Sapienza University Research Articles

P-498 Psychological care during ART treatments In Italy: the patients’ point of view

Abstract Study question What are the characteristics of the psychological care and the emotional needs of couples undergoing ART treatment in Italy? Summary answer The presence of psychological support services in ART centers is poorly communicated to patients, with less than half being advised to take a pathway. What is known already Couples who decide to undergo ART treatment show significantly higher depression and shame scores, lower acceptance and self-compassion scores, greater reliance and avoidant coping strategies. Couples experience the procedure as source of stress, anxiety and pain, fluctuating between hope and despair, and all of this seem to negatively impact on treatment continuation and outcomes. A review of 25 studies using different psychological interventions (counseling, focused educational interventions and integrated educational programs) found positive effects on anxiety (61.5%), depression (38.4%) and infertility-related stress (100%) reduction. Several studies showed the effectiveness of psychological intervention in promoting pregnancy rates. Study design, size, duration The ART Italian National Register (National Health Institute) with the Department of Dynamic and Clinical Psychology and Health Studies (Sapienza University) proposed a national survey to 195 Italian ART centres and patient associations. Patient associations and the Medical Director of each centre were invited by e-mail to participate and to encourage all patients to fill a questionnaire made available on an on-line platform. Data collection was between March to October 2021. Participants/materials, setting, methods 324 ART patients completed an online questionnaire consisting of 19 closed-ended and 8 open-ended questions. In this abstract we focus on the closed-ended questions. The questionnaire was created ad hoc for the survey starting from a previous study on the characteristics of the services offered in Italian ART centres. Main results and the role of chance In 90% of cases women responded to the questionnaire, only 10% of responses were from men. On average, participants are 38 years old, married (60%), and have a bachelor's degree or post-graduate degree (59%). In half of the cases respondents are employed. In 68% of cases, participants performed ART treatment in centers with public service. Most of the respondents are facing their first or second ART cycle. They share their infertility condition with family and friends, and in 60% of cases they have been informed of the presence of the psychological service, mainly from gynecologists and through informed consent. Only in 31% of cases patients were invited to undertake psychological counseling, strongly recommended to only 8% of them. In fact, 65% of respondents never had a meeting with the psychologist during ART treatment. Those who resorted to counseling had mainly couple (45%) and individual (31.3%) meetings. Participants did not know the cost of counseling, would prefer it to be included in the cost of ART treatment, and would like it to be available throughout treatment The main emotions felt during ART treatment are sadness, fear and anger, those attributed to the partner are the same but joy also appears. Limitations, reasons for caution Firstly the limited sample size, mainly related to the ability of ART center staff to spread the initiative among patients. The low response from male partners, that could be related to their rare presence in ART centers, as the medical treatment is mainly targeted to women. Wider implications of the findings In conclusion, the results show that psychological services in Italian ART centers are not yet fully operational and integrated in the ART procedure. All this highlights the importance of further investigations with the aim of sharing information to establish common protocols for psychological interventions in ART centres. Trial registration number Not applicable

Relapses of idiopathic inflammatory myopathies after vaccination against COVID-19: a real-life multicenter Italian study

