Decline in academic performance and mental health during the COVID-19 pandemic: a cross-sectional survey among Sapienza University of Rome students.

Introduction: The COVID-19 pandemic has posed significant challenges to the education system, leading to changes in student academic performance and mental health. The aim of this study was to evaluate variables relating to changes in academic performance and mental health during the pandemic. Methods: We carried out a cross-sectional study from 28 February 2022 to 13 April 2022, during the free SARS-CoV-2 screening campaign offered by Sapienza University of Rome. A structured questionnaire was constructed to explore the decline in academic performance during the COVID-19 pandemic. The Coronavirus Anxiety Scale (CAS), a validated self-reporting mental health screener of dysfunctional anxiety associated with the coronavirus crisis, was used. Results: A sample of 1,134 students was enrolled. A total of 25.4% of the participants reported a decline in academic performance. In addition, Coronavirus Anxiety Scale scores revealed that 133 (11.5%) students had a dysfunctional anxiety problem due to COVID-19. A multivariable logistic regression model showed that being a senior student (aOR: 0.70 95% CI: 0.52-0.96) and having good financial status (aOR: 0.64, 95% CI: 0.47-0.88) decrease the likelihood of a decline in academic performance, while not being Italian (aOR: 2.12, 95% CI: 1.29-3.48), having felt the need for psychological support (aOR: 2.58, 95% CI: 1.87-3.55) and being enrolled in a science/technology faculty (aOR: 1.81, 95% CI: 1.27-2.57) were more likely to result in a decline in academic performance. Conclusion: Our results show that the pandemic has affected academic performance. The COVID-19 emergency highlighted the importance of considering mental health and economic status in policymaking to effectively support students.

Optimizing human thermal comfort and mitigating the urban heat island effect on public open spaces in Rome, Italy through sustainable design strategies.

The climate affects how a city's outdoor spaces are utilized. It is more likely that people will use and appreciate public areas designed for pedestrian use, such as parks, squares, streets, and foot-cycle pathways, when they provide a comfortable and healthy environment. A predicted increase in global temperature has made the climate uncomfortable, especially during the summer when heat stress is strengthened and anticipated. This phenomenon is more severe in urban areas, often affected by the Urban Heat Island (UHI) effect. Since the spatial characteristics of a city influence its climate, urban design can be deployed to mitigate the combined effects of climate change and UHI. This research is conducted to study the UHI effect on thermal comfort in an urban open space in Rome (Italy) and aims at identifying and implementing a methodology that urban designers can follow to reduce the impact of urban heat islands and increase thermal comfort in urban outdoor space. This study is based on an urban design concept adopting the Sustainable Development Goals as guidelines; it investigates how UHI's effect affects the use of public space and examines the influence of urban microclimatic conditions on the thermal perception of users through PET, PMV and PPD values, that were assessed through simulations with ENVI-MET software. The study thus proposes a redesign for the site in Rome, with a masterplan based on sustainable design principles, aimed at improving the microclimatic conditions in the site. The design solution was then validated through ex post simulations.

Nature-based solutions for monitoring the impact of vehicular particulate matter and for the preventive conservation of the Palatine Hill archaeological site in Rome, Italy.

Magnetic and chemical biomonitoring methodologies were applied to the southern slopes of the Palatine Hill archaeological area in Rome, Italy. Plant leaves and lichen transplants were respectively sampled and exposed between July 2022 and June 2023 to assess the impact of vehicular particulate matter from Via dei Cerchi, a trafficked road coasting Circus Maximus, towards the archaeological area upon the Palatine Hill. The magnetic properties of leaves and lichens, inferred from magnetic susceptibility, hysteresis loops and first order reversal curves, were combined with the concentration of trace elements. It was demonstrated that the bioaccumulation of magnetite-like particles, associated with tracers of vehicular emissions, such as Ba and Sb, decreased with longitudinal distance from the road, without any important influence of elevation from the ground. Lichens demonstrated to be more efficient biomonitors of airborne PM than leaves, irrespective of the plant species. Conversely, leaves intercepted and accumulated all PM fractions, including road dusts and resuspended soil particles. Thus, plant leaves are suitable for providing preventive conservation services that limit the impact of particulate pollution on cultural heritage sites within busy metropolitan contexts.

