PRIN LEVANTE 2020: Levulinic acid valorization through advanced novel technologies

The project LEVANTE deals with the development of new catalytic processes for the valorization of levulinic acid and its esters towards three classes of compounds: levulinic ketals, diphenolic acid and γ-valerolactone together with other reduction products

The role of mobile technologies in health care processes:The case of cancer supportive care

Background: Health care systems are gradually moving towards new models of care based on integrated care processes, shared by different care givers, and on an empowered role of the patient. Mobile technologies are assuming an emerging role in this scenario. This is particularly true in care processes where the patient has a particularly enhanced role, as is the case of cancer supportive care. Objective: This paper aims to review existing studies on the actual role and use of mobile technology during the different stages of care processes, with particular reference to cancer supportive care. Methods: We carried out a review of literature with the aim of identifying studies related to the use of mhealth in cancer care and cancer supportive care. The final sample size consists in 106 records. Results: There is scant literature concerning the use of mhealth in cancer supportive care. Looking more generally at cancer care, we found that mhealth is mainly used for self management activities carried out by patients. The main tools used are mobile devices like smartphones and tablets, but remote monitoring devices also play an important role. SMS technologies have a minor role with the exception of middle income-countries where SMS plays a major role. Tele-health technologies are still rarely used in cancer care processes. If we look at the different stages of health care processes, we can see that mhealth is mainly used during the treatment of patients, especially for self management activities. It is also used for prevention and diagnosis, although to a lesser extent, whereas it appears rarely used for decision-making and follow-up activities. Conclusions: Since mhealth only seems to be employed for limited uses and during limited phases of the care process, it is unlikely that it can really contribute to the creation of new care models. This under-utilization may depend on many issues, including the need for it to be embedded into broader information systems. If the purpose of introducing mhealth is to promote the adoption of integrated care models, using mhealth should not be limited to some activities or to some phases of the health care process. Instead, there should be a higher degree of pervasiveness at all stages and in all health care delivery activities

Mobile health divide between clinicians and patients in cancer care: results from a cross-sectional international survey

Background: Mobile technologies are increasingly being used to manage chronic diseases, including cancer, with the promise of improving the efficiency and effectiveness of care. Among the myriad of mobile technologies in health care, we have seen an explosion of mobile apps. The rapid increase in digital health apps is not paralleled by a similar trend in usage statistics by clinicians and patients. Little is known about how much and in what ways mobile health (mHealth) apps are used by clinicians and patients for cancer care, what variables affect their use of mHealth, and what patients’ and clinicians’ expectations of mHealth apps are. Objective: This study aimed to describe the patient and clinician population that uses mHealth in cancer care and to provide recommendations to app developers and regulators to generally increase the use and efficacy of mHealth apps. Methods: Through a cross-sectional Web-based survey, we explored the current utilization rates of mHealth in cancer care and factors that explain the differences in utilization by patients and clinicians across the United States and 5 different countries in Europe. In addition, we conducted an international workshop with more than 100 stakeholders and a roundtable with key representatives of international organizations of clinicians and patients to solicit feedback on the survey results and develop insights into mHealth app development practices. Results: A total of 1033 patients and 1116 clinicians participated in the survey. The proportion of cancer patients using mHealth (294/1033, 28.46%) was far lower than that of clinicians (859/1116, 76.97%). Accounting for age and salary level, the marginal probabilities of use at means are still significantly different between the 2 groups and were 69.8% for clinicians and 38.7% for patients using the propensity score–based regression adjustment with weighting technique. Moreover, our analysis identified a gap between basic and advanced users, with a prevalent use for activities related to the automation of processes and the interaction with other individuals and a limited adoption for side-effect management and compliance monitoring in both groups. Conclusions: mHealth apps can provide access to clinical and economic data that are low cost, easy to access, and personalized. The benefits can go as far as increasing patients’ chances of overall survival. However, despite its potential, evidence on the actual use of mobile technologies in cancer care is not promising. If the promise of mHealth is to be fulfilled, clinician and patient usage rates will need to converge. Ideally, cancer apps should be designed in ways that strengthen the patient-physician relationship, ease physicians’ workload, be tested for validity and effectiveness, and fit the criteria for reimbursement

Nutritional Management of Oncological Symptoms: A Comprehensive Review

Throughout their experience of illness and during the course of treatment, a substantial proportion of cancer patients are prone to develop nutritional and/or metabolic disturbances. Additionally, cancer patients often encounter long-term side effects from therapies, which may lead to impaired digestion, nutrient absorption or bowel motility. Therefore, the preservation and maintenance of an optimal and balanced nutritional status are pivotal to achieving a better prognosis, increasing the tolerance and adherence to cancer therapies and improving the overall quality of life. In this context, personalized nutritional programs are essential for addressing conditions predisposing to weight loss, feeding difficulties, digestion problems and intestinal irregularity, with the goal of promoting adequate nutrient absorption and minimizing the detrimental effects of treatment regimens. The focus of this research is to examine the most common clinical conditions and metabolic changes that cancer patients may experience, including stomatitis, xerostomia, diarrhea, nausea, vomiting, dysphagia, sub-occlusion, dysgeusia, dysosmia, anorexia, and cachexia. Furthermore, we present a pragmatic example of a multidisciplinary workflow that incorporates customized recipes tailored to individual clinical scenarios, all while maintaining the hedonic value of the meals