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccination plays a crucial role as pivotal strategy to curb the coronavirus disease-19 (COVID-19) pandemic. The present study described the clinical status of patients affected by idiopathic inflammatory myopathies (IIM) after COVID-19 vaccination to assess the number of relapses. We included all patients affected by IIM and followed by Myositis Clinic, Rheumatology and Respiratory Diseases Units, Siena University Hospital, Bari University Hospital, Policlinico Umberto I, Sapienza University, Rome, and Policlinico Paolo Giaccone, Palermo. They underwent a telephone survey. A total of 119 IIM patients (median, IQR 58 (47–66) years; 32males; 50 dermatomyositis, 39 polymyositis and 30 anti-synthetase syndrome) were consecutively enrolled. Except four patients who refused the vaccination, 94 (81.7%) received Comirnaty, 16 (13.9%) Spikevax, 5 (4.4%) Vaxzevria. Seven (6.1%) patients had flare after vaccination. One of them had life-threatening systemic involvement and died two months after second dose of COVID-19 vaccination. From logistic regression analysis, Chi2-log ratio = 0.045,the variable that most influences the development of flare was the number of organs involved (p = 0.047). Sixty-eight patients received the third dose of COVID-19 vaccination: 51(75%) Comirnaty and 17 (25%) Moderna. No patients had flares after third dose. Our study represents the largest cohort of IIM patients in which the incidence of recurrence after anti-SARS-CoV-2 vaccine was assessed. In line with real-life data from other diseases, we found a clinical non-statistically significant risk of relapse in our patients, which occurred seldom, usually mild and in patients with a more severe and aggressive course of disease.

When in Rome, Not All International Students Do as the Romans Do. A Survey-based Typification of International Students’ Experiences and Profiles at Sapienza University of Rome

Universities often consider international students as a homogeneous group, that is of value for internationalisation purposes. Yet, migratory paths, cultural encounters, motivations and expectations make the experience of these students much varied and highly differentiated. Acknowledging this diversity allows to go beyond aggregate statistics and to assess specific needs and constraints. The present study focuses on the Italian context, introducing a quali-quantitative survey developed to investigate the variety of experiences and profiles of international students enrolled at Sapienza University of Rome. An analysis of multiple correspondence was applied to the survey’s responses. Results were triangulated with qualitative data collected in previous steps of the research, confirming the reliability of the survey and its capacity to discriminate different profiles. Three groups were identified (the «transnational migrants», the «international students», and the «invisible» ones), revealing a series of specificities, and a particular group as most vulnerable. Results are discussed highlighting the need to implement inclusive policies.

Effects of COVID-19 lockdown on weight in a cohort of allergic children and adolescents

BackgroundCOVID-19 lockdown caused sudden changes in people’s lifestyle, as a consequence of the forced lockdown imposed by governments all over the world. We aimed to evaluate the impact of lockdown on body mass index (BMI) in a cohort of allergic children and adolescents.MethodsFrom the first of June until the end of October 2020, we submitted a written questionnaire to all the patients who, after lockdown, carried out a visit at the Pediatric Allergy Unit of the Department of Mother-Child, Urological Science, Sapienza University of Rome. The questionnaire was composed by 10 questions, referring to the changes in their daily activities. Data were extrapolated from the questionnaire and then analyzed considering six variables: BMI before and BMI after lockdown, sugar intake, sport, screens, sleep, and anxiety.ResultsOne hundred fifty-three patients agreed to answer our questionnaire. Results showed a statistically significant increase in the BMI after lockdown (20.97 kg/m2 ± 2.63) with respect to the BMI before lockdown (19.18 kg/m2 ± 2.70). A multivariate regression analysis showed that the two variables that mostly influenced the increase in BMI were sleep and anxiety.ConclusionsFor the analyzed cohort of allergic children and adolescents we obtained significant gain in BMI as consequences of lockdown, which can be explained by many factors: high consumption of consolatory food, less sport activities, more time spent in front of screens, sleep alteration associated with increased anxiety. All these factors acted together, although sleep alteration and increased anxiety were the most influential factors that led to the worsening or the onset of weight gain, creating the basis for future health problems.

