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Through a competitive proposal process for a recent funding opportunity, 38 community based organizations submitted proposals that addressed vaccine hesitancy among adults who are members of racial or ethnic minority communities. Proposals were required to include discussion of barriers identified in the community of focus and evidence to support all assertions. Submissions ranged from single employee projects to large collaborative networks, and were submitted from all regions of the US, including both tribal and territorial areas, including more than 45 ethnic and language groups. Barriers were coded by two reviewers and six (6) primary themes were identified: access related to transportation, distance, or time; lack of culturally responsive materials or sensitivity of providers; structural issues such as poor data collection, historical inequity, mistrust, or systemic racism; messages coming from untrusted sources; misinformation or no information available; and differing cultural perspectives. The most commonly identified issues were related to mistrust, historical structural issues or fear and racism (n=23), and lack of access due to transportation, distance, or time (n=17). This group of proposals for funding represent a small cross-section of communities who continue to have significant pockets of unvaccinated persons. While it is possible to see themes for barriers that are encountered in increasing vaccination rates among adults, communities demonstrate extremely nuanced realities, filtered through a range of culturally and paradigmatically different ways of knowing. Success in public health initiatives requires intensive focus on the variance across these different perspectives and careful attention to appropriately focus outreach and messaging.

Objective: Angiogenin (ANG) is a pro-angiogenic and neurotrophic factor with an important role in stress-induced injury, by promoting neovascularization and neuronal survival. Identification of loss-of-function mutations and evidence of beneficial effect of ANG administration in transgenic SOD1G93A mice have linked ANG to the pathogenesis of Amyotrophic Lateral Sclerosis (ALS), stimulating interest in considering circulating ANG levels as an ALS disease biomarker although robust evidence is still lacking. Aim of our study was to assess differences of ANG levels in the cerebrospinal fluid (CSF) of a large cohort of patients with ALS and frontotemporal dementia (FTD) compared to controls and to explore correlations between ANG content and disease-related clinical variables. Methods: ANG levels were measured in CSF samples using a commercially available ELISA kit in 88 patients affected with ALS and/or FTD and 46 unrelated individuals (control group). Results: ANG levels didn’t differ significantly between cases and controls. Patients with FTD or ALS-FTD showed significantly increased CSF concentration of ANG compared to ALS patients without dementia and controls in a multivariate regression model (p found in ALS/FTD patients between ANG levels and clinical parameters, including age, presence of C9orf72 repeat expansion, body mass index (BMI). Conclusions: our findings highlight a role of ANG as CSF biomarker useful to identify ALS patients with concurrent FTD and suggest that it should be further explored as potential biomarker for FTD.

This study presents the Italian validation of the recently developed Edinburgh Cognitive and Behavioural ALS Screen (ECAS), a short screen for cognitive/behavioural alterations in patients with amyotrophic lateral sclerosis (ALS). We evaluated the psychometric properties of the ECAS Italian version in terms of reliability and convergent validity for both cognitive and behavioural features. Furthermore, we investigated the relationship with affective and clinical variables, in addition to ECAS usability and patients’ insight into cognitive/behaviour changes. Finally, correlations between genetic and cognitive/behavioural data were analysed. We recruited 107 patients with ALS. Normative data were collected on 248 healthy subjects. Participants were administered the ECAS and two standard cognitive screening tools (FAB, MoCA), two psychological questionnaires (BDI, STAI/Y) and an ad hoc usability questionnaire. The FBI was also carried out with caregivers. Results showed that the ECAS Italian version discriminated well between patients and controls. The most prevalent deficit occurred in executive functions and fluency. Correlations were observed between the ECAS and standard cognitive screening tools and between the ECAS carer interview and the FBI, supporting its full convergent validity. In conclusion, the ECAS Italian version provides clinicians with a rapid, feasible and sensitive tool, useful to identify different profiles of cognitive-behavioural impairment in ALS.

