PROGETTAZIONE DI UN CENTRO BENESSERE E RECUPERO DELLE TERME DI SAN MICHELE ALLE FORMICHE NEL COMUNE DI POMARANCE (PI)

La tesi si pone come obiettivo il recupero e la riqualificazione di un’area situata nel territorio Comunale di Pomarance, posta al di fuori dal centro storico, in direzione di Montecerboli. Alla base di questo lavoro di tesi c’è la necessità di valorizzare e recuperare da un punto di vista idrotermale una zona compresa nel comune di Pomarance, che per le sue potenzialità ha un carattere di preminenza rispetto a molte altre della Val di Cecina. Percorrendo la storia a ritroso, si è visto come questa zona abbia radici termali molto antiche risalenti all’epoca romana. Grazie a questa importante ricchezza e naturalità del territorio l’obiettivo preposto è quello di un rilancio della zona dal punto di vista turistico e quello di rispondere anche alla ricerca del benessere psico-fisico da parte di un numero crescente di persone. Il lavoro della presente tesi si sviluppa nel rispetto dell’Amministrazione Comunale di Pomarance di valorizzare e sviluppare l’intero comprensorio come evidenziato nel Piano strutturale del Comune, inserendo la proposta progettuale all’interno di un progetto a grande scala denominato “Piana dei Turisti”. L’intervento prevede la ristrutturazione delle terme di San Michele alle Formiche, il recupero della zona dei ruderi dell’eremo di San Michele per la loro posizione panoramica, il recupero del Podere Gabbri, e la progettazione di un centro benessere in località I Gabbri. Il percorso di studio e analisi che ha portato al concepimento e alla realizzazione della tesi si è sviluppato secondo tre linee principali: 1. Analisi storica e urbanistica del territorio comunale di Pomarance ed in particolare dell’area oggetto di studio; 2. Ideazione e sviluppo del progetto di recupero dal punto di vista sia urbanistico, che compositivo; 3. Realizzazione una struttura turistico-ricettiva nuova che integri anche una funzione sanitaria-ricreativa con piscina termale

Personalized, Naturalistic Virtual Reality Scenarios Coupled With Web-Based Progressive Muscle Relaxation Training for the General Population: Protocol for a Proof-of-Principle Randomized Controlled Trial

Background: Virtual reality (VR) is an innovative tool that can facilitate exposure to either stressful or relaxing stimuli and enables individuals who have difficulties visualizing scenes to be involved in a more realistic sensorimotor experience. It also facilitates multisensory stimulation, a sense of presence, and achievement of relaxation. VR scenarios representing visual and auditory elements of natural relaxing environments can facilitate the learning of relaxation techniques such as the progressive muscle relaxation technique (PMRT). A complementary standardized technique deployed to reduce anxiety symptoms is the integration of PMRT and guided imagery (GI). Exposure to a pleasant imaginary environment helps the establishment of an association between a relaxing scenario and the relaxation technique, consequently promoting relaxation. Empirical evidence has shown that VR scenarios can increase the effects of relaxation techniques by enabling people to experience emotional conditions in more vivid settings. Objective: The main aim of this pilot study protocol is to investigate the impact on state anxiety of PMRT, associated with a personalized relaxing scenario in VR, and the role of VR scenarios in facilitating the recall of relaxing images and a sense of presence. A secondary aim is to understand if relaxing sessions administered via Zoom are more effective for managing anxiety and stress than a procedural setting based on audio-track guidance. Methods: Based on a longitudinal, between-subject design, 108 university students will be randomly exposed to one of three experimental conditions: (1) PMRT via Zoom and GI exposure, (2) PMRT via Zoom and personalized VR exposure, and (3) PMRT based on audio-track guidance and personalized VR exposure. Individuals are assessed before and after 7 training sessions based on self-report questionnaires investigating anxiety, depression, quality of life, coping strategies, sense of presence, engagement, and side effects related to VR exposure. Heart rate data are also detected by an Mi Band 2 sensor. Results: The experimental procedure is ongoing. In this paper, preliminary data from a sample of 40 participants will be illustrated. The experimental phase is expected to conclude in May 2023, and the final results of the research will be presented in June 2023. Conclusions: The results of this study will help shape the experimental design to apply it on a subsequent randomized controlled trial, also considering clinical samples. This work is expected to measure whether VR is a more engaging and helpful technique in promoting relaxation and decreasing anxiety levels than GI, by making the visualization process easier and by helping people to face more realistic sensory experiences. Assessing the efficacy of the PMRT in alternative delivery modes may extend its applications, especially in situations where the standard procedure is more challenging to be administered. To our knowledge, no equivalent study has been published so far on this matter. Trial registration: ClinicalTrials.gov NCT05478941; https://clinicaltrials.gov/ct2/show/NCT05478941. International registered report identifier (irrid): DERR1-10.2196/44183

