Light and shadow of watch-and-wait strategy in rectal cancer: oncological result, clinical outcomes, and cost-effectiveness analysis

BACKGROUND

The watch-and-wait (WW) strategy is a potential option for patients with rectal cancer who obtain a complete clinic response after neoadjuvant therapy. The aim of this study is to analyze the long-term oncological outcomes and perform a cost-effectiveness analysis in patients undergoing this strategy for rectal cancer.

MATERIAL AND METHODS

The data of patients treated with the WW strategy were prospectively collected from January 2015 to January 2020. A control group was created, matched 1:1 from a pool of 480 patients undergoing total mesorectal excision. An independent company carried out the financial analysis. Clinical and oncological outcomes were analyzed in both groups. Outcome parameters included surgical and follow-up costs, quality-adjusted life years (QALYs), and the incremental cost per QALY gained or the incremental cost-effectiveness ratio (ICER).

RESULTS

Forty patients were included in the WW group, with 40 patients in the surgical group. During a median follow-up period of 36 months, metastasis-free survival (MFS) and overall survival (OS) were similar in the two groups. In the WW group, nine (22%) local regrowths were detected in the first 2 years. The permanent stoma rate was slightly higher after salvage surgery in the WW group compared to the surgical group (48.5% vs 20%, p < 0.01). The cost-effectiveness analysis was slightly better for the WW group, especially for low rectal cancer compared to medium-high rectal cancer (ICER =  - 108,642.1 vs ICER =  - 42,423).

CONCLUSIONS

The WW strategy in locally advanced rectal cancer offers similar oncological outcomes with respect to the surgical group and excellent results in quality of life and cost outcomes, especially for low rectal cancer. Nonetheless, the complex surgical field during salvage surgery can lead to a high permanent stoma rate; therefore, the careful selection of patients is mandatory.

Does F4TCNQ Adsorption on Cu(111) Form a 2D-MOF?

The results of a quantitative experimental structural investigation of the adsorption phases formed by 2,3,5,6-tetrafluoro-7,7',8,8'-tetracyanoquinodimethane (F4TCNQ) on Cu(111) are reported. A particular objective was to establish whether Cu adatoms are incorporated into the molecular overlayer. A combination of normal incidence X-ray standing waves, low-energy electron diffraction, scanning tunneling microscopy, and X-ray photoelectron spectroscopy measurements, complemented by dispersion-inclusive density functional theory calculations, demonstrates that F4TCNQ on Cu(111) does cause Cu adatoms to be incorporated into the overlayer to form a two-dimensional metal-organic framework (2D-MOF). This conclusion is shown to be consistent with the behavior of F4TCNQ adsorption on other coinage metal surfaces, despite an earlier report concluding that the adsorption structure on Cu(111) is consistent with the absence of any substrate reconstruction.

Increasing Influenza Vaccination Uptake by Sending Reminders: A Representative Cross-Sectional Study on the Preferences of Italian Adults

Evidence from countries that achieved a high seasonal influenza vaccination (SIV) coverage suggests that reminders to get vaccinated may increase SIV uptake. The goal of this study was to explore the experience and attitudes of Italian adults toward an active invitation to receive SIV, triggered by different sources and delivered via different communication channels, and to assess the projected benefits of this strategy. A cross-sectional survey on a representative sample of Italian adults was conducted by using computer-assisted web interviewing. Responses from 2513 subjects were analyzed. A total of 52.2% of individuals previously received invitations to undergo SIV and compared with people who did not receive any reminder were three times more likely (68.2% vs. 22.2%) to be vaccinated in the last season. Compared with other sources, reminders sent by general practitioners (GPs) were perceived as the most attractive. As for communication channels, most participants preferred text/instant messaging (24.6%) or email (27.2%), suggesting an acceleration in the Italian digital transformation triggered by the COVID-19 pandemic. Conversely, traditional postal letters or phone calls were preferred by only 17.0% and 8.6% of respondents, respectively. Reminders sent by GPs via text/instant messages or email are a valuable option for increasing SIV uptake among Italian adults.

First Measurement of Hard Exclusive π^{-}Δ^{++} Electroproduction Beam-Spin Asymmetries off the Proton

The polarized cross-section ratio σ_{LT^{'}}/σ_{0} from hard exclusive π^{-}Δ^{++} electroproduction off an unpolarized hydrogen target has been extracted based on beam-spin asymmetry measurements using a 10.2  GeV/10.6  GeV incident electron beam and the CLAS12 spectrometer at Jefferson Lab. The study, which provides the first observation of this channel in the deep-inelastic regime, focuses on very forward-pion kinematics in the valence regime, and photon virtualities ranging from 1.5  GeV^{2} up to 7  GeV^{2}. The reaction provides a novel access to the d-quark content of the nucleon and to p→Δ^{++} transition generalized parton distributions. A comparison to existing results for hard exclusive π^{+}n and π^{0}p electroproduction is provided, which shows a clear impact of the excitation mechanism, encoded in transition generalized parton distributions, on the asymmetry.

