Heterogeneity in Preferences for Primary Care Consultations: Results from a Discrete Choice Experiment

Abstract: Purpose: The increasing importance of flexibility in the general practitioner (GP) -patient consultation approach in primary care requires healthcare managers and physicians to find a balance among all the potentially important characteristics of consultation. This study used a discrete choice experiment (DCE) to assess patients' preferences for different attributes of GP consultation and how the rate at which they traded between different attributes is affected by socio-demographic characteristics and past experiences with primary care services . Methods: A survey was conducted to a sample of 6970 residents in Tuscany region, Italy. Besides socio-demographic characteristics the survey collected information about participants' past experience with GP consultation in the last 12 months. Moreover, participants were asked to select their preferred option in a series of pairwise choices, defined by the following attributes: level of involvement in decision making, amount of information received from the GP and waiting time for the visit. Results: Results revealed that receiving information from the GP was more important than being involved in the decisions and that, approximately, a complete involvement had the same importance as a partial involvement. Participants' past experience with GP's consultation appeared to have the greatest influence on the involvement level. The amount of information required by the respondents was also influenced by a complex interplay of personal and contextual factors. Conclusions: This large-scale study extends the body of literature on DCE applications for different GP consultation approaches, providing new information about the influence that patients' socio-demographic characteristics and past experiences could have on consultation preferences.

Blue-green endoscopy in canine digestive neoplastic conditions – two cases

Two dogs - one presenting with soft stools for one year and the other vomiting for about a week - were examined at the University Veterinary Teaching Hospital, Camerino University. After clinical evaluations and laboratory tests, both dogs underwent firstly an abdominal ultrasonography, and subsequently a digestive endoscopy (colonoscopy and esophago-gastroscopy, respectively). In case 1, the ultrasonography revealed the presence of markedly enlarged mesenteric lymph nodes and an abnormal colon, presenting irregular mucosa, wall thickening, and in some points, loss of wall layering, while in case 2, a thickening of the gastric body wall and a loss of wall layering. Endoscopically (performed using an endoscope provided with a single blue + green (BG) filter, restraining wavelengths from 400 to 550 nm), in case 1 (using a white light endoscopy) the mucosa of the whole descending colon appeared irregular, in some tracts even nodular, and hyperemic; many diffusely interspersed erosions were also present; in case 2 (using a white light endoscopy), many ulcers were found at the level of the passage between the gastric body and the antrum. In both cases, with the BG endoscopy, lesions of the mucosa and bleeding areas were visible in dark blue and the lesions appeared to be more clearly defined from the remaining mucosa compared to when using a white light endoscopy. Histopathology revealed in case 1 (samples from lymphnodes and colon) a B associate high-grade lymphoma – large cells – B form (transmural type), while in case 2 (samples from the stomach) pathologic ulcers associated with a non-signet type, intestinal type, gastric adenocarcinoma. To the author’s knowledge, information regarding this endoscopic technique in veterinary medicine literature is absent; nevertheless, even if in our cases the lesions appeared to be more clearly defined with a BG endoscopy, many further studies are needed in order to determine the clinical, endoscopic and pathological significance in canine colonic and gastric neoplastic infiltrates, of this technique

Genetic variability in Peregrine Falcon populations of the Western Palaearctic region

We analysed variation in ten polymorphic microsatellite loci and a portion of cytochrome bgeneof mitochondrial DNA in 65 samples from four populations of Peregrine Falcon (Falco peregrinus peregrinus and F. p. brookei) breeding in Northern and Southern Italy, Northern Spain and the Czech Republic to assess genetic diversity in the poorly investigated Western Palearctic region. We added to our cytochrome b sequences a dataset of previously published mtDNA sequences of other populations and subspecies to outline genetic variation in the region on a worldwide basis. Regarding mtDNA we identified 12 haplotypes from our 65 Peregrine Falcon samples, nine of which were new and three already known. The 52% of our samples, including all Italian and Czech specimens, belonged to the previously identified HI haplotype, another 22% of the samples, most of which were from Sicily, showed the new H1 haplotype, while the remaining 26% of the sample partitioned among the other 10 haplotypes. Allelic patterns and genetic structuring of microsatellites were similar to those of other European populations. Genetic differentiation in both mtDNA and microsatellites loci is almost absent and it is not possible to distinguish geographical groups according to taxonomic designation at the subspecies level