Carotid artery stenting with flow inversion cerebral protection and MicroNet-covered stent.

BACKGROUND: The study aims to evaluate the association of proximal flow-inversion cerebral protection and MicroNet-covered CGuard stents in reducing early and late embolic events in carotid artery stenting procedures. METHODS: From 2018 to 2023, we performed 204 procedures in 180 patients with flow inversion cerebral protection and CGuard stents at the Vascular Surgery Unit of Sant'Eugenio Hospital in Rome. Cerebral protection was achieved with a Flow-Gate2 catheter connected to a peripheral vein. The tip balloon is inflated in the CCA to obtain an effective endoclamping, the pressure difference between the carotid bifurcation and the venous compartment ensures a constant back flow with wash-out in the venous compartment. Inclusion criteria were: life expectancy of >12 months, target lesions indicating treatment according to ESVS Guidelines, increased surgical risk due to comorbidities or anatomic issues. ECD follow-up was performed immediately postoperatively, at 30 days, 6 and 12 months, and subsequently annually. RESULTS: The treatment protocol was successfully implemented in 99% of cases. No major strokes occurred, while one minor stroke (0.5%) occurred within 8 hours of the procedure, regressing in the following months. One perioperative death (0.5%) due to cerebral hemorrhage occurred three hours after the procedure. All patients remained asymptomatic, with no short or medium-term neurological score deterioration. One hemodynamically significant restenosis (0.5%) was detected at the 6-month follow-up. All patients completed the 6 months follow-up, though 6 (3%) were lost at the 12-month appointment. CONCLUSIONS: Our prospective monocentric study has demonstrated the effectiveness and safety of the FlowGate2 flow inversion cerebral protection system in association with MicroNet covered CGuard stent.

Green infrastructure design for the containment of biological invasions. Insights from a peri-urban case study in Rome, Italy.

Secondary shrublands and transitional woodland/shrub formations are recognised to be particularly susceptible to plant invasions, one of the main global threats to biodiversity, especially in dynamic peri-urban landscapes. Urban fringes are in fact often the place for the sprawl of artificial surfaces, fragmentation of habitats, and complex land transitions (including both agriculture intensification and abandonment), which in turn increase propagule pressure of exotic species over residual semi-natural ecosystems. Within this framework, the present study was aimed at analysing i) how landscape composition and configuration affect the richness of woody exotic species in shrubland and transitional woodland/shrub patches, and ii) how this threat can be addressed by means of green infrastructure design in a peri-urban case study (Metropolitan City of Rome, Italy). Accordingly, the occurrence of exotic plants was recorded with field surveys and then integrated with landscape analyses, both at patch level and over a 250 m buffer area around each patch. Thus, the effect of landscape features on exotic plant richness was investigated with Generalised Linear Models, and the best model identified (pseudo R-square = 0.62) for inferring invasibility of shrublands throughout the study area. Finally, a Green Infrastructure (GI) to contain biological invasion was planned, based on inferred priority sites for intervention and respective, site-tailored, actions. The latter included not only the removal of invasive woody alien plants, but also reforestation and planting of native trees for containment of dispersal and subsequent establishment. Even though specifically developed for the study site, and consistent with local government needs, the proposed approach represents a pilot planning process that might be applied to other peri-urban regions for the combined containment of biological invasions and sustainable development of peripheral complex landscapes.

Rome-Galen (129 to ca. 216).

Over the last 50 years the significance of Galen's contributions to the arts of medicine and surgery have been increasingly recognized. Despite his errors, his contributions to medical and surgical practice have been profound. In the present context, his teachings on cranial surgical instruments and technique would continue to be influential throughout one and a half millenia. His technical advice was sound. His error about the anatomy of blood vessels supplying CNS were not of much consequence since the CNS would remain surgically inaccessible until the end of the 19th century. He reclassified fractures as extending to the diploe or through the internal table. Moreover, they could be simple, comminuted, depressed, or elevated. He did not mention indications or clinical changes, on the other hand he had many sensible remarks to make on the instrumentation required for cranial surgery. As will be seen in what follows, he was much quoted in justification of the decisions of his successors. The major errors of significance related to his description of the anatomy of the cranium and its sutures. His concern about the cranial attachment, vascular components and excretory functions of the sutures added to Hippocrates' concerns about their inherent weakness resulted in the teaching that trepanation should avoid these structures. This was to have a limiting effect on the placement of trepanation openings which was of no benefit to the patients. Moreover, his enthusiasm for bloodletting would also serve to potentiate Hippocrates teaching on this matter, to the advantage of nobody.