First CLAS12 Measurement of Deeply Virtual Compton Scattering Beam-Spin Asymmetries in the Extended Valence Region

Deeply virtual Compton scattering (DVCS) allows one to probe generalized parton distributions describing the 3D structure of the nucleon. We report the first measurement of the DVCS beam-spin asymmetry using the CLAS12 spectrometer with a 10.2 and 10.6 GeV electron beam scattering from unpolarized protons. The results greatly extend the Q^{2} and Bjorken-x phase space beyond the existing data in the valence region and provide 1600 new data points measured with unprecedented statistical uncertainty, setting new, tight constraints for future phenomenological studies.

Nuclear magnetic resonance signal decay in the presence of a background gradient: Normal and anomalous diffusion

A novel way for calculating the diffusion-weighted nuclear magnetic resonance (NMR) attenuation signal expression in the presence of a background gradient is developed. This method is easily applicable to NMR-attenuated signals arising from any pulse field gradient sequence experiments. Here, we provide detailed calculations for the classical pulsed gradient stimulated echo and the pulsed gradient spin echo, as the particular cases. Within this general theoretical framework, devised for Gaussian processes with stationary increments, we recover and extend the previous Stejskal-Tanner results in the case of normal diffusion and we furnish a new expression in the case of anomalous diffusion.

First Measurement of Λ Electroproduction off Nuclei in the Current and Target Fragmentation Regions

We report results of Λ hyperon production in semi-inclusive deep-inelastic scattering off deuterium, carbon, iron, and lead targets obtained with the CLAS detector and the Continuous Electron Beam Accelerator Facility 5.014 GeV electron beam. These results represent the first measurements of the Λ multiplicity ratio and transverse momentum broadening as a function of the energy fraction (z) in the current and target fragmentation regions. The multiplicity ratio exhibits a strong suppression at high z and an enhancement at low z. The measured transverse momentum broadening is an order of magnitude greater than that seen for light mesons. This indicates that the propagating entity interacts very strongly with the nuclear medium, which suggests that propagation of diquark configurations in the nuclear medium takes place at least part of the time, even at high z. The trends of these results are qualitatively described by the Giessen Boltzmann-Uehling-Uhlenbeck transport model, particularly for the multiplicity ratios. These observations will potentially open a new era of studies of the structure of the nucleon as well as of strange baryons.

Donor-Acceptor Co-Adsorption Ratio Controls the Structure and Electronic Properties of Two-Dimensional Alkali-Organic Networks on Ag(100)

The results are presented of a detailed combined experimental and theoretical investigation of the influence of coadsorbed electron-donating alkali atoms and the prototypical electron acceptor molecule 7,7,8,8-tetracyanoquinodimethane (TCNQ) on the Ag(100) surface. Several coadsorption phases were characterized by scanning tunneling microscopy, low-energy electron diffraction, and soft X-ray photoelectron spectroscopy. Quantitative structural data were obtained using normal-incidence X-ray standing wave (NIXSW) measurements and compared with the results of density functional theory (DFT) calculations using several different methods of dispersion correction. Generally, good agreement between theory and experiment was achieved for the quantitative structures, albeit with the prediction of the alkali atom heights being challenging for some methods. The adsorption structures depend sensitively on the interplay of molecule-metal charge transfer and long-range dispersion forces, which are controlled by the composition ratio between alkali atoms and TCNQ. The large difference in atomic size between K and Cs has negligible effects on stability, whereas increasing the ratio of K/TCNQ from 1:4 to 1:1 leads to a weakening of molecule-metal interaction strength in favor of stronger ionic bonds within the two-dimensional alkali-organic network. A strong dependence of the work function on the alkali donor-TCNQ acceptor coadsorption ratio is predicted.

Closed hyperthermic intraperitoneal chemotherapy with CO2 recirculation system compared with the open Coliseum technique in peritoneal malignity treatment

BACKGROUND

Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis can be performed in two ways: first, the standard open abdominal technique (Open HIPEC); or second, the closed technique. In recent years, a new technique has been introduced to perform closed HIPEC; the Peritoneal Recirculation System (PRS-1.0 Combat) with CO₂ recirculation technology (PRS Closed HIPEC). The objective of this study is to present our experience with the PRS Closed HIPEC by comparing the intraoperative, postoperative and oncological results with the standard Open HIPEC technique (the Coliseum technique).

METHODS

Data on patients undergoing CRS and HIPEC at the Sanchinarro University Hospital, Madrid from October 2012 to June 2021 were collected in a prospective database. The inclusion criteria were patients with primary or recurrent peritoneal metastases in gastrointestinal malignancies or ovarian cancer. The presence of an unresectable peritoneal carcinomatosis, the coexistence of another oncological disease, unresectable and distant metastases were the exclusion criteria.

RESULTS

From October 2014 to June 2021, 84 patients underwent CRS and HIPEC at the Sanchinarro University Hospital, Madrid with curative intent. Since the introduction of the PRS Closed HIPEC technique in 2016, 65 patients have been treated. Before the introduction of PRS Closed HIPEC, 19 cases were performed using the Coliseum technique (the Open HIPEC group). The intraoperative results were similar in the two groups. Complete cytoreduction was achieved in all cases in the Open HIPEC group and in 98% in the PRS Closed HIPEC group. The rate of major complications was similar between the groups. Median Overall Survival (OS) resulted better in the Closed HIPEC group (67 months) with respecto to the Open group (43 months) (p < 0,001). Median Disease-Free Survival (DFS) was 15 months in the Open HIPEC group and 40 months in the PRS Closed HIPEC group (p < 0.001).

