EFFICACY OF LAI IN FIRST EPISODE PSYCHOSIS: AN OBSERVATIONAL STUDY - CLINICAL REPORTS

The use of antipsychotics, especially second generation antipsychotics, represents the milestone treatment of “first episode of psychosis” (FEP). Although prodromal symptoms of psychosis have long been recognized, the clinical management of psychotic disorders conventionally begins at the first episode of frank psychosis, as it is well acknowledged that “duration of untreated psychosis” (DUP) is one of the main factor that negatively affects prognosis: a longer DUP is highly correlated to reduced response to treatment, poor clinical and social outcomes, and an overall worst prognosis. Long-acting injectable (LAI) formulations of antipsychotics have traditionally been used for those patients with psychosis with the most severe symptoms, poorest compliance, most hospitalizations and poorest outcomes; moreover it seems that psychiatrists tend to prescribe LAI at the latter stages of the disease. We retrospectively collected clinical and sociodemographic data regarding patients consecutively presenting with symptoms of FEP attending the Community Mental Health Service (CMHS) in Foggia from 1st June 2014 to 31st May 2015. We selected patients who attended the CMHS in Foggia with symptoms of FEP. Different scales were administered to assess symptoms severity, quality of life, side effects, adherence, and overall functionality. In our sample LAI treatment was found to be effective in treating symptoms associated to FEP, improved quality of life and it was associated with a clinically irrelevant incidence of extrapyramidal side effect. Considering that achieving a full symptoms remission in people affected by FEP is associated to better outcomes, and that DUP is associated to poor prognosis, LAIs could play an important role in improving overall recovery

A new projection method for Navier-stokes equations by using Raviart-thomas finite element

Computational Fluid Dynamics codes usually adopt velocity-pressure splitting to reduce the computational effort in the solution of the Navier-Stokes equations. In standard projection methods, the finite element approximations show difficulties to find a solution with discrete free-divergence velocity field in all space points. In this work, a new velocity-pressure method for Navier-Stokes equations that projects the velocity field inside the discrete free-divergence velocity space is presented. This algorithm computes the velocity field on the discrete free-divergence space by using Raviart-Thomas finite elements. The projection is obtained by the minimization of the distance, over the discrete free-divergence space, between the auxiliary field and the desired Raviart-Thomas interpolation space. The Raviart-Thomas discretization is based on the quadrilateral and hexahedral finite element space and therefore the divergence mimetic computational approach is used to avoid the well-known degradation of the divergence term convergence. The auxiliary velocity field is obtained by solving the velocity-pressure split system used in the classical Chorin­Temam algorithm. The pressure is recovered by the orthogonal space to the projection on the Raviart-Thomas interpolation space. The method is investigated with an explicit and semi-implicit treatment of the pressure terms. The issues on boundary conditions and the errors in the reproducibility of the tangential components are investigated. Several numerical examples are reported to support this new projection method

Simulation of TALL-3D experimental facility with a multiscale and multiphysics computational platform

This work details the development of a computational platform in joint collaboration between the Italian National Agency for New Technologies, Energy and Sustainable Economic Development (enea) and the University of Bologna (unibo). The platform is based on the open-source SALOME software that integrates the CATHARE system code for nuclear safety, FEMUS and OpenFOAM CFD codes in a unique framework, with efficient methods for data exchange. The computational platform has been used to simulate complex multiscale and multiphysics systems, such as the tall-3d facility, with a defective boundary condition approach on overlapping domains. The tall-3d experimental facility has been realized with the purpose of providing reference results to be used for both standalone and coupled System Thermal-Hydraulic (STH) and Computational Fluid Dynamic (CFD) code validation. The transient phenomenon of unprotected loss of lead-bismuth eutectic (LBE) flow that has been experimentally simulated at tall-3d is here studied. The system code is used to simulate the tall-3d apparatus while the CFD code is used to get a better insight into the fluid streaming occurring in the main tank component and improve the system code predictions. A flow transition from forced to natural convection is used to validate the codes and the platform ability to reproduce the experimental data

