THE INVOLVEMENT OF BREAST CANCER PATIENTS AND FAMILY MEMBERS DURING ONCOLOGICAL CONSULTATIONS. A STUDY TO EXPLORE THE INFORMATION NEEDS AND TO ASSESS THE EFFECTS OF A PRE-CONSULTATION INTERVENTION TO INCREASE THE PATIENTS INVOLVEMENT IN THE INFORMATION EXCHANGE.

Contesto: L'interesse per la comunicazione tra medico e paziente in ambito oncologico \ue8 in costante aumento, in particolare per quanto riguarda i bisogni informativi dei pazienti oncologici. Gli studi sul coinvolgimento dei pazienti mostrano che i medici adottano pochi tentativi aventi lo scopo di coinvolgere i loro pazienti, i quali, se non facilitati, chiedono poche informazioni ed esprimono pochi dubbi circa la loro condizione. D'altra parte, i pazienti che partecipano al processo decisionale dimostrano, invece, una maggiore aderenza al trattamento e hanno migliori esiti per quanto riguarda la salute. Due tecniche di intervento principali sono state testate nel tentativo di rendere i pazienti pi\uf9 consapevoli circa i loro bisogni e per incoraggiarli a fare pi\uf9 domande nel corso della consultazione. In primo luogo, essi sono stati incoraggiati, anche attraverso un processo educativo, a generare un proprio elenco di domande. In secondo luogo ai pazienti \ue8 stata fornita, invece, una lista strutturata e pre-costituita di domande basate sull\u2019evidenza, il Question Prompt Sheet (QPS). Obiettivi: L'obiettivo di questo studio \ue8 quello di valutare gli effetti di un intervento strutturato di pre-consultazione (QPS) confrontato con un semplice intervento (QL) nell\u2019aumentare il coinvolgimento dei pazienti con carcinoma mammario, attraverso un aumento delle domande. Metodi: Tutti i pazienti con cancro al seno che frequentano i servizi ambulatoriali di oncologia per la prima volta vengono assegnati in modo casuale a uno dei due gruppi di intervento. L'intervento consiste nella presentazione di un elenco di domande rilevanti, inerenti alla patologia oncologica (QPS) o nella richiesta di generare un elenco personale di domande pertinenti (QL) prima della consultazione. Questionari standardizzati vengono somministrati al baseline (prima della randomizzazione) e subito dopo la consultazione. La misura di esito primario \ue8 il numero di domande poste dai pazienti nel corso della consultazione misurato tramite l\u2019audio-registrazione della visita. Risultati: Tra tutti i pazienti (537), 143 sono stati esclusi per criteri di esclusione. Dei 394 pazienti eleggibili, 70 hanno rifiutato di partecipare allo studio, in modo che dei rimanenti 324 pazienti, 164 sono stati assegnati al gruppo QPS e 160 al gruppo QL, secondo la randomizzazione. 16 registrazioni sono state perse per motivi tecnici. Il campione finale comprendeva 308 pazienti con dati completi: 158 nel gruppo QPS e 150 nel gruppo QL. Il totale dei pazienti ha fatto in media 14 domande. I pazienti nel gruppo QPS hanno fatto in media 13 domande, mentre nel gruppo QL ne hanno fatte in media 16. La differenza tra i due bracci era statisticamente significativa (t (271) = - 1.99, p = .05). L'effetto della struttura gerarchica del campione \ue8 stata misurata mediante correlazione intra-classe (ICC). I risultati ottenuti con il modello lineare misto, tenendo conto della struttura gerarchica, mostrano che la differenza fra gli interventi ha perso di significativit\ue0 (b = 1,7; 95%; CI: - .29; 3.64 p = 9%.). Discussione: Nel nostro studio abbiamo confrontato il QPS con una domanda aperta (QL) nell\u2019altro gruppo, che pu\uf2 aver giocato un ruolo importante, tanto quanto il QPS nella preparare i pazienti, prima della consultazione, a focalizzare meglio la loro attenzione su ci\uf2 che desiderano chiedere al loro oncologo. Preparare i pazienti per la consultazione (tramite il QPS o il QL) \ue8 un modo semplice e veloce per promuovere i pazienti a fare domande e pu\uf2 migliorare la comunicazione globale tra l\u2019oncologo e il paziente.Background: The interest in communication issues regarding cancer care has steadily increased, in particular concerning the information needs of oncology patients. Studies on patient involvement show that physicians make few attempts to involve their patients who ask few questions if not facilitated. On the other hand, patients who participate in the decision making process show greater treatment adherence and have better health outcomes. Two main intervention techniques have been tested in an attempt to make patients more aware about their needs and to encourage them to make more questions during the consultation. Firstly, they have been encouraged, though a coaching process to generate their own list of questions. Secondly patients have been provided with a structured pre-prepared list of evidence based questions, a Question Prompt Sheet (QPS). Aims: The aim of this study is to assess the effects of a pre-consultation structured intervention (QPS) compare to a simple intervention (QL) to increase the involvement of breast cancer patients by determining an increase in questioning. Methods: All patients with breast cancer who attend the Oncology Out-patient Services for the first time are randomly assigned to one of the two intervention groups. The intervention consists of the presentation of a list of relevant illness-related questions (QPS) or a request to generate a list of relevant questions (QL) before the consultation. Standardised questionnaires are administered at baseline (before the randomisation) and immediately after the consultation. The main outcome measure is the number of questions asked by patients during the consultation Results: Among all patients (537), 143 were excluded for exclusion criteria. Of the 394 eligible patients, 70 refused to participate in the study, so that the remaining 324 patients, 164 were assigned to the QPS group and 160 to the QL, according to the randomization. 16 audiotapes were lost due to technical reasons so that the final sample comprised 308 patients with complete data: 158 and 150 respectively in the QPS and QL group. All Patient asked an average of 14 questions. Patients in the QPS group asked an average of 13 while in the QL group they asked an average of 16 questions. The difference between pooled arms was statistically significant (t (271) = \u2013 1.99, p = .05). The effect of hierarchical structure of the sample was measured by intra-class correlation (ICC). The results obtained by the mixed linear model, taking into account what mentioned above, show that the difference between interventions lost its significance (b = 1.7; 95%; CI: \u2013 .29; 3.64. p = 9%). Discussion: In our study we compared QPS to an open-ended question (QL) in the other group which can have played an important role as well as the QPS in preparing patients, prior the consultation, to focus better their attention to what they wish to ask their oncologist. Preparing patients for the consultation (using QPS or a QL as well) is a quick and simple way to promote patients asking questions and may improve the overall communication between oncologist and patient

