The Sapienza University of Rome network of automated external defibrillators: a prototype webMap developed to speed access to community defibrillators and increase survival from out-of-hospital cardiac arrest.

OBJECTIVE: In Italy, only around 10% of people who experience out-of-hospital cardiac arrest (OHCA) survive. A large portion of OHCA events in public settings are characterized by an initial shockable rhythm, which requires prompt defibrillation. We aimed to create a system to quickly locate nearby public access automated external defibrillators (AEDs) on the campus of Sapienza University of Rome, the largest public university in Europe. MATERIALS AND METHODS: We developed the AED webMap through a 6-step process involving the: 1) collection of information and geographical coordinates for each AED from the university management system; 2) development of a new geolocation database; 3) integration of information contained in the new database with data provided by university departments; 4) geolocation of AEDs in the Google MyMaps environment; 5) graphic representation of all AEDs on digital map templates using specific symbols, with pop-ups containing additional information for each AED; and 6) publication of the webMap on the university website. RESULTS: The AED webMap was published on the university website (https://www.uniroma1.it/it/pagina/defibrillatori-sapienza-in-rete) and facilitates prompt identification of nearby AEDs by providing: 1) detailed AED geolocalization with interactive pop-up information for each AED, including whether the AED is located internally or externally; 2) the option to use different base maps (e.g., digital street map); 3) calculation and display of the route to reach the chosen AED; and 4) the possibility to migrate towards multiple platforms. CONCLUSIONS: The webMap can help bystanders quickly identify, locate, and reach nearby AEDs present on the campus of the largest public university in Europe, a measure that could help speed defibrillation and maximize the life-saving potential of AEDs in the event of OHCA.

Investigating the synergistic effect of socio-demographic fac- tors on behaviors and attitudes concerning alcohol and illicit drug use among Italian students: a large cross-sectional study.

Background: Alcohol, drug consumption and polysubstance use are some of the most important causes of illnesses and mortality among adolescents, who have been identified as common users of these substances. Aim of this study was to assess and describe the current scenery of alcohol and other drugs consumption habits among a wide sample of Italian high school and university students. Methods: A cross-sectional study was carried out using an online survey. The questionnaire was developed and administered via an internet forum for middle school, high school and university students named "Skuola.net". The statistical analysis included descriptive statistics, univariate and multivariate analysis. Additive interactions were assessed by calculating the synergy index. Results: A total of 11,379 Italian students answered the questionnaire. The prevalence of alcohol drinkers was 34.2%; among these, 17.8% of the individuals showed unhealthy drinking behaviors (frequency of alcohol use of four times or more per week); 10.3% of individuals declared daily assumption of six or more glasses of alcohol. Concerning drugs, 15.7% of the responders classified themselves as illicit drug users, with cannabis getting the highest prevalence rates (6.9%). Finally, concerning alcohol, a synergistic effect was recorded for male and adult individuals (SI = 1.04); while concerning illicit drugs, a synergistic effect was found between male gender and older age (SI = 1.42), and between university students and male gender (SI = 1.10). Conclusions: This study gives an overview about the attitudes of a wide sample of Italian students concerning alcohol and drugs habits. These results are in line with evidences from the scientific literature and will be helpful for developing future prevention strategies towards this target population.

Life of a droplet: Buoyant vortex dynamics drives the fate of micro-particle expiratory ejecta.

We show that the dynamics of the expiratory cloud ejected during human respiratory events can be modeled by extending the theory of buoyant vortex rings with an initial momentum. We embed the integral conservation laws that govern the cloud's motion into the model of an expanding vortex to determine the velocity field inside and outside the cloud. We then apply a Lagrangian particle-tracking model to calculate the trajectories of the mucosalivary droplets suspended within the cloud. Our results show very good agreement with the available experimental data. The vortex is shown to have a significant effect on suspending the droplets present in the cloud, increasing the time they remain airborne and extending their range further than predicted by the existing models. We also study the role that initial conditions have on the maximum streamwise range of the droplets, finding that decreasing the angle of projection can reduce the spread of the droplets by an order of meters. Finally, we discuss the importance of these findings in the context of informing public health policies and global information campaigns to slow down the spread of respiratory viruses.

