397 research outputs found

    Determinants of out-of-hours service users' potentially inappropriate referral or non-referral to an emergency department: a retrospective cohort study in a local health authority, Veneto Region, Italy

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    BACKGROUND: A growing presence of inappropriate patients has been recognised as one of the main factors influencing emergency department (ED) overcrowding, which is a very widespread problem all over the world. On the other hand, out-of-hours (OOH) physicians must avoid delaying the diagnostic and therapeutic course of patients with urgent medical conditions. The aim of this study was to analyse the appropriateness of patient management by OOH services, in terms of their potentially inappropriate referral or non-referral of non-emergency cases to the ED. METHODS: This was an observational retrospective cohort study based on data collected in 2011 by the local health authority No. 4 in the Veneto Region (Italy). After distinguishing between patients contacting the OOH service who were or were not referred to the ED, and checking for patients actually presenting to the ED within 24\u2005hours thereafter, these patients' medical management was judged as potentially appropriate or inappropriate. RESULTS: The analysis considered 22\u2005662 OOH service contacts recorded in 2011. The cases of potentially inappropriate non-referral to the ED were 392 (1.7% of all contacts), as opposed to 1207 potentially inappropriate referrals (5.3% of all contacts). Age, nationality, type of disease and type of intervention by the OOH service were the main variables associated with the appropriateness of patient management. CONCLUSIONS: These findings may be useful for pinpointing the factors associated with a potentially inappropriate patient management by OOH services and thus contribute to improving the deployment of healthcare and the quality of care delivered by OOH services

    Scelte ottimizzate di trattamento termico nel rispetto di Sicurezza ed Ambiente

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    Il processo di fabbricazione di un componente forgiato, fuso o laminato in acciaio speciale vede come fasedeterminante, nel suo percorso tecnologico, necessario per l’ottenimento delle caratteristiche di impiegorichieste, il trattamento termico: infatti, per fare estrinsecare ad un acciaio le caratteristiche ottimali richieste, ènecessario effettuare un mirato trattamento termico, nel rispetto di parametri principali molto selettivi, definitidal progettista e produttore del componente stesso. Gli aspetti per il miglioramento continuo del prodotto e delprocesso di trattamento termico devono essere affrontate in sicurezza e nel rispetto dell’ambiente: è questo unaspetto culturale ed etico, che non deve restare un fatto teorico, ma deve trasformarsi in competenza eprevenzione sui rischi e sulle misure, da attuare sugli impianti e da comunicare e monitorare con continuità. Lamemoria propone una comparazione dei vantaggi e svantaggi nella gestione del processo di tempra, con utilizzodi differenti mezzi di spegnimento quali acqua, fluidi interi base olio e soluzioni sintetiche polimeriche, intermini qualitativi, ambientali e di sicurezza. Segue poi una sintesi delle esperienze condotte da Lucchini RSnell’applicazione di tecnologie di trattamento termico con soluzioni polimeriche Houghton (Aqua-Quench),“spray cooling” e “rim chilling”, affrontate in sicurezza e nel rispetto dell’ambiente

    Development of Quantum Dot (QD) Based Color Converters for Multicolor Display.

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    Many displays involve the use of color conversion layers. QDs are attractive candidates as color converters because of their easy processability, tuneable optical properties, high photoluminescence quantum yield, and good stability. Here, we show that emissive QDs with narrow emission range can be made in-situ in a polymer matrix, with properties useful for color conversion. This was achieved by blending the blue-emitting pyridine based polymer with a cadmium selenide precursor and baking their films at different temperatures. To achieve efficient color conversion, blend ratio and baking temperature/time were varied. We found that thermal decomposition of the precursor leads to highly emissive QDs whose final size and emission can be controlled using baking temperature/time. The formation of the QDs inside the polymer matrix was confirmed through morphological studies using atomic force microscopy (AFM) and transmission electron microscopy (TEM). Hence, our approach provides a cost-effective route to making highly emissive color converters for multi-color displays

    Olfactory neuroepithelium alterations and cognitive correlates in schizophrenia

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    BACKGROUND: Few studies have investigated alterations of olfactory neuroepithelium (ONE) as a biomarker of schizophrenia, and none its association with cognitive functioning. METHOD: Fresh ONE cells from twelve patients with schizophrenia and thirteen healthy controls were collected by nasal brushing, cultured in proper media and passed twelve times. Markers of cell proliferation (BrdU incorporation, Cyclin-D1 and p21 protein level) were quantified.Cognitive function was measured using Brief Neuropsychological Examination-2. PRIMARY OUTCOME: proliferation of ONE cells from schizophrenic patients at passage 3. Secondary outcome: association between alteration of cell proliferation and cognitive function. RESULTS: Fresh ONE cells from patients showed a faster cell proliferation than those from healthy controls at passage 3. An opposite trend was observed at passage 9, ONE cells of patients with schizophrenia showing slower cell proliferation as compared to healthy controls. In schizophrenia, overall cognitive function (Spearman's rho -0.657, p\u202f<\u202f0.01), verbal memory - immediate recall, with interference at 10\u202fs and 30\u202fs (Spearman's rho from -0.676 to 0.697, all p\u202f<\u202f0.01) were inversely associated with cell proliferation at passage 3. CONCLUSION: Fresh ONE cells collected by nasal brushing might eventually represent a tool for diagnosing schizophrenia based upon markers of cell proliferation, which can be easily implemented as single-layer culture. Cell proliferation at passage 3 can be regarded as a promising proxy of cognitive functioning in schizophrenia. Future studies should replicate these findings, and may assess whether ONE alterations are there before onset of psychosis, serving as an early sign in patients with at risk mental state

