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Racano E, Malfatti G, Pertile R, Delle Site R, Romanelli F, Nicolini A. A novel smartphone App to support the clinical practice of pediatric ophthalmology and strabismus: the validation of visual acuity tests. Eur J Pediatr 2023; 182:4007-4013. [PMID: 37386193 DOI: 10.1007/s00431-023-05058-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/08/2023] [Accepted: 06/06/2023] [Indexed: 07/01/2023]
Abstract
This study is aimed at describing the TreC Oculistica novel smartphone App that facilitated the clinical practice of pediatric ophthalmology and strabismus during the COVID-19 pandemic and at reporting on the validation of visual acuity tests in a home setting. The Trec Oculistica smartphone App was prescribed to eligible patients at the Pediatric Ophthalmology and Strabismus Clinic, Ophthalmology Unit of Rovereto Hospital, between September 2020 and March 2022. Four key indicators were identified for monitoring visual and visuo-motor functions remotely: visual acuity, ocular motility, head posture, and color vision. Clinicians selected few mobile applications (iOS, Android) and printable materials within the Trec Oculistica App: the Snellen Chart Visual Acuity App, the 9Gaze App, the eyeTilt App, the Color Blind test App, the LEA Symbols pdf, and the Snellen Chart pdf. All patients, aged 4 and older, were screened at home for visual acuity at 3 m and later in the clinic (LEA Symbols cabinet or Snellen computerized optotype). The 9Gaze, the eyeTilt, and the Color Blind test Apps were only recommended to a subset of patients based on clinical suspicion or diagnosis. The Wilcoxon signed rank sum test and weighted Cohen's kappa coefficient were applied to compare pairs of scores from different settings. The Trec Oculistica App was downloaded and activated by 97 patients or their caregiver. 40 patients were tested at home using the 9Gaze App, 7 used the eyeTilt App, and 11 used the Color-Blind test App. Families reported that all the Apps were easy and intuitive to use; clinicians reported that measurements were reliable. 82 eyes of 41 patients (mean age 5.2 years, SD ± 0.4, range 4.4-6.1) were tested for visual acuity using the self-administered LEA Symbols pdf. 92 eyes of 46 patients (mean age 11.6 years, SD ± 5.2, range 6-35) were evaluated using the self-administered Snellen Chart Visual Acuity App or the Snellen Chart pdf. Home median visual acuity score was statistically different from that registered in clinical setting for both the LEA Symbols pdf (P-value = 0.0074) and the Snellen Chart App and pdf (P-value = 0.0001). The strength of agreement was 0.12 (slight) for the LEA Symbols pdf, 0.50 (moderate) for the Snellen Chart Visual Acuity App, and 0.69 (substantial) for the Snellen Chart pdf. CONCLUSION The novel TreC Oculistica smartphone App was a useful tool for facilitating the clinical practice of pediatric ophthalmology and strabismus during the COVID-19 pandemic. In the follow-up of strabismus patients and patients with suspected inherited retinal diseases, the 9Gaze, eyeTilt, and Color Blind test applications were deemed to be intuitive and easy to use by families and were considered reliable by clinicians. In a home setting, visual acuity tested by means of Snellen Charts was moderately congruent with the in-office examination. On the contrary, agreement was poor in younger children tested with the LEA Symbols pdf. WHAT IS KNOWN • Teleophthalmology enables clinicians to evaluate patients' ocular diseases remotely and various tools are helpful for screening, follow-ups and treatment. • Smartphones can currently be used to obtain ocular images and vision measurements of patients' eyes and this information can be shared with the ophthalmologist for further evaluations and medical management (mhealth). WHAT IS NEW • Smartphone Apps can be successfully used in a hybrid teleophthalmology service concerning first visits and follow-ups. • Apps and printable materials are easy, intuitive to use for patients and also reliable for clinicians.
