Metaplasticity A Promising Tool to Disentangle Chronic Disorders of Consciousness Differential Diagnosis

The extent of cortical reorganization after brain injury in patients with Vegetative State/Unresponsive Wakefulness Syndrome (UWS) and Minimally Conscious State (MCS) depends on the residual capability of modulating synaptic plasticity. Neuroplasticity is largely abnormal in patients with UWS, although the fragments of cortical activity may exist, while patients MCS show a better cortical organization. The aim of this study was to evaluate cortical excitability in patients with disorders of consciousness (DoC) using a transcranial direct current stimulation (TDCS) metaplasticity protocol. To this end, we tested motor-evoked potential (MEP) amplitude, short intracortical inhibition (SICI), and intracortical facilitation (ICF). These measures were correlated with the level of consciousness (by the Coma Recovery Scale-Revised, CRS-R). MEP amplitude, SICI, and ICF strength were significantly modulated following different metaplasticity TDCS protocols only in the patients with MCS. SICI modulations showed a significant correlation with the CRS-R score. Our findings demonstrate, for the first time, a partial preservation of metaplasticity properties in some patients with DoC, which correlates with the level of awareness. Thus, metaplasticity assessment may help the clinician in differentiating the patients with DoC, besides the clinical evaluation. Moreover, the responsiveness to metaplasticity protocols may identify the subjects who could benefit from neuromodulation protocols

Motor recovery after stroke: the role of overground exoskeletons in shaping brain plasticity

The use of neurorobotic devices into gait rehabilitative programs, including Ekso, is reported to increase the engagement and motivation of the patients while actively performing a task, and to shape the sensory-motor plasticity (SMP) and its balance between the primary motor areas (M1), and the fronto-parietal network (FPN) connectivity, thus contributing to successful gait rehabilitation [1]. Aim of our study was to assess whether Ekso would foster the recovery of deteriorated FPN connectivity and SMP patterns involved in limb coordination during walking [2] in a sample of patients with hemiparesis due to stroke. To this end, we enrolled ten patients who underwent Ekso training (24 sessions) and were evaluated about gait performance, FPN connectivity, and SMP pattern. Esko significantly increased gait performance index as revealed by surface EMG (p=0.01) and the deterioration of prefrontal-SMA and SMA-centroparietal connectivity (both p=0.02), and rebalanced the equilibrium between the SMP patterns of the two M1-leg areas (p=0.03). Moreover, the baseline plasticity and FPN connectivity were the most important factors in using Ekso fruitfully (r=0.9, p=0.03). Even though our findings need to be confirmed by future research further addressing the safety and effectively use of Ekso, our small cohort study provides new cues supporting the role of powered exoskeletons in rehabilitation protocols for persons with stroke

COVID-19 & privacy: Enhancing of indoor localization architectures towards effective social distancing

Abstract The way people access services in indoor environments has dramatically changed in the last year. The countermeasures to the COVID-19 pandemic imposed a disruptive requirement, namely preserving social distance among people in indoor environments. We explore in this work the possibility of adopting the indoor localization technologies to measure the distance among users in indoor environments. We discuss how information about people's contacts collected can be exploited during three stages: before, during, and after people access a service. We present a reference architecture for an Indoor Localization System (ILS), and we illustrate three representative use-cases. We derive some architectural requirements, and we discuss some issues that concretely cope with the real installation of an ILS in real-world settings. In particular, we explore the privacy and trust reputation of an ILS, the discovery phase, and the deployment of the ILS in real-world settings. We finally present an evaluation framework for assessing the performance of the architecture proposed

The use of electronical devices and relative levels of Nomophobia within a group of Italian nurses: an Observational Study

