Linguistic markers of demoralization improvement in schizophrenia: A pilot study

Background and objectives Individuals with schizophrenia display language impairments involving pragmatics, semantics and syntax. Language impairments may show diagnostic specificity and could relate to the ability of engaging in psychotherapy. This pilot study sought to: (1) identify linguistic features that might differentiate individuals with schizophrenia from distressed controls without psychotic symptoms; and (2) examine the association between linguistic abilities and clinical changes during psychotherapy. Methods We recruited patients with schizophrenia and a comparison group of individuals with demoralization and distress due to cancer. Participants underwent Dignity Therapy (DT), an existentially-oriented brief psychotherapy focused on legacy and subjective dignity. Verbatim transcripts of the DT sessions were analysed using Natural Language Processing (NLP). In addition, we measured changes in levels of demoralization and dignity-related distress before and after DT, exploring the association with linguistic variables with network analysis. Results Patients with schizophrenia could be differentiated from those with cancer-related distress using only three out of 141 linguistic variables: total number of words, number of prepositional chains and conversational elements. Across groups, better levels of discourse coherence and higher number of arguments controlled by a predicate (verb “arity”) were associated with larger improvements in demoralization and, indirectly, dignity-related distress. Conclusions Reproducible linguistic markers may be able to differentiate individuals with schizophrenia from those with less severe psychopathology, and to predict better uptake of psychotherapy independent from diagnosis. Future studies should explore whether linguistic features derived from NLP may be exploited as accessible diagnostic or prognostic markers to tailor psychotherapy and other interventions in schizophrenia. (AU)

Determinants of Post-Traumatic Stress Disorders in Italian university students during the Covid-19 outbreak: the leading role of sex, health concerns, and health engagement.

Background: The unprecedented changes in daily-life caused by Covid-19 restrictions had many psycho-logical and adverse effects, not only in sufferers but also in the general population, including university students. To date, little is known about Post-Traumatic Stress Disorder symptoms experienced by university students during the peak of Covid-19 in Italy. Thus, the study describes Post-Traumatic Stress Disorders related to the Covid-19 outbreak among Italian university students and identifies the psychological distress risk and protective factors. Study design: A multicentre observational cross-sectional study. Methods: Data collection was involved in a self-reported web questionnaire, using the on-line platform Qualtrics®, in March and April 2020, involving convenience and consecutive sampling of Italians university students in different Italy regions. Results: A sample of 720 Italian university students was enrolled. Data analysis highlighted the leading role of sex, health concerns, and health engagement as negative or positive determinants of Post-Traumatic Stress Disorders in Italian university students during the Covid-19 outbreak. In particular, it is very insightful having discovered that health engagement is a protective factor of students' mental health. Conclusions: This is the first study identifying sex, health issues and health commitment as positive or negative determinants of Post-Traumatic Stress Disorders symptoms in Italian university students during the Covid-19 epidemic. Accordingly, this new achievement could be the starting point for the development of awareness campaigns for the psychological health of Italian university students.

Nanopatterning of oxide 2-dimensional electron systems using low-temperature ion milling.

We present a 'top-down' patterning technique based on ion milling performed at low-temperature, for the realization of oxide two-dimensional electron system devices with dimensions down to 160 nm. Using electrical transport and scanning Superconducting QUantum Interference Device measurements we demonstrate that the low-temperature ion milling process does not damage the 2DES properties nor creates oxygen vacancies-related conducting paths in the STO substrate. As opposed to other procedures used to realize oxide 2DES devices, the one we propose gives lateral access to the 2DES along the in-plane directions, finally opening the way to coupling with other materials, including superconductors.

Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study.

BACKGROUND: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. METHODS: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. RESULTS: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19·8 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6·6 and 2·4 per cent respectively before, but 23·7 and 5·3 per cent, during the pandemic (both P < 0·001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. CONCLUSION: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2.