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Affiliation(s)
| | - Giulia Malfatti
- , TrentinoSalute4.0, Fondazione Bruno Kessler, Trento, Italy
| | - Riccardo Pertile
- Department of Clinical and Evaluative Epidemiology, APSS, Trento, Italy
| | | | | | - Andrea Nicolini
- , TrentinoSalute4.0, Fondazione Bruno Kessler, Trento, Italy
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Giovanazzi A, Gios L, Mastellaro M, Gentilini MA, Valent F, Condini S, Bincoletto G, Bacchiega A, Zorzi A, Malfatti G, Perini F, Eccher C, Marchesoni M, Dall'Alda M, Orrasch M, Conforti D, Inchiostro S. Organisational models supported by technology for the management of diabetic disease and its complications in a diabetic clinic setting: study protocol for a randomised controlled trial targeting type 2 diabetes individuals with non-ideal glycaemic values (Telemechron study). Trials 2023; 24:513. [PMID: 37563665 PMCID: PMC10413726 DOI: 10.1186/s13063-023-07515-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 07/16/2023] [Indexed: 08/12/2023] Open
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) is a non-communicable disease representing one of the most serious public health challenges of the twenty-first century. Its incidence continues to rise in both developed and developing countries, causing the death of 1.5 million people every year. The use of technology (e.g. smartphone application-App) in the health field has progressively increased as it has been proved to be effective in helping individuals manage their long-term diseases. Therefore, it has the potential to reduce the use of health service and its related costs. The objective of this study is to evaluate the impact of using a digital platform called "TreC Diabete" embedded into a novel organisational asset targeting poorly controlled T2DM individuals in the Autonomous Province of Trento (PAT), Italy. METHODS This trial was designed as a multi-centre, open-label, randomised, superiority study with two parallel groups and a 1:1 allocation ratio. Individuals regularly attending outpatient diabetes clinics, providing informed consent, are randomised to be prescribed TreC Diabete platform as part of their personalised care plan. Healthcare staff members will remotely assess the data shared by the participants through the App by using a dedicated online medical dashboard. The primary end-point is the evaluation of the Hb1Ac level at 12-month post-randomisation. Data will be analysed on an intention-to-treat (ITT) basis. DISCUSSION This trial is the first conducted in the PAT area for the use of an App specifically designed for individuals with poorly controlled T2DM. If the effects of introducing this specific App within a new organisational asset are positive, the digital platform will represent a possible way for people diagnosed with T2DM to better manage their health in the future. Results will be disseminated through conferences and peer-reviewed journals once the study is completed. TRIAL REGISTRATION ClinicalTrials.gov NCT05629221. Registered on November 29, 2022, prior start of inclusion.
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Affiliation(s)
- Alexia Giovanazzi
- Azienda Provinciale Per I Servizi Sanitari, Provincia Autonoma Di Trento, Trento, Italy
| | - Lorenzo Gios
- TrentinoSalute4.0, Competence Center for Digital Health, Trento, Italy
| | - Marina Mastellaro
- Azienda Provinciale Per I Servizi Sanitari, Provincia Autonoma Di Trento, Trento, Italy
| | | | - Francesca Valent
- Servizio di Igiene e Sanità Pubblica, Dipartimento di Prevenzione, Azienda sanitaria universitaria Friuli Centrale, Gemona del Friuli, Italy
| | - Sara Condini
- Azienda Provinciale Per I Servizi Sanitari, Provincia Autonoma Di Trento, Trento, Italy
| | - Giorgia Bincoletto
- Facoltà Di Giurisprudenza, Università Degli Studi Di Trento, Trento, Italy
| | | | | | - Giulia Malfatti
- TrentinoSalute4.0, Competence Center for Digital Health, Trento, Italy
| | - Francesca Perini
- TrentinoSalute4.0, Competence Center for Digital Health, Trento, Italy
| | | | | | - Marlene Dall'Alda
- Azienda Provinciale Per I Servizi Sanitari, Provincia Autonoma Di Trento, Trento, Italy
| | - Massimo Orrasch
- Azienda Provinciale Per I Servizi Sanitari, Provincia Autonoma Di Trento, Trento, Italy
| | | | - Sandro Inchiostro
- Azienda Provinciale Per I Servizi Sanitari, Provincia Autonoma Di Trento, Trento, Italy.
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Ursino S, Calistri E, De Felice F, Bonomo P, Desideri I, Franco P, Arcadipane F, Colosimo C, Mazzola R, Maddalo M, Gonnelli A, Malfatti G, Morganti R, Musio D, Paiar F. Patient-Reported Outcomes After Swallowing (SWOARs)-Sparing IMRT in Head and Neck Cancers: Primary Results from a Prospective Study Endorsed by the Head and Neck Study Group (HNSG) of the Italian Association of Radiotherapy and Clinical Oncology (AIRO). Dysphagia 2023; 38:159-170. [PMID: 35587295 PMCID: PMC9118191 DOI: 10.1007/s00455-022-10434-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 02/25/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To prospectively investigate changes in M.D. Anderson Dysphagia Inventory (MDADI) scores in patients affected by naso- and oropharynx cancer after definitive radiochemotherapy (ChemoRT) using swallowing organs at risk (SWOARs)-sparing IMRT. METHODS MDADI questionnaires were collected at baseline and at 6 and 12 months after treatment. MDADI scores were categorized as follows: ≥ 80 "optimal," 80-60 "adequate," < 60 "poor" deglutition-related quality of life (QoL) group, and dichotomized as "optimal" vs "adequate/poor" for the analysis. A mean MDADI composite (MDADI-C) change of 10 points was considered as minimal clinically important difference (MCID). RESULTS Sixty-three patients were enrolled of which 47 were considered for the analysis. At baseline, 26 (55%) were "optimal" and 21 (45%) were "adequate/poor." The mean baseline MDADI-C score was 93.6 dropping to 81 at 6 months (p = 0.013) and slightly rising to 85.5 at 12 months (p = 0.321) for the "optimal" group. Indeed, the mean baseline MDADI-C score was 64.3 rising to 77.5 at 6 months (p = 0.006) and stabilizing at 76 at 12 months (p = 0.999) for the "adequate/poor" group. A statistically significant but not clinically relevant worsening of the MDADI-C score was reported for the "optimal" group, whereas both a statistically significant and clinically meaningful improvement of the MDADI-C score were reported for the "adequate/poor" group from before to post-treatment. CONCLUSION Our results suggest a doubly clinical benefit of dose optimization to SWOARs to minimize the RT sequalae in patients with a baseline "optimal" deglutition-related QoL and to recover from cancer dysphagia in those with a baseline "adequate/poor" deglutition-related QoL.