The involvement of early stage breast cancer patients during oncology consultations in Italy: a multi-centred, randomized controlled trial of a question prompt sheet versus question listing

OBJECTIVES: To investigate, prior to an oncology consultation, the use of a pre-prepared list of evidence based questions, Question Prompt Sheet (QPS), compared with a Question List (QL), a patient self-generated list of questions. DESIGN: Multi-centred, randomised controlled trial. SETTING: Secondary-care patients attending three outpatient oncology clinics in Northern Italy. PARTICIPANTS: 308 women completed the study. Inclusion criteria were an age between 18 and 75 years, a recent diagnosis of early stage, non-metastatic breast cancer, adequate Italian language skills, no previous oncology visits and no evidence of cognitive impairment. INTERVENTION: Patients received the QPS or the QL prior to the consultation, completed it without suggestion or coaching session and delivered back before the visit.The consultations were audio-recorded and analysed for the number and content of questions. Multilevel linear models were used to compare the two groups. OUTCOME MEASURES: The primary outcome was the comparison of questions asked between QPS and QL group. Secondary outcomes included satisfaction about questions asked, satisfaction with decision, and level of anxiety. RESULTS: Patients in the QPS and QL group asked 13 and 16 questions respectively. The difference was not significant (b=1.7, CI -0.3 to 3.6, p=0.10). A mean of 22 questions was selected in the QPS, while a mean of 2 questions was written in the QL. Patients in the QPS group were significantly less satisfied (t=3.60, p<0.01) with questions asked but wanted less additional information (t=2.20, p<0.05). Levels of patient decisional satisfaction were equivalent between groups. Similarly, anxiety levels were equal between groups prior to the consultation and decreased in similar way after the consultation. CONCLUSIONS: Both interventions have similar impact on patients' participation in terms of question asking during the consultation. Future research is needed in order to explore which components of the interventions are really useful and efficacious. TRIAL REGISTRATION: ClinicalTrials.gov NCT01510964

The Third Fermi Large Area Telescope Catalog of Gamma-ray Pulsars

We present 294 pulsars found in GeV data from the Large Area Telescope (LAT) on the Fermi Gamma-ray Space Telescope. Another 33 millisecond pulsars (MSPs) discovered in deep radio searches of LAT sources will likely reveal pulsations once phase-connected rotation ephemerides are achieved. A further dozen optical and/or X-ray binary systems co-located with LAT sources also likely harbor gamma-ray MSPs. This catalog thus reports roughly 340 gamma-ray pulsars and candidates, 10% of all known pulsars, compared to $\leq 11$ known before Fermi. Half of the gamma-ray pulsars are young. Of these, the half that are undetected in radio have a broader Galactic latitude distribution than the young radio-loud pulsars. The others are MSPs, with 6 undetected in radio. Overall, >235 are bright enough above 50 MeV to fit the pulse profile, the energy spectrum, or both. For the common two-peaked profiles, the gamma-ray peak closest to the magnetic pole crossing generally has a softer spectrum. The spectral energy distributions tend to narrow as the spindown power $\dot E$ decreases to its observed minimum near $10^{33}$ erg s$^{-1}$, approaching the shape for synchrotron radiation from monoenergetic electrons. We calculate gamma-ray luminosities when distances are available. Our all-sky gamma-ray sensitivity map is useful for population syntheses. The electronic catalog version provides gamma-ray pulsar ephemerides, properties and fit results to guide and be compared with modeling results.Comment: 142 pages. Accepted by the Astrophysical Journal Supplemen