40Ar–39Ar ages and isotope geochemistry of Cretaceous basalts in northern Madagascar: Refining eruption ages, extent of crustal contamination and parental magmas in a flood basalt province

The Madagascar Cretaceous igneous province exposed in the Mahajanga basin is represented by basalt and basaltic andesite lavas. New 40Ar–39Ar plateau ages (92.3 ± 2.0 Ma and 91.5 ± 1.3 Ma) indicate that the magmatism in the Mahajanga basin started about 92 Ma ago. Four geochemically distinct magma types (Groups A–D) are present. Group A and C rocks have low to moderate TiO2 (1.2–2.6 wt%), Nb (3–9 μg g−1) and Zr (82–200 μg g−1), and show large variations in ɛNdi (+0.1 to −10.8), 206Pb/204Pb (15.28 to 16.33) and γOs (+11.4 to +7378). The large isotopic variations, particularly in Os, Nd and Pb isotopic compositions, are likely due to crustal contamination. The low Pb isotope ratios observed in the Group A and C rocks suggest involvement of continental crust with low μ (238U/204Pb). Group B and D rocks have moderate to high TiO2 (2.2–4.9 wt%), Nb (8–24 μg g−1) and Zr (120–327 μg g−1). Age-corrected isotopes of Group B and D lavas show a small range in ɛNdi (+1.0 to +4.0) and a wide range in γOs (+128 to +1182). Values of 207Pb/204Pb are within the range for Groups A and C, but the Group D 206Pb/204Pb (16.52–17.08) and 208Pb/204Pb (37.51–38.01) values are higher, indicating a different crustal contaminant. Pb isotopic values of the Group B rocks seem to reflect the isotopic features of their mantle source. The magma groups of Mahajanga display a wide range of trace element and isotopic compositions that cannot be explained only by open-system crystallization processes but, rather, by distinct mantle sources

U-Pb ages, Pb-Os isotope ratios, and platinum-group element (PGE) composition of the west-central Madagascar flood basalt province

The Mailaka lava succession (central-western Madagascar) forms part of the Madagascar large igneous province and is characterized by basaltic to picritic basalt lava flows and minor evolved flows. In situ U-Pb dating of zircon in rhyodacites yields concordant ages of 89.7 \ub1 1.4 and 90.7 \ub1 1.1 Ma. Therefore, the capping rhyodacitic unit of the Mailaka lava succession was emplaced just after the underlying basalt sequence (dated paleontologically at Coniacian-Turonian). Two geochemically different lava series are present. A transitional series ranging from picritic basalts to basalts has incompatible element abundances and Pb, Os, and Nd isotope ratios within the range of mid-ocean ridge basalts. In addition, the concentrations of platinum-group elements (Ir<0.35 ng/g, Ru<0.17 ng/g, Pd p 1.0-1.6 ng/g) in the transitional basalts are generally lower than in basaltic lavas from oceanic plateaus (e.g., Ontong Java and Kerguelen) and other continental flood basalt provinces (e.g., Deccan and Etendeka). A tholeiitic series ranges from picritic basalts to rhyodacites and has relatively high concentrations of trace elements (e.g., Rb, Ba, Th, and light lanthanides) and the Pb-Sr-Nd and Os isotopic characteristic of magmas that have assimilated continental crust. The Pb isotope ratios of tholeiitic andesites indicate the involvement of a component highly depleted in radiogenic Pb, very likely old lower crust. Energy-constrained- assimilation-fractional-crystallization modeling indicates that the rhyodacites may be the result of 3c25% assimilation of upper continental crust, with a ratio between assimilated mass and subtracted solid of 3c0.35. An andesite with low Pb isotope ratios may be the result of 3c8% assimilation of lower continental crust with a mass assimilated/mass accumulated ratio of 3c0.1. Interaction of mantle-derived magmas with crustal lithologies of different age and evolutionary history thus occurred in this sector of the flood basalt province. Contamination of mantle-derived rocks by material of different crustal domains is a process also observed in other large igneous provinces, such as the Deccan Traps

Mobile health divide between clinicians and patients in cancer care:Results from a cross-sectional international survey

