The Humble Charisma of a White-Dressed Man in a Desert Place: Pope Francis’ Communicative Style in the Covid-19 Pandemic

The context of deep uncertainty, fear, and “social distancing” characterizing the COVID-19 pandemic has led to a need for cultural anchorages and charismatic leaders who may conjointly and effectively support human beings, strengthen their identity, and empower social commitment. In this perspective, the charismatic leadership of Pope Francis, which is widely shared not only within the religious world, may play a crucial role in facing emergency with existential reasons and psychological resources. The general aim of this work is to shed light on the communicative features of the charismatic leadership of Pope Francis during the pandemic emergency; in order to better understand his effectiveness, we analyzed both the core issues and his multimodal body signals in the global TV event of the Universal Prayer with the Urbi et Orbi Blessing. The multimodal and discursive analyses of the homily enabled us to define the “humble” charisma of the Pope, which is based upon on authentic and informal presence, manifested emotional signals (and, in particular commotion) showing features of equity and familiarity. From a discursive point of view, the common and overarching affiliation is constructed through a multiple focus on the “we” pronoun, which is constructed through socio-epistemic rhetoric. The results show how this integrated methodological perspectives, which is multimodal and discursive, may offer meaningful pathways detection of effective and persuasive signals

Off–label long acting injectable antipsychotics in real–world clinical practice: a cross-sectional analysis of prescriptive patterns from the STAR Network DEPOT study

Introduction: Information on the off–label use of Long–Acting Injectable (LAI) antipsychotics in the real world is lacking. In this study, we aimed to identify the sociodemographic and clinical features of patients treated with on– vs off–label LAIs and predictors of off–label First– or Second–Generation Antipsychotic (FGA vs. SGA) LAI choice in everyday clinical practice. Method: In a naturalistic national cohort of 449 patients who initiated LAI treatment in the STAR Network Depot Study, two groups were identified based on off– or on–label prescriptions. A multivariate logistic regression analysis was used to test several clinically relevant variables and identify those associated with the choice of FGA vs SGA prescription in the off–label group. Results: SGA LAIs were more commonly prescribed in everyday practice, without significant differences in their on– and off–label use. Approximately 1 in 4 patients received an off–label prescription. In the off–label group, the most frequent diagnoses were bipolar disorder (67.5%) or any personality disorder (23.7%). FGA vs SGA LAI choice was significantly associated with BPRS thought disorder (OR = 1.22, CI95% 1.04 to 1.43, p = 0.015) and hostility/suspiciousness (OR = 0.83, CI95% 0.71 to 0.97, p = 0.017) dimensions. The likelihood of receiving an SGA LAI grew steadily with the increase of the BPRS thought disturbance score. Conversely, a preference towards prescribing an FGA was observed with higher scores at the BPRS hostility/suspiciousness subscale. Conclusion: Our study is the first to identify predictors of FGA vs SGA choice in patients treated with off–label LAI antipsychotics. Demographic characteristics, i.e. age, sex, and substance/alcohol use co–morbidities did not appear to influence the choice towards FGAs or SGAs. Despite a lack of evidence, clinicians tend to favour FGA over SGA LAIs in bipolar or personality disorder patients with relevant hostility. Further research is needed to evaluate treatment adherence and clinical effectiveness of these prescriptive patterns

Rapid and Accurate Prediction and Scoring of Water Molecules in Protein Binding Sites

Water plays a critical role in ligand-protein interactions. However, it is still challenging to predict accurately not only where water molecules prefer to bind, but also which of those water molecules might be displaceable. The latter is often seen as a route to optimizing affinity of potential drug candidates. Using a protocol we call WaterDock, we show that the freely available AutoDock Vina tool can be used to predict accurately the binding sites of water molecules. WaterDock was validated using data from X-ray crystallography, neutron diffraction and molecular dynamics simulations and correctly predicted 97% of the water molecules in the test set. In addition, we combined data-mining, heuristic and machine learning techniques to develop probabilistic water molecule classifiers. When applied to WaterDock predictions in the Astex Diverse Set of protein ligand complexes, we could identify whether a water molecule was conserved or displaced to an accuracy of 75%. A second model predicted whether water molecules were displaced by polar groups or by non-polar groups to an accuracy of 80%. These results should prove useful for anyone wishing to undertake rational design of new compounds where the displacement of water molecules is being considered as a route to improved affinity

Comparing Long-Acting Antipsychotic Discontinuation Rates Under Ordinary Clinical Circumstances: A Survival Analysis from an Observational, Pragmatic Study