All-sky Medium Energy Gamma-ray Observatory: Exploring the Extreme Multimessenger Universe

The All-sky Medium Energy Gamma-ray Observatory (AMEGO) is a probe class mission concept that will provide essential contributions to multimessenger astrophysics in the late 2020s and beyond. AMEGO combines high sensitivity in the 200 keV to 10 GeV energy range with a wide field of view, good spectral resolution, and polarization sensitivity. Therefore, AMEGO is key in the study of multimessenger astrophysical objects that have unique signatures in the gamma-ray regime, such as neutron star mergers, supernovae, and flaring active galactic nuclei. The order-of-magnitude improvement compared to previous MeV missions also enables discoveries of a wide range of phenomena whose energy output peaks in the relatively unexplored medium-energy gamma-ray band

Multi-messenger observations of a binary neutron star merger

On 2017 August 17 a binary neutron star coalescence candidate (later designated GW170817) with merger time 12:41:04 UTC was observed through gravitational waves by the Advanced LIGO and Advanced Virgo detectors. The Fermi Gamma-ray Burst Monitor independently detected a gamma-ray burst (GRB 170817A) with a time delay of ~1.7 s with respect to the merger time. From the gravitational-wave signal, the source was initially localized to a sky region of 31 deg2 at a luminosity distance of 40+8-8 Mpc and with component masses consistent with neutron stars. The component masses were later measured to be in the range 0.86 to 2.26 Mo. An extensive observing campaign was launched across the electromagnetic spectrum leading to the discovery of a bright optical transient (SSS17a, now with the IAU identification of AT 2017gfo) in NGC 4993 (at ~40 Mpc) less than 11 hours after the merger by the One- Meter, Two Hemisphere (1M2H) team using the 1 m Swope Telescope. The optical transient was independently detected by multiple teams within an hour. Subsequent observations targeted the object and its environment. Early ultraviolet observations revealed a blue transient that faded within 48 hours. Optical and infrared observations showed a redward evolution over ~10 days. Following early non-detections, X-ray and radio emission were discovered at the transient’s position ~9 and ~16 days, respectively, after the merger. Both the X-ray and radio emission likely arise from a physical process that is distinct from the one that generates the UV/optical/near-infrared emission. No ultra-high-energy gamma-rays and no neutrino candidates consistent with the source were found in follow-up searches. These observations support the hypothesis that GW170817 was produced by the merger of two neutron stars in NGC4993 followed by a short gamma-ray burst (GRB 170817A) and a kilonova/macronova powered by the radioactive decay of r-process nuclei synthesized in the ejecta

VizieR Online Data Catalog: Third catalog of LAT-detected AGNs (3LAC) (Ackermann+, 2015)

Supplemental material related to the Fermi LAT third source catalog (3FGL) (Acero et al, 2015)The gamma-ray results used in this paper were derived in the context of the 3FGL catalog (Fermi-LAT Collaboration 2015, J/ApJS/218/23). No additional analysis of the gamma-ray data was performed in the context of the present paper except for the fitting of the monthly light curves and the broadband SED fitting. The data were collected over the first 48 months of the mission, from 2008 August 4 to 2012 July 31 (MJD 54682 to 56139). Using the Australia Telescope Compact Array (ATCA) at 5 GHz and 9 GHz, Petrov et al. (2013, J/MNRAS/432/1294) detected 424 sources in the LAT error ellipses of southern unassociated 2FGL sources. See table 2

