Street-level netocracy: rules, discretion and professionalism in a network-based intervention

Purpose: The paper aims to analyse the meaning and extension of discretionary power of social service professionals within network-based interventions. Design/methodology/approach: Empirically, the paper is based on a case study of a network-based policy involving private and public organisations in the Northeast of Italy (Province of Trento). Findings: The paper identifies netocracy as a social policy logic distinct from bureaucracy and professionalism. What legitimises netocracy is neither authority nor expertise but cooperation, the activation of connections and involvement, considered "good" per se. In this framework, professionalism and discretion acquire new and problematic meanings compared to street-level bureaucracy processes. Research limitations/implications: Based on a case study, the research results cannot be generalised but pave the way to further comparative investigations. Practical implications: The paper reveals that the position of professionals in netocracy is to some extent trickier than that in a bureaucracy because netocracy seems to have the power to encapsulate them and make it less likely for them to deviate from expected courses of action. Originality/value: Combining different literature streams - street level bureaucracy, professionalism, network organisations and welfare governance - and building on an original case study, the paper contribute to understanding professionalism in welfare contexts increasingly characterised by the combination of bureaucratic, professional and network logics

Neonatal effects of the administration of meperidine and promethazine to the mother in labor. Double blind study

Peer Reviewe

Feasibility of Ultra-short Term Complexity Analysis of Heart Rate Variability in Resting State and During Orthostatic Stress

In this work, we study ultra-short term (UST) complexity of Heart Rate Variability (HRV) and its agreement with analysis of standard short-term (ST) HRV recordings obtained at rest and during orthostatic stress. Conditional Entropy (CE) measures have been computed using both a linear Gaussian approximation and a more accurate model-free approach based on nearest neighbors. The agreement between UST and ST indices has been compared via statistical tests and correlation analysis, suggesting the feasibility of exploiting faster algorithms and shorter time series for detecting changes in cardiovascular control during various states

Input for baroreflex analysis: which blood pressure signal should be used?

The baroreflex (BR) is an important physiological regulatory mechanism which reacts to blood pressure perturbations with reflex changes of target variables such as the heart period (electrocardiogram derived RR interval) or the peripheral vascular resistance (PVR). Evaluation of cardiac chronotropic (RR as a target variable) and vascular resistance (target PVR) BR arms was in previous studies mainly based on the use of the spontaneous variability of the systolic or diastolic blood pressure (SBP, DBP), respectively, as the input signals. The use of other blood pressure measures such as the mean blood pressure (MBP) as an input signal for BR analysis is still under investigation. Making the assumption that the strength of coupling along the BR indicates the more appropriate input signal for baroreflex analysis, we employ partial spectral decomposition to assess in the frequency domain the causal coupling from SBP, MBP or DBP to RR or PVR. Noninvasive beat-to-beat recording of RR, SBP, MBP and DBP and PVR was performed in 39 and 36 volunteers in whom orthostatic and cognitive loads were evoked respectively through head-up tilt and mental arithmetic task. At rest, the MBP was most tightly coupled with RR, in contrast to the analysis of the vascular resistance BR arm where the results showed similar importance of all blood pressure input signals. During orthostasis, the increased importance of SBP as the input signal for BR analysis along the cardiac chronotropic arm was demonstrated. In addition, the gain from MBP to RR was more sensitive to physiological state changes compared to gains with SBP or DBP signal as inputs. We conclude that the coupling strength depends not only on the analysed baroreflex arm but also on the selection of the input blood pressure signal and the physiological state. The MBP signal should be more frequently used for the cardiac baroreflex analysis

Perception of the role of food and dietary modifications in patients with inflammatory bowel disease: Impact on lifestyle

Background: Diet has a relevant role in triggering symptoms in inflammatory bowel disease (IBD) from the patients’ perspective, but there is gap the between patients’ and doctors’ perceptions. Few studies have addressed this topic. The aim of this study was to evaluate food habits and nutrition knowledge in a homogeneous cohort of patients with IBD from southern Italy. Methods: 167 consecutive patients with IBD were recruited. The survey was based on the administration of a semi-structured questionnaire assessing demographics, disease features, dietary behavior, and food intolerance. Results: The majority of patients did not consider food a cause of their disease. However more than 80% changed their diet after the diagnosis and most report an improvement in symptoms. Spiced and seasoned foods, dairy products, vegetables, and fruit were often avoided. A dairy-free diet was adopted by 33.7%. Food choices were based on self-experience and not on medical counselling. Dietary modifications deeply impact on lifestyle. Conclusions: Most of the patients with IBD set diet and lifestyle on self-experience and give up many foods. This has an impact on psychosocial functioning and can lead to nutritional deficiencies. High quality studies are warranted to assess evidence-based dietary strategies and develop patient-targeted dietary recommendations