Effectiveness of clinical simulation on nursing student's improving critical care knowledge: a pretest-posttest study.

AIM: To evaluate the effectiveness of Human Patient Simulation method, as an additional method to theoretical lectures, on improving critical care knowledge of third course nursing students compared to only theoretical lectures. It was hypothesised that, the greater cognitive abilities used and trained around a specific subject, more strengthening of the subject contents is done by the students. METHODS: A non-experimental pretest-post test study was carried out with a questionnaire created ad hoc specifically for this study. Pretest questionnaire was administered after students received five weeks of theoretical lectures on critical care subjects. Post test was administered after students performed the theoretical classes and the simulation based learning activity on critical care subjects. RESULTS: 60 nursing students of the Campus Docent Sant Joan de Déu, attending to critical care subjects, were enrolled in the study. The statistical analyses performed showed a significance of the intervention in the post-test: p value 0.01 and the students improved on average by 1 point after the intervention, passing from 11.94 in the pre-test to 12.94 in the post-test. Results of this study suggest that use of Human Patient Simulation method of zone two made a positive difference in nursing students' ability to answer questions about critical care when there was need to apply their cognitives abilities. CONCLUSIONS: We evidenced that is crucial to direct cognitive resources appropriately toward each section of the simulation activity. Choosing the quantity and the kind of cognitive abilities that will be used by a specific group of students in a simulation activity, facilitators can upgrade the student knowledges and avoid impaired learning.

Risk of medication errors and nurses' quality of sleep: a national cross-sectional web survey study.

OBJECTIVE: We aimed to evaluate quality of sleep and self-perception risk of medication errors, in a significantly-sized sample of nurses in Italy, using a web survey. SUBJECTS AND METHODS: An anonymous questionnaire about self-perception of quality of sleep (Pittsburgh Sleep Quality Index - PSQI) and risk of medication errors (based on the 7 R-rule), was made up and delivered by social media, i.e., Facebook and Instagram. Risk of medication errors was intended as near misses, i.e., accidents that do not cause the patient harm. RESULTS: A poor quality of sleep stated by PSQI score >5, was present in 87.9% of subjects and the risk of medication errors during the last shift was reported in 76% of them. However, more than half of nurses' sample (60.1%) reported a good or excellent self-perception quality of sleep. Risk of medication errors was associated with poor quality of sleep and it was independently associated with short resting time after night shift and bad self-perception quality of sleep (OR 3.165, 95% CI 1.468-6.827, p=0.003). CONCLUSIONS: Absence of proper resting is crucial on performance even if nurses perceived a good quality sleep. The relationship between shift work, poor sleep quality, and risk of medication errors represents crucial point for all health professionals' community, and web-survey represents a valuable information in order to capture the risk of medication errors. Health care organizations should encourage such a type of research in order to show a more proactive approach towards patient safety.

Measuring knowledge, attitudes and behavior of nurses in medication management: cross-cultural comparisons in Italy and Malta.

OBJECTIVE: Medication errors are one of the most common causes of negative events affecting patient safety all over the world.  Scientific literature divides the factors that contribute to the occurrence of harmful events into factors related to the characteristics of the healthcare workers and factors related to the organization of the drug management process. The aim of the study was to examine the knowledge, attitudes and behaviours related to medication errors among Italian and Maltese nurses. SUBJECTS AND METHODS: Cross-sectional survey of nurses working in Intensive Care settings in Italian and Maltese hospitals was conducted. A valid and reliable questionnaire used in previous studies was adapted for online use. Despite improved reporting, The Strengthening the Reporting of Observational Studies in Epidemiology was used. RESULTS: Findings showed good psychometric properties and reliability. MANOVA demonstrated significant differences in nurses' perception of the pharmacist presence during medication process and of the use of computerized provider order entry. MANOVA also demonstrated significant differences in the control of vital parameters and the application of the 8 right. CONCLUSIONS: These findings support the contention that knowledge, attitude and behaviour of nurses is similar across different contexts in different countries wherein nurse training is harmonised and regulated through a transnational directive.

Inhibiting proliferation in KB cancer cells by RNA interference-mediated knockdown of nicotinamide N-methyltransferase expression.

