Financial Toxicity in Swiss Cancer Patients Treated with Proton Therapy: An Observational Cross-Sectional Study on Self-Reported Outcome

BACKGROUND Proton therapy is indicated for cancers that would be difficult to treat with conventional radiotherapy. Compulsory healthcare insurance covers the costs of this therapy in Switzerland, but this does not mean that proton therapy is cost-neutral for every cancer patient. Significant out-of-pocket (OOP) costs may arise due to expenses associated with proton therapy, and patients may experience treatment-related financial distress-an effect known as "financial toxicity." This study investigates the financial toxicity of patients undergoing proton therapy in a high-income country with a compulsory health insurance policy. METHODS Between September 2019 and November 2021, 146 Swiss cancer patients treated with proton therapy participated in this study, of whom 90 (62%) were adults and 56 (38%) were caregivers of child cancer patients. Financial toxicity was assessed using the FACIT Comprehensive Score for Financial Toxicity (COST). OOP costs during proton therapy were recorded weekly, and financial coping strategies were captured at the end of treatment. FINDINGS The median COST score, indicating financial toxicity, was 29.9 (IQR 21.0; 36.0) for all patients, 30.0 (IQR 21.3; 37.9) for adults, and 28.0 (IQR 20.5; 34.0) for children's caregivers. Higher income (estimate 8.1, 95% CI 3.7 to 12.4, p ≤ 0.001) was significantly associated with higher COST scores, indicating less financial toxicity. Further distance from home to the treatment centre per 100 km (estimate -3.7, 95% CI -5.7 to -1.9, p ≤ 0.001) was significantly associated with lower COST scores, indicating increased financial toxicity. Married adult patients had substantially lower COST scores than single patients (estimate: -9.1, 95% CI -14.8 to -3.4, p ≤ 0.001). The median OOP cost was 2050 Swiss francs (CHF) and was spent mainly on travel, accommodation, and eating out. Sixty-three (43%) patients used their savings; 54 (37%) cut spending on leisure activities; 21 (14.4%) cut living expenses; 14 (9.6%) borrowed money; nine (6.2%) worked more; and four (2.7%) sold property. Patients with high COST scores used significantly fewer coping strategies such as saving on leisure activities (estimate -9.5, 95% CI -12.4 to -6.6, p ≤ 0.001), spending savings (estimate -3.9, 95% CI -6.3 to -1.4, p = 0.002), borrowing money (estimate -6.3, 95% CI -10.4 to -2.2, p = 0.003), and increasing workload (estimate -5.5, 95% CI -10.5 to -0.4, p = 0.035). INTERPRETATION A substantial number of cancer patients treated with proton therapy experience financial toxicity in Switzerland. Long travel distances to the proton therapy centre and low income negatively affect the financial well-being of these patients during proton therapy

Radiation therapy in mycosis fungoides

Radiation therapy (RT) is administered with varying intentions, sometimes even several times in the same or in different body areas, to over 50% of patients with neoplastic conditions. Numerous techniques are available to patients in the clinical evolution of mycosis fungoides (MF), and there are several indications for radiation therapy (RT). RT as a skin-directed therapy is very widely used in these patients, either alone or in conjunction with other therapies. The application of RT, a tried-and-true therapy that improves MF patients’ quality of life and treatment, can be encouraged by a multidisciplinary approach and an understanding of current methods and action mechanisms

Non-Invasive Assessment of Arterial Stiffness: Pulse Wave Velocity, Pulse Wave Analysis and Carotid Cross-Sectional Distensibility: Comparison between Methods

