San Camillo IRCCS di Venezia

The planning of sample size for research studies often focuses on obtaining a significant result given a specified level of power, significance, and an anticipated effect size. This planning requires prior knowledge of the study design and a statistical analysis to calculate the proposed sample size. However, there may not be one specific testable analysis from which to derive power (Silberzahn et al., Advances in Methods and Practices in Psychological Science, 1(3), 337356, 2018) or a hypothesis to test for the project (e.g., creation of a stimuli database). Modern power and sample size planning suggestions include accuracy in parameter estimation (AIPE, Kelley, Behavior Research Methods, 39(4), 755–766, 2007; Maxell et al., Annual Review of Psychology, 59, 537–563, 2008) and simulation of proposed analyses (Chalmers & Adkins, The Quantitative Methods for Psychology, 16(4), 248–280, 2020). These toolkits offer flexibility in traditional power analyses that focus on the if-this, then-that approach. However, both AIPE and simulation require either a specific parameter (e.g., mean, effect size, etc.) or a statistical test for planning sample size. In this tutorial, we explore how AIPE and simulation approaches can be combined to accommodate studies that may not have a specific hypothesis test or wish to account for the potential of a multiverse of analyses. Specifically, we focus on studies that use multiple items and suggest that sample sizes can be planned to measure those items adequately and precisely, regardless of the statistical test. This tutorial also provides multiple code vignettes and package functionality that researchers can adapt and apply to their own measures.

BACKGROUND Existing clinical tools do not comprehensively assess gait patterns in patients with multiple sclerosis (MS) across all planes or account for spatiotemporal and kinematic parameters. This study investigated the feasibility of the Wisconsin Gait Scale (WGS), originally designed to evaluate hemiparetic gait after stroke, in individuals with the spastic hemiplegic subtype of MS. MATERIAL AND METHODS The study included 30 patients with the spastic hemiplegic subtype of MS. The WGS-based assessment of participants' gait was performed twice, by 3 independent raters. The results of the 2 measurements reported by the 3 raters were compared to determine intra-rater and inter-rater reliability. The WGS scores were also compared with results of clinical tools: the 10-Meter Walk Test, the 2-Minute Walk Test, and the Timed Up and Go Test, to determine the concurrent criterion validity of the WGS. RESULTS A comparison of the scores assigned by the same rater during measurement 1 and measurement 2 showed excellent agreement in each case, with intraclass correlation coefficients (ICCs) equal to or higher than 0.991. Likewise, there was excellent agreement between the scores awarded by the 3 raters, both in measurement 1 and measurement 2, with ICCs of 0.988 and 0.978, respectively. The analyses showed very strong and significant correlations (P<0.001) between the mean scores in the WGS and all the clinical tests applied in this study to assess gait. CONCLUSIONS The findings show excellent intra-rater and inter-rater reliability and confirm the concurrent criterion validity of the WGS in patients with hemiplegic MS.