FEMuS-Platform: a numerical platform for multiscale and multiphysics code coupling

Nowadays, many open-source numerical codes are available to solve physical problems in structural mechanics, fluid flow, heat transfer, and neutron diffusion. However, even if these codes are often highly specialized in the numerical simulation of a particular type of physics, none of them allows simulating complex systems involving all the physical problems mentioned above. In this work we present a numerical framework, based on the SALOME platform, developed to perform multiscale and multiphysics simulations involving all the mentioned physical problems. In particular, the developed numerical platform includes the multigrid finite element in-house code FEMuS for heat transfer, fluid flow, turbulence and fluid-structure modeling; the open-source finite volume CFD software OpenFOAM; the multiscale neutronic code DONJON-DRAGON; and a system-scale code used for thermal-hydraulic simulations. Efficient data exchange among these codes is performed within computer memory by using the MED libraries, provided by the SALOME platform

Prevalence of hepatic steatosis in patients with type 2 diabetes and response to glucose-lowering treatments. A multicenter retrospective study in Italian specialist care

Type 2 diabetes (T2D) is a risk factor for metabolic dysfunction-associated fatty liver disease (MAFLD), which is becoming the commonest cause of chronic liver disease worldwide. We estimated MAFLD prevalence among patients with T2D using the hepatic steatosis index (HSI) and validated it against liver ultrasound. We also examined whether glucose-lowering medications (GLM) beneficially affected HSI

Similar effectiveness of dapagliflozin and GLP-1 receptor agonists concerning combined endpoints in routine clinical practice: A multicentre retrospective study

Aims According to cardiovascular outcome trials, some sodium-glucose contransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) are recommended for secondary cardiovascular prevention in type 2 diabetes (T2D). In this real-world study, we compared the simultaneous reductions in HbA1c, body weight and systolic blood pressure after initiation of dapagliflozin or GLP-1RA as second or a more advanced line of therapy. Materials and methods DARWIN-T2D was a retrospective multi-centre study conducted at diabetes specialist clinics in Italy that compared T2D patients who initiated dapagliflozin or GLP-1RA (exenatide once weekly or liraglutide). Data were collected at baseline and at the first follow-up visit after 3 to 12 months. The primary endpoint was the proportion of patients achieving a simultaneous reduction in HbA1c, body weight and systolic blood pressure. To reduce confounding, we used multivariable adjustment (MVA) or propensity score matching (PSM). Results Totals of 473 patients initiating dapagliflozin and 336 patients initiating GLP-1RA were included. The two groups differed in age, diabetes duration, HbA1c, weight and concomitant medications. The median follow-up was 6 months in both groups. Using MVA or PSM, the primary endpoint was observed in 30% to 32% of patients, with no difference between groups. Simultaneous reduction of HbA1c, BP and SBP by specific threshold, as well as achievement of final goals, did not differ between groups. GLP-1RA reduced HbA1c by 0.3% more than the reduction achieved with dapagliflozin. Conclusion In routine specialist care, initiation of dapagliflozin can be as effective as initiation of a GLP-1RA for attainment of combined risk factor goals

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

Proceedings of the Fifth Italian Conference on Computational Linguistics CLiC-it 2018

On behalf of the Program Committee, a very warm welcome to the Fifth Italian Conference on Computational Linguistics (CLiC-­‐it 2018). This edition of the conference is held in Torino. The conference is locally organised by the University of Torino and hosted into its prestigious main lecture hall “Cavallerizza Reale”. The CLiC-­‐it conference series is an initiative of the Italian Association for Computational Linguistics (AILC) which, after five years of activity, has clearly established itself as the premier national forum for research and development in the fields of Computational Linguistics and Natural Language Processing, where leading researchers and practitioners from academia and industry meet to share their research results, experiences, and challenges