Una faena física y psicológica de excavador

Translation into Spanish of Luciano Bianciardi's ?Una fatica fisica e psicologica da sterratore?, published in Notizie, 5th february 1961, with an introduction taken from Albanese, A. and Nasi, F. (eds.). (2015). L?artefice aggiunto: riflessioni sulla traduzione in Italia: 1900-1975. Ravenna, Longo, pp. 246-249

Lean Management: organizational innovations in hematological Day-Hospitals

Background. Lean Thinking is a management method which, despite its industrial origins, has spread in the health-care environment too. Objective. To describe the path followed and the results reached implementing Lean Thinking in four case studies. Methods. Such case studies were conducted in as many hematological Day-Hospitals (DHs), located in Central-Italy. At the beginning of each study, the DH internal processes, activity volumes and patient flows were analyzed and satisfaction questionnaires were administered to both operators and patients. Based on the returned questionnaires, deficiencies were focused on; for each deficiency data was collected and objectives defined. Following such definitions, the analysis of inefficiency causes was performed and countermeasures were identified. In the final meeting the results were assessed and monitoring/maintenance methods were defined. All these steps were supported by Lean Thinking instruments for analysis and solution. Results. Activity organization and patient satisfaction improved everywhere. Time losses and workloads imbalances were minimized in two DHs, particularly through higher standardization in the management of clinical-administrative documents. In another DH, the output capacity of the hospital pharmacy and the workflows in the DH were aligned with respect to the course of the day, so reducing delays in the delivery of therapies. Appointment planning was improved in the fourth DH, standardizing time slots (15-minutes) necessary for each therapy, so optimizing the number of stations (beds and chairs) used. Conclusions. Poor management of health care facilities can affect efficiency, security and quality of services provided. Lean Thinking is a valid method to address such problems

Integrating lean thinking and mathematical optimization: A case study in appointment scheduling of hematological treatments

This paper addresses the relationship between lean thinking and mathematical optimization. We discuss the roles of the two approaches, using as a reference case study the appointment scheduling process in a hematological center of a large Italian hospital. We report on how lean tools have been deployed to improve the process, we present a mathematical optimization model and discuss its implementation. Our aim is to show that the joint use of lean thinking and mathematical optimization can disclose large benefits when they are properly integrated in the improvement process. In our case study, simulated experiments point out that the average patient lead time could be decreased by more than 30%. Keywords: Appointment scheduling, Hematological treatments, Lean thinkin

Investigating temporal and prosodic markers in clinical high-risk for psychosis participants using automated acoustic analysis

Introduction: Research into language abnormalities has gained attention given the role of language impairments as a plausible marker for early detection and diagnosis of psychosis. Semantic and syntactic aberrations have been widely observed in schizophrenia across illness stages. Recently, acoustic abnormalities such as temporal and prosodic features of speech have been observed in schizophrenia patients. Yet, mixed evidence exists on the presence of acoustic deficits in participants meeting clinical high-risk for psychosis (CHR-P) criteria. The present study aimed to clarify whether acoustic impairments could be used to identify CHR-P individuals when compared to participants with substance use and affective disorders (clinical high-risk negative; (CHR-N) and to healthy controls (HC) participants. Crucially, methodological issues were addressed including the duration of speech samples to determine their impact on the acoustic results. Methods: Data were available from the Youth mental health, risk and Resilience (YouR) study. Speech samples were recorded from the semi structured clinical interviews of the Comprehensive Assessment of At Risk Mental States (CAARMS) in 50 CHR-P participants who were compared against a group of 17 HC and 23 CHR-N participants. Temporal and prosodic features were extracted from the recordings. Linear regression was used to determine the influence of interview duration on the acoustic estimates. After examining group differences for each of the acoustic features, temporal and prosodic indices were used to determine whether they could be used determine group status using binary logistic regressions. Results: No deficits were observed in temporal or prosodic variables in the CHR-P group when compared to HCs. Instead, CHR-N individuals were characterized by slower speech rate, more and longer pauses and higher unvoiced frames percentage compared to CHR-P participants. Temporal features could better discriminate between groups compared to prosodic features, with models explaining up to 47% of the variance between CHR-Ns and HCs and up to 28% of variance between CHR-Ps and CHR-Ns. Yet, none of these models survived bootstrapping. Moreover, group differences for temporal and prosodic features were largely robust to the interview duration effects. Finally, no significant relationship was obtained for temporal and prosodic features with clinical and functional symptom severity. Discussion: These finding suggests that temporal and prosodic features of speech are not impaired in early-stage psychosis. The acoustic features examined indicated the presence of acoustic impairments in CHR-N participants, which resulted spurious following bootstrapping and therefore hinted to the importance of employing validation methods on acoustic signatures in psychosis. This is crucial given the small sample sizes across the literature and heterogeneity of the clinical groups. Given the absence of acoustic disturbances of speech in CHR-P individuals observed in the present research, sematic and syntactic abnormalities may constitute a more promising biomarker of early psychosis. Further studies are required to clarify whether acoustic abnormalities are present in sub-groups of CHR-P participants with elevated psychosis-risk