Tele-neuropsychology (t-NP) is defined "as the application of audiovisual technologies to enable remote clinical encounters with patients to conduct neuropsychological assessments" (Bilder et al., 2020, p. 648; through the Inter Organizational Practice Committee, IOPC). t-NP has emerged as a critical area of research particularly during the COVID-19 pandemic, when the need for remote cognitive assessment and intervention became evident, as a result of social distancing measures.Recent reviews and meta-analyses have provided support for the diagnostic applicability of t-NP when compared to face-to-face modality (Marra et al., 2020;Alva et al., 2025; see also Sperling et al., 2024), demonstrating the feasibility of t-NP as a viable form of healthcare delivery and offering an alternative to traditional in-person evaluations. However, some limitations including the study publication bias, as well as technical and digital literacy issues were outlined, and additional research on administration modifications to standardize practice is encouraged. Furthermore, telephone-based cognitive screening (e.g., Montemurro et al., 2023) and web-based computerized testing platforms have been considered as a remote alternative to administering conventional "paper and pencil" tests (e.g., Tsiaras et al., 2024, see Bonvino et al., 2025, for a systematic review and meta-analysis). These tools are not intended as a stand-alone or adjunctive diagnostic device, but can represent a screening phase to identify persons who require a more indepth clinical assessment (e.g., comprehensive neuropsychological evaluation). This special issue aimed to foster research about the applications of telehealth in the field of neuropsychological assessment and cognitive intervention. It welcomed studies that evaluated the reliability of tele-administered neuropsychological tests compared to the face-to-face counterparts, collected normative data for tele-and web-administered versions of neuropsychological tools, and proposed remote rehabilitation protocols. It covered the areas of both assessment and intervention, as well as different technologies and types of digital support.In the context of cognitive assessment, three papers in the current issue describe studies that provide new reliability and/or validity, or normative data for remote self-administered digital screening in adults. This type of screening increases the number of people who can be easily reached, including elderly populations, individuals with mobility limitations, or those living in remote and/or geographically disadvantaged areas. In particular, the contribution of Giaquinto and colleagues provided normative data in the Italian population for a brief computer-based global cognitive assessment, the Self-Administered Tasks Uncovering Risk of Neurodegeneration (SATURN). The open-source test investigates several cognitive domains such as memory, attention, temporal orientation, visuo-constructional abilities, calculation, executive functions, and reading speed. The results support the tool's suitability for self-and remote administration and convergent validity on normative samples. In a similar vein, Huynh and colleagues highlighted the potential of remote digital cognitive testing as an efficient and cost-effective solution for cognitive screening of people who, for socio-economic or situational reasons, are struggling to access primary care services. The group reported initial evidence on the feasibility and reliability of the BrainCheck, a platform for cognitive assessment in English, that can be remotely self-administered using different devices (smartphone, tablet, laptop). Although remote and self-administered testing may introduce greater variability due to uncontrolled factors in the testing environment, moderate to good agreement between self-and research coordinator-administered versions was found, supporting the feasibility of the tool for remote screening in the healthy population. Finally, Livoti and colleagues demonstrated the feasibility of web-based testing of age-related changes in multitasking abilities. The self-administered battery consists of three dual-tasks that allow for the assessment of age-related trajectories in dual-task costs, particularly relevant in everyday life contexts across the adult lifespan, as well as the early detection of cognitive impairments.The results from these studies provide evidence to support the integration of self-administered remote screening tools into clinical workflows to optimize cognitive health outcomes.Alongside the typical neuropsychological screening and assessment approaches, the contribution by Henneghan and colleagues expanded the ways in which digital tools can be applied by using a cognitive ecological momentary assessment (EMA) methodology. EMA protocols include daily or almost daily evaluation of subjective and objective cognitive functioning in the natural environment, This special issue brings together various lines of evidence on the applicability of t-NP within diagnostic and intervention pathways, particularly for individuals who are difficult to reach due to logistical barriers, as well as its potential use as a general screening tool integrated into routine clinical practice.

Radiation therapy is a widely used and effective treatment for various types of cancer; however, it is associated with several side effects, including an increased risk of cardiovascular disease. While the molecular mechanisms underlying RT-induced cardiovascular damage remain unclear, the NLRP3 inflammasome has emerged as a central player in its pathogenesis. This review focuses on the current understanding of the involvement of NLRP3 in radiation-induced cardiotoxicity, highlighting emerging evidence reported in the literature. Recent findings shown that the NLRP3 inflammasome may play a role in radiation-induced cardiovascular diseases, drawing attention to it as a potential therapeutic target. We summarize key findings on the role of radiation in modulating the NLRP3 inflammasome and inducing cardiovascular disease, providing a detailed overview of NLRP3 inflammasome functions in different radiation-induced cardiovascular diseases. Moreover, we discuss the therapeutic potential of targeting NLRP3 to prevent radiation-induced cardiovascular diseases. The development of effective treatments for radiotherapy-induced cardiotoxicity is becoming increasingly urgent and understanding NLRP3-dependent mechanisms could pave the way for innovative therapeutic approaches.

BackgroundMarked increases in mental health services utilisation across university settings mean that students often spend long periods waiting for evaluation and treatment.AimsTo assess whether digital unguided self-help delivered while waiting for face-to-face therapy could reduce anxiety and depression and improve functioning in university students.MethodWe retrospectively analysed routinely collected data from the student mental health service at the University of Padua, Italy. From June 2022, all students waiting for clinical evaluation and treatment received a self-help stress management booklet (The World Health Organization’s Doing What Matters in Time of Stress (DWM)). The clinical evaluation included depression (Patient Health Questionnaire-9), anxiety (Generalised Anxiety Disorder-7) and functional impairment (Work and Social Adjustment Scale). Single-group interrupted time series (ITS) analyses compared outcomes in users contacting the service between October 2021 and 23 June 2022 (pre-intervention) and, respectively, between 24 June 2022 and 18 November 2023 (post-intervention).ResultsSeven hundred and forty-nine Italian students (77% women, median age 23 years) were included; of these, 411 (55%) received the intervention and 338 (45%) did not. ITS indicated that the intervention introduction coincided with immediate and sharp decreases in depression (level change, β = −2.26, 95% CI −3.89, −0.64), anxiety (β = −1.50, 95% CI −3.89, −0.65) and impaired functioning (β = −2.66, 95% CI −4.64, −0.60), all largely maintained over time.ConclusionsIn the absence of a control group, no causal inferences about intervention effects could be drawn. DWM should be studied as a promising candidate for bridging waiting time for face-to-face treatment.