Rome-Celsus (ca 25BC to ca. 50AD).

Celsus gave an adequate description of the bones and sutures of the calvarium. His classification of injuries was simple including fissures and depressions. He is the first to relate specific symptoms to specific tissue injury. In addition, he was aware that fractures could be present in the absence of typical findings. He was also the first to note the meningeal vessels could rupture producing severe localized pain. His treatment was more conservative than that of Hippocrates. Plasters were to be used and if there was no deterioration trepanation was avoided. He described the use of the crown trepan (modiolus) and the instrument with a smaller tip which expands rapidly to prevent penetration. He also described the technique of rotating the trepan between the palms. His description of operations for depressed fractures were unusually clear and relevant even by modern standards. His wound care is strikingly different from that of Hippocrates as he advocates various dressings soaked in vinegar and as time passes plasters should be softened with rose oil. Regrettably, Celsus influence would not be felt until the time of the Renaissance, because his texts were lost. However, his "De Medicina" was rediscovered and became the first medical text to be published using the new moveable type printing press, in the year 1478. Thus, his influence was minimal in the Arabic world and the early Renaissance. Thereafter it was profound.

Manners of terminology and description in Galen's anatomy in the ancient Rome and their historical consequences up to the modern time.

The oldest extant anatomy textbooks compiled in ancient Rome were by Galen who described in writing most of the various parts and organs of the body. History tells us that ever since the time of Galen, anatomical terminology would be a necessary and beneficial feature, but it also brought unexpected and annoying consequences into the field. The benefits are readily apparent in the case of muscle terminology. Galen identified more than 150 different kinds of skeletal muscles, most of which were unnamed, hence difficult to identify without professional knowledge of anatomy. Vesalius introduced detailed anatomical illustrations in Fabrica (1543), which made the identification of the muscles easier. Bauhin then introduced proper descriptive names for the muscles in Theatrum anatomicum (1605), which enabled the identification of the muscles without illustrations. After the terminology became complex and diverse, a logically consistent standard nomenclature was established by Nomina anatomica (1895). The unexpected consequences may be found in the terminology of bones and joints. Galen gave 39 proper names for individual bones, and classified and termed the types of bony joints. Many of these terms have survived in modern anatomy as literal translations of the bone terms, as well as the joint terms. The annoying consequences may be found in the terminology of intestines. Galen divided the small and large intestines into three portions, such that the major part of the small intestine suspended by the mesentery was divided into two without sufficient reason. The Latin translations of jejunum and ileum were, respectively assigned to them by Mondino in his Anatomia written in 1316.

Clinical variables influencing the perception of fatigue in people with multiple sclerosis: a cross-sectional study using FSIQ-RMS.

BACKGROUND: Physical fatigue is one of the most disabling symptoms in people with Multiple Sclerosis (PwMS). Several factors might influence the development of fatigue, such as gender, education, body mass index (BMI), Expanded Disability Status Scale (EDSS), disease duration, working status (Ws), physiotherapy (Ph), and disease-modifying therapies (DMTs). Fatigue Symptoms and Impacts Questionnaire-Relapsing Multiple Sclerosis (FSIQ-RMS) is a patient-reported outcome (PRO) that allows one to define the impact of fatigue in PwMS clearly. This study aimed to assess fatigue impact on PwMS by using FSIQ-RMS. METHODS: The participants were enrolled from May to July 2021 in MS Centers of Sant'Andrea Hospital and Policlinico Umberto I Hospital in Rome. Fatigue was evaluated using the FSIQ-RMS, validated, and culturally adapted in Italian. Clinical and demographic data were collected at the same time. RESULTS: We enrolled 178 PwMS [Female 74.16%; RMS 82.58%, SPMS 17.52%]. FSIQ-RMS scores were significantly correlated with EDSS (p-value < 0.01). Analysis of variance between means showed a statistically significant difference between the BMI groups at the 24hours_FSIQ-RMS score and the 7days_FSIQ-RMS score (p < 0.01), with the lower BMI group having the highest scores. Furthermore, perceived fatigue significantly improved both in subjects performing Ph (p < 0.05) and in those who actively work (p < 0.01). CONCLUSIONS: The use of FSIQ-RMS in a real-world setting confirmed that underweight and high levels of disability are closely related to fatigue. In addition, Ph and active Ws are strongly correlated with fatigue in PwMS.

