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Italy is prone to major earthquakes and has experienced several devastating earthquakes in the far and recent past. The objectives of this study were to assess the level of Italian households’ preparedness for earthquakes and to measure the public’s perception of the risk and its impact on preparedness behavior.
Italian households’ preparedness for earthquakes is insufficient and is influenced by different threat perception components that were assessed.
A cross-sectional study, using an online questionnaire, was conducted in early 2018. The sample included 1,093 responders from a diverse sociodemographic background. The primary outcome was the Preparedness Index (PI), a score indicating the number of preparedness actions complied-with out of 10.
The PI’s mean was 5.26 (SD = 2.17). The recommendation most complied-with was keeping a flashlight at home (87.7%) and the least was securing the kitchen cupboards (15.1%). The PI was positively correlated with a higher sense of preparedness (r = 0.426; P <.001). The PI was higher for responders residing in high-seismic-risk areas and those who experienced a major earthquake before. The predictors of PI were: gender, age, prior experience, sense of preparedness, searching for information, and threat intrusiveness (negatively).
The findings demonstrate a medium-level of preparedness; however, this might be circumstantial. Italians perceive major earthquakes to be unlikely, yet severe if and when they do occur. A validated tool in Italian now exists and can be used in future studies.
Bodas M, Giuliani F, Ripoll-Gallardo A, Caviglia M, Dell’Aringa MF, Linty M, Della Corte F, Ragazzoni L. Threat perception and public preparedness for earthquakes in Italy. Prehosp Disaster Med. 2019;34(2):114–124
This article investigates the role, reception, and socio-cultural, political relevance of mondo movies in the context of late 1950s–early 1980s film and documentary. The mondo genre debuted with reportage films about sexuality in Europe and reached its pinnacle with Gualtiero Jacopetti’s assemblage films. The historical context in which this genre evolved, and white masculinity was rearticulated and positioned at the centre of the national imagined community, is mapped focusing both on gender and race constructions and on the gaze identifying, encoding and decoding the sensationalist presentation of postcolonial/ decolonising Otherness. A brief review of some of the author’s published work on 1962–1971 mondo movies introduces Cannibal Holocaust (1979) and director Ruggero Deodato’s controversial reflection on the white, capitalist, sexist, Western and neo-colonial anthropological gaze.
Objectives: The aim of the present study was to investigate “Proactive-Adjustment hypothesis” (PA) during the Stop Signal Task (SST). The PA is implied in the highly inconsistent literature, and it deals with the role of response inhibition (RI) in obsessive-compulsive disorder (OCD). This hypothesis assumed that participants would balance stopping and going by adjusting the response threshold (RT) in the go task. We verified whether the PA strategy was also implemented in our clinical group. Methods: To reach this goal, we analyzed SST performances in a group of 36 patients with OCD and 36 healthy controls (HCs). To identify different participants’ behaviors during the task, without preconceived notions regarding the diagnosis, we performed a cluster analysis. Furthermore, we analyzed the influence of drug therapy and we investigated whether the rule and reversal acquisition investigated with the Intra-Extra Dimensional Set Shift, differed in the two clusters. Results: We did not find any difference relative to the number of patients with OCD and HCs included in the two clusters. Furthermore, we found that only Not Proactive participants performed the task as fast as possible, while Proactive participants consistently slowed down their RTs and showed a lower number of Direction Errors, higher Stop Signal Delay, and worse cognitive flexibility. Conclusions: Our results show that among patients with OCD the use of PA is changeable and does not differ from HCs. This finding supports the idea that the RI heterogeneity concerning patients with OCD could be related to PA. (JINS, 2018, 24, 1–12)
In a budget constrained environment characterized by an increasing number of high-cost medicines, manufacturers need to demonstrate that their drugs can provide value-for-money. In this complex environment Managed Entry Agreements (MEAs) have been developed with the aim of sharing the risk between the National Health Service (NHS) and manufacturers (1). The objective of this analysis was to identify a correlation between Anatomical Therapeutic Chemical Classification (ATC) and different type of agreements assigned taking into consideration the distribution of Italian Medicines Agency registries by ATC and by kind of agreement negotiated (financial or performance based) (2).