CONCLUSION

The Peritoneal Recirculation System with CO₂ recirculation technology (PRS Closed HIPEC) is a reproducible and safe technique and may represent a valid alternative for the administration of HIPEC.

Observation of Correlations between Spin and Transverse Momenta in Back-to-Back Dihadron Production at CLAS12

We report the first measurements of deep inelastic scattering spin-dependent azimuthal asymmetries in back-to-back dihadron electroproduction in the deep inelastic scattering process. In this reaction, two hadrons are produced in opposite hemispheres along the z axis in the virtual photon-target nucleon center-of-mass frame, with the first hadron produced in the current-fragmentation region and the second in the target-fragmentation region. The data were taken with longitudinally polarized electron beams of 10.2 and 10.6 GeV incident on an unpolarized liquid-hydrogen target using the CLAS12 spectrometer at Jefferson Lab. Observed nonzero sinΔϕ modulations in ep→e^{'}pπ^{+}X events, where Δϕ is the difference of the azimuthal angles of the proton and pion in the virtual photon and target nucleon center-of-mass frame, indicate that correlations between the spin and transverse momenta of hadrons produced in the target- and current-fragmentation regions may be significant. The measured beam-spin asymmetries provide a first access in dihadron production to a previously unexplored leading-twist spin- and transverse-momentum-dependent fracture function. The fracture functions describe the hadronization of the target remnant after the hard scattering of a virtual photon off a quark in the target particle and provide a new avenue for studying nucleonic structure and hadronization.

Observation of Azimuth-Dependent Suppression of Hadron Pairs in Electron Scattering off Nuclei

We present the first measurement of dihadron angular correlations in electron-nucleus scattering. The data were taken with the CLAS detector and a 5.0 GeV electron beam incident on deuterium, carbon, iron, and lead targets. Relative to deuterium, the nuclear yields of charged-pion pairs show a strong suppression for azimuthally opposite pairs, no suppression for azimuthally nearby pairs, and an enhancement of pairs with large invariant mass. These effects grow with increased nuclear size. The data are qualitatively described by the gibuu model, which suggests that hadrons form near the nuclear surface and undergo multiple scattering in nuclei.These results show that angular correlation studies can open a new way to elucidate how hadrons form and interact inside nuclei.

Minimizing plasma temperature for antimatter mixing experiments

The ASACUSA collaboration produces a beam of antihydrogen atoms by mixing pure positron and antiproton plasmas in a strong magnetic field with a double cusp geometry. The positrons cool via cyclotron radiation inside the cryogenic trap. Low positron temperature is essential for increasing the fraction of antihydrogen atoms which reach the ground state prior to exiting the trap. Many experimental groups observe that such plasmas reach equilibrium at a temperature well above the temperature of the surrounding electrodes. This problem is typically attributed to electronic noise and plasma expansion, which heat the plasma. The present work reports anomalous heating far beyond what can be attributed to those two sources. The heating seems to be a result of the axially open trap geometry, which couples the plasma to the external (300 K) environment via microwave radiation.

Multidimensional, High Precision Measurements of Beam Single Spin Asymmetries in Semi-inclusive π^{+} Electroproduction off Protons in the Valence Region

High precision measurements of the polarized electron beam-spin asymmetry in semi-inclusive deep inelastic scattering (SIDIS) from the proton have been performed using a 10.6 GeV incident electron beam and the CLAS12 spectrometer at Jefferson Lab. We report here a high precision multidimensional study of single π^{+} SIDIS data over a large kinematic range in Bjorken x, fractional energy, and transverse momentum of the hadron as well as photon virtualities Q^{2} ranging from 1-7  GeV^{2}. In particular, the structure function ratio F_{LU}^{sinϕ}/F_{UU} has been determined, where F_{LU}^{sinϕ} is a twist-3 quantity that can reveal novel aspects of emergent hadron mass and quark-gluon correlations within the nucleon. The data's impact on the evolving understanding of the underlying reaction mechanisms and their kinematic variation is explored using theoretical models for the different contributing transverse momentum dependent parton distribution functions.

Improved Λp Elastic Scattering Cross Sections between 0.9 and 2.0 GeV/c as a Main Ingredient of the Neutron Star Equation of State

Strange matter is believed to exist in the cores of neutron stars based on simple kinematics. If this is true, then hyperon-nucleon interactions will play a significant part in the neutron star equation of state. Yet, compared to other elastic scattering processes, there is very little data on Λ-N scattering. This experiment utilized the CEBAF Large Acceptance Spectrometer (CLAS) detector to study the Λp→Λp elastic scattering cross section in the incident Λ momentum range 0.9-2.0  GeV/c. These are the first data on this reaction since the 1970s. The new cross sections have significantly better accuracy and precision than the existing world data, and the techniques developed here can also be used in future experiments.