Conservation risks for paper collections induced by the microclimate in the repository of the Alessandrina Library in Rome (Italy)

The Alessandrina Library was founded in 1667 by pope Alexander VII Chigi and is nowadays housed in the Campus of Sapienza University of Rome (Italy). Within its Ancient (mostly made of rag paper) and Modern (mostly made of contemporary paper) collections, it includes more than one million books produced from the XVI to the XXI century. In 2019, six thermo-hygrometers were deployed in its multi-storey repository to monitor temperature (T) and relative humidity (RH). Hourly T and RH data collected over 2 years allowed us to evaluate spatial and temporal thermo-hygrometric distributions and to carry out a comprehensive assessment of the climate-induced risks (mechanical, chemical, and biological deterioration mechanisms). Vertical temperature gradients associated with unstable conditions occurred in winter, resulting in upraising air flows up to the ceiling. The risky short-term RH fluctuations (EN 15757:2010) were determined to avoid mechanical stress in case of loans, relocation, and consultation. The Time Weighted Expected Lifetime (TWEL) index was used to evaluate the chemical risk for different paper-based collections as a function of their acidity and degree of polymerisation, also considering the typical response time of paper books to T and RH changes. The TWEL calculation estimated that the durability of acidic paper was around 300 years and highlighted that rag paper could be subject to cellulose hydrolysis only in summer and autumn, while contemporary paper was mostly at no risk. The risk of mould germination (Sedlbauer diagram) was possible on few days in Autumn, while the production of insect eggs (Brimblecombe empirical function) was favoured during approximately 42% of time over the year. In addition, illuminance and colorimetric measurements (performed on selected book covers) showed that light-sensitive objects could be exposed to the photodeterioration risk in the east-facing side of the repository. Although the investigation focussed on a specific case study, a similar approach could be effectively adapted to most library and archival repositories conserving paper-based collections.

Comprehensive global collaboration in the care of 1182 pediatric oncology patients over 12 years: The Iraqi-Italian experience.

Iraq's health care system has gradually declined after several decades of wars, terrorism, and UN economic sanctions. The Oncology Unit at Children's Welfare Teaching Hospital (CWTH) in Baghdad was lacking basic facilities and support. To address this shortcoming, a humanitarian and educational partnership was established between CWTH and Sapienza University of Rome (SUR). We investigated the outcomes of 80 online and 16 onsite educational sessions and 142 teleconsultation sessions from 2006 to 2014. We also determined the outcomes of pathology reviews by SUR of 1216 tissue specimens submitted by CWTH from 2007 until 2019 for second opinions. The primary outcomes were discordance, concordance, and changes among clinical diagnoses and pathology review findings. The measures included the frequency of teleconsultation and tele-education sessions, the topics discussed in these sessions, and the number of pathology samples requiring second opinions. A total of 500 cases were discussed via teleconsultations during the study period. The median patient age was 7 years (range, 24 days to 16·4 years), and the cases comprised 79 benign tumors, 299 leukemias, 120 lymphomas, and 97 solid tumors. The teleconsultation sessions yielded 27 diagnostic changes, 123 confirmed diagnoses, and 13 equivocal impacts. The pathology reviews by SUR were concordant for 996 (81·9%) cases, discordant for 186 (15·3%), and inconclusive for 34 (2·8%). The major cause of discordance was inadequate immunohistochemical staining. The percentage of discordance markedly decreased over time (from 40% to 10%). The cause of the improvement is multifactorial: training of two CWTH pathologists at SUR, better immunohistochemical staining, and the ongoing clinical and pathologic telemedicine activities. The partnership yielded 12 publications, six posters, and three oral presentations by CWTH investigators. The exchange of knowledge and expertise across continental boundaries meaningfully improved the diagnoses and management of pediatric cancer at CWTH.

Photodynamic Therapy with 5-Aminolevulinic Acid Patch for the Treatment of Actinic Keratosis.