This analysis takes into account all drugs under monitoring AIFA registries in place in Italy from 2006. For each registry included in the analysis it was collected the status of the registry (active, closed or incoming), the disease area that the registry covers and the monitored drugs with or without an associated Managed Entry Agreements. Considering the high weight of oncology drugs, a sub-analysis was done to investigate registries distribution for each specific form of cancer.
The majority of drugs monitored are under a registry with no associated risk sharing agreement according to AIFA (60 percent). For what concerned monitored drugs with an associated agreement, performance-based agreement is the most diffused type of MEA. In terms of therapeutic area involved in the monitoring registries activity, oncology was the most common area. Financial based agreements characterize principally medicines used for Leukemia and Hepatitis C, whereas drugs administrated for Melanoma, Breast and Ovarian Cancer and Ophthalmology diseases follow performance based agreements.
MEAs represent a way to guarantee a sustainable access for innovative medicines. It is proven that oncology products are most likely to have a MEA since they represent some of the most expensive drugs launched in recent years. From this study appear a correlation between the therapeutic disease area of the monitored drugs and MEA assigned by AIFA which is influenced also by other factors like budget impact, risk-benefit ratio and the presence of appropriate endpoints to evaluate the treatment response.
Payment by result agreements have been quite widely used in Italy to provide access for high costs oncologic drugs and minimize uncertainties of real life benefits (1). The aim of this analysis was to overview the Roche experience in terms of Payment by Result (Pbr) in oncology and investigate the relation between timing for the evaluation of treatment failures and observed Time to Off Treatment (TTOT) from Phase III clinical trials (2).
A retrospective analysis of the Roche payment by results schemes in place in Italy was conducted. For each drug included in the analysis it was collected: (i) the negotiated timing to assess the treatment failure for payment by result, (ii) the median time to off treatment curve observed in clinical trials for the experimental drug, (iii) the median time to off treatment observed in clinical trials for the control arm. The mean ratios between timing to assess the treatment failure for payment by result and the time to off treatment observed for the experimental drug or the median time to off treatment observed in the control arm were calculated to identify potential correlations. High level of correlation was expected if ratio was close to 1 (±.2).
Roche products or different indications of the same product were identified as candidates for the analysis from 2008 to 2016. The timing for the evaluation of treatment failures for Pbr varies between 2 and 9 months, depending on the type of tumor and line of therapy. The mean Time to Payment By Result (TTPbr) / Control arm Time To Off Treatment (cTTOT) ratio was 1.16 (±.37) while the mean Time to Payment By Result (TTPbr) / Experimental arm Time To Off Treatment (eTTOT) ratio was .71 (±.13). Data analysis according to different time periods shows that the mean TTPbr/cTTOT and TTPbr/eTTOT for drugs negotiated from 2008 to 2015 were respectively 1.07 and 1.39 whereas for drugs negotiated in 2016 were respectively and .63 and 1.
Good level of correlation between TTPbr and cTTOT was found. This finding is in line with the methodology used by Italian Medicines Agency so far, leveraging the cTTOT as the most appropriate proxy to assess any incremental effect of a new drug compared to the previous Standard of Care. The analysis over time of TTPbr shows that in the first years of payment by result negotiation TTPbr is more correlated to the cTTOT whereas in the last years is moving closer to the experimental one.
The Italian Medicines Agency Registry represents a tool that could be a precious source of information regarding the mean treatment duration of a drug in a real world context. Monitoring registries are applied at the national level after market authorization and are designed not only to apply the Managed Entry Agreements (MEAs) but also to collect Real World Data on drugs safety, effectiveness and real life utilization. The purpose of this analysis was to compare the treatment duration from clinical trials and the mean treatment duration calculated using data from monitoring registries (1).
For each drug included in the analysis it was collected the treatment duration from Time To Off Treatment curves for the experimental drug (eTTOT) from Phase III clinical trials and the mean treatment duration data calculated by using the number of cycles (converted in months of treatment) of all treated patients extracted from AIFA registries (TTAR). The mean ratios between the Time of Treatment of Italian Medicines Agency and Experimental arm time to off treatment were calculated to identify potential correlations. High level of correlation was expected if Time to Payment By Result /Time To Off Treatment ratio was close to 1 (±.2).
