A review of clinical decision-making: Models and current research

Aims and objectives: The aim of this paper was to review the current literature with respect to clinical decision-making models and the educational application of models to clinical practice. This was achieved by exploring the function and related research of the three available models of clinical decision making: information processing model, the intuitive-humanist model and the clinical decision making model. Background: Clinical decision-making is a unique process that involves the interplay between knowledge of pre-existing pathological conditions, explicit patient information, nursing care and experiential learning. Historically, two models of clinical decision making are recognised from the literature; the information processing model and the intuitive-humanist model. The usefulness and application of both models has been examined in relation the provision of nursing care and care related outcomes. More recently a third model of clinical decision making has been proposed. This new multidimensional model contains elements of the information processing model but also examines patient specific elements that are necessary for cue and pattern recognition. Design: Literature review Methods: Evaluation of the literature generated from MEDLINE, CINAHL, OVID, PUBMED and EBESCO systems and the Internet from 1980 – November 2005

Epidemiology of distal radius fractures: a detailed survey on a large sample of patients in a suburban area

Background: Literature lacks data on correlations between epidemiology and clinical data of patients with distal radius fractures (DRFs). Aim: The aim of this study was to present a detailed epidemiologic survey of a large consecutive series of patient with DRFs. Materials and Methods: This retrospective study included 827 consecutive patients (579 females, 248 men) who sustained a DRFs in the last 5 years. All fractures were radiographically evaluated. DRFs were classifed according to Association of Osteosynthesis classifcation. Data on age, gender, side, period in which fracture occurred, and fracture mechanism were collected. Statistical analysis was performed. Results: The patients’ mean age was 60.23 [standard deviation (SD) 16.65] years, with the left side being most frequently involved (56.1%). The mean age of females at the time of fracture was signifcantly higher than that of males. The most frequent pattern of fracture was the complete articular fracture (64.3%), while the most represented fracture type was 2R3A2.2 (21.5%). Regarding the period in which the fracture occurred, 305 DRFs (37.5%) were observed in the warmer months and 272 (33.4%) in the colder months. Low-energy trauma occurring outside home was found to be the major cause of DRF throughout the year. In both genders, trauma mechanism 2 was more frequent (59.4% F; 31.9% M; p<0.01). A bimodal distribution of fracture mechanisms was found in males when considering the patient’s age with a highenergy mechanism of fracture (3 and 4), identifed in 21% (n=52) of males aged 18–45 years, and a low-energy mechanism (1 and 2) was observed in 39.9% (n=99) of males aged>45 years. A signifcant correlation between all trauma mechanisms (from 1 to 6) and diferent fracture patterns (complete, partial, and extraarticular) was found (p value<0.001). The mean age of patients with extraarticular fractures (mean age 61.75 years; SD 18.18 years) was higher than that of those with complete (mean age 59.84 years; SD 15.67 years) and partial fractures (mean age 55.26 years; SD 18.31 years). Furthermore, considering diferent fracture patterns and patient age groups, a statistically signifcant diference was found (p<0.001). Conclusions: DRFs have a higher prevalence in females, an increase in incidence with older age, and no seasonal predisposition. Low-energy trauma occurring at home is the main cause of fracture among younger males sustaining fractures after sports trauma; Complete articular is the most frequent fracture pattern, while 2R3A2.2 is most frequent fracture type. Level of evidence: Level IV; case series; descriptive epidemiology stud

Age-Related Changes in Cardiac Autonomic Modulation and Heart Rate Variability in Mice

