From the Streets to the Judicial Evidence: Determination of Traditional Illicit Substances in Drug Seizures by a Rapid and Sensitive UHPLC-MS/MS-Based Platform.

According to the 2021 World Drug Report, around 275 million people use drugs of abuse, and 36 million people suffer from addiction, fostering a thriving market for illicit substances. In Italy, 30,083 people were reported to the Judicial Authority for offenses in violation of the Italian Law D.P.R. 309/1990. These offences are sentenced after a qualitative-quantitative analysis of seized materials. Given the large quantity of seized drugs and the need to perform accurate analytical determinations, Italian forensic laboratories struggle to complete analyses in a short time, delaying the entire reporting process needed to achieve sentencing. For this purpose, an UHPLC-MS/MS-based platform was developed at the University of Milano-Bicocca to support law-enforcement authorities. Software was designed to easily manage street seizure acquisition, documentation registration, and sampling. A sensitive UHPLC-MS/MS method was fully validated for the quantification of the traditional illicit substances (cocaine, heroin, 6-MAM, morphine, amphetamine, methamphetamine, MDMA, ketamine, GHB, GBL, LSD, trans-∆9-THC, and THCA) at the ppb level. The final report is relayed to the Prefecture in 3-4 days, even within 24 h for urgent requests. The platform allows for semi-automatic data handling to minimize erroneous results for an accurate report generation by standardized procedures.

Sensing the virus. How social capital enhances hoteliers' ability to cope with COVID-19.

In this study, we propose a broad conceptual model that incorporates social capital dimensions and problem-solving routines to understand the determinants behind hotel managements' perception of and ability to cope with the COVID-19 pandemic-and thus, to innovate their service offering. We provide empirical support for the notion that, due to uncertainty about reopening after lockdown, the hospitality sector has found existing problem-solving routines to be of little use. Although the local community has been unable to form a shared vision around the pandemic, hoteliers have nevertheless relied on their network of relationships to sense the crisis and find their own ways to adapt. Interestingly, we find that overreliance on trustworthy relationships can diminish the ability to sense a crisis objectively. Our results not only shed light on sensemaking in the hotel industry, but also grapple with the theoretical nature of sensemaking as a socially constructed process.

Direct observation of aqueous secondary organic aerosol from biomass-burning emissions.

The mechanisms leading to the formation of secondary organic aerosol (SOA) are an important subject of ongoing research for both air quality and climate. Recent laboratory experiments suggest that reactions taking place in the atmospheric liquid phase represent a potentially significant source of SOA mass. Here, we report direct ambient observations of SOA mass formation from processing of biomass-burning emissions in the aqueous phase. Aqueous SOA (aqSOA) formation is observed both in fog water and in wet aerosol. The aqSOA from biomass burning contributes to the "brown" carbon (BrC) budget and exhibits light absorption wavelength dependence close to the upper bound of the values observed in laboratory experiments for fresh and processed biomass-burning emissions. We estimate that the aqSOA from residential wood combustion can account for up to 0.1-0.5 Tg of organic aerosol (OA) per y in Europe, equivalent to 4-20% of the total OA emissions. Our findings highlight the importance of aqSOA from anthropogenic emissions on air quality and climate.

Optimization of an ultrasound-assisted derivatization for GC/MS analysis of oxygenated organic species in atmospheric aerosol.

A novel ultrasound-assisted derivatization followed by GC/MS analysis was developed for the quantification of oxygenated organic species in ambient aerosol. Derivatization parameters mostly influencing the analytical response were investigated, i.e., solvent type, reagent concentration, and reaction duration. Response surface methodology was used to design experiments and a quadratic model was utilized to predict the variables and establish the optimal conditions. The study was performed on standard solutions of 30 compounds representing the major classes of oxygenated compounds typically found in ambient aerosol, i.e., low molecular weight carboxylic acids, sugars, and phenols. In comparison with conventional methods, the optimized procedure uses mild reaction temperature (room temperature instead of 70 °C), reduces the amount of silyl reagent (24 vs. 40 µL), and shortens derivatization times (45 vs. 70 min), participating in the current trend of analytical chemistry towards clean, green methods that reduce costs and decrease pollution. Once optimized, the ultrasound procedure was validated by assessing for repeatability, linearity, detection limits, and derivative stability. For all oxygenated organic species, the proposed method showed a good reproducibility-as the relative standard deviations (RSDs%, n = 5) of intra-day analysis were ≤7% - a good linearity with the correlation coefficients of calibration curves R 2 ≥ 99.8, and low detection limits, ranging from 0.34 to 6.50 ng µL-1; thus it is suitable for its applicability in air quality monitoring. Finally, this method was successfully applied to determine 30 oxygenated organic species in three ambient PM2.5 samples collected at an urban site in Northern Italy in three different seasons. Graphical abstract Ultrasound-assisted derivatization is a green alternative method for GC/MS analysis of oxygenated organic species in atmospheric aerosol towards reduction of energy and reactive consumption.