Six Roche products or different indications of the same product were identified as candidates for the analysis from 2013 to 2016. The mean TTAR/eTTOT ratio observed in patients treated from 2013 to 2016 was .97 (±.10), meaning that the mean treatment duration calculated from AIFA Registries is strongly comparable with the treatment duration observed in clinical trials. In one case the TTAR is even more major than eTTOT.
A high level of correlation between TTAR and eTTOT was found. Additional analyses considering different cohorts of patients over time could be useful to have a more precise estimate of real world drug utilization. Even though RCTs remain the gold standard for demonstrating clinical efficacy in restricted trial setting, Real World Evidence from AIFA registries can contribute to the evidence base needed for healthcare decisions.
The Italian 2013 election ended the period of bipolarism that characterized the so-called ‘Second Republic’, and paved the way for new parties such as the Five Star Movement. We investigate that election, which took place after the technocratic government led by Mario Monti, through the analytical lenses of the retrospective theory of economic voting applied at the provincial level. Local unemployment rates shape the electoral performances of those parties that were more supportive and sympathetic to the caretaker executive, thus confirming a distinction between incumbent and non-incumbent even in that critical and politically undecided election. We further contribute to the literature on retrospective voting by relaxing the locally untenable assumption of independence among the units. Making use of spatial regression models, we demonstrate the relevance of both the internal and contiguous economies, and their relative impact due to the different size of the provinces.
Work on thermal pools at Poggetti Vecchi in Grosseto, Italy, exposed an up to 3-meter-thick succession of seven sedimentary units. Unit 2 in the lower portion of the succession contained vertebrate bones, mostly of the straight-tusked elephant, Palaeoloxodon antiquus, commingled with stone, bone, and wooden tools. Thermal carbonates overlying Unit 2 are radiometrically dated to the latter part of the middle Pleistocene. This time span indicates that early Neanderthals produced the human artifacts from Poggetti Vecchi. The elephant bones belong to seven individuals of different ages. Sedimentary facies analysis and paleoecological evidence suggest a narrow lacustrine-palustrine embayment affected by water-level fluctuations and, at times, by hydrothermal water. Cyclic lake-level variations were predominantly forced by the rapid climatic fluctuations that occurred at Marine Isotope Stage (MIS) 6–7 transition and throughout the MIS 6. Possibly an abrupt, intense, and protracted cold episode during the onset of MIS 6 led to the sudden death of the elephants, which formed an unexpected food resource for the humans of the area. The Poggetti Vecchi site adds new information on the behavioral plasticity and food procurement strategies that early Neanderthals were able to develop in Italy during the middle to the late Pleistocene transition.
We present single-dish imaging of the well-known Supernova Remnants (SNRs) IC443 and W44 at 1.5 GHz and 7 GHz with the recently commissioned 64-m diameter Sardinia Radio Telescope (SRT). Our images were obtained through on-the-fly mapping techniques, providing antenna beam oversampling, automatic baseline subtraction and radio-frequency interference removal. It results in high-quality maps of the SNRs at 7 GHz, which are usually lacking and not easily achievable through interferometry at this frequency due to the very large SNR structures. SRT continuum maps of our targets are consistent with VLA maps carried out at lower frequencies (at 324 MHz and 1.4 GHz), providing a view of the complex filamentary morphology. New estimates of the total flux density are given within 3% and 5% error at 1.5 GHz and 7 GHz respectively, in addition to flux measurements in different regions of the SNRs.
In the framework of the Sardinia Radio Telescope (SRT) Early Science Program, we obtained single-dish high-resolution imaging of the Supernova Remnants IC443 and W44 at 7 GHz. By coupling them with SRT 1.5 GHz maps, we provided spatially-resolved spectral measurements that are highlighting a spread in spectral slope distribution. The observed features range from flat or slightly inverted spectra corresponding to bright radio limbs and filaments, to relatively steep spectra in fainter radio regions. Different theoretical possibilities explaining the above challenging findings are discussed. In particular, we exclude that the observed region-dependent wide spread in spectral slope distribution could be related to absorption processes. Our high-frequency results can be directly related to distinct electron populations in the SNRs including secondary hadronic electrons and resulting from different shocks conditions and/or undergoing different cooling processes. Integrated fluxes associated with the whole SNRs obtained by SRT in comparison with previous results in the literature support the evidence for a slight spectral steepening above 1 GHz for both sources, which could be related to primary electrons or more likely secondary hadronic electrons cut-offs.
