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While healthcare is becoming more patient-centred, evidence-based nutrition interventions are still not accessible to all patients with cancer. As nutrition interventions directly improve clinical and socioeconomic outcomes, patient-centred care is not complete without nutrition care. While awareness of the negative impact of malnutrition on clinical outcomes, quality of life, and functional and emotional wellbeing in cancer is growing, there is relatively poor awareness amongst patients, clinicians, policymakers, and payers that nutrition interventions -particularly those begun in the early stages of the disease course- are an effective method for improving such outcomes. The European Beating Cancer Plan recognises the need for a holistic approach to cancer but lacks actionable recommendations to implement integrated nutrition cancer care at member state level. When considering nutrition care as a human right, the impact on quality of life and functional status must be prioritized, as these may be equally as important to patients, especially in advanced cancer where improvements in clinical outcomes such as survival or tumour burden may not be attainable. We formulate actions needed at the regional and the European level to ensure integrated nutrition care for all patients with cancer. The 4 main Take Home Messages are as follows: 1. The goals of Europe’s Beating Cancer Plan cannot be achieved without integrating nutrition across the cancer care continuum. 2. Malnutrition negatively impacts clinical outcomes and has socioeconomic consequences for patients and healthcare systems. 3. Championing integrating nutrition care into cancer care is therefore the duty and ethical responsibility of clinicians (Hippocratic Oath—primum non nocere) and 4. Nutrition care is a cost effective, evidence-based therapy.

Malnutrition, muscle loss, and cachexia are prevalent in cancer and remain key challenges in oncology today. These conditions are frequently underrecognized and undertreated and have devastating consequences for patients. Early nutrition screening/assessment and intervention are associated with improved patient outcomes. As a multifaceted disease, cancer requires multimodal care that integrates supportive interventions, specifically nutrition and exercise, to improve nutrient intake, muscle mass, physical functioning, quality of life, and treatment outcomes. An integrated team of healthcare providers that incorporates societies’ recommendations into clinical practice can help achieve the best possible outcomes. A multidisciplinary panel of experts in oncology, nutrition, exercise, and medicine participated in a 2-day virtual roundtable in October 2020 to discuss gaps and opportunities in oncology nutrition, alone and in combination with exercise, relative to current evidence and international societies’ recommendations. The panel recommended five principles to optimize clinical oncology practice: (1) position oncology nutrition at the center of multidisciplinary care; (2) partner with colleagues and administrators to integrate a nutrition care process into the multidisciplinary cancer care approach; (3) screen all patients for malnutrition risk at diagnosis and regularly throughout treatment; (4) combine exercise and nutrition interventions before (e.g., prehabilitation), during, and after treatment as oncology standard of care to optimize nutrition status and muscle mass; and (5) incorporate a patient-centered approach into multidisciplinary care.

BackgroundIn dental laboratories, exposure to crystalline silica can occur during procedures that generate suspended mineral dusts, e.g. dispersion of mixing powders, removal of castings from molds grinding, polishing of castings and porcelain, and use of silica sand for blasting. There is also a large list of toxic agents (acrylic resins, polymeric materials, etc.) used to produce removable and fixed prostheses, but also impression materials and more. Using personal protective equipment and other aids reduces the exposure to these potentially harmful agents.Case presentationWe report the case of a 42-year-old male dental technician who began to suffer from a dry cough and exertional dyspnea after approximately 15 years of work. The operations he conducted for his job resulted in the generation of crystalline silica, aluminum, chromium and titanium dust. The worker did not regularly wear personal protective equipment and some of the above operations were not carried out in closed circuit systems. The Chest X-ray showed diffused micronodules in the pulmonary interstitium of the upper-middle lobes, bilaterally, and a modest left basal pleural effusion. Simple spirometry showed small airway obstruction in its initial stage. High Resolution Computerized Tomography of the chest showed bilateral micronodulation of a miliariform type, with greater profusion to the upper lobes, also present in the visceral pleura, bilaterally. Histological examination showed aggregates of pigment-laden macrophages forming perivascular macules or arranged in a radial pattern around a core of sclerohyalinosis. Scanning Electron Microscopy and Energy Dispersive Spectrometry revealed several mineral particles, typically characterized by the presence of crystalline silica and metal aggregates. The environmental concentrations of total dust and its respirable fraction were all lower than the relative TLV-TWA—ACGIH, yet not negligible.ConclusionsThe above findings and a multidisciplinary assessment led to the diagnosis of mixed dust pneumoconiosis s/q with 2/2 profusion of occupational origin. This diagnosis in a dental technician was supported for the first time in literature by environmental exposure analysis.

