Measuring and benchmarking the quality of two different organizational ways in delivering infant vaccination

Introduction: The aim of this study was the quality of service evaluation of two different organizational ways in delivering infant vaccination according to a Regional Vaccination Plan. Materials and Methods: Eleven vaccination centres were selected in two Local Health Units (ASLs) belonging to the Regional Health Service of the Lazio Region, Italy. The services offering paediatric vaccinations for children under three years of age, delivered with the need for an appointment (VACL) or else without an appointment (VACP), were investigated. The quality aspects under evaluation were communicational efficiency, organisational efficiency and comfort. Three steps are necessary to quantify the overall quality of service. Step 1 involves different stakeholders and the elicitation of best and worst feasible performance conditions for the ASLs when delivering VACP/VACL services (i.e., subjective data collection). Step 2 consists in the observation of current performances of the selected vaccination centres (i.e., objective data collection). Step 3 involves the combination of all data. Benchmarking between VACP and VACL, i.e., two different organisational ways in delivering infant vaccination, can be performed as a result of the probabilistic meaning of the evaluated scores. Results: An expert of vaccination services, i.e., a virtual combination of patients, doctors and nurses, claims the quality of service delivery of the ASLs under investigation with probability 78.03% and 69.67% for VACL and VACP, respectively. In other words, for short, the quality scores of the ASLs were 78.03% for VACP and 69.67% for VACL. Furthermore our results show how to practically improve the current service delivery

The Challenge of Resilience in a Globalised World

Resilience determines the capacity to successfully deal with difficult events and to adapt and overcome adversity. It creates stability in a changing world which in turn promotes job creation, economic growth and environmental sustainability. Resilience is a fundamental prerequisite for Europe as the largest integrated economic area in the world and has an important social dimension which requires the active cooperation of all stakeholders; citizens, the private sector, governments and NGOs included. This report discusses the concept of resilience from different perspectives and the role of science in the continuous process of building a resilient, stable, competitive and prosperous Europe.JRC.G-Institute for the Protection and Security of the Citizen (Ispra

Differences in Spontaneously Avoiding or Approaching Mice Reflect Differences in CB1-Mediated Signaling of Dorsal Striatal Transmission

Approach or avoidance behaviors are accompanied by perceptual vigilance for, affective reactivity to and behavioral predisposition towards rewarding or punitive stimuli, respectively. We detected three subpopulations of C57BL/6J mice that responded with avoiding, balancing or approaching behaviors not induced by any experimental manipulation but spontaneously displayed in an approach/avoidance conflict task. Although the detailed neuronal mechanisms underlying the balancing between approach and avoidance are not fully clarified, there is growing evidence that endocannabinoid system (ECS) plays a critical role in the control of these balancing actions. The sensitivity of dorsal striatal synapses to the activation of cannabinoid CB1 receptors was investigated in the subpopulations of spontaneously avoiding, balancing or approaching mice. Avoiding animals displayed decreased control of CB1 receptors on GABAergic striatal transmission and in parallel increase of behavioral inhibition. Conversely, approaching animals exhibited increased control of CB1 receptors and in parallel increase of explorative behavior. Balancing animals reacted with balanced responses between approach and avoidance patterns. Treating avoiding animals with URB597 (fatty acid amide hydrolase inhibitor) or approaching animals with AM251 (CB1 receptor inverse agonist) reverted their respective behavioral and electrophysiological patterns. Therefore, enhanced or reduced CB1-mediated control on dorsal striatal transmission represents the synaptic hallmark of the approach or avoidance behavior, respectively. Thus, the opposite spontaneous responses to conflicting stimuli are modulated by a different involvement of endocannabinoid signaling of dorsal striatal neurons in the range of temperamental traits related to individual differences

Il commercio di organi umani fra normativa nazionale e internazionale

il commercio di organi umani è un fenomeno transnazionale che viola i diritti fondamentali dell'uomo. Il presente lavoro si propone di definire il reato di commercio d'organi attraverso un esame delle forme, cause, modalità e mezzi con cui si esplica, delineando i profili dei protagonisti e delle vittime di questo reato ed analizzando l'inquadramento giuridico e le normative emanate a livello nazionale ed internazionale per valutare la loro concreta portata nell aprevenzione e repressione del reato in esame. Le legislazioni sono sempre state insufficienti ed inadeguate sia a livello nazionale che internazionale. l'obiettivo primario che la normativa penale dovrebbe perseguire, affinchè le misure volte alla riduzione del fenomeno in oggetto siano efficaci, è quello di realizzare, a livello internazionale una cooperazione giudiziaria ed un'armonizzazione normativa al fine di creare, altresì, una omogeneizzazione delle risposte punitive. In tal modo si verrebbe a contrastare il turismo dei trapianti reato parallelo che spesso si associa al commercio di organi umani, e si offrirebbe una effettiva tutela al principio sancito dalle solenni Carte internazionali europee e nazionali secondo cui il corpo umano e le sue parti non devono essere, in quanto tali fonti di profitto

