Program In Italy Research Articles

Shaping a Critical Study Abroad Engagement through Experiential Arts-Based Inquiry

Study abroad (SA) is often equated to cultural learning, which is problematic when culture is presented as a fixed concept free of context. To challenge cultural labeling and develop students’ critical consciousness, this study implemented an arts-based inquiry intervention within a United States (US) SA program in Italy. Using a Deweyan experiential frame it incorporated arts-based pedagogy, which refers to the artistic tools and strategies used to support and stimulate students’ reflective learning. This qualitative case study describes the process of 13 undergraduate US students’ participation in a multi-phase inquiry project as a scaffold for educators and illuminates the complexity of learning through participants’ art and reflections. Findings suggest the inclusion of arts-based inquiry can support the development of critical consciousness of “cultural hybridity” and can decenter students’ assumptions and perspectives to feature the voices of those around them. Additionally, the article highlights that the learning process is both complex and continual. It indicates that scholar practitioners must be aware of the potential for essentialization through representation, and therefore the need to continue to address cultural stereotypes while also guiding students to examine their own understandings of self and culture. The paper concludes with recommendations for continued improvement and implications for both the international field of SA and for educators in general who seek to expand critical thinking and meaning-making in the classroom.

JAK Inhibition with Ruxolitinib in Patients with COVID-19 and Severe Pneumonia: Multicenter Clinical Experience from a Compassionate Use Program in Italy.

Jak inhibitors are potent anti-inflammatory drugs that have the potential to dampen the hyperactive inflammatory response associated with severe COVID-19. We reviewed the clinical outcomes of 218 patients with COVID-19 hospitalized for severe pneumonia and treated with ruxolitinib through a compassionate use program. Data on the duration of treatment; outcomes at 4, 7, 14, and 28 days; oxygen support requirements; clinical status; and laboratory parameters were retrospectively collected. Overall, according to the physician evaluation, 66.5% of patients showed improvement at follow-up; of these, 83.5% showed improvement by day 7. Oxygen support status also showed improvement, and by day 7, 21.6% of patients were on ambient air, compared with 1.4% at baseline, which increased to 48.2% by day 28. Significant decreases in C-reactive protein and increases in the lymphocyte total count were already observed by day 4, which seemed to correlate with a positive outcome. At the end of the observation period, 87.2% of patients were alive. No unexpected safety findings were observed, and grade 3/4 adverse events were reported in 6.9% of patients.

PNS33 Recommendations for the Design and Implementation of an Early Feasibility Studies Program in Italy

Early Feasibility Studies (EFS) are limited exploratory clinical investigations taking place early in the development of devices, in small number of patients, typically before the device design has been finalized, when further non-clinical testing is not possible or meaningful. An EFS program was introduced by the US Food and Drug Administration (FDA) in 2013 to accelerate access of American patients to medical technologies and recoup a leading role in the pre-market research. The aim of this study was to explore perceptions of relevant stakeholders about the desirability and feasibility of an EFS program in Italy and of critical factors favoring or hampering its implementation.

Hospital Employees' Well-Being Six Months after the COVID-19 Outbreak: Results from a Psychological Screening Program in Italy.

The COVID-19 outbreak has taken a heavy toll on the mental well-being of healthcare workers. This study aims to describe a psychological screening program developed at a large University Hospital in Milan, Italy, and assess the psychological outcomes of employees and associated factors. A survey was electronically conducted among hospital employees between July and October 2020. Sociodemographic data, information about COVID-19 experience and three scales assessing anxiety (STAI-Y1), depression (HAM-D) and post-traumatic stress disorder (PCL-5) were collected. A total of 308 employees (80% women; mean age 45.1 years) responded: 16% physicians, 68% other healthcare professionals, and 16% administrative staff. Employees reported moderate/severe symptoms of anxiety (23%), depression (53%), and post-traumatic stress disorder (40%). At multivariate logistic regression analysis, having suffered a loss for COVID-19 in the personal context was independently associated with higher risk of moderate/severe anxiety (OR = 2.40; 95% CI 1.16–4.98), being female was associated with higher risk of moderate/severe depression (OR = 2.82; 95% CI 1.43–5.59), and having had a family member affected by COVID-19 was associated with higher risk of moderate/severe post-traumatic stress disorder (OR = 2.75; 95% CI 1.01–7.48). COVID-19 personal experience may have a profound impact on hospital workers’ mental health and should be considered in supportive interventions.

