We are in an era of rapid evolution of scholarly communication. The inaccessibility of quality texts, data, and processes is being replaced by a choral demand for transparency, equity, and democraticity. The idea of a competitive and exclusive science is replaced by that of a collaborative science in which the sharing of results is the founding value and strength for faster development. The role of commercial publishers who must rein-vent themselves in this new context changes and is challenged; the balance of power between editors, reviewers and authors changes. The tools for responding to this choral demand for transparency are all at our disposal, but still from the scientific communities there is some difficulty in taking on board the new ways of practicing, validating and disseminating research. There is still some distrust and perhaps dismay in front of possible audienc-es and a research life cycle that is potentially never-ending. On the shoulders of giants, Newton quoted. And this is especially true if the economic and legal barriers that have hitherto been an obstacle, or at least a slowdown to the development of scientific research are removed. "Doctor Virtualis" is a humanistic journal that embraced in rather dis-tant times the philosophy of openness promoted by the university that has proved successful today. Its story is the story of the journal platform that hosts it to which the journal has joined since its first year.

Ci troviamo in un’epoca di grandi mutamenti e di veloce evoluzione della comunicazione scientifica. Alla chiusura e inaccessibilità di testi, dati e processi di qualità si sostituisce la richiesta corale di trasparenza, equità e democraticità. All’idea di una scienza competitiva ed esclusiva si sostituisce quella di una scienza collaborativa in cui la condivisione dei risultati è il valore fondante e punto di forza per un più veloce sviluppo. Cambia e viene messo in discussione il ruolo degli editori commerciali che devono reinventarsi in questo nuovo contesto, cambiano gli equilibri di potere fra editor, revisori ed autori. Gli strumenti per rispondere a questa richiesta corale di trasparenza sono tutti a nostra disposizione, ma ancora da parte delle comunità scientifiche si avverte qualche difficoltà a recepire le nuove modalità di pratica, validazione e disseminazione della ricerca. Ancora si assiste a una certa diffidenza e forse sgomento di fronte ai pubblici possibili e ad un ciclo di vita delle ricerche che è potenzialmente infinito. Sulle spalle dei giganti, citava Newton. E ciò è soprattutto vero se vengono eliminate le barriere economiche e legali che hanno fino ad ora rappresentato un ostacolo, o per lo meno un rallentamento per lo sviluppo della ricerca scientifica. "Doctor Virtualis" è una rivista umanistica, di settore, che ha abbracciato in tempi piuttosto lontani la filosofia dell’apertura promossa dall’ateneo che oggi si è rivelata vincente. La sua storia è la storia della piattaforma di riviste che la ospita alla quale la rivista ha aderito fin dal primo anno. We are in an era of rapid evolution of scholarly communication. The inaccessibility of quality texts, data, and processes is being replaced by a choral demand for transparency, equity, and democraticity. The idea of a competitive and exclusive science is replaced by that of a collaborative science in which the sharing of results is the founding value and strength for faster development. The role of commercial publishers who must reinvent themselves in this new context changes and is challenged; the balance of power between editors, reviewers and authors changes. The tools for responding to this choral demand for transparency are all at our disposal, but still from the scientific communities there is some difficulty in taking on board the new ways of practicing, validating and disseminating research. There is still some distrust and perhaps dismay in front of possible audiences and a research life cycle that is potentially never-ending. On the shoulders of giants, Newton quoted. And this is especially true if the economic and legal barriers that have hitherto been an obstacle, or at least a slowdown to the development of scientific research are removed. Doctor Virtualis is a humanistic journal that embraced in rather distant times the philosophy of openness promoted by the university that has proved successful today. Its story is the story of the journal platform that hosts it to which the journal has joined since its first year.