ANTECEDENTES: Las estrategias quirúrgicas están siendo adaptadas en presencia de la pandemia de la COVID-19. Las recomendaciones del tratamiento de la apendicitis aguda se han basado en la opinión de expertos, pero hay muy poca evidencia disponible. Este estudio abordó este aspecto a través de una visión de los enfoques mundiales de la cirugía de la apendicitis. MÉTODOS: La Asociación de Cirujanos Italianos en Europa (ACIE) diseñó una encuesta electrónica en línea para evaluar la actitud actual de los cirujanos a nivel mundial con respecto al manejo de pacientes con apendicitis aguda durante la pandemia. Las preguntas se dividieron en información basal, organización del hospital y cribaje, equipo de protección personal, manejo y abordaje quirúrgico, así como las características de presentación del paciente antes y durante de la pandemia. Se utilizó una prueba de ji al cuadrado para las comparaciones. RESULTADOS: De 744 respuestas, se habían completado 709 (66 países) cuestionarios, los datos de los cuales se incluyeron en el estudio. La mayoría de los hospitales estaban tratando a pacientes con y sin COVID. Hubo variabilidad en las indicaciones de cribaje de la COVID-19 y en la modalidad utilizada, siendo la tomografía computarizada (CT) torácica y el análisis molecular (PCR) (18,1%) las pruebas utilizadas con más frecuencia. El tratamiento conservador de la apendicitis complicada y no complicada se utilizó en un 6,6% y un 2,4% antes de la pandemia frente a un 23,7% y un 5,3% durante la pandemia (P < 0.0001). Un tercio de los encuestados cambió la cirugía laparoscópica a cirugía abierta debido a las recomendaciones de los grupos de expertos (pero carente de evidencia científica) durante la fase inicial de la pandemia. No hubo acuerdo en cómo filtrar el humo generado por la laparoscopia. Hubo una reducción general del número de pacientes ingresados con apendicitis y un tercio consideró que los pacientes atendidos presentaban una apendicitis más grave que las comúnmente observadas. CONCLUSIÓN: La pandemia ha demostrado que ha sido posible el tratamiento conservador de la apendicitis leve. El hecho de que algunos cirujanos cambiaran a una apendicectomía abierta podría ser el reflejo de las pautas deficientes que se propusieron en la fase inicial del SARS-CoV2.

The state of the evidence about the Synergy Model for patient care.

AIM: To systematically and critically summarize the state of the evidence about the Synergy Model and its utilization in nursing practice. BACKGROUND: The Synergy Model emphasizes the importance of alignment between patient needs and nurse competencies in achieving adequate patient- and nurse-related outcomes. It is a relatively new patient-centred care model developed at the end of the 1990s. INTRODUCTION: Despite the Synergy Model's potential to support patient-centred care, its practical application is still mainly limited. Thus far, literature about the Synergy Model has not yet been synthesized, undermining its broader utilization globally. METHODS: A systematic search was performed on the following databases: PubMed, CINAHL and Scopus. The authors used the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement and checklist to guide the systematic search; 26 papers were included in this study. A critical interpretative synthesis was adopted to summarize the data extracted from the included papers. RESULTS: Five interpretative themes emerged: conceptualization, experiences from the field, nursing education, patient-related outcomes and system-related outcomes. Synergy Model shows a precise theoretical definition, and it was implemented in multiple clinical settings, mainly in critical care contexts. It seems to have a positive influence on patient-related, nurse-related and system-related outcomes. DISCUSSION: Synergy Model seems to be positively associated with specific susceptible outcomes, such as patient satisfaction, reduction of patient's complications, staff satisfaction, empowerment, and engagement of patients and healthcare providers. However, the level of evidence is still limited. CONCLUSION: Future international research should demonstrate the feasibility of implementing the Synergy Model at an international level. More empirical research is needed to demonstrate the effectiveness of the model on susceptible outcomes. IMPLICATIONS FOR NURSING AND HEALTH POLICY: This systematic review could support further development of international programmes based on the Synergy Model. The Synergy Model's implementation has the potential to optimize nursing competencies, patient- and nurse-related outcomes.

Robotic versus laparoscopic surgery for rectal cancer: a comparative cost-effectiveness study.

BACKGROUND: The differences between the costs of robotic rectal resection and of the laparoscopic approach are still not well known. The aim of this study was to evaluate the cost-effectiveness of robotic versus laparoscopic surgery. METHODS: We conducted an observational, comparative, prospective, non-randomized study on patients having laparoscopic and robotic rectal resection between February 2014 and March 2018 at the Sanchinarro University Hospital, Madrid. Outcome parameters included surgical and post-operative costs, quality adjusted life years (QALY) and incremental cost per QALY gained or the incremental cost effectiveness ratio (ICER). The primary endpoint was to compare cost effectiveness in the robotic and laparoscopic surgery groups. A willingness-to-pay of 20,000€ and 30,000€ per QALY was used as a threshold to determine the most cost-effective treatment. RESULTS: A total of 81 RRR and 104 LRR were included. The mean operative costs were higher for RRR (4307.09€ versus 3834.58€; p = 0.04), although mean overall costs were similar (7272.03€ for RRR and 6968.63€ for the LLR; p = 0.44). Mean QALYs at 1 year for the RRR group (0.8482) was higher than that associated with LRR (0.6532) (p = 0.018). At a willingness-to-pay threshold of 20,000€ and 30,000€ there was a 95.54% and 97.18% probability, respectively, that RRR was more cost-effective than LRR. CONCLUSIONS: Our data regarding the cost-effectiveness of RRR versus LRR shows a benefit for RRR.