HPV Type-Specific Prevalence a Decade after the Implementation of the Vaccination Program: Results from a Pilot Study.

Human papillomavirus infection is a cause of the development of invasive cervical cancer. Three types of vaccine are currently available to prevent precancerous/cancerous lesions due to persistent infection, which is supported mainly by 7 different high-risk genotypes. The aim of this pilot study was to acquire preliminary data on type-specific prevalence 10 years after the implementation of the HPV vaccination program in Italy, in order to subsequently plan appropriate observational studies in the Italian population. First-voided urine samples were collected from 393 consenting subjects, both females and males, aged 18–40 years, and HPV DNA was detected by PCR amplification of a 450 bp L1 fragment. All amplified products were genotyped by means of the Restriction Fragment Length Polymorphism (RFLP) method. The female population was divided into three cohorts (“vaccine-eligible”, “pre-screening” and “screening” cohorts) according to the preventive intervention scheduled by age; males were included in the same three cohorts according to their year of birth. The overall prevalence of HPV infection was 19%, being higher in females than in males (22.1% vs. 13.6%, p = 0.03729). In the female population, 10 years after the start of the national immunization program, we observed a reduction in the prevalence of vaccine types and the number of circulating genotypes, especially in the “vaccine-eligible” cohort. The frequency of HPV vaccine types increased with age, particularly in males in the “pre-screening” and “screening” cohorts. Our study highlights the importance of monitoring HPV infection in both genders, to validate the effect of the HPV vaccination program.

Needlestick injuries among obstetrics and gynecology trainees: A survey study

ObjectiveTo assess characteristics, incidence, risk factors, and reporting rate of needlestick injuries (NSIs) among Obstetrics and Gynecology trainees. Study designWe performed a nationwide cross-sectional survey study. The 40-items survey Obstetrics Needlestick Injury Questionnaire (ONSI-Q) was used to investigate the prevalence of NSIs, participant attitudes, associated factors, and the NSI reporting rate among trainees in Obstetrics and Gynecology. The target responders were all trainees of Obstetrics and Gynecology training programs in Italy. The trainees were invited between September 2018 and December 2018 via a web-based platform. ResultsAmong 1049 trainees, 1041 (99.2%) completed the survey. Out of 1041 trainees, 639 (61.4%) had at least one NSI, and 90.9% (581/639) experienced at least one during obstetric surgery. The number of NSIs increased with the year of training, with 2.48 NSIs per trainee in the fifth year. 90.6% (579/639) reported details about the most recent NSI, which was during obstetric surgery in 95.3% (552/579) of cases. 57.1% (315/552) experienced the most recent NSI during cesarean section, which was mainly inflicted by someone else (72.4%; 228/315). 42.9% (237/552) of NSIs were during perineal suture, and 84% (199/237) of them were self-inflicted. 77.9% (417/535) of trainees did not report the NSI. Associated factors were non-high-risk patients, self-inflicted NSI, and the first NSI. ConclusionsNSIs are frequent among Obstetrics and Gynecology trainees but not reported, and obstetric surgery is the primary source. These data support the European efforts to improve working practices' safety. The education about protective strategies and reporting should be a priority.

Molecular survey on tick-borne pathogens and Leishmania infantum in red foxes (Vulpes vulpes) from southern Italy

Red foxes (Vulpes vulpes) have been recognised to harbour and transmit a wide range of tick-borne pathogens (TBPs) including those of zoonotic concern. To investigate the prevalence and the distribution of TBPs and of Leishmania infantum in foxes (n = 244), spleen samples were collected within the frame of a multi-regional wildlife health surveillance program in Italy. A combined PCR/sequencing approach was performed for the detection of Anaplasma spp., Babesia spp., Borrelia spp., Ehrlichia spp., Hepatozoon spp. and L. infantum DNA. Overall, 146 foxes (59.8 %, 95 % CI: 53.6–65.8) tested positive for at least one pathogen with Hepatozoon canis being the most prevalent (i.e., n = 124; 50.8 %, 95 % CI: 44.6–57.0), followed by Babesia vulpes (n = 20; 8.2 %, 95 % CI: 5.4–12.3), different spirochete species from Borrelia burgdorferi sensu lato complex (n = 9; 3.7 %, 95 % CI: 1.9–6.9), Ehrlichia canis and L. infantum (n = 7; 2.9 % each, 95 % CI: 1.4–5.8), Anaplasma platys (n = 4; 1.6 %, 95 % CI: 0.6–4.1), Anaplasma phagocytophilum ecotype I and Candidatus Neoehrlichia sp. (n = 3; 1.2 % each, 95 % CI: 0.4–3.5). All samples scored negative for Babesia canis and Borrelia miyamotoi. This study revealed the presence of spirochetes from B. burgdorferi s.l. complex, Ca. Neoehrlichia sp., A. platys and A. phagocytophilum ecotype I in red fox population from Italy, underling the necessity to monitoring these carnivores, mainly because they live in contact with dogs and humans. Data on the tick fauna circulating on wildlife species will complement information herein obtained, instrumentally to establish preventive strategies for minimizing the risk of infection for animals and humans.