Abstract Introduction Little is known about progression of atrial fibrillation (AF) from paroxysmal to persistent form. Electrical remodeling may play a pivotal role in the arrhythmia transition. The aim of the study was the characterization of the atrial electrical substrate in patients suffering from AF. Methods Twenty-seven patients were included in the study (14 with paroxysmal AF and 13 with persistent AF). Two simultaneous electroanatomical maps of the left atrium were collected using PentaRay catheter using the parallel mapping feature [first map during sinus rhythm and a second one with an extrastimulus from coronary sinus (CS)]. We analyzed the propagation of the wavefront and we identified zones of abnormal conduction: slow conduction (SC) corridors and pivot points (PP). SC corridors were defined by the slowing of conduction velocity; pivot points were zones in which propagation pattern changed the direction of 90° or more. Maximum delay between the recording dipoles located at the extremities of the PentaRay splines was calculated. At each of these sites, EGMs were collected and analyzed in terms of amplitude and duration. We checked if areas of abnormal conduction during sinus rhythm were present or they disappeared by delivering an extrastimulus from the coronary sinus. Results The average number of collected EGMs per map was 4790 ± 1333 (PAF 4829 ± 1407; PsAF 4745 ± 1402). Total abnormal conduction areas in the 27 patients were 62, 65% of which were slow conduction. Pivot points and slow conduction manifested a trend to cluster in some areas: both of them were mostly present at the ostia of pulmonary veins, in a specific segment between LAA ostium and mitral annulus and in the posterior wall. During sinus rhythm, pivot points were 29, while pacing from distal CS catheter the same zones showed normal conduction in 14 cases: they were still present in 60% in PAF group and 50% in PsAF. Slow conduction corridors, instead, show a trend to remain while pacing from CS: 76% in the first group and 78% in the second one. Conclusions SC corridors are fixed alterations of atrial substrate, while pivot sites may be more dynamic entities: both of them may have a key role in remodeling atrial structures and atrial fibrillation progression and maintenance. These may represent future targets for AF therapy and prevention.

Abstract Background The introduction of Cardiac-MRI (cMRI) in clinical practice has considerably improved risk stratification of patients with hypertrophic cardiomyopathy (HCM). However, the prediction of adverse outcome based on imaging markers remains suboptimal. Right ventricular (RV) involvement is an emerging finding in this disease of unknown clinical value. The identification of accurate and sensible imaging markers to detect morpho-functional alterations of the RV is therefore essential to establish, in the future, any prognostic impact of RV involvement in HCM in order to improve risk stratification. RV free wall longitudinal strain (RV-FWLS) is a promising marker to unveil subclinical RV dysfunction despite normal conventional indices of RV systolic function; however, RV-FWLS has been scarcely explored in HCM patients. Case Summary A 29-year-old man with sarcomeric HCM due to MYBPC3 mutation was referred to our Institution. Trans-Thoracic Echocardiography (TTE) showed left ventricular (LV) apical hypertrophy (27 mm) with an ace of spades morphology and mid-ventricular obstruction (peak gradient 38 mmHg). LV-EF was normal (62%) while LV global longitudinal strain was significantly impaired (-9.3% with a reverse apical sparing pattern). 2nd-degree diastolic dysfunction and left atrial enlargement (maximum volume: 42 ml/m2) were observed. No LV apical aneurysm nor paradoxical diastolic flow at the apex were noted. RV hypertrophy was present (maximum thickness 8 mm) with normal conventional indices of RV systolic function: TAPSE 26 mm, S’ TDI 12 cm/s, FAC 50%. In contrast, RV-FWLS was significantly reduced (–16%). cMRI confirmed normal bi-ventricular function in presence of left and right hypertrophy (maximum wall thickness 28 and 12 mm, respectively) and LV apical thinning. At tissue characterization, elevated native T1 and T2 values were evident in the apex (1071 +/- 45 ms and 54 +/- 6 ms, respectively) and a significant amount of patchy LGE was present in the mid-apical segments of the LV (28% of LV mass) and of the RV. After consideration of clinical and imaging data, an s-ICD for primary prevention was implanted. Discussion The present case highlights known issues and poses new challenges in managing HCM patients. First, it confirms the central role of cMRI, demonstrating its unique capability to spot myocardial fibrosis, guiding our decision to implant an s-ICD in our patient. Second, it draws attention to RV involvement in HCM, an emerging finding in this condition. MYBPC3 mutation has been associated with RV hypertrophy. Both of these conditions, together with patchy RV-LGE, were found in our patient. Notably, RV-FWLS was the only RV systolic index to be impaired and might represent an early and more accurate marker of RV systolic dysfunction compared to other conventional indices, including RV-EF by cMRI. Future studies assessing the prognostic value of RV involvement, including RV-LGE and RV-FWLS, are needed in HCM patients to potentially refine risk stratification in this challenging population.