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Affiliation(s)
- Stefano Ursino
- Radiation Oncology Unit, University Hospital Santa Chiara, Via Roma 67, 56100, Pisa, Italy.
| | - Elisa Calistri
- Radiation Oncology Unit, University Hospital Santa Chiara, Via Roma 67, 56100, Pisa, Italy
| | - Francesca De Felice
- Radiation Oncology Unit, University Hospital La Sapienza, Viale del Policlinico 155, 00161, Rome, Italy
| | - Pierluigi Bonomo
- Radiation Oncology Unit, University Hospital Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Isacco Desideri
- Radiation Oncology Unit, University Hospital Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Pierfrancesco Franco
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Francesca Arcadipane
- Department of Oncology, Radiation Oncology, University of Turin, Via Camillo Benso di Cavour 31, 10123, Turin, Italy
| | - Caterina Colosimo
- Radiation Oncology Unit, University Hospital Santa Chiara, Via Roma 67, 56100, Pisa, Italy
- Radiation Oncology Unit, S.Luca Hospital, Via Guglielmo Lippi Francesconi 556, 55100, Lucca, Italy
| | - Rosario Mazzola
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore-Don Calabria Hospital Cancer Care Center, Via Sempreboni 5, 37024, Verona, Italy
| | - Marta Maddalo
- Radiation Oncology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili of Brescia, University of Brescia, Via del Medolo 2, 25123, Brescia, Italy
| | - Alessandra Gonnelli
- Radiation Oncology Unit, University Hospital Santa Chiara, Via Roma 67, 56100, Pisa, Italy
| | - Giulia Malfatti
- Radiation Oncology Unit, University Hospital Santa Chiara, Via Roma 67, 56100, Pisa, Italy
| | - Riccardo Morganti
- Department of Clinical and Experimental Medicine, Section of Statistics, Via Roma 67, 56100, Pisa, Italy
| | - Daniela Musio
- Radiation Oncology Unit, University Hospital La Sapienza, Viale del Policlinico 155, 00161, Rome, Italy
| | - Fabiola Paiar
- Radiation Oncology Unit, University Hospital Santa Chiara, Via Roma 67, 56100, Pisa, Italy
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Pasqualetti F, Montemurro N, Desideri I, Loi M, Giannini N, Gadducci G, Malfatti G, Cantarella M, Gonnelli A, Montrone S, Visani L, Scatena C, Naccarato AG, Perrini P, Gambacciani C, Santonocito O, Morganti R, Paiar F. Impact of recurrence pattern in patients undergoing a second surgery for recurrent glioblastoma. Acta Neurol Belg 2022; 122:441-446. [PMID: 34396487 DOI: 10.1007/s13760-021-01765-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 07/26/2021] [Indexed: 12/19/2022]
Abstract
The impact of different patterns of glioblastoma (GBM) recurrence has not yet been fully established in patients suitable for a second surgery. Through the present observational study carried out at Pisa University Hospital, we aimed to investigate how different patterns of GBM failure influence second surgery outcomes. Overall survival (OS) and post-recurrence survival (PRS) were assessed according to clinical characteristics, including pattern of recurrence, in a prospective cohort of recurrent GBM patients. Survival curves were calculated using the Kaplan-Meier method and the log-rank test was applied to evaluate the differences between curves. Patients with local recurrence had better OS than patients with non-local one, 24.1 versus 18.2 months, respectively [P = 0.015, HR = 1.856 (1.130-3.050)]. The second surgery conferred an advantage in OS respect to non-operated patients, however, this advantage was more evident in patients with local recurrence [P = 0.002 with HR 0.212 (95% CI 0.081-0.552) and P = 0.029 with HR = 0.522 (95% CI 0.291-0.936), respectively]. The recurrence pattern can influence the outcome of patients with recurrent GBM suitable for a second surgery.
