Distributed Solutions for a Reliable Data-Driven Transformation of Healthcare Management and Research

Modern healthcare management and clinical practice strongly rely on data and scientific evidence. Digital technologies, tools, and services are core components of Healthcare Management and scientific Research (HMR). Data interoperability, security, privacy, and ease of sharing represent fundamental conditions for guaranteeing quality HMR. Current data management solutions in HMR are mainly built on two technological infrastructures: cloud-based (CB) or distributed ledger systems (DLTs). DLTs offer alternative and reliable alternatives for the management and sharing of data in HMR. Their use can help increase confidence and trust in the integrity of data and the resulting evidence. The aim of this paper is to shed light on CB and DLT solutions, emphasizing the potential role of innovative digital solutions based on DLTs in creating a data-driven transformation of HMR, and to describe relevant examples and practical uses of DLT-based solutions for patients, healthcare management, and research activities. DLTs in particular can be increasingly useful for patients to truly have control over their health, for healthcare policymakers to increase the quality of organizational processes, and for research funders, editors and publishers to increase the return on investment, and the reuse and reproducibility of research. In conclusion, harnessing the potential of digital technologies is essential to transform healthcare management and research, by enhancing data quality, reliability, and trust

Association between Economic Growth, Mortality, and Healthcare Spending in 31 High-Income Countries

: This study aims to investigate the association between gross domestic product (GDP), mortality rate (MR) and current healthcare expenditure (CHE) in 31 high-income countries. We used panel data from 2000 to 2017 collected from WHO and OECD databases. The association between CHE, GDP and MR was investigated through a random-effects model. To control for reverse causality, we adopted a test of Granger causality. The model shows that the MR has a statistically significant and negative effect on CHE and that an increase in GDP is associated with an increase of CHE (p < 0.001). The Granger causality analysis shows that all the variables exhibit a bidirectional causality. We found a two-way relationship between GDP and CHE. Our analysis highlights the economic multiplier effect of CHE. In the debate on the optimal allocation of resources, this evidence should be taken into due consideration

CRUSTAL FRACTURING FIELD AS REVEALED BY SEISMIC ANISOTROPY IN THREE SEISMOGENIC AREAS OF THE APENNINIC CHAIN

In the last three years, we developed, tested and improved an automatic analysis code to calculate the shear wave splitting parameters, fast polarization direction (φ) and delay time (∂t). The code is a set of MatLab scripts able to retrieve crustal anisotropy parameters from three-component seismic recording of local earthquakes using horizontal component cross-correlation method. The analysis procedure consists in choosing an appropriate frequency range, that better highlights the signal containing the shear waves, and a length of time window on the seismogram centred on the S arrival (the temporal window contains at least one cycle of S wave). The code was compared to other two automatic analysis code (SPY and SHEBA) and tested on three Italian areas (Val d’Agri, Tiber Valley and L’Aquila surrounding) along the Apennine mountains. For each region we used the anisotropic parameters resulting from the automatic computation as a tool to determine the fracture field geometries connected with the active stress field. The anisotropic fast directions are used to define the active stress field (EDA model), finding a general consistence between fast direction and main stress indicators (focal mechanism and borehole break-out). The magnitude of delay time is used to define the fracture field intensity finding higher value in the volume where micro-seismicity occurs. Furthermore we studied temporal variations of anisotropic parameters in order to explain if fluids play an important role in the earthquake generation process. The close association of anisotropic parameters variations and seismicity rate changes supports the hypothesis that the background seismicity is influenced by the fluctuation of pore fluid pressure in the rocks

Referral Patterns in Oral Medicine: A Retrospective Analysis of an Oral Medicine University Center in Southern Italy

Referral of a patient from one healthcare provider to another is an important part of the medical practice. The aim of this study was to analyze the referral process to the Oral Medicine Unit in a university-based tertiary center in Southern Italy. A chart review of new referrals to the Oral Medicine Unit during a 24-month period was conducted. The following data were recorded: demographic characteristics, medical history, number of physicians seen prior to Oral Medicine assessment, referral source, diagnostic procedures ordered by referrals, reason for referral, site of lesion/condition, final diagnosis. Then, the rates of correct identification for health-care professionals and the appropriateness of the reference diagnosis based on the disease were calculated with descriptive statistic indicators. There were 583 new first consultations. A total of 62.9% of patients were referred by general dental practitioners, 27.4% by physicians, and 9.7% did not have a referral. The most common diseases for referral were immune-mediated diseases (39.6%) and oro-facial pain disorders (25.2%). Only 28.5% of patients had a correct provisional diagnosis. The results of this study show the need to implement curricula in the field of oral medicine among dentistry and medical students, and to support the continuing education among healthcare providers to reduce diagnostic delay for oral diseases