Background: In healthcare, the use of smartphones and other electronical devices are becoming important tools among health professionals. Thanks to these devices, there are new methods of assistance. However, if used incorrectly, they may cause distraction during clinical practice. The excessive use of such devices has generated a new form of addiction in the workplace named nomophobia, a phobia still little explored in literature. We reported an analysis of the frequency and method of use of these electronical devices. The primary aim of the research was to investigate the level of dependence on electronic devices (nomophobia) and the digital habits of nurses. Secondary aim of the study was to evaluate the possible association between nomophobia and distraction in the workplace. Methods: A transversal multicenter study was conducted on a sample of Italian nurses, using the Nurses’ Use of Personal Communication Devices Questionnaire and the Nomophobia Questionnaire (NMP-Q). Results: 34.1% of the sample (n=184) declared that they used smartphones and other electronical devices a moderately during working hours. 20.2 % (n=109) used them frequently and 8.9% (n=48) uses devices during working hours constantly. However, 44.0% (n=222) never uses health apps for patient medical assistance, the 32.9% (n=166) never uses learning apps or apps for professional development. 16.6% (n=87) admit that the use of these devices negatively affected their working performance (mean 80.5; SD 40.1). Study participants showed moderated levels of nomophobia (media=50.34; SD=29.0). Conclusion: The results of the study demonstrate the scares use of such electronical tools to implement adequate care among Italian nurses. Nomophobia can have significant impact on the risk of making mistakes. Future studies should examine not only nurses but also other help professionals and support staff, to bring out an underestimated dimension

Attitudes, knowledge and Practices of Nurses towards HIV/AIDS Patients. An Observational, Cross Sectional, Multicenter study

Background. Attitudes, knowledge and practices of nurses towards HIV/AIDS patients are of continuous interest, especially in developing countries. However, in Italy, this topic is still scarcely debated. Materials and methods. An observational, cross sectional, multicentre study was conducted on a sample of 144 nurses in two Italian Hospitals of the Puglia Region ("Vito Fazzi" Hospital in Lecce and "San Giuseppe da Copertino" Hospital in Copertino (Le)). Results. A large part of the sample (97.2%, n=140) stated that they never refused to take care of a patient with AIDS. Only 22.9%, (n=33), of the sample had attended a training course and almost half (63.2%, n=91) used the gloves regularly when performing blood samples or when administering therapy to patients. With regard to the assessment of HIV knowledge, the percentage of nurses who know the meaning of the terms " seropositive" (83.3%, n=120), "HIV-positive person" (91.7%, n=132) and "window period" (47.9%, n=69) decreased. Conclusions. The results of the study show that a non-negligible percentage of nurses could be considered at risk of infection due to non-routine use of gloves, incorrect handling of the patient's biological samples and not knowing how to decontaminate a surface with potentially infected blood

Attitudes, perceptions, and knowledge of the population on End-of-Life and Advance Treatment Declaration: an observational study in Southern Italy

In an advanced scientific and technological context, where it is now tangible the possibility of interfering indefinitely in the process of dying, it becomes necessary to disseminate knowledge about end of life that, for the great variety of areas that it invests, presents many controversial aspects. With the Law no. 219/2017, the right of self-determination and freedom of treatment of the patient is enshrined, aspects that to date still remain too little discussed. An online survey was conducted from December 2019 to February 2020, among the population residing in the provinces of Lecce and Brindisi, spread thanks to the collaboration of local authorities. A large part of the sample (82.4%, N=333) claims the right to self-determination, stating that therapeutic decisions are up to the patient who has signed his advance treatment dispositions, declared absolutely binding for 50% (N=205) of the sample. However, there is still a lack of information about how to draw up advance treatment agreements (AADs). 12.6% (N=51) of those interviewed stated that they knew nothing about it and only 32.9% (N=133) felt ready and adequately informed to make their own declarations. Another peculiar aspect is that topics such as euthanasia and assisted suicide seem to be considered at the margins of acceptability among End-of-Life instances. The results of the study show that knowledge on the subject has definitely improved over the years and that in most of the issues addressed, the population has an adequate degree of preparedness even though there is still some skepticism in dealing with issues such as assisted suicide and euthanasia. Future research could explore the possibility of identifying effective training tools and communication strategies that can be used by the widest possible segment of the population

The Eye-tracking technology in the healthcare settings: an observational, cross sectional, multicenter study