Retraso Diagnóstico en Oncología Pediátrica

Fueron revisados retrospectivamente las historias clínicas de 550 pacientes menores de 19 años de edad con diagnóstico citohistológico de malignidad, admitidos entre 01/01/1980 a 31/12/2000. La revisión de datos incluyó: tiempo del inicio de síntomas a la primera consulta (retraso familiar), tiempo desde primera consulta médica hasta la referencia a Centro especializado (con o sin diagnóstico de enfermedad tumoral) (retraso médico) y el tiempo desde la admisión al Centro de Referencia hasta el diagnóstico (Retraso del Centro de Referencia). Del total de 550 pacientes 204 (36%) reclutados en el Grupo A (ingresados entre 1979-89) y 346 (64%) en Grupo B (ingresados entre 1990-2000). De ellos, 189 (92.5%) del grupo A y 342 (98.5%) del grupo B (n: 531) fueron evaluables. Diecinueve pacientes (3.4%) fueron excluidos debido a datos incompletos (8 pacientes), sin seguimiento o referido a otro centro luego del diagnóstico (11 pacientes). En esta serie fue claro que aquellos pacientes con diagnóstico temprano (menor de 30 días) tuvieron una sobrevida alta (83.5%), siendo menor con retrasos mayores (53.3% en 30-60 días y 30.8% en retrasos mayores del 90 días), pero el periodo de seguimiento del Grupo A (1979- 1989) fue más largo. Igualmente se notifica que el incremento de la sobrevida entre ambos períodos fue comparado (1979- 89 vs. 1990-2000) fue de 54.8% al 72.8%, sin cambios significativos en el retraso diagnóstico. Esta observación sostiene el hecho de que los avances terapéuticos pueden disminuir el efecto de los retrasos. De cualquier manera, el retraso diagnóstico determina cambios metabólicos y nutricionales, y progresion de la enfermedad que pueden prevenirse con el uso protocolos cortos y agresivos. La pobre respuesta a la to quimioterapia es más frecuente en pacientes con estadios avanzados of disease. Dichos pacientes también presentan regularmente complicaciones infecciosas y malnutricion que resulta en pobre tolerancia al tratamiento.We retrospectively reviewed the charts of 550 patients of less than 19 years of age with cyto-histological diagnosis of malignancy, admitted from January 1979 to December2000. Retrieved data included: time from the beginning of symptoms to first consultation (family delay), time from first medical consultation to reference to the specialized Centre (with or without diagnosis of tumor disease) (Medical delay) and time from admission at the Reference Centre to diagnosis (Reference Centre delay). Of the grand total of 550 patients 204 (36%) belonged to group A (1979-89) and 346 (64%) to group B (1990-2000). Of these, 189 (92.5%) of group A and 342 (98.5%) of group B (n:531) were adequate for evaluation. Nineteen patients (3.4%) were excluded due to incomplete data (8 patients), no follow-up, or referral to another center after diagnosis (11 patients). As grand total from this series it is clear that those patients with early diagnosis (less than 30 days) had a high survival (83.5%), while this number decreased with longer delays (53.3% in 30-60 days and 30.8% in longer than 90 days), but the period of follow-up of Group A (1979-1989) was longer. At the same it was noticed that the survival increased when both periods were compared (1979-89 vs. 1990-2000) from 54.8% to 72.8%, even with no significant changes in the diagnostic delay. This observation sustains the fact that therapeutic advances may disregard the delays. Anyway, delay in diagnosis determines metabolic and nutritional changes, and progression of the disease all of which prevent the use of aggressive and short therapeutic protocols. So, poor response to chemotherapy is more frequent in patients with advanced stages of disease. These patients also present more regularly infectious complications and malnutrition which result in poor tolerance to the treatment

Adiponectin and cardiometabolic risk factor: effect on myocardial blood flow in patients with dilated cardiomyopathy

