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Lorenzo Viselli,1,* Fabiana Festucci,1,* Maria Chiara Pino,1 Aurora D’Atri,1 Federico Salfi,1 Giulia Amicucci,1,2 Domenico Corigliano,1,2 Federica Naccarato,1 Michele Ferrara,1 Daniela Tempesta1 1Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy; 2Department of Psychology, Sapienza University of Rome, Rome, Italy*These authors contributed equally to this workCorrespondence: Michele Ferrara, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy, Email michele.ferrara@univaq.itPurpose: The present study aimed to validate the Italian version of the Iowa Resistance to Sleeplessness Test (iREST), a 16-item self-report assessing resilience to sleep debt in the affective, cognitive, and somatic domains.Participants and Methods: We examined its factor structure, assessed internal consistency and criterion validity, and established test-retest reliability on 768 Italian native speakers (65.8% of women) with a mean age of 25.98 years old.Results: Confirmatory factor analysis (CFA) revealed a new 13-item structure for the Italian iREST (iREST-13), demonstrating more satisfactory goodness-of-fit values, and exhibiting good internal consistency (Cronbach’s α ranging from 0.73 to 0.89), relative to the 16-item original version. Results supported the iREST convergent validity, showing significant independence from established measures of sleep; low correlations with conceptually unrelated measures supported divergent validity, indicating that the iREST effectively measures resistance to sleeplessness without confounding with other constructs. Lastly, test-retest reliability was evaluated by administering the iREST to the same sample with a 2-week interval: the significant correlations supported its temporal stability.Conclusion: Further studies are needed to evaluate the applicability of the iREST in diverse populations and explore its relationship with objective sleep measures. Nevertheless, the Italian iREST provides a valuable tool for assessing resistance to sleep loss, offering insights into individual differences in resilience. Additionally, the iREST can assist in identifying individuals who require interventions to enhance resilience to sleep debt, as well as help clinicians evaluate the impact of chronic sleep disruption and deliver targeted interventions.Keywords: sleeplessness, resilience, sleep loss, vulnerability, individual differences, Italian validation

The right to live with dignity during the final stages of existence, enshrined in national and supranational Charters of Rights, represents a significant step towards humanizing medicine and is integral to the right to health. Palliative Care, rooted in health, dignity, and therapeutic self-determination, has emerged as a fundamental human right and a moral imperative within health systems. It seeks to alleviate suffering, emphasizing the holistic well-being of patients with life-limiting illnesses. This paper provides an analysis of the current situation of Palliative Care in Italy and examines its critical aspects, also in relation to the issues found in other European and non-European countries. In Italy, although laws have been enacted to ensure the provision of Palliative Care, its availability remains inconsistent across different regions. Financial constraints and insufficient support hinder the comprehensive dissemination of these services. Recognizing the significance of Palliative Care, the Catholic Church also endorses its implementation as a response to human suffering and an approach to end-of-life care. Efforts to strengthen Palliative Care are critical to meeting the rising demand and ensuring access to compassionate and dignified care for all individuals in need. Through legislative advancements and adequate resources, Italy can make significant strides in advancing the provision of Palliative Care. [ABSTRACT FROM AUTHOR]

A subgroup H of a group G is said to be pronormal in G if each of its conjugates $H^g$ in G is already conjugate to it in the subgroup $\langle H,H^g\rangle $. The aim of this paper is to classify those (locally) finite simple groups which have only nilpotent or pronormal subgroups. [ABSTRACT FROM AUTHOR]