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Isidori V, Diamanti F, Gios L, Malfatti G, Perini F, Nicolini A, Longhini J, Forti S, Fraschini F, Bizzarri G, Brancorsini S, Gaudino A. Digital technologies and the role of healthcare professionals: a scoping review exploring nurses’ skills in the digital era and in light of the Covid-19 pandemic. (Preprint). JMIR Nurs 2022; 5:e37631. [PMID: 36194466 PMCID: PMC9579937 DOI: 10.2196/37631] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/28/2022] [Accepted: 05/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background The nursing role significantly changed following reforms in the nurse training process. Nowadays, nurses are increasingly trained to promote and improve the quality of clinical practice and to provide support in the assistance of patients and communities. Opportunities and threats are emerging as a consequence of the introduction of new disruptive technologies in public health, which requires the health care staff to develop new digital skills. Objective The aim of this paper is to review and define the role of nurses and the skills they are asked to master in terms of new methodological approaches and digital knowledge in a continuously evolving health care scenario that relies increasingly more on technology and digital solutions. Methods This scoping review was conducted using a thematic summary of previous studies. Authors collected publications through a cross-database search (PubMed, Web of Science, Google Scholar) related to new telemedicine approaches impacting the nurses’ role, considering the time span of 2011-2021 and therefore including experiences and publications related to the first phase of the COVID-19 pandemic. Results The assessment was completed between April and July 2021. After a cross-database search, authors reviewed a selection of 60 studies. The results obtained were organized into 5 emerging macro areas: (1) leadership (nurses are expected to show leadership capabilities when introducing new technologies in health care practices, considering their pivotal role in coordinating various professional figures and the patient), (2) soft skills (new communication skills, adaptiveness, and problem solving are needed to adapt the interaction to the level of digital skills and digital knowledge of the patient), (3) training (specific subjects need to be added to nursing training to boost the adoption of new communication and technological skills, enabling health care professionals to largely and effectively use new digital tools), (4) remote management of COVID-19 or chronic patients during the pandemic (a role that has proved to be fundamental is the community and family nurse and health care systems are adopting novel assistance models to support patients at home and to enable decentralization of services from hospitals to the territory), and (5) management of interpersonal relationships with patients through telemedicine (a person-centered approach with an open and sensitive attitude seems to be even more important in the framework of telemedicine where a face-to-face session is not possible and therefore nonverbal indicators are more problematic to be noticed). Conclusions Further advancing nurses’ readiness in adopting telemedicine requires an integrated approach, including combination of technical knowledge, management abilities, soft skills, and communication skills. This scoping review provides a wide-ranging and general—albeit valuable—starting point to identify these core competences and better understand their implications in terms of present and future health care professionals’ roles.
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Affiliation(s)
- Valentina Isidori
- Department of Medicine and Surgery, University of Perugia, Terni, Italy
| | | | - Lorenzo Gios
- TrentinoSalute4.0, Centro di Competenza per la Sanità Digitale, Trento, Italy
| | - Giulia Malfatti
- TrentinoSalute4.0, Centro di Competenza per la Sanità Digitale, Trento, Italy
| | - Francesca Perini
- TrentinoSalute4.0, Centro di Competenza per la Sanità Digitale, Trento, Italy
| | - Andrea Nicolini
- TrentinoSalute4.0, Centro di Competenza per la Sanità Digitale, Trento, Italy
| | | | - Stefano Forti
- TrentinoSalute4.0, Centro di Competenza per la Sanità Digitale, Trento, Italy
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Malfatti G, Racano E, Delle Site R, Gios L, Micocci S, Dianti M, Molini PB, Allegrini F, Ravagni M, Moz M, Nicolini A, Romanelli F. Enabling teleophthalmology during the COVID-19 pandemic in the Province of Trento, Italy: Design and implementation of a mHealth solution. PLoS One 2021; 16:e0257250. [PMID: 34506578 PMCID: PMC8432860 DOI: 10.1371/journal.pone.0257250] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/26/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Due to the many restrictions imposed during the COVID-19 emergency, the normal clinical activities have been stopped abruptly in view of limiting the circulation of the virus. The extraordinary containment measures have had a dramatic impact on the undertaking and follow-up of ophthalmic outpatients. OBJECTIVE In order to guarantee proper monitoring and routine care, the Pediatric Ophthalmology equipe of Rovereto Hospital (North-East of Italy) supported by the Competence Center on Digital Health TrentinoSalute4.0, designed and implemented a digital platform, TreC Oculistica, enabling teleophthalmology. We report our innovative-albeit restricted-experience aiming at testing and maximizing the efficacy of remote ophthalmic and orthoptic visits. METHODS A multidisciplinary team created the TreC Oculistica platform and defined a teleophthalmology protocol. The system consists of a clinician web interface and a patient mobile application. Clinicians can prescribe outpatients with the App and some preliminary measurements to be self-collected before the televisit. The App conveys the clinician's requests (i.e. measurements) and eases the share of the collected information in a secure digital environment, promoting a new health care workflow. RESULTS Four clinicians took part in the testing phase (2 ophthalmologists and 2 orthoptists) and recruited 37 patients (mostly pediatric) in 3 months. Thanks to a continuous feedback between the testing and the technical implementation, it has been possible to identify pros and cons of the implemented functionalities, considering possible improvements. Digital solutions such as TreC Oculistica advance the digitalization of the Italian health care system, promoting a structured and effective reorganization of the workload supported by digital systems. CONCLUSIONS The study tested an innovative digital solution in the teleophthalmology context and represented the first experience within the Italian healthcare system. This solution opens up new possibilities and scenarios that can be effective not only during the pandemic, but also in the traditional management of public health services.
