The tiered restrictions enforced in November 2020 did not impact the epidemiology of the second wave of COVID-19 in Italy.

In the attempt to counter the second COVID-19 wave in autumn 2020, the Italian government introduced a unique countrywide system of physical distancing measures organized in progressively restrictive tiers (coded as yellow, orange, and red) imposed on a regional basis according to epidemiological risk assessments. This followed a set of other scattered or limited measures described in full detail by Manica et al.1. This paper concerns the introduction of the tiered restrictions. The data used to evaluate the impact of the restriction system on SARS-CoV-2 transmissibility and hospitalization burden in Italy is from the Italian COVID-19 integrated surveillance system. The reproduction number R(t) estimated on the onset of COViD-19 symptoms constantly decreased during most of the observation period 04 October 2020 - 06 December 2020 than is centered on the date of introduction of the measures and includes the expected latency to reach an effect. The fastest decrease of R(t) occurred in the period preceding the introduction of the tiered restrictions. There was no evidence that introducing the tiered restrictions determined the reduction of R(t). An alternative analysis using the daily growth rate of the epidemic curve confirms these conclusions. Similar considerations are made concerning the health system burden, analyzing hospitalizations at country level. The trend of R(t) tending to increase shortly after the measures became effective does not allow to exclude that the enforcement of such restrictions might have been counterproductive. These results are instrumental in informing public health efforts aimed at attempting to manage the epidemic efficiently. Planning further use of the tiered restrictions and the associated containment measures should be carefully and critically revised to avoid a useless burden to the population with no advantage for the containment of the epidemic or a possible worsening.

Glocalization – An Objective Condition for a Successful Management of the Multinational Companies in the Context of the Economic Globalization

Currently, one of the most concise expressions of the phenomenon of economic globalization is the extent of the organization of production on a global or regional basis and the integration on new criteria, of a functional nature, of the activities within it. A decisive role in the organization of production processes abroad is played by multinational companies, which, in order to achieve their objectives, most “export” not only know-how, but also management methods and techniques, applicable in the countries of origin. In this article, the authors aim to identify and highlight the main arguments that support the glocalization as an objective necessity and, at the same time, a viable solution to achieving a successful management of the multinational companies, to ensure a win-win relationship between them and the communities and the local markets in which they operate, in the context of economic globalization.

Oxford Textbook of Plastic and Reconstructive Surgery

The Oxford Textbook of Plastic and Reconstructive Surgery is a comprehensive reference text detailing all aspects of plastic surgery pertinent to a surgeon in training for specialization and suitable to use in preparation for the Intercollegiate Examination as all aspects of the curriculum are covered. This volume is also the perfect resource for practising plastic surgeons, summarizing contemporary trial knowledge as well as discussing anatomy, examination, and techniques. Chapters are divided into those that detail basic principles and technique, and those that, on a regional basis, describe the conditions and their treatments that form the wide spectrum of reconstructive and aesthetic plastic surgery. Bringing together the expertise of almost 200 specialist contributors in the field, the Oxford Textbook of Plastic and Reconstructive Surgery is a highly valuable source of information.

Impact of tiered restrictions on human activities and the epidemiology of the second wave of COVID-19 in Italy

To counter the second COVID-19 wave in autumn 2020, the Italian government introduced a system of physical distancing measures organized in progressively restrictive tiers (coded as yellow, orange, and red) imposed on a regional basis according to real-time epidemiological risk assessments. We leverage the data from the Italian COVID-19 integrated surveillance system and publicly available mobility data to evaluate the impact of the three-tiered regional restriction system on human activities, SARS-CoV-2 transmissibility and hospitalization burden in Italy. The individuals’ attendance to locations outside the residential settings was progressively reduced with tiers, but less than during the national lockdown against the first COVID-19 wave in the spring. The reproduction number R(t) decreased below the epidemic threshold in 85 out of 107 provinces after the introduction of the tier system, reaching average values of about 0.95-1.02 in the yellow tier, 0.80-0.93 in the orange tier and 0.74-0.83 in the red tier. We estimate that the reduced transmissibility resulted in averting about 36% of the hospitalizations between November 6 and November 25, 2020. These results are instrumental to inform public health efforts aimed at preventing future resurgence of cases.

The Impact of Land-Ocean Contrast on The Seasonal To Decadal Variability of The Northern Hemisphere Jet Stream

Seasonal to decadal variations in Northern Hemisphere jet stream latitude and speed over land (Eurasia, North America) and oceanic (North Atlantic, North Pacific) regions are presented for the period 1871 – 2011 from the Twentieth Century Reanalysis dataset. Significant regional differences are seen on seasonal to decadal timescales. The ocean acts to reduce the seasonal jet latitude range from 20° over Eurasia to 10° over the North Atlantic where the ocean meridional heat transport is greatest. The mean jet latitude range is at a minimum in winter (DJF), along the western boundary of the North Pacific and North Atlantic, where the land-sea contrast and SST gradients are strongest. The 141-year trends in jet latitude and speed show differences on a regional basis. The North Atlantic has significant increasing jet latitude trends in all seasons, up to 3° in winter. Eurasia has significant increasing trends in winter and summer, however, no increase is seen across the North Pacific or North America. Jet speed shows significant increases evident in winter (up to 4.7ms -1 ), spring and autumn over the North Atlantic, Eurasia and North America however, over the North Pacific no increase is observed. Long term trends are generally overlaid by multidecadal variability, particularly evident in the North Pacific, where 20-year variability in jet latitude and jet speed are seen, associated with the Pacific Decadal Oscillation which explains 50% of the winter variance in jet latitude since 1940. Northern hemisphere jet variability and trends differ on a regional basis (North Atlantic, North Pacific, Eurasia and America) on seasonal to decadal timescales, indicating different mechanisms are influencing the jet latitude and speed. It is important that the differing regional trends and mechanisms are incorporated into climate models and predictions.