Background: The stiffening of large elastic arteries is currently estimated in research and clinical practice by propagative and non-propagative models, as well as parameters derived from aortic pulse waveform analysis. Methods: Common carotid compliance and distensibility were measured by simultaneously recording the diameter and pressure changes during the cardiac cycle. The aortic and upper arm arterial distensibility was estimated by measuring carotid-femoral and carotid-radial pulse wave velocity (PWV), respectively. The augmentation index and blood pressure amplification were derived from the analysis of central pulse waveforms, recorded by applanation tonometry directly from the common carotid artery. Results: 75 volunteers were enrolled in this study (50 females, average age 53.5 years). A significant inverse correlation was found between carotid distensibility and carotid-femoral PWV (r = -0.75; p < 0.001), augmentation index (r = -0.63; p < 0.001) and central pulse pressure (r = -0.59; p < 0.001). A strong correlation was found also between the total slope of the diameter/pressure rate carotid curves and aortic distensibility, quantified from the inverse of the square of carotid-femoral PWV (r = 0.67). No correlation was found between carotid distensibility and carotid-radial PWV. Conclusions: This study showed a close correlation between carotid-femoral PWV, evaluating aortic stiffness by using the propagative method, and local carotid cross-sectional distensibility

Field emission from two-dimensional GeAs

GeAs is a layered material of the IV-V groups that is attracting growing attention for possible applications in electronic and optoelectronic devices. In this study, exfoliated multilayer GeAs nanoflakes are structurally characterized and used as the channel of back-gate field-effect transistors. It is shown that their gate-modulated p-type conduction is decreased by exposure to light or electron beam. Moreover, the observation of a field emission current demonstrates the suitability of GeAs nanoflakes as cold cathodes for electron emission and opens up new perspective applications of two-dimensional GeAs in vacuum electronics. Field emission occurs with a turn-on field of ~80 V/{\mu}m and attains a current density higher than 10 A/cm^2, following the general Fowler-Nordheim model with high reproducibility.Comment: 10 pages, 3 figure

Considerazioni psicopatologiche, sociali e giuridiche sul mobbing: un’esperienza clinica nell’ospedale generale

Object. The  authors  intend  to  estimate  in  depth  the  following  questions:1) To  define  mobbing  and  how  to  detect  its  characteristics,  considering  the  psychopathological  questions  and  the  legal  medical  implications.2) To  try  to  analize  psychological  factors,  individual  and  organisational,  that  contribute  to  the  onset  of  mobbing.3) To  present  the  results  of   clinical  experience,  developed  by  the  collaboration established  with  the  Working  Medicine  Section  of  S. Martino  Hospital  in  Genoa. Methods. 237  persons  reporting  to  be  victims  of  a  mobbing  situation  have  undergone  a  psychodiagnostic  interview and  a  clinical  psychological  assessment  with  mental  tests (WAIS,  short  MMPI,  Rorschach).  The  compilation  of  specific  questionnaires  has  been  proposed  to detect  the  characteristics  of  mobbing  situation  and  the  sequential  subjective  symptoms reported  by  the  patients.Results.  In  75%  of  cases,  patients  presented  a  negative  anamnesis  for  psychiatric  disorders. They  had  enough  items  to  be  included  in  the  Adjustment  Disorder  (in  its  different  subdivisions).Conclusions.  In  the  majority  of  cases,  psychiatric  symptoms  reported  by  job  distress  victims  were  strictly  related  to  the  mobbing  experience,  that  causes  such  a  trend  of  stressing  and  painful  events  that  constitute  a  significant  risk  for  the  psycho-physical  integrity  of  a  person,  independent  of  previous  factors.  This  result  have  induced  the  Authors  to  analize  in  depth  some  of  the  legal  questions  about  the  detection  of  mobbing  and  the  contingent  compensation  of  undergone  damages.Gli Autori  si  propongono  di:1) Definire  il  mobbing  ed  individuare  le  caratteristiche  del fenomeno,  tenendo  presenti  le  problematiche  psicopatologiche  e  le  implicazioni  medico-legali;2) Analizzare  i  fattori  psicologici,  individuali  ed  organizzativi, che  contribuiscono  all'insorgenza  del  mobbing;3) Presentare  i  risultati  di  un’esperienza  clinica  nata  dalla  collaborazione tra  la  Clinica  Psichiatrica  e  l’U.O.  di  Medicina  del  Lavoro  dell’Azienda Ospedaliera  Universitaria San Martino  di  Genova.Metodo.  237  persone  che  riferivano  una  situazione  di  mobbing  a  loro  danno  sono  state sottoposte  a  colloquio  psicodiagnostico  e  a  valutazione  psicologica  clinica  mediante reattivi  mentali  (WAIS,  MMPI abbreviato,  Rorschach).  È  stata  inoltre  proposta  la compilazione  di  specifici  questionari  per  rilevare  le  caratteristiche  della  situazione  mobbizzante  e  i  conseguenti  sintomi  soggettivi  lamentati  dai  pazienti.Risultati.  Nel  75%  dei casi  i  pazienti  hanno  presentato  anamnesi  negativa  per disturbi  di interesse  psichiatrico,  rispondendo  invece ai  criteri  del  DSM-IV-TR  per  il  Disturbo  dell'Adattamento  (nelle  sue  varie  sottospecie).Conclusioni.  Nella  gran  maggioranza  dei  casi, i sintomi psichici  lamentati  dalle vittime  di disadattamento  lavorativo  risultano  in  stretta  connessione  con  l’esperienza  mobbizzante,  che innesca  una  serie  di  eventi  stressanti  e  dolorosi  tali  da  costituire  un  rischio  significativo  per l'integrità  psico-fisica  della  persona,  indipendentemente  da  variabili  preesistenti.  Questo  riscontro  ha  spinto  gli  Autori  ad  approfondire  alcune  problematiche  medico-legali  inerenti  il  riconoscimento  del  mobbing  e  l'eventuale  risarcibilità  dei  danni  subiti