Objective: The aim of this study was to assess age-related changes in cardiac autonomic modulation and heart rate variability (HRV) and their association with spontaneous and pharmacologically induced vulnerability to cardiac arrhythmias, to verify the translational relevance of mouse models for further in-depth evaluation of the link between autonomic changes and increased arrhythmic risk with advancing age. Methods: Heart rate (HR) and time- and frequency-domain indexes of HRV were calculated from Electrocardiogram (ECG) recordings in two groups of conscious mice of different ages (4 and 19 months old) (i) during daily undisturbed conditions, (ii) following peripheral β-adrenergic (atenolol), muscarinic (methylscopolamine), and β-adrenergic + muscarinic blockades, and (iii) following β-adrenergic (isoprenaline) stimulation. Vulnerability to arrhythmias was evaluated during daily undisturbed conditions and following β-adrenergic stimulation. Results: HRV analysis and HR responses to autonomic blockades revealed that 19-month-old mice had a lower vagal modulation of cardiac function compared with 4-month-old mice. This age-related autonomic effect was not reflected in changes in HR, since intrinsic HR was lower in 19-month-old compared with 4-month-old mice. Both time- and frequency-domain HRV indexes were reduced following muscarinic, but not β-adrenergic blockade in younger mice, and to a lesser extent in older mice, suggesting that HRV is largely modulated by vagal tone in mice. Finally, 19-month-old mice showed a larger vulnerability to both spontaneous and isoprenaline-induced arrhythmias. Conclusion: The present study combines HRV analysis and selective pharmacological autonomic blockades to document an age-related impairment in cardiac vagal modulation in mice which is consistent with the human condition. Given their short life span, mice could be further exploited as an aged model for studying the trajectory of vagal decline with advancing age using HRV measures, and the mechanisms underlying its association with proarrhythmic remodeling of the senescent heart

Optimizing Performance of Continuous-Time Stochastic Systems using Timeout Synthesis

We consider parametric version of fixed-delay continuous-time Markov chains (or equivalently deterministic and stochastic Petri nets, DSPN) where fixed-delay transitions are specified by parameters, rather than concrete values. Our goal is to synthesize values of these parameters that, for a given cost function, minimise expected total cost incurred before reaching a given set of target states. We show that under mild assumptions, optimal values of parameters can be effectively approximated using translation to a Markov decision process (MDP) whose actions correspond to discretized values of these parameters

Reduced recognition of facial emotional expressions in global burnout and burnout depersonalization in healthcare providers

The healthcare provider profession strongly relies on the ability to care for others' emotional experiences. To what extent burnout may relate to an actual alteration of this key professional ability has been little investigated. In an experimentally controlled setting, we investigated whether subjective experiences of global burnout or burnout depersonalization (the interpersonal component of burnout) relate to objectively measured alterations in emotion recognition and to what extent such alterations are emotion specific. Healthcare workers (n = 90) completed the Maslach Burnout Inventory and a dynamic emotion recognition task in which faces with neutral emotional expressions gradually changed to display a specific basic emotion (happiness, anger, fear, or sadness). Participants were asked to identify and then classify each displayed emotion. Before the task, a subsample of 46 participants underwent two salivary cortisol assessments. Individuals with global burnout were less accurate at recognizing others' emotional expressions of anger and fear, tending to misclassify these as happiness, compared to individuals without global burnout. Individuals with high burnout depersonalization were more accurate in recognizing happiness and less accurate in recognizing all negative emotions, with a tendency to misclassify the latter as positive ones, compared to healthcare workers with moderate/low depersonalization. Moreover, individuals with high depersonalization-but not participants with global burnout-were characterized by higher cortisol levels. These results suggest that the subjective burnout experience relates to an actual, but selective, reduction in the recognition of facial emotional expressions, characterized by a tendency to misclassify negative emotional expressions as positive ones, perhaps due to an enhanced seeking of positive social cues. This study adds to the understanding of emotional processing in burnout and paves the way for more nuanced studies on the role of altered processing of threat signals in the development and/or persistence of burnout

Life cycle assessment of hydrogen-powered city buses in the High V.LO-City project: integrating vehicle operation and refuelling infrastructure

During the project High V.LO-City, which ended in December 2019, 14 hydrogen fuel cell buses were operated in four European cities. This paper aims at presenting total emissions through the lifetime of fuel cell buses with different hydrogen production options, including the refuelling stations. The environmental assessment of such bus system is carried out using the life cycle assessment methodology. Three hydrogen production pathways are investigated: water electrolysis, chlor-alkali electrolysis and steam methane reforming. Fuel economy during bus operation is around 10.25 KgH2/100 km, and the refuelling station energy demand ranges between 7 and 9 KWh/KgH2. To support the inventory stage, dedicated software tools were developed for collecting and processing a huge amount of bus data and refuelling station performance, for automating data entry and for impacts calculation. The results show that hydrogen-powered buses, compared to a diesel bus, have the potential to reduce emissions during the use phase, if renewables resources are used. On the other hand, impacts from the vehicle production, including battery pack and fuel cell stack, still dominate environmental load. Consequently, improving the emission profile of fuel cell bus system requires to promote clean electricity sources to supply a low-carbon hydrogen and to sharpen policy focus regarding life cycle management and to counter potential setbacks, in particular those related to problem shifting and to grid improvement. For hazardous emissions and resource use, the high energy intensity of mining and refining activities still poses challenges on how to further enhance the environmental advantages of fuel cells and battery packs