    Oenological characterisation of indigenous strains of S. cerevisiae isolated in a biodynamic winery in the Cortona DOC area

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    Genotypic and technological characterisation of the S. cerevisiae population isolated in a biodynamic winery in the Cortona DOC area was performed to gain better knowledge of the variables that influence winemaking. The oenological performance of 11 S. cerevisiae strains was evaluated with physiological tests; strain typing was performed through analysis of interdelta sequences and 26S rDNA sequencing. The analysis revealed a remarkable variability in terms of S. cerevisiae strains, despite the homogeneity of wine features, underlining the high levels of biodiversity characterising biodynamic agriculture. Some strains were found in wines of different vintages, suggesting the presence of an established microbiota in the winery. Oenological tests demonstrated that while some yeasts provided reliable oenological performance, other strains were not able to accomplish prompt and effective alcoholic fermentation, or were characterised by spoilage characteristics, such as excessive production of volatile phenols or acetic acid. Indigenous strains of S. cerevisiae could be a useful instrument for reliable winemaking without altering the native microbiota of each oenological environment. However, characterisation of their oenological suitability, and the application of practices able to drive the evolution of microbiota, must be employed to reduce the risk of wine spoilage

    Changes of consultation-liaison psychiatry practice in Italian general hospitals: A comparative 20-year multicenter study

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    Introduction: Conducted under the auspices of the Italian Society of Consultation Liaison Psychiatry (SIPC) the aim of this study was to describe the characteristics of Consultation Liaison Psychiatry (CLP) activity in Italy (SIPC-2—2018) over the past 20 years by comparing with data from the first Italian nation-wide study (SIPC-1—1998). Methods: We collected data on CLP visits of 3,943 patients from 10 Italian hospitals over a period of 1 year. Data were compared with those from the SIPC-1 1998 study (4,183 participants). Patients were assessed with the same ad hoc 60-item Patient Registration Form recording information from five different areas: Sociodemographic, hospitalization-related, consultation-related, interventions and outcome. Results: Compared with participants from the previous study, SIPC-2-2018 participants were significantly older (d = 0.54) and hospitalized for a longer duration (d = 0.20). The current study detected an increase in the proportion of referrals from surgical wards and for individuals affected by onco-hematologic diseases. Depressive disorders still represented the most frequent psychiatric diagnosis, followed by adjustment and stress disorders and delirium/dementia. Also, CLP psychiatrists prescribed more often antidepressants (Φ = 0.13), antipsychotics (Φ = 0.09), mood stabilizers (Φ = 0.24), and less often benzodiazepines (Φ = 0.07). Conclusion: CLP workload has increased considerably in the past 20 years in Italy, with changes in patient demographic and clinical characteristics. A trend toward increase in medication-based patient management was observed. These findings suggest that the psychiatric needs of patients admitted to the general hospital are more frequently addressed by referring physicians, although Italian CLP services still deserve better organization and autonomy

    Task-Dependent Individual Differences in Prefrontal Connectivity

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    Recent advances in neuroimaging have permitted testing of hypotheses regarding the neural bases of individual differences, but this burgeoning literature has been characterized by inconsistent results. To test the hypothesis that differences in task demands could contribute to between-study variability in brain-behavior relationships, we had participants perform 2 tasks that varied in the extent of cognitive involvement. We examined connectivity between brain regions during a low-demand vigilance task and a higher-demand digit–symbol visual search task using Granger causality analysis (GCA). Our results showed 1) Significant differences in numbers of frontoparietal connections between low- and high-demand tasks 2) that GCA can detect activity changes that correspond with task-demand changes, and 3) faster participants showed more vigilance-related activity than slower participants, but less visual-search activity. These results suggest that relatively low-demand cognitive performance depends on spontaneous bidirectionally fluctuating network activity, whereas high-demand performance depends on a limited, unidirectional network. The nature of brain-behavior relationships may vary depending on the extent of cognitive demand. High-demand network activity may reflect the extent to which individuals require top-down executive guidance of behavior for successful task performance. Low-demand network activity may reflect task- and performance monitoring that minimizes executive requirements for guidance of behavior

    Meniscal T1rho and T2 measured with 3.0T MRI increases directly after running a marathon

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    PURPOSE: To prospectively evaluate changes in T1rho and T2 relaxation time in the meniscus using 3.0 T MRI in asymptomatic knees of marathon runners and to compare these findings with those of age-matched healthy subjects. MATERIAL AND METHODS: Thirteen marathon runners underwent 3.0 T MRI including T1rho and T2 mapping sequences before, 48-72 h after, and 3 months after competition. Ten controls were examined at baseline and after 3 months. All images were analyzed by two musculoskeletal radiologists identifying and grading cartilage, meniscal, ligamentous. and other knee abnormalities with WORMS scores. Meniscal segmentation was performed to generate T1rho and T2 maps in six compartments. RESULTS: No differences in morphological knee abnormalities were found before and after the marathon. However, all marathon runners showed a significant increase in T1rho and T2 values after competition in all meniscus compartments (p &lt; 0.0001), which may indicate changes in the biochemical composition of meniscal tissue. While T2 values decreased after 3 months T1rho values remained at a high level, indicating persisting changes in the meniscal matrix composition after a marathon. CONCLUSION: T2 values in menisci have the potential to be used as biomarkers for identifying reversible meniscus matrix changes indicating potential tissue damage. T1rho values need further study, but may be a valuable marker for diagnosing early, degenerative changes in the menisci following exercise
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