Effectiveness of opioid analgesics in chronic noncancer pain.

BACKGROUND: There is general agreement about the need to perform a screening test to assess the risk of opioid misuse prior to starting a long-term opioid treatment for chronic noncancer pain. The evidence supporting the effectiveness of opioid long-term treatment is weak, and no predictors of its usefulness have been assessed. OBJECTIVE: The aim of this study was to assess the effect on pain and quality of life of chronic opioid treatment, and detect the possible predictors of its effectiveness. METHODS: This observational, prospective study was conducted in 2 Italian Pain Relief Units on 77 patients affected by intractable chronic pain. Patients were submitted to psycho-logical tests, investigating the individual pain experience, risk of opioid misuse, mood states, quality of life, and personality characteristics prior to starting treatment and at 2,4, and 6-month follow-up. RESULTS: Both maximum and habitual pain, as measured with VAS, underwent a statistically significant reduction at 2, 4, and 6-month follow-up. In multivariate analysis, lower scores in the Pain Medication Questionnaire (PMQ) were predictive of a major reduction in maximum VAS (P = 0.005). Both low PMQ and MMPI-cynicism scores were predictive of habitual VAS decrease (P = 0.012 and P = 0.028, respectively). CONCLUSION: The results indicate that pain relief significantly improved over a 6-month period of opioid treatment, together with quality of life. The outcome was better in patients with a pretreatment low risk of opioid misuse, low scores in the Cynicism scale of MMPI-2, and no aberrant drug behaviors at follow-up. Therefore, a psychological screening and support is crucial for a good outcome of opioid therapy for chronic noncancer pain patients.

Determination of polar organic compounds in atmospheric aerosols by gas chromatography with ion trap tandem mass spectrometry.

A gas chromatography with ion trap mass spectrometry method has been developed and validated for the analysis of 27 polar organic compounds in atmospheric aerosols. The target analytes were low-molecular-weight carboxylic acids and methoxyphenols, as relevant markers of source emissions and photochemical processes of organic aerosols. The operative parameters were optimized in order to achieve the best sensitivity and selectivity for the analysis. In comparison with the previous gas chromatography with mass spectrometry procedure based on single ion monitoring detection, the tandem mass spectrometry technique increased the analytical sensitivity by reducing detection limits for standard solutions from 1-2.6 to 0.1-0.4 ng/µL ranges (concentrations in the injected solution). In addition, it enhanced selectivity by reducing matrix interferences and chemical noise in the chromatogram. The applicability of the developed method in air quality monitoring campaigns was effectively checked by analyzing environmental samples collected in the Po Valley (Northern Italy) in different seasons. The obtained results indicate that the ion trap mass spectrometer may be an ideal alternative to high-resolution mass spectrometers for the user-friendly and cost-effective determination of a wide range of molecular tracers in airborne particulate matter.

The effectiveness of the quality program Pac-IficO to improve pain management in hospitalized cancer patients: a before-after cluster phase II trial.

