Development of a test for recording both visual and auditory reaction times, potentially useful for future studies in patients on opioids therapy

Luca Miceli,1 Rym Bednarova,2 Alessandro Rizzardo,1 Valentina Samogin,1 Giorgio Della Rocca1 1Department of Anesthesia and Intensive Care Medicine, University of Udine, 2Department of Pain Medicine and Palliative Care, Hospital of Latisana, Latisana, Udine, Italy Objective: Italian Road Law limits driving while undergoing treatment with certain kinds of medication. Here, we report the results of a test, run as a smartphone application (app), assessing auditory and visual reflexes in a sample of 300 drivers. The scope of the test is to provide both the police force and medication-taking drivers with a tool that can evaluate the individual’s capacity to drive safely. Methods: The test is run as an app for Apple iOS and Android mobile operating systems and facilitates four different reaction times to be assessed: simple visual and auditory reaction times and complex visual and auditory reaction times. Reference deciles were created for the test results obtained from a sample of 300 Italian subjects. Results lying within the first three deciles were considered as incompatible with safe driving capabilities. Results: Performance is both age-related (r>0.5) and sex-related (female reaction times were significantly slower than those recorded for male subjects, P<0.05). Only 21% of the subjects were able to perform all four tests correctly. Conclusion: We developed and fine-tuned a test called Safedrive that measures visual and auditory reaction times through a smartphone mobile device; the scope of the test is two-fold: to provide a clinical tool for the assessment of the driving capacity of individuals taking pain relief medication; to promote the sense of social responsibility in drivers who are on medication and provide these individuals with a means of testing their own capacity to drive safely. Keywords: visual reaction time, auditory reaction time, opioids, Safedriv

Outpatient therapeutic chronic opioid consumption in Italy: a one-year survey.

BACKGROUND: In Italy since the 38/2010 law concerning Palliative Care and pain therapy has been promulgated, the consumption of opioids started increasing. However, despite the availability of a large amount of data regarding opioid prescription, a database including all patients on chronic opioid therapy does not yet exist. METHODS: Retrospective analysis of analgesic opioid consumption was performed between January 2013 and December 2013 using the data of national refunded medications for outpatients, collected by Italian Ministry of Health. We considered patients on chronic opioid therapy those patients with at least three opioids prescriptions in three consecutive months and/or six opioid prescriptions in six even not consecutive months in the observation period. We considered cancer patients those with neoplasm exemption code in the scheduled prescription and/or patients with at least one ROOs prescription (rapid onset opioids, approved in Italy for Break Through cancer Pain-BTcP- only). We also calculated the patient's morphine daily mean dose (MED) converting all prescribed opioids in equivalent of morphine using specific conversion tables. RESULTS: This census revealed a total of 422,542 patients in chronic therapy with opioids, of those 369.961 with chronic non-cancer pain and 52,581 with chronic cancer pain. This represents about 4% of the estimated requirement in Italy for both groups based on previous surveys regarding the prevalence of chronic pain. CONCLUSIONS: Relatively to MED, We found that in Italy chronic cancer pain patients receive doses similar to patients with cancer pain in other Literature reports, whereas patients with chronic non-cancer pain received lower dosages

Preoperative Evaluation of Patients Undergoing Lung Resection Surgery: Defining the Role of the Anesthesiologist on a Multidisciplinary Team

IN THE FIELD of thoracic surgery, one of the key problems in lung resection is the management and function of the residual lung, which has the potential to interfere with both the pulmonary and cardiovascular systems, and, therefore, influence surgical outcome in terms of morbidity and mortality. Between 2007 and 2013, 5 papers addressing preoperative evaluation and risk stratification were published.1-5 However, the members of the task forces responsible for these documents did not include all the professionals involved in the preoperative surgical evaluation, and the documents mainly addressed the stratification of respiratory risk

The nature of Composite Seyfert/Star-forming galaxies revealed by X-ray observations

This paper presents new Chandra and BeppoSAX observations aimed at investigating the optical/X-ray mismatch in the enigmatic class of the Composite galaxies, discovered by a cross-correlation of IRAS and ROSAT all sky survey catalogues. These galaxies have been classified as star-forming objects on the basis of their optical spectra, while the detection of weak broad wings in the H(alpha) emission in a few of them and their high X-ray luminosity in the ROSAT band indicated the presence of an active nucleus. The analysis of Chandra observations for 4 Composites has revealed nuclear point-like sources, with a typical AGN spectrum (Gamma = 1.7-1.9) and little intrinsic absorption. A strong flux variability has been observed on different time scales, in particular most of the sources were brighter at the ROSAT epoch. Although of relative low luminosity for the AGN class (L(2-10 keV) = 3-60 x 10^{41} erg/s), the active nucleus is nevertheless dominant in the X-ray domain. At other wavelengths it appears to be overwhelmed by the starburst and/or host galaxy light, yielding the Composite classification for these objects.Comment: 20 pages, 10 figures, accepted by Ap