COVID-19 impact on neurology training program in Italy.

The ongoing COVID-19 pandemic is having a huge impact on clinical activity of all hospitals, including the ones involved in training of residents. In addition, neurology residents underwent substantial modifications of their training program. Aim of our investigation was to evaluate the impact of COVID-19 pandemic on the educational activities of Italian neurology residents through an online questionnaire delivered to neurology residents. The results obtained showed that almost 30% of the respondents were redistributed to COVID-19 units. Neurology departments underwent substantial modifications of their organization influencing clinical educational activities; lessons and seminars were rescheduled online and research protocols were stopped and transferred to remote working, when feasible. There was a relevant use of telemedicine approach even if most of the respondents had never been trained before. Some of the changes had a North-South gradient, following the epidemiology of the pandemic. The data obtained from our survey highlight those points to address to be prepared for possible future emergencies.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10072-020-04991-5.

Targeted Audiological Surveillance Program in Campania, Italy

To identify children with postnatal hearing loss, a structured monitoring system is needed. The goal of this study was to describe a targeted surveillance program in Italy to identify children with postnatal hearing loss. Between January, 2013, and December, 2016, all children who received bilateral 'pass' result at the newborn hearing screening, and who were identified as having at least one risk factor, were referred for targeted surveillance. The hospital records of these children were retrieved. Among children enrolled, 66 were identified with permanent hearing loss. The most frequent risk factors were family history (35%), prematurity (25.5%), low birthweight (19.2%), severe hyperbilirubinemia (19%), prolonged ventilation (15%) and congenital infection (12.5%). An audiological surveillance program in newborns who 'pass' in neonatal screening, but have risk factors, is effective in identifying permanent postnatal hearing disorders.

20 anni di NpL, come sono cambiate le pratiche di lettura in famiglia in Italia

Available data regarding the implementation and main outcomes of the Nati per Leggere program in Italy over twenty years are described, based on the findings of both surveys conducted by the program and studies made by a variety of institutions. The extension of the program in all regions has strongly increased, although still with a more favourable trend in the North and Centre of the country with respect to the South, and has paralleled an increase in the proportion of children who are exposed to shared reading early in their families at least four times per week, and a dramatic decrease of those who are not exposed from 46 to 10.9%. The gap in exposure to shared reading in children from low educated mothers is also substantially smaller.

Humoral and Cellular Immune Response Elicited by mRNA Vaccination Against SARS-CoV-2 in People Living with HIV (PLWH) Receiving Antiretroviral Therapy (ART) According with Current CD4 T-Lymphocyte Count