BACKGROUND: Cancer-related pain continues to be a major healthcare issue worldwide. Despite the availability of effective analgesic drugs, published guidelines and educational programs for Health Care Professionals (HCPs) the symptom is still under-diagnosed and its treatment is not appropriate in many patients. The objective of the study is to evaluate the efficacy of the Pac-IFicO programme in improving the quality of pain management in hospitalised cancer patients. METHODS/DESIGN: This is a before-after cluster phase II study. After the before assessment, the experimental intervention - the Pac-IFicO programme - will be implemented in ten medicine, oncology and respiratory disease hospital wards. The same assessment will be repeated after the completion of the intervention. The Pac-IFicO programme is a complex intervention with multiple components. It includes focus group with ward professionals for identifying possible local obstacles to optimal pain control, informative material for the patients, an educational program performed through guides from the wards, and an organisational intervention to the ward. The primary end-point of the study is the proportion of cancer patients with severe pain. Secondary end-points include opioids administered in the wards, knowledge in pain management, and quality of pain management. We plan to recruit about 500 cancer patients. This sample size should be sufficient, after appropriate statistical adjustments for clustering, to detect an absolute decrease in the primary end-point from 20% to 9%. DISCUSSION: This trial is aimed at exploring with an experimental approach the efficacy of a new quality improvement educational intervention. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02035098.

Novel, User-Friendly Experimental and Analysis Strategies for Fast Voltammetry: Next Generation FSCAV with Artificial Neural Networks.

Fast-scan adsorption-controlled voltammetry (FSCAV) was recently derived from fast-scan cyclic voltammetry to estimate the absolute concentrations of neurotransmitters by using the innate adsorption properties of carbon fiber microelectrodes. This technique has improved our knowledge of serotonin dynamics in vivo. However, the analysis of FSCAV data is laborious and technically challenging. First, each electrode requires post-experimental in vitro calibration. Second, current analysis methods are semi-manual and time-consuming and require a steep learning curve. Finally, the calibration methods used do not adapt to nonlinear electrode responses. In this work, we provide freely accessible computational solutions to these issues. First, we design an artificial neural network (ANN) and train it with a large data set (calibrations from 140 electrodes by six different researchers) to achieve calibration-free estimations and improve predictive error. We discuss the power of the ANN to obtain a low predictive error without electrode-specific calibrations as a function of being able to predict the sensitivity of the electrode. We use the ANN to successfully predict the absolute serotonin concentrations of real in vivo data. Finally, we create a fast and user-friendly, fully automated analysis web platform to simplify and reduce the expertise required for the postanalysis of FSCAV signals.

[Patients' satisfaction with pain management: the italian version of the Patient Outcome Questionnaire of the American Pain Society]. / La soddisfazione del paziente per il trattamento del dolore: la versione italiana del Patient Outcome Questionnaire dell'American Pain Society.

According to American Pain Society (APS), assessment of quality of pain management must consider not only improvement of symptoms but also patients' satisfaction with care. To this purpose, Patient Outcome Questionnaire (APS-POQ) was made. Aim of the study was to analyze reliability and construct validity of the Italian version of the questionnaire. The tool was administered to 322 hospitalized adults. Results showed positive psychometric properties of the Italian version of APS-POQ, particularly for the sections assessing intensity and interference of pain, and satisfaction with pain management.

Application of IBM Watson to Support Literature Reviews: A Preliminary Experience in Restorative Dentistry.

Literature reviews are crucial in the choice of the best personalized material type and restauration type in restorative dentistry. We developed an IBM-Watson based system to support literature search for restorative dentistry, and compared its results to a literature search performed by a trained professional. We found that our system could assist the researcher in performing a literature review, but the grounding semantic model needs to be refined in order to provide more extensive results.

[The Italian version of NOPPAIN Scale: validation during education]. / La versione italiana della scala NOPPAIN: validazione in un contesto di formazione.

UNLABELLED: Pain assessment in elderly people may be complex due to the occurrence of neurodegenerative disorders, which often impair the ability to verbally report pain to hospital staff Several tools have been developed to assess pain behaviors in patients unable to communicate. The Italian version of the Non-Communicative Patient's Pain Assessment Instrument (NOPPAIN) has shown good preliminary qualities in the clinical setting. AIM: Aim of the paper is to analyze the psychometric properties of the Italian version of the NOPPAIN in a training setting. METHODS: 142 hospital staff members of the Medical Department of Vicenza Hospital assessed with NOPPAIN 5 videotapes, portraying different levels of pain intensity. Inter-rater reliability (nonparametric Kendall's W) and construct validity were examined. RESULTS: A significant inter-rater agreement was found overall (Kendall's W = 0.89, p < 0.01) and for each of the 5 videos; inter-rater agreement was high both in the total score and in the main sections of the tool. NOPPAIN scores correctly discriminated between the different levels of pain intensity. CONCLUSION: The results confirm interrater reliability and construct validity of the Italian version of the NOPPAIN.

