Reorganizing territorial healthcare to avoid inappropriate ED visits: does the spread of Community Health Centres make Walk-in-Clinics redundant?

BACKGROUND: Community care has recently been restructured with the development of Community Health Centres (CHCs), forcing a general rethink on the survival of previous organizational solutions adopted to reduce inappropriate ED access, for example Walk-in-Clinics (WiCs). METHODS: We focus on the Italian Emilia-Romagna Region that has made huge investments in CHC development, whilst failing to proceed at a uniform rate from area to area. Estimating panel count data models for the period 2015-2018, we pursue two goals. First we test the existence of a "CHC effect", choosing five urban cities with different degree of development of the CHC model and assessing whether, all else being equal, patients treated by GPs who have their premises inside the CHC show a lower need to seek inappropriate care (Aim 1). Second, we focus our attention on Walk-in-Clinics, investigating the long-established WiC in the city of Parma that currently coexists with three CHCs recently established in the same catchment area. In this case we try to assess whether, and to what extent, the progressive development of the CHCs in the city of Parma has been affecting the dynamics of WiC access (Aim 2). RESULTS: As regards Aim 1, we show that CHCs reduce the probability of inappropriate patient access to emergency care. As regards Aim 2, in the city of Parma patients whose GP belongs to the CHC are less likely to visit the WiC on a workday, with no significant change during the weekend when CHCs are closed, questioning the need to maintain them both in the same area when the CHC model is fully implemented. CONCLUSIONS: Our results confirm the hypothesis that expanding access to primary care settings diminishes inappropriate ED use. In addition, our findings suggest that where CHCs and WiCs coexist in the same area, it may be advisable to implement strategies that bring WiC activities into step with CHC-based general primary care reforms to avoid duplication

Pêche et paramètres de reproduction de Pellonula leonensis Boulenger 1916, dans le lac de Taabo (Fleuve Bandama, Côte d’Ivoire): implications pour une exploitation durable du stock

La pêche et la reproduction de Pellonula leonensis provenant du lac de barrage de Taabo, ont été étudiées de novembre 2008 à octobre 2009, en vue d’une meilleure gestion du stock de l’espèce. L’engin de pêche utilisé pour la capture de P. leonensis est la senne de plage de maille variant entre 6 et 8 mm. L’effort de pêche fourni est de 3547 sorties de pêche par an. La prise par unité d’effort est de 59,52 kg/sortie de pêche. La production totale de P. leonensis à Taabo-village, a été estimée à 211,860 tonnes. Au total, 621 spécimens de P. leonensis (de longueur standard comprise entre 27 et 65 mm pour une moyenne de 40,33 ± 6,08 mm et de masse variant de 0,078 à 5,54 g avec une moyenne de 1,19 ± 0,63 g) ont été examinés pour l’étude de la reproduction. Le sex-ratio de 1 : 0,68 est en faveur des mâles. La taille de première maturité sexuelle est de 27,45 mm et de 27,48 mm respectivement chez les femelles et les mâles. Les évolutions du rapport gonadosomatique et des fréquences des stades matures ont révélé que la période de reproduction de P. leonensis s’étend principalement de décembre à avril et accessoirement en juin et août.Mots-clés : Effort de pêche, production annuelle, taille de première maturité, période de reproduction, Côte d’Ivoir

Quality of life assessment in elderly patients with aggressive non-Hodgkin's Lymphoma treated with anthracycline-containing regimens. Report of a prospective study by the Intergruppo Italiano Linfomi

Background and Objectives. The aim of this study was to evaluate quality of life (QOL) in a group of elderly patients ( > 65 years) with aggressive non-Hodgkin's lymphoma (NHL) treated with chemotherapy regimens containing anthracyclines. Design and Methods. QOL was evaluated in a population of elderly patients with aggressive NHL enrolled in a phase III clinical trial run by the Intergruppo Italiano Linfomi (11L) from 1996 to 1999 to compare two different anthracycline-containing regimens (mini-CEOP vs P-VEBEC). The EORTC-QLQ-C30 questionnaire, which has already been validated in oncology, was used. The questionnaire was administered at the time of diagnosis, half way through the chemotherapy and at the time of restaging. Results. Ninety-one patients completed pre-therapy and post-therapy questionnaires and they are the subject of this report. Baseline QOL assessment showed a strong correlation of poor values of QOL with anemia and high risk according to the International Prognostic Index (IPI). At the end of treatment no functional scales showed worse values. A significant improvement was observed for pain (p = 0.003), appetite (p = 0.006), sleep (p = 0.015) and global health (p = 0.027). Considering only the 50 patients who achieved a complete remission (CR), an improvement was also recorded for emotional state (p = 0.10), role (P = 0.05), constipation (p = 0.04) and global QOL (p = 0.05). Interpretation and Conclusions. The EORTC-QLQ-C30 is feasible even in a population of elderly patients, in whom it had never been tested before. The improvement of QOL at the end of the treatment demonstrated that the symptoms of the disease have a greater negative influence on the patient's life than do the side effects of the therapy

Efficient ultrafast all-optical modulation in a nonlinear crystalline gallium phosphide nanodisk at the anapole excitation