Multi-messenger Observations of a Binary Neutron Star Merger

On 2017 August 17 a binary neutron star coalescence candidate (later designated GW170817) with merger time 12:41:04 UTC was observed through gravitational waves by the Advanced LIGO and Advanced Virgo detectors. The Fermi Gamma-ray Burst Monitor independently detected a gamma-ray burst (GRB 170817A) with a time delay of ∼ 1.7 {{s}} with respect to the merger time. From the gravitational-wave signal, the source was initially localized to a sky region of 31 deg2 at a luminosity distance of {40}-8+8 Mpc and with component masses consistent with neutron stars. The component masses were later measured to be in the range 0.86 to 2.26 {M}ȯ . An extensive observing campaign was launched across the electromagnetic spectrum leading to the discovery of a bright optical transient (SSS17a, now with the IAU identification of AT 2017gfo) in NGC 4993 (at ∼ 40 {{Mpc}}) less than 11 hours after the merger by the One-Meter, Two Hemisphere (1M2H) team using the 1 m Swope Telescope. The optical transient was independently detected by multiple teams within an hour. Subsequent observations targeted the object and its environment. Early ultraviolet observations revealed a blue transient that faded within 48 hours. Optical and infrared observations showed a redward evolution over ∼10 days. Following early non-detections, X-ray and radio emission were discovered at the transient’s position ∼ 9 and ∼ 16 days, respectively, after the merger. Both the X-ray and radio emission likely arise from a physical process that is distinct from the one that generates the UV/optical/near-infrared emission. No ultra-high-energy gamma-rays and no neutrino candidates consistent with the source were found in follow-up searches. These observations support the hypothesis that GW170817 was produced by the merger of two neutron stars in NGC 4993 followed by a short gamma-ray burst (GRB 170817A) and a kilonova/macronova powered by the radioactive decay of r-process nuclei synthesized in the ejecta.</p

Shared decision making in Italy: An updated revision of the current situation

The aim of this paper is to update the previous review on the state of patient and public participation in healthcare in Italy. Policymakers consider patient involvement an important aspect in health care decisions and encourage patients to actively participate in the clinical interaction. Nevertheless, the term shared decision making (SDM) is still not clearly defined. Patient associations promote patient participation in health care decisions. Several experts attended the latest consensus conference about patient engagement to reach a consensus on the definition of SDM. Research regarding SDM in Italy continues to increase with 17 articles published between 2012 and 2017. Researchers have assessed the variables associated with patient involvement and explored the use of the SDM approach in different medical settings. Despite the dedicated SDM initiative, researchers in Italy recognize room for improvement. Work is needed to reach a common language regarding SDM and its mechanisms to implement this approach at the clinical level

Barium Titanate Functionalization with Organosilanes: Effect on Particle Compatibility and Permittivity in Nanocomposites

Barium titanate (BT) recently gained new interest in the preparation of dielectric and piezoelectric lead-free materials for applications in sensors, electronics, energy harvesting and storage fields. Barium titanate nanocomposites can achieve attractive performance, provided that the compatibility between ceramic particles and polymeric matrices is enhanced to the benefit of the physical properties of the final composite. Tuning the particle&ndash;matrix interface through particle functionalization represents a viable solution. In this work, surface functionalization of BT nanoparticles (NPs), obtained by hydrothermal synthesis, with 3-glycidyloxypropyltrimethoxysilane, 2-[(acetoxy(polyethyleneoxy)propyl]triethoxysilane and triethoxysilylpropoxy(polyethyleneoxy)dodecanoate, was performed after optimizing the hydroxylation process of the NPs to improve their surface reactivity and increase the yield of grafting. Solid-state nuclear magnetic resonance and thermogravimetric analysis were used to quantify the molecules grafted onto the ceramic nanoparticles. Both bare and functionalized particles were employed in the realization of epoxy- and polydimethylsiloxane (PDMS)-based nanocomposites. Functionalization was proven to be beneficial for particle dispersibility and effective for particle alignment in the PDMS matrix. Moreover, the dielectric constant measurements revealed the potential of PDMS-based nanocomposites for applications in the field of dielectric elastomers

Effects of a question prompt sheet on the oncologist-patient relationship: a multi-centred randomised controlled trial in breast cancer

This study assessed the effect of a question prompt sheet (QPS) on the oncologist-patient relationship as compared with a question listing (QL). In particular, the differences in difficulties perceived by the oncologist during the consultation and in the patient's experience of the therapeutic aspects of the relationship were assessed. A total of 324 patients with a recent diagnosis of early stage breast cancer were involved in the study. The results showed that 15.7% of patients were perceived as 'difficult' by the oncologists. The proportion of 'difficult' patients varied in the two groups: 20.6% in the QPS group versus 11.8% in the QL group. The results also showed that the higher the difficulty perceived by oncologists, the lower the satisfaction of patients for their relationship with the oncologists during the consultation (r\u2009=\u2009-\u2009.135, p\u2009=\u2009.033). It is likely that the higher level of difficulty perceived by the oncologist in the QPS group may be connected with the pre-prepared list of evidence-based questions. Further research is needed to understand which components of the interventions, relating to the patient, the oncologist or their interaction, really promote patient participation in cancer setting. Trial registration: ClinicalTrials.gov NCT01510964. https://clinicaltrials.gov/ct2/show/NCT01510964