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Affiliation(s)
- Giulia Malfatti
- TrentinoSalute4.0, Competence Center for Digital Health of the Province of Trento, Trento, Italy
| | - Elisabetta Racano
- Azienda Provinciale per i Servizi Sanitari, U.O. di Oculistica, Ospedale di Rovereto, Trento, Italy
| | - Roberta Delle Site
- Azienda Provinciale per i Servizi Sanitari, U.O. di Oculistica, Ospedale di Rovereto, Trento, Italy
| | - Lorenzo Gios
- TrentinoSalute4.0, Competence Center for Digital Health of the Province of Trento, Trento, Italy
| | | | - Marco Dianti
- Fondazione Bruno Kessler, Digital Health Lab, Povo, Italy
| | | | - Francesca Allegrini
- Azienda Provinciale per i Servizi Sanitari, U.O. di Oculistica, Ospedale di Rovereto, Trento, Italy
| | - Mariangela Ravagni
- Azienda Provinciale per i Servizi Sanitari, U.O. di Oculistica, Ospedale di Rovereto, Trento, Italy
| | - Monica Moz
- TrentinoSalute4.0, Competence Center for Digital Health of the Province of Trento, Trento, Italy
| | - Andrea Nicolini
- TrentinoSalute4.0, Competence Center for Digital Health of the Province of Trento, Trento, Italy
| | - Federica Romanelli
- Azienda Provinciale per i Servizi Sanitari, U.O. di Oculistica, Ospedale di Rovereto, Trento, Italy
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Gonnelli A, Pasqualetti F, Molinari A, Gadducci G, Giannini N, Malfatti G, Fabiola P. OC-0404 Role of single nucleotide polymorphisms (SNPs) in high-grade gliomas treated with concomitant RTCT. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06891-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Giannini N, Gonnelli A, Gadducci G, Montrone S, Sainato A, Manfredi B, Pasqualetti F, Laliscia C, Malfatti G, Calistri E, Morganti R, Paiar F. PO-1247 Radiochemotherapy in anal cancer, what is the optimal dose? A single istitutional experience. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07698-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gadducci G, Pasqualetti F, Gonnelli A, Giannini N, Gabelloni M, Morganti R, Neri E, Malfatti G, Paiar F. PO-1156 Temporal muscle thickness as a potential biomarker of OS in NSCLC patients with BM treated with SRT. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07607-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Pantomimes are a unique movement category which can convey complex information about our intentions in the absence of any interaction with real objects. Indeed, we can pretend to use the same tool to perform different actions or to achieve the same goal adopting different tools. Nevertheless, how our brain implements pantomimed movements is still poorly understood. In our study, we explored the neural encoding and functional interactions underlying pantomimes adopting multivariate pattern analysis (MVPA) and connectivity analysis of fMRI data. Participants performed pantomimed movements, either grasp-to-move or grasp-to-use, as if they were interacting with two different tools (scissors or axe). These tools share the possibility to achieve the same goal. We adopted MVPA to investigate two levels of representation during the planning and execution of pantomimes: (1) distinguishing different actions performed with the same tool, (2) representing the same final goal irrespective of the adopted tool. We described widespread encoding of action information within regions of the so-called “tool” network. Several nodes of the network—comprising regions within the ventral and the dorsal stream—also represented goal information. The spatial distribution of goal information changed from planning—comprising posterior regions (i.e. parietal and temporal)—to execution—including also anterior regions (i.e. premotor cortex). Moreover, connectivity analysis provided evidence for task-specific bidirectional coupling between the ventral stream and parieto-frontal motor networks. Overall, we showed that pantomimes were characterized by specific patterns of action and goal encoding and by task-dependent cortical interactions.
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Affiliation(s)
- Giulia Malfatti
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Corso Bettini 31, 38068, Rovereto, Italy
| | - Luca Turella
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Corso Bettini 31, 38068, Rovereto, Italy.