Objective: The study presents data on the longitudinal administration of the Italian Edinburgh Cognitive and Behavioural ALS Screen (ECAS). We investigated cognitive-behavioural performance in a group of ALS patients over time and the feasibility of repeating the ECAS longitudinally compared to standard neuropsychological tests. Finally, correlations between clinical/genetic and cognitive/behavioural data were considered. Methods: 168 ALS patients were tested at baseline (T0). Among these, 48 patients performed the ECAS after 6 months (T1), 18 patients performed it at T2 (12 months) and 5 patients were assessed after 24 months (T3). Participants were also administered two cognitive test (FAB; MoCA) and psychological questionnaires (BDI; STAI/Y). The FBI was carried out with caregivers. Results: No cognitive deterioration was found across follow-ups. In contrast, although scores did not change between T0 and T1, scores improved significantly for ECAS Total/ALS Non-specific and Memory domains when the ECAS was repeated on three occasions (T0, T1, T2). Apathy/Inertia was the most common behavioural symptom, but no worsening of behavioural scores was detected over time. After 12–24 months, patients were still able to perform the ECAS in total, in contrast to FAB and MoCA, which were only partially administrable.Conclusions: The significant improvement of some ECAS scores over time supports the presence of possible practice effects, particularly in the memory domain, highlighting the need to accommodate for these in longitudinal assessments, through healthy controls groups or alternate versions. This work represents the first Italian ECAS follow-up study and confirms ECAS feasibility in patients with increasing physical disability.

We assessed language, attention, executive, and social cognition abilities in a sample of patients with Amyotrophic Lateral Sclerosis (ALS) by means of a recently developed cognitive battery based on oculomotor control with eye-tracking (ET) technology. Twenty-one ALS patients and 21 age- and education-matched healthy subjects underwent the ET-based cognitive assessment, together with the standard cognitive screening tools [Frontal Assessment Battery (FAB); Montreal Cognitive Assessment (MoCA); and Digit Sequencing Task]. Psychological measures of anxiety (State-Trait Anxiety Inventory-Y) and depression (Beck Depression Inventory) were also collected, and an ET usability questionnaire was administered. For patients, clinical and respiratory examinations were also performed, together with behavioural assessment (Frontal Behavioural Inventory). The developed battery discriminated among patients and controls with regard to measures of verbal fluency, frontal abilities, and social cognition. Measures of diagnostic utility confirmed a higher diagnostic accuracy of such ET-based tests with respect to FAB; similar diagnostic accuracy emerged when comparing them to the other standard cognitive tools (MoCA, WM). Usability ratings about the ET tests were comparable among the two groups. The ET-based neuropsychological battery demonstrated good levels of diagnostic accuracy and usability in a clinical population of non-demented ALS patients, compared to matched healthy controls. Future studies will be aimed at further investigate validity and usability components by recruiting larger sample of patients, both in moderate-to-severe stages of the disease and affected by more severe cognitive impairment.

Traditional cognitive assessment in neurological conditions involving physical disability is often prevented by the presence of verbal-motor impairment; to date, an extensive motor-verbal-free neuropsychological battery is not available for such purposes. We adapted a set of neuropsychological tests, assessing language, attentional abilities, executive functions and social cognition, for eye-tracking (ET) control, and explored its feasibility in a sample of healthy participants. Thirty healthy subjects performed a neuropsychological assessment, using an ET-based neuropsychological battery, together with standard "paper and pencil" cognitive measures for frontal (Frontal Assessment Battery-FAB) and working memory abilities (Digit Sequencing Task) and for global cognitive efficiency (Montreal Cognitive Assessment-MoCA). Psychological measures of anxiety (State-Trait Anxiety Inventory-Y-STAI-Y) and depression (Beck Depression Inventory-BDI) were also collected, and a usability questionnaire was administered. Significant correlations were observed between the "paper and pencil" screening of working memory abilities and the ET-based neuropsychological measures. The ET-based battery also correlated with the MoCA, while poor correlations were observed with the FAB. Usability aspects were found to be influenced by both working memory abilities and psychological components. The ET-based neuropsychological battery developed could provide an extensive assessment of cognitive functions, allowing participants to perform tasks independently from the integrity of motor or verbal channels. Further studies will be aimed at investigating validity and usability components in neurological populations with motor-verbal impairments.

La depressione negli anziani istituzionalizzati e una problematica particolarmente critica per le condizioni cliniche generali e la difficolta di relazione con questo tipo di pazienti. Il lavoro propone un intervento di psicoterapia di gruppo della durata di sei mesi a orientamento cognitivo-relazionale che, accanto ai tradizionali strumenti della terapia cognitiva, affianca un intervento sulla dimensione narrativa in relazione alle tematiche centrali nel lavoro con gli anziani come il rapporto con il corpo, le perdite, la dipendenza. Sono stati reclutati 34 pazienti con punteggio MMSE > 22 e GDS > 6 di cui 18 hanno completato il percorso di psicoterapia di gruppo e di cui e stata valutata la sintomatologia depressiva e l’assertivita all’inizio, a 1 e 3 mesi e alla fine dell’intervento. I risultati mostrano una riduzione significativa dei punteggi alla GDS e ai punteggi di disagio della SIB e un miglioramento delle capacita assertive e relazionali. Questi risultati preliminari suggeriscono che l’intervento di gruppo a orientamento cognitivo-relazionale rappresenta un intervento utile nel trattamento della depressione e si inserisce bene nel contesto delle strutture residenziali per anziani.

