A new tool for the evaluation of the rehabilitation outcomes in older persons. a machine learning model to predict functional status 1 year ahead

Purpose To date, the assessment of disability in older people is obtained utilizing a Comprehensive Geriatric Assessment (CGA). However, it is often difficult to understand which areas of CGA are most predictive of the disability. The aim of this study is to evaluate the possibility to early predict—1year ahead—the disability level of a patient using machine leaning models. Methods Community-dwelling older people were enrolled in this study. CGA was made at baseline and at 1year follow-up. After collecting input/independent variables (i.e., age, gender, schooling followed, body mass index, information on smoking, polypharmacy, functional status, cognitive performance, depression, nutritional status), we performed two distinct Support Vector Machine models (SVMs) able to predict functional status 1year ahead. To validate the choice of the model, the results achieved with the SVMs were compared with the output produced by simple linear regression models. Results 218 patients (mean age = 78.01; SD = 7.85; male = 39%) were recruited. The combination of the two SVMs is able to achieve a higher prediction accuracy (exceeding 80% instances correctly classified vs 67% instances correctly classified by the combination of the two linear regression models). Furthermore, SVMs are able to classify both the three categories, self sufficiently, disability risk and disability, while linear regression model separates the population only in two groups (self-sufficiency and disability) without identifying the intermediate category (disability risk) which turns out to be the most critical one. Conclusions The development of such a model can contribute to the early detection of patients at risk of self-sufficiency loss

The italian version of the Alexithymia Questionnaire for Children (AQC). Factor structure and reliability

The aims of the study were to investigate factor structure and reliability of the Alexithymia Questionnaire for Children (AQC), originally validated by Rieffe et al. (2006), on an Italian population. A total sample of 1265 participants, ranging in age from 8 to 14 years, filled in the Italian version of the AQC and 160 children also completed the Youth Self Report (YSR), during school time. A sub-sample (N = 60) was retested after eight weeks for an assessment of the measure’s stability. The three-factor model reported good fit indices on the total sample, even though not all items loading on the Externally Oriented Thinking (EOT) factor appeared statistically relevant. Moreover, the model was only partially invariant across gender and age groups: analysis indicated developmental gender-specific differences on Difficulty Identifying Feelings (DIF) and EOT factors. Significant correlations were found between AQC scores and the YSR internalizing and externalizing symptomatology scales. In conclusion, the three-factor model was confirmed and some evidence emerged concerning its generalization to gender and age-group

Modelling Calcium Signal Intensity Difference Between Cells

Cell signaling involves the transmission of a signal from a sending cell to a receiving cell. Calcium ions (Ca2+) are a widely used type of messenger. In this study the evolution over time of calcium signal intensity and how these evolutions depend on the four groups of cells of subjects with different health condition was investigated. A longitudinal data analysis based on 110 subjects was used and to account non-linearity and correlated nature of the data, non-linear mixed model was used. Based on the exploratory data analysis result supported with CurveExpert professional software the model used has sigmoid structure. From the result, the rate of change of average signal intensity was nearly 0.033 and the time at which the rate of change of average calcium signal intensity reaches its maximum (i.e. the inflection point) was nearly 198 seconds. Furthermore, there were statistically significant differences in average calcium signal intensity between the groups. It is also observed that significant differences between mild hyperplasia and benign tumor patient’s cells and also between malignant tumor and healthy subject’s cells. Keywords: Calcium, Cell Signaling, Non Linear Mixed Model, Random Effect, Signal Intensit

Efficiency assessment for a small heliostat solar concentration plant

Summary In this paper, a small non-imaging focusing heliostat is presented, and an analytical model for assessing its performance is described. The main novelty of the system lies in the tracking mechanism and the mirror mount, which are based on off-the-shelf components and allow a good trade-off between accuracy and costs. The concentrator mirrors are moved by this two-axis tracking machinery to reflect the sun's rays onto a fixed target, the dimensions of which can be varied to suit the user's needs. A prototype plant to be located in central Italy was designed and simulated with a ray-tracing algorithm, and it comprises 90 heliostats for a total reflective area of 7.5 m2. The reflected solar rays are tracked taking the mechanical positioning errors of the tracking system into account. The total flux of radiation energy hitting the target was determined, and intensity distribution maps were drawn. Simulations showed that the system's optical efficiency can exceed 90% in summer, despite the tracking errors, mainly because of the smaller distance between the heliostats and the receiver. The solar concentration ratio over a receiver of 250 mm in diameter reached 80 suns with a very good uniformity. Over a 400-mm receiver, the concentrated radiation was less uniform, and the solar concentration ratio reached 50 suns, with a higher optical efficiency and collected solar radiation. The present concentration ratio is still suitable for many applications ranging from the electric power production, industrial process heat, and solar cooling. Copyright © 2014 John Wiley & Sons, Ltd