The enzyme Nicotinamide N-methyltransferase (NNMT) catalyzes the methylation of nicotinamide and other pyridines, playing a pivotal role in the biotransformation and detoxification of many drugs and xenobiotic compounds. Several tumours have been associated with abnormal NNMT expression, however its role in tumour development remains largely unknown. In this study we investigated expression levels of Nicotinamide N-methyltransferase in a cancer cell line and we evaluated the effect of shRNA-mediated silencing of NNMT on cell proliferation. Cancer cells were examined for NNMT expression by semiquantitative RT-PCR and Western blot analysis. A HPLC-based catalytic assay was performed to assess enzyme activity. Cells were transfected with four shRNA plasmids against NNMT and control cells were treated with transfection reagent only (mock). The efficiency of gene silencing was detected by Real-Time PCR and Western blot analysis. MTT cell proliferation assay and the soft agar colony formation assay were then applied to investigate the functional changes in cancerous cell. NNMT mRNA was detected in cancer cells, showing a very high expression level. In keeping with the results of RT-PCR analysis, the protein level and NNMT enzyme activity were particularly high in KB cells. ShRNA vectors targeted against NNMT efficiently suppressed gene expression, showing inhibition observed at both the mRNA and protein levels. Down-regulation of NNMT significantly inhibited cell proliferation and decreased colony formation ability on soft agar. The present data support the hypothesis that the enzyme plays a role in tumour expansion and its inhibition could represent a possible molecular approach to the treatment of cancer.

The DREAM model's effectiveness in health promotion of AIDS patients in Africa.

This study evaluates the effectiveness of a holistic model for treating people living with AIDS in Africa; the model aims to improve knowledge about AIDS prevention and care, increase trust in the health centre, impact behaviour, and promote a high level of adherence to HAART. The study took place in the context of the DREAM (Drug Resource Enhancement against AIDS and Malnutrition) programme in Mozambique, designed by the Community of Sant'Egidio to treat HIV patients in Africa. It provides patients with free anti-retroviral drugs, laboratory tests (including viral load), home care and nutritional support. This is a prospective study involving 531 patients over a 12-month period. The patients, predominantly poor and with a low level of education, demonstrated a good level of knowledge about AIDS (more than 90% know how it is transmitted) and trust in the treatment, with a relatively small percentage turning to traditional healers. Overall the patients had a low level of engaging in risky sexual behaviour and a very good level of adherence to HAART (69.5% of the 531 subjects had a pill count higher than 95%). The positive results of the programme's educational initiatives were confirmed with the patients' good clinical results.

Disorders of visual recognition.

Agnosias are disorders of recognition, specific to one sensory channel, that affect either the perceptual analysis of the stimulus or the recognition of its meaning. In the visual modality, objects, faces, and colors can be separately disrupted. Apperceptive object agnosia refers to failure to achieve a structured description of the shape of the object. Associative agnosia refers to inability to attribute a meaning to a correctly perceived stimulus. It must be differentiated from optic aphasia, in which the object is recognized but cannot be named in the visual modality. Associative agnosia and optic aphasia are associated with left occipitotemporal damage, and they differ more quantitatively than qualitatively. The inability to recognize familiar faces (prosopagnosia) can appear in isolation and be, in some cases, associated with a lesion confined to the occipitotemporal region of the right hemisphere. These findings are supportive of the idea that faces have a separate representation in the brain. Disorders of color cognition can affect color categorization, color-name association, and color-object association. They are linked to left hemisphere damage. The ability to recognize objects presented in the visual modality is a hierarchical process in which several cortical areas, corresponding to about 30% of the cortical mantle, participate. Their selective lesion results in a gamut of disorders whose identification provides the experienced neurologist with clues to the locus of damage and contributes to the understanding of the cognitive architecture underpinning recognition. They can result either in the inability to detect any change occurring in the visual field or in the impairment of further stages of the recognition process, from the analysis of the perceptual properties of the stimulus (form, color, motion, depth, etc.) to the achievement of its structural description and, eventually, the attribution of a meaning. In this paper, I focus on the diagnostic and clinical features characterizing the disruption of the last stage of visual information processing; that is, the failure to identify what a stimulus represents despite evidence that its three-dimensional structure has been properly reconstructed. In the literature, this impairment is traditionally referred to as associative agnosia, a psychological construct that attributes the deficit to the inability to associate a well-discriminated percept with its semantic attributes, which are stored in separate cortical areas. In the visual modality, three discrete forms of associative agnosia have been described, affecting objects, faces, and colors. These are treated separately.