Background: Mobile technologies are increasingly being used to manage chronic diseases, including cancer, with the promise of improving the efficiency and effectiveness of care. Among the myriad of mobile technologies in health care, we have seen an explosion of mobile apps. The rapid increase in digital health apps is not paralleled by a similar trend in usage statistics by clinicians and patients. Little is known about how much and in what ways mobile health (mHealth) apps are used by clinicians and patients for cancer care, what variables affect their use of mHealth, and what patients’ and clinicians’ expectations of mHealth apps are. Objective: This study aimed to describe the patient and clinician population that uses mHealth in cancer care and to provide recommendations to app developers and regulators to generally increase the use and efficacy of mHealth apps. Methods: Through a cross-sectional Web-based survey, we explored the current utilization rates of mHealth in cancer care and factors that explain the differences in utilization by patients and clinicians across the United States and 5 different countries in Europe. In addition, we conducted an international workshop with more than 100 stakeholders and a roundtable with key representatives of international organizations of clinicians and patients to solicit feedback on the survey results and develop insights into mHealth app development practices. Results: A total of 1033 patients and 1116 clinicians participated in the survey. The proportion of cancer patients using mHealth (294/1033, 28.46%) was far lower than that of clinicians (859/1116, 76.97%). Accounting for age and salary level, the marginal probabilities of use at means are still significantly different between the 2 groups and were 69.8% for clinicians and 38.7% for patients using the propensity score–based regression adjustment with weighting technique. Moreover, our analysis identified a gap between basic and advanced users, with a prevalent use for activities related to the automation of processes and the interaction with other individuals and a limited adoption for side-effect management and compliance monitoring in both groups. Conclusions: mHealth apps can provide access to clinical and economic data that are low cost, easy to access, and personalized. The benefits can go as far as increasing patients’ chances of overall survival. However, despite its potential, evidence on the actual use of mobile technologies in cancer care is not promising. If the promise of mHealth is to be fulfilled, clinician and patient usage rates will need to converge. Ideally, cancer apps should be designed in ways that strengthen the patient-physician relationship, ease physicians’ workload, be tested for validity and effectiveness, and fit the criteria for reimbursement

Intravitreal Brolucizumab for Pachychoroid Neovasculopathy Associated With Chronic Central Serous Chorioretinopathy

Purpose: To evaluate the anatomical and functional outcomes of intravitreal brolucizumab in eyes with chronic central serous chorioretinopathy complicated by pachychoroid neovasculopathy. Methods: Retrospective analysis of 34 eyes treated with intravitreal brolucizumab. Twenty-five eyes (73.5%) had been treated with other anti-vascular endothelial growth factor agents before switching to brolucizumab, whereas nine eyes were naïve. Outcome measures included the change of central foveal thickness and subfoveal choroidal thickness, evaluation of sub/intraretinal fluid on optical coherence tomography, and change in best-corrected visual acuity. Results: Before starting brolucizumab, 23 eyes showed subretinal fluid, 8 both subretinal and intraretinal fluid, and 3 intraretinal fluid only. At the last visit, 22 eyes (64.7%) showed complete reabsorption of both intraretinal and subretinal fluid, whereas subretinal fluid was still present in 8 eyes (23.5%), and both intraretinal and subretinal fluid in 4 eyes (11.8%). The mean number of brolucizumab injections required to achieve complete fluid reabsorption was 2.8 ± 1.8. central foveal thickness decreased from 317.8 ± 109.3&nbsp;μm to 239.8 ± 74.8&nbsp;μm (P = 0.0005) and subfoveal choroidal thickness decreased from 399.3 ± 86.2&nbsp;μm to 355.5 ± 92.7&nbsp;μm at the end of the follow-up period (P = 0.0008). The mean logarithm of the minimum angle of resolution best-corrected visual acuity improved from 0.4 ± 0.2 to 0.3 ± 0.2 at 1 month after the first injection and remained stable at the same values at the end of the follow-up period (P = 0.04). Conclusions: Intravitreal brolucizumab is effective for the treatment of naïve and recalcitrant pachychoroid neovasculopathy. Translational relevance: Intravitreal brolucizumab may represent an option in patients with pachychoroid neovasculopathy complicating chronic central serous chorioretinopathy

Managing health care in the digital world:A comparative analysis

Recently, most reforms affecting healthcare systems have focused on improving the quality of care and containing costs. This has led many scholars to advocate the adoption of Health Information systems, especially electronic medical records, by highlighting their potential benefits. This study is based on a comparative analysis using a multiple method approach to examine the implementation of the same electronic medical record system at two different hospitals. Its findings offer insights into the processes of the adoption of innovation and its implementation in a healthcare context. The need to innovate, the decision to innovate, the implementation process and consequently, the results produced are quite distinctive at each study site. This comparative case study reveals that what appears to be the same can be quite different: this can be due to several conditions at the organization, the organization’s characteristics, and the process of implementation adopted. We need to understand these elements in order to be able to plan and manage such programs in the future