Photodynamic therapy (PDT) using 5-aminolevulinic acid (5-ALA) is an emerging treatment option in the care of actinic keratosis (AK). A self-adhesive 5-ALA patch was recently developed that allows a precise PDT procedure. Here, we review the current literature and report the findings of our case series that observed the outcomes and safety of 5-ALA patch PDT. Ten patients with a total of 40 AKs were treated with a single session of conventional or daylight PDT using 5-ALA patch at the Department of Dermatology and Venereology, Sapienza University of Rome or at the European Institute of Oncology, Milan, Italy. Complete response was observed in three patients, while partial response was seen in seven patients. Overall tolerability was good or excellent, with local adverse events observed in four patients. This is the first case series reported where the 5-ALA patch was applied using daylight PDT, and its efficacy and tolerability in the treatment of AK were demonstrated. In conclusion, the self-adhesive 5-ALA patch is a convenient application of PDT that provides a well-tolerated and effective treatment option with satisfactory cosmetic outcomes.

A Stranger in Rome: Musine Kokalari and Her Memoir La mia vita universitaria in Twentieth-Century Albanian Literature

ABSTRACT This article focuses on the memoir of Musine Kokalari, the first woman writer in Albanian literature. Her memoir La mia vita universitaria (My University Life) was written in Italian during her stay in Rome as a student at Sapienza University. It was published only in 2009 (Tirana) and in 2016 (Rome) as a result of the author being harshly persecuted by the communist regime and her work being banned in Albania for almost half a century. Kokalari’s memoir is analyzed through a cultural and biographical approach as well as text analysis. Being a stranger and remaining one while living in Italy is a fundamental aspect of Kokalari’s memoir as she narrates her journey toward the expression of the self as an Albanian woman writer in fascist Rome.

Preparedness and satisfaction of European medical students: development and validation of the EUSPSQ.

In Europe, during an era of globalization in which traveling and studying abroad is becoming easier and more affordable, an open question remains on whether different European medical schools educate students with a dissimilar level of preparedness and/or satisfaction. To develop and validate the EUropean Students' Preparedness and Satisfaction Questionnaire (EUSPSQ), a standardized European tool to assess preparedness and satisfaction in medical education. 30 participants belonging to the 5th and 6th year of two different European medical schools (Sapienza University of Rome and Universidad Complutense de Madrid) participated in the validation of the study. A standard validation protocol that included item development, test-retesting, and a series of statistical validation analyses, was used. Feasibility, test-retest reliability, inter-item reliability were assessed quantitatively. Face validity was evaluated qualitatively by an expert professor in the field. Test-retest and inter-item reliability were considered satisfactory for all the parts of the questionnaire. Part III and IV presented lower Cohen's kappa values, probably as a consequence of their inherent subjectivity. When one item in Part III was removed, the Cronbach's alpha values of both initial and 48h answers consider-ably increased (-0.355 to 0.713 and -0.202 to 0.808 respectively). We therefore decided to eliminate the question from the EUSPSQ. Internal and external validity were considered appropriate. The questionnaire was also feasible and viable to complete. Preliminary findings indicate that the EUSPSQ can be a valid, viable and reliable questionnaire to measure preparedness and satisfaction of 5th and 6th year medical students across different European Universities.

Student firing tests and launches with commercial and self-made solid rocket motors

This paper presents work performed by students at Sapienza University of Rome regarding on-ground testing of solid rocket motors and launch of single-stage rocket models. The activities are part of a multidisciplinary project, in collaboration with the Italian Space Agency, aimed at the design, test, build, and launch of model rockets to be used as technological demonstrators and for educational purposes. Student activities included: (i) building of electronic components; (ii) designing and building of an experimental test bench; (iii) manufacturing of rocket parts and fuels; (iv) static firing tests of commercial and self-made solid rocket motors; (v) rocket launches. Self-made solid propellants were obtained as a mixture between potassium nitrate and sorbitol, yielding chamber pressures up to 20 bar and thrust up to 20 N, while commercial motors with thrust up to 90 N were tested. Additive manufacturing was employed for building specific rocket parts such as the nosecone, fins, and videocamera housing. The payload consisted in self-programmed board computers which recorded telemetry during flight. A total of four rocket launches up to 540 m have been performed.