Characterization of the electric transport properties of black phosphorous back-gated field-effect transistors

We use thin layers of exfoliated black phosphorus to realize back-gated field-effect transistors in which the Si/SiO2 substrate is exploited as gate electrode. To prevent the detrimental effect of the air exposure the devices are protected by Poly(methyl methacrylate). We report the observation of an improved contact resistance at the interface between the layered material and the metal contact by electrical conditioning. We also demonstrate the existence of a hysteresis in the transfer characteristics that improves by increasing the gate voltage sweep range. Finally, we prove the suitability of such transistors as memory devices

Nonalcoholic Fatty Liver Disease Is Associated With Higher 1-year All-Cause Rehospitalization Rates in Patients Admitted for Acute Heart Failure

Repeat hospitalization due to acute heart failure (HF) is a global public health problem that markedly impacts on health resource use. Identifying novel predictors of rehospitalization would help physicians to determine the optimal postdischarge plan for preventing HF rehospitalization. Nonalcoholic fatty liver disease (NAFLD) is an emerging risk factor for many heart diseases, including HF. We assessed whether NAFLD at hospital admission predicts 1-year all-cause rehospitalization in patients with acute HF.We enrolled all patients consecutively admitted for acute HF to our General Medicine Division, from January 2013 to April 2014, after excluding patients with acute myocardial infarction, severe heart valve diseases, malignancy, known liver diseases, and those with volume overload related to extracardiac causes. NAFLD was diagnosed by ultrasonography and exclusion of competing etiologies. The primary outcome of the study was the 1-year all-cause rehospitalization rate.Among the 107 patients enrolled in the study, the cumulative rehospitalization rate was 12.1% at 1 month, 25.2% at 3 months, 29.9% at 6 months, and 38.3% at 1 year. Patients with NAFLD had markedly higher 1-year rehospitalization rates than those without NAFLD (58% vs 21% at 1 y; P\u200a&lt;\u200a0.001 by the log-rank test). Cox regression analysis revealed that NAFLD was associated with a 5.5-fold increased risk of rehospitalization (adjusted hazard ratio 5.56, 95% confidence interval 2.46-12.1, P\u200a&lt;\u200a0.001) after adjustment for multiple HF risk factors and potential confounders.In conclusion, NAFLD was independently associated with higher 1-year rehospitalization in patients hospitalized for acute HF