Primary breast lymphoma: case reports and review of the literature

As the prevalence of breast cancer has increased over recent years many cases with unusual presentation are emerging. This revue attempts to identify different types of primary malignancies that can affect the breast. A five years review was undertaken at the Breast Unit of Azienda Ospedaliera “Santa Maria”, Terni (Italy). All cases of breast malignancy admitted to the Breast Unit between 2001 and 2005 were reviewed: 750 patients were diagnosed with malignant breast disease. Primary breast lymphoma (was found only in two cases accounting for an incidence of 0,26%. The pre-operative diagnosis was infiltrating carcinoma in both cases and the patients were treated with surgery and systemic chemotherapy; currently they are disease-free

The potential benefits of legacy mentoring for newly qualified nurses

Editoria

Aqua Traiana, a Roman infrastructure embedded in the present: the mineralogical perspective

Construction materials from the internal ducts of Aqua Traiana, a still operative Roman aqueduct built in 109 AD to supply water to Rome, were characterized by optical microscopy (OM), scanning electron microscopy (SEM-EDS), X-ray powder diffraction (XRPD) and electron microprobe analysis (EMPA). Petrographic analysis and XRPD revealed that mortar aggregates are compatible with Vitruvius’ harena fossicia and allowed the distinction of the original mortars from those of the 17th-century papal restoration. The first showed an amorphous binder while the latter have a typical lime binder. By SEM-EDS and EMPA, the microstructure of mortar aggregates was analyzed and the composition of specific minerals quantified. Microanalysis testifies the Romans’ great expertise in the selection of pozzolanic building materials, giving evidence of the possible use of local tuffs from the Sabatini Volcanic District. It also confirms the exploitation of red pozzolan from the Roman Magmatic Province, specifically from the Alban Hills district. OM also proves a high compatibility with local supplies for bricks and cocciopesto. Of these, the first were fired at moderately low temperature, while the latter show an amorphous binder as in the original Trajan mortars. All building materials thus stand for similar technological choices and a coeval production

Negative ozone anomalies at a high mountain site in northern Italy during 2020: a possible role of COVID-19 lockdowns?

Several studies investigated the possible impacts of the restriction measures related to the containment of the spread of the COrona VIrus Disease (COVID-19) to atmospheric ozone (O3) at global, regional, and local scales during 2020. O3 is a secondary pollutant with adverse effects on population health and ecosystems and with negative impacts on climate, acting as greenhouse gas. Most of these studies focused on spring 2020 (i.e. March–May) and on observations in the planetary boundary layer (PBL), mostly in the vicinity of urban agglomerates. Here, we analyzed the variability of O3 above the PBL of northern Italy in 2020 by using continuous observations carried out at a high mountain WMO/GAW global station in Italy (Mt. Cimone–CMN; 44°12' N, 10°42' E, 2165 m a.s.l.). Low O3 monthly anomalies were observed during spring (MAM) and summer (JJA), when periods of low O3 intertwined with periods with higher O3, within climatological ranges. A similar variability was observed for O3 precursors like NO2 and 15 anthropogenic non-methane volatile organic carbons, but the systematic O3 anomalies were not reflected in these variables. The analysis of meteorological variables and diel O3 cycles did not suggest major changes in the vertical transport related to the thermal circulation system in the mountain area. The analysis of five days back-trajectories suggested that the observed O3 anomalies cannot be explained by differences in the synoptic-scale circulation with respect to the previous years alone. On the other hand, the characterization of two transport patterns (i.e. air masses from the regional PBL or from the free troposphere) and the analysis of back-trajectories suggested an important contribution of transport from the continental PBL during the periods with the lowest O3 at CMN. When proxies of air mass transport from the regional PBL are considered, a lower NOx content was pointed out with respect to the previous years, suggesting a lower O3 production in a NOx-limited atmosphere. Our study suggested for the first time that, during MAM and JJA 2020, the reduced anthropogenic emissions related to the COVID-19 restrictions lowered the amount of this short-lived climate forcer/pollutant at remote locations above the PBL over northern Italy. This work suggests the importance of limiting anthropogenic precursor emissions for decreasing the O3 amount at remote locations and in upper atmospheric layers

Draft Genome Sequence of CO33, a Coffee-Infecting Isolate of Xylella fastidiosa

The draft genome sequence of Xylella fastidiosa CO33 isolate, retrieved from symptomatic leaves of coffee plant intercepted in northern Italy, is reported. The CO33 genome size is 2,681,926 bp with a GC content of 51.7%

Providing a nurse-led complex nursing INtervention FOcused on quality of life assessment on advanced cancer patients: The INFO-QoL pilot trial.