This paper introduces deep neural network (DNN)–hidden Markov model (HMM)-based methods to tackle speech recognition in heterogeneous groups of speakers including children. We target three speaker groups consisting of children, adult males and adult females. Two different kind of approaches are introduced here: approaches based on DNN adaptation and approaches relying on vocal-tract length normalisation (VTLN). First, the recent approach that consists in adapting a general DNN to domain/language specific data is extended to target age/gender groups in the context of DNN–HMM. Then, VTLN is investigated by training a DNN–HMM system by using either mel frequency cepstral coefficients normalised with standard VTLN or mel frequency cepstral coefficients derived acoustic features combined with the posterior probabilities of the VTLN warping factors. In this later, novel, approach the posterior probabilities of the warping factors are obtained with a separate DNN and the decoding can be operated in a single pass when the VTLN approach requires two decoding passes. Finally, the different approaches presented here are combined to take advantage of their complementarity. The combination of several approaches is shown to improve the baseline phone error rate performance by thirty per cent to thirty-five per cent relative and the baseline word error rate performance by about ten per cent relative.
Gem minerals at Lava Plains, northeast Queensland, offer further insights into mantle-crustal gemformation under young basalt fields. Combined mineralogy, U-Pb age determination, oxygen isotope and petrological data on megacrysts and meta-aluminosilicate xenoliths establish a geochemical evolution in sapphire, zircon formation between 5 to 2 Ma. Sapphire megacrysts with magmatic signatures (Fe/Mg ∼100–1000, Ga/Mg 3–18) grew with ∼3 Ma micro-zircons of both mantle (δ18O 4.5–5.6%) and crustal (δ18O 9.5–10.1‰) affinities. Zircon megacrysts (3±1 Ma) show mantle and crustal characteristics, but most grew at crustal temperatures (600–800°C). Xenolith studies suggest hydrous silicate melts and fluids initiated from amphibolized mantle infiltrated into kyanite+sapphire granulitic crust (800°C, 0.7 GPa). This metasomatized the sapphire (Fe/Mg ∼50–120, Ga/Mg ∼3–11), left relict metastable sillimanite-corundum-quartz and produced minerals enriched in high field strength, large ion lithophile and rare earth elements. The gem suite suggests a syenitic parentage before its basaltic transport. Geographical trace-element typing of the sapphire megacrysts against other eastern Australian sapphires suggests a phonolitic involvement.
Background: Multiple sclerosis (MS) exhibits a spectrum of clinical findings, especially in relapsing-remitting MS (RR-MS). To assess the effects of geographic location and ethnicity on RR-MS phenotype, we investigated RR-MS patients in Canada and Saudi Arabia. Methods: A retrospective cross-sectional analysis of patients receiving active care in MS Clinics was performed in Medina, Saudi Arabia and Edmonton, Alberta. Demographic and clinical data was collected for each patient. Results: 98 patients with treated RR-MS were recruited (n=51, Medina; n=47, Edmonton); 40 patients were Caucasian (Edmonton) while 46 patients were Bedouin (Medina). Although the disease duration was longer in the Edmonton (5.7+2.3 yr) compared to the Medina group (4.4+1.4 yr) (p<0.05), the mean age of RR-MS onset, relapse rate and EDSS change were similar. The female:male ratio was comparable in Edmonton (35:12) and Medina (32:19), as was the risk of optic neuritis. The likelihood of an infratentorial lesion-associated presentation differed (Edmonton, n=23; Medina; n=13) among groups (p<0.05). Spinal cord lesions on MRI were more frequent in Edmonton (n=18) compared to Medina (n=1) patients (p<0.05). Conclusions: Despite differences in location, ethnicity, and a predominance of infratentorial lesion burden the Edmonton group, the RR-MS phenotype displayed similar disease severity and trajectory in these cohorts.