Successful communication is considered an essential component of the quality of care and safety of the patient with Amyotrophic Lateral Sclerosis (ALS). Recent technology has provided alternative communication systems, including the Eye-tracking technology, which enables interaction with others in the more advanced stages of the disease. The aim of the study is to investigate patients' difficulties in using the eye tracker, their problem in obtaining the device and the clinical complications resulting from it. A "snowball sampling" method study was conducted from April to September 2020 until sample saturation. The results of the study demonstrate the countless difficulties in obtaining the eye- tracker, with long waiting times, which are not followed by adequate training in its correct use. Among the consequences linked to the use of this device, the most frequent were nystagmus (8.8%), onset of eyelid ptosis (16.2%) and the appearance of increased fatigue. 56.1% of the sample used the eye tracker to surf the Internet whereas 9.1% used it to write e-mails. Overall, the use of the eye tracker led to an improvement in overall quality of life (24%). In Conclusions, the Eye-tracking technology is a valuable device for Alternative Augmentative Communication (AAC) in ALS patients and can be used with good performance, therefore the need for information, training and improvement on this topic is essentia

Clinical Study Sativex in the Management of Multiple Sclerosis-Related Spasticity: Role of the Corticospinal Modulation

Sativex is an emergent treatment option for spasticity in patients affected by multiple sclerosis (MS). This oromucosal spray, acting as a partial agonist at cannabinoid receptors, may modulate the balance between excitatory and inhibitory neurotransmitters, leading to muscle relaxation that is in turn responsible for spasticity improvement. Nevertheless, since the clinical assessment may not be sensitive enough to detect spasticity changes, other more objective tools should be tested to better define the real drug effect. The aim of our study was to investigate the role of Sativex in improving spasticity and related symptomatology in MS patients by means of an extensive neurophysiological assessment of sensory-motor circuits. To this end, 30 MS patients underwent a complete clinical and neurophysiological examination, including the following electrophysiological parameters: motor threshold, motor evoked potentials amplitude, intracortical excitability, sensory-motor integration, and H max /M max ratio. The same assessment was applied before and after one month of continuous treatment. Our data showed an increase of intracortical inhibition, a significant reduction of spinal excitability, and an improvement in spasticity and associated symptoms. Thus, we can speculate that Sativex could be effective in reducing spasticity by means of a double effect on intracortical and spinal excitability

GM Allotypes and COVID-19. A Pilot Study Performed on Sicilian Patients

Several studies suggest that genetic variants that influence the onset, maintenance and resolution of the immune response might be fundamental in predicting the evolution of COVID-19. In the present paper, we analysed the distribution of GM allotypes (the genetic markers of immunoglobulin γ chains) in symptomatic and asymptomatic COVID-19 patients and in healthy controls, all born and residing in Sicily. Indeed, the role played by GM allotypes in immune responses and infection control is well known. Our findings show that the GM23 allotype is significantly reduced in healthy controls. Interestingly, in a previous study, Sicilians carrying the GM23 allotype were associated with the risk of developing a symptomatic Human Cytomegalovirus infection. However, a note of caution should be considered, due to the small sample size of patients and controls

Effectiveness of nursing intervention in short-term hospitalization for patients suffered from borderline personality disorder and self-harm. A narrative literature review

Introduction: Personality disorder sufferers with severe self-harm and experience long psychiatric hospitalizations have complex mental health conditions and are at risk of suicide. When the symptoms of emotional instability are combined with self-harm, the resulting crisis often becomes difficult for patients and caregivers to manage. To improve care during these crises, the Dutch Multidisciplinary Guideline for Personality Disorders designates “brief admission” (BA) hospitalizations as an ameliorative intervention. Objective: To describe the effectiveness of short hospitalization nursing care for people with borderline personality disorder and who practice self-harm, compared to ordinary hospitalization. Methods: A narrative review was conducted through the Embase and CINAHL databases, the selected articles had to answer the following research questions: “what are the observable benefits of short-term hospitalization on patients with borderline personality disorder?”; and “what are the benefits compared to short hospitalization operators?”. Results: Seven studies were selected. The results show that BA was perceived as an effective nursing intervention, which promoted the patient’s self-determination and self-care. This helped increase confidence in daily life and allowed people to maintain their daily routines, work, and relationships by decreasing long hospitalizations and increasing patient compliance. There has also been benefit from the staff, who report an improvement in work quality. Conclusions: This type of hospitalization has developed in Northern European states. BA has never been tested in the Italian healthcare sector. It would be appropriate and desirable, given the results obtained, to experiment with this procedure also in Italy to obtain specific feedback regarding the relationship of short-term hospitalization with our National Health Service. It is hoped that this research can be a stimulus in this sense