Acromegaly is associated with increased cancer risk: A survey in Italy

It is debated if acromegalic patients have an increased risk to develop malignancies. The aim of the present study was to assess the standardized incidence ratios (SIRs) of different types of cancer in acromegaly on a large series of acromegalic patients managed in the somatostatin analogs era. It was evaluated the incidence of cancer in an Italian nationwide multicenter cohort study of 1512 acromegalic patients, 624 men and 888 women, mean age at diagnosis 45 \uc2\ub1 13 years, followed up for a mean of 10 years (12573 person-years) in respect to the general Italian population. Cancer was diagnosed in 124 patients, 72 women and 52 men. The SIRs for all cancers was significantly increased compared to the general Italian population (expected: 88, SIR 1.41; 95% CI, 1.18-1.68, P < 0.001). In the whole series, we found a significantly increased incidence of colorectal cancer (SIR 1.67; 95% CI, 1.07-2.58, P = 0.022), kidney cancer (SIR 2.87; 95% CI, 1.55-5.34, P < 0.001) and thyroid cancer (SIR 3.99; 95% CI, 2.32-6.87, P < 0.001). The exclusion of 11 cancers occurring before diagnosis of acromegaly (all in women) did not change remarkably the study outcome. In multivariate analysis, the factors significantly associated with an increased risk of malignancy were age and family history of cancer, with a non-significant trend for the estimated duration of acromegaly before diagnosis. In conclusion, we found evidence that acromegaly in Italy is associated with a moderate increase in cancer risk

Synergistic Parasite-Pathogen Interactions Mediated by Host Immunity Can Drive the Collapse of Honeybee Colonies

The health of the honeybee and, indirectly, global crop production are threatened by several biotic and abiotic factors, which play a poorly defined role in the induction of widespread colony losses. Recent descriptive studies suggest that colony losses are often related to the interaction between pathogens and other stress factors, including parasites. Through an integrated analysis of the population and molecular changes associated with the collapse of honeybee colonies infested by the parasitic mite Varroa destructor, we show that this parasite can de-stabilise the within-host dynamics of Deformed wing virus (DWV), transforming a cryptic and vertically transmitted virus into a rapidly replicating killer, which attains lethal levels late in the season. The de-stabilisation of DWV infection is associated with an immunosuppression syndrome, characterized by a strong down-regulation of the transcription factor NF-κB. The centrality of NF-κB in host responses to a range of environmental challenges suggests that this transcription factor can act as a common currency underlying colony collapse that may be triggered by different causes. Our results offer an integrated account for the multifactorial origin of honeybee losses and a new framework for assessing, and possibly mitigating, the impact of environmental challenges on honeybee health

Measurements of the leptonic branching fractions of the τ\tau

Data collected with the DELPHI detector from 1993 to 1995 combined with previous DELPHI results for data from 1991 and 1992 yield the branching fractions B({\tau \rightarrow \mbox{\rm e} \nu \bar{\nu}}) = (17.877 \pm 0.109_{stat} \pm 0.110_{sys} )\% and $B({\tau \rightarrow \mu \nu \bar{\nu}}) = (17.325 \pm 0.095_{stat} \pm 0.077_{sys} )\%$

Investigation of the splitting of quark and gluon jets

The splitting processes in identified quark and gluon jets are investigated using longitudinal and transverse observables. The jets are selected from symmetric three-jet events measured in Z decays with the Delphi detector in 1991-1994. Gluon jets are identified using heavy quark anti-tagging. Scaling violations in identified gluon jets are observed for the first time. The scale energy dependence of the gluon fragmentation function is found to be about two times larger than for the corresponding quark jets, consistent with the QCD expectation TeX . The primary splitting of gluons and quarks into subjets agrees with fragmentation models and, for specific regions of the jet resolution TeX , with NLLA calculations. The maximum of the ratio of the primary subjet splittings in quark and gluon jets is TeX . Due to non-perturbative effects, the data are below the expectation at small TeX . The transition from the perturbative to the non-perturbative domain appears at smaller TeX for quark jets than for gluon jets. Combined with the observed behaviour of the higher rank splittings, this explains the relatively small multiplicity ratio between gluon and quark jets

Search for Neutral Heavy Leptons Produced in Z Decays

Weak isosinglet Neutral Heavy Leptons ($\nu_m$) have been searched for using data collected by the DELPHI detector corresponding to $3.3\times 10^{6}$ hadronic~Z$^{0}$ decays at LEP1. Four separate searches have been performed, for short-lived $\nu_m$ production giving monojet or acollinear jet topologies, and for long-lived $\nu_m$ giving detectable secondary vertices or calorimeter clusters. No indication of the existence of these particles has been found, leading to an upper limit for the branching ratio $BR($Z$^0\rightarrow \nu_m \overline{\nu})$ of about $1.3\times10^{-6}$ at 95\% confidence level for $\nu_m$ masses between 3.5 and 50 GeV/$c^2$. Outside this range the limit weakens rapidly with the $\nu_m$ mass. %Special emphasis has been given to the search for monojet--like topologies. One event %has passed the selection, in agreement with the expectation from the reaction: %$e^+e^- \rightarrow\ell \bar\ell \nu\bar\nu$. The results are also interpreted in terms of limits for the single production of excited neutrinos

Search for scalar fermions and long-lived scalar leptons at centre-of-mass energies of 130 GeV to 172 GeV

Data taken by DELPHI during the 1995 and 1996 LEP runs have been used to search for the supersymmetric partners of electron, muon and tau leptons and of top and bottom quarks. The observations are in agreement with standard model predictions. Limits are set on sfermion masses. Searches for long lived scalar leptons from low scale supersymmetry breaking models exclude stau masses below 55~GeV/c$^2$ at the 95\% confidence level, irrespective of the gravitino mass