Il commercio di organi umani fra normativa nazionale e internazionale

il commercio di organi umani è un fenomeno transnazionale che viola i diritti fondamentali dell'uomo. Il presente lavoro si propone di definire il reato di commercio d'organi attraverso un esame delle forme, cause, modalità e mezzi con cui si esplica, delineando i profili dei protagonisti e delle vittime di questo reato ed analizzando l'inquadramento giuridico e le normative emanate a livello nazionale ed internazionale per valutare la loro concreta portata nell aprevenzione e repressione del reato in esame. Le legislazioni sono sempre state insufficienti ed inadeguate sia a livello nazionale che internazionale. l'obiettivo primario che la normativa penale dovrebbe perseguire, affinchè le misure volte alla riduzione del fenomeno in oggetto siano efficaci, è quello di realizzare, a livello internazionale una cooperazione giudiziaria ed un'armonizzazione normativa al fine di creare, altresì, una omogeneizzazione delle risposte punitive. In tal modo si verrebbe a contrastare il turismo dei trapianti reato parallelo che spesso si associa al commercio di organi umani, e si offrirebbe una effettiva tutela al principio sancito dalle solenni Carte internazionali europee e nazionali secondo cui il corpo umano e le sue parti non devono essere, in quanto tali fonti di profitto

Impaired repair of DNA damage is associated with autistic-like traits in rats prenatally exposed to valproic acid

Prenatal exposure to the antiepileptic and mood stabilizer valproic acid (VPA) is an environmental risk factor for autism spectrum disorders (ASD), although recent epidemiological studies show that the public awareness of this association is still limited. Based on the clinical findings, prenatal VPA exposure in rodents is a widely used preclinical model of ASD. However, there is limited information about the precise biochemical mechanisms underlying the link between ASD and VPA. Here, we tested the effects of increasing doses of VPA on behavioral features resembling core and secondary symptoms of ASD in rats. Only when administered prenatally at the dose of 500mg/kg, VPA induced deficits in communication and social discrimination in rat pups, and altered social behavior and emotionality in the adolescent and adult offspring in the absence of gross malformations. This dose of VPA inhibited histone deacetylase in rat embryos and favored the formation of DNA double strand breaks (DSB), but impaired their repair. The defective DSB response was no more visible in one-day-old pups, thus supporting the hypothesis that unrepaired VPA-induced DNA damage at the time of neural tube closure may underlie the autistic-like traits displayed in the course of development by rats prenatally exposed to VPA. These experiments help to understand the neurodevelopmental trajectories affected by prenatal VPA exposure and identify a biochemical link between VPA exposure during gestation and ASD

Greater cardiovascular risk reduction with once-daily fixed combination of three antihypertensive agents and statin versus free-drug combination. the all-in-one trial

BACKGROUND: The ultimate goal of antihypertensive therapy is cardiovascular risk (CVR) reduction. The aim of this study was to compare the efficacy and safety of once-daily fixed combination (ODFC) versus free-drug combination (FDC) of 3antihypertensive agents and statin. METHODS: The ALL-IN-ONE trial was a 12-week randomized, prospective, multicenter trial. A total of 305 hypertensive patients were randomized 1:1. The "fixed group" was given an ODFC of perindropil 10mg plus indapamide 2.5mg plus amlodipine 5 or 10mg plus atorvastatin 20mg. The "free group" was given a FDC of the 3antihypertensive agents plus atorvastatin 20mg. Primary end-points were the differences in clinic BP, cholesterol levels and CVR risk between the 2 groups after treatments. Secondary end-points included intragroup differences in clinic BP. Safety and compliance were also assessed. RESULTS: At 12-weeks, the fixed group had lower systolic BP and similar diastolic BP compared to the free group. BP targets at week 12 were more commonly reached with fixed than free combination (89% and 80% respectively, p=0.048). For cholesterol serum in both groups there was a significant reduction of values. Also CVR reduction was greater in those taking ODF. Safety was not significantly different between the 2 groups. Conversely, compliance was significantly greater in the fixed-group vs. the free-group. CONCLUSION: This randomized trial shows that ODF combination of perindropil, indapamide and amlodipine is as safe as free combination of the 3 drugs, but is associated with a greater efficacy in BP control, compliance and, associated with statin, in cholesterol reduction. A better cardiovascular risk control is achieved with ODF combination than with a free administratio

Acute and chronic neurobehavioral effects of the designer drug and bath salt constituent 3,4-methylenedioxypyrovalerone in the rat

Background: The substantial increase in use of 3,4-methylenedioxypyrovalerone (MDPV), a popular recreational synthetic cathinone, has raised legitimate questions about its behavioral consequences and abuse liability. Aims: The aim of this study was to study MDPV-induced neurobehavioral effects in the rat, using different paradigms traditionally developed to study drug-attributed addictive properties. Methods: Different patterns of intraperitoneal 3 mg/kg MDPV administration were investigated. Consequences on rat horizontal locomotion and behavior of acute, intermittent (once daily dosing over 10 days), and binge (three-time daily dosing for 3 days) MDPV administration as well as challenge after 10 day MDPV withdrawal were studied. The dopamine receptor-D1 antagonist, SCH23390, was bilaterally infused in the nucleus accumbens to determine the role of D1-receptors in MDPV-related effects on the associative memory recall using the conditioned place preference paradigm. In addition, in a separate experience using western blot, we investigated the effects of chronic MDPV administration (four injections during 24 h) on ΔFosB expression in the nucleus accumbens, caudate putamen, and prefrontal cortex. Results: Acute MDPV administration increased stereotypies and open arm entries in the elevated plus maze while SCH23390 abolished MDPV-induced enhancing effects on memory consolidation. Intermittent MDPV administration resulted in sensitization of MDPV-induced locomotor effects and tolerance during the following challenge. With binge MDPV administration, locomotor activity was not altered despite tolerance onset after challenge. SCH23390 abolished MDPV-induced onditioned place preference. Chronic MDPV administration induced ΔFosB accumulation in the nucleus accumbens, caudate putamen, and prefrontal cortex. Conclusions: Our findings clearly show that MDPV produces profound behavioral alterations mediated by the activation of the dopaminergic system similarly to other amphetamines