The archaeometric investigation of 46 potsherds of “Torre Alemanna type” pottery aimed to define a compositional reference group and to understand the technological characteristics of its production. Principal component analysis applied to bulk chemical data (XRF) of the ceramic body showed a strong compositional homogeneity. Their comparison with local clays and 6 fragments of bricks sampled from the ceramic kiln, on the one hand, revealed the use of alluvial clays as raw material and, on the other hand, proved their fractionation for the production of pottery. The mineralogical assemblages detected by X-ray powder diffraction analysis inferred maximum firing temperatures between 750 and 1000 °C for the ceramic body. Polarising optical microscopy and scanning electron microscopy with energy dispersive spectroscopy (SEM–EDS) investigations on coating revealed the presence of quartz-rich white engobe covered with a high lead transparent glaze. The polychromatic decoration was analysed by colorimetry and EDS to compare the colour characteristics through all the potsherds. A temperature range between 780 and 950 °C of liquidus temperatures was inferred from the ternary phase diagram of PbO-Al2O3-SiO2 system. Overlap of temperature ranges for sintering of the ceramic body and maturing glaze points to a single firing of the Torre Alemanna type ware. The results obtained define the reference compositional group and technology of the Torre Alemanna type ware, already attested in several archaeological contexts of southern Italy, and showed a technological continuity with the past about the use of local carbonate-rich clays to produce fine pottery.

Fil: Marrodan, Mariano. Fleni. Departamento de Neurologia. Servicio de Neuroinmunologia y Enfermedades Desmielinizantes; Argentina.

Electronic health records (EHRs) present extensive patient information and may be used as a tool to improve health care. However, the oncology context presents a complex content that increases the difficulties of EHR application. This study aimed at developing openEHR-archetypes representing clinical concepts in cancer nutrition-care, as well as to develop an openEHR-template including the aforementioned archetypes. The study involved the following stages: 1) a thorough literature review, followed by an expert’s (nutrition guideline authors) survey, aiming to identify the main statements of published clinical guidelines on nutrition in cancer patients that were not included on the Clinical Knowledge Manager (CKM) repository; 2) modelling of the archetypes using the Ocean Archetype Software and submission to the CKM repository; 3) creating an example template with Template Designer; and 4) automatic conversion of the openEHR-template into a readily usable EHR using VCIntegrator. The clinical concepts (among 17 clinical concepts not yet available in the CKM repository) chosen for further development were: body composition, diet plan, dietary nutrients, dietary supplements, dietary intake assessment, and Malnutrition Screening Tool (MST). So far, four archetypes were accepted for review in the CKM repository and a template was created and converted into an EHR. This study designed new openEHR-archetypes for nutrition management in cancer patients. These archetypes can be included in EHR. Future studies are needed to assess their applicability in other areas and their practical impact on data quality, system interoperability and, ultimately, on clinical practice and research. Electronic supplementary material The online version of this article (10.1007/s10916-020-01649-9) contains supplementary material, which is available to authorized users.

In cancer patients, delivery of palliative care during anticancer treatment (i.e., concurrent care) leads to enhanced clinical outcome. Nutrition therapy is part of palliative care and, therefore, should be prescribed to prevent or treat cachexia. Effective nutrition therapy is based on a thorough assessment of weight loss history, eating behaviour, changes in appetite, and the presence of nutrition impact symptoms. By identifying a patient’s needs, the delivery of nutritional care (i.e., counselling, supplements, enteral or parenteral nutrition according to the "maximal use of supportive therapy" approach) has greater likelihood to be highly effective. However, a careful monitoring programme, which includes periodical check of body weight, energy and protein intake, quality of life, ensures constant adaptation of nutritional care to the changing needs of cancer patients. Nutrition therapy is becoming a key component of cancer patients management. In this new role, nutrition therapy is key in allowing cancer patients to receive and complete treatments and in improving quality of life. Whether these effects also translate into longer survival remains to be demonstrated but preliminary results are encouraging.