Face-to-face vs distance learning in human anatomy education: a longitudinal study of students’ perspective and learning outcomes during COVID-19 pandemic

On March 9, 2020 attendance classes in Italian universities were suspended due to Covid-19 Pandemic. Thanks to the fast actions put in place by Sapienza University Governance and to the efforts made by all components of the university, the face-to-face courses were turned into on-line courses in only one week. This sudden change has been an even more exciting challenge for the Faculties of Medicine, whose members were also involved in the frontline battle against the virus. Anatomy academics, recognizing the challenges as opportunities to innovate anatomy teaching, set up at the same time: a specific survey to investigate students’ perspective on educational preferences and their mood; a longitudinal quantitative study to compare, for the first time in the same student’s population, exam grades after face-to-face classes and after online classes. The students, although with different motivations, considered valid both modes of attendance. Exam grades statistical analysis showed that anatomy exam marks after the online course had a higher average value (statistically significant) and with an excellent correlation factor, compared to the marks obtained at the end of the face-to-face course. Considering our data as a whole, we can suggest that face-to-face classes and online classes, rather than being interchangeable education modes, should be considered as modes with different characteristics that offer different educational benefits. These advantages may have different relevance for individual students, depending on their specific needs and individual preferences. This suggests the opportunity to propose customizable courses, centered on the student’s needs.

Persistence of Juvenile Idiopathic Arthritis-Associated Uveitis in Adulthood: A Retrospective Study.

Background: Juvenile idiopathic arthritis (JIA) is a rheumatic condition of childhood that is frequently associated with anterior chronic uveitis. Evidence suggests that uveitis may persist up to adulthood in some cases, possibly causing severe visual impairment. Methods: We conducted a retrospective study on a series of patients aged 16 years or older with JIA-related active uveitis who were referred to the Uveitis Service of Sapienza University of Rome from 1990 to 2019 to evaluate the characteristics of ocular disease in patients with JIA-associated uveitis (JIA-U) who still exhibit uveitis in adulthood. Data on clinical features, treatment, complications and visual outcomes were collected. Results: Twenty adults (85% female; median age 23.4 ± 6.6 years, range 16–38 years) with ongoing uveitis (35 eyes) were identified. The median age at JIA onset was 6.15 ± 2.9 years (range 2–10), and uveitis onset was 8.7 ± 4.7 years (range 3–20). The patients were observed in a median follow-up of 16 ± 7.7 years (range 4–35). Fifty-seven percent of affected eyes (20 eyes) had good visual acuity (>0.4 logMAR), while eleven percent of affected eyes (4 eyes) were blind (≤20/200). Uveitis required topical steroids and mydriatic/cycloplegic in all cases. Orbital steroid injection was performed in 13 eyes. Systemic corticosteroids and biologic drugs were used in 14 patients. Conclusions: Although the visual prognosis of JIA-U has improved in recent years, persistent uveitis up to adulthood is still observed. Therefore, protracted follow-up of JIA-U patients is warranted because of the high burden of delayed visual complications.

DGPR e digital safety. Un’indagine nazionale sulla consapevolezza digitale degli adolescenti

In recent years, the daily consumption of digital devices has filled international sociological scientific debate and reflection on the issue of data and the ethical, social and cultural implications of using such platforms. The issue of digital security has also become central to the public debate, in two significant moments: in 2018, on the occasion of the entry into force of the G.D.R. 2016/679 (General Data Protection Regulation) and in March 2020 on the occasion of the lockdown generated by the Covid-19 which, in fact, forced the whole world to re-organize its production and communication structure, intensifying the digitalization of communication processes and the use of devices in everyday life. In the first case, Article 8 offered the possibility to EU member states to lower the age threshold to thirteen to authorize the processing of personal data online, raising questions on the issue of the ‘digital awareness’ of minors. This is the background to this proposal, which aims to illustrate the results of a national survey on digital safety conducted by the Sapienza University of Rome. The research focuses on the degree of media awareness of adolescents, taking into account the conditioning of digital and social, school and family capital.

