A telescope detection system for direct and high resolution spectrometry of intense neutron fields

A high energy- and spatial-resolution telescope detector was designed and constructed for neutron spectrometry of intense neutron fields. The detector is constituted by a plastic scintillator coupled to a monolithic silicon telescope (MST), in turn consisting of a DE and an E stage. The scintillator behaves as an “active” recoil-proton converter, since it measures the deposited energy of the recoil-protons generated across. The MST measures the residual energy of recoil-protons downstream of the converter and also discriminates recoil-protons from photons associated to the neutron field. The lay-out of the scintillator/MST system was optimized through an analytical model for selecting the angular range of the scattered protons. The use of unfolding techniques for reconstructing the neutron energy distribution was thus avoided with reasonable uncertainty (about 1.6% in neutron energy) and efficiency (of the order of 106 counts per unit neutron fluence). A semi-empirical procedure was also developed for correcting the non-linearity in light emission from the organic scintillator. The spectrometer was characterized with quasi-monoenergetic and continuous fields of neutrons generated at the CN Van De Graaff accelerator of the INFN-Legnaro National Laboratory, Italy, showing satisfactory agreement with literature data

Definition of indicators of appropriateness in the management of neovascular age-related macular degeneration: An expert opinion

Wet age-related macular degeneration is a chronic condition culminating, in most cases, in blindness. The introduction of anti-angiogenic agents in 2006 has represented a major breakthrough in the treatment of the disease, but timely and effective treatment with regular follow-up and monitoring is mandatory to stabilize and preserve visual acuity. In clinical practice, however, appropriate therapy provision is frequently challenged by economic and organizational issues that result in suboptimal visual outcomes and increased incidence of legal blindness. International Guidelines have defined a diagnostic and therapeutic pathway to ensure the best practice in wet age-related macular degeneration management, but reference parameters to evaluate and compare the performance of Retina Centers are lacking. To address the appropriateness of wet age-related macular degeneration management in Italy, a multidisciplinary panel of ten experts gathered in three meetings. They defined three sets of indicators and relative benchmark values that each Center should comply with to ensure patients optimal care already from the first access: (a) clinical intervention indicators, to determine the possible Center\u2019s deviation from the diagnostic and therapeutic pathway; (b) outcome indicator, to evaluate the socioeconomic impact of the healthcare systems\u2019 performance; (c) management indicators, to test the size of the gap between the Center\u2019s supply and demand. Once the indicators have been analyzed, healthcare systems can plan actions to improve appropriateness and monitor their effects. However, to put this in practice, a concerted effort by all parts involved in healthcare provision is required, together with adequate systems to analyze clinical and administrative documentation

Are Urologists Ready for Interpretation of Multiparametric MRI Findings? A Prospective Multicentric Evaluation

Aim: To assess urologists’ proficiency in the interpretation of multiparametric magnetic resonance imaging (mpMRI). Materials and Methods: Twelve mpMRIs were shown to 73 urologists from seven Italian institutions. Responders were asked to identify the site of the suspicious nodule (SN) but not to assign a PIRADS score. We set an a priori cut-off of 75% correct identification of SN as a threshold for proficiency in mpMRI reading. Data were analyzed according to urologists’ hierarchy (UH; resident vs. consultant) and previous experience in fusion prostate biopsies (E-fPB, defined as <125 vs. ≥125). Additionally, we tested for differences between non-proficient vs. proficient mpMRI readers. Multivariable logistic regression analyses (MVLRA) tested potential predictors of proficiency in mpMRI reading. Results: The median (IQR) number of correct identifications was 8 (6–8). Anterior nodules (number 3, 4 and 6) represented the most likely prone to misinterpretation. Overall, 34 (47%) participants achieved the 75% cut-off. When comparing consultants vs. residents, we found no differences in terms of E-fPB (p = 0.9) or in correct identification rates (p = 0.6). We recorded higher identification rates in urologists with E-fBP vs. their no E-fBP counterparts (75% vs. 67%, p = 0.004). At MVLRA, only E- fPB reached the status of independent predictor of proficiency in mpMRI reading (OR: 3.4, 95% CI 1.2–9.9, p = 0.02) after adjusting for UH and type of institution. Conclusions: Despite urologists becoming more familiar with interpretation of mpMRI, their results are still far from proficient. E-fPB enhances the proficiency in mpMRI interpretation

Computed tomography use in a large Italian region: trend analysis 2004-2014 of emergency and outpatient CT examinations in children and adults

Objectives: To analyse CT use in recent years in a high-density Italian area (\ub110 million inhabitants, including 1 million children), focusing on developing age. Methods: Retrospective analysis of records from HealthCare IT System, covering >400 hospitals and clinics. Description of CT use between 2004\u20132014 in emergency and outpatient care and assessment of radiation exposure trend. Results: Over 9 million scans were performed. Emergency procedures showed a global increase of 230 %, mainly head examinations. In the global outpatient setting, the annual number of CT scans/person increased \ub119 %. A moderate increase in CT examinations was observed in the developing age population, while a remarkable increase in dental, chest and abdominal procedures occurred for the 10- to 30-year age range. The increase in mean annual dose/capita in the global patient pool was approximately 42 %, increasing from 0.72\u20131.03 mSv. The population rate receiving an annual CT radiation dose/capita higher than 1 mSv tripled in the 11-year interval, increasing from 16\u201348 %. Conclusions: The remarkable increase in radiation exposure raises a special concern for teenagers and young adults, whose risk tends to be underestimated. The fivefold increase in dental CTs in the younger age groups requires further investigations. Key Points: \u2022 Literature highlights a remarkable increase in CT use over the last decades.\u2022 The paediatric age had higher exposure to X-ray risk.\u2022 A detailed retrospective analysis of more than 9 million scans was performed.\u2022 Dental, chest, abdominal procedures increased remarkably in 10- to 30-year age range.\u2022 This study raises concern about exposure for teenagers and young adults

Non-nociceptive roles of opioids in the CNS: opioids' effects on neurogenesis, learning, memory and affect.

Mortality due to opioid use has grown to the point where, for the first time in history, opioid-related deaths exceed those caused by car accidents in many states in the United States. Changes in the prescribing of opioids for pain and the illicit use of fentanyl (and derivatives) have contributed to the current epidemic. Less known is the impact of opioids on hippocampal neurogenesis, the functional manipulation of which may improve the deleterious effects of opioid use. We provide new insights into how the dysregulation of neurogenesis by opioids can modify learning and affect, mood and emotions, processes that have been well accepted to motivate addictive behaviours