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Testa S, Mayora-Ibarra O, Piras EM, Balagna O, Micocci S, Zanutto A, Forti S, Conforti D, Nicolini A, Malfatti G, Moz M, Gios L, Benetollo PP, Turra E, Orrasch M, Zambotti F, Del Greco M, Maines M, Filippi L, Ghezzi M, Romanelli F, Racano E, Marin M, Betta M, Bertagnolli E. Implementation of tele visit healthcare services triggered by the COVID-19 emergency: the Trentino Province experience. Z Gesundh Wiss 2021; 30:77-92. [PMID: 34150467 PMCID: PMC8203489 DOI: 10.1007/s10389-021-01609-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 05/27/2021] [Indexed: 12/05/2022]
Abstract
Aim In response to the SARS-CoV-2 emergency, the Competence Centre on digital health ‘TrentinoSalute4.0’ has developed TreC_Televisita, a tele visit solution that meets the needs of the Trentino healthcare system and maintains high-quality patient–doctor interactions while respecting social distancing. This paper highlights how ‘TreC_Televisita’ was integrated into the Trentino healthcare system and its potential to become a structural and durable solution for the future local healthcare service provisioning. Subject and methods This paper presents the multifactorial context that TreC_Televisita has faced for its implementation and the strategies adopted for its structural integration into the healthcare system. The analysis focuses on the main issues faced for the integration of the tele visits (e.g. privacy, payments) and how the context of TrentinoSalute4.0 permitted responding quickly to its implementation during the pandemic. It also describes how TreC_Televisita fits into the healthcare continuum from the organisational and technological standpoint, the end-user perspective and the barriers that could hamper the solution scalability. Results TreC_Televisita has demonstrated to be a technological solution that can be contextualised for different clinical domains beyond SARS-CoV-2. Moreover, it has shown its potential to scale up the solution beyond the COVID-19 emergency to the whole healthcare provisioning system in the long term. Conclusion Being a positive experience in the first months of its implementation, the long-term goal is to transform TreC_Televisita into a structural pillar of the Trentino healthcare system, setting the bases for a sustainable, win–win situation for all the stakeholders involved in healthcare service provisioning.
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Affiliation(s)
- Sara Testa
- Fondazione Bruno Kessler, Via Santa Croce 77, 38122 Trento, Italy
| | | | | | - Olivia Balagna
- Provincia Autonoma di Trento, Piazza Dante 15, 38122 Trento, Italy
| | - Stefano Micocci
- Fondazione Bruno Kessler, Via Santa Croce 77, 38122 Trento, Italy
| | - Alberto Zanutto
- Fondazione Bruno Kessler, Via Santa Croce 77, 38122 Trento, Italy
| | - Stefano Forti
- Fondazione Bruno Kessler, Via Santa Croce 77, 38122 Trento, Italy
| | - Diego Conforti
- Provincia Autonoma di Trento, Piazza Dante 15, 38122 Trento, Italy
| | - Andrea Nicolini
- Fondazione Bruno Kessler, Via Santa Croce 77, 38122 Trento, Italy
| | - Giulia Malfatti
- Fondazione Bruno Kessler, Via Santa Croce 77, 38122 Trento, Italy
| | - Monica Moz
- Fondazione Bruno Kessler, Via Santa Croce 77, 38122 Trento, Italy
| | - Lorenzo Gios
- Fondazione Bruno Kessler, Via Santa Croce 77, 38122 Trento, Italy
| | - Pier Paolo Benetollo
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
| | - Ettore Turra
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
| | - Massimo Orrasch
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
| | - Francesca Zambotti
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
| | - Maurizio Del Greco
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
| | - Massimiliano Maines
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
| | - Lorena Filippi
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
| | - Monica Ghezzi
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
| | - Federica Romanelli
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
| | - Elisabetta Racano
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
| | - Mauro Marin
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
| | - Marta Betta
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
| | - Elisabetta Bertagnolli
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
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Gios L, Crema Falceri G, Micocci S, Patil L, Testa S, Sforzin S, Turra E, Conforti D, Malfatti G, Moz M, Nicolini A, Guarda P, Bacchiega A, Mion C, Marchesoni M, Maimone R, Molini PB, Zanella A, Osmani V, Mayora-Ibarra O, Forti S. Use of eHealth Platforms and Apps to Support Monitoring and Management of Home-Quarantined Patients With COVID-19 in the Province of Trento, Italy: App Development and Implementation. JMIR Form Res 2021; 5:e25713. [PMID: 33909586 PMCID: PMC8168637 DOI: 10.2196/25713] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/22/2020] [Accepted: 04/13/2021] [Indexed: 02/07/2023] Open
Abstract