Optimization of e-Mobility Service for Disabled People Using a Multistep Integrated Methodology

The penetration of e-mobility is growing thanks to the European guidelines on climate preservation regarding the reduction in CO2 emission. Governments are adapting their economic policies with the aim to incentivize e-mobility. At the same time, with a view to equality and accessibility, countries are working to introduce e-mobility services also for people with disabilities in order to improve the quality of their lives. The paper reports the deployment of an e-mobility service for persons with disabilities carried out in a project financed by Sapienza University of Rome. The project includes a feasibility study and a cost–benefit analysis in order to identify the optimal solution from a technical and environmental point of view for a sustainable e-mobility service for people with reduced mobility. A methodology to design a service based on optimal routes and electric vehicles with respect to energy consumption, time travel, energy and vehicle costs and quality of service is proposed. The 5-step methodology calculates the most energy-efficient routes and defines the optimal charging schedule, taking into account charging points dislocated along the routes and choosing vehicle typologies with the best performance based on economic evaluations. A software was developed to automatize the methodology.

Lifestyle and Life Expectancy Questionnaire: validation and assessment in an Italian sample.

The objective of this study was to evaluate the relia-bility and validity of the lifestyle (Miller-Smith) and life expectancy (Schneider) questionnaires in the Italian setting in order to make this instrument available for the determination of lifestyle and hope level in the different domains of everyday life. Before testing their psychometric properties, the original versions of the two questionnaires, lifestyle (Miller-Smith) and life expectancy (Schneider), were translated into the Italian language. We tested the instrument's psychometric properties on a sample of 18 patients over 60 years old with Alzheimer's disease in the Sapienza University of Rome teaching hospital, policlinico Umberto 1. Internal consistency was considered to assess the reliability of the results across items within the adopted scale by using Cronbach's α coefficient. Using Kolmogorov-Smirnov's test, the normality distribution was evaluated to guarantee the applicability of a parametric or non-parametric test. The software used to analyze data was SPSS version 26 for Windows. According to the outcome of our statistical analysis, the lifestyle scale showed high overall internal consistency, and the Cron-bach's α coefficient for the total 20-item scale was 0.80 in the Italian population. On the other hand, using the 12-item questionnaire about life expectancy resulted in a high overall internal consistency of 0.93, according to the Cronbach's alpha test. The outcome of our study shows that the Italian versions of the lifestyle (Miller-Smith) and life expectancy (Schneider) questionnaires demonstrated good psychometric properties and good characteristics of factorial validity for future epidemiological studies aimed at evaluating lifestyle and lifestyle expectancy in the Italian population and can as well be used in clinical practice and research.