Valentina Alfonsi,1,2 Rossella Palmizio,3 Annalisa Rubino,3 Serena Scarpelli,2 Maurizio Gorgoni,1 Aurora D’Atri,4 Mariella Pazzaglia,1,2 Michele Ferrara,4 Salvatore Giuliano,3 Luigi De Gennaro1,2 1Department of Psychology, “Sapienza” University of Rome, Rome, Italy; 2I.R.C.C.S. Fondazione Santa Lucia, Rome, Italy; 3I.I.S.S. “Ettore Majorana”, Brindisi, Italy; 4Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, ItalyCorrespondence: Luigi De Gennaro“Sapienza” University of Rome, Via Dei Marsi, 78, Rome 00185, ItalyTel (+39) 06-49917647Fax (+39) 06-49917711Email luigi.degennaro@uniroma1.itPurpose: In adolescence, physiological (circadian and homeostatic regulation of sleep) and social habits contribute to delayed sleep onset, while social obligations impose early sleep offset. The effects of delayed school start time on the subjective/objective measures of sleep–wake patterns and academic achievement have not been established.Methods: This pre-, post-, and longitudinal non-randomized study included an early (8:00 am; ESC=30 students) and the late (9:00 am; LSC=21 students) start class. Multiple sleep data included a weekly sleep diary, Karolinska Sleepiness Scale, Pittsburgh Sleep Quality Index, and Epworth Sleepiness Scale. Sustained attention was measured using the Psychomotor Vigilance Task. Academic performance was evaluated by two different mathematical and scientific standard tests (entrance and final) and by school attendance indicators. Data were collected at monthly intervals from October 2018 to May 2019 and the beginning and end of the academic year (pre/post).Results: All students turned their lights off at similar times (LSC=11:21pm, ESC=11:11pm), but LSC students woke up later (7:23am) than ESC students (6:55am; F1,48=11.81, p=0.001) on school days. The groups did not differ in total sleep duration on non-school days. Longitudinal measures revealed a significant increase (8.9%, 34 min) in total sleep duration of LSC students across the academic year. ESC students maintained approximately the same sleep duration. Furthermore, changes in sleep duration had parallelled significant differences in sustained attention, with LSC students outperforming ESC students. Longitudinal changes of sleep and sustained attention were associated with a coherent pattern of changes in academic performance.Conclusion: Findings indicate that a one-hour delay in school start time is associated with longer sleep, better diurnal sustained attention, attendance, and improved academic performance. Notably, sleep changes were limited to school days. A delay in school start time should be seriously considered to improve sleep and academic achievements of students.Keywords: sleep, school start time, attention, school health, sleep loss, adolescence

Serena Scarpelli,1,2 Chiara Bartolacci,1 Aurora D’Atri,1,3 Milena Camaioni,1 Ludovica Annarumma,1 Maurizio Gorgoni,1 Chiara Cloos,1 Michele Ferrara,3 Luigi De Gennaro1,2 1Department of Psychology, Sapienza University of Rome, Rome 00185, Italy; 2IRCCS Fondazione Santa Lucia, Rome, Italy; 3Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Coppito, L’Aquila 67100, ItalyCorrespondence: Luigi De GennaroDepartment of Psychology, Sapienza University of Rome, Via Dei Marsi, 78, Rome 00185, ItalyTel +39-06-49917647Fax +39-06-49917711Email luigi.degennaro@uniroma1.itPurpose: In the current study, we aimed to investigate the EEG correlates of dream recall (DR) monitoring both the homeostatic and state-trait like factors. We assessed the influence of the time of night on the EEG correlates of DR from REM sleep. Specifically, we tested the continuity-hypothesis (on the theta EEG band) and the activation-hypothesis (on the delta and beta bands).Methods: Twenty-seven subjects underwent polysomnography with multiple provoked awakenings during REM sleep. Only the subjects showing combinations of dream recall (REC) and non-REC (NREC) conditions in both first (1st– 2nd sleep cycle) and second (3rd– 4th sleep cycle) part of the night were included in the analyses. The final sample was composed of 10 subjects (mean age 24± 0.70). EEG power spectra of the 5-min of REM sleep preceding each awakening were computed by a fast Fourier transform. The following frequency bands were considered: delta (0.50– 4.75 Hz), theta (5.00– 7.75 Hz), and beta (16.00– 24.75 Hz). We also calculated the delta/beta power ratio as an integrated EEG index of activation.Results: The 2× 2 within-subjects ANOVA recall × time revealed: a) no significant effect for time and no interaction; b) significant differences over the occipital area in the beta band; c) significant differences over the parietal area for the activation index values. Overall, the results indicated that DR is associated with higher activation regardless of homeostatic pressure across the night of sleep.Conclusion: In line with recent findings, we have shown that DR is predicted by desynchronized EEG activity during REM sleep, providing clear evidence in favor of the activation-hypothesis. We have also confirmed that the EEG pattern of DR can be ascribed to state-like factors. Further studies should assess whether homeostatic modulation may interact with some dream features and the related EEG predictors.Keywords: dream recall, REM sleep, EEG, activation hypothesis, multiple awakenings, sleep homeostasis