First Measurement of Timelike Compton Scattering

We present the first measurement of the timelike Compton scattering process, γp→p^{'}γ^{*}(γ^{*}→e^{+}e^{-}), obtained with the CLAS12 detector at Jefferson Lab. The photon beam polarization and the decay lepton angular asymmetries are reported in the range of timelike photon virtualities 2.25<Q^{'2}<9  GeV^{2}, squared momentum transferred 0.1<-t<0.8  GeV^{2}, and average total center-of-mass energy squared s=14.5  GeV^{2}. The photon beam polarization asymmetry, similar to the beam-spin asymmetry in deep virtual Compton scattering, is sensitive to the imaginary part of the Compton form factors and provides a way to test the universality of the generalized parton distributions. The angular asymmetry of the decay leptons accesses the real part of the Compton form factors and thus the D-term in the parametrization of the generalized parton distributions.

Microstructural features assessment of different waterlogged wood species by NMR diffusion validated with complementary techniques

Wood is a hygroscopic, multi-scale and anisotropic natural material composed of pores with different size and differently oriented. In particular, archaeologically excavated wood generally is waterlogged wood with very high moisture content (400%-800%) that need to have a rapid investigation at the microstructural level to obtain the best treatment with preservative agents. Time-dependent diffusion coefficient D(t) quantified by Pulse Field Gradient (PFG) Nuclear Magnetic Resonance (NMR) techniques provides useful information about complex porous media, such as the tortuosity (τ) describing pore connectivity and fluid transport through media, the average-pore size, the anisotropic degree (a_n). However, diffusion NMR is intrinsically limited since it is an indirect measure of medium microstructure and relies on inferences from models and estimation of relevant diffusion parameters. Therefore, it is necessary to validate the information obtained from NMR diffusion parameters through complementary investigations. In this work, the structures of five waterlogged wood species were studied by PFG of absorbed water. D(t) and τ of water diffusing along and perpendicular to vessels/tracheids main axes together with relaxation times and a_n were quantified. From these parameters, the pore sizes distribution and the wood microstructure characterization were obtained. Results among wood species were compared, validated and integrated by micro-imaging NMR (μ-MRI), environmental-scanning electron-microscope (ESEM) images, wood dry density and imbibition times measurement of all woods. The work suggests that a_n vs τ rather than the estimated pore size diversifies and characterize the different wood species. As a consequence diffusion-anisotropy vs tortuosity could be an alternative method to characterize and differentiate wood species of waterlogged wood when high resolution images (μ-MRI and ESEM) are not available. Moreover, the combined use of D(t) and micro-MRI expands the scale of dimensions observable by NMR covering all the interesting length scales of wood.

The first report on coronavirus disease 2019 (COVID-19) vaccine refusal by patients with solid cancer in Italy: Early data from a single-institute survey

INTRODUCTION

Patients with cancer have an increased risk of complications from coronavirus disease 2019 (COVID-19) infection, including death, and thus, they were considered as high-priority subjects for COVID-19 vaccination. We report on the compliance with the COVID-19 vaccine of patients affected by solid tumours.

MATERIALS AND METHODS

Patients with cancer afferent to Medical Oncology 1 Unit of Regina Elena National Cancer Institute in Rome were considered eligible for vaccination if they were receiving systemic immunosuppressive antitumor treatment or received it in the last 6 months or having an uncontrolled advanced disease. The Pfizer BNT162b2 vaccine was proposed to all candidates via phone or during a scheduled visit. The reasons for refusal were collected by administrating a 6-item multiple-choice questionnaire.

RESULTS

From 1st March to 20th March 2021, of 914 eligible patients, 102 refused vaccination (11.2%, 95% confidence interval [CI] 9.1-13.2). The most frequent (>10%) reasons reported were concerns about vaccine-related adverse events (48.1%), negative interaction with concomitant antitumor therapy (26.7%), and the fear of allergic reaction (10.7%). The refusal rate (RR) after 15th March (date of AstraZeneca-AZD1222 suspension) was more than doubled compared with the RR observed before (19.7% versus 8.6%, odds ratio [OR] 2.60, 95% CI 1.69-3.99; P < 0.0001). ECOG-PS 2 was associated with higher RR compared with ECOG-PS 0-1 (OR 2.94, 95% CI 1.04-8.34; P = 0.04). No statistically significant differences in RR according to other clinical characteristics were found.

CONCLUSIONS

Our experience represents the first worldwide report on the adherence of patients with cancer to COVID-19 vaccination and underlines how regulatory decisions and media news spreading could influence the success of the campaign.

Observation of Beam Spin Asymmetries in the Process ep→e^{'}π^{+}π^{-}X with CLAS12

The observation of beam spin asymmetries in two-pion production in semi-inclusive deep inelastic scattering off an unpolarized proton target is reported. The data presented here were taken in the fall of 2018 with the CLAS12 spectrometer using a 10.6 GeV longitudinally spin-polarized electron beam delivered by CEBAF at JLab. The measured asymmetries provide the first opportunity to extract the parton distribution function e(x), which provides information about the interaction between gluons and quarks, in a collinear framework that offers cleaner access than previous measurements. The asymmetries also constitute the first ever signal sensitive to the helicity-dependent two-pion fragmentation function G_{1}^{⊥}. A clear sign change is observed around the ρ mass that appears in model calculations and is indicative of the dependence of the produced pions on the helicity of the fragmenting quark.