P26: EXTRAMEDULLARY MULTIPLE MYELOMA: A MONOCENTRIC RETROSPECTIVE OBSERVATIONAL STUDY

Extramedullary Multiple Myeloma (EMM) is a distinctive sub-entity of Multiple Myeloma, characterized by clonal plasma-cells proliferation outside the bone marrow; it can be diagnosed either as a tissue growing in contiguity with bone marrow (paraskeletal) or in distant organs (extramedullary). This subset of patients, especially the latter ones, have a poor prognosis, and there are not EMM-specific therapy schedules. The aim of our observational study was to describe patients that presented both type of EMM in order to report which common therapeutic approaches were used and to identify which disease characteristics mostly affected overall survival. We retrospectively analyzed 111 patients (pts) with EMM disease referred to the Hematology Department of Sapienza University of Rome between 2004 and 2021: 64 presented EMM at the onset of disease and 37 at relapse. Sixty-one pts were male and 50 were female (55% vs 45%); 60 pts (54.1%) were ISS-1 and the most common isotype was IgG (62.2%), followed by IgA (22.5%) and light chain myeloma (11.7%). Cytogenetics data were available for 37 patients: among them, 8 patients showed a high-risk cytogenetics profile: the most frequent findings were del13q (40.5%), amp/gain1q (24.3%) and t(4;14) (13.5%). Out of these 37 pts, 11 (30%) presented 2 or more cytogenetics alterations, while 4 pts (11%) presented a complex karyotype. Ninety-eight pts (88%) presented a paraskeletal localization, while 13 pts (12%) showed extramedullary localizations; the most frequent organs involved were soft tissues (5/13), followed by nervous central system, lymph nodes and orbit (2/13). Regarding the therapeutic approaches, 47% of pts with EMM at diagnosis received regimens containing a proteasome inhibitor (PI) and immunomodulatory drugs (IMiDs); 38% of pts underwent autologous stem cell transplantation (ASCT). At relapse, the most used regimens (30% of pts) were combinations containing monoclonal antibodies or IMiDs monotherapy. In both groups, one-third of patients underwent radiotherapy to reduce the local symptoms. After a median follow-up of 52 months for pts with EMM at diagnosis and 20 months for pts at relapse, the median OS was 147 months (mo) in first group and 32 mo in the second group (p<0.001). Among pts with EMM at diagnosis, pts who underwent ASCT showed a better median OS compared to other pts (NR vs 87.6 mo, p=0.004). Analyzing the type of EMM, we showed that pts with an extramedullary localization had a worse outcome compared to pts with paraskeletal disease (median OS 43.4 vs 147 months, p=0.011). Despite the limit of our cohort, pts with EMM at diagnosis and high-risk cytogenetics had a worse outcome compared to those with standard-risk cytogenetics (median OS: 33.2 months vs NR, p=0.041). Multivariate analysis showed that the ASCT and obtaining at least a very good partial response after therapy were independent factors associated with better progression free survival (PFS). Regarding OS, obtaining at least a partial response and a previous therapy with a PI were independent factors associated with better OS. Despite the limits of the retrospective study, our data demonstrated that specific therapy based on PIs and ASCT could overcome the poor prognostic factor of EMM, according to the previous published data. Further studies are warranted to assess the optimal strategies for pts with extramedullary EMM, whose prognosis is still poor.

Severe accident sensitivity and uncertainty estimation using MELCOR and RAVEN

Today, using a best-estimate approach is a key factor in the simulation and prediction of thermal-hydraulic and other multi-physics phenomena occurring during nuclear severe accidents. The best-estimate approach requires the quantification of both epistemic and stochastic uncertainties of safety codes to be effective. This safety assessment approach, named Best Estimate Plus Uncertainty (BEPU), is being pursued as an alternative to traditional deterministic analyses that are intrinsically conservative with not clearly defined safety margins. While in a conservative approach, the results are expressed in terms of a set of calculated conservative values of parameters, in a best-estimate methodology, the results are expressed in terms of uncertainty ranges for the calculated parameters. The International Technical Nuclear Community has made great efforts to develop methods and tools for uncertainty and sensitivity analyses of severe accident codes. In this framework, Sapienza University of Rome has developed a new Python script to use RAVEN as a tool for the application of the BEPU methods within the safety analyses performed with MELCOR. The aim of this paper is to show the capabilities of the coupling between RAVEN and MELCOR by performing a statistical analysis to estimate the range of evolution of a severe accident scenario.

Evaluation of the thermal-hydraulic performances of a once-through steam generator in nuclear fusion applications

