1,906 research outputs found
Case Report: All That Glisters Is Not* Cancer
Properly performed staging in non-small-cell lung cancer (NSCLC) is necessary to avoid wrong therapeutic decisions. Here we present a case which manifested as advanced NSCLC but ultimately was composed of two different and rare pathologies. The first is a TTF-1 positive axillary lymph node that could be defined either as an unusual isolated differentiated cancer of unknown primary or as an even rarer case of ectopic lung epithelium which underwent malignant transformation. The second is sarcoidosis, a sarcoid-like alteration, in remission after oral steroids. The main implication of a correct diagnosis regards patient outcome and the avoidance of toxic inappropriate systemic chemotherapy
Thermal effects on the hydraulic conductivity of a granular geomaterial
Geotechnical challenges arising from thermal loading are associated with many engineering applications such as ground source energy systems (5℃-40℃) and nuclear waste disposal (in excess of 100℃). The effects of temperature on soils have been the subject of limited research, particularly in terms of the fundamental characterisation of the non-isothermal behaviour of granular geomaterials. This study describes challenges associated with determining the hydraulic conductivity (k_ℎ) of such materials at different temperatures using a bespoke temperature-controlled triaxial apparatus. A methodology is proposed for interpreting thermo-hydro-mechanical (THM) tests on isotropically consolidated specimens and is applied to data obtained for a uniform sand. It is shown that the intrinsic head losses of the system need to be minimised in order to obtain reliable measurements; this requires a detailed calibration procedure. The developed approach is used to determine the hydraulic conductivity at ambient temperature and at 40℃, showing that the increase in k_ℎ with temperature is mostly due to the reduction in the viscosity of water. A detailed analysis of the volumetric response of the sample during heating is also carried out
Identidade espectral entre cultivares de uvas vinÃferas em duas regiões da Campanha Gaúcha.
O uso de tecnologias de sensoriamento remoto na análise e na caracterização de assinaturas espectrais de culturas vitÃcolas por meio de imagens de satélite contribuem para o controle e monitoramento nas tomadas de decisões relativas à gestão da produção e qualidade dos vinhos. O presente trabalho visou separar as assinaturas espectrais de cultivares de uvas vinÃferas em duas regiões distintas, nos municÃpios de Santana do Livramento e Candiota, localizados na Campanha Gaúcha. Foram utilizados mapas georreferenciados fornecidos pelos proprietários das áreas com a localização das cultivares para delimitar as regiões de interesse a partir do produto L1B do sensor ASTER (Advanced Spaceborne Thermal and Reflection Radiometer) e coletar as informações de refletância normalizada nas faixas espectrais das bandas do VNIR (Visible Near Infrared) e SWIR (Short Wave Infrared) de 48 parcelas das cultivares Vitis vinÃfera Cabernet Sauvignon, Merlot, Chardonnay, Pinot Noir, Sauvignon Blanc e Tannat. As classes de estudo compreenderam as cultivares e para teste de desempenho foi incluÃda a classe ?banhado? nas duas regiões. As imagens foram submetidas à s correções do efeito Cross Talk, reamostragem para 15 metros das bandas do SWIR e correção atmosférica utilizando o algoritmo FLAASH (Fast Line-of-Sight Atmospheric Analysis of Spectral Hypercubes). Para verificar a separabilidade das variedades foi utilizado o algoritmo de classificação Máxima Verossimilhança e também a Análise Discriminante das médias de refletância de cada parcela nas bandas (1, 2, 3N, 4, 5, 6, 7, 8 e 9). Os resultados obtidos mostraram que a Análise Discriminante (AD) distinguiu totalmente as regiões, enquanto a separabilidade das assinaturas espectrais das cultivares teve menor desempenho, com percentagens entre 37 e 75% de acurácia. O classificador de Máxima Verossimilhança, aplicado separadamente a cada região, teve desempenho de 91% de acurácia para a região de Santana do Livramento e 75% para Candiota. Os resultados indicam que dados de refletância obtidos de imagens ASTER permitem com relativo sucesso a discriminação espectral de classes de vegetação com assinaturas espectrais muito próximas entre si, como é o caso de cultivares vitÃcolas. A distinta separação das regiões, caracterizadas como ?terroirs? vitÃcolas, pode ser atribuÃda à s diferenças fÃsico-quÃmicas do solo das regiões transmitidas à folhagem das videiras e em seguida à s suas refletâncias. A classe ?banhado? teve assinatura espectral totalmente diferente das cultivares e, portanto, foi identificada e totalmente separada das classes como era esperado
Birth control knowledge among freshmen of four Italian universities
Since sexual health education (SHE) is not mandatory in Italian schools, we conducted a survey on
freshmen of four Italian university campuses in 2012 to investigate the respective level of sexual
health knowledge (SHK) in relation to birth control, with the aim to inform public health policy
