Lean-ing method in an emergency department of the italian epicenter of the covid-19 outbreak: When the algorithm makes difference

The Lean method entails a set of standardized processes intending to optimize resources, reduce waste, and improve results. Lean has been proposed as an operative model for the Covid-19 outbreak. Herein, we summarized data resulted from the Lean model adoption in an Emergency Department of the Lombardy region, the Italian epicenter of the pandemic, to critically appraise its effectiveness and feasibility. The Lean algorithm was applied in the Humanitas Clinical and Research Hospital, Milan, north of Italy. At admission, patients underwent outdoor pre-triage for fe-ver, respiratory, and gastrointestinal symptoms, with a focus on SpO2. Based on these data, they were directed to the most appropriate area for the Covid-19 first-level screening. High-risk patients were assisted by trained staff for second-level screening and planning of treatment. Out of 7.778 patients, 21.9% were suspected of SARS-CoV-2 infection. Mortality was 21.9% and the infection rate in health workers was 4.8%. The lean model has proved to be effective in optimizing the overall management of Covid-19 patients in an emergency setting. It allowed for screening of a large volume of patients, while also limiting the health workers’ infection rate. Further studies are necessary to validate the suggested approach

PULSE-SHAPE DISCRIMINATION OF LIQUID SCINTILLATORS

In this paper we describe the results of different techniques applied to characterize experimentally the pulse shape discrimination capability of liquid scintillators. A detailed comparison of the results obtained with each method is reported, together with the description of an optimization strategy which can be adopted to obtain the best exploitation of the intrinsic PSD feature of the scintillator samples

Le nouveau cirque américain

On peut dire que depuis ses débuts, vers les 1870, le cirque américain a connu des périodes où il aspirait au grand art et où il empruntait au théâtre des artistes, des techniques et la dramaturgie. Ce n’est qu’en 1975, lorsque des artistes ont abandonné l’idéal américain de la grandeur pour adopter le modèle européen de la piste simple que ce mouvement a connu son véritable essor. Le Big Apple Circus, le Pickle Family Circus, le Cirque du Soleil et Circus Flora ont réussi à théâtralisé le cirque américain. Même le géant du cirque à trois pistes, le Ringling Bros. and Barnum & Bailey, a commencé à donner à ses spectacles une allure plus théâtrale. Le Midnight Circus, Circus Sarasota ainsi que Barnum’s Kaleidoscape, entre autres, ont continué à trouver de nouvelles façons d’allier le cirque et le théâtre. Des écoles de cirque ont été fondées afin de fournir aux nouveaux cirques des artistes formés aux nouvelles techniques. Tous visent à faire évoluer le cirque vers la forme d’art à laquelle il a toujours aspiré.Almost from its very beginning, in the 1870's, the American circus has gone through periods when it aspired to high art and borrowed artists, techniques and dramaturgy from the theatre. It was not until 1975, when certain artists abandoned the all-American ideal that bigger was always better and opted, instead, to model their new circuses after the European model of the one ring circus, that this movement began to gain momentum. The Big Apple Circus, The Pickle Family Circus, Cirque du Soleil, and Circus Flora were leaders in the movement to theatricalize the American circus. Eventually even the three-ring giant, Ringling Bros. and Barnum & Bailey, began to refashion its performance in a more theatrical manner. These early circuses were followed by the Midnight Circus, Circus Sarasota and Barnum's Kaleidoscape, among others, which continued to find new ways of melding circus and theatre. To provide performing artists for these new circuses, new circus schools had to be founded to train the artists in the new style and technique demanded by the new circuses. Together the artists and the various circuses are seeking to have the circus evolve into the unique art form it has always hoped to be

Postambulatory Hand Swelling (Big Hand Syndrome): Prevalence, Demographics, and Association with Dog Walking

