Economic Impact of Inter-Regional Health Mobility In The Oldest European Administrative Region: A Starting Point For Changing Organizational Model?

Objectives: The aim of this study is to evaluate the inter-regional mobility expenditures, with particular reference to oncology, in Liguria Region. Study design: A descriptive analysis of inter-regional mobility expenditures from 2008 to 2015 was carried out. Methods: The analysis involved a detailed assessment of global balance of interregional health mobility by means the DRGs; the flow of specialist outpatient and pharmaceutical was also used. Results: Since 2008 until 2012 an increase of negative balance of global healthcare expenditure in Liguria Region was observed [34.7 \u20ac mill (2008) and 62.3 \u20ac mill (2012)]; subsequently a quite stable trend was recorded between 2012 and 2015 [ranging between 59.8 \u20ac mill (2013) and 63.2 \u20ac mill (2014)]. The passive mobility was 15.1% on the total spending for hospital acute care in 2012 and a similar value was detected in 2015 (15.2%). The higher costs for passive mobility were attributable to the surgical DRGs (69.4% in 2012 and 69.8% in 2015) with a double estimate of the expenditure in comparison with medical ones (2012: 99.4 \u20ac mill vs 43.8 \u20ac mill, \u394= 55.6 \u20ac mill; 2015: 96.6 \u20ac mill vs 41.9 \u20ac mill, \u394= 54.7 \u20ac mill). The highest cost sources in the process of passive mobility are the surgical areas, particularly the surgical hospitalizations for orthopaedic and cardiologic interventions. The spending analysis for oncologic DRG, divided into surgical and medical for passive and active mobility, showed that the surgical DRG determined a negative balance of 3.8 \u20ac mill in 2012 and 4.3 \u20ac mill in 2015, while the medical DRG showed a positive balance of 0.5 \u20ac mill in 2012 and 0.7 \u20ac mill in 2015. Conclusions: Our evaluation highlights that the inter-regional mobility for hospital acute care is the most relevant issue for the economic regional balance and reveals an important flow of patients moving from Liguria Region to neighbouring regions. As the equity of access and distribution of the supply of care remains a priority of Regional Health System, the active mobility in oncologic field could be a marker of quality health planning

Structure-Property Correlations in Aqueous Binary Na+/K+-CH3COO- Highly Concentrated Electrolytes

Highly concentrated aqueous binary solutions of acetate salts are promising systems for different electrochemical applications, for example, energy storage devices. The very high solubility of CH3COOK allows us to obtain water-in-salt electrolyte concentrations, thus reducing ion activity and extending the cathodic stability of an aqueous electrolyte. At the same time, the presence of Li+ or Na+ makes these solutions compatible with intercalation materials for the development of rechargeable alkaline-ion batteries. Although there is a growing interest in these systems, a fundamental understanding of their physicochemical properties is still lacking. Here, we report and discuss the physicochemical and electrochemical properties of a series of solutions based on 20 mol kg-1 CH3COOK with different concentrations of CH3COONa. The most concentrated solution, 20 mol kg-1 CH3COOK + 7 mol kg-1 CH3COONa, gives the best compromise between transport properties and electrochemical stability, displaying a conductivity of 21.2 mS cm-1 at 25 \ub0C and a stability window of up to 3 V in “ideal” conditions, i.e., using a small surface area and highly electrocatalytic electrode in a flooded cell. Careful Raman spectroscopy analyses help to address the interaction network, the phase evolution with temperature, and the crystallization kinetics

Cosmogenic radionuclides reveal an extreme solar particle storm near a solar minimum 9125 years BP

During solar storms, the Sun expels large amounts of energetic particles (SEP) that can react with the Earth’s atmospheric constituents and produce cosmogenic radionuclides such as 14C, 10Be and 36Cl. Here we present 10Be and 36Cl data measured in ice cores from Greenland and Antarctica. The data consistently show one of the largest 10Be and 36Cl production peaks detected so far, most likely produced by an extreme SEP event that hit Earth 9125 years BP (before present, i.e., before 1950 CE), i.e., 7176 BCE. Using the 36Cl/10Be ratio, we demonstrate that this event was characterized by a very hard energy spectrum and was possibly up to two orders of magnitude larger than any SEP event during the instrumental period. Furthermore, we provide 10Be-based evidence that, contrary to expectations, the SEP event occurred near a solar minimum

Tree-rings reveal two strong solar proton events in 7176 and 5259 BCE

The Sun sporadically produces eruptive events leading to intense fluxes of solar energetic particles (SEPs) that dramatically disrupt the near-Earth radiation environment. Such events have been directly studied for the last decades but little is known about the occurrence and magnitude of rare, extreme SEP events. Presently, a few events that produced measurable signals in cosmogenic radionuclides such as 14C, 10Be and 36Cl have been found. Analyzing annual 14C concentrations in tree-rings from Switzerland, Germany, Ireland, Russia, and the USA we discovered two spikes in atmospheric 14C occurring in 7176 and 5259 BCE. The ~2% increases of atmospheric 14C recorded for both events exceed all previously known 14C peaks but after correction for the geomagnetