methodological developments for the implementation, operation, and benefits of EMS in pharmaceutical production, especially to ensure processes regarding the readiness of enterprises to respond to emergencies. Insufficient support was noted, particularly in regulatory and financial incentives, and no benefits could encourage more efficient greening of pharmaceutical production. The negative consequence is the lack of interest of small and medium enterprises in investing in new technologies and sustainable business practices to reduce environmental pressures. EMS should be implemented as a part of the overall management system of the enterprise to manage environmental aspects, meet mandatory legal requirements and voluntary commitments in accordance with the objectives and environmental policy of the enterprise, as well as to address risks and opportunities. It is important to note the urgency of developing theoretical and methodological principles of design, implementation, and further development of EMS to increase the environmental efficiency of the enterprise, greening in medicines production, and achieving sustainable development goals.

The prehospital care experiences and perceptions of ambulance staff and Eastern European patients: An interview study in Lincolnshire, UK.

Background: EU enlargement after 2004 was a major factor in increasing Eastern European migration to the UK. This population requires access to high quality public services generally, and ambulance services more specifically. To understand how Eastern European migrants use ambulance care, this study explored the perceptions and experiences of ambulance staff and the Eastern European patients themselves. Methods: We undertook qualitative semi-structured interviews across Lincolnshire. Purposive and maximum variation sampling ensured that participants were knowledgeable about Eastern European patients' use of ambulance care and were demographically diverse. Data were analysed using framework analysis. Results: There were interviews with 15 ambulance staff and 12 Eastern European patients. A staff interviewee problematised "Health Tourism", which suggests that migrants deliberately exploit state-funded healthcare. However, most disagreed. Patient interviewees often undertook medical travel to access healthcare in response to perceived healthcare problems in the UK. Medical travel increased the likelihood of ambulance staff encountering foreign medication. Variable quality of, and access to, professional interpreters prompted patients to rely instead on informal interpreters. Patients did not register with GPs perhaps due to limited understanding of how the NHS worked. This led to inappropriate use of ambulance services. Recommendations for service delivery improvements included: Eastern European language information on how and when to use ambulance care; improving GP registration; and greater engagement between the ambulance service and Eastern European communities. Conclusions: Frequent medical travel can limit how Eastern Europeans acculturate to the NHS and anchor roots in the UK. Acculturation is about how migrant cultures adjust to the host country. This is not assimilation, where they dilute their cultural identity. Language and communication barriers, as well as inadequate availability and quality of interpreting services, can impede patient-staff dialogue in time-critical emergencies.

The number of androgen receptor CAG repeats and mortality in men.

INTRODUCTION: The androgen receptor (AR) mediates peripheral effects of testosterone. Evidence suggests that the number of CAG repeats in exon-1 of the AR gene negatively correlates with AR transcriptional activity. The aim of this analysis was to determine the association between CAG repeat number and mortality in men. METHODS: Men aged 40-79 years were recruited from primary care for participation in the UK arm of the European Male Aging Study between 2003 and 2005. Cox proportional hazards modelling was used to determine the association between CAG repeat number/mortality. Results were expressed as hazard ratios(HR)/95% confidence intervals (CI). RESULTS: 312 men were followed up. The mean baseline age was 59.5 years. At follow up, 85/312(27%) men had died. CAG repeat length ranged from 14 to 39, with the highest proportion of CAG repeat number at 21 repeats(16.4%). In a multivariable model, using men with CAG repeat numbers of 22-23 as the reference, men with a lower number of CAG repeats(<22) showed a trend for a higher mortality in the follow-up period (HR 1.46 (0.75, 2.81)) as did men with higher number of repeats (>23) (1.37 (0.65, 2.91)). CONCLUSION: Our data suggest that CAG repeat number may partially influence the risk of mortality in men. Further larger studies are required to quantify the effect.

Results of an international Delphi consensus in epilepsy with myoclonic atonic seizures/ Doose syndrome.

OBJECTIVE: To establish a standard framework for early phenotypic diagnosis, investigations, expected findings from investigations, evolution, effective therapies and prognosis in the syndrome of Epilepsy with myoclonic atonic seizures (EMAS) / Doose syndrome. METHODS: A core study group (CSG) interested in EMAS was convened. CSG then identified and nominated 15 experts in the field of EMAS. This expert panel (EP) from English speaking nations was invited to participate in anonymous questionnaires. A literature review was provided to them (supplement 1). Three rounds of questionnaires were sent to identify areas of consensus, strength of consensus and areas of contention. RESULTS: Strong consensus was obtained regarding the clinical phenotype of EMAS: myoclonic atonic seizure was identified among others as a mandatory seizure type with typical onset of afebrile seizures between one and six years. A new term "stormy phase" (SP) was designated to delineate a characteristic phenotypic evolution in EMAS patients associated with seizure worsening. Strong consensus regarding the existence and time of onset of the SP, mandatory investigations to be performed early and later in the clinical course of EMAS, first and second tier treatment and prognostic factors for poor outcome were identified. Areas of lack of consensus included some seizure types that are necessary to diagnose EMAS, interictal EEG findings that prognosticate the course of EMAS, overall duration of SP, time to complete remission, and best approach to treat drug resistant EMAS. SIGNIFICANCE: Expert consensus on core diagnostic criteria of EMAS necessary for natural history studies, phenotype-genotype correlations, and clinical trials including comparative studies was demonstrated. Areas of disagreements (especially prognostic features; treatment options) need further research.

Impact of the COVID-19 Pandemic on Health-Related Quality of Life, Anxiety, and Training Among Young Gastroenterologists in Romania.

The novel COVID-19 infection has spread all over the world and is still generating a lot of issues at different levels. There is a lack of control in disease early diagnosis and rapid evolution, which impacts both the medical and the economic system. Young gastroenterologists should adapt to overcome current difficulties and continue their life and general training. This is a multi-center national study, which aims to assess the general perspective of young gastroenterologists (residents and young specialists) from six university centers in Romania regarding their current training and the psychological effect the pandemic has on their life and job. An online survey with 58 items was distributed using Google Forms, and quality of life and anxiety were assessed. The validated instruments 15D (for assessing the health-related quality of life) and endler multidimensional anxiety scales (EMAS-for assessing anxiety) were used. All analyses were performed using SPSS 25. Of the 174 gastroenterologists approached, 96 (response rate of 55%) responded. A majority of the respondents were residents in gastroenterology (64%), and 40.6% were male. The pandemic influenced the number of examined patients as well as young gastroenterologists' endoscopy training. Health-related quality of life was negatively associated with the level of anxiety generated by the cognitive component of anxiety as a state, the new and ambiguity of the state, and how threatened the respondent felt. The level of anxiety was moderate (median = 51), and no difference was found between the physicians working in a designated hospital or not. General caution should be considered for young gastroenterologists' training, and continuous observation should be done to ensure better mental health on the current evolution. These findings would need to be verified in larger-sample studies and in different types of specialties.

Management of depressive symptoms in peri- and postmenopausal women: EMAS position statement.

INTRODUCTION: Globally, the total number of people with depression exceeds 300 million, and the incidence rate is 70 % greater in women. The perimenopause is considered to be a time of increased risk for the development of depressive symptoms and major depressive episodes. AIM: The aim of this position statement is to provide a comprehensive model of care for the management of depressive symptoms in perimenopausal and early menopausal women, including diagnosis, treatment and follow-up. The model integrates the care provided by all those involved in the management of mild or moderate depression in midlife women. MATERIALS AND METHODS: Literature review and consensus of expert opinion. SUMMARY RECOMMENDATIONS: Awareness of depressive symptoms, early detection, standardized diagnostic procedures, personalized treatment and a suitable follow-up schedule need to be integrated into healthcare systems worldwide. Recommended treatment comprises antidepressants, psychosocial therapies and lifestyle changes. Alternative and complementary therapies, although widely used, may help with depression, but a stronger evidence base is needed. Although not approved for this indication, menopausal hormone therapy may improve depressive symptoms in peri- but not in postmenopausal women, especially in those with vasomotor symptoms.

Antecedents of environmental management system internalization: Assessing managerial interpretations and cognitive framings of sustainability issues.

Drawing on Bansal & Roth's model of ecological responsiveness, the study investigates how environmental managers' cognitive framings of sustainability issues and interpretations of field-level contextual factors affect decision-making processes with regard to environmental management system (EMS) internalization. Using data from a survey questionnaire of 457 ISO 14001-certified and EMAS-registered European companies, the research analyses the influence of managers' perceptions of contextual factors (i.e. environmental issue salience and governmental regulatory incentives) and managers' cognitive traits (i.e. managers' environmental concern and cognitive framings of environmental practices) on internalization. The results highlight that, while managers' perceived stakeholders' concern for the natural environment directly influences substantive internalization, governmental regulatory reliefs fail to influence the internalization of EMS. Similarly, managers' environmental concern emerges as an antecedent of internalization, while managers' adherence to an alignment logic between economic and environmental objectives does not contribute to internalization. Furthermore, the study contributes to the conceptualization of substantive internalization of environmental practices, by highlighting the existence of two distinct dimensions of EMS internalization, i.e. operational and strategic internalization.

Innovative approaches to enhancing maternal and newborn survival: Indonesia's experience in an era of global commitments to reducing mortality.

Globally, countries have made impressive strides toward achieving targets set by the Millennium Development Goals (MDGs) to reduce maternal mortality. The subsequent Sustainable Development Goals (SDGs) have further challenged countries to accelerate these reductions. While Indonesia invested in several initiatives to improve care for mothers and newborns and made large gains in improving skilled care at birth, the country fell short of its MDG target. This paper outlines some of the remaining challenges and highlights the role of the US Agency for International Development-funded Expanding Maternal and Neonatal Survival (EMAS) program in eliminating the barriers to improved care. Achieving the SDGs by 2030 will require strong cross-sectoral collaboration and innovative approaches, such as the recent launch of Indonesia's national health insurance program, which can accelerate reductions in mortality by reaching women most in need of services.

Diagnosis switching and outcomes in a cohort of patients with potential epilepsy with myoclonic-atonic seizures.

INTRODUCTION: There is overlap in the electroclinical features of many childhood epilepsy syndromes, especially those presenting with multiple seizure types, such as epilepsy with myoclonic-atonic seizures (EMAS) and Lennox-Gastaut syndrome (LGS). This study aimed to determine the frequency of diagnosis switching and the factors influencing epilepsy syndrome diagnosis in a cohort of children with possible EMAS, as well as to explore the relationship between epilepsy syndrome diagnoses, key electroclinical features, and clinically relevant outcomes. METHODS: This is a cross-sectional retrospective chart review of children treated at the Children's Hospital of Colorado with a potential diagnosis of EMAS. RESULTS: There were 77 patients that met eligibility criteria, including 39% (n = 30) with an initial diagnosis of EMAS and 74% (n = 57) with a final diagnosis of EMAS. On average, for the 65% of patients who received more than one epilepsy diagnosis, the first, second, and third diagnoses were received within one year, three years, and ten years after epilepsy onset, respectively. Final diagnosis was significantly related to obtaining at least a six-month period of seizure freedom, p = 0.03. Classic LGS traits, including paroxysmal fast activity, slow spike-and-wave, and tonic seizures were present in 50% of the overall cohort, although a minority of these patients had a final diagnosis of LGS. However, the presence of more LGS traits was associated with a higher likelihood of ongoing seizures. Adjusted for age of epilepsy onset, seizure freedom was half as likely for every additional LGS trait observed (0.49[0.31, 0.77], p = 0.002). CONCLUSION: Current epilepsy syndrome classification has reduced applicability due to overlapping features. This results in diagnosis switching and limited prognostic value for patients with an overlapping clinical phenotype. Future studies should attempt to stratify patients based not only on epilepsy syndrome diagnosis, but also on the presence of various electroclinical traits to more accurately predict outcome.

Morfologia da bolsa cloacal de emas, Rhea americana americana Linnaeus, 1758 / Morphology of rhea's cloacal bursa, Rhea americana americana Linnaeus, 1758

A bolsa cloacal é o órgão das aves responsável pela maturação e transferência de linfócitos para outros tecidos. Apesar da importância deste órgão nos mecanismos imunológicos desses animais, são escassas as informações a respeito de sua morfologia em emas. Neste estudo, objetivou-se descrever o desenvolvimento morfológico da bolsa cloacal de emas jovens. Utilizou-se 12 animais de ambos os sexos (6 machos e 6 fêmeas) para a microscopia de luz, eletrônica de transmissão e varredura. Microscopicamente, a bolsa cloacal da ema apresentou, em todas as idades a mucosa interna pregueada composta por lóbulos linfoides de diversos tamanhos, organizados como estrutura alveolar. Em cada prega verificou-se quatro componentes histológicos: as camadas mucosa, submucosa, muscular e adventícia. Esses lóbulos eram compostos de uma zona cortical, uma zona corticomedular e uma zona medular. Verificou-se a existência de linfócitos de tamanhos variados, linfoblastos, capilares sanguíneos, células reticulares epiteliais e macrófagos. Pela microscopia eletrônica de varredura, verificou-se que a superfície da mucosa dos lóbulos bursais apresentaram projeções poligonais, com a presença de curtas microvilosidades em toda a superfície. A comparação nas idades de 0 e 15 semanas de vida demostrou o desenvolvimento dos lóbulos bursais. O padrão morfológico da bolsa cloacal de emas difere do padrão comumente reportado para outras aves tais como pato selvagem, galinha da angola, ganso nativo, peru, codorna japonesa e falcão.(AU)

The cloacal bursa is the bird's organ responsible for maturation and transfer of lymphocytes to other tissues. Despite the importance of this organ in the immunological mechanisms of these animals, information about their morphology in rhea are scarce. We used 12 animals (6 males and 6 females) for light, transmission electron, and scanning microscopy. Microscopically, the cloacal bursa presented the inner mucosa consists of pleated lymphoid lobes of various sizes, organized as alveolar structure, in all ages. In each nail was found four histological components: mucosa, submucosa, muscular and adventitia layers. These lobes were composed of a cortical zone, a corticomedular zone and a medular area. It was verified the existence of varying sizes lymphocytes, lymphoblasts, blood capillaries, epithelial reticular cells and macrophages. By scanning electron microscopy, it was found that the mucous membrane surface of the bursal lobes showed polygonal projections, with the presence of short microvilli membranes throughout the surface. The comparison between 0 and 15 weeks demonstrated the development of the bursal lobes. The morphological pattern of the rhea cloacal bursa differs from standard commonly reported for other birds such as wild duck, Angola's chicken, native goose, turkey, Japanese quail, and Hawk.(AU)

How do we diagnose and treat epilepsy with myoclonic-atonic seizures (Doose syndrome)? Results of the Pediatric Epilepsy Research Consortium survey.

OBJECTIVE: To obtain and assess opinions on EMAS diagnostic criteria, recommended investigations, and therapeutic options, from a large group of physicians who care for children with EMAS. METHODS: The EMAS focus group of PERC created a survey to assess the opinions of pediatric neurologists who care for children with EMAS regarding diagnosis and treatment of this condition, which was sent to members of PERC, AES, and CNS. A Likert scale was used to assess the respondents' opinions on the importance of diagnostic and exclusion criteria (five point scale), investigations (four point scale), and treatment (six point scale) of EMAS. Inclusion/exclusion criteria were then classified as critical, strong, or modest. Investigations were classified as essential, recommended, or possible. Therapies were classified as first line, beneficial, indeterminate benefit, or contraindicated. RESULTS: Survey results from the 76 participants determined the following: EMAS inclusion criteria: history suggestive of MAS (critical), recorded or home video suggestive of MAS, generalized discharges on inter-ictal EEG, normal neuroimaging, normal development prior to seizure onset (strong). EMAS exclusionary criteria: epileptic spasms, abnormal neuroimaging, focal abnormal exam, seizure onset six years (strong). RECOMMENDED INVESTIGATIONS: EEG and MRI (essential), amino acids, organic acids, fatty acid/acylcarnitine profile, microarray, genetic panel, lactate/pyruvate, CSF and serum glucose/lactate (strong). RECOMMENDED TREATMENTS: Valproic acid (first line), topiramate, zonisamide, levetiracetam, benzodiazepines, and dietary therapies (beneficial). SIGNIFICANCE: To date, no similar surveys have been published, even though early syndrome identification and initiation of effective treatment have been associated with improved outcome in EMAS. Medications that exacerbate seizures in EMAS have also been identified. This survey identified critical and preferred diagnostic electro clinical features, investigations, and treatments for EMAS. It will guide future research and is a crucial first step in defining specific diagnostic criteria, recommended evaluation, and most effective therapies for EMAS.

Aspects of spermatogenesis and microscopic testicular morphology in Greater Rhea, Rhea americana (Linnaeus, 1758) / Aspectos da espermatogênese e morfologia microscópica testicular em Emas, Rhea americana (Linnaeus, 1758)

The purpose of this study was to study the microscopic morphology of the testicular parenchyma of Rhea americana birds. Fifty-four 2.5±0.5 year-old male adults bred in captivity. were used. During commercial slaughter, samples of testis were collected in November/2005, December/2006 and May/2007, in order to compare possible differences. The samples underwent optical microscopy analysis and measurements of seminiferous tubule (ST) total diameters, lumen, epithelium thickness and the relative volume of parenchyma. The ST had circular form in transverse cross sections. November/2005 and December/2006 samples had many types of germinative cells and spermatozoa in lumen, but in May/2007 the samples of epithelium were poor regarding meiotic and mitotic pictures, and it was difficult to find any spermatozoon; in many tubules the lumen was inexistent or diminished. In December/2006 and May/2007 the averages were: tubule diameter 110.3 and 5.3mµ, lumen 52.4 and 4.5mµ, epithelium thickness 57.8 and 0.7mµ respectively. The volumetric proportions were: seminiferous epithelium 75.6 and 75.9, cysts in epithelium 2.1 and 1.0, ST 93.3 and 84.0, interstitium 6.2 and 15.6 respectively. The sperm reserves were: 19.7±2 and 0±0 x109 sperm cells in December 2006 and May 2007 respectively. Microscopic measures of seminiferous tubules, spermatic cells and diameter of the nuclei were presented. These data confirm reproductive seasonality, with breeding season in spring-summer with sperm production. A great variation n parenchyma, when compared breeding was noticeable.(AU)

O objetivo do estudo foi estudar a morfologia microscópica do parênquima testicular de emas (Rhea americana). Foram utilizados 54 machos adultos criados em cativeiro de 2,5±0,5 anos de idade. Durante o abate comercial foram coletadas amostras de testículos em novembro/2005, dezembro/2006 e maio/2007, para efeitos de comparação. As amostras foram processadas e para microscopia ótica de rotina para análise. Foram medidas diâmetro total de túbulos seminíferos (ST), lúmen, espessura do epitélio e a proporção volumétrica dos componentes do parênquima. O ST apresentou forma circular nas seções transversais. Em novembro/2005 e dezembro/2006, se observaram os tipos de células germinativas e espermatozoides no lúmen. Em maio/2007, as amostras de epitélio se observaram escassas meioses e imagens de mitose e era difícil de ver qualquer espermatozoide, em muitos dos túbulos o lúmen era inexistentes ou diminuído de tamanho. Em dezembro/2006 e maio/2007, as médias das características estudadas foram: diâmetro dos túbulos 110,3 e 5,3 mµ, lúmen 52,4 e 4,5mµ, espessura do epitélio 57,8 e 0,7mµ, respectivamente. As proporções volumétricas foram: epitélio seminífero 75,6 e 75,9, cistos no epitélio 2,1 e 1,0, túbulos seminíferos 93,3 e 84,0, interstício 6,2 e 15,6, respectivamente. Foram apresentadas medidas microscópicas de túbulos seminíferos, diâmetro dos núcleos das espermátides. Estes dados confirmam a sazonalidade reprodutiva, com época de reprodução na primavera - verão, com a produção de esperma. Foi perceptível uma grande variação nas medidas do parênquima testicular, quando se comparou a estação reprodutiva.(AU)

A model of care for healthy menopause and ageing: EMAS position statement.

Worldwide, the number of menopausal women is increasing. They present with complex medical issues that lie beyond the traditional scope of gynaecologists and general practitioners (GPs). The European Menopause and Andropause Society (EMAS) therefore provides a holistic model of care for healthy menopause (HM). The HM healthcare model's core consists of a lead clinician, specialist nurse(s) and the woman herself, supported by an interdisciplinary network of medical experts and providers of alternative/complementary medicine. As HM specialist teams are scarce in Europe, they are also responsible for structuring and optimizing processes in primary care (general gynaecologists and GPs) and secondary care (HM specialists). Activities for accreditation of the subspecialty Women's Health are encouraged.

Exploring the link between institutional pressures and environmental management systems effectiveness: An empirical study.

Institutional theory has been widely debated by scholars. A part of literature examines how institutional pressures act on company choices regarding proactive environmental strategies. However, the institutional perspective has still not completely clarified the influence of these pressures on the effectiveness of environmental management systems (EMSs) in achieving goals in terms of eco-innovation, competitiveness and corporate reputation. This paper analyses the role played by coercive, mimetic and normative forces in stimulating innovative and competitive responses by firms with an environmental certification. Using the results of a survey on 242 European EMAS-registered organisations, the paper highlights the more positive influence of mimetic and normative pressures than coercive ones. The paper contributes to the literature debate on EMSs analysed through the lens of institutional theory.