Purpose: Adiponectin (ADN) is an insulin-sensitizing, anti-atherogenic and anti-inflammatory adipocytokine, with endothelial protective effects. In patients with dilated cardiomyopathy (DCM), absolute myocardial blood flow (MBF) is frequently impaired because of coronary microvascular/endothelial dysfunction. We aimed at evaluating whether the potential effects of ADN on MBF in DCM are modulated by cardiometabolic risk factors. Methods: Sixty-one consecutive patients (46 males, age 59?10 yrs) with LV dysfunction (LV ejection fraction 38?9%, range 19-54%) and angiographically normal coronary arteries were studied. Absolute MBF was measured by positron emission tomography, using 13N-Ammonia as flow tracer, both at rest and during dipyridamole infusion (0.56 mg/kg I.V. over 4 min). Abnormal MBF was defined for resting MBF<0.65 ml/min/g and dipyridamole MBF<1.36 ml/min/g. Plasma adiponectin was measured by a specific ELISA (Linco Research). Cardiometabolic risk factors including age, sex, insulin resistance, lipid profile and obesity were entered into a multivariate linear regression analysis to assess independent determinants of adiponectin and, in turn, their effect on myocardial and microvascular damage. Results: Abnormal MBF was present in 34/61 patients, in 13/31 (42%) with ADN higher than median value and in 21/30 (70%) with ADN levels lower than median value (p<0.05). Among cardiometabolic risk factors, only HDL-cholesterol and obesity were independent determinants of ADN [0.34 (0.13), -0.34 (0.14), &#946;-coefficient (SE), respectively, p<0.05] at multivariate analysis. After correction for HDL-cholesterol and obesity the positive association between ADN and MBF remained significant (p<0.05). Conclusion: ADN is a determinant of MBF in DCM patients and is related with low HDL-cholesterol and obesity

Prime osservazioni su specie perenni ed annue autoriseminanti in vista della organizzazione di catene di foraggiamento in ambienti mediterranei

Nel corso del periodo 1987-89 sono state valutate le potenzialità produttive e la distribuzione della produzione di 32 tra ecotipi e varietà di graminacee e leguminose foraggere annue e perenni provenienti prevalentemente dall'Italia centrale. La prova è stata condotta contemporaneamente in tre ambienti appartenenti a diverse zone bioclimatiche dell'area mediterranea (Perugia, Grosseto e Sassari) utilizzando uno schema sperimentale a blocchi randomizzati con quattro ripetizioni. I rilievi effettuati hanno riguardato il ricopri mento specifico e la produzione di sostanza secca determinata con criteri differenti: mensilmente per le leguminose annue; al 50% della fioritura e quindi mensilmente per le leguminose perenni; all'inizio della spigatura e quindi mensilmente per le graminacee. Per le specie annuali oltre alla sostanza secca è stata determinata la produzione di seme. L'obiettivo è stato quello di caratterizzare materiali che possano essere impiegati scalarmente per dilatare il periodo di utilizzazione diretta al pascolo. Dai risultati è stato possibile individuare, a seconda delle località, alcune popolazione di Medicago polymorpha L., Trifolium subterraneum L. e Lotus sp. pl. che hanno permesso di anticipare il periodo di utilizzazione primaverile e prolungare quello autunnale. Su questa base sono stati ipotizzati esempi di catene di foraggiamento semplificate (a tre anelli). Per quanto concerne le specie annue autoriseminanti, esse sembrano poter svolgere un importante ruolo nella regolazione della distribuzione stagionale della produzione foraggera nelle due località caratterizzate da un clima più tipicamente mediterraneo (Grosseto e Sassari) mentre la produzione di seme è risultata più che soddisfacente per assicurare l'autorisemina in tutte e tre le località. During the period 1987-1989, the yield and the distribution of forage production of 32 ecotypes and varieties of annual and perennial forage Iegumes and grasses were evaluated. The origin of plant materials was CentraI Italy. The trial was carried out in three environments characterized by different Mediterranean subclimates (Perugia, Grosseto and Sassari). The experimental design was a randomized complete block with four replicates. Specific ground cover was assessed in fall 1987, 1988 and 1989. Dry matter yield was assessed: monthly for annual legumes; at 50% of flowering and then monthly for perennial legumes; at early heading and then monthly for grasses. Seed yield of annual species was also recorded. Aim of the trial was to characterize plant materials that could be utilized subsequently in order to extend the period of direct utilization of herbage by grazing animals. It was possible depending on localities, to identify some populations of Medicago polymorpha L., Trifolium subterraneum L. and Lotus sp. pl.. that allowed to bring forward the spring utilization and to extend the autumn utilization. On the basis of the resu1ts obtained, it was possible to set up some simplified forage chains. Annual self reseeding species seemed to be more important to improve seasonal distribution of herbages in the typical Mediterranean locations (Sassari and Grosseto). Seed production was more than appreciable in order to allow self reseeding at the three locations