Global Vaccine Hesitancy Segmentation: A Cross-European Approach

Vaccine-preventable diseases are global mainly in a globalized world that is characterized by a continuous movement of people and goods across countries. Vaccine hesitancy, the reluctance or refusal to vaccinate despite the availability of vaccines, is rising worldwide. What if the problem of vaccine hesitancy could be most effectively managed when treated globally rather than on a national or regional basis? What if a global vaccine-hesitant segment exists and the differences among countries are not so significant? Based on the Global Marketing Strategy paradigm, this paper shows that seven different cross-European segments exist based on the beliefs, attitudes, and behaviors collected in 28 European countries. These pan-European segments are differentiable (people in those segments have similar characteristics that are visibly dissimilar from the ones in other segments) and actionable (organizations would be able to propose interventions to the hesitant segments based on their profiles). With segmentation being the starting point of many public health intervention strategies for avoiding vaccine-hesitancy, the results recommend moderating the full-adaptation strategy that follows the “context matters” principle suggested by several political and public health international organizations. Embracing a more standardized strategy will allow the development of better services and strategies that support and enable desirable vaccination behaviors.

The Efficiency of Financing the Regional Smart-Specialization Strategies’ Implementation from the EU Structural Funds

The paper provides the empirical analysis of the efficiency of financing the regional smart-specialization strategies’ implementation from the structural funds in the context of its impact on the improvement of economic wellbeing and prevention of growing regional misbalances in the EU at the NUTS 2 level. It verifies the inverse correlation between the GRP volumes per capita in the EU Member States and the volumes of funding of the smart-specialization activities. The financial resources of the EU structural funds for the implementation of the regional smart-specialization strategies are established to be distributed on a regional basis and to be showing the signs of the aligning policy, which is a reasonable tactic from the viewpoint of the need to secure the balanced spatial development. However, the paper emphasizes that the less developed regions aren’t able to fully generate powerful innovations that would boost the economic activity in the smart-specialization domains yet.

A 2D Photographic and 3D Digital Dental Model Analysis of Golden Percentage in Maxillary Anterior Teeth

The objective of this paper was to evaluate the existence of golden percentage in natural maxillary anterior teeth with the aid of 3D digital dental models and 2D photographs. And to propose regional values of golden percentage for restoration of maxillary anterior teeth. For this purpose, one hundred and ninety dentate subjects with sound maxillary anterior teeth were selected. Standardized frontal images were captured with DSLR, and the apparent width of maxillary anterior teeth was measured utilizing a software on a personal laptop computer. Once the dimensions were recorded, the calculations were made according to the golden percentage theory (GPT). The data were analyzed by independent and paired T -test. The level of significance was set at p < 0.05 . The golden percentage values were not found in this study. The values obtained were 16%, 15%, 20%, 20%, 15%, and 16% moving from the right canine to the left canine teeth. There was no significant gender difference in the golden percentage values. Thus, golden percentage should not be used solely for the correction of anterior teeth or for determining dental attractiveness. Emphasis should be given to a range of dental proportion on regional basis.

The known burden of Huntington disease in the North of Scotland: prevalence of manifest and identified pre-symptomatic gene expansion carriers in the molecular era

Background Huntington disease prevalence was first estimated in Grampian, northern Scotland in 1984. Molecular testing has since increased ascertainment. Objective To estimate the prevalence of manifest Huntington disease and identified pre-symptomatic gene expansion carriers (IPGEC) in northern Scotland, and estimate the magnitude of biases in prevalence studies that rely upon routine coding in primary care records. Methods Cases were ascertained using North of Scotland genetic laboratory, clinic, and hospital records. Prevalence was calculated for manifest and IPGEC on 01/07/2016 and 01/01/2020 and compared with local published data. Results The prevalence of manifest Huntington disease in northern Scotland in 2020 was 14.6 (95% CI 14.3–15.3) per 100,000, and of IPGEC was 8.3 (95% CI 7.8–9.2) per 100,000. Whilst the population of northern Scotland decreased by 0.05% between 2016 and 2020, the number of manifest and identified pre-symptomatic gene expansion carriers increased by 7.4% and 23.3%, respectively. Manifest disease in Grampian increased by 45.9% between 1984 and 2020. More women than men had a diagnosis. General Practice coding underestimated symptomatic molecularly confirmed prevalence by 2.2 per 100,000 people. Conclusion Even in an area with previously high ascertainment, there has been a 45.9% increase in manifest Huntington disease over the last 30 years. Within our catchment area, prevalence varies between health board regions with similar community-based services. Such variation in prevalence could have major drug cost and service delivery implications, especially if expensive, complexly administered therapies prove successful. Health services should gather accurate population-based data on a regional basis to inform service planning.