Background: Recent guidelines suggested a wider use of long-acting injectable antipsychotics (LAI) than previously, but naturalistic data on the consequences of LAI use in terms of discontinuation rates and associated factors are still sparse, making it hard for clinicians to be informed on plausible treatment courses. Objective: Our objective was to assess, under real-world clinical circumstances, LAI discontinuation rates over a period of 12 months after a first prescription, reasons for discontinuation, and associated factors. Methods: The STAR Network ‘Depot Study’ was a naturalistic, multicentre, observational prospective study that enrolled subjects initiating a LAI without restrictions on diagnosis, clinical severity or setting. Participants from 32 Italian centres were assessed at baseline and at 6 and 12 months of follow-up. Psychopathology, drug attitude and treatment adherence were measured using the Brief Psychiatric Rating Scale, the Drug Attitude Inventory and the Kemp scale, respectively. Results: The study followed 394 participants for 12 months. The overall discontinuation rate at 12 months was 39.3% (95% confidence interval [CI] 34.4–44.3), with paliperidone LAI being the least discontinued LAI (33.9%; 95% CI 25.3–43.5) and olanzapine LAI the most discontinued (62.5%; 95% CI 35.4–84.8). The most frequent reason for discontinuation was onset of adverse events (32.9%; 95% CI 25.6–40.9) followed by participant refusal of the medication (20.6%; 95% CI 14.6–27.9). Medication adherence at baseline was negatively associated with discontinuation risk (hazard ratio [HR] 0.853; 95% CI 0.742–0.981; p = 0.026), whereas being prescribed olanzapine LAI was associated with increased discontinuation risk compared with being prescribed paliperidone LAI (HR 2.156; 95% CI 1.003–4.634; p = 0.049). Conclusions: Clinicians should be aware that LAI discontinuation is a frequent occurrence. LAI choice should be carefully discussed with the patient, taking into account individual characteristics and possible obstacles related to the practicalities of each formulation

The PROVENT-C19 registry: A study protocol for international multicenter SIAARTI registry on the use of prone positioning in mechanically ventilated patients with COVID-19 ARDS

Background The worldwide use of prone position (PP) for invasively ventilated patients with COVID-19 is progressively increasing from the first pandemic wave in everyday clinical practice. Among the suggested treatments for the management of ARDS patients, PP was recommended in the Surviving Sepsis Campaign COVID-19 guidelines as an adjuvant therapy for improving ventilation. In patients with severe classical ARDS, some authors reported that early application of prolonged PP sessions significantly decreases 28-day and 90-day mortality. Methods and analysis Since January 2021, the COVID19 Veneto ICU Network research group has developed and implemented nationally and internationally the "PROVENT-C19 Registry", endorsed by the Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care. . .'(SIAARTI). The PROVENT-C19 Registry wishes to describe 1. The real clinical practice on the use of PP in COVID-19 patients during the pandemic at a National and International level; and 2. Potential baseline and clinical characteristics that identify subpopulations of invasively ventilated patients with COVID-19 that may improve daily from PP therapy. This web-based registry will provide relevant information on how the database research tools may improve our daily clinical practice. Conclusions This multicenter, prospective registry is the first to identify and characterize the role of PP on clinical outcome in COVID-19 patients. In recent years, data emerging from large registries have been increasingly used to provide real-world evidence on the effectiveness, quality, and safety of a clinical intervention. Indeed observation-based registries could be effective tools aimed at identifying specific clusters of patients within a large study population with widely heterogeneous clinical characteristics. Copyright

Strategies to Calculate Water Binding Free Energies in Protein–Ligand Complexes

Water molecules are commonplace in protein binding pockets, where they can typically form a complex between the protein and a ligand or become displaced upon ligand binding. As a result, it is often of great interest to establish both the binding free energy and location of such molecules. Several approaches to predicting the location and affinity of water molecules to proteins have been proposed and utilized in the literature, although it is often unclear which method should be used under what circumstances. We report here a comparison between three such methodologies, Just Add Water Molecules (JAWS), Grand Canonical Monte Carlo (GCMC), and double-decoupling, in the hope of understanding the advantages and limitations of each method when applied to enclosed binding sites. As a result, we have adapted the JAWS scoring procedure, allowing the binding free energies of strongly bound water molecules to be calculated to a high degree of accuracy, requiring significantly less computational effort than more rigorous approaches. The combination of JAWS and GCMC offers a route to a rapid scheme capable of both locating and scoring water molecules for rational drug design

Tra rassegnazione e resilienza: la normalizzazione narrativa delle malattie rare 25º Convegno nazionale di psicologia sociale. Book of abstract. Ediz. multilingue