Maternal and Sex Dependency of Insulin Resistance: Longitudinal PET and Echocardiography Study from the Healthy Fetus to the Adult Minipig

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RISK ASSESSMENT IN PET RADIOPHARMACEUTICALS PRODUCTION: PLANNING THE IMPLEMENTATION OF A PRODUCTION LINE COMPLIANT WITH GMP REGULATION

The aim of this paper is to provide some indications for carrying out the risk assessment for the activation of a production line of a radiopharmaceutical containing a positrons emitting radionuclide. The risk analysis was performed by following the ICH Q10 guideline and ISO 9001:2015 standards and by using the risk-based thinking approach applied to the entire production cycle. The overall analysis has shown that hard and soft skills of the expert group are key factors of success both in technical and radiopharmaceuticals-related preparations as well as in risk management methodologies

The Free and Cued Selective Reminding Test: Discriminative Values in a Naturalistic Cohort

Background: Neuropsychological assessment is still the basis for the first evaluation of patients with cognitive complaints. The Free and Cued Selective Reminding Test (FCSRT) generates several indices that could have different accuracy in the differential diagnosis between Alzheimer's disease (AD) and other disorders. Objective: In a consecutive series of naturalistic patients, the accuracy of the FCSRT indices in differentiating patients with either mild cognitive impairment (MCI) due to AD or AD dementia from other competing conditions was evaluated. Methods: We evaluated the accuracy of the seven FCSRT indices in differentiating patients with AD from other competing conditions in 434 consecutive outpatients, either at the MCI or at the early dementia stage. We analyzed these data through the receiver operating characteristics curve, and we then generated the odds-ratio map of the two indices with the best discriminative value between pairs of disorders. Results: The immediate and the delayed free total recall, the immediate total recall, and the index of sensitivity of cueing were the most useful indices and allowed to distinguish AD from dementia with Lewy bodies and psychiatric conditions with very high accuracy. Accuracy was instead moderate in distinguishing AD from behavioral variant frontotemporal dementia, vascular cognitive impairment, and other conditions. Conclusion: By using odd-ratio maps and comparison-customized cut-off scores, we confirmed that the FCSRT represents a useful tool to characterize the memory performance of patients with MCI and thus to assist the clinician in the diagnosis process, though with different accuracy values depending on the clinical hypothesis

Air pollution: a study of citizen's attitudes and behaviors using different information sources

Background: From November 2015 to January 2016, the routine air monitoring showed a peak of air pollution (in particular of PM10) that caused alarm in many Italian cities and was widely reported by mass media. After some weeks from this alarm, we tried to evaluate the citizen awareness and interest towards air pollution together with their positive behaviors, using different information sources. Methods: From September 2015 to March 2016, in parallel with the number of exceedances of the PM10 in Italy we evaluated the press coverage, the average monthly searches on Google and the interest on Twitter. Moreover, a qualitative content analysis on daily newspapers was conducted and a self-compiled questionnaire on the attitudes and behaviors about environmental issues and their determinants was administered to 598 parents involved in the project MAPEC_LIFE (LIFE12 ENV/IT/00614). Results: The media coverage of the theme of air pollution was very high from the end of 2015 to the beginning of 2016, as well as internet searches and twitter messages. Our qualitative analysis highlighted that only a small portion of articles included information about positive behaviors and environmental awareness. Despite the high media coverage and the satisfactory self-perceived knowledge, the majority of respondents judged negatively the received information (as untrue and incomplete) and declared a limited adoption of pro-environmental behaviors.&nbsp; Conclusion: The parallel study of mass media information and people’s attitudes and behaviors seem to indicate that the high media coverage was not followed by a very high motivation towards pro-environmental behaviors