A questionnaire to evaluate the knowledge and attitudes of health care providers on pain.

The aims of this study were to survey the knowledge and attitudes of Italian health care professionals toward pain and develop a valid instrument to assess pain knowledge of physicians and nurses. A 21-item questionnaire on a Likert scale was given to 4,961 health professionals in 20 hospitals in Italy who volunteered to participate in the study. The results were analyzed psychometrically in three phases: the Principal Component Analysis phase identified two components, of which only the one that had 10 items about pain knowledge and attitudes (PAK) was studied; the Homogeneity Analysis revealed its acceptable internal reliability (Cronbach's alpha=0.72) and confirmed the Likert equidistance of the item options response; and the Confirmatory Factor Analysis proved that it had a very good construct validity. A standardized score was calculated on the PAK questionnaire using the final 10 selected items, considering 100% as the best level of knowledge of pain management and 0% as the worst. The standardized mean score on the whole sample was equal to 52.6% (95% Confidence Interval: 52.3%-53.0%). There was a statistically significant difference (P<0.001) in percentage score between physicians (56.5%) and nurses (51.3%). Knowledge was best among physicians in Anesthesiology and Emergency; this was followed by doctors in Medicine and then surgeons. The knowledge of nurses was almost constant. This scale fills a void by providing a validated instrument for testing the general knowledge about pain treatment of hospital staff. It is brief and can easily be administered to a considerable number of people.

Results of an interlaboratory comparison of analytical methods for quantification of anhydrosugars and biosugars in atmospheric aerosol.

An interlaboratory comparison was performed to evaluate the analytical methods for quantification of anhydrosugars - levoglucosan, mannosan, galactosan - and biosugars - arabitol, glucose and mannitol - in atmospheric aerosol. The performance of 10 laboratories in Italy currently involved in such analyses was investigated on twenty-six PM (particulate matter) ambient filters, three synthetic PM filters and three aqueous standard solutions. An acceptable interlaboratory variability was found, determined as the mean relative standard deviation (RSD%) of the results from the participating laboratories, with the mean RSD% values ranging from 25% to 46% and decreasing with increasing sugar concentration. The investigated methods show good accuracy, evaluated as the percentage error (ε%) related to mean values, since method biases ranged within ±20% for most of the analytes measured in the different laboratories. The detailed investigation (ANOVA analysis at p < 0.05) of the contribution of each laboratory to the total variability and the measurement accuracy shows that comparable results are generated by the different methods, despite the great diversity in terms of extraction conditions, chromatographic separation - more recent LC (liquid chromatography) and EC (exchange chromatography) methods compared to more widespread GC (gas chromatography) - and detection systems, namely PAD (pulsed amperometric detection) or mass spectrometry.

Urban PM2.5 oxidative potential: Importance of chemical species and comparison of two spectrophotometric cell-free assays.

Oxidative potential (OP) of particulate matter (PM) - defined as the capacity of PM to oxidize target molecules generating reactive oxygen species (ROS) - has been proposed as a more health relevant metric than PM mass. In this study two cell-free methods were used to assess the OP of PM filters collected at an urban site and to evaluate correlation with PM mass and PM composition. Among the different assays existing, two inexpensive and user-friendly methods were used both based on spectrophotometric measurements of depletion rate of target reagents oxidized by redox-active species present in PM. One assay measures the consumption of dithiothreitol (OPDTT) and the other the ascorbate (OPAA). Although both assays respond to the same redox-active species, i.e., quinones and transition metals, no correlations were found between OPDTT and OPAA responses to compounds standard solutions as well as to ambient samples. When expressed in relation to air volume, OPDTT m-3 strongly correlates with PM2.5 mass whereas no correlation was found for OPAA m-3 with PM2.5. When expressed on mass basis, both OPDTT µg-1 and OPAA µg-1 show a strong dependence on the sample composition, with higher OP for summer samples. OPDTT m-3 were highly correlated with the determined metals (Cu, Zn, Cr, Fe, Ni, Mn) whereas OPAA m-3 showed only moderate correlation with Cu and Mn. Thus, the two assays could potentially provide complementary information on oxidative potential characteristic of PM. Consequently, the combination of the two approaches can strengthen each other in giving insight into the contribution of chemical composition to oxidative properties of PM, which can subsequently be used to study health effects.

