An evaluation of the variability of episiotomy rates across hospitals: the case of Sardinia

The aim of this paper is to assess the extent of variation in the use of episiotomy across hospitals and to evaluate how much of this variation can be explained by case-mix factors. Using ocial hospital abstracts on deliveries occurred in the hospitals of the Italian region of Sardinia during 2009, we implement a multilevel logistic model in order to predict the likelihood of an episiotomy from a set of covariates which includes both socio-demographic and clinical indices. Results suggest that, with the exception of education, socio-demographic variables were not signicant in determining episiotomy while several clinical predictors were signicant. Our main nding is that almost half of the variation in episiotomy rates remains unexplained after conditioning on clinical indicators and socio-demographic factors

Hospital differences in rates of cesarean deliveries in the Sardinian region: An observational study

Background: The rates of cesarean deliveries have been increasing steadily in several European countries in recent decades, with Italy having the second-highest rate (38% in 2010), causing concern and debate about the appropriateness of many interventions. Moreover, some recent studies suggest that rates of common obstetric interventions are not homogeneous across hospitals, maybe not only because of patient case mix but also possibly because of different hospital practices and cultures. Thus, it is important to investigate whether the variation in rates of cesarean sections can be traced back to patient characteristics or whether it depends upon context variables at the hospital level. Objective and method: Using official hospital abstracts on deliveries that occurred in Sardinia over a two-year period, we implement multilevel logistic regression models in order to assess whether the observed differences in cesarean rates across hospitals can be justified by case-mix differences across hospitals. Results: The between-hospital variation in rates of cesarean delivery is estimated to be 0.388 in the model with only the intercept and 0.382 in the model controlling for the mother’s clinical and sociodemographic characteristics. Conclusions: The results show that taking into account the individual characteristics of delivered mothers is not enough to justify the observed variation across hospital rates, suggesting the important role of unobserved variables at the hospital level in determining cesarean section rates

Prediction of late/early arrivals in container terminals - A qualitative approach

Vessel arrival uncertainty in ports has become a very common problem worldwide. Although ship operators have to notify the Estimated Time of Arrival (ETA) at predetermined time intervals, they frequently have to update the latest ETA due to unforeseen circumstances. This causes a series of inconveniences that often impact on the efficiency of terminal operations, especially in the daily planning scenario. Thus, for our study we adopted a machine learning approach in order to provide a qualitative estimate of the vessel delay/advance and to help mitigate the consequences of late/early arrivals in port. Using data on delays/advances at the individual vessel level, a comparative study between two transshipment container terminals is presented and the performance of three algorithmic models is evaluated. Results of the research indicate that when the distribution of the outcome is bimodal the performance of the discrete models is highly relevant for acquiring data characteristics. Therefore, the models are not flexible in representing data when the outcome distribution exhibits unimodal behavior. Moreover, graphical visualisation of the importance-plots made it possible to underline the most significant variables which might explain vessel arrival uncertainty at the two European ports

Job Satisfaction and Subjective Well-Being in Europe

n/

Financial Activities Taxes and Banks' Systemic Risk

The recent financial crisis has highlighted the risks posed by individual banks to the entire banking system. Next to the issue of determining individual contributions to systemic risk, the question of additional taxes on the financial sector has been debated. This paper uses SYMBOL, a micro-simulation model of the banking system, to estimate these individual contributions and compares them to the potential individual tax liabilities of banks under the assumption of a Financial Activity Tax.JRC.G.1-Scientific Support to Financial Analysi

Spatiotemporal genetic variation of atlantic bluefin tunas from sardinian and mediterranean tuna traps

Tuna traps of the Sardinian and Mediterranean have provided from long to short term series of data and samples of bluefin tuna (BFT) populations inhabiting the Mediterranean. By analyzing genetic variation in BFT trap samples, we have shown that more than one BFT population have been entered and spread in the Mediterranean across the last century and that over short period, the interannual composition of BFT trap catches are genetically constant