Dexamethasone measurement during low-dose suppression test for suspected hypercortisolism: threshold development with and validation

BACKGROUND AND AIM

Dexamethasone Suppression Test (DST), recommended for Cushing's Syndrome (CS) diagnosis, explores the pituitary feedback to glucocorticoids. Its diagnostic accuracy could be affected by dexamethasone bioavailability, and therefore, we have developed and validated a dexamethasone threshold after 1-mg DST.

MATERIALS AND METHODS

We studied 200 subjects: 125 patients were considered retrospectively and 75 were enrolled prospectively as the validation cohort. Serum dexamethasone, Late Night Salivary Cortisol (LNSC), and Urinary Free Cortisol (UFC) were measured with LC-MS/MS. Normal LNSC and UFC levels were used to exclude CS. The lower 2.5th percentile of dexamethasone distribution in non-CS patients with cortisol ≤ 50 nmol/L after 1-mg DST was used as threshold.

RESULTS

16 patients were CS and 184 non-CS (108 adrenal incidentaloma and 76 excluded CS); 4.5 nmol/L resulted the calculated threshold. Cortisol after 1-mg DST confirmed high sensitivity (100% at 50 nmol/L cut-off) and moderate-low specificity (63%, increased to 91% at 138 nmol/L) to diagnose CS in the whole cohort of patients. We could reduce the number of false-positive results (from 10 to 6 and from 7 to 4 in AI and excluded CS) considering adequate dexamethasone levels. Dexamethasone levels were not affected by hypercortisolism, age, gender, smoke, weight, and creatinine. 6% of non-CS patients did not achieve adequate dexamethasone levels (40% of tests with serum cortisol > 138 nmol/L after 1-mg DST).

CONCLUSIONS

We developed and validated the routine dexamethasone measurement during 1-mg DST: it is independent from patient's clinical presentation, and it should be used to increase the specificity of serum cortisol levels.

Surface structural phase transition induced by the formation of metal-organic networks on the Si(111)--In surface

We studied the adsorption of 7,7,8,8-tetracyanoquinodimethane (TCNQ) on the Si(111)- -In surface, a known surface superconductor. Scanning tunneling microscopy shows the development of a surface-confined metal-organic network (SMON) where TCNQ molecules coordinate with indium atoms from the underlying reconstruction. The formation of the SMON causes a surface structural phase transition from the reconstruction to a previously unknown 5 × 5 reconstruction of the Si(111)-In surface. Scanning tunneling spectroscopy measurements indicate that the 5 × 5 reconstruction has a stronger insulating character than the reconstruction. Density-functional-theory calculations are used to evaluate the atomic arrangement and stability of the 5 × 5 and reconstructions as a function of In coverage, and suggest that the structural phase transition is driven by a slight reduction of the In coverage, caused by the incorporation of indium atoms into the SMON.

The Structure of VOPc on Cu(111): Does V=O Point Up, or Down, or Both?

The local structure of the nonplanar phthalocyanine, vanadyl phthalocyanine (VOPc), adsorbed on Cu(111) at a coverage of approximately one-half of a saturated molecular layer, has been investigated by a combination of normal-incidence X-ray standing waves (NIXSW), scanned-energy mode photoelectron diffraction (PhD), and density-functional theory (DFT), complemented by scanning tunnelling microscopy (STM). Qualitative assessment of the NIXSW data clearly shows that both "up" and "down" orientations of the molecule (with V=O pointing out of, and into, the surface) must coexist on the surface. O 1s PhD proves to be inconclusive regarding the molecular orientation. DFT calculations, using two different dispersion correction schemes, show good quantitative agreement with the NIXSW structural results for equal co-occupation of the two different molecular orientations and clearly favor the many body dispersion (MBD) method to deal with long-range dispersion forces. The calculated relative adsorption energies of the differently oriented molecules at the lowest coverage show a strong preference for the "up" orientation, but at higher local coverages, this energetic difference decreases, and mixed orientation phases are almost energetically equivalent to pure "up"-oriented phases. DFT-based Tersoff-Hamann simulations of STM topographs for the two orientations cast some light on the extent to which such images provide a reliable guide to molecular orientation.

A video-based training to effectively teach CPR with long-term retention: the ScuolaSalvaVita.it ("SchoolSavesLives.it") project

Enhancing CPR knowledge in schools is the key to improving bystander CPR rate and survival after an out-of-hospital cardiac arrest, but the best method to do so in a whole area is unknown. We wanted to assess if a province-based project, which involves the Secondary Schools of a whole Province, is effective in teaching schoolchildren CPR, and how well the skills are retained. We trained 100 teachers from the 21 Secondary Schools of the Province of Pavia with a BLS/AED course and we supplied each school with 10 low-budget manikins and four educational videos. These videos, about 2 min each, consist of a motivational part, an instructive part, a demonstrative part and a practice-while-watching part. We explained to the teachers how to use manikins and videos in a 2-h course. We carried out both a theoretical and a practical test in 21 classes, randomly selected between the classes trained by the teachers, 3 months and 6 months after the training. In the first 5 months of the project, 5146 schoolchildren aged 14-19, in the 21 Secondary Schools of our Province, were trained by their teachers. We tested 304 students 3 months after the course and 318 students 6 months after the course, with good results both in theoretical and practical skills. Our study demonstrates that the ScuolaSalvaVita project is able to effectively teach CPR through teachers using a video-based training in the Secondary Schools of a whole Province obtaining good long-term memory of CPR skills.