High–refractive index nanostructured dielectrics have the ability to locally enhance electromagnetic fields with low losses while presenting high third-order nonlinearities. In this work, we exploit these characteristics to achieve efficient ultrafast all-optical modulation in a crystalline gallium phosphide (GaP) nanoantenna through the optical Kerr effect (OKE) and two-photon absorption (TPA) in the visible/near-infrared range. We show that an individual GaP nanodisk can yield differential reflectivity modulations of up to ~40%, with characteristic modulation times between 14 and 66 fs, when probed at the anapole excitation (AE). Numerical simulations reveal that the AE represents a unique condition where both the OKE and TPA contribute with the same modulation sign, maximizing the response. These findings highly outperform previous reports on sub–100-fs all-optical switching from resonant nanoscale dielectrics, which have demonstrated modulation depths no larger than 0.5%, placing GaP nanoantennas as a promising choice for ultrafast all-optical modulation at the nanometer scale

Personalizing Cancer Pain Therapy: Insights from the Rational Use of Analgesics (RUA) Group

Introduction: A previous Delphi survey from the Rational Use of Analgesics (RUA) project involving Italian palliative care specialists revealed some discrepancies between current guidelines and clinical practice with a lack of consensus on items regarding the use of strong opioids in treating cancer pain. Those results represented the basis for a new Delphi study addressing a better approach to pain treatment in patients with cancer. Methods: The study consisted of a two-round multidisciplinary Delphi study. Specialists rated their agreement with a set of 17 statements using a 5-point Likert scale (0 = totally disagree and 4 = totally agree). Consensus on a statement was achieved if the median consensus score (MCS) (expressed as value at which at least 50% of participants agreed) was at least 4 and the interquartile range (IQR) was 3–4. Results: This survey included input from 186 palliative care specialists representing all Italian territory. Consensus was reached on seven statements. More than 70% of participants agreed with the use of low dose of strong opioids in moderate pain treatment and valued transdermal route as an effective option when the oral route is not available. There was strong consensus on the importance of knowing opioid pharmacokinetics for therapy personalization and on identifying immediate-release opioids as key for tailoring therapy to patients’ needs. Limited agreement was reached on items regarding breakthrough pain and the management of opioid-induced bowel dysfunction. Conclusion: These findings may assist clinicians in applying clinical evidence to routine care settings and call for a reappraisal of current pain treatment recommendations with the final aim of optimizing the clinical use of strong opioids in patients with cancer

Peuplement ichtyologique du complexe Brimé-Méné-Nounoua, Côte d’Ivoire (Afrique de l’Ouest)

La composition et la distribution de la faune ichtyologique de l’ensemble du complexe Brimé-Méné-Nounoua ont été étudiées entre janvier et décembre 2001. Au total, 29 stations ont été échantillonnées sur l’ensemble du complexe. Les poissons ont été capturés à l’aide d’un appareil de pêche électrique et de 17 filets maillants. Quarante-trois (43) espèces dont 29 espèces dulçaquicoles, un hybride et 13 espèces affinité marine et/ou estuarienne ont été identifiées. L’analyse quantitative a indiqué que Petrocephalus bovei, Schilbe mandibularis et Brycinus longipinnis sont les mieux représentées du peuplement ichtyologique. La richesse spécifique s’est révélée plus élevée dans les affluents que dans le cours principal. Neuf (9) espèces ont été capturées uniquement pendant la saison sèche et 10 espèces exclusivement en saison pluvieuse. La distribution de l’ichtyofaune en fonction des variables environnementales par l’analyse canonique de correspondance (ACC) a montré que le pH, la largeur du bassin versant, la nature du substrat (roche, gravier, mélange argileboue), les macrophytes aquatiques et la canopée influencent la répartition des poissons dans le complexe Brimé-Méné-Nounoua.Mots clés: Inventaire, distribution, poissons, bassins côtiers, Côte d’Ivoir

Action of Gentamicin, Aminosidin, and Ampicilltn on Uterine Tone and Motility

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Evolutionary trends and stasis in carnassial teeth of European Pleistocene wolf Canis lupus (Mammalia, Canidae)

The evolutionary trends of tooth size in quaternary carnivores support an almost direct association with climate. However, phenotypic trait may follow distinct tempo and mode of evolution such as Brownian, Ornstein-Uhlenbeck or random walk. Here, we investigated the morphometric variations and evolutionary trends in the carnassial teeth size of the European wolf (Canis lupus) by means of modern statistical tools. Recent contributions highlighted linear increase trend in tooth size through the Pleistocene, but those differences in time have not been tested using modern statistical strategies. Examining a wide sample of linear measurements of carnassials of extinct and extant wolves (486 M1 and 491 P4), we tested which evolutionary model (random walk, stasis, Ornstein-Uhlenbeck) better explains the dimensional pattern of teeth through time at the continental scale and at the regional scale (France and Italy). Our results clearly show different models for the carnassials of C. lupus. Lower and upper carnassials for the entire sample of C. lupus are characterized by a directional trend, whereas Italian and French subsets show a random fluctuation of carnassials size through time. The carnassials dimensions are not directly correlated with the climate changes during the Middle-Late Pleistocene and Holocene, but they are possibly correlated with spread of the cold mega-fauna in Europe, and thus with the changes in the dietary regime