The proposed geological itinerary connects a series of impressive outcrops distributed between the front and the inner portion of the Southern Apennine thrust belt. It offers the opportunity to visit some of the most interesting and best-exposed Southern Apennine geosites, inserted within landscapes typical of the different sectors of the thrust belt, in order to illustrate its geological evolution. The itinerary has been designed in such a way as to intersect different stacked tectonic units and a great variety of sedimentary successions whose age ranges from Triassic to Pleistocene. Each of the chosen geosite contains multidisciplinary geological information that may be of interest for researchers, but may be also appreciated by a general public interested in geology. In particular, the stratigraphy, the structural geology and the geomorphology are the most recurrently treated topics. Most of these outcrops extend for many hundreds or thousands of metres and include villages or mountain reliefs. Therefore, every single site can be considered as an areal geosite containing particular geological features. However, the largest geosite can also be observed in a panoramic view from suitable locations. Thus, each of these sites provides different evidence and when combined together provides an opportunity to understand the complex geological history of the Southern Apennines. The motivation for establishing this itinerary mostly resides in the great scientific interest of the chosen outcrops; this will hopefully facilitate their conservation and the development of geotourism.

Hypogenic caves, developed by sulphuric acid speleogenesis, are known all over the world among which the Santa Cesarea Terme caves have been included. They are four submerged caves, located along a coastal carbonate sector in Southern Italy and hosting the outflow of coastal springs of thermal mixed waters (from 21 to 33 °C). These waters derive from the mixing of three water end members: the fresh pure groundwater of a wide karstic aquifer, the deep sulphur thermal water and the seawater. This cave system represents an almost unique case of hypogenic sea caves in carbonate environment. The thermal mixed waters have a different effect on the surrounding rocks of the caves, influencing the sulphuric acid speleogenetic process within the whole cave system. To understand the complex and overlapping natural processes acting on the development of these coastal caves, a multidisciplinary study has been carried out. This study has integrated all the data resulting from different methods and technologies, merging morphology, structural geology, hydrogeology, hydrogeochemistry and mineralogy. This multidisciplinary study has allowed to define the main geochemical processes acting within these caves, including the cave development and the formation of the mineral concretions. After the introduction of H2S in the thermal waters, formed by the reduction of sulphates in the sedimentary deposits crossed at depth in the offshore, the oxidation occurs within the caves, producing sulphuric acid. Favoured by upwelling deep-seated thermal flows, this acid dissolves the limestone, with condensation corrosion process that involve replacement of limestone rock with gypsum. This process has resulted to be more active and remarkable within the Gattulla Cave, one of the Santa Cesarea Terme sea caves.

Glazed pottery with “negative decoration” samples, dating back to the twelfth to thirteenth century ad and coming from three sites along the Adriatic coast, Siponto, Egnatia and Trani (Southern Italy) were characterized from physical–chemical, mineralogical and morphological points of view. Optical microscopy, scanning electron microscopy with energy dispersive X-ray spectroscopy, inductively coupled plasma-mass spectroscopy, X-ray diffraction and micro-Raman spectroscopy investigations were carried out on ceramic bodies, pigments and glazes of the fragments. We aimed to outline the technological features, define the nature of decorations and coatings—glazes and engobes—and look for clues to hypothesize provenance. Results obtained show clear differences in raw materials and production technology between the impressed ceramic of Islamic tradition and the incised one of Byzantine tradition. Regarding the latter, evidences of a non-local origin can be found in the compositional diversity of raw materials used for the ceramic bodies of fragments decorated with spiral and pseudo-kufic motifs, which stressed the use of clays so far not recorded in Apulia. At the same time, at least in the case of Siponto, the compositional similarity of both ceramic bodies and materials used under the glaze for impressed ceramic and painted polychrome ceramics (RMR and protomaiolica), more likely local production, could suggest that both were produced in the same workshops.