Probing the interplay between geometric and electronic structure in a two-dimensional K-TCNQ charge transfer network

Scanning tunnelling microscopy (STM), low energy electron diffraction (LEED), ultraviolet and soft X-ray photoelectron spectroscopy (UPS and SXPS) have been used to characterise the formation of a coadsorption phase of TCNQ and K on Ag(111), while the normal incident X-ray standing waves (NIXSW) technique has been used to obtain quantitative structural information. STM and LEED show that an ordered incommensurate phase is formed in which the K atoms are surrounded by four TCNQ molecules in a 'windmill' motif, characteristic of other metal/TCNQ phases, in which the nominal TCNQ : K stoichiometry is 1 : 1. UPS and SXPS data indicate the TCNQ is in a negatively-charged state. NIXSW results show that the carbon core of the TCNQ is essentially planar at a height above the Ag(111) surface closely similar to that found without coadsorbed K. In the presence of TCNQ the height of the K ions above the surface is significantly larger than on clean Ag(111), and the ions occupy sites above 'holes' in the TCNQ network. NIXSW data also show that the N atoms in the molecules must occupy sites with at least two different heights above the surface, which can be reconciled by a tilt or twist of the TCNQ molecules, broadly similar to the geometry that occurs in bulk TCNQ/K crystals.

Re-evaluating how charge transfer modifies the conformation of adsorbed molecules

The archetypal electron acceptor molecule, TCNQ, is generally believed to become bent into an inverted bowl shape upon adsorption on the coinage metal surfaces on which it becomes negatively charged. New quantitative experimental structural measurements show that this is not the case for TCNQ on Ag(111). DFT calculations show that the inclusion of dispersion force corrections reduces not only the molecule-substrate layer spacing but also the degree of predicted molecular bonding. However, complete agreement between experimentally-determined and theoretically-predicted structural parameters is only achieved with the inclusion of Ag adatoms into the molecular layer, which is also the energetically favoured configuration. The results highlight the need for both experimental and theoretical quantitative structural methods to reliably understand similar metal-organic interfaces and highlight the need to re-evaluate some previously-investigated systems.

Two-year real-life efficacy, tolerability and safety of dimethyl fumarate in an Italian multicentre study

BACKGROUND

Dimethyl-fumarate (DMF) demonstrated efficacy and safety in relapsing-remitting multiple sclerosis (MS) in randomized clinical trials.

OBJECTIVES

To track and evaluate post-market DMF profile in real-world setting.

MATERIALS AND METHODS

Patients receiving DMF referred to Italian MS centres were enrolled and prospectively followed, collecting demographic clinical and radiological data.

RESULTS

Among the 735 included patients, 45.4% were naïve to disease-modifying therapies, 17.8% switched to DMF because of tolerance, 27.4% switched to DMF because of lack of efficacy, and 9.4% switched to DMF because of safety concerns. Median DMF exposure was 17 months (0-33). DMF reduced the annual relapse rate (ARR) by 63.2%. At 12 and 24 months, 85 and 76% of patients were relapse-free. NEDA-3 status after 12 months of DMF treatment was maintained by 47.5% of patients. 89 and 70% of patients at 12 and 24 months regularly continued DMF. Most frequent adverse events (AEs) were flushing (37.2%) and gastro-enteric AEs (31.1%).

CONCLUSION

Our post-market study corroborated that DMF is a safe and effective drug. Additionally, the study suggested that naïve patients strongly benefit from DMF and that DMF improved ARR also in patients who were horizontally switched from injectable therapies due to tolerability and efficacy issues.

Body-worn triaxial accelerometer coherence and reliability related to static posturography in unilateral vestibular failure

Since changes in vestibular function may be one cause of disequilibrium, major advances in measuring postural control and sensory integration in vestibular impairments have been achieved by using posturography. However, in order to overcome problems related to this type of technology, body-worn accelerometers (ACC) have been proposed as a portable, low-cost alternative to posturography for measurements of postural sway in a friendly and ecologic environment. Due to the fact that no study to date has shown the experimental validity of ACC-based measures of body sway with respect to posturography for subjects with vestibular deficits, the aim of the present study was: i) to develop and validate a practical tool that can allow clinicians to measure postural sway derangements in an otoneurological setting by ACC, and ii) to provide reliable, sensitive and accurate automatic analysis of sway that could help in discriminating unilateral vestibular failure (UVF) patients. Thus, a group of 13 patients (seven females, 6 males; mean age 48.6 ± 6.4 years) affected for at least 6 months by UVF and 13 matched healthy subjects were instructed to maintain an upright position during a static forceplate-based posturography (FBP) acquisition while wearing a Movit® sensor (by Captiks) with 3-D accelerometers mounted on the posterior trunk near the body centre of mass. Pearson product moment correlation demonstrated a high level of correspondence of four time-domain and three frequency-domain measures extracted by ACC and FBP testing; in addition, t-test demonstrated that two ACC-based time- and frequency-domain parameters were reliable measures in discriminating UVF subjects. These aspects, overall, should further highlight the attention of clinicians and researchers to this kind of sway recording technique in the field of otoneurological disorders by considering the possibility to enrich the amount of quantitative and qualitative information useful for discrimination, diagnosis and treatment of UVF. In conclusion, we believe the present ACC-based measurement of sway offers a patient-friendly, reliable, inexpensive and efficient alternative recording technique that is useful - together with clinical balance and mobility tests - in various circumstances, as well as in outcome studies involving diagnosis, follow-up and rehabilitation of UVF patients.