Background Italy was the first country to largely experience the COVID-19 epidemic among other Western countries during the so-called first wave of the COVID-19 pandemic. Proper management of an increasing number of home-quarantined individuals created a significant challenge for health care authorities and professionals. This was especially true when considering the importance of remote surveillance to detect signs of disease progression and consequently regulate access to hospitals and intensive care units on a priority basis. Objective In this paper, we report on an initiative promoted to cope with the first wave of the COVID-19 epidemic in the Spring/Summer of 2020, in the Autonomous Province of Trento, Italy. A purposefully built app named TreCovid19 was designed to provide dedicated health care staff with a ready-to-use tool for remotely monitoring patients with progressive symptoms of COVID-19, who were home-quarantined during the first wave of the epidemic, and to focus on those patients who, based on their self-reported clinical data, required a quick response from health care professionals. Methods TreCovid19 was rapidly developed to facilitate the monitoring of a selected number of home-quarantined patients with COVID-19 during the very first epidemic wave. The app was built on top of an existing eHealth platform, already in use by the local health authority to provide home care, with the following functionalities: (1) to securely collect and link demographic and clinical information related to the patients and (2) to provide a two-way communication between a multidisciplinary health care team and home-quarantined patients. The system supported patients to self-assess their condition and update the multidisciplinary team on their health status. The system was used between March and June 2020 in the province of Trento. Results A dedicated multidisciplinary group of health care professionals adopted the platform over a period of approximately 3 months (from March-end to June 2020) to monitor a total of 170 patients with confirmed COVID-19 during home quarantine. All patients used the system until the end of the initiative. The TreCovid19 system has provided useful insights of possible viability and impact of a technological–organizational asset to manage a potentially critical workload for the health care staff involved in the periodic monitoring of a relevant number of quarantined patients, notwithstanding its limitations given the rapid implementation of the whole initiative. Conclusions The technological and organizational model adopted in response to the COVID-19 pandemic was developed and finalized in a relatively short period during the initial few weeks of the epidemic. The system successfully supported the health care staff involved in the periodic monitoring of an increasing number of home-quarantined patients and provided valuable data in terms of disease surveillance.
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Affiliation(s)
- Lorenzo Gios
- TrentinoSalute4.0 - Competence Center for Digital Health of the Province of Trento, Trento, Italy
| | | | | | - Luigi Patil
- Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | | | - Simona Sforzin
- Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Ettore Turra
- Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | | | - Giulia Malfatti
- TrentinoSalute4.0 - Competence Center for Digital Health of the Province of Trento, Trento, Italy
| | - Monica Moz
- TrentinoSalute4.0 - Competence Center for Digital Health of the Province of Trento, Trento, Italy
| | - Andrea Nicolini
- TrentinoSalute4.0 - Competence Center for Digital Health of the Province of Trento, Trento, Italy
| | - Paolo Guarda
- Facoltà di Giurisprudenza, Università degli Studi di Trento, Trento, Italy
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13
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Papale P, Betta M, Handjaras G, Malfatti G, Cecchetti L, Rampinini A, Pietrini P, Ricciardi E, Turella L, Leo A. Common spatiotemporal processing of visual features shapes object representation. Sci Rep 2019; 9:7601. [PMID: 31110195 PMCID: PMC6527710 DOI: 10.1038/s41598-019-43956-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 04/25/2019] [Indexed: 02/02/2023] Open
Abstract
Biological vision relies on representations of the physical world at different levels of complexity. Relevant features span from simple low-level properties, as contrast and spatial frequencies, to object-based attributes, as shape and category. However, how these features are integrated into coherent percepts is still debated. Moreover, these dimensions often share common biases: for instance, stimuli from the same category (e.g., tools) may have similar shapes. Here, using magnetoencephalography, we revealed the temporal dynamics of feature processing in human subjects attending to objects from six semantic categories. By employing Relative Weights Analysis, we mitigated collinearity between model-based descriptions of stimuli and showed that low-level properties (contrast and spatial frequencies), shape (medial-axis) and category are represented within the same spatial locations early in time: 100–150 ms after stimulus onset. This fast and overlapping processing may result from independent parallel computations, with categorical representation emerging later than the onset of low-level feature processing, yet before shape coding. Categorical information is represented both before and after shape, suggesting a role for this feature in the refinement of categorical matching.
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Affiliation(s)
- Paolo Papale
- Momilab, IMT School for Advanced Studies Lucca, 55100, Lucca, Italy
| | - Monica Betta
- Momilab, IMT School for Advanced Studies Lucca, 55100, Lucca, Italy
| | | | - Giulia Malfatti
- Center for Mind/Brain Sciences (CIMeC), University of Trento, 38068, Trento, Italy
| | - Luca Cecchetti
- Momilab, IMT School for Advanced Studies Lucca, 55100, Lucca, Italy
| | | | - Pietro Pietrini
- Momilab, IMT School for Advanced Studies Lucca, 55100, Lucca, Italy
| | | | - Luca Turella
- Center for Mind/Brain Sciences (CIMeC), University of Trento, 38068, Trento, Italy
| | - Andrea Leo
- Momilab, IMT School for Advanced Studies Lucca, 55100, Lucca, Italy.