[Spontaneous renal hematoma. Report of 4 cases]. / Ematomi renali spontanei. Descrizione di 4 casi.

Spontaneous renal and perirenal hematomas are heavy clinical events and, even if rare, they need an early diagnosis in order to plan therapy. A spontaneous renal hematoma should be suspected in case of acute lumbar pain because in more than 60% of cases it is due to a neoplastic lesion. In the other cases it is due to vascular and infectious kidney diseases while in 5 to 15% of cases the cause of the hematoma can not be found. In this paper 4 cases of spontaneous renal hematomas quite interesting both for their rarity and the imaging features are reported. All cases have been treated by medical therapy. According to personal experience and to the literature reports, the primary imaging diagnostic methods are ultrasonography and CT, while renal angiography should be employed when a vascular disease is suspected. In fact, US can provide the diagnosis of spontaneous renal hematoma but only CT can accurately assess its extension and moreover detect the cause of the hemorrhage. In personal experience, MR did not add significative diagnostic information if compared with CT.

Tactile morphagnosia secondary to spatial deficits.

A 73-year old man showed visual and tactile agnosia following bilateral haemorrhagic stroke. Tactile agnosia was present in both hands, as shown by his impaired recognition of objects, geometrical shapes, letters and nonsense shapes. Basic somatosensory functions and the appreciation of substance qualities (hylognosis) were preserved. The patient's inability to identify the stimulus shape (morphagnosia) was associated with a striking impairment in detecting the orientation of a line or a rod in two- and three-dimensional space. This spatial deficit was thought to underlie morphagnosia, since in the tactile modality form recognition is built upon the integration of the successive changes of orientation in space made by the hand as it explores the stimulus. Indirect support for this hypothesis was provided by the location of the lesions, which could not account for the severe impairment of both hands. Only those located in the right hemisphere encroached upon the posterior parietal cortex, which is the region assumed to be specialised in shape recognition. The left hemisphere damage spared the corresponding area and could not, therefore, be held responsible for the right hand tactile agnosia. We submit that tactile agnosia can result from the disruption of two discrete mechanisms and has different features. It may arise from a parietal lesion damaging the high level processing of somatosensory information that culminates in the structured description of the object. In this case, tactile recognition is impaired in the hand contralateral to the side of the lesion. Alternatively, it may be caused by a profound derangement of spatial skills, particularly those involved in detecting the orientation in space of lines, segments and complex patterns. This deficit results in morphagnosia, which affects both hands to the same degree.

[Nursing care of psychiatric emergencies]. / L'infermieristica nelle emergenze psichiatriche.

Starting from an analysis of the different psychiatrical emergencies, and devoting the attention to the more frequent events, we analyse the guide lines the nurse must conform to, so that he can satisfy psychiatrical patient's demands, and provide him with a specific relief, in order to get better quality of his life, and at the same time offering a substantial and high quality assistance.

The nature of the disorder underlying the inability to retrieve proper names.

Two patients with the syndrome of proper name anomia were investigated. Both patients were only able to produce around 50% of the names of contemporary celebrities, but performed significantly better on a task calling for naming of historical figures. The names of relatives and friends were spared in one patient, while the other retrieved names of people known since childhood much better than those of people familiar to him since the age of 25. Geographical names, names of monuments and masterpieces were preserved. The above dissociations are taken to imply that in moderately impaired patients, a temporal gradient effect concurs to modulate the severity of the naming block. A similar impairment was found in both patients when they attempted to retrieve or relearn familiar telephone numbers. This finding suggests that the core of the disorder resides in the inability to gain access to words used to identify a single entity, regardless of whether they belong to the class of proper or common names.

Let not thy left hand know what thy right hand knoweth. The case of a patient with an infarct involving the callosal pathways.