Molecular self-assembly of substituted terephthalic acids at the liquid/solid interface: investigating the effect of solvent

Self-assembly of three related molecules – terephthalic acid and its hydroxylated analogues – at liquid/solid interfaces (graphite/heptanoic acid and graphite/1-phenyloctane) has been studied using a combination of scanning tunnelling microscopy and molecular mechanics and molecular dynamics calculations. Brickwork-like patterns typical for terephthalic acid self-assembly have been observed for all three molecules. However, several differences became apparent: (i) formation or lack of adsorbed monolayers (self-assembled monolayers formed in all systems, with one notable exception of terephthalic acid at the graphite/1-phenyloctane interface where no adsorption was observed), (ii) the size of adsorbate islands (large islands at the interface with heptanoic acid and smaller ones at the interface with 1-phenyloctane), and (iii) polymorphism of the hydroxylated terephthalic acids’ monolayers, dependent on the molecular structure and/or solvent. To rationalise this behaviour, molecular mechanics and molecular dynamics calculations have been performed, to analyse the three key aspects of the energetics of self-assembly: intermolecular, substrate–adsorbate and solvent–solute interactions. These energetic characteristics of self-assembly were brought together in a Born–Haber cycle, to obtain the overall energy effects of formation of self-assembled monolayers at these liquid/solid interfaces.

Two-dimensional core-shell donor-acceptor assemblies at metal-organic interfaces promoted by surface-mediated charge transfer

Organic charge transfer (CT) complexes obtained by combining molecular electron donors and acceptors have attracted much interest due to their potential applications in organic opto-electronic devices. In order to work, these systems must have an electronic matching - the highest occupied molecular orbital (HOMO) of the donor must couple with the lowest unoccupied molecular orbital (LUMO) of the acceptor - and a structural matching, so as to allow direct intermolecular CT. Here it is shown that, when molecules are adsorbed on a metal surface, novel molecular organizations driven by surface-mediated CT can appear that have no counterpart in condensed phase non-covalent assemblies of donor and acceptor molecules. By means of scanning tunneling microscopy and spectroscopy it is demonstrated that the electronic and self-assembly properties of an electron acceptor molecule can change dramatically in the presence of an additional molecular species with marked electron donor character, leading to the formation of unprecedented core-shell assemblies. DFT and classical force-field simulations reveal that this is a consequence of charge transfer from the donor to the acceptor molecules mediated by the metallic substrate.

Positioning of strained islands by interaction with surface nanogrooves

When strained Stranski-Krastanow islands are used as "self-assembled quantum dots," a key goal is to control the island position. Here we show that nanoscale grooves can control the nucleation of epitaxial Ge islands on Si(001), and can drive lateral motion of existing islands onto the grooves, even when the grooves are very narrow and shallow compared to the islands. A position centered on the groove minimizes energy. We use as prototype grooves the trenches which form naturally around islands. During coarsening, the shrinking islands move laterally to sit directly astride that trench. In subsequent growth, we demonstrate that islands nucleate on the "empty trenches" which remain on the surface after complete dissolution of the original islands.

Neural associative memory storing gray-coded gray-scale images

We present a neural associative memory storing gray-scale images. The proposed approach is based on a suitable decomposition of the gray-scale image into gray-coded binary images, stored in brain-state-in-a-box-type binary neural networks. Both learning and recall can be implemented by parallel computation, with time saving. The learning algorithm, used to store the binary images, guarantees asymptotic stability of the stored patterns, low computational cost, and control of the weights precision. Some design examples and computer simulations are presented to show the effectiveness of the proposed method.

Interplay between thermodynamics and kinetics in the capping of InAs/GaAs(001) quantum dots

A microscopic picture for the GaAs overgrowth of self-organized quantum dots is developed. Scanning tunneling microscopy measurements reveal two capping regimes: the first being characterized by a dot shrinking and a backward pyramid-to-dome shape transition. This regime is governed by fast dynamics resulting in island morphologies close to thermodynamic equilibrium. The second regime is marked by a true overgrowth and is controlled by kinetically limited surface diffusion processes. A simple model is developed to describe the observed structural changes which are rationalized in terms of energetic minimization driven by lattice mismatch and alloying.