Il presente lavoro intende illustrare i principali approcci psicoterapici presenti, rivolti al trattamento del disagio psicologico nell’anziano. Dopo una breve presentazione della psicologia dell’invecchiamento, nella sua evoluzione storica tra miti e scienza, e della cornice teorica e storico-culturale in cui si inserisce la psicoterapia dell’anziano, vengono illustrate le caratteristiche del setting e delle modalita di intervento, nonche le evidenze sperimentali relative agli studi di efficacia, nei principali approcci della terapia psicodinamica, cognitivocomportamentale e cognitivo-costruttivista. Vengono inoltre brevemente descritti ulteriori approcci significativi di intervento clinico, quali la terapia interpersonale e la Mindfullness che hanno contribuito a realizzare adattamenti ai classici modelli di intervento per la cura dell’anziano, e la Life Review Therapy. Viene infine presentata una sintesi delle evidenze empiriche circa l’efficacia di alcuni approcci adattati a persone affette da declino cognitivo, presenti in quadri di Mild Cognitive Impairment o demenza, riportando tra questi un intervento specificatamente rivolto a persone affette da demenza di grado moderato-severo, quale la Doll Therapy. Dai lavori descritti emerge un quadro complesso ed articolato, dal quale si evince l’esigenza, trasversale ai diversi approcci, di adattare gli interventi psicoterapici alle caratteristiche peculiari ed ai bisogni specifici della persona anziana, al fine di valorizzarne risorse e potenzialita.

Background and objective The presence of executive deficits in patients with Amyotrophic Lateral Sclerosis is well established, even if standardized measures are difficult to obtain due to progressive physical disability of the patients. We present clinical data concerning a newly developed measure of cognitive flexibility, administered by means of Eye-Tracking (ET) technology in order to bypass verbal-motor limitations. Methods 21 ALS patients and 21 age-and education-matched healthy subjects participated in an ET-based cognitive assessment, including a newly developed test of cognitive flexibility (Arrows and Colors Cognitive Test–ACCT) and other oculomotor-driven measures of cognitive functions. A standard screening of frontal and working memory abilities and global cognitive efficiency was administered to all subjects, in addition to a psychological self-rated assessment. For ALS patients, a clinical examination was also performed. Results ACCT successfully discriminated between patients and healthy controls, mainly concerning execution times obtained at different subtests. A qualitative analysis performed on error distributions in patients highlighted a lower prevalence of perseverative errors, with respect to other type of errors. Correlations between ACCT and other ET-based frontal-executive measures were significant and involved different frontal sub-domains. Limited correlations were observed between ACCT and standard ‘paper and pencil’ cognitive tests. Conclusions The newly developed ET-based measure of cognitive flexibility could be a useful tool to detect slight frontal impairments in non-demented ALS patients by bypassing verbal-motor limitations through the oculomotor-driven administration. The findings reported in the present study represent the first contribution towards the development of a full verbal-motor free executive test for ALS patients.

Background and Objective: Counterfactual thinking (CFT) refers to the generation of mental simulations of alternatives to past events, actions and outcomes. CFT is a pervasive cognitive feature in every-day life and is closely related to decision-making, planning and problem-solving - all of which are cognitive processes linked to unimpaired frontal lobe functioning. Huntington's Disease (HD) is a neurodegenerative disorder characterised by motor, behavioral and cognitive dysfunctions. Because an impairment in frontal and executive functions has been described in HD, we hypothesised that HD patients may have a CFT impairment. Methods: Tests of spontaneous counterfactual thoughts and counterfactual-derived inferences were administered to 24 symptomatic HD patients and 24 age- and sex-matched healthy subjects. Results: Our results show a significant impairment in the spontaneous generation of CFT and low performance on the Counterfactual Inference Test (CIT) in HD patients. Low performance on the spontaneous CFT test significantly correlates with impaired attention abilities, verbal fluency and frontal lobe efficiency, as measured by Trail Making Test - Part A, Phonemic Verbal Fluency Test and FAB. Conclusions: Spontaneous CFT and the use of this type of reasoning are impaired in HD patients. This deficit may be related to frontal lobe dysfunction, which is a hallmark of HD. Because CFT has a pervasive role in patients' daily lives regarding their planning, decision making and problem solving skills, cognitive rehabilitation may improve HD patients' ability to analyse current behaviors and future actions.