Bulbar function in spinal muscular atrophy (SMA): State of art and new challenges. 21st July 2023, Rome, Italy.

Progressive bulbar involvement is frequent in spinal muscular atrophy, with prevalence and severity of deficits associated with type. The report provides an overview of the presentations made at the workshop grouped into 4 sessions: the first section was dedicated to videofluoroscopy with a revision of the existing protocols and discussion on which one should be used in routine clinical practice and in research settings. The second session was dedicated to interprofessional routine assessments of bulbar function, with a review of the recent clinical tools specifically developed for SMA. The third section was focused on the assessments performed by speech and language therapists/pathologists in the new SMA phenotypes. The last section focused on how the new therapies have changed the approach in rehabilitation for bulbar dysfunction. Finally, we present the consensus that was achieved on these aspects and possible action points from these.

A Very "Distilled" Emblem in Baroque Rome: Natural Philosophy, Alchemy, and Atomism in the Academy of the Umoristi.

Created and published in a printed volume in 1611, the emblem chosen by the literary Academy of the Umoristi is intriguing at multiple levels. At a time when the water cycle was still unknown, the image engaged the thorny question of how the evaporation of salty seawater, condensed into clouds, could subsequently pour down as sweet rain. Additionally, the Lucretian motto "Redit agmine dulci" audaciously evoked the philosophy of atoms. The combination of the image and the motto suggested looking at the meteorological phenomenon on display as a sort of natural distillation process, not different from the circulations taking place in the alembic. This enquiry will document how the Academy of the Umoristi was influenced in the choice of its emblem by the scientific Academy of the Lincei and how, towards the end of the seventeenth century, under the patronage of Christina of Sweden, the interconnection of alchemy and atomism alluded to in the academic emblem was reclaimed as a distinctive philosophical banner.

The Middle Pleistocene human metatarsal from Sedia del Diavolo (Rome, Italy).

The peopling of Europe during the Middle Pleistocene is a debated topic among paleoanthropologists. Some authors suggest the coexistence of multiple human lineages in this period, while others propose a single evolving lineage from Homo heidelbergensis to Homo neanderthalensis. The recent reassessment of the stratigraphy at the Sedia del Diavolo (SdD) site (Latium, Italy), now dated to the beginning of marine isotope stage (MIS) 8, calls for a revision of the human fossils from the site. In this paper, we present the morphometric, biomechanical and palaeopathological study of the second right metatarsal SdD2, to both re-evaluate its taxonomical affinities and possibly determine the levels of physical activity experienced by the individual during lifetime. Results demonstrate the persistence of archaic features in SdD2 suggesting new insights into the technology and hunting strategies adopted by Homo between MIS 9 and MIS 8.

Bicycle-related accidents in Rome: Investigating clinical patterns, demographics, injury contexts, and health outcomes for enhanced public safety.

INTRODUCTION: This study aims to analyze the clinical characteristics, demographic features, and injury circumstances of patients admitted to the Emergency Department (ED) at Fondazione Policlinico Universitario A. Gemelli (IRCCS) in Rome, Italy, due to bicycle accidents. METHODS: Data on clinical characteristics, accident timing, injury circumstances, and helmet use were collected for ED patients involved in bicycle accidents from January 2019 to December 2022. Subsequently, Abbreviated Injury Scale codes of all diagnoses were recorded and the Injury Severity Score was calculated. RESULTS: Over the study period, 763 patients were admitted to the ED following bicycle accidents, with a 0.3 % fatality rate and a 30.4 % frequency of multitrauma. Multivariate analysis revealed that collisions with other vehicles increased trauma severity and the risk of ICU admission. Conversely, helmet use was associated with reduced severity of head trauma and a lower likelihood of ICU admission. Notably, toxicological investigations were not conducted for any ED-admitted patients. CONCLUSIONS: Although a low mortality rate and a low incidence of multi-trauma have been shown in comparison to other nations, it is necessary to adopt prevention strategies like safety devices, more cycle paths, and better infrastructures on the one hand, and stricter laws on the other. It is essential to require toxicological testing in Italy for all accidents involving this means of transport, and to make helmet use compulsory for all ages.