Abstract Introduction Post-operative atrial fibrillation (POAF) represents the most common arrhythmia in the post-operative setting, with a peak incidence from day 0 to 5 after surgery and it represents a main cause of morbidity, mortality, length of stay, thromboembolic events and stroke. Cardiothoracic surgery has the highest rates of POAF, while data about other surgeries are contrasting amongst various studies. Aim of this study was to detect POAF onset in the 28 days after surgery and to better assess its predictors, especially the role of inflammation. Methods This is a retrospective single center cohort study of 53.387 patients undergoing surgery from January 2016 to January 2020. Patients were classified in four groups according to types of surgery performed: (I) orthopedic surgery, (II) not thoracic nor abdominal surgery, (III) abdominal and esophageal surgery and (IV) lung and cardiovascular surgery. Kaplan–Meier estimates were used to draw the cumulative incidence curves by surgery groups; finally, they were compared with a log-rank test. Furthermore, multivariable Cox proportional hazards (PH) models of prognostic factors were used. Confounders were selected according to a review of the literature, statistical relevance, and consensus opinion by an expert group of physicians and methodologists. After fitting the model, the PH assumption was examined on the basis of Schoenfeld residual. Results The primary endpoint of AF onset occurred in 570 patients (1.1%) with a mean incidence after surgery of 3.4±2.6 days. 90 patients died (0.17%) after an average of 13.7±8.4 days. The Kaplan-Meier analysis showed the lowest 28-day event-free survival in group IV and the highest in group I (log-ranks test p=0.0001). In patients who developed AF, levels of C-Reactive Protein (CRP) were higher than the others (mean 0,70+0.03 log10 mg/dL versus mean 0,40+0.01 log10 mg/dl; p <0.0001) with higher levels in group III and group IV. In the univariable Cox regression, CRP was a strong predictor of AF (HR per 1 unit increase in log-scale, 2.64; 95% C.I,1.74–4.0; p<0.0001). This was confirmed at the multivariable analysis, adjusting for confounding factors like age, gender, length of stay in hospital and group of surgery (adjusted HR per 1 mg/dL increase in log-scale, 1.81; 95% CI,1.18–2.79; p = 0.007). Other strong predictors of POAF were age (HR per 1 year increase, 1.06; 95% CI, 1.04–1.08; p< 0.0001) and surgery of group III and IV (HR, 23.62; 95% CI, 5.65–98.73; p< 0.0001 and HR,6.26; 95% CI, 1.48–26.49; p 0.013, respectively).The PH assumption was not violated (p=0.12). Conclusions POAF represents a frequent complication of surgery and major burden for healthcare. Inflammation may represent a major driver in its pathophysiology, especially in non-cardiac surgery, in which manipulation of cardiac tissue is avoided. This may explain the poor response to antiarrhythmic drugs and its self-limiting nature, which expires when post-operative inflammation turns off.

. EOSC's vision of opening the research cycle and facilitating the collaboration of researchers will certainly lead to better quality science and in theory it is easy to share. However, its realization must be made possible through policies at national and institutional level. There is a need of creating a socio-technical infrastructure in order to improve FAIR RDM in Italy. FAIR RDM initiatives in Italy are still based on communities of practice that voluntarily carry out national awareness and training activities. The authors have investigated the perception of some leaders of FAIR RDM initiatives in Italy with respect to good practices, challenges and the strategic vision that should be sought. Findings ev-idence that to implement EOSC in Italy, investments and policies are needed to support the initiatives and services launched by the forerunner institutions. There is also the need of trained data stewards as competent professionals.