Characteristics and major sources of carbonaceous aerosols in PM2.5 in Emilia Romagna Region (Northern Italy) from four-year observations.

The concentrations of organic and elemental carbon in PM2.5 aerosol samples were measured in two sites of Emilia Romagna (Po Valley, Northern Italy) in eight campaigns during different seasons from 2011 to 2014. Strong seasonality was observed with the highest OC concentrations during the cold periods (≈ 5.5 µg m(-3)) and the lowest in the warm months (≈ 2.7 µg m(-3)) as well as with higher EC levels in fall/winter (≈ 1.4 µg m(-3)) in comparison with spring/summer (≈ 0.6 µg m(-3)). Concerning spatial variability, there were no statistically significant difference (p<0.05) between OC concentrations at the two sampling sites in each campaign, while the EC values were nearly twofold higher levels at the urban site than those at the rural one. Specific molecular markers were investigated to attempt the basic apportionment of OC by discriminating between the main emission sources of primary OC, such as fossil fuels burning - including traffic vehicle emission - residential wood burning, and bio-aerosol released from plants and microorganisms, and the atmospheric photo-oxidation processes generating OCsec. The investigated markers were low-molecular-weight carboxylic acids - to describe the contribution of secondary organic aerosol - anhydrosugars - to quantify primary emissions from biomass burning - bio-sugars - to qualitatively estimate biogenic sources - and Polycyclic Aromatic Hydrocarbons - to differentiate among different combustion emissions. Using the levoglucosan tracer method, contribution of wood smoke to atmospheric OC concentration was computed. Wood burning accounts for 33% of OC in fall/winter and for 3% in spring/summer. A clear seasonal trend is also observed for the impact of secondary processes with higher contribution in the warm seasons (≈ 63%) in comparison with that in colder months (≈ 33%), that is consistent with enhanced solar radiation in spring/summer.

Gabapentin for neuropathic cancer pain: a randomized controlled trial from the Gabapentin Cancer Pain Study Group.

PURPOSE: To determine the analgesic effect of the addition of gabapentin to opioids in the management of neuropathic cancer pain. PATIENTS AND METHODS: One hundred twenty-one consecutive patients with neuropathic pain due to cancer, partially controlled with systemic opioids, participated in a multicenter, randomized, double-blind, placebo-controlled, parallel-design, 10-day trial from August 1999 to May 2002. Gabapentin was titrated from 600 mg/d to 1,800 mg/d in addition to stable opioid dose. Extra opioid doses were available as needed. Zero to 10 numerical scale was used to rate average daily pain. The average pain score over the whole follow-up period was used as main outcome measure. Secondary outcome measures were: intensity of burning pain, shooting/lancinating pain, dysesthesias (also scored on 0 to 10 numerical scale), number of daily episodes of lancinating pain, presence of allodynia, and daily extra doses of opioid analgesics. RESULTS: Overall, 79 patients received gabapentin and 58 (73%) completed the study; 41 patients received placebo and 31 (76%) completed the study. Analysis of covariance (ANCOVA) on the intent-to-treat population showed a significant difference of average pain intensity between gabapentin (pain score, 4.6) and placebo group (pain score, 5.4; P =.0250). Among secondary outcome measures, dysesthesia score showed a statistically significant difference (P =.0077; ANCOVA on modified intent-to-treat population = 115 patients with at least 3 days of pain assessments). Reasons for withdrawing patients from the trial were adverse events in six patients (7.6%) receiving gabapentin and in three patients receiving placebo (7.3%). CONCLUSION: Gabapentin is effective in improving analgesia in patients with neuropathic cancer pain already treated with opioids.

Prevalence and treatment of pain in adults admitted to Italian hospitals.