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14
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Betta M, Handjaras G, Papale P, Rampinini A, Malfatti G, Pietrini P, Turella L, Ricciardi E, Leo A. MEG spectro-temporal patterns underlying semantic processing. Int J Psychophysiol 2018. [DOI: 10.1016/j.ijpsycho.2018.07.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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15
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Monaco S, Malfatti G, Pizzato L, Cattaneo L, Turella L. Decoding action intention from the activity pattern in the Foveal Cortex. J Vis 2018. [DOI: 10.1167/18.10.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Simona Monaco
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Italy
| | - Giulia Malfatti
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Italy
| | - Laura Pizzato
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Italy
| | - Luigi Cattaneo
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Italy2.Department of Neurological, Neuropsychological, Morphological, and Movement Sciences, University of Verona, Italy
| | - Luca Turella
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Italy
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16
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Monaco S, Malfatti G, Culham J, Cattaneo L, Turella L. Decoding real and imagined actions: overlapping but distinct neural representations for planning vs. imagining hand movements. J Vis 2017. [DOI: 10.1167/17.10.458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Simona Monaco
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Italy
| | - Giulia Malfatti
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Italy
| | - Jody Culham
- Center for Mind/Brain Sciences (CIMeC), University of Trento, ItalyBrain and Mind Institute, University of Western Ontario, London, Ontario, Canada
| | - Luigi Cattaneo
- Center for Mind/Brain Sciences (CIMeC), University of Trento, ItalyDepartment of Neurological, Neuropsychological, Morphological, and Movement Sciences, University of Verona, Italy
| | - Luca Turella
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Italy
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17
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Malfatti G, Monaco S, Barchiesi G, Cattaneo L, Turella L. Do dorsolateral and dorsomedial pathways interact? Investigating parieto-frontal connectivity during a prehension task: a TMS-fMRI study. J Vis 2016. [DOI: 10.1167/16.12.676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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18
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Meini M, Vincenti A, De Gennaro M, Luchi S, Ricciardi L, Moneta S, Malfatti G, Sabot C, Mattei R, Scasso A. Visceral leishmaniasis in AIDS: a case report. Int J Infect Dis 2002. [DOI: 10.1016/s1201-9712(02)90206-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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19
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Ricci PD, Guaiana G, Malfatti G, Mosaico A. [A rare case of cholostasis from tuberculotic infiltration of Vater's ampulla]. MINERVA GASTROENTERO 2000; 46:57-9. [PMID: 16498350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
A rare case of cholostasis from tuberculotic infiltration of the Vater's ampulla is described and was observed in a patient 83 years old. The diagnosis was made at operation after a positive radiologic evidence of an oddian stenosis with cholostasis and an important dilatation of the bile ducts. The surgical operation and the antituberculotic therapy allowed to overcome the cholostasis and the specific infection of the patient and to improve his quality of life and to prolong his survival. The description of this case, in our opinion, is important to underline that tuberculosis of the biliary papilla should be kept in mind as a possible, but rare cause, of obstructive jaundice, during the differential diagnosis.
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Affiliation(s)
- P D Ricci
- Azienda USL n. 2--Lucca, Unità Operativa di Medicina Generale
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20
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Giraldi C, Mazzoni M, Sabò C, Paterni F, Morgantini PG, Malfatti G. Cryptococcal meningoencephalitis in a non immunocompromised patient: case report with necropsy. Ital J Neurol Sci 1993; 14:79-81. [PMID: 8473156 DOI: 10.1007/bf02339046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- C Giraldi
- Unità Operativa di Neurologia, Ospedale Civile di Lucca
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21
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Domenici R, Malfatti G, Cianti F, Castelli S. [Non-immunologic hydrops fetalis. Considerations apropos of a case associated with a chorioangioma of the placenta]. Pediatr Med Chir 1984; 6:327-32. [PMID: 6531255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
A case of hydrops fetalis in a newborn infant in association with a choroangioma of the placenta in described. It was only with a report in 1943 by Potter that nonimmunologic hydrops fetalis was identified. Until recently immunologic hydrops fetalis secondary to Rh incompatibility has been the most frequent cause for infants with this condition. Presently, because of the decline in the incidence of Rh sensitization, non immunologic hydrops fetalis accounts for a larger number of cases. Numerous etiologies have been reported with the occurrence of non immunologic hydrops fetalis: a review of the literature for those entities found in association with this condition is inclused.
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