Using EHRs to integrate research with patient care: promises and challenges

Clinical research is the foundation for advancing the practice of medicine. However, the lack of seamless integration between clinical research and patient care workflow impedes recruitment efficiency, escalates research costs, and hence threatens the entire clinical research enterprise. Increased use of electronic health records (EHRs) holds promise for facilitating this integration but must surmount regulatory obstacles. Among the unintended consequences of current research oversight are barriers to accessing patient information for prescreening and recruitment, coordinating scheduling of clinical and research visits, and reconciling information about clinical and research drugs. We conclude that the EHR alone cannot overcome barriers in conducting clinical trials and comparative effectiveness research. Patient privacy and human subject protection policies should be clarified at the local level to exploit optimally the full potential of EHRs, while continuing to ensure participant safety. Increased alignment of policies that regulate the clinical and research use of EHRs could help fulfill the vision of more efficiently obtaining clinical research evidence to improve human health

Solvent effects on Grubbs’ pre-catalyst initiation rates

Initiation rates for Grubbs and Grubbs-Hoveyda second generation pre-catalysts have been measured accurately in a range of solvents. Solvatochromic fitting reveals different dependencies on key solvent parameters for the two pre-catalysts, consistent with different mechanisms by which the Grubbs and Grubbs-Hoveyda pre-catalysts initiate

Surface Periodic Poling in Lithium Niobate and Lithium Tantalate

Periodic Poling of Lithium Niobate crystals (PPLN) by means of electric field has revealed the best technique for finely tailoring PPLN structures and parameters, which play a central role in many current researches in the field of nonlinear integrated optics. Besides the most studied technique of bulk poling, recently a novel technique where domain inversion occurs just in a surface layer using photoresist or silica masks has been devised and studied. This surface periodic poling (SPP) approach is best suited when light is confined in a thin surface guiding layer or stripe, as in the case of optical waveguide devices. Also, we found that SPP respect to bulk poling offers two orders of magnitude reduction on the scale of periodicity, so that even nanostructures can be obtained provided an high resolution holographic mask writing technique is adopted. We were able to demonstrate 200 nm domain size, and also good compatibility with alpha-phase proton exchange channel waveguide fabrication. Our first experiments on Lithium Tantalate have also shown that the SPP technology appears to be applicable to this crystal (SPPLT), whose properties can allow to overcome limitations such as optical damage or UV absorption still present in PPLN devices. Finally, the issue of SPP compatibility with proton exchange waveguide fabrication will be addresse

Weight bearing versus conventional CT for the measurement of patellar alignment and stability in patients after surgical treatment for patellar recurrent dislocation

Purpose: To compare weight-bearing cone-beam computer tomography (CBCT) and conventional computer tomography (CT)-based measurements of patellofemoral alignment and stability in patients surgically treated for recurrent patellar dislocation. These scans implied respectively single-leg up-right posture, the knee flexed, and lower limb muscles activation, versus supine position with the knee extended. Methods: A total of 17 patients (11 males/6 females) after surgical reconstruction with fascia lata allograft for recurrent patellofemoral dislocation were analyzed at 60-month follow-up. Tilt and congruence angles and tibial tuberosity–trochlear groove (TT-TG) offset were measured on images obtained from CBCT and conventional CT scans by three independent and expert radiologists. Paired t tests were performed to compare measurements obtained from the two scans. Inter-rater reliability was assessed using a two-way mixed-effects model intra-class correlation coefficient (ICC). Results: Only TT-TG offset was found significantly smaller (p < 0.001) in CBCT (mean 9.9 ± 5.3 mm) than in conventional CT (mean 15.9 ± 4.9 mm) scans. ICC for tilt and congruence angles and for TT-TG offset ranged between 0.80–0.94 with measurements in CBCT scans, between 0.52 and0.78 in conventional CT. Conclusion: In patients surgically treated for recurrent patellar dislocation, TT-TG offset was found overestimated with conventional CT. All measurements of patellofemoral stability and alignment were found more consistent when obtained with weight-bearing CBCT compared to conventional CT