Background: Data on SARS-CoV-2 vaccine immunogenicity in PLWH are currently limited. Aim of the study was to investigate immunogenicity according to current CD4 T-cell count and predictive role on immune response to vaccination in PLWH.Methods: PLWH attending a single-center SARS-CoV-2 vaccination program in Italy, were included in a prospective evaluation for immunogenicity after receiving BNT162b2 or mRNA-1273. PLWH were stratified according to current CD4 T-cell count (severe immunodeficiency, SID: 500/mm 3 ). RBD-binding IgG, SARS-CoV-2 neutralizing antibodies (nAbs) and cell-mediated (IFN-γ/IL-2) immune response were measured. As control group, not-matched HIV-negative healthcare workers (HCWs) were used.Findings: Participants were 166 PLWH (SID=32; MID=56; NID=78) on ART. After 1 month from the booster dose, detectable RBD-binding IgG in 86.7% of SID, in 100% of MID, in 98.7% of NID (SID vs NID, p=0.021) and nAbs (titre ≥1:10) in 70.0%, 88.2% and 93.1%, respectively (SID vs NID, p=0.002), were elicited. Compared to NID, magnitude of anti-RBD, nAbs and IFN-γ production was significantly lower in SID and comparable in MID. After adjusting for confounders, current CD4 T-cell Interpretation: Neutralizing and cell-mediated immune response against SARS-CoV-2 were elicited in most of PLWH receiving ART, albeit significantly poorer in those with current CD4 T-cell 500/mm 3 and HIV-negative controls. A marginal decreased immunogenicity than HCWs was also observed in PLWH with CD4 T-cell 200-500/mm 3 , whereas immune response elicited in PLWH with a CD4 T-cell >500/mm 3 was comparable to HIV-negative population.Funding: Italian Ministry of Health; European Commission, European Virus Archive – GLOBAL.Declaration of Interest: None to declare. Ethical Approval: The study was approved by the Scientific Committee of the Italian Drug Agency (AIFA) and by the Ethical Committee of the Lazzaro Spallanzani Institute, as National Review Board for COVID-19 pandemic in Italy (approval number 323/2021).

Manual on the creation of quality indicators for population based cancer screening programs in Italy

Abstract Issue In many countries the organized screening programs have been in the frontline in developing and implementing the evaluation of the quality of screening and of the entire process of care following a positive test. Over the years, the three Italian Screening Groups (GIS) have separately published indicators and standards concerning the programs for breast, cervical and colorectal cancers they were responsible for, thus hampering coherence, homogeneity. In addition, at local level, an increasing number of indicators have been observed with difficult to monitor all of them. Description of the Problem The Screening Indicators Manual, prepared by a multidisciplinary working group, represents the guidance agreed upon by the Italian Screening Network (ONS) and the three GIS on how to develop, implement, communicate and maintain a set of quality indicators for the evaluation of cancer screening programs. Results The Manual indicates that the three GIS must first constitute, with ONS, the common steering committee made of six-nine experts. The involvement of the public and the management of the conflicts of interests are foreseen. The conceptual framework distinguishes indicators of context, coverage and process. It is based on six dimensions: efficacy, efficiency, security, appropriateness, person centeredness, equity. There are four macro-processes: invitation; test, further assessment and diagnosis; treatment and follow-up; evaluation. The methods include: a survey of the existent indicators, their selection with the Delphi method, the evaluation of the completeness of the resulting indicators set, its integration, when needed, by means of a public call, and finally a new Delphi round. Appropriate standards, empirical or evidence based, are then identified. Last, indicators are assigned to core or library list based on priority. Lessons Select, define and measure an indicator is a way to understand what we are aiming at even more than provide the measure of how we do it. Key messages The creation of the Manual allows to build a coherent evaluation framework for the three screening programs. The Manual promotes the adoption of rigorous methods and make feasible the monitoring activity according to its purpose, level of observation and detail of information needed.

Results of Compliant Participation in Five Rounds of Fecal Immunochemical Test Screening for Colorectal Cancer

We investigated the magnitude and temporal patterns of the decreasing trend in main performance measures of fecal immunochemical test (FIT) screening for colorectal cancer (CRC) observed in second and subsequent rounds. We followed up 494,187 participants from the first round of a regional biennial FIT screening program in Italy (cut-off value for positivity, 20 μg hemoglobin/g feces) for 5 total rounds (2005-2016). At each round, only compliant participants were eligible. Performance measures from the first, third, fourth, and fifth rounds were compared with those from the second round (the first incidence round) using rate ratios from multivariate Poisson regression models and relative risk ratios from multinomial logistic regression models. Between the second and the third rounds, a significant 20% to 30% decrease was found in the proportion of men with a positive FIT result (from 5.2% to 4.3%) and in detection rates of advanced adenoma (from 13.4 to 10.2 per 1000), CRC (from 1.7 to 1.4 per 1000), and advanced neoplasia (from 15.1 to 11.6 per 1000). Positive predictive values (PPVs) decreased by 10% or less between the second and third rounds. Detection rates and PPVs for adenoma stabilized by the fourth and fifth rounds. The PPVs for advanced adenoma, CRC, and advanced neoplasia decreased slightly in men and women by the fourth and fifth rounds. The detection rate of proximal colon cancer stabilized after the second round, whereas the detection rate of distal colon cancer decreased until the fourth round in men (from 0.7 to 0.3 per 1000), and the fifth round in women. These findings support the notion that FIT screening prevents progression of a subset of advanced adenomas. Screening intensity could be modulated based on results from previous rounds, with a risk-based strategy.