Background/Objectives: Mental health and emotional well-being are critical yet often overlooked in older adults. Immersive virtual reality (VR) may offer novel strategies for promoting relaxation in this population, but the diversity of intervention designs and underlying mechanisms remains insufficiently mapped. This scoping review aimed to systematically examine head-mounted display (HMD) VR interventions for relaxation in older adults, focusing on core scenarios, mechanisms, and conceptual paradigms. Methods: Following the JBI Manual for Evidence Synthesis and PRISMA-ScR guidelines, comprehensive searches of MEDLINE, Cochrane Library, Web of Science, and Scopus were conducted for empirical studies of HMD-based VR relaxation interventions in adults aged 60 and older. Data on study characteristics, hardware, intervention scenarios, and reported physiological and psychological mechanisms were extracted and categorized into conceptual paradigms. Results: Twenty-four studies were included, covering diverse clinical and community samples. Four main VR relaxation paradigms emerged: environmental relaxation, guided meditation, psychotherapy integration, and interactive gamified relaxation. Reported mechanisms included parasympathetic activation, multisensory immersion, attentional distraction, positive affect induction, mindfulness, cognitive engagement, and reminiscence activation. Considerable heterogeneity was found in intervention design and outcomes, with mechanisms often inferred rather than directly described. Conclusions: Similar relaxation mechanisms were engaged across paradigms, including hybrid interventions combining multiple approaches, highlighting the adaptability of VR to meet diverse needs. Identifying these four paradigms provides a foundation for future research and development of targeted VR-based relaxation for older adults. Further studies should clarify mechanisms, use standardized physiological outcome measures, and assess long-term benefits of VR relaxation interventions in geriatric populations.

Chronic kidney disease, diabetes mellitus and heart failure represent three chronic conditions closely linked to each other from a pathophysiological and prognostic point of view. This link has led to an ever-increasing emphasis in recent years on the need for a holistic approach to patients who are affected by optimizing the therapeutic management of what has recently been defined as cardio-kidney-metabolic syndrome. The cardiorenal and metabolic approach has gained relevance thanks to recent studies on new drug classes. Initially in diabetic patients and later in those suffering from heart failure and chronic kidney disease, these new drugs have demonstrated their effectiveness in reducing cardiovascular risk, the progression of heart failure and chronic kidney disease. This review aims to address the main pharmacological aspects of two of these new classes, that of sodium-glucose co-transporter 2 inhibitors and the more recent one of non-steroidal mineralocorticoid receptor antagonists.

Background/Objectives: Depression, anxiety and apathy are often associated with subjective cognitive complaints (SCCs) in people with Parkinson’s disease (PwPD) without cognitive impairment. Cognitive reserve (CR) enhances emotional resilience, allowing people to better cope with stress and emotional challenges, factors affecting quality of life. We aimed to explore the relationship between CR and mood/anxiety in cognitively intact PwPD with and without SCCs. Methods: In this cross-sectional study we enrolled 133 PwPD and normal cognitive function (age 59.8 ± 6.7 years; disease duration 9.0 ± 5.5 years; male/female 84/49). We assessed cognitive reserve (CR scale), subjective cognitive complaints (with PD-CFRS), QoL (PDQ8), mood, anxiety and apathy (BDI-II; STAI, PAS, Apathy scales). We used a t-test to compare groups (with/without SCC; M/F); correlations and moderation analysis to evaluate the relation between CR and behavioral features and the interplay between CR, behavioral discomfort and QoL. Results: The group with SCCs had significantly (p < 0.05) higher scores in PDQ8, Apathy, STAI, PAS-C and BDI-II scales than those with no SCCs. Males with SCCs had higher scores in PDQ8, Apathy scale and BDI-II while females differed in PDQ8 and Apathy scale scores. In the SCC group, late-life CR was negatively correlated with PAS-C (avoidance behavior) and BDI-II; correlations were confirmed in the male group where CR also correlated with PDQ-8 and PAS persistent anxiety. Conclusions: PwPD and SCCs are more depressed and anxious compared to people without SCCs. Furthermore, we found a relationship between depressive symptoms, anxiety and CR: PwPD with SCCs may rely on cognitive reserve to better cope with the feeling of anxiety and depression, especially in male gender.