Editor: Emma Lazzeri, Federica Tanlongo, Gina Pavone. Authors: Federico Alpi (SciRe Foundation), Alessio Ansuini (Area Science Park), Elis Bertazzon (GARR), Daniele Bonacorsi (INFN), Federica Cappelluti (Politecnico of Turin), Sara Casati (BBMRI-ERIC), Donatella Castelli (CNR), Roberto Cippitani (University of Perugia), Valentina Colcelli (CNR), Alessandro Costantini (INFN), Stefano Cozzini (Area Science Park), Emiliano Degl'Innocenti (CNR), Francesca Di Donato (CNR), Sara Di Giorgio (GARR), Ilaria Fava (University of Göttingen), Sandro Fiore (University of Trento), Monica Forni (University of Bologna), Paola Galimberti (Università Statale di Milano), Elena Giglia (University of Turin), Alessandra Giorgetti (OGS), Shalini Kurapati (Politecnico di Torino), Marco Landoni (INAF), Marialuisa Lavitrano (University of Milano-Bicocca), Emma Lazzeri (GARR and CNR), Cristina Marras (CNR), Franco Niccolucci (INFN), Marisol Occioni (Ca' Foscari University of Venice), Elda Osmenaj (Area Science Park), Gabriella Paolini (GARR), Valentina Pasquale (IIT), Gina Pavone (CNR), Caterina Petrillo (Area Science Park), Roberto Pugliese (Elettra Sincrotrone), Ermann Ripepi (CNR), Giorgia Rivoira (OGS), Giorgio Rossi (University of Milan), Stefano Salon (OGS), Alessandro Sarretta (CNR), Alberto Sartori (SISSA), Daniele Spiga (INFN), Donatella Tamagno (Scuola Normale Superiore di Pisa), Anna Maria Tammaro (University of Modena and Reggio Emilia), Federica Tanlongo (GARR), Michela Vellico (OGS), Marialaura Vignocchi (University of Bologna), Antonella Zane (University of Padua). ICDI Competence Centre for Open Science, FAIR, and EOSC 1.Mission and objectives 1 2.Stakeholders and roles 3 3.Definition of skills and competences 3 4.Definition of activities and services 5 5.Web portal 6 6.Added value for stakeholders 6

This article is intended to be a contribution to the discourse on evaluation in the humanities and on its effects, including - and above all - those not foreseen (for naivety or superficiality) and those unintended (for failure to understand that the 'one size fits all' cannot be applied indiscriminately). Evaluation is not good or bad: it is its use that should make us aware and careful. What has been reported derives from years of observation of the dynamics of research in the field of human and social sciences, and unfortunately from the awareness that these dynamics are often oriented by motivations that are outside the scope of the its primary purpose, which is the advancement of knowledge and well-being of society.

The aim of this contribution is to investigate how open science can influence/support research evaluation and whether and how open science practice can be evaluated in its effort to avoid what is predicted by Goodhart's law (When a measure becomes a target, it ceases to be a good measure). The enterprise is not simple, as it focus on giving up points of reference that have been part of common practice of hard sciences for years while we are now trying to implement them in humanities and social sciences. We must accept that the internet has changed the way science is produced, disseminated, validated and evaluated and has multiplied its channels of communication. For this reason the traditional bibliometric indicators, which refer to articles published in peer reviewed journals, preferably in English, as the only viable publication channel, become inapplicable. In an open environment, the role of peer review, in particular the idea of blind (single or double) peer review must also radically change.

Le tematiche della apertura e dell’accesso ai risultati della ricerca scientifica sono state variamente affrontate in Italia, in momenti e in modi diversi, senza che si sia mai riusciti a produrre un piano nazionale che portasse ad interventi organici, senza che si siano sviluppate strategie finalizzate al raggiungimento di Certamente sono stati commessi errori di comunicazione da parte degli enti finanziatori, che hanno imposto determinate regole senza curarsi del contesto (un contesto che definiremo sinteticamente ‘publish or perish’). Non ci sono ricette che vadano bene per tutti e ovunque, ma certamente quanto fatto fino ad ora in Italia è del tutto insufficiente e non ha modificato minimamente le pratiche dei ricercatori in un’ottica di trasparenza dei processi, di riproducibilità delle ricerche di collaborazione e condivisione dei risultati. Quella che segue è la descrizione del percorso (tutt’ora in atto) di un grande ateneo multidisciplinare verso un cambiamento culturale che renda la scienza aperta il modo di fare scienza dei suoi ricercatori e non semplicemente una serie di dichiarazioni di principio che restano lettera morta.