PURPOSE Unmet needs for advanced-disease cancer patients are fatigue, pain, and emotional support. Little information is available about the feasibility of interventions focused on patient-reported outcome measurement developed according to the Medical Research Council (MRC) Framework in advanced-disease cancer patients. We aimed to pilot a nurse-led complex intervention focused on QoL assessment in advanced-disease cancer patients. METHODS The INFO-QoL study was based on an exploratory, nonequivalent comparison group, pre-test-post-test design. Study sites received either the INFO-QoL intervention or usual care. Adult advanced-disease cancer patients admitted to hospice inpatient units that gave their informed consent were included in the study. Subjects were 187 patients and their families and 19 healthcare professionals. We evaluated feasibility, acceptability, and patients' outcomes using the Integrated Palliative Care Outcome Scale. RESULTS Nineteen healthcare professionals were included. The mean competence score increased significantly over time (p < 0.001) and the mean usefulness score was high 8.63 (±1.36). In the post-test phase, 54 patients were allocated to the experimental unit and 36 in the comparison unit. Compared to the comparison unit, in the experimental unit anxiety (R2 = 0.07; 95% CI = -0.06; 0.19), family anxiety (R2 = 0.22; 95% CI = -0.03; 0.41), depression (R2 = 0.31; 95% CI = -0.05; 0.56) and sharing feelings (R2 = 0.09; 95% CI = -0.05; 0.23), were improved between pre-test and post-test phase. CONCLUSIONS The INFO-QoL was feasible and potentially improved psychological outcomes. Despite the high attrition rate, the INFO-QoL improved the quality and safety culture for patients in palliative care settings

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

The Role of Attitudes Toward Medication and Treatment Adherence in the Clinical Response to LAIs: Findings From the STAR Network Depot Study

Background: Long-acting injectable (LAI) antipsychotics are efficacious in managing psychotic symptoms in people affected by severe mental disorders, such as schizophrenia and bipolar disorder. The present study aimed to investigate whether attitude toward treatment and treatment adherence represent predictors of symptoms changes over time. Methods: The STAR Network \u201cDepot Study\u201d was a naturalistic, multicenter, observational, prospective study that enrolled people initiating a LAI without restrictions on diagnosis, clinical severity or setting. Participants from 32 Italian centers were assessed at three time points: baseline, 6-month, and 12-month follow-up. Psychopathological symptoms, attitude toward medication and treatment adherence were measured using the Brief Psychiatric Rating Scale (BPRS), the Drug Attitude Inventory (DAI-10) and the Kemp's 7-point scale, respectively. Linear mixed-effects models were used to evaluate whether attitude toward medication and treatment adherence independently predicted symptoms changes over time. Analyses were conducted on the overall sample and then stratified according to the baseline severity (BPRS &lt; 41 or BPRS 65 41). Results: We included 461 participants of which 276 were males. The majority of participants had received a primary diagnosis of a schizophrenia spectrum disorder (71.80%) and initiated a treatment with a second-generation LAI (69.63%). BPRS, DAI-10, and Kemp's scale scores improved over time. Six linear regressions\u2014conducted considering the outcome and predictors at baseline, 6-month, and 12-month follow-up independently\u2014showed that both DAI-10 and Kemp's scale negatively associated with BPRS scores at the three considered time points. Linear mixed-effects models conducted on the overall sample did not show any significant association between attitude toward medication or treatment adherence and changes in psychiatric symptoms over time. However, after stratification according to baseline severity, we found that both DAI-10 and Kemp's scale negatively predicted changes in BPRS scores at 12-month follow-up regardless of baseline severity. The association at 6-month follow-up was confirmed only in the group with moderate or severe symptoms at baseline. Conclusion: Our findings corroborate the importance of improving the quality of relationship between clinicians and patients. Shared decision making and thorough discussions about benefits and side effects may improve the outcome in patients with severe mental disorders

Characterization of ancient hydraulic mortars from the Roman Aqueduct Aqua Traiana

Aqua Traiana is a still functioning Roman aqueduct, built in 109 AD during Trajan empire, that collects water from the springs located north-west of Lake Bracciano (north of Rome) and carries it for 57 km to Transtiber (Rome). The mortars employed in its construction show an impressive durability, as they have maintained their mechanical characteristics for nearly two thousand years. Despite their high quality, only few studies deal with the characterization of hydraulic mortars in ancient roman aqueducts.The purpose of this work is to characterize the materials employed for the mortars of Aqua Traiana and to evaluate the provenance of the raw material. Fifteen samples were collected inside the specus of the aqueduct and analysed by optical microscopy (OM) in thin section and X-ray powder diffraction (XRPD) to determine the mineralogical composition; scanning electron microscopy with energy-dispersive X-ray spectroscopy (SEM-EDS) to obtain the chemical composition; electron microprobe analysis (EMPA) to define the mineralogical phases identified by SEM-EDS; thermogravimetric analysis (TGA) to quantify CaCO3 content in the binder. The results allowed classifying the samples as pozzolan-lime mortars, and distinguishing original from restoration mortars (probably dating back to pope Paulus V restauration). More specifically, in the original mortars the binder is composed only of amorphous gel-like C-A-S-H. The absence of calcite in Trajan age mortars constitutes a unique case due to the environmental conditions and the starting raw materials that influenced the reactions involved

Caratterizzazione preliminare dei materiali costruttivi dell'acquedotto Traiano

Il presente studio si propone di offrire un’analisi più ampia rispetto alla letteratura precedentemente riportata, attraverso la caratterizzazione approfondita delle differenti categorie di materiali costruttivi impiegati nell’aqua Traiana. L’obiettivo è quello di ottenere informazioni sul livello tecnologico raggiunto in età Romana nella costruzione di acquedotti, e verificare l’uso di materiali locali o d’importazione. Nello specifico, una serie di campioni di malta, mattoni e cocciopesto, provenienti da uno dei bracci del sistema di captazione delle Sette Botti (fig. 1) nei pressi di Trevignano Romano (RM) 8, sono stati sottoposti ad indagine archeometrica mediante approccio multi-analitico