Apulian red figured pottery is part of the most recognizable and appreciated artworks of Italian cultural heritage. The initial objective of the research was checking the non-authenticity of some parts of two important Apulian red figured vases, stored in the National Archaeological Museum of Naples and subjected, through the ages, to several unrecorded restorations. The results obtained, in addition to achieve the set goal, revealed the non-authenticity of the whole upper part of one of the two vases, supplied further knowledge on nineteenth century restoration techniques, for these vases never adequately described, but mostly underlined how the answers to the archeological questions can only arise from a detailed characterization of the materials, succeeded by a scientific multi-technique strategy. Specifically, the complete chemical–physical characterization of the samples was accomplished by inductively coupled plasma mass spectrometry, scanning electron microscopy coupled with energy dispersive X-ray spectroscopy, X-ray diffraction, Raman and Fourier transform infrared spectroscopies.

Magnetic shielding properties of MgB2 bulk samples synthesized by the SPS (Spark–Plasma–Sintering) technique were characterized in low applied magnetic fields at temperatures ranging from 20 to 37 K. The used growth technique allows one to produce this compound in different shapes and sizes required for shielding applications. In this framework, shielding magnetic-induction field profiles generated by MgB2-based shield components, shaped as planar thick disks, were measured by means of a suitable Hall probe in-plane array. The magnetic field distribution at different vertical distances above the sample was also obtained by a micrometric motion of the probe ensemble. Magnetic field profiles were then analyzed in the framework of the critical state model and the critical current density, Jc, was evaluated. The Jc magnitude indicates that the material under test is a good candidate for passive magnetic shield manufacturing up to temperatures close to the transition one.

Cancer-associated malnutrition results from a deadly combination of anorexia, which leads to reduced food intake, and derangements of host metabolism inducing body weight loss, and hindering its reversal with nutrient supplementation. Cancer patients often experience both anorexia and weight loss, contributing to the onset of the clinical feature named as anorexia-cachexia syndrome. This condition has a negative impact upon patients' nutritional status. The pathogenesis of the anorexia-cachexia syndrome is multifactorial, and is related to: tumour-derived factors, host-derived factors inducing metabolic derangements, and side effects of anticancer therapies. In addition, the lack of awareness of cancer patients' nutritional issues and status by many oncologists, frequently results in progressive weight loss going undiagnosed until it becomes severe. The critical involvement of host inflammatory response in the development of weight loss, and, in particular, lean body mass depletion, limits the response to the provision of standard nutrition support. A novel nutritional and metabolic approach, named "parallel pathway", has been devised that may help maintain or improve nutritional status, and prevent or delay the onset of cancer cachexia. Such an approach may improve tolerance to aggressive anticancer therapies, and ameliorate the functional capacity and quality of life even in advanced disease stages. The "parallel pathway" implies a multiprofessional and multimodal approach aimed at ensuring early, appropriate and continuous nutritional and metabolic support to cancer patients in any phase of their cancer journey.

Tumor growth is associated with profound metabolic and neurochemical alterations, which can lead to the onset of anorexia-cachexia syndrome. Anorexia is defined as the loss of the desire to eat, while cachexia results from progressive wasting of skeletal muscle mass--and to a lesser extent adipose tissue--occurring even before weight loss becomes apparent. Cancer anorexia-cachexia syndrome is highly prevalent among cancer patients, has a large impact on morbidity and mortality, and impinges on patient quality of life. However, its clinical relevance is frequently overlooked, and treatments are usually only attempted during advanced stages of the disease. The pathogenic mechanisms of cachexia and anorexia are multifactorial, but cytokines and tumor-derived factors have a significant role, thereby representing a suitable therapeutic target. Energy expenditure in anorexia is frequently increased while energy intake is decreased, which further exacerbates the progressive deterioration of nutritional status. The optimal therapeutic approach to anorectic-cachectic cancer patients should be based on both changes in dietary habits, achieved via nutritional counseling; and drug therapy, aimed at interfering with cytokine expression or activity. Our improved understanding of the influence a tumor has on the host's metabolism is advancing new therapeutic approaches, which are likely to result in better preservation of nutritional status if started concurrently with specific antineoplastic treatment.