makers. A convenience strategy was employed to sample 4,552 freshmen registered with various
undergraduate courses at four Italian universities: Padua university (Veneto Region); university of
Milan (Lombardy Region); university of Bergamo (Lombardy Region); university of Palermo (Sicily
Region). We investigated the level of SHK on birth control using 6 proxy indicators: (1) the average
length of a woman\u2019s period [outcome with 3 levels: wrong (base) vs. acceptable vs. correct]; (2) the
most fertile interval within a woman\u2019s period (binary outcome: correct vs. wrong answer); (3) the event
between the end of a period and the beginning of the next cycle (binary outcome: correct vs. wrong
answer); (4) the average survival of spermatozoa in the womb (binary outcome: correct vs. wrong
answer); (5) the concept of contraception (binary outcome: correct vs. wrong answer); (6) the efcacy
of various contraceptives to prevent unintended pregnancies (linear score: 0\u201317). We ftted 6 separate
models of multiple regression: multinomial for outcome 1; logistic for outcomes 2, 3, 4, 6; linear for
outcome 6. Statistical estimates were adjusted for a number of socio-demographic factors. Results
were expressed as odds ratios (OR) for the 4 multiple logistic regression models, linear coefcients
(RC) for the linear regression model and relative risk ratio (RRR) for the multinomial logistic regression
model. The level of signifcance of each risk estimate was set at 0.05. The level of SHK of freshmen
sampled was rather low, as 60% interviewees did not know the average length of a woman\u2019s period,
the average survival of spermatozoa in the womb and the concept of contraception, whilst the most
fertile interval within a woman\u2019s period was known only to 55% of interviewees. The mean score of
SHK on the efcacy of various contraceptive methods was only 5 (scale 0\u201317). Some categories of
students were consistently and signifcantly less knowledgeable on birth control at multivariable
analysis: males; students from the university of Palermo; those with vocational secondary school
education and those not in a romantic relationship at the time the survey was conducted. The results
of this survey clearly call for the introduction of SHE programs in Italian schools, as already done
in several European countries. School SHE should start as early as possible, ideally even before
secondary school. SHE should be holistic and delivered with a multiple agency coordinated approach
involving the Ministry of Health, the Ministry of Education, University and Scientifc Research (MIUR),
families, schools, public health departments, primary health care providers, pharmacists, media,
other
Determinants of Length of Stay After Vaginal Deliveries in the Friuli Venezia Giulia Region (NorthEastern Italy), 2005\u20132015
Although length of stay (LoS) after childbirth has been diminishing in several high-income countries
in recent decades, the evidence on the impact of early discharge (ED) on healthy mothers and term
newborns after vaginal deliveries (VD) is still inconclusive and little is known on the characteristics
of those discharged early. We conducted a population-based study in Friuli Venezia Giulia (FVG)
during 2005\u20132015, to investigate the mean LoS and the percentage of LoS longer than our proposed
ED benchmarks following VD: 2 days after spontaneous vaginal deliveries (SVD) and 3 days post
instrumental vaginal deliveries (IVD). We employed a multivariable logistic as well as a linear regression
model, adjusting for a considerable number of factors pertaining to health-care setting and timeframe,
maternal health factors, newborn clinical factors, obstetric history factors, socio-demographic
background and present obstetric conditions. Results were expressed as odds ratios (OR) and regression
coefcients (RC) with 95% confdence interval (95%CI). The adjusted mean LoS was calculated by level
of pregnancy risk (high vs. low). Due to a very high number of multiple tests performed we employed
the procedure proposed by Benjamini-Hochberg (BH) as a further selection criterion to calculate the BH
p-value for the respective estimates. During 2005\u20132015, the average LoS in FVG was 2.9 and 3.3 days
after SVD and IVD respectively, and the pooled regional proportion of LoS>ED was 64.4% for SVD
and 32.0% for IVD. The variation of LoS across calendar years was marginal for both vaginal delivery
modes (VDM). The adjusted mean LoS was higher in IVD than SVD, and although a decline of LoS>\u2009ED
and mean LoS over time was observed for both VDM, there was little variation of the adjusted mean
LoS by nationality of the woman and by level of pregnancy risk (high vs. low). By contrast, the adjusted
fgures for hospitals with shortest (centres A and G) and longest (centre B) mean LoS were 2.3 and 3.4
days respectively, among \u201clow risk\u201d pregnancies. The corresponding fgures for \u201chigh risk\u201d pregnancies
were 2.5 days for centre A/G and 3.6 days for centre B. Therefore, the shift from \u201clow\u201d to \u201chigh\u201d risk
pregnancies in all three latter centres (A, B and G) increased the mean adjusted LoS just by 0.2 days.