Ambient air pollution and hypertensive disorders of pregnancy in Rome.

BACKGROUND: Ambient air pollution has been associated with hypertensive disorders of pregnancy (HDP), but few studies rely on assessment of fine-scale variation in air quality, specific subtypes and multi-pollutant exposures. AIM: To study the impact of long-term exposure to individual and mixture of air pollutants on all and specific subtypes of HDP. METHODS: We obtained data from 130,470 liveborn singleton pregnacies in Rome during 2014-2019. Spatiotemporal land-use random-forest models at 1 km spatial resolution assigned to the maternal residential addresses were used to estimate the exposure to particulate matter (PM2.5 and PM10), nitrogen dioxide (NO2), and ozone (O3). RESULTS: For PM2.5, PM10 and NO2, there was suggestive evidence of increased risk of preeclampsia (PE, n = 442), but no evidence of increased risk for all subtypes of HDP (n = 2297) and gestational hypertension (GH, n = 1901). For instance, an interquartile range of 7.0 µg/m3 increase in PM2.5 exposure during the first trimester of pregnancy was associated with an odds ratio (OR) of 1.06 (95% confidence interval: 0.81, 1.39) and 1.04 (0.92, 1.17) after adjustment for NO2 and the corresponding results for a 15.7 µg/m3 increase in NO2 after adjustment for PM2.5 were 1.11 (0.92, 1.34) for PE and 0.83 (0.76, 0.90) for HDP. Increased risks for HDP and GH were suggested for O3 in single-pollutant models and for PM after adjustment for NO2, but all other associations were stable or attenuated in two-pollutant models. CONCLUSIONS: The results of our study suggest that PM2.5, PM10 and NO2 increases the risk of PE and that these effects are robust to adjustment for O3 while the increased risks for GH and HDP suggested for O3 attenuated after adjustment for PM or NO2. Additional studies are needed to evaluate the effects of source-specific component of PM on subtypes as well as all types of HDP which would help to target preventive actions.

Prevalence of Rome IV Pediatric Diagnostic Questionnaire-Assessed Disorder of Gut-Brain Interaction, Psychopathological Comorbidities and Consumption of Ultra-Processed Food in Pediatric Anorexia Nervosa.

Anorexia nervosa (AN) is a severe eating disorder primarily affecting children and adolescents. Disorders of the gut-brain interaction (DGBIs) have gained recognition as significant symptoms in individuals with AN. However, limited studies have explored GI symptoms in pediatric populations with AN using age-specific diagnostic tools. This study aims to investigate the prevalence of DGBIs, their associated psychopathological aspects and their potential correlations with ultra-processed food (UPF) consumption among pediatric AN patients. The study included AN patients who were under the care of a specialized multidisciplinary team. We assessed DGBI-related symptoms using the Rome IV Pediatric Diagnostic Questionnaire on Functional Gastrointestinal Disorders (R4PDQ) and conducted psychological evaluations. Dietary intake and UPF consumption were evaluated. Among 56 AN patients, we observed a lower prevalence of DGBIs (functional constipation: 61%; functional dyspepsia: 54%; irritable bowel syndrome: 25%) compared to the existing literature. The psychological assessments revealed high rates of depression (72%) and anxiety (70%). UPF consumption was inversely related to depression levels (p = 0.01) but positively correlated with functional constipation (p = 0.046). This study highlights the importance of using age-specific diagnostic tools and emphasizes the crucial role of a specialized multidisciplinary team in the treatment of AN.

Analysing arterial blood gas results using the RoMe technique.