Federico Salfi,1 Marco Lauriola,2 Daniela Tempesta,1 Pierpaolo Calanna,3 Valentina Socci,1 Luigi De Gennaro,4 Michele Ferrara1 1Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy; 2Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy; 3Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy; 4Department of Psychology, Sapienza University of Rome, Rome, ItalyCorrespondence: Michele FerraraDepartment of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Via Vetoio (Coppito 2), Coppito 67100, AQ, ItalyEmail michele.ferrara@univaq.itStudy Objectives: To evaluate the effects of total and partial sleep deprivation on reflection impulsivity and risk-taking in tasks requiring deliberative decision-making processes.Participants and Methods: Seventy-four healthy young adults were selected to participate in two independent experiments, each consisting of a crossover design. In Experiment 1, 32 participants were tested after one night of regular sleep (RS), and after one night of total sleep deprivation (TSD). In Experiment 2, 42 participants were tested following five nights of RS and after five nights of partial sleep deprivation (PSD), implying five hours of sleep per night. In both the experiments, two deliberative decision-making tasks were administered, involving different decision-making constructs. The Mosaic Task (MT) assessed reflection impulsivity, the tendency to gather information before making a decision. The Columbia Card Task cold version (CCTc) evaluated risk-taking propensity in a dynamic environment.Results: Unlike TSD, PSD led to an increment of reflection impulsivity and risk-taking. Nevertheless, analyses taking into account the individuals’ baseline (RS) performance showed consistent results between the two experimental sleep manipulations. Participants who gathered more information to make decisions in the MT when well-rested, then relied on less evidence under sleep loss, and more cautious participants in the CCTc tended to make riskier decisions.Conclusion: Results pointed to differential consequences of sleep deprivation depending on the habitual way to respond during decision-making involving deliberative reasoning processes. Results were interpreted according to a putative interaction between sleep loss effect and individual difference factors.Keywords: sleep deprivation, sleep restriction, reflection impulsivity, risk-taking, deliberative decision-making, individual differences

Aurora D’Atri,1,2 Serena Scarpelli,1 Maurizio Gorgoni,1 Valentina Alfonsi,1 Ludovica Annarumma,1 Anna Maria Giannini,1 Michele Ferrara,3 Fabio Ferlazzo,1 Paolo Maria Rossini,4,5 Luigi De Gennaro1,2 1Department of Psychology, University of Rome “Sapienza”, Rome, Italy; 2Area of Neuroscience, IRCCS San Raffaele Pisana, Rome, Italy; 3Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy; 4Institute of Neurology, Catholic University of the Sacred Heart, Rome, Italy; 5Department Geriatrics, Neuroscience & Orthopaedics, Policlinic A. Gemelli Foundation-IRCCS, Rome, ItalyCorrespondence: Luigi De GennaroDepartment of Psychology, University of Rome “Sapienza”, Via Dei Marsi, 78, Rome 00185, Italy, Tel +39 06-49917647Fax +39 06-49917711Email luigi.degennaro@uniroma1.itPurpose: Recent studies demonstrate that 5-Hz bilateral transcranial alternating current stimulation (θ-tACS) on fronto-temporal areas affects resting EEG enhancing cortical synchronization, but it does not affect subjective sleepiness. This dissociation raises questions on the resemblance of this effect to the physiological falling asleep process. The current study aimed to evaluate the ability of fronto-temporal θ-tACS to promote sleep.Subjects and methods: Twenty subjects (10 F/10 M; mean age: 24.60 ± 2.9 y) participated in a single-blind study consisting of two within-subject sessions (active/sham), one week apart in counterbalanced order. Stimulation effects on EEG were assessed during wake and post-stimulation nap. The final sample included participants who fell asleep in both sessions (n=17).Results: Group analyses on the whole sample reported no θ-tACS effects on subjective sleepiness and sleep measures, while a different scenario came to light by analysing data of responders to the stimulation (ie, subjects actually showing the expected increase of theta activity in the wake EEG after the θ-tACS, n=7). Responders reported a significant increase in subjective sleepiness during wakefulness after the active stimulation as compared to the sham. Moreover, the sleep after the θ-tACS compared to sham in this sub-group showed: (1) greater slow-wave activity (SWA); (2) SWA time-course revealing increases much larger as closer to the sleep onset; (3) stimulation-induced changes in SWA during sleep topographically associated to those in theta activity during wake.Conclusion: Subjects who show the expected changes during wake after the stimulation also had a consistent pattern of changes during sleep. The enhancement of cortical synchronization by θ-tACS during wakefulness actually corresponds to increased sleep pressure, but it occurs only in some individuals. Thus, θ-tACS can enhance sleep, although individual factors to be further investigated affect the actual responsiveness to this treatment.Keywords: transcranial alternating current stimulation, sleep, EEG, slow-wave activity, sleep onset