By contrast, the discrepancy between maternity centres with highest and lowest adjusted mean LoS
post SVD (hospital B vs. A/G) was 1.1 days both among \u201clow risk\u201d (1.1 = 3.4\u20132.3 days) and \u201chigh risk\u201d
(1.1 = 3.6\u20132.5) pregnanices. Similar patterns were obseved also for IVD. Our adjusted regression models
confrmed that maternity centres were the main explanatory factor for LoS after childbirth in both VDM.
Therefore, health and clinical factors were less infuential than practice patterns in determining LoS
after VD. Hospitalization and discharge policies following childbirth in FVG should follow standardized
guidelines, to be enforced at hospital level. Any prolonged LoS post VD (LoS>\u2009ED) should be reviewed
and audited if need be. Primary care services within the catchment areas of the maternity centres
of FVG should be improved to implement the follow up of puerperae undergoing ED after VD.
At the beginning of the 20th century home births were the norm and hospital deliveries very rare. Women started to deliver in hospital during World War 2 (WW2), in facilities near the military areas where their respective partners were training. Tis trend continued in the decades following WW2, with standard length of stay afer childbirth (LoS) increasing up to 10 days.
In the 70 ies some USA hospitals started to assess the health of mothers and newborn for eligibility to returnhome within 12\u201324 hours afer childbirth, with a midwife on call for domiciliary care up to 3 days for 2 weekspost discharge.
In 1992 the American Academy of Pediatrics (AAP) and the American College of Obstetricians and
Gynecologists (ACOG) formalized the most frequently shared defnition of early discharge (ED) afer childbirth worldwide as a LoS less than 48 h post spontaneous vaginal deliveries (SVD) and less than 96 h post cesarean section (CS). Tereafer the reduction of LoS expanded to other high-income countries, with increasing applications of ED.
LoS afer childbirth remained however a controversial aspect of obstetric care, creating an open debate not
only on its impact on the health of mothers and babies but also on health policies, state legislations and functioning of the respective health care systems. Nevertheless, ED of mothers and newborn has in fact increased dramatically in several high-income countries over the past 10\u201315 years. However, the evidence on the impact of ED on healthy mothers and term newborns ( 6537 weeks) afer a vaginal delivery (VD) is still inconclusive and little is known of the characteristics of those discharged early.
Since LoS has become a critical indicator of efciency of health care delivery, understanding its associated
factors could provide information helpful in the reduction of health care costs, improvement in the delivery
of obstetric care, containment of untoward events associated with comorbidities and complications requiring readmission. For instance, in Canada (excluding Quebec) from 2003 to 2010, neonatal readmission rates were lowest for LoS of 1\u20132 days following VD and 2\u20134 days afer CS.
Several factors are reportedly associated with LoS in the open literature, including readiness for discharge
(clinical and perceived) of the mother8,17\u201319. However, information on the impact of medical/obstetrical conditions associated with pregnancies is scarce or totally lacking.
Using a comprehensive database with information on a considerable number of factors, we previously
reviewed the case mix of hospital performance by LoS post SVD as well as instrumental vaginal deliveries (IVD) during 2005\u20132015 in Friuli Venezia Giulia (FVG), a region of North-Eastern Italy.
In this study we present the impact of the outstanding determinants on LoS following SVD and IVD, with the aim of inforing health care policy makers
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