Diagnosis, genetic characterization and clinical follow up of mitochondrial fatty acid oxidation disorders in the new era of expanded newborn screening: A single centre experience

IntroductionMitochondrial fatty acid oxidation disorders (FAODs) are a heterogeneous group of hereditary autosomal recessive diseases included in newborn screening (NBS) program in Italy. The aim of this study was to analyse FAODs cases, identified either clinically or by NBS,for clinical and genetic characterization and to evaluate a five years' experience of NBS, in the attempt to figure out the complexity of genotype-phenotype correlation and to confirm the clinical impact of NBS in our centre experience. Materials and methodsWe analysed FAODs patients diagnosed either by NBS or clinically, followed since February 2014 to April 2019 at the Regional Screening Centre and Inherited Metabolic Diseases Unit of Verona. Diagnosis was confirmed by plasma acylcarnitines, urinary organic acids, enzymatic and genetic testing. For not clear genotypes due to the presence of variants of uncertain significance, in silico predictive tools have been used as well as enzymatic activity assays. Patients underwent clinical, nutritional and biochemical follow up. ResultsWe diagnosed 30 patients with FAODs. 20 by NBS: 3 CUD, 6 SCADD, 5 MCADD, 4 VLCADD, 2 MADD. Overall incidence of FAODs diagnosed by NBS was 1:4316 newborns. No one reported complications during the follow up period. 10 patients were diagnosed clinically: 2 CUD, 2 CPT2D, 1 VLCADD, 5 MADD. Mean age at diagnosis was 29.3 years. Within this group, complications or symptoms were reported at diagnosis, but not during follow-up. 12 mutations not previously reported in literature were found, all predicted as pathogenic or likely pathogenic. Discussion and conclusionsOur study highlighted the great phenotypic variability and molecular heterogeneity of FAODs and confirmed the importance of a tailored follow up and treatment. Despite the short duration of follow up, early identification by NBS prevented diseases related complications and resulted in normal growth and psycho-motor development as well.

Being an obstetrics and gynaecology resident during the COVID-19: Impact of the pandemic on the residency training program

Objectiveto evaluate the impact of the COVID-19 pandemic on the obstetrics and gynecology residency training program in Italy. Study designThis was a cross-sectional survey study aimed to assess the impact of the COVID-19 pandemic on the obstetrics and gynecology residency training program in Italy. An online survey with 45 questions was sent and completed anonymously by residents after accepting an informed consent. The invitation to the online survey was sent to all the Italian residents in obstetrics and gynecology. Those on maternity leave at the time of the study were excluded. Residents were asked about their routinely activity before the COVID-19 pandemic, and to report the reduction in their clinical practice. They were also asked about psychological impact of COVID-19 on their clinical practice. Results933 Italian residents in obstetrics and gynecology, were invited for this survey study. Four-hundred and seventy-six (51 %) completed the survey and were included in the study. Three-hundred and eighty-seven (81.3 %) were female, and 89 (18.7 %) were male. Residents age ranged from 25 to 42. In 71,8 % (342/476) of the cases residents work in a COVID-19 reference Hospitals. One-hundred and eighty-four out of 76 residents (38.6 %) were tested on RT-PCR assay of nasal and pharyngeal swab specimens, and of them 12/184 (6.5 %) were positive to SARS−COV-2. Regarding the use of personal protective equipment (PPE), 267 (56.1 %) reported to receive adequate device, and 379 (79.6 %) felt to be well informed about prevention and management protocols. Three-hundred and thirty-one residents (69.5 %) reported to have managed COVID-19 positive patients. For 54,7 % of respondent residents, training activity in general decreased significantly during the COVID-19 epidemic. A one-third reduction was reported in 31,4 % of the cases, whereas a total suspension of the training in 9,9 % of the cases. In 89,3 % of cases the reduction was caused by the reorganization of work. Anxiety about the professional future was reported in 84 % of the residents, and 59 % of them had the perception that their training was irreversibly compromised. ConclusionsAmong Italian residents in obstetrics and gynecology, COVID-19 pandemic was associated with a significant training impairment.