Comparison of amsler–krumeich and sandali classifications for staging eyes with keratoconus

Keratoconus (KC) is the most common corneal ectasia characterized by progressive corneal thinning, protrusion, and irregular astigmatism. The Amsler–Krumeich classification based on the analysis of corneal topography, corneal thickness, refraction and biomicroscopy is the most commonly used; recently, a new classification based on anterior segment Optical Coherence Tomography was introduced by Sandali and colleagues. Since there is no information about the possible agreement between these two classifications, the aim of this study is to compare the stratification of consecutive KC patients using the Amsler–Krumeich and Sandali classifications, and to further ascertain KC cases in which one classification is preferred over the other. Overall, 252 eyes of 137 patients (41.45 ± 16.93 years) were analyzed: in 156 eyes (61.9%), the Amsler and Sandali staging differed in one stage while in 75 cases (29.8%) it differed in two or more stages. In 222 eyes (88.1%), the Sandali staging was higher compared to the Amsler one. These results show that the two classifications are not fully interchangeable: the Amsler–Krumeich classification is more appropriate in identifying and longitudinally monitoring patients with early stages of KC, while the Sandali classification for the diagnosis and follow-up of patients with more advanced stages, particularly when a surgical planning has to be chosen

Exercise Intensity Modulation of Hepatic Lipid Metabolism

Lipid metabolism in the liver is complex and involves the synthesis and secretion of very low density lipoproteins (VLDL), ketone bodies, and high rates of fatty acid oxidation, synthesis, and esterification. Exercise training induces several changes in lipid metabolism in the liver and affects VLDL secretion and fatty acid oxidation. These alterations are even more conspicuous in disease, as in obesity, and cancer cachexia. Our understanding of the mechanisms leading to metabolic adaptations in the liver as induced by exercise training has advanced considerably in the recent years, but much remains to be addressed. More recently, the adoption of high intensity exercise training has been put forward as a means of modulating hepatic metabolism. The purpose of the present paper is to summarise and discuss the merit of such new knowledge

Assessment of the Precision ID Identity Panel kit on challenging forensic samples

The performance of the Precision ID Identity Panel (Thermo Fisher Scientific) was assessed on a set of 87 forensic samples with different levels of degradation for which a reference sample from the \u201csame donor\u201d or from a \u201cfirst degree relative\u201d was available. PCR-MPS analysis was performed with DNA input ranging from 1 ng to 12 pg and through 21-26 PCR cycles, in replicate tests, and a total number of 255 libraries were sequenced on the Ion Personal Genome Machine\u2122 (PGM\u2122) System. The evaluation of the molecular data allowed to set a fix threshold for locus call at 50 x which suitably worked even when low amounts of degraded DNA (12 pg) were investigated. In these analytical conditions, in fact, 25 PCR cycles allowed the genotyping of about 50% and 35% of the autosomal and the Y-specific markers on average, respectively, for each single amplification with a negligible frequency of drop ins (0.01 %). On the other hand, drop out artefacts reached 18-23% when low copy number and degraded DNA samples were studied, with surviving alleles showing more than 600 reads in 2.9 % of the cases. Our data pointed out that the Precision ID Identity Panel allowed accurate typing of almost any amount of good quality/moderately degraded DNA samples, in duplicate tests. The analysis of low copy number DNAs evidenced that the same allele of a heterozygous genotype could be lost twice, thus suggesting that a third amplification could be useful for a correct genotype assignment in these peculiar cases. Using the consensus approach, a limited number of genotyping errors were computed and about 37% of the autosomal markers was finally typed with a corresponding combined random match probability of at least 1.6 x 10-13, which can be considered an excellent result for this kind of challenging samples. In the end, the results presented in this study emphasize the crucial role of the expert opinion in the correct evaluation of artefacts arising from PCR-MPS technology that could potentially lead to genetic mistyping