Introduction. Postambulatory hand swelling (PAHS) seems to be common in the general population. There are few mention in the medical literature. The objective were (1) to identify prevalence; (2) to compare gender and age groups; (3) to determine if dog owners and walkers are more or less prone. Materials and Methods. 1009 semirandomly surveys were completed from walkers. Age, gender, and dog ownership were assessed. We discussed, among dog owners, whether or not they walk their dog regularly, whether or not they notice swollen hands after walking, and, if so, if the swelling resolves over 24 hours or persists. Results. 699 females and 410 males, among whom, 28.9% of females but only 16.3% of males reported PAHS (P < 0.001). Surprisingly, those with swelling were statistically younger than those without (49.2 versus 52.8 years, P = 0.003), and dog owners were more likely than nonowners to report swelling (28.1% versus 21.7%; P = 0.015). In terms of persistent swelling, this was observed in twice the percentage of females as males (13.3 versus 6.5%) and tended to involve older subjects (54.0 versus 48.8 years), but with no statistical difference significance. Conclusions. PAHS is a relatively common phenomenon, seemingly more common in females

The Borexino Thermal Monitoring & Management System and simulations of the fluid-dynamics of the Borexino detector under asymmetrical, changing boundary conditions

A comprehensive monitoring system for the thermal environment inside the Borexino neutrino detector was developed and installed in order to reduce uncertainties in determining temperatures throughout the detector. A complementary thermal management system limits undesirable thermal couplings between the environment and Borexino's active sections. This strategy is bringing improved radioactive background conditions to the region of interest for the physics signal thanks to reduced fluid mixing induced in the liquid scintillator. Although fluid-dynamical equilibrium has not yet been fully reached, and thermal fine-tuning is possible, the system has proven extremely effective at stabilizing the detector's thermal conditions while offering precise insights into its mechanisms of internal thermal transport. Furthermore, a Computational Fluid-Dynamics analysis has been performed, based on the empirical measurements provided by the thermal monitoring system, and providing information into present and future thermal trends. A two-dimensional modeling approach was implemented in order to achieve a proper understanding of the thermal and fluid-dynamics in Borexino. It was optimized for different regions and periods of interest, focusing on the most critical effects that were identified as influencing background concentrations. Literature experimental case studies were reproduced to benchmark the method and settings, and a Borexino-specific benchmark was implemented in order to validate the modeling approach for thermal transport. Finally, fully-convective models were applied to understand general and specific fluid motions impacting the detector's Active Volume.Comment: arXiv admin note: substantial text overlap with arXiv:1705.09078, arXiv:1705.0965

Relevance of brain lesion location to cognition in relapsing multiple sclerosis

OBJECTIVE: To assess the relationship between cognition and brain white matter (WM) lesion distribution and frequency in patients with relapsing-remitting multiple sclerosis (RR MS). METHODS: MRI-based T2 lesion probability map (LPM) was used to assess the relevance of brain lesion location for cognitive impairment in a group of 142 consecutive patients with RRMS. Significance of voxelwise analyses was p<0.05, cluster-corrected for multiple comparisons. The Rao Brief Repeatable Battery was administered at the time of brain MRI to categorize the MS population into cognitively preserved (CP) and cognitively impaired (CI). RESULTS: Out of 142 RRMS, 106 were classified as CP and 36 as CI. Although the CI group had greater WM lesion volume than the CP group (p = 0.001), T2 lesions tended to be less widespread across the WM. The peak of lesion frequency was almost twice higher in CI (61% in the forceps major) than in CP patients (37% in the posterior corona radiata). The voxelwise analysis confirmed that lesion frequency was higher in CI than in CP patients with significant bilateral clusters in the forceps major and in the splenium of the corpus callosum (p<0.05, corrected). Low scores of the Symbol Digit Modalities Test correlated with higher lesion frequency in these WM regions. CONCLUSIONS: Overall these results suggest that in MS patients, areas relevant for cognition lie mostly in the commissural fiber tracts. This supports the notion of a functional (multiple) disconnection between grey matter structures, secondary to damage located in specific WM areas, as one of the most important mechanisms leading to cognitive impairment in MS