Background: A definitive diagnosis of multiple sclerosis (MS), as distinct from a clinically isolated syndrome, requires one of two conditions: a second clinical attack or particular magnetic resonance imaging (MRI) findings as defined by the McDonald criteria. MRI is also important after a diagnosis is made as a means of monitoring subclinical disease activity. While a standardized protocol for diagnostic and follow-up MRI has been developed by the Consortium of Multiple Sclerosis Centres, acceptance and implementation in Canada have been suboptimal. Methods: To improve diagnosis, monitoring, and management of a clinically isolated syndrome and MS, a Canadian expert panel created consensus recommendations about the appropriate application of the 2010 McDonald criteria in routine practice, strategies to improve adherence to the standardized Consortium of Multiple Sclerosis Centres MRI protocol, and methods for ensuring effective communication among health care practitioners, in particular referring physicians, neurologists, and radiologists. Results: This article presents eight consensus statements developed by the expert panel, along with the rationale underlying the recommendations and commentaries on how to prioritize resource use within the Canadian healthcare system. Conclusions: The expert panel calls on neurologists and radiologists in Canada to incorporate the McDonald criteria, the Consortium of Multiple Sclerosis Centres MRI protocol, and other guidance given in this consensus presentation into their practices. By improving communication and general awareness of best practices for MRI use in MS diagnosis and monitoring, we can improve patient care across Canada by providing timely diagnosis, informed management decisions, and better continuity of care.
Simulation has been effective for changing attitudes towards team-based competencies in many areas, but its role in teaching interprofessional collaboration (IPC) in radiation medicine (RM) is unknown. This study reports on feasibility and IPC outcomes of a team-based simulation event; ‘Radiation Medicine Simulation in Learning Interprofessional Collaborative Experience’ (RM SLICE).
Radiation therapy (RTT), medical physics (MP) and radiation oncology (RO) trainees in a single academic department were eligible. Scheduled closure of a modern RM clinic allowed rotation of five high-fidelity cases in three 105-minute timeslots. A pre/post-survey design evaluated learner satisfaction and interprofessional perceptions. Scales included the Readiness for Interprofessional Learning Scale (RIPLS), UWE Entry Level Interprofessional Questionnaire (UWEIQ), Trainee Test of Team Dynamics and Collaborative Behaviours Scale (CBS).
Twenty-one trainees participated; six ROs (28·57%), six MPs (28·57%) and nine RTTs (42·86%). All cases were conducted, resolved and debriefed within the allotted time. Twenty-one complete sets (100%) of evaluations were returned. Participants reported limited interaction with other professional groups before RM SLICE. Perceptions of team functioning and value of team interaction in ‘establishing or improving the care plan’ were high for all cases, averaging 8·1/10 and 8·9/10. Average CBS scores were 70·4, 71·9 and 69·5, for the three cases, scores increasing between the first and second case for 13/21 (61·9%) participants. RIPLS and UWEIQ scores reflected positive perceptions both pre- and post-event, averaging 83·5 and 85·2 (RIPLS) and 60·6 and 55·7 (UWEIQ), respectively. For all professions for both scales, the average change in score reflected improved IP perceptions, with agreement between scales for 15/20 (75·0%) participants. Overall, perception of IPC averaged 9·14/10, as did the importance of holding such an event annually.
Team-based simulation is feasible in RM and appears to facilitate interprofessional competency-building in high-acuity clinical situations, reflecting positive perceptions of IPC.
The chief concern of this article is the organization and administration of rural policing in colonial Bengal during the last 40 years of the nineteenth century. It connects its design and implementation with the consolidation of India's colonial police force, while highlighting the ongoing negotiations made by the Bengal police in a wider colonial model. The article argues that the police administration of rural Bengal was shaped initially by the ordinary constraints of the colonial state which underpinned the design of the Indian police—namely its frugality and preference for collaborating with local intermediaries, a manifestation of salutary neglect. Yet, it highlights the role of Bengal's largely British police executive in renegotiating customs of governance and, ultimately, as an established model of policing in India. The article focuses, therefore, on ongoing and at times informal police reforms which were based upon notions contradictory to an official discourse about policing in India. This article thus contextualizes the development of rural police administration in Bengal in a strong tradition of police-led reform in the province. In so doing, the article redresses a traditional historiographical focus on the political origins and coercive function of the police, and problematizes current research which situates Indian policing within customs of British governance in the subcontinent.