Entanglement entropy production in Quantum Neural Networks

Quantum Neural Networks (QNN) are considered a candidate for achieving quantum advantage in the Noisy Intermediate Scale Quantum computer (NISQ) era. Several QNN architectures have been proposed and successfully tested on benchmark datasets for machine learning. However, quantitative studies of the QNN-generated entanglement have been investigated only for up to few qubits. Tensor network methods allow to emulate quantum circuits with a large number of qubits in a wide variety of scenarios. Here, we employ matrix product states to characterize recently studied QNN architectures with random parameters up to fifty qubits showing that their entanglement, measured in terms of entanglement entropy between qubits, tends to that of Haar distributed random states as the depth of the QNN is increased. We certify the randomness of the quantum states also by measuring the expressibility of the circuits, as well as using tools from random matrix theory. We show a universal behavior for the rate at which entanglement is created in any given QNN architecture, and consequently introduce a new measure to characterize the entanglement production in QNNs: the entangling speed. Our results characterise the entanglement properties of quantum neural networks, and provides new evidence of the rate at which these approximate random unitaries

Disentangling the taxonomic status and phylogeographic structure of Marmora\u2019s (Curruca sarda) and Balearic Warbler (Curruca balearica): a genetic multi-marker approach

Marmora\u2019s Warbler (Curruca sarda) and Balearic Warbler (C. balearica) are allopatric sibling species and were recently split mostly based on morphological and ethological characteristics. Here we provide the first phylogenetic and phylogeographic analyses of this species complex to support the taxonomic status of C. sarda and C. balearica in light of integrative taxonomy. We sampled the two taxa in most of their breeding ranges and we sequenced three mitochondrial and one nuclear gene region. All C. balearica individuals had private haplotypes for the four markers and formed monophyletic clades. Genetic distances between the two taxa were comparable with those found between other species belonging to the Curruca genus. Furthermore, most of the genetic variance was expressed at the interspecific level, rather than between different populations within taxa or between individuals within populations. Our results strongly support the current taxonomic status of these two warblers as distinct species

Exploring the Gut Microbiome Alteration of the European Hare (Lepus europaeus) after Short-Term Diet Modifications

This study aimed to characterise the gut microbiome composition of European hares (Lepus europaeus) and its potential changes after a short-term diet modification. The high sensitivity of European hare to habitat changes makes this species a good model to analyse possible alterations in gut microbiome after the introduction of additional nourishment into the diet. In total, 20 pairs were chosen for the experiments; 10 pairs formed the control group and were fed with standard fodder. The other 10 pairs represented the experimental group, whose diet was integrated with apples and carrots. The DNA from fresh faecal pellets collected after 4 days from the start of the experiment was extracted and the V3-V4 hypervariable regions were amplified and sequenced using the Illumina MiSeq® platform. The obtained amplicon sequence variants were classified into 735 bacterial genera belonging to 285 families and 36 phyla. The control and the experimental groups appeared to have a homogenous dispersion for the two taxonomic levels analysed with the most abundant phyla represented by Bacteroidetes and Firmicutes. No difference between control and experimental samples was detected, suggesting that the short-term variation in food availability did not alter the hares’ gut microbiome. Further research is needed to estimate significant time threshold

Pyrosequencing Unveils Cystic Fibrosis Lung Microbiome Differences Associated with a Severe Lung Function Decline

Chronic airway infection is a hallmark feature of cystic fibrosis (CF) disease. In the present study, sputum samples from CF patients were collected and characterized by 16S rRNA gene-targeted approach, to assess how lung microbiota composition changes following a severe decline in lung function. In particular, we compared the airway microbiota of two groups of patients with CF, i.e. patients with a substantial decline in their lung function (SD) and patients with a stable lung function (S). The two groups showed a different bacterial composition, with SD patients reporting a more heterogeneous community than the S ones. Pseudomonas was the dominant genus in both S and SD patients followed by Staphylococcus and Prevotella. Other than the classical CF pathogens and the most commonly identified non-classical genera in CF, we found the presence of the unusual anaerobic genus Sneathia. Moreover, the oligotyping analysis revealed the presence of other minor genera described in CF, highlighting the polymicrobial nature of CF infection. Finally, the analysis of correlation and anti-correlation networks showed the presence of antagonism and ecological independence between members of Pseudomonas genus and the rest of CF airways microbiota, with S patients showing a more interconnected community in S patients than in SD ones. This population structure suggests a higher resilience of S microbiota with respect to SD, which in turn may hinder the potential adverse impact of aggressive pathogens (e.g. Pseudomonas). In conclusion, our findings shed a new light on CF airway microbiota ecology, improving current knowledge about its composition and polymicrobial interactions in patients with CF

Essential Oil from Origanum vulgare Completely Inhibits the Growth of Multidrug-Resistant Cystic Fibrosis Pathogens.