Liquidity and Consumption: Evidence from Three Post-Earthquake Reconstruction Programs in Italy

In Italian regions hit by earthquakes, homeowners typically receive public funds to finance reconstruction. While these funds are strictly tied to reconstruction work, they are in part disbursed up front, leading to significant variation in cash on hand. We exploit this variation to study the effects of liquidity on relatively wealthy households’ consumption. We find a large and significant response in the first year that homeowners receive the cash and provide evidence that this response is driven by illiquid households with bank debt. Instead, we find no evidence that consumption responds to funds paid directly to firms, thus leaving households’ liquidity unaffected. (JEL E21, G51, H76, Q54, R31)

Digital narrative medicine for the personalization of epilepsy care pathways

Among neurological conditions, epilepsy is the disorder best suited to a narrative approach. In epilepsy, the disease, i.e., the condition from the clinical and therapeutic point of view, the illness, the personal experience and impact of the condition, and the sickness, the representations, and social imaginary of epilepsy, are strongly interdependent. Within this context, the Italian League Against Epilepsy (LICE) has launched a multiyear narrative program in Italy resulting in the foundation of a specific Study Group on Narrative Medicine in Epileptology. The Epimena Study is part of this program and involves the “Epilepsy Center, Department of Human Neurosciences, Sapienza University of Rome and Umberto 1° Hospital”. The study consists of a pilot project whose aim is to assess the usefulness and feasibility of integrating narrative medicine methodologies into routine clinical practice through a digital platform. The carrying out of the study is based on the acquisition of narrative elements of the patient that the referring doctor uses, integrating them with clinical data, to share and customize the diagnostic–therapeutic pathway of patients. The Epimena Study preliminary results look encouraging. Over 12 months, 57% of the invited patients (37 out of a total of 65) decided to formalize their registration in the digital diary, and 46% responded to one or more narrative prompt generating the story of their experience. Every patient story was then analyzed according to a methodology (Illness Digital StoryMap - IDS) that made it possible to detect the existential impact of the disease and the perception of care. Patients' overall judgment on the project was positive. Through it, they were able to better focus on themselves, bringing out and communicating information to the physician that otherwise would not have been taken into consideration. The majority of patients involved believe that the methodology should be included in the regular clinical practice or in any case would like to continue using it. The data collected confirmed that the time spent on story sharing contributed objectively to a clinical practice of greater quality and effectiveness.

Benefits for Older People Engaged in Environmental Volunteering and Socializing Activities in City Parks: Preliminary Results of a Program in Italy.

The objective of this pilot study was to investigate the feasibility of an environmental volunteering program involving park restoration and social activities for older people. Older people face a series of challenges, ranging from social isolation and depression to a lack of exercise, as well as the difficult task of creating new meaning to deal with a decrease in vitality and new social relationships, interests, and commitments. From this perspective, this pilot study aimed to contribute to highlighting if or how these aspects can be positively correlated with organized activities associated with caring for public green spaces. A single-group, pre-test/post-test design was used, and baseline and post-participation measurements were recorded. The data were collected using a questionnaire aimed at evaluating variations in physical activity, positive and negative emotions, life satisfaction, and perceived social support. Through focus group interviews with participants at the baseline and after one year of participating in the program, the participants’ motivations and experienced effects were explored. The sample was composed of a group of 19 healthy people who joined the program. The quantitative results showed that the participants’ level of physical activity, subjective life satisfaction, and positive feelings were significantly increased at the follow-up. Positive correlations were found between increasing moderate physical activities, walking, and The Positive and Negative Affect Schedule (PANAS) positive feelings. A pro-environmental attitude of the elderly emerged from the qualitative data. The results, limitations, and improvements of the study are discussed.

A lesson from Bollywood.