After decades of operation in nuclear power plants, Once-Through Steam Generators (OTSGs) were recently proposed for nuclear fusion applications. In particular, they are supposed to be installed in the primary cooling systems of the European Union Demonstration fusion power plant (EU-DEMO). One of the key reactor components is the Breeding blanket (BB). Among the BB concepts that are currently under study, Water-Cooled Lithium-Lead (WCLL) option was considered for this work. The WCLL blanket is divided in two main subsystems, the breeder zone (BZ) and the first wall (FW), each one provided with an independent cooling circuit, named Primary Heat Transfer System (PHTS). Thermal power removed from BB by BZ and FW PHTS is driven to the Power Conversion System (PCS) to be converted into electricity. The thermal coupling is ensured by two OTSGs per system. At the Department of Astronautical, Electrical and Energy Engineering (DIAEE) of Sapienza University of Rome, a simulation activity was carried out to understand the component thermal-hydraulic behavior during DEMO normal operations. For calculation purposes, a full model of the steam generator was prepared by using a modified version of RELAP5/MOD3.3 system code. The computational activity performed allows to preliminary characterize the OTSG thermal-hydraulic performances during both pulse and dwell phases.

European survey on knowledge and attitudes of public health professionals on public health genomics: Pilot Study

Background: During the past decade a debate has arisen on the possible utility of genomic science for public health purposes. Within this context, a survey is being conducted to assess attitudes of European public health (PH) professionals belonging to EUPHA network regarding their role in the implementation of public health genomics (PHG), and their knowledge and attitudes regarding genetic testing and the delivery of genetic services.&#x0D; Methods: A pilot on-line survey was conducted on professionals from Sapienza University of Rome and the Vrije University of Amsterdam. The survey tool is composed of 5 sections: Personal details, Professional activity, Knowledge on genetic testing and delivery of genetic services, Attitudes on genetic testing and delivery of genetic services, Attitudes on the role of PH professionals in PHG.&#x0D; Results: 34 people responded to the questionnaire, mostly medical doctors (61,8%). No respondents correctly identified all evidence-based applications of genetic testing. More than one third of respondents agreed that it would be more important to invest resources in the social and environmental causes of ill health than in genetic testing. Nearly 70% thought that PHG needs to be grounded on evidence of effectiveness, a lower rate agreed ii should be grounded on cost-effectiveness. The rate of agreement with the proposed roles of PH professionals in PHG was very high.&#x0D; Conclusions: This pilot study showed a positive attitude but the need to improve knowledge of PH professionals on PHG. It provided useful input for the implementation of the survey to all members of the EUPHA network.

Graft weight integration in the early allograft dysfunction formula improves the prediction of early graft loss after liver transplantation

The role of the graft-to-recipient weight ratio (GRWR) in adult liver transplantation (LT) has been poorly investigated so far. The aim is to evaluate the contribution of the GRWR to the well-recognized early allograft dysfunction (EAD) model (i.e., Olthoff model) for the prediction of 90-day graft loss after LT in adults. Three hundred thirty-one consecutive adult patients undergoing LT between 2009 and 2018 at Tor Vergata and Sapienza University in Rome, Italy, served as the Training-Set. The Validation-Set included 123 LTs performed at the Erasmus Medical Center, Rotterdam, the Netherlands. The mEAD model for 90-day graft loss included the following variables: GRWR le 1.57 = 2.5, GRWR ge 2.13 = 2.5, total bilirubin ≥ 10.0 mg/dL = 2.0, INR ≥ 1.60 = 2.3, and aminotransferase > 2000 IU/L = 2.2. The mEAD model showed an AUC = 0.74 (95%CI = 0.66–0.82; p < 0.001) and AUC = 0.68 (95%CI = 0.58–0.88; p = 0.01) in the Training-Set and Validation-Set, respectively, outperforming conventional EAD in both cohorts (Training-Set: AUC = 0.64, 95%CI = 0.57–0.72; p = 0.001; Validation-Set: AUC = 0.52, 95%CI = 0.35–0.69, p = 0.87). Incorporation of graft weight in a composite multivariate model allowed for better prediction of patients who presented an aminotransferase peak > 2000 IU/L after LT (OR = 2.39, 95%CI = 1.47–3.93, p = 0.0005). The GRWR is important in determining early graft loss after adult LT, and the mEAD model is a useful predictive tool in this perspective, which may assist in improving the graft allocation process.