Solar neutrino detection in a large volume double-phase liquid argon experiment

Precision measurements of solar neutrinos emitted by specific nuclear reaction chains in the Sun are of great interest for developing an improved understanding of star formation and evolution. Given the expected neutrino fluxes and known detection reactions, such measurements require detectors capable of collecting neutrino-electron scattering data in exposures on the order of 1 ktonne yr, with good energy resolution and extremely low background. Two-phase liquid argon time projection chambers (LAr TPCs) are under development for direct Dark Matter WIMP searches, which possess very large sensitive mass, high scintillation light yield, good energy resolution, and good spatial resolution in all three cartesian directions. While enabling Dark Matter searches with sensitivity extending to the "neutrino floor" (given by the rate of nuclear recoil events from solar neutrino coherent scattering), such detectors could also enable precision measurements of solar neutrino fluxes using the neutrino-electron elastic scattering events. Modeling results are presented for the cosmogenic and radiogenic backgrounds affecting solar neutrino detection in a 300 tonne (100 tonne fiducial) LAr TPC operating at LNGS depth (3,800 meters of water equivalent). The results show that such a detector could measure the CNO neutrino rate with ~15% precision, and significantly improve the precision of the 7Be and pep neutrino rates compared to the currently available results from the Borexino organic liquid scintillator detector.Comment: 21 pages, 7 figures, 6 table

The significance of cheese sampling in the determination of histamine concentration: Distribution pattern of histamine in ripened cheeses

Cheeses are becoming a major safety and public health concern: cheeses available in supermarkets occasionally contain high histamine concentrations that can have negative effects on consumer health. In this study, we have attempted to assess the histamine distribution pattern in ripened cheeses, with the purpose of establishing a correct cheese sampling strategy for the quantification of histamine. To this aim, histamine was determined in four distinct areas of twelve long-ripened hard cheeses: the external and internal rind, along with the outer and inner core of the wedge. The concentrations measured were remarkably different: histamine accumulated in the central core, whereas the lowest amount was found in the peripheral rind. To explain this heterogenous distribution, histamine producers were determined in the four areas by identifying the hdc sequences obtained from cheese samples. Non-starter bacteria were identified as main histamine producers; however, these microbiota were homogeneously distributed throughout the wedge. Nevertheless, the analysis of psychochemical properties of the different areas revealed an observable trend: histamine tended to accumulate in the saltier, more humid, and less oxidized areas in a wedge. Overall, this study highlights the significance of a correct sampling strategy when histamine is quantified in cheese

Clinical outcomes in the second versus first pandemic wave in italy: Impact of hospital changes and reorganization

The region of Lombardy was the epicenter of the COVID‐19 outbreak in Italy. Emergency Hospital 19 (EH19) was built in the Milan metropolitan area during the pandemic’s second wave as a facility of Humanitas Clinical and Research Center (HCRC). The present study aimed to assess whether the implementation of EH19 was effective in improving the quality of care of COVID‐19 patients during the second wave compared with the first one. The demographics, mortality rate, and in‐hospital length of stay (LOS) of two groups of patients were compared: the study group involved patients admitted at HCRC and managed in EH19 during the second pandemic wave, while the control group included patients managed exclusively at HCRC throughout the first wave. The study and control group included 903 (56.7%) and 690 (43.3%) patients, respectively. The study group was six years older on average and had more pre‐existing comorbidities. EH19 was associated with a decrease in the intensive care unit admission rate (16.9% vs. 8.75%, p &lt; 0.001), and an equal decrease in invasive oxygen therapy (3.8% vs. 0.23%, p &lt; 0.001). Crude mortality was similar but overlap propensity score weighting revealed a trend toward a potential small decrease. The adjusted difference in LOS was not significant. The implementation of an additional COVID‐ 19 hospital facility was effective in improving the overall quality of care of COVID‐19 patients during the first wave of the pandemic when compared with the second. Further studies are necessary to validate the suggested approach