IMAGING THE ACTIVE STRESS FIELD OF THREE SEISMOGENIC AREAS ALONG THE APENNINES AS REVEALED BY CRUSTAL ANISOTROPY

During the last decades, the study of seismic anisotropy has provided useful information for the interpretation and evaluation of the stress field and active crustal deformation. Seismic anisotropy can yield valuable information on upper crustal structure, fracture field, and presence of fluid-saturated rocks crossed by shear waves. Several studies worldwide demonstrate that seismic anisotropy is related to stress-aligned, filled-fluid micro-cracks (EDA model). An automatic analysis code, “Anisomat+”, was developed, tested and improved to calculate the anisotropic parameters: fast polarization direction (φ) and delay time (∂t). Anisomat+ has been compared to other two automatic analysis codes (SPY and SHEBA) and tested on three zones of the Apennines (Val d’Agri, Tiber Valley and L’Aquila surroundings). The anisotropic parameters, resulting from the automatic computation, have been interpreted to determine the fracture field geometries; for each area, we defined the dominant fast direction and the intensity of the anisotropy, interpreting these results in the light of the geological and structural setting and of two anisotropic interpretative models, proposed in the literature. In the first one, proposed by Zinke and Zoback, the local stress field and cracks are aligned by tectonics phases and are not necessarily related to the presently active stress field. Therefore the anisotropic parameters variations are only space-dependent. In the second, EDA model, and its development in the APE model fluid-filled micro-cracks are aligned or ‘opened’ by the active stress field and the variation of the stress field might be related to the evolution of the pore pressure in time; therefore in this case the variation of the anisotropic parameters are both space- and time- dependent. We recognized that the average of fast directions, in the three selected areas, are oriented NW-SE, in agreement with the orientation of the active stress field, as suggested by the EDA model, but also, by the proposed by Zinke and Zoback model; in fact, NW-SE direction corresponds also to the strike of the main fault structures in the three study regions. The mean values of the magnitude of the normalized delay time range from 0.005 s/km to 0.007 s/km and to 0.009 s/km, respectively for the L'Aquila (AQU) area, the High Tiber Valley (ATF) and the Val d'Agri (VA), suggesting a 3-4% of crustal anisotropy. In each area are also examined the spatial and temporal distribution of anisotropic parameters, which lead to some innovative observations, listed below. 1) The higher values of normalized delay times have been observed in those zones where most of the seismic events occur. This aspect was further investigated, by evaluating the average seismic rate, in a time period, between years 2005 and 2010, longer than the lapse of time, analyzed in the anisotropic studies. This comparison has highlighted that the value of the normalised delay time is larger where the seismicity rate is higher. 2) In the Alto Tiberina Fault area the higher values of normalised delay time are not only related to the presence of a high seismicity rate but also to the presence of a tectonically doubled carbonate succession. Therefore, also the lithology, plays a important role in hosting and preserving the micro-fracture network responsible for the anisotropic field. 3) The observed temporal variations of anisotropic parameters, have been observed and related to the fluctuation of pore fluid pressure at depth possibly induced by different mechanisms in the different regions, for instance, changes in the water table level in Val D’Agri, occurrence of the April 6th Mw=6.1 earthquake in L’Aquila.Since these variations have been recognized, it is possible to affirm that the models that better fit the results, both in term of fast directions and of delay times, seems to be EDA and APE models

Oral Mucosa and Nails in Genodermatoses: A Diagnostic Challenge

Genodermatoses represent a group of uncommon, hereditary, single-gene skin disorders, characterized by multisystem involvement, heterogeneous clinical manifestations and different degrees of morbidity and mortality. Some genodermatoses may have oral mucosa and nail involvement, since the oral cavity and cutaneous organ system, including nails, share a close embryologic origin. Nail disorders can manifest with nail hypoplasia or nail hypertrophy. Clinical pictures of affected oral mucosa can be extremely heterogeneous, ranging from asymptomatic papules to painful blisters, leukokeratosis, oral papillomas and fibromas to oral potentially malignant disorders and cancerous lesions. Oral mucosa and nails pathological features may occur synchronously or not and are usually associated with other systemic and skin manifestations. In some cases, oral mucosa and nails diseases may be distinct and constitute the principal sign of the genetic disorder, in other cases they represent only a part of the puzzle for the confirmation of the diagnosis. Continued awareness of the correlation between oral mucosa and nails findings can help physicians to diagnose genodermatosis in a timely manner, allowing more effective clinical management and prevention and/or early detection of complications. This article provides an overview of all specific genodermatoses affecting both oral mucosa and nails. Moreover, the correlation between teeth and nails is summarized in tabular form

Charcot-Marie-Tooth Type 2B: A New Phenotype Associated with a Novel RAB7A Mutation and Inhibited EGFR Degradation

The rare autosomal dominant Charcot-Marie-Tooth type 2B (CMT2B) is associated with mutations in the RAB7A gene, involved in the late endocytic pathway. CMT2B is characterized by predominant sensory loss, ulceromutilating features, with lesser-to-absent motor deficits. We characterized clinically and genetically a family harboring a novel pathogenic RAB7A variant and performed structural and functional analysis of the mutant protein. A 39-year-old woman presented with early-onset walking diculties, progressive distal muscle wasting and weakness in lower limbs and only mild sensory signs. Electrophysiology demonstrated an axonal sensorimotor neuropathy. Nerve biopsy showed a chronic axonal neuropathy with moderate loss of all caliber myelinated fibers. Next-generation sequencing (NGS) technology revealed in the proband and in her similarly affected father the novel c.377A>G (p.K126R) heterozygous variant predicted to be deleterious. The mutation affects the biochemical properties of RAB7 GTPase, causes altered interaction with peripherin, and inhibition of neurite outgrowth, as for previously reported CMT2B mutants. However, it also shows differences, particularly in the epidermal growth factor receptor degradation process. Altogether, our findings indicate that this RAB7A variant is pathogenic and widens the phenotypic spectrum of CMT2B to include predominantly motor CMT2. Alteration of the receptor degradation process might explain the different clinical presentations in this family