Mental health care in oncology. Contemporary perspective on the psychosocial burden of cancer and evidence-based interventions.

With cancer incidence increasing over time worldwide, attention to the burden of psychiatric and psychosocial consequences of the disease is now mandatory for both cancer and mental health care professionals. Psychiatric disorders have been shown to affect at least 30-35% of cancer patients during all phases of the disease trajectory, and differ in nature according to stage and type of cancer. Other clinically relevant distressing psychosocial and existential conditions (e.g. demoralisation, health anxiety, loss of meaning and existential distress) not included as 'disorders' in the usual diagnostic and nosological systems (i.e. meta-diagnostic conditions) have also been shown to be present in another 15-20% of cancer patients. In this editorial, we will present a summary of the extensive literature regarding the epidemiology of the several psychosocial disorders affecting cancer patients as a cause of distress and burden to be taken into consideration and addressed in cancer care through evidence-based intervention.

Author Correction: Superconductor to resistive state switching by multiple fluctuation events in NbTiN nanostrips.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

A systematic review and Meta-analysis on the association between Hand-Foot Syndrome (HFS) and Cancer Chemotherapy Efficacy.

Hand-foot syndrome (HFS) is a common skin toxicity of traditional chemotherapies. Some studies showed that HFS has an association with progression-free survival (PFS) and the overall survival (OS). So far, there is not available any systematic literature reviews or meta-analysis aimed to assess the associations between HFS, PFS and OS. For this reason, this study aims to quantitatively summarize, critically review, and interpret the recent literature related to the associations between HFS and efficacy of chemotherapy in terms of PFS and OS. Queries shaped by PICOM framework, a systematic search of three electronic databases (PubMed, Scopus, and Science Direct) was carried out for the period between January 2010 and December 2017. Quantitative data pooling was based on the calculation of Hazard Ratio (HR) with 95% Confidence Interval (95% CI) for the OS and PFS associated to the presence of HFS, through the data of original publications. Five papers were included in this systematic review for the quantitative data pooling. Patients with HFS showed improved PFS (HR = 0.532 [0.431-0.656]; p = 0.000) and improved OS (HR = 0.522 [0.427-0.638]; p = 0.000). HFS causes a reduction of compliance with oncology treatments. Healthcare providers should use this result as a trigger to foster patients' coping and the one of their family caregivers, enhancing their adherence to cancer treatments.

Superconductor to resistive state switching by multiple fluctuation events in NbTiN nanostrips.

We report on measurements of the switching current distributions on two-dimensional superconducting NbTiN strips that are 5 nm thick and 80 nm wide. We observe that the width of the switching current distributions has a non-monotonous temperature dependence, where it is constant at the lowest temperatures up to about 1.5 K, after which it increases with temperature until 2.2 K. Above 2.5 K any increase in temperature decreases the distribution width which at 4.0 K is smaller than half the width observed at 0.3 K. By using a careful analysis of the higher order moments of the switching distribution, we show that this temperature dependence is caused by switching due to multiple fluctuations. We also find that the onset of switching by multiple events causes the current dependence of the switching rate to develop a characteristic deviation from a pure exponential increase, that becomes more pronounced at higher temperatures, due to the inclusion of higher order terms.

A specific gene-microbe interaction drives the development of Crohn's disease-like colitis in mice.

Bacterial dysbiosis is associated with Crohn's disease (CD), a chronic intestinal inflammatory disorder thought to result from an abnormal immune response against intestinal bacteria in genetically susceptible individuals. However, it is unclear whether dysbiosis is a cause or consequence of intestinal inflammation and whether overall dysbiosis or specific bacteria trigger the disease. Here, we show that the combined deficiency of NOD2 and phagocyte NADPH oxidase, two CD susceptibility genes, triggers early-onset spontaneous TH1-type intestinal inflammation in mice with the pathological hallmarks of CD. Disease was induced by Mucispirillum schaedleri, a Gram-negative mucus-dwelling anaerobe. NOD2 and CYBB deficiencies led to marked accumulation of Mucispirillum, which was associated with impaired neutrophil recruitment and killing of the bacterium by luminal neutrophils. Maternal immunoglobulins against Mucispirillum protected mutant mice from disease during breastfeeding. Our results indicate that a specific intestinal microbe triggers CD-like disease in the presence of impaired clearance of the bacterium by innate immunity.