Arterial blood gas (ABG) analysis is a fundamental skill in healthcare practice, particularly when caring for acutely unwell or deteriorating patients. It can be useful in the assessment of patients' acid-base balance and gas exchange, thereby informing appropriate care and management. However, many nurses find interpreting ABG results challenging. This article outlines a simplified approach to ABG analysis using three main values - pH, partial pressure of carbon dioxide and bicarbonate - and applying the RoMe ('Respiratory opposite, Metabolic equal') technique. It also provides brief descriptions of selected acid-base imbalances and explains how to identify whether these are uncompensated, partially compensated or fully compensated.

Burden of delayed discharge on acute hospital medical wards: A retrospective ecological study in Rome, Italy.

INTRODUCTION: Delayed discharge represents the difficulty in proceeding with discharge of patients who do not have any further benefit from prolonged stay. A quota of this problem is related to organizational issues. In the Lazio region in Italy, a macro service re-organization in on the way, with a network of hospital and territorial centers engaged in structuring in- and out- of hospital patient pathways, with a special focus on intermediate care structures. Purpose of this study is to quantify the burden of delayed discharge on a single hospital structure, in order to estimate costs and occurrence of potential resource misplacement. MATERIAL AND METHODS: Observational Retrospective study conducted at the Santo Spirito Hospital in Rome, Italy. Observation period ranged from 1/09/2022, when the local database was instituted, to 1/03/2023 (6 months). Data from admissions records was anonymously collected. Data linkage with administrative local hospital database was performed in order to identify the date a discharge request was fired for each admission. Surgical discharges and Intensive Care Unit (ICU) discharges were excluded from this study. A Poisson hierarchical regression model was employed to investigate for the role of ward, Severity of Disease (SoD) and Risk of Mortality (RoM) on elongation of discharge time. RESULTS: 1222 medical ward admissions were recorded in the timeframe. 16% of them were considered as subject to potentially elongated stay, and a mean Delay in discharge of 6.3 days (SD 7.9) was observed. DISCUSSION AND CONCLUSIONS: Delayed discharge may cause a "bottleneck" in admissions and result in overcrowded Emergency Department, overall poor performance, and increase in overall costs. A consisted proportion of available beds can get inappropriately occupied, and this inflates both direct and indirect costs. Clinical conditions on admission are not a good predictor of delay in discharge, and the root causes of this phenomenon likely lie in organizational issues (on structure\system level) and social issues (on patient's level).

Validation of the Rome Severity Classification of Chronic Obstructive Pulmonary Disease Exacerbation: A Multicenter Cohort Study.

Background: The Rome severity classification is an objective assessment tool for the severity of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) based on readily measurable variables but has not been widely validated. The aim of this study is to evaluate the validity of the Rome classification in distinguishing the severity of AECOPD based on short-term mortality and other adverse outcomes. Methods: The Rome severity classification was applied to a large multicenter cohort of inpatients with AECOPD. Differences in clinical features, in-hospital and 60-day mortality, intensive care unit (ICU) admission, mechanical ventilation (MV) and invasive mechanical ventilation (IMV) usage were compared among the mild, moderate and severe AECOPD according to the Rome proposal. Moreover, univariate logistic analysis and Kaplan Meier survival analysis were also performed to find the association between the Rome severity classification and those adverse outcomes. Results: A total of 7712 patients hospitalized for AECOPD were included and classified into mild (41.88%), moderate (40.33%), or severe (17.79%) group according to the Rome proposal. The rate of ICU admission (6.4% vs 12.0% vs 14.9%, P <0.001), MV (11.7% vs 33.7% vs 45.3%, P <0.001) and IMV (1.4% vs 6.8% vs 8.9%, P <0.001) increased significantly with the increase of severity classification from mild to moderate to severe AECOPD. The 60-day mortality was higher in the moderate or severe group than in the mild group (3.5% vs 1.9%, 4.3% vs 1.9%, respectively, P <0.05) but showed no difference between the moderate and severe groups (2.6% vs 2.5%, P >0.05), results for in-hospital mortality showed the same trends. Similar findings were observed by univariate logistic analysis and survival analysis. Conclusion: Rome severity classification demonstrated excellent performance in predicting ICU admission and the need for MV or IMV, but how it performs in differentiating short-term mortality still needs to be confirmed.