BACKGROUND: Very few studies have been conducted on the presence and control of pain in Italian hospitals. AIMS: The present study estimates pain prevalence and therapy in Italian hospitalised patients. METHODS: In the autumn of 2000, a survey was taken on 4523 inpatients throughout Italy. All eligible patients were given a questionnaire with two Numerical Rating Scales (NRS) concerning their pain intensity at interview and over the previous 24 h. Nurses were given a second questionnaire asking for information on analgesic treatment and another NRS about the pain they supposed the patient felt. RESULTS: At interview, 91.2% (95%CI: 90.3-92.1%) of the patients reported pain; 46.6% reported severe pain. The prevalence of severe pain was significantly lower in women and was double in general medicine wards compared to surgical wards. The degree of agreement between the pain reported by the patient and the pain scores given by the nurse was poor (Cohen K=0.318). Only 28.5% of the inpatients had taken analgesics in the past 24 h and the probability of receiving analgesic treatment was higher for women (adjusted OR=1.33, 95%CI: 1.14-1.54) and lower for general medicine compared to surgical wards (adjusted OR=0.55, 95%CI: 0.45-0.64), while it was unrelated both to the patient's self-reported pain and to level of pain assessed by the nurse. CONCLUSIONS: Pain affects an impressively high percentage of inpatients and is largely untreated and unrecognised in Italian wards. Educational intervention is required to improve the knowledge and attitudes of health professionals towards the approach and handling of patients in pain.

[Towards a pain-free hospital. Description of the campaign]. / Verso un ospedale senza dolore. Un'esperienza di svolgimento del progetto.

The various stages of the campaign "Towards a pain-free hospital", carried out at St. Bortolo Hospital in Vicenza, Italy, are described. They concerned: measuring pain prevalence, patients' beliefs, staff education, giving patients information, daily pain measurement, preparing pain treatment protocols, assessing patient satisfaction. The methods for carrying out the various initiatives and the data collected are reported.

Risk assessment of opioid misuse in italian patients with chronic noncancer pain.

Objective. Opioid therapy in patients with chronic noncancer pain must be preceded by evaluation of the risk of opioid misuse. The aim of this study was to evaluate the predictive validity of the Italian translation of the Pain Medication Questionnaire (PMQ) and of the Diagnosis Intractability Risk and Efficacy Score (DIRE) in chronic pain patients. Design. 75 chronic noncancer pain patients treated with opioids were enrolled and followed longitudinally. Risk of opioid misuse was evaluated through PMQ, DIRE, and the physician's clinical evaluation. Pain experience and psychological characteristics were assessed through specific self-report instruments. At follow-ups, pain intensity, aberrant drug behaviors, and presence of the prescribed opioid and of illegal substances in urine were also checked. Results. PMQ demonstrated good internal consistency (Cronbach's α = 0.77) and test-retest reliability (r = 0.86). Significant correlations were found between higher PMQ scores and the number of aberrant drug behaviors detected at 2-, 4-, and 6-month follow-ups (P < 0.01). Also the DIRE demonstrated good predictive validity. Conclusions. The results obtained with specific tools are more reliable than the clinician's evaluation alone in predicting the risk of opioid misuse; regular monitoring and psychological intervention will contribute to improving compliance and outcome of long-term opioid use.

A new Italian questionnaire to assess caregivers of cancer patients' satisfaction with palliative care: multicenter validation of the post mortem questionnaire-short form.

CONTEXT: Caregiver satisfaction with palliative care is a crucial indicator of its effectiveness. In light of the lack of validated or reliable Italian instruments, the Post Mortem Questionnaire-Short Form (QPM-SF), a self-report questionnaire, has been developed to assess home and inpatient hospice care. OBJECTIVES: The present study was designed to evaluate the psychometric properties of QPM-SF and assess for differences in quality of palliative care between hospice and home care settings. METHODS: A total of 584 caregivers of terminal cancer patients completed QPM-SF one month after the death of the care recipient. To assess test-retest reliability, a subgroup of 50 caregivers completed the questionnaire a second time, one month later. RESULTS: QPM-SF showed good internal consistency and temporal stability and a four-factor structure: "Integrated home care," "Hospice," "Physical care-Information-Global evaluation," and "Needs." CONCLUSION: QPM-SF may be considered a valid, reliable, and well-accepted self-report instrument for examining and implementing palliative care interventions.