Tuning of Magnetic Activity in Spin-Filter Josephson Junctions Towards Spin-Triplet Transport.

The study of superconductor-ferromagnet interfaces has generated great interest in the last decades, leading to the observation of spin-aligned triplet supercurrents and 0-π transitions in Josephson junctions where two superconductors are separated by an itinerant ferromagnet. Recently, spin-filter Josephson junctions with ferromagnetic barriers have shown unique transport properties, when compared to standard metallic ferromagnetic junctions, due to the intrinsically nondissipative nature of the tunneling process. Here we present the first extensive characterization of spin polarized Josephson junctions down to 0.3 K, and the first evidence of an incomplete 0-π transition in highly spin polarized tunnel ferromagnetic junctions. Experimental data are consistent with a progressive enhancement of the magnetic activity with the increase of the barrier thickness, as neatly captured by the simplest theoretical approach including a nonuniform exchange field. For very long junctions, unconventional magnetic activity of the barrier points to the presence of spin-triplet correlations.

Shaping nursing profession regulation through history - a systematic review.

AIM: The aim of this systematic review was to provide a critical synthesis of the factors that historically shaped the advancements of nursing regulators worldwide. BACKGROUND: An in-depth examination of the different factors that moulded regulatory changes over time is pivotal to comprehend current issues in nursing. INTRODUCTION: In the light of global health scenarios, the researchers explored the factors that historically influenced the socio-contextual circumstances upon which governments made regulatory changes. METHODS: A systematic search was performed on the following databases: PubMed, CINAHL, Scopus, OpenGrey and ScienceDirect. The review included papers from January 2000 to October 2016 published in English. The authors used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and an inductive thematic approach for synthesis. RESULTS: Two main themes were identified: factors underpinning current challenges and historical and contextual triggers of regulation. The first theme was composed of three aspects: education, migration and internationalization, and policy and regulation; the second theme consisted of four attributes: demographics, economics, history of registration and wars, and historical changes in nursing practice. DISCUSSION: Factors that shaped nursing regulation were linked to changing demographics and economics, education, history of nursing registration, shifting patterns of migration and internationalization, nursing practice, policy and regulation and significant societal turns often prompted by wars. CONCLUSION: A deeper understanding of the developments of the nursing regulatory institutions provides the foundation for portable standards that can be applied across an array of jurisdictions to guarantee a better public safety. IMPLICATION FOR NURSING AND HEALTH POLICY: Understanding factors that socially, legislatively and politically have influenced the development of regulatory bodies over time helps to mould local, national and international policies that have a stronger impact on health worldwide. To achieve this, there must be effective cooperation among systems of nursing regulations globally.

The use of antidepressants in oncology: a review and practical tips for oncologists.

Background: The use of psychotropic drugs, namely those with an antidepressant profile (ADs), is a mandatory part of an integrated treatment of psychiatric disorders among cancer patients. We aimed to synthetize the most relevant data emerging from published studies to provide tips about the use of ADs in oncology. Design: A search was made of the major databases over the last 30 years (Embase/Medline, PsycLIT, PsycINFO, the Cochrane Library), including narrative reviews, systematic reviews and meta-analyses summarizing the results from observational studies and randomized clinical trials assessing effectiveness, safety profile, interactions, contraindications and use of ADs in oncology with regard to both psychiatric (depressive spectrum, stress-related, anxiety disorders) and cancer-related symptoms (e.g. pain, hot flashes and fatigue). Results: The weight of evidence supports the efficacy of ADs for more severe major depression in individuals with cancer and as an adjuvant treatment in cancer-related symptoms, although the methodological limitations of reported randomized controlled trials do not permit definite conclusions. Data also indicate that there should be caution in the use of ADs in cancer patients in terms of their safety profile and potential clinically significant interactions with other prescribed medications. Practical recommendations that have been made for the use of ADs in cancer patients, in the context of a multimodal approach to depression treatment, have been summarized here. Conclusions: ADs are a relatively safe and effective treatment for more severe major depression in cancer patients. However, more research is urgently needed regarding the efficacy of ADs in different cancer types and cancer settings, their interactions with anticancer agents and their additive benefit when integrated with psychosocial interventions.

First case of complete full robotic surgical resection of leiomyosarcoma of the right renal vein.