Essential oils (EOs) are known to inhibit the growth of a wide range of microorganisms. Particularly interesting is the possible use of EOs to treat multidrug-resistant cystic fibrosis (CF) pathogens. We tested the essential oil (EO) from Origanum vulgare for in vitro antimicrobial activity, against three of the major human opportunistic pathogens responsible for respiratory infections in CF patients; these are methicillin-resistant Staphylococcus aureus, Stenotrophomonas maltophilia and Achromobacter xylosoxidans. Antibiotic susceptibility of each strain was previously tested by the standard disk diffusion method. Most strains were resistant to multiple antibiotics and could be defined as multi-drug-resistant (MDR). The antibacterial activity of O. vulgare EO (OEO) against a panel of 59 bacterial strains was evaluated, with MIC and MBC determined at 24, 48 and 72 hours by a microdilution method. The OEO was effective against all tested strains, although to a different extent. The MBC and MIC of OEO for S. aureus strains were either lower or equal to 0.50%, v/v, for A. xylosoxidans strains were lower or equal to 1% and 0.50%, v/v, respectively; and for S. maltophilia strains were lower or equal to 0.25%, v/v. The results from this study suggest that OEO might exert a role as an antimicrobial in the treatment of CF infections

Multifunctional nanoassemblies target bacterial lipopolysaccharides for enhanced antimicrobial DNA delivery

The development of new therapeutic strategies against multidrug resistant Gram-negative bacteria is a major challenge for pharmaceutical research. In this respect, it is increasingly recognized that an efficient treatment for resistant bacterial infections should combine antimicrobial and anti-inflammatory effects. Here, we explore the multifunctional therapeutic potential of nanostructured self-assemblies from a cationic bolaamphiphile, which target bacterial lipopolysaccharides (LPSs) and associates with an anti-bacterial nucleic acid to form nanoplexes with therapeutic efficacy against Gram-negative bacteria. To understand the mechanistic details of these multifunctional antimicrobial-anti-inflammatory properties, we performed a fundamental study, comparing the interaction of these nanostructured therapeutics with synthetic biomimetic bacterial membranes and live bacterial cells. Combining a wide range of experimental techniques (Confocal Microscopy, Fluorescence Correlation Spectroscopy, Microfluidics, NMR, LPS binding assays), we demonstrate that the LPS targeting capacity of the bolaamphiphile self-assemblies, comparable to that exerted by Polymixin B, is a key feature of these nanoplexes and one that permits entry of therapeutic nucleic acids in Gram-negative bacteria. These findings enable a new approach to the design of efficient multifunctional therapeutics with combined antimicrobial and anti-inflammatory effects and have therefore the potential to broadly impact fundamental and applied research on self-assembled nano-sized antibacterials for antibiotic resistant infections

An update of the Worldwide Integrated Assessment (WIA) on systemic insecticides. Part 2: impacts on organisms and ecosystems

New information on the lethal and sublethal effects of neonicotinoids and fipronil on organisms is presented in this review, complementing the previous WIA in 2015. The high toxicity of these systemic insecticides to invertebrates has been confirmed and expanded to include more species and compounds. Most of the recent research has focused on bees and the sublethal and ecological impacts these insecticides have on pollinators. Toxic effects on other invertebrate taxa also covered predatory and parasitoid natural enemies and aquatic arthropods. Little, while not much new information has been gathered on soil organisms. The impact on marine coastal ecosystems is still largely uncharted. The chronic lethality of neonicotinoids to insects and crustaceans, and the strengthened evidence that these chemicals also impair the immune system and reproduction, highlights the dangers of this particular insecticidal classneonicotinoids and fipronil. , withContinued large scale – mostly prophylactic – use of these persistent organochlorine pesticides has the potential to greatly decreasecompletely eliminate populations of arthropods in both terrestrial and aquatic environments. Sublethal effects on fish, reptiles, frogs, birds and mammals are also reported, showing a better understanding of the mechanisms of toxicity of these insecticides in vertebrates, and their deleterious impacts on growth, reproduction and neurobehaviour of most of the species tested. This review concludes with a summary of impacts on the ecosystem services and functioning, particularly on pollination, soil biota and aquatic invertebrate communities, thus reinforcing the previous WIA conclusions (van der Sluijs et al. 2015)