We present results from an extended magneto-optical (MO) analysis of two samples cut from high-density pellets of MgB2. The first sample was studied in order to show that no matter how large the sample is and despite the bulk granularity, the material enters into a critical state in a crystal-like fashion. The second sample was chosen for the quantitative analysis. A numerical approach based on an inverted 2D Biot-Savart model was used to calculate the current paths across the homogeneous polycrystalline bulk, as well as in the vicinity and across some morphological defects. Local current densities in the homogeneous part were estimated as a function of the applied magnetic field at different temperatures, in three regimes: below full penetration, at full penetration and above full penetration, respectively. A hypothesis of interpretation of the apparent absence of magnetic granularity inside the polycrystalline microstructure is presented. It is related to a critical state likely reached by a network of strongly coupled Josephson junctions.

People now have available to them a diversity of digital storage devices, including palmtops, cell phone address books, laptops, desktop computers and Web-based services. Unfortunately, as the number of personal data repositories increases, so does the management problem of ensuring that the most up-to-date version of any document is available to the user on the storage device he/she is currently using. We introduce the Roma personal metadata service to make it easier to locate current file versions and ensure their availability across different repositories. This centralized service stores information about each of a user's files, such as its name, location, timestamp and keywords, on behalf of mobility-aware applications. Separating out these metadata from the data repositories makes it practical to keep the metadata store on a highly available, portable device. In this paper, we describe the design requirements, architecture and current prototype implementation of Roma.

Autonomic nervous system activity is involved in body weight regulation. We assessed whether the body mass index (BMI) is related to the autonomic nervous system activity as assessed by heart rate variability (HRV). Twenty-five adult normotensive, euglycemic healthy males (M) and females (F) were studied (M/F=13/12). BMI was assessed in each individual. HRV was assessed and the domains of low frequencies (LF, index of the sympathetic modulation) and high frequencies (HF, index of the parasympathetic modulation) were measured. Data were statistically analyzed and are presented as mean+/-s.d. Mean BMI did not correlate with either HF or LF. It inversely related to HF (r=-0.50, P0.01), whereas its relationship with LF was marginally significant (r=-0.39, P=0.05). The HF in individuals with BMI20 kg/m(2) was significantly higher from those measured in the remaining subjects (P0.05). The results support the role of parasympathetic activity in influencing BMI through likely modulation of body weight.

OBJECTIVE: In obese patients, brain serotonergic stimulation via orally administered 5-hydroxy-tryptophan (5-HTP), the precursor of serotonin, causes decreased carbohydrate intake and weight loss. Since diabetes mellitus is associated with depressed brain serotonin, hyperphagia and carbohydrate craving, we hypothesized that in diabetic patients, orally administered 5-HTP stimulates brain serotonergic activity and thus normalizes eating behaviour. To test this hypothesis, we investigated whether in diabetic patients: 1) predicted brain serotonin concentrations are depressed as a result of decreased availability of the precursor, tryptophan; and 2) oral 5-HTP is effective in reducing energy and carbohydrate intake. SUBJECTS AND METHODS: 25 overweight non-insulin dependent diabetic outpatients were enrolled in a double-blind, placebo-controlled study, and randomized to receive either 5-HTP (750 mg/d) or placebo for two consecutive weeks, during which no dietary restriction was prescribed. Energy intake and eating behaviour, as expressed by macronutrient selection, were evaluated using a daily diet diary. Plasma amino acid concentrations and body weight, as well as serum glucose, insulin and glycosylated haemoglobin were assessed. RESULTS: 20 patients (nine from the 5-HTP group and 11 from the Placebo group) completed the study. Brain tryptophan availability in diabetic patients was significantly reduced when compared to a group of healthy controls. Patients receiving 5-HTP significantly decreased their daily energy intake, by reducing carbohydrate and fat intake, and reduced their body weight. CONCLUSIONS: These data confirm the role of the serotonergic system in reducing energy intake, by predominantly inhibiting carbohydrate intake, and suggest that 5-HTP may be safely utilized to improve the compliance to dietary prescriptions in non-insulin dependent diabetes mellitus.