1st year EFAST annual report

The present report provides information about the activities conducted during the 1st year of the EFAST project. The first chapter is dedicated to describe the inquiries conducted at the beginning of the project and to briefly summarise the main results. The second chapter is dedicated to the first EFAST workshop where some of the leading scientists in the field of earthquake engineering have met to discuss about the need and the technologies related to earthquake engineering. The third chapter contains a state of the art and future direction in seismic testing and simulation. The final chapter is dedicated to describe the preliminary design of the web portal of the future testing facility.JRC.DG.G.5-European laboratory for structural assessmen

Pro-active monitoring and social interventions at community level mitigate the impact of coronavirus (COVID-19) epidemic on older adults' mortality in Italy: A retrospective cohort analysis

BackgroundThe COVID-19 epidemic in Italy has severely affected people aged more than 80, especially socially isolated. Aim of this paper is to assess whether a social and health program reduced mortality associated to the epidemic.MethodsAn observational retrospective cohort analysis of deaths recorded among > 80 years in three Italian cities has been carried out to compare death rate of the general population and "Long Live the Elderly!" (LLE) program. Parametric and non-parametric tests have been performed to assess differences of means between the two populations. A multivariable analysis to assess the impact of covariates on weekly mortality has been carried out by setting up a linear mixed model.ResultsThe total number of services delivered to the LLE population (including phone calls and home visits) was 34,528, 1 every 20 day per person on average, one every 15 days during March and April. From January to April 2019, the same population received one service every 41 days on average, without differences between January-February and March-April. The January-April 2020 cumulative crude death rate was 34.8% (9,718 deaths out of 279,249 individuals; CI95%: 34.1-35.5) and 28.9% (166 deaths out of 5,727 individuals; CI95%:24.7-33.7) for the general population and the LLE sample respectively. The general population weekly death rate increased after the 11th calendar week that was not the case among the LLE program participants (p<0.001). The Standardized Mortality Ratio was 0.83; (CI95%: 0.71-0.97). Mortality adjusted for age, gender, COVID-19 weekly incidence and prevalence of people living in nursing homes was lower in the LLE program than in the general population (p<0.001).ConclusionsLLE program is likely to limit mortality associated with COVID-19. Further studies are needed to establish whether it is due to the impact of social care that allows a better clients' adherence to the recommendations of physical distancing or to an improved surveillance of older adults that prevents negative outcomes associated with COVID-19

AIRO Breast Cancer Group Best Clinical Practice 2022 Update

Introduction: Breast cancer is the most common tumor in women and represents the leading cause of cancer death. Radiation therapy plays a key-role in the treatment of all breast cancer stages. Therefore, the adoption of evidence-based treatments is warranted, to ensure equity of access and standardization of care in clinical practice.Method: This national document on the highest evidence-based available data was developed and endorsed by the Italian Association of Radiation and Clinical Oncology (AIRO) Breast Cancer Group.We analyzed literature data regarding breast radiation therapy, using the SIGN (Scottish Intercollegiate Guidelines Network) methodology (www.sign.ac.uk). Updated findings from the literature were examined, including the highest levels of evidence (meta-analyses, randomized trials, and international guidelines) with a significant impact on clinical practice. The document deals with the role of radiation therapy in the treatment of primary breast cancer, local relapse, and metastatic disease, with focus on diagnosis, staging, local and systemic therapies, and follow up. Information is given on indications, techniques, total doses, and fractionations.Results: An extensive literature review from 2013 to 2021 was performed. The work was organized according to a general index of different topics and most chapters included individual questions and, when possible, synoptic and summary tables. Indications for radiation therapy in breast cancer were examined and integrated with other oncological treatments. A total of 50 questions were analyzed and answered.Four large areas of interest were investigated: (1) general strategy (multidisciplinary approach, contraindications, preliminary assessments, staging and management of patients with electronic devices); (2) systemic therapy (primary, adjuvant, in metastatic setting); (3) clinical aspects (invasive, non-invasive and micro-invasive carcinoma; particular situations such as young and elderly patients, breast cancer in males and cancer during pregnancy; follow up with possible acute and late toxicities; loco-regional relapse and metastatic disease); (4) technical aspects (radiation after conservative surgery or mastectomy, indications for boost, lymph node radiotherapy and partial breast irradiation).Appendixes about tumor bed boost and breast and lymph nodes contouring were implemented, including a dedicated web application. The scientific work was reviewed and validated by an expert group of breast cancer key-opinion leaders.Conclusions: Optimal breast cancer management requires a multidisciplinary approach sharing therapeutic strategies with the other involved specialists and the patient, within a coordinated and dedicated clinical path. In recent years, the high-level quality radiation therapy has shown a significant impact on local control and survival of breast cancer patients. Therefore, it is necessary to offer and guarantee accurate treatments according to the best standards of evidence-based medicine