Le modalità di fronteggiamento di una malattia rara rappresentano uno speciale osservatorio delle dinamiche psicosociali con cui gli esseri umani gestiscono quella generale condizione di incertezza che caratterizza la loro esistenza. Dalla diagnosi ai difficili trattamenti terapeutici, si avviano processi che non solo destabilizzano le comuni attese di vita quotidiana delle persone, ma minacciano anche il loro senso di continuità fisica, psicologica e sociale. Il nostro studio esplora le risorse discorsive con cui i malati rari si “normalizzano” (Goldstein & Kenet, 2002; Emiliani, 2010), adattando la loro “disability identity” (Bogart, 2015) al mutato contesto di vita. La nostra ipotesi è che tale percorso di “normalizzazione si configuri in un orizzonte di senso marcato dal contrasto tra le retoriche socio-epistemiche della rassegnazione e della resilienza. Per verificare tale ipotesi abbiamo condotto delle interviste narrative (Athinkson, 2008) con 40 adulti affetti da malattia rara e i loro testi sono stati sottoposti a quattro tipi di analisi: del Contenuto con il software T-LAB (Lancia, 2004), Diatestuale con il Modello SAM (Mininni, 2013), Narrativa con i markers di posizionamento (Davies, Herré, 1990) e Psicostilistica con i markers di mitigazione (Caffi, 2009). I risultati ottenuti con tale approccio multi-metodo consentono di configurare il percorso di normalizzazione come un alternarsi dinamico tra quattro differenti posizionamenti identitari: il normalizzato, il guerriero, il rassegnato e il solitario che si susseguono nel corso dell’esperienza di malattia e si orientano verso un futuro possibile

Dai racconti 3.0 la resilienza: l’apporto dei social network alla gestione della malattia rara

INTRODUZIONE Benché siano varie, le malattie rare sono accomunate dall’essere destabilizzanti, costringono chi ne è affetto a mettere in discussione i progetti di costruzione dell’identità personale e sociale. Per fronteggiare la solitudine, il ricorso a gruppi di sostegno online è una valida strategia di coping, perché induce le persone a condividere le problematiche e a dare/ricevere sostegno emotivo (Wallace, 2017). Per il malato raro tali interazioni virtuali comportano una crescita della resilienza che, nell’ottica della psicologia culturale (Valsiner, 2017) e discorsiva (Mininni, 2013), è riconducibile alle risorse di senso offerte dai racconti, che consentono di (ri)pensare e (ri)costruire eventi. METODO Questo lavoro vuole indagare i percorsi di sense-making con cui i social network sorreggono le persone nel superare la condizione di solitudine, imposta dalla loro malattia. Sono stati raccolti 500 post tratti da 15 gruppi chiusi sulla malattia rara presenti su Facebook. I testi sono stati esaminati con procedure quanti/qualitative, con strumenti interpretativi quali Sentiment Analysis e Analisi del Discorso quali retoriche socio-epistemiche, metafore, marcatori affettivi, indici di certezza/incertezza (Mininni, 2017). RISULTATI I racconti di vita circolanti nei social network creano un forte senso di appartenenza, perché i malati vi svelano anche aspetti intimi delle proprie esperienze. Benché i post a focalità emotiva prevalgano su quelli a focalità informativa, le persone sperimentano empowerment presentandosi più resilienti nel fronteggiare la malattia. L’indizio narrativo più evidente è dato dal loro ricorso alle diverse retoriche socio-epistemiche dell’in-certezza. CONCLUSIONI I social network sono il nuovo scenario di interazione capace di integrare i bisogni di self-disclosure con le dinamiche di mutuo supporto. I malati se ne avvalgono per accrescere il senso di fiducia in sé e le capacità di controllo: mettere in rete narrativa l’incertezza della malattia consente non solo di percepirsi meno soli, ma di esperire la certezza di essere utili ai propri “simili”

Impact of Adherence (Compliance) to Oral Acyclovir Prophylaxis in the Recurrence of Herpetic Keratitis: Long-Term Results From a Pediatric Cohort

PURPOSE: To evaluate the long-term role of adherence to oral acyclovir prophylaxis in reducing the risk for recurrent herpes simplex virus keratitis (HSK) in children. METHODS: A retrospective cohort study was performed including all pediatric patients 16 years or younger) with their first HSK diagnosis and treatment at our center. Children were started on a standardized oral acyclovir prophylactic regimen after the acute phase. Adherence to prophylaxis was assessed monthly through parent interviews. The possible association between any recurrence (not only the first) and exposure to acyclovir prophylaxis was evaluated using random-effects multivariate logistic regression. RESULTS: A total of 20 eyes of 17 patients (8 boys and 9 girls) were included. The mean follow-up time was 3.5 years. Adherence to acyclovir prophylaxis was registered in 100% of patients with no recurrences and in 36.4% of patients with 1 or more recurrences (P = 0.035). All other tested variables (time of follow-up, sex, age, infectious diseases, underlying hematological diseases, eye, and HSK type) did not differ between the 2 groups. The multivariate model confirmed the lower risk for recurrence in patients who were compliant to therapy (adjusted odds ratio 0.04, 95% confidence intervals 0.00-0.42, P = 0.008). No adverse effects were recorded during follow-up. CONCLUSIONS: Oral acyclovir prophylaxis is a safe and an effective medical treatment for recurrent HSK and its long-term efficacy is associated with compliance to the therapy