Psychological, emotional and social impairments are associated with adherence and healthcare spending in type 2 diabetic patients: an observational study

OBJECTIVE: The aim of the present study was to assess the association among anxiety, depression, stress, social support and emotional abilities with adherence and healthcare spending in type 2 diabetic patients. PATIENTS AND METHODS: Sixty-four patients were enrolled and completed: Interpersonal Processes of Care (IPC), 20-item Toronto Alexithymia Scale (TAS-20), Rapid Stress Assessment Scale (RSAS), Morisky Medication Adherence Scale (MMAS-4), International Physical Activity Questionnaire (IPAQ)-Short Form and a socio-anamnestic questionnaire regarding also the healthcare spending. RESULTS: Mathematical linear regressions models were performed showing the predictive effects of: anxiety and social support scores (RSAS) on adherence levels (respectively p =. 019; p =. 016); adherence levels on anxiolytic use (p =.04); aggressiveness scores (RSAS) on the number of general check-ups (p =.031); TAS-20 and physician-patient communication (IPC) on the number of hospitalization days (respectively p=.001; p=.008); physician patient decision making (IPC) scores on physical activity (IPAQ) levels (p=.025); physical activity (IPAQ) on the number of medical examinations (p=.039). CONCLUSIONS: An association among psychosocial impairment, adherence and health- care spending was found. Future studies should investigate the effect of a brief psychological intervention in increasing adherence levels and reducing the healthcare spending in this clinical population

“La tecnica della scrittura di Pennebaker nella fecondazione assistita: studio empirico su 34 soggetti”

Introduzione: L’O.M.S. stima che nei paesi industrializzati i problemi di infertilità riguardino il 15-20% delle coppie. Obiettivo: valutare l'effetto della tecnica di Pennebaker nel contesto della fecondazione assistita ipotizzando l'efficacia della scrittura espressiva nella diminuzione dei punteggi di alessitimia e nella maggiore probabilità di gravidanza. Metodologia: Il lavoro prevede un campione di 100 donne. Vengono riferiti i risultati relativi a 34 donne (con età dai 29 ai 43 anni), che nella fase iniziale del percorso di procreazione assistita sono state suddivise, tramite randomizzazione a coppie, in un gruppo sperimentale, i cui soggetti hanno scritto per tre incontri dei sentimenti e pensieri connessi all'esperienza infertilità, e in uno di controllo, che non ha scritto. Le donne di entrambi i gruppi hanno compilato una scheda socio-anagrafiche e la TAS-20 prima e dopo gli interventi medico e di scrittura. Risultati e conclusioni: L’ANOVA per misure ripetute mostra che nelle donne del gruppo sperimentale si verifica una diminuzione dopo la scrittura sia dei punteggi totali alla TAS-20 (da m= 53.4 a m= 47.5; p=.00) che di quelli di Difficoltà ad Identificare i Sentimenti (DIS; da m= 20.1 a m= 16.7; p=.00) e di Pensiero Orientato all’Esterno (POE; da m= 19.05 a m= 17.1; p=.03), rispetto alle donne del gruppo di controllo i cui punteggi rimangono stabili. Tuttavia i punteggi iniziali alla TAS-20 risultano più alti nel gruppo sperimentale (p=.00) il che può aver influito sui risultati: le donne che mostravano minore capacità di contatto con le proprie emozioni hanno beneficiato della promozione delle capacità cognitivo-emozionali attivata dalla scrittura. Rispetto all’esito delle procedure mediche sono stati riscontrati 4 successi nel gruppo sperimentale a fronte di 2 nei controlli, ma il risultato non è statisticamente significativo per l’esiguità dei numeri. Tuttavia i dati appaiono incoraggianti rispetto ad una continuazione del lavoro