Following a cerebral vascular accident, a patient showed a classical disconnection syndrome: left-hand tactile anomia, apraxia and dysgraphia and right-hand constructional apraxia. What made the case unusual was the presence of hand asymmetry in the performance of some matching-to-sample tasks carried out in foveal vision. The left hand committed significantly more errors than the right hand when it was not possible to identify on a perceptual basis the stimulus that was to be matched, because it was removed (memory condition) or was indicated verbally (verbo-visual matching), or had the same name but not the same physical appearance as the match (capital and lower-case letter matching). No hand difference emerged when the stimulus remained in full view throughout the matching task (perceptual condition). The hand effect, however, was limited to colours and letters. Objects, geometrical shapes and unfamiliar faces were matched with equal proficiency by both hands under every condition of presentation. Left-hand errors also significantly outnumbered right-hand errors in sorting colours according to hue and colouring drawings. MRI showed an infarct in the left cingulate white matter that ran parallel to the trunk of the corpus callosum, and an infarct of the splenium. However, the latter did not prevent the transmission of colour and letter information between the two hemispheres, as shown by the performance on perceptual equivalence tasks and by the correct right-hand responses to stimuli projected to the left visual field. We propose that this pattern of deficit is contingent upon the specific role that the left hemisphere plays in categorizing a given colour patch as belonging to a definite colour region (red, blue, etc.) and in grapheme recognition. Without the assistance of the left side the right hemisphere lacks the benefit provided by meaning identification. In our patient the left brain did receive information from the right brain and was able to process it, but was prevented by the paracallosal lesion from transmitting what it knew to the right motor area. No hand effect emerged for objects and geometrical shapes, because their semantic memory is bilaterally represented.

Prosopagnosia and alexia without object agnosia.

Following a trauma causing bilateral posterior brain damage, a patient complained of dyslexia and prosopagnosia, but not object agnosia. On testing she showed intact recognition of object drawings, even when it was assessed with perceptually demanding tasks such as Ghent's overlapping figures and Street completion test. This pattern of deficit is inconsistent with Farah's (1990) prediction that the simultaneous occurrence of alexia and prosopagnosia is invariably associated with object agnosia. The patient's reading performance had the features typically found in letter-by-letter readers. On face tests, she showed a discrepancy between the impairment exhibited in familiarity recognition and famous face naming and the correct (though slow) performance in matching the names of famous persons with their photographs. This apparent contradiction was clarified by showing that the patient had maintained the ability to generate the mental images of famous faces in response to the presentation of their names. We assume that face recognition units were intact, but partially disconnected from the output of perceptual processing.

Is memory loss without anatomical damage tantamount to a psychogenic deficit? The case of pure retrograde amnesia.

Following a car accident, a patient remained unconscious for approximately 20 min and confused for a few hours. When he could be questioned, he was found to have lost all past memories. The retrograde amnesia covered his whole life and concerned autobiographic events as well as famous facts and encyclopaedic knowledge. It also partially involved the verbal and visual lexicon. Reading, writing and counting were no longer possible. The profound impairment of retrograde memory contrasted with the preservation of anterograde memory, which permitted the patient to reacquire some of the notions he had lost, without, however, recovering the feeling of a personal experience of autobiographical information. Four years later, the retrograde deficit was unmodified, except for what had been relearnt. The search for data in support of an organic or psychological aetiology was negative. No signs of brain damage were apparent at the neurological examination and on CT, MRI and SPECT. On the other hand, there was no evidence of a psychiatric history, psychological stress or emotional precipitants that could substantiate the hypothesis that the patient derived a primary or secondary gain from amnesia. We propose that cases of focal retrograde amnesia, similar to the present one, deserve to be classified separately from organic and psychogenic forms under the label of 'functional' retrograde amnesia, a syndrome in which the threshold of activation of premorbid memories is abnormally raised by the trauma, leaving the encoding and retrieval of new memories unaffected.

Associative agnosia and optic aphasia: qualitative or quantitative difference?