Tavola rotonda conclusiva della IV conferenza AISA Scienza aperta, pubblicita, democrazia [Final panel discussion of the AISA 4th annual conference Scienza aperta, pubblicita, democrazia]

Purpose of reviewAtrial fibrillation and heart failure are commonly encountered in current clinical practice. This review aims to revisit the complex interaction of these two common situations and the best treatment whenever both occurs, especially focusing on heart failure patients undergoing cardiac resynchronization therapy (CRT).Recent findingsIt has been recently confirmed that in patients undergoing cardiac resynchronization therapy, 100% biventricular pacing percentage should be pursued. Large observational studies confirmed that atrioventricular junction ablation is very often the only way to gain 100% biventricular pacing in atrial fibrillation.SummaryOn the basis of the recent observational extensive data, in patients presenting intermediate or elevated atrial tachycardia-atrial fibrillation burden, atrioventricular junction ablation may represent a fundamental tool to achieve full CRT delivery, thus, conferring marked improvements in global cardiac function, and by extension, in survival. Atrial fibrillation patients should not be excluded from CRT, provided that maximal biventricular pacing is warranted.

The aim of the present study was to investigate sources of variation of milk composition and technological characteristics routinely collected in field conditions in the Italian dairy industry. A total of 40,896 bulk milk records from 620 herds and 10 regions across Italy were analyzed. Composition traits were fat, protein, and casein percentages, urea content, and somatic cell score; and technological characteristics were rennet coagulation time, curd firming time, curd firmness 30 min after rennet addition to milk, and titratable acidity. Data of herd bulk milks were analyzed using a model that included fixed effects of region, herd nested within region, and season of milk analysis. An average good milk quality was reported in the dairy industry (especially concerning fat, protein, and casein percentages), and moderate to high correlations between composition and technological traits were observed. All factors included in the statistical model were significant in explaining the variation of the studied traits except for region effect in the analysis of casein and somatic cell score. Northeast and central-southern Italian regions showed the best performance for composition and technological features, respectively. Traits varied greatly across regions, which could reflect differences in herd management and strategies. Overall, less suitable milk for dairy processing was observed in summer. Results of the present study suggested that a constant monitoring of technological traits in the dairy industry is necessary to improve production quality at herd level and it may be a way to segregate milk according to its processing characteristics.

The atrioventricular junction ablation (AVJA) and pacing method has been a well-known strategy since the 1980s. It is nowadays essentially performed in two groups of patients. First of all, it is indicated in atrial fibrillation (AF) patients who have failed rhythm control with pulmonary vein isolation ablation and different medical rate control strategies. The procedure dramatically reduces symptoms and it is associated with an increase in ejection fraction in patients with AF-induced cardiomyopathy. The second group of patients is represented by heart failure patients with a cardiac resynchronization system presenting with a low biventricular pacing percentage due to a high AF burden. Several studies have documented the necessity to achieve the highest biventricular pacing to maximize cardiac resynchronization therapy (CRT) benefits. In this context of AF patient with CRT, AVJA is the only tool that allows complete rhythm regularization and heart rate control, thus favouring a ‘pure’, constant delivery of CRT, while negative chronotropic drug use is limited and device algorithms only partially effective. An improvement of symptoms, of left ventricular function, as well as survival benefit has been clearly documented after AVJA in AF CRT patients. The procedure is usually safe and effective; nonetheless, it is often perceived as a potentially harmful therapy that should be avoided as much as possible because it causes pacemaker dependency. However, no studies on conventional ablate and pace therapy have reported significant complications during the follow-up. Furthermore, the aforementioned benefits of AVJA in the heart failure population seem to well overweigh possible risks associated with pacemaker dependency.