To investigate the use of P300-based Brain Computer Interface (BCI) technology for the administration of motor-verbal free cognitive tests in Amyotrophic Lateral Sclerosis (ALS).We recruited 15 ALS patients and 15 age- and education-matched healthy subjects. All participants underwent a BCI-based neuropsychological assessment, together with two standard cognitive screening tools (FAB, MoCA), two psychological questionnaires (BDI, STAI-Y) and a usability questionnaire. For patients, clinical and respiratory examinations were also performed, together with a behavioural assessment (FBI).Correlations were observed between standard cognitive and BCI-based neuropsychological assessment, mainly concerning execution times in the ALS group. Moreover, patients provided positive rates concerning the BCI perceived usability and subjective experience. Finally, execution times at the BCI-based neuropsychological assessment were useful to discriminate patients from controls, with patients achieving lower processing speed than controls regarding executive functions.The developed motor-verbal free neuropsychological battery represents an innovative approach, that could provide relevant information for clinical practice and ethical issues. Its use for cognitive evaluation throughout the course of ALS, currently not available by means of standard assessment, must be addressed in further longitudinal validation studies. Further work will be aimed at refining the developed system and enlarging the cognitive spectrum investigated.

An extensive duct acoustics propagation study is presented that has been conducted to assess the design of a liner for an aeroengine inlet duct. The aim is to predict how different liner configuarations, at various flight conditions affect the attenuation of sound in an inlet. Two different noise source models are used: single mode and multimode. These represent the two principal fan noise sources: tonal and broadband noise. The two noise source models are then combined to predict the overall attenuation. An optimization procedure based on a response surface model is presented, to investigate a uniform and an axially segmented acoustic liner. The objective function used in the optimization is based on an approximate calculation of the perceived noise level. The aim is to utilize and axially segmented liner to increase, compared to a unifrom liner, the overall sound attenuation that is predicted. The main feature that emerges is that it is possible to increase the attenuation with an axially segmented liner only when a limited number of propagating modes are present.

This article describes research to improve the practice of organizational affiliation in community health improvement efforts. The model brings together systems and institutional theories to study affiliation as an organizational issue, along with the relevant public health literature. It was tested against practice in two sites and revised to reflect feedback from research participants that was confirmed in the literature. Case studies describe how each site adopted a form of affiliation other than partnership. Lessons learned included the importance of marrying public health research with the management and organization development literature for the study of organizational affiliation, the need for flexibility in developing a model to address organizational affiliation, and the need for local ownership to ensure maximum benefit. Recommendations include further research to refine elements of the model and a ‘partnership’ of practitioners, researchers, and funding agencies to use the model in feasibility and evaluation studies of affiliation efforts.

The main object of this thesis is to investigate acoustic lining in turbofan ducts which have optimal attenuation for a tonal and broadband noise sources. Liner attenuation is necessary in modern turbofan engines. There are several techniques for achieving increased attenuation with acoustic liners. Thisstudy concentrated on two-dimensional and three-dimensional piecewise liner distribution simulated with an advanced acoustic models in which the nacelle geometry is kept unchanged while the liner characteristics are tuned to optimum values. Two computational acoustic prediction codes are used. First a semi-analytic method based on a modal representation of the pressure field to propagate sound in a circular duct is used. Then a more realistic geometry is examined with a spectral/finite element method. The code presented allows the treatment of non-axisymmetric nacelles by combining a standard bi-quadratic approximation in the axial and radial directions, with a spectral representation in the circumferential direction.The aim is to predict how different liner configurations, at various flight conditions, affect the attenuation of sound within an inlet. Two different noise models are used: single-mode and multimode. These represent the two principal fan noise sources: tonal and broadband noise. A robust and consistent optimization procedure based on a Response Surface Model and formal design of experiment methods is built and used. The optimization problems presented are demanding in terms of computer resources, number of variables, optimization convergence and acoustic modeling. In order to allowefficient use of computational resources and effective management of the results the design optimization makes use of Grid computing technology within the Geodise environment. The use of these various techniques in combination makes possible improvements of liner designs with more realistic geometries at modest computational cost. The main feature that emerges from the current study is that it is possible to predict and optimize turbofan liner characteristics in terms of impedance and geometrical distribution to attenuate the noiseemission. One of the main indication drawn from this study is the important reduction in terms of fan sound emission when a piecewise azimuthal liner variation is optimized.