We report a patient who, following the partial removal of a tentorial meningioma, suffered a hematoma in the left occipital lobe, which was resected. He showed severe anomia for visually presented stimuli, while naming was normal when they were presented in the tactile, auditory and verbal modality. His performance on visuo-perceptual tests, not requiring meaning identification, provided evidence that he was able to access the stored representations of stimuli. When recognition was assessed with non-verbal tasks, a mixed pattern of findings emerged and the patient showed features of both associative agnosia and optic aphasia. He was severely impaired in producing pantomimes in response to pictures, but only marginally impaired in sorting figures from the same superordinate category into fine-grained subcategories. He performed within the normal range on an associative task, in which the distractors bore no semantic relation to the target, but made many errors when the distractors and the target were semantically related. We propose that the interpretation advanced by Coslett and Saffran (Brain, 1989) for optic aphasia also holds for associative agnosia and argue that both syndromes reflect the impaired access of structured representations to left hemisphere semantics, but differ in terms of the degree of compensation provided by the semantic resources of the right hemisphere. Since the anatomical basis of the two syndromes may be very similar, we submit that what makes the difference is the semantic potential of the patient's right hemisphere.

Imitation and utilisation behaviour.

OBJECTIVE: To investigate the incidence, anatomical correlates, and clinical features of imitation and utilisation behaviour, which are thought by Lhermitte and coworkers to represent a reliable and frequent index of frontal lobe disease. METHODS: 78 patients with hemispheric local lesions were tested in two separate sessions, in which their reactions to a series of gestures performed by the examiner and to the presentation of a set of objects were recorded. The patients were stratified into a frontal (n = 52) and a non-frontal group (n = 26) on the basis of their CT data. RESULTS AND CONCLUSIONS: Imitation behaviour was present in 39% of the frontal patients and was mainly associated with medial and lateral lesions, at odds with the claim of Lhermitte et al that it is a constant accompaniment of lower, mediobasal lesions. In the non-frontal group it was found in three patients, all with damage to the deep nuclei region. Utilisation behaviour was a much rarer phenomenon, present in only two patients, both of whom had frontal damage. Neither imitation behaviour nor utilisation behaviour were found in patients with retrorolandic cortical lesions.

Condensable chemical vapors for sterilization of freeze dryers.

Sterilization of freeze dryers is usually performed by subjecting them to saturated steam under pressure by steam (121 degrees C, 2 bar a., 30 minutes). In order to avoid such stressful conditions, another process was designed on the basis of a strong oxidizing mixture of condensable chemical vapors, consisting of ozone and hydrogen peroxide in acidic conditions. This process works at sub-zero temperatures up to 30 degrees C and under negative pressure. 10(6), inoculum of standard biological indicators as well as wild types of bioburden were easely sterilized from 2 minutes up to 10 minutes. Other parameters were studied, in order to optimize the main process conditions: temperature, pressure, concentration of chemicals, type of micro-organisms and their environmental surroundings.

Sparing of verbs and preserved, but ineffectual reading in a patient with impaired word production.

We report a patient who, following a left fronto-temporal lesion, showed a complete sparing of the semantic store and a deficit of word production characterized by two types of dissociations. First, oral and written output was severely disrupted in naming and partially impaired in repetition, writing to dictation and oral spelling, with the exception of verbs, which were normally produced in every modality and condition of stimulation. Second, reading was normal for all type of words as well as non-words. This pattern of deficits suggests two functional lesions, one affecting the connections between the semantic store and the phonological lexicon and the other damaging the sublexical route that converts sound to sound and sound to print. It also implies that words are independently organized in the phonological lexicon, based on their grammatical class and have discrete connections with the semantic store. However, CT scan evidence does not support the hypothesis that this functional dissociation finds its anatomical correlate in the specialization of the frontal premotor cortex for verbs and the antero-medial temporal cortex for nouns. In spite of his normal reading performance, both in terms of comprehension and of accuracy and speed in word production, the patient complained that he met with great difficulty in reading newspapers and books, to the point that he had to renounce to this previously favourite activity. It was found that it took him time and effort to grasp the meaning of complex sentences and passages and it was speculated that, contrary to single words and elementary sentences, comprehension of this type of material cannot be achieved by the mere access of orthographic stimuli to semantics, but requires the retrieval of word-forms. It would appear that a patient, whose lexical route is blocked, can only read passages, by first converting print to sound via the sublexical route and then re-entering the semantic store with oral input.