Robotic total gastrectomy with intracorporeal robot-sewn anastomosis. A novel approach adopting the double-loop reconstruction method

Gastric cancer constitutes a major health problem. Robotic surgery has been progressively developed in this field. Although the feasibility of robotic procedures has been demonstrated, there are unresolved aspects being debated, including the reproducibility of intracorporeal in place of extracorporeal anastomosis. Difficulties of traditional laparoscopy have been described and there are well-known advantages of robotic systems, but few articles in literature describe a full robotic execution of the reconstructive phase while others do not give a thorough explanation how this phase was run. A new reconstructive approach, not yet described in literature, was recently adopted at our Center. Robotic total gastrectomy with D2 lymphadenectomy and a socalled ‘‘double-loop’’ reconstruction method with intracorporeal robotsewn anastomosis (Parisi’s technique) was performed in all reported cases. Preoperative, intraoperative, and postoperative data were collected and a technical note was documented. All tumors were located at the upper third of the stomach, and no conversions or intraoperative complications occurred. Histopathological analysis showed R0 resection obtained in all specimens. Hospital stay was regular in all patients and discharge was recommended starting from the 4th postoperative day. No major postoperative complications or reoperations occurred. Reconstruction of the digestive tract after total gastrectomy is one of the main areas of surgical research in the treatment of gastric cancer and in the field of minimally invasive surgery. The double-loop method is a valid simplification of the traditional technique of construction of the Roux-limb that could increase the feasibility and safety in performing a full hand-sewn intracorporeal reconstruction and it appears to fit the characteristics of the robotic system thus obtaining excellent postoperative clinical outcome

Can alexithymia be assessed through an interview in adolescents? The Toronto Structured Interview for Alexithymia: Reliability, concurrent validity, discriminant validity, and relationships with emotional-behavioral symptoms

Alexithymia is connected to adolescents' psychopathology, but the current methods of assessment present limitations. The Toronto Structured Interview for Alexithymia (TSIA) was developed to overcome the limits of the main used self-rating scale in adults, but no studies investigated its feasibility with adolescents. This study involved 95 community adolescents aged 12–19 years. Adolescents were assessed with the TSIA, the 20-item Toronto Alexithymia Scale (TAS-20), the Verbal Comprehension Index of the WISC-IV for verbal skills, and the Child Behavior Checklist and Youth Self Report for emotional-behavioral symptoms. The aims were to investigate the TSIA internal consistency, concurrent validity with the TAS-20, discriminant validity with participants' verbal skills, and relationships with emotional-behavioral symptoms. TSIA showed good internal consistency, concurrent validity with the TAS-20 (except for factor DDF), and independence by participants' verbal skills, but few relationships with emotional-behavioral symptoms. In conclusion, TSIA showed some good psychometric proprieties but little convergence with research findings obtained with the TAS-20, suggesting the need for further research to check the feasibility of using the TSIA with adolescents. Meanwhile, a precautionary multi-method assessment of alexithymia is recommended

A case of a paraduodenal hernia with a concomitant mesosigmoid defect

Abstrac

Association between serum vitamin D and metabolic syndrome in middle-aged and older adults and role of supplementation therapy with vitamin D

Objectives. To evaluate i) the correlation between vitamin D (vit. D) serum concentra-tions and metabolic syndrome (MetS); ii) the efficacy of 6 months supplementation therapy with vit. D. Method. 200 patients were enrolled. Blood analyses and anthropometric measurements were carried out. Patients with hypovitaminosis D received an oral supplement therapy. Results. 81% of the sample shows vit. D levels < 30 ng/mL. Rate of MetS was significant-ly higher in vit. D deficiency group than in vit D insufficiency (p = 0.009) and sufficiency (p = 0.002) groups. Vit. D shows a significant negative correlation with both waist circum-ference (WC) (ρ - 0.202 p = 0.004) and glycaemia values (FBG) (ρ -0.185 p = 0.009). After the supplementation therapy in a group of 60 subjects a significant increase in vit. D levels (p = 0.001) and a significant reduction in WC values (p = 0.001) were observed. Conclusions. MetS, WC and FBG appeared to be associated vit. D status and it is well-known that central obesity, with the inflammatory alterations thereto correlated that determine insulin resistance, can be considered the “primum movens” for the develop-ment of MetS