Metabolic surgery for type II diabetes: an update

Bariatric operations have been documented in clinical trials to promote remission or dramatic improvement of Type II Diabetes Mellitus and related comorbidities. Herein we review randomized trials and meta-analyses published during the last 20 years on the results of bariatric/metabolic surgery in obese patients with type 2 diabetes with the aim of highlighting the scientific evidence available. Several studies and RCTs in the last 20 years have showed outstanding results of bariatric/metabolic surgery on Type II diabetes and comorbidities in patients with either BMI > 35 kg/m(2) or BMI < 35 kg/m(2). They have established that bariatric procedures are superior to non-surgical interventions for inducing weight loss and amelioration of type 2 diabetes, even in patients with a BMI between 30 and 35 kg/m(2). The physiopatologic changes that improve glucose homeostasis after bariatric surgery remain unclear but glycemic control is improved after sleeve gastrectomy, duodenal-jejunal bypass, Roux-en-Y gastric bypass, gastric banding, One Anastomosis Gastric Bypass, and biliopancreatic diversion. Nevertheless, it is suggested that the various gastrointestinal procedures may have different effects and mechanisms of action. Metabolic surgery will help integrate knowledge and multidisciplinary expertise to provide a combination of conservative and surgical treatments for Type II diabetes. These treatments must be considered as complementary options and not alternative strategies, with the same goal of controlling diabetes and achieving cure

organizational solutions to improve timeliness and effectiveness of the stroke care

Saving time means saving neurons in stroke care process. Managerial and organizational solutions that lean the processes should be considered in order to overcome the effects of stroke, which is the second worldwide cause of death. The purpose of the paper is to understand how Health Lean Management (HLM) can be adopted to achieve a more efficient stroke care process. In this peculiar context, efficiency enhancement leads to safety and effectiveness results. For this reason, the investigated projects have been recognized as Lean & Safety (L&S) projects, being HLM projects reporting patient safety improvements. Due to the peculiarity of the project to investigate, a holistic case study has been conducted in a university hospital of Tuscany region. Thanks to the research framework developed in the literature for L&S projects, data regarding motivations, objectives, organizational and managerial aspects, outcomes, enablers and obstacles of the project have been collected and analysed. A multidisciplinary team, already trained on HLM and supported by the top management, was created and the step-by-step Six Sigma approach was adopted. After a mapping phase, a value stream map was created, Key Performance Indicators were defined and, finally, the Door To Needle (DTN) times and the modified Rankin Scales (mRS) were measured. Thanks to root cause analysis, the identified wastes were analyzed and intervention actions were defined and implemented. They regarded mainly different organizational interventions and they led to a decrease of both DTN times and mRS. The analysed project has demonstrated how it is possible to obtain relevant operational and clinical outcomes through organizational solutions. The analysis of this project, in which pursuing efficiency has led to safety and effectiveness results, has demonstrated how these different performances are linked each other in some peculiar care processes, in which shorter time means more effective and safer care, as in the stroke case. The implementation of L&S projects can improve care processes, providing a contribution to realize a more efficient, effective and safer healthcare system

In vivo structural connectome of arousal and motor brainstem nuclei by 7 Tesla and 3 Tesla MRI

Brainstem nuclei are key participants in the generation and maintenance of arousal, which is a basic function that modulates wakefulness/sleep, autonomic responses, affect, attention, and consciousness. Their mechanism is based on diffuse pathways ascending from the brainstem to the thalamus, hypothalamus, basal forebrain and cortex. Several arousal brainstem nuclei also participate in motor functions that allow humans to respond and interact with the surrounding through a multipathway motor network. Yet, little is known about the structural connectivity of arousal and motor brainstem nuclei in living humans. This is due to the lack of appropriate tools able to accurately visualize brainstem nuclei in conventional imaging. Using a recently developed in vivo probabilistic brainstem nuclei atlas and 7 Tesla diffusion-weighted images (DWI), we built the structural connectome of 18 arousal and motor brainstem nuclei in living humans (n = 19). Furthermore, to investigate the translatability of our findings to standard clinical MRI, we acquired 3 Tesla DWI on the same subjects, and measured the association of the connectome across scanners. For both arousal and motor circuits, our results showed high connectivity within brainstem nuclei, and with expected subcortical and cortical structures based on animal studies. The association between 3 Tesla and 7 Tesla connectivity values was good, especially within the brainstem. The resulting structural connectome might be used as a baseline to better understand arousal and motor functions in health and disease in humans