OBIETTIVO: Il presente lavoro ha l'obiettivo di esplorare se e come sono ricordati gli infermieri italiani dipendenti dell'Ospedale Maggiore di Milano caduti nella Grande Guerra. Inoltre, si vuole contribuire a tratteggiare l'identiti professionale nei primi anni del Novecento in Italia.METODO: Si e esaminata la documentazione amministrativa di 127 infermieri in servizio nell'Ospedale Maggiore di Milano e chiamati alle armi tra il 1915 e il 1918. I documenti sono stati rinvenuti nell'Archivio storico dell'ospedale milanese dal luglio 2015 al marzo 2016 e analizzati attraverso l'impiego della metodologia della ricerca storica secondo Chabod (2012).RISULTATI: Si e scoperta la testimonianza di 5 infermieri caduti durante la Prima Guerra Mondiale. Onorati come soldati coraggiosi, sono ricordati per la diligenza, la sollecitudine e il riguardo nella cura dei malati. Per non dimenticarli, la comuniti ospedaliera esprime riconoscenza alle famiglie con contributi economici e li commemora incidendone i nomi in un'epigrafe marmorea.CONCLUSIONI: Dai risultati dell'indagine sono emersi numerosi ricordi d'infermieri civili periti negli anni 1915-1918, dai quali e stato possibile scorgere l'identiti professionale negli anni 20 del Novecento. La partecipazione degli infermieri nella Prima Guerra Mondiale, in concomitanza con la ricorrenza del suo centenario, puo essere ulteriormente approfondita.PAROLE CHIAVE: Infermieri italiani, Prima Guerra Mondiale, Storia.ABSTRACTAIM: Several Italian male nurses employed at the Ospedale Maggiore in Milan were among the dead during First World War. This paper investigates whether and in which way these people are remembered. In addition the authors draw a picture of the nursing profession as it were in the early Twentieth Century in Italy.METHOD: The administrative documentation of 127 male nurses on duty at the Ospedale Maggiore in Milan and called to arms between 1915 and 1918 was examined. The documents were found in the historical archive of the Ospedale Maggiore from July 2015 to March 2016 and analyzed using the method of historical research according to Chabod (2012).RESULTS: Documents that witnessed the death of 5 male nurses during the war were found. These people were praised for their courage, self-sacrifice and commitment in attending the sick and the wounded. The hospital community arranged to devolve a sumof money to their families in sign of gratitude and commemorated them by engraving their names in a marble monument.CONCLUSIONS: Many memories of civilian male nurses in the years 1915-1918 emerged from this investigation, and the professional identity of nurses in the 1920s emerged quiteclearly. The participation of male nurses in the First World War, in conjunction with the recurrence of its centenary, could be further deepened.KEYWORDS: Italian Male Nurses, First World War, History.

AIM:Several Italian male nurses employed at the Ospedale Maggiore in Milan were among the dead during First World War. This paper investigates whether and in which way these people are remembered. In addition the authors draw a picture of the nursing profession as it were in the early Twentieth Century in Italy.METHOD:The administrative documentation of 127 male nurses on duty at the Ospedale Maggiore in Milan and called to arms between 1915 and 1918 was examined. The documents were found in the historical archive of the Ospedale Maggiore from July 2015 to March 2016 and analyzed using the method of historical research according to Chabod (2012).RESULTS:Documents that witnessed the death of 5 male nurses during the war were found. These people were praised for their courage, self-sacrifice and commitment in attending the sick and the wounded. The hospital community arranged to devolve a sum of money to their families in sign of gratitude and commemorated them by engraving their names in a marble monument.CONCLUSIONS:Many memories of civilian male nurses in the years 1915-1918 emerged from this investigation, and the professional identity of nurses in the 1920s emerged quite clearly. The participation of male nurses in the First World War, in conjunction with the recurrence of its centenary, could be further deepened.

Use of cardiac implantable devices and catheter ablation is steadily increasing in Western countries following the positive results of clinical trials. Despite the advances in scientific knowledge, tools development, and techniques improvement we still have some grey area in the field of electrical therapies for the heart. In particular, several reports highlighted differences both in medical behaviour and procedural outcomes between female and male candidates. Women are referred later for catheter ablation of supraventricular arrhythmias, especially atrial fibrillation, leading to suboptimal results. On the opposite females present greater response to cardiac resynchronization, while the benefit of implantable defibrillator in primary prevention seems to be less pronounced. Differences on aetiology, clinical profile, and development of myocardial scarring are the more plausible causes. This review will discuss all these aspects together with gender-related differences in terms of acute/late complications. We will also provide useful hints on plausible mechanisms and practical procedural aspects.

L’intervento percorre i passi fondamentali della creazione della piattaforma di riviste open access dell’Universita degli Studi di Milano, come modello in cui una istituzione che produce conoscenza decide di assumersi la responsabilita di validare e diffondere questa conoscenza ad un pubblico che sia il piu ampio possibile, liberandosi da scelte e vincoli imposti dagli editori commerciali e dalle logiche editoriali e riportando nelle mani dei ricercatori le attivita che da tempo erano state consegnate agli editori.