Active silver nanoparticles for wound healing

In this preliminary study, the silver nanoparticle (Ag NP)-based dressing, ActicoatTM Flex 3, has been applied to a 3D fibroblast cell culture in vitro and to a real partial thickness burn patient. The in vitro results show that Ag NPs greatly reduce mitochondrial activity, while cellular staining techniques show that nuclear integrity is maintained, with no signs of cell death. For the first time, transmission electron microscopy (TEM) and inductively coupled plasma mass spectrometry (ICP-MS) analyses were carried out on skin biopsies taken from a single patient during treatment. The results show that Ag NPs are released as aggregates and are localized in the cytoplasm of fibroblasts. No signs of cell death were observed, and the nanoparticles had different distributions within the cells of the upper and lower dermis. Depth profiles of the Ag concentrations were determined along the skin biopsies. In the healed sample, most of the silver remained in the surface layers, whereas in the unhealed sample, the silver penetrated more deeply. The Ag concentrations in the cell cultures were also determined. Clinical observations and experimental data collected here are consistent with previously published articles and support the safety of Ag NP-based dressing in wound treatment

Cognitive benefits of using non-invasive compared to implantable neural feedback

A non-optimal prosthesis integration into an amputee's body schema suggests some important functional and health consequences after lower limb amputation. These include low perception of a prosthesis as a part of the body, experiencing it as heavier than the natural limb, and cognitively exhausting use for users. Invasive approaches, exploiting the surgical implantation of electrodes in residual nerves, improved prosthesis integration by restoring natural and somatotopic sensory feedback in transfemoral amputees. A non-invasive alternative that avoids surgery would reduce costs and shorten certification time, significantly increasing the adoption of such systems. To explore this possibility, we compared results from a non-invasive, electro-cutaneous stimulation system to outcomes observed with the use of implants in above the knee amputees. This non-invasive solution was tested in transfemoral amputees through evaluation of their ability to perceive and recognize touch intensity and locations, or movements of a prosthesis, and its cognitive integration (through dual task performance and perceived prosthesis weight). While this managed to evoke the perception of different locations on the artificial foot, and closures of the leg, it was less performant than invasive solutions. Non-invasive stimulation induced similar improvements in dual motor and cognitive tasks compared to neural feedback. On the other hand, results demonstrate that remapped, evoked sensations are less informative and intuitive than the neural evoked somatotopic sensations. The device therefore fails to improve prosthesis embodiment together with its associated weight perception. This preliminary evaluation meaningfully highlights the drawbacks of non-invasive systems, but also demonstrates benefits when performing multiple tasks at once. Importantly, the improved dual task performance is consistent with invasive devices, taking steps towards the expedited development of a certified device for widespread use.ISSN:2045-232

Impact of the community-based active monitoring program on the long term care services use and in-patient admissions of the over-74 population

Introduction: Social isolation increases in the over-74 population and it is a risk factor for death and Long Term Care (LTC) use. In order to prevent the negative consequences of social isolation on this population community interventions focused on strengthening the social network should be intensified. The aim of this paper is to describe the impact on health care use of a Communitybased pro-Active Monitoring Program (CAMP) providing phone monitoring to all the clients and home visits according to the individual’s needs. Methodology: In order to provide an evaluation of the program outcomes, the rates of clients’ hospitalization and admissions to Long Term Care facilities during 2011 have been assessed. The observed rates have been compared with expected ones calculated on available information for similar population. A cost-analysis has been also carried out to analyze the program sustainability. Results: The studied sample is made up by 1408 over-74 citizens followed up during 2011 in Rome (Italy) by CAMP. The cumulative observation time was 1362 p/y; 61 individuals died during 2011 (death rate 4.3%). The hospital admission rate observed among CAMP’s clients was 254‰ (357/1408; CL95% ± 91‰), lower than the 282‰ reported for the over-74 population of Rome. This translates into 39 averted hospitalization. The LTC admission rate is also reduced among CAMP’s clients (9/1,408, 6.6‰ CL95% ± 0.8‰ vs. 9.7‰ reported for a comparable sample); it translates into 4 averted LTC admissions. The averted cost ranged between 47,153 € and 220,117 € according to the range of services used by the clients, which translates into a percentage of estimated cost reduction on yearly basis ranged between 3% and 12.5% of the whole cost of services used by the studied population. Discussion: The paper suggests the capacity of CAMP to reduce both the over-74 hospitalization rate and use of LTC. Cost analysis also indicates a cost reduction as a consequence of the CAMP implementation. Further studies including a control group and a detailed cost-benefit analysis are needed to check the program sustainability on larger populatio

La valutazione

Nel contributo viene presentato l'impianto di valutazione, i metodi e gli strumenti utilizzati per il monitoraggio del processo di formazione integrata (presenza e distanza) sviluppato. Le autrici commentano i dati mettendo in luce le difficolt\ue0 e i punti di forza del lavoro formativo svolto e le ricadute sui contesti scolastici di provenienza dei docenti coinvolt