Lateral motion of SiGe islands driven by surface-mediated alloying

SiGe islands move laterally on a Si(001) substrate during in situ postgrowth annealing. This surprising behavior is revealed by an analysis of the substrate surface morphology after island removal using wet chemical etching. We explain the island motion by asymmetric surface-mediated alloying. Material leaves one side of the island by surface diffusion, and mixes with additional Si from the surrounding surface as it redeposits on the other side. Thus the island moves laterally while becoming larger and more dilute.

Atomic-scale pathway of the pyramid-to-dome transition during ge growth on Si(001)

By high resolution scanning tunneling microscopy, we investigate the morphological transition from pyramid to dome islands during the growth of Ge on Si(001). We show that pyramids grow from top to bottom and that, from a critical size on, incomplete facets are formed. We demonstrate that the bunching of the steps delimiting these facets evolves into the steeper dome facets. Based on first principles and Tersoff-potential calculations, we develop a microscopic model for the onset of the morphological transition, able to reproduce closely the experimentally observed behavior.

Hierarchical self-assembly of GaAs/AlGaAs quantum dots

A novel structure containing self-assembled, unstrained GaAs quantum dots is obtained by combining solid-source molecular beam epitaxy and atomic-layer precise in situ etching. Photo-luminescence (PL) spectroscopy reveals light emission with very narrow inhomogeneous broadening and clearly resolved excited states at high excitation intensity. The dot morphology is determined by scanning probe microscopy and, combined with single band and eight-band k.p theory calculations, is used to interpret PL and single-dot spectra with no adjustable structural parameter.

String ratchets: ac driven asymmetric kinks

We simulated numerically the time evolution of a one-kink bearing, damped elastic string sitting on noiseless periodic substrates of two types: (I) asymmetric, time independent, (II) symmetric, periodically deformable. An asymmetric kink subjected to an ac drive is shown to drift steadily with finite average speed independent of its initial kinetic conditions. In the overdamped regime the resulting net kink transport can be attributed to the rectification of the Brownian motion of a pointlike particle with oscillating mass. For intermediate to low damping completely different features show up, due to the finite size of the objects being transported; in particular, the kink current hits a maximum for an optimal value of the damping constant, resonates at the kink internal-mode frequency and, finally, reverses sign within a certain range of the drive parameters.

Deterministic ratchets: route to diffusive transport

The rectification efficiency of an underdamped ratchet operated in the adiabatic regime increases according to a scaling current-amplitude curve as the damping constant approaches a critical threshold; below threshold the rectified signal becomes extremely irregular and eventually its time average drops to zero. Periodic (locked) and diffusive (fully chaotic) trajectories coexist on fine tuning the amplitude of the input signal. The transition from regular to chaotic transport in noiseless ratchets has been studied numerically.

Asymmetric kinks: stabilization by entropic forces

Asymmetric kinks bridging two adjacent potential valleys of equal depth but different curvature are unstable against phonon modes. When coupled to a heat bath, a kink-bearing string tends to cross over into the shallower valley; kinks are thus predicted to drift in the appropriate direction with velocity proportional to the temperature, in close agreement with numerical simulation. When contrasted by a mechanical bias, these entropic forces give rise to a rich phenomenology that includes configurational phase transitions, double-kink dissociation, and noise-directed signal transmission.

Postmortem interval (PMI) determined by study sarcophagous biocenoses: three cases from the province of Venice (Italy)

This paper presents and discusses three cases of cadavers found, unburied, in the province of Venice, Northern Italy. In each case, all insect species playing some role in carrion decay processes, both sarcophagous and their predators, found on or in the bodies, were collected and determined. In one case, many larvae of the black soldier fly, Hermetia illucens L. (Diptera: Stratiomyidae) were found and are reported, for the first time in Italy, as necrophagous. Experimental breeding of some fly species was also carried out in controlled temperature and humidity conditions. In particular, it was of interest to know how the Neotropical black soldier fly modified its life-cycle to adapt to a temperate climate. It was thus possible to establish the rate of larval growth and timing of pupation, emergence, oviposition and hatching in various external conditions. The postmortem interval (PMI) established by identifying the life-cycle stages of dipterofauna were later confirmed in all cases through police investigations and the results of forensic analyses.

Driven kinks in discrete chains: phonon damping

Phonon radiation is shown numerically to damp the motion of a relativistically driven straight phi(4) soliton, even in the extremely weak discreteness limit. At higher discreteness, the soliton mobility is characterized by a discontinuous dependence on the driving force; jumps are related to phonon and breather-radiation thresholds. Moreover, the speed of a frictionless soliton cannot be lowered below a certain threshold value, or else it might get trapped between two adjacent chain sites.

Is ion sputtering always a "negative homoepitaxial deposition"?

We present a scanning tunneling microscopy study of the direct comparison between homoepitaxial deposition and surface ion sputtering on the Ag(001) system. At a temperature of 200 K, sputtering results in mound formation similar to the epitaxy case, while at higher temperatures an erosive regime sets in with the appearance of regular square pits. Contrary to the conventional wisdom, which considers ion sputtering as a deposition of vacancies, the analysis of single ion impact events reveals that the process produces both adatom and vacancy clusters. The key parameter determining the temperature dependence of surface morphology turns out to be the mobility of the adatom clusters which exceeds that of vacancy clusters.