INTERMUSCULAR TWO-INCISION TECHNIQUE FOR S-ICD IMPLANTATION

Background The traditional technique for subcutaneous implantable cardioverter defibrillator (S-ICD) implantation, which involves three incisions and a subcutaneous pocket, is associated with possible complications, including inappropriate interventions. The aim of this prospective multicenter study was to evaluate the efficacy and safety of an alternative intermuscular two-incision technique for S-ICD implantation. Methods The study population included 36 consecutive patients (75% male, mean age 44 ± 12 years [range 20–69]) who underwent S-ICD implantation using the intermuscular two-incision technique. This technique avoids the superior parasternal incision for the lead placement and consists of creating an intermuscular pocket between the anterior surface of the serratus anterior and the posterior surface of the latissimus dorsi muscles instead of a subcutaneous pocket. Results All patients were successfully implanted in the absence of any procedure-related complications with a successful 65-J standard polarity defibrillation threshold testing, except in one, who received a second successful shock after pocket revision. During a mean follow-up of 10 months (range 3–30), no complications requiring surgical revision were observed. At device interrogation, stable sensing without interferences was observed in all patients. Two patients (5.5%) experienced appropriate and successful shock on ventricular fibrillation and in four patients (11%), a total of seven nonsustained self-terminated ventricular tachycardias were correctly detected. No inappropriate interventions were observed. Conclusions Our experience suggests that the two-incision intermuscular technique is a safe and efficacious alternative to the current technique for S-ICD implantation that may help reducing complications including inappropriate interventions and offer a better cosmetic outcome, especially in thin individuals

A population genomics insight by 2b‐RAD reveals populations' uniqueness along the Italian coastline in Leptopsammia pruvoti (Scleractinia, Dendrophylliidae)

Aim Marine bioconstructions such as coralligenous formations are hotspot of biodiversity and play a relevant ecological role in the preservation of biodiversity by providing carbon regulation, protection and nursery areas for several marine species. For this reason, the European Union Habitat Directive included them among priority habitats to be preserved. Although their ecological role is well established, connectivity patterns are still poorly investigated, representing a limit in conservation planning. The present study pioneers a novel approach for the analysis of connectivity in marine bioconstructor species, which often lack suitable genetic markers, by taking advantage of next‐generation sequencing techniques. We assess the geographical patterns of genomic variation of the sunset cup coral Leptopsammia pruvoti Lacaze‐Duthiers, 1897, an ahermatypic, non‐zooxanthellate and solitary scleractinian coral species common in coralligenous habitats and distributed across the Mediterranean Sea. Location The Italian coastline (Western and Central Mediterranean). Methods We applied the restriction site‐associated 2b‐RAD approach to genotype over 1,000 high‐quality and filtered single nucleotide polymorphisms in 10 population samples. Results The results revealed the existence of a strongly supported genetic structure, with highly significant pairwise FST values between all the population samples, including those collected about 5 km apart from each other. Moreover, genomic data indicate that the strongest barriers to gene flow are between the western (Ligurian–Tyrrhenian Sea) and the eastern side (Adriatic Sea) of the Italian peninsula. Main conclusions The strong differentiation found in L. pruvoti is similar to that found in other species of marine bioconstructors investigated in this area, but it strongly contrasts with the small differences found in many fish and invertebrates at the same geographical scale. All in one, our results highlight the importance of assessing connectivity in species belonging to coralligenous habitats as, due to their limited dispersal ability, they might require specific spatial conservation measures

Genome-wide Analyses Identify KIF5A as a Novel ALS Gene

To identify novel genes associated with ALS, we undertook two lines of investigation. We carried out a genome-wide association study comparing 20,806 ALS cases and 59,804 controls. Independently, we performed a rare variant burden analysis comparing 1,138 index familial ALS cases and 19,494 controls. Through both approaches, we identified kinesin family member 5A (KIF5A) as a novel gene associated with ALS. Interestingly, mutations predominantly in the N-terminal motor domain of KIF5A are causative for two neurodegenerative diseases: hereditary spastic paraplegia (SPG10) and Charcot-Marie-Tooth type 2 (CMT2). In contrast, ALS-associated mutations are primarily located at the C-terminal cargo-binding tail domain and patients harboring loss-of-function mutations displayed an extended survival relative to typical ALS cases. Taken together, these results broaden the phenotype spectrum resulting from mutations in KIF5A and strengthen the role of cytoskeletal defects in the pathogenesis of ALS.Peer reviewe