My Ph.D. adviser called me into his office, saying I needn't bring my notebook. Puzzled, I followed him and sat down. We'd met for 2 hours the day before to finalize our project plan for the coming months, and it wasn't clear what more we had to discuss. He started by saying, “Anurag, this conversation isn't going to be easy,” instantly sending my mind into a flurry of thoughts about what was to follow. After 15 minutes of listing positive things about my academic capabilities, he looked me in the eye and said, “You are fired from the lab.” I stared back, blinking in disbelief. “Is he joking?” I wondered. “How is this possible?” ![][1] ILLUSTRATION: ROBERT NEUBECKER > “When life gives you lemons, make lemonade.” I had moved to Israel from my native India the year before, excited to experience a new culture and pursue a Ph.D. I'd already completed a master's degree in the Netherlands, and at first things went well in my new lab: I got along with my Ph.D. adviser, and my experiments progressed as planned. Then, 3 months before I was fired, I ran into some problems. I made a few mistakes in the lab that slowed my research, but I wasn't aware that my adviser noticed them, and he never spoke to me about any concerns. That's why I was caught off guard in his office that day. I'm still not sure why he fired me, but I suspect it was because of those mistakes. He wasn't confident that I could complete my research in the time frame we'd planned. The first few days after my dismissal were especially difficult. I spent hours staring at my computer screen, unable to get anything done. One day all I could do was sit on a beach, crying as I looked out across the Mediterranean Sea and wondered what I should do. My adviser gave me 2 months to wrap up my work. I tried to change his mind with promising results, but he remained resolute. I could not break the news to my family in India, as the fear of disappointing them overwhelmed me. I soon spiraled into a state of depression and anxiety. Meanwhile, the date for me to leave the country was drawing near, as my visa required me to be enrolled as a student. I was lonely and without hope. I started to wonder whether my experience was unique. Poking around on the internet, I was relieved to discover that many Ph.D. students never finish their studies for various reasons, one of which is a broken relationship with their adviser. At least I wasn't alone. Around that time, I watched Dasvidaniya , a Bollywood movie that's about a man who is told that he has 3 months to live. He responds by reframing his perspective on life and setting out to make the most of his remaining months. Even though it is a common saying, one line from the movie stuck out to me: “When life gives you lemons, make lemonade.” What kind of “lemonade” could I make out of my current situation? My desire to complete a Ph.D. was never in doubt; it was my confidence that had taken a hit after my dismissal. After much reflection, I told myself that one failed attempt was not the end of the world, and that I needed to give it another try. I reminded myself that even if I am not the most skilled researcher in the lab, I am a good teacher and I care passionately about mentoring students. My goal is to go back to India to work as a professor, a job I think I would excel at. With renewed confidence, I emailed prospective advisers and applied to other programs. My previous adviser had not yet secured tenure; this time, I sent my applications to more senior, tenured professors. I thought they would have more experience working with international students and would be more patient as I developed my research abilities. Within 2 months of that fateful conversation in my adviser's office, I landed an offer from a Ph.D. program in Italy. I accepted it and relocated to Europe, happy that my goal of completing a Ph.D. was alive once again. I've faced other challenges during my current Ph.D. program, but my adviser has been supportive, and I've felt comfortable going to him for help and guidance. I'm thankful that I didn't give up on my dream and that I found another professor willing to take me on. So, if you find yourself in a similar situation and life gives you lemons, ask yourself: “How can I make lemonade?” [1]: /embed/graphic-1.gif

HPV-Specific Systemic Antibody Responses and Memory B Cells are Independently Maintained up to 6 Years and in a Vaccine-Specific Manner Following Immunization with Cervarix and Gardasil in Adolescent and Young Adult Women in Vaccination Programs in Italy.

Human papillomavirus (HPV) persistent infections are associated with cervical cancer and other HPV-related diseases and tumors. Thus, the characterization of long lasting immunity to currently available HPV vaccines is important. A total of 149 female subjects vaccinated with Cervarix or Gardasil participated to the study and they were stratified according to age (10–12-year-old and 16–20-year-old). Humoral immune responses (IgG and neutralizing antibody titers, antibody avidity) and circulating memory B cells were analyzed after an average of 4–6 years from the third immunization. The humoral responses against HPV-16 and HPV-18 (and HPV-6 and HPV-11 for Gardasil) were high in both age groups and vaccines up to six years from the third dose. However, Cervarix induced significantly higher and more persistent antibody responses, while the two vaccines were rather equivalent in inducing memory B cells against HPV-16 and HPV-18. Moreover, the percentage of subjects with vaccine-specific memory B cells was even superior among Gardasil vaccinees and, conversely, Cervarix vaccinated individuals with circulating antibodies, but undetectable memory B cells were found. Finally, a higher proportion of Cervarix-vaccinated subjects displayed cross-neutralizing responses against non-vaccine types HPV-31 and HPV-45. Gardasil and Cervarix may, thus, differently affect long-lasting humoral immunity from both the quantitative and qualitative point of view.