BACKGROUND: Leiomyosarcomas present high postoperative morbidity and poor prognosis [1]. In the literature, only few cases of localized small leiomyosarcoma have been described [2, 3]. These cases might benefit from a minimally invasive approach. Robotic surgery has been claimed to have several advantages over laparoscopy such as enhanced vision and instruments movements which might make more feasible the execution of this type of surgery where partial renal resection is required. METHODS: A 53-year-old female with a medical history of myeloid leukemia and with chronic renal failure (creatinine: 2.6) was referred to our hospital for an incidental finding of right perirenal tumor of almost 3 cm compatible with leiomyosarcoma arising from the right renal vein. RESULTS: The operation was performed using a Da Vinci Robotic Surgical System model Si (Intuitive Surgical, Sunnyvale, CA, USA).Robotic ports were placed in a standard configuration for minimally invasive right nephrectomy. The dissection started with the partial mobilization of the right liver and Kocher maneuver. After the identification of the inferior vena cava the tumor was finally localized and dissected. Resection ended with a partial right vein resection and suture. Pathological final exam confirmed the diagnosis with margins free from tumor. CONCLUSIONS: In selected cases, robotic resection of leiomyosarcoma might be a safe and feasible procedure in experienced hands.

Robotic versus laparoscopic surgery for rectal cancer: a comparative study of clinical outcomes and costs.

PURPOSE: The costs involved in performing robotic surgery present a critical issue which has not been well addressed yet. The aims of this study are to compare the clinical outcomes and cost differences of robotic versus laparoscopic surgery in the treatment of rectal cancer and to conduct a literature review of the cost analysis. METHODS: This is an observational, comparative study whereby data were abstracted from a retrospective database of patients who underwent laparoscopic and robotic rectal resection from October 2010 to March 2017, at Sanchinarro University Hospital, Madrid. An independent company performed the financial analysis, and fixed costs were excluded. RESULTS: A total of 86 robotic and 112 laparoscopic rectal resections were included. The mean operative time was significantly lower in the laparoscopic approach (336 versus 283 min; p = 0.001). The main pre-operative data, overall morbidity, hospital stay and oncological outcomes were similar in both groups, except for the readmission rate (robotic: 5.8%, laparoscopic: 11.6%; p = 0.001). The mean operative costs were higher for robotic surgery (4285.16 versus 3506.11€; p = 0.04); however, the mean overall costs were similar (7279.31€ for robotic and 6879.8€ for the laparoscopic approach; p = 0.44). We found four studies reporting costs, three comparing robotic versus laparoscopy costs, with all of them reporting a higher overall cost for the robotic rectal resection. CONCLUSION: Robotic rectal resection has similar clinical outcomes to that of the conventional laparoscopic approach. Despite the higher operative costs of robotic rectal resection, overall mean costs were similar in our series.

Nursing students' clinical competencies: a survey on clinical education objectives.

BACKGROUND: Developing clearly defined competencies and identifying strategies for their measurement remain unfortunately a critical aspect of nursing training. In the current international context, which continues to be characterised by deep economic crisis, universities have a fundamental role to play in redefining the educational goals to respond to the expectations of certain geographical areas of interest, as underscored in the Bologna Process (Joint Declaration of the European Ministers of Education Convened in Bologna 19 June 1999). DESIGN AND AIM OF STUDY: The aim of this observational study was to examine the clinical learning context of nursing students using a tool developed by a team of teachers for the analysis of clinical learning. METHODS: Redefinition of the clinical learning objectives with reference to the competencies set out in the questionnaire validated by Venturini et al. (2012) and the subsequent use of the tool created by the team of teachers for students in the first, second and third-year courses of the 2013/14 academic year, covering all the internships called for in those years. RESULTS: All nursing students enrolled in the first, second and third year of the nursing undergraduate degree program at the University of Pavia (no. 471) participated in this survey. A total of 1,758 clinical internships were carried out: 461 for the first year, 471 for the second year and 826 for the third year. Setting objectives, beginning with the educational offerings in the several clinical contexts, represents a strong point for this process. The results highlight a level of heterogeneity and complexity intrinsic to the University of Pavia educational system, characterized by clinical settings with different clinical levels (Research hospital and other traditional hospitals) that offering different levels of training. CONCLUSIONS: The use of the self-evaluation form for clinical learning made it possible to perform real-time observations of the training activities of the entire student body. An educational model structured in this way allows the student to develop their capacity for critical thinking. For educational activities, such a self-evaluation form represents an ideal instrument for identifying areas in need of improvement. This explorative study, carried out by means of a self-evaluation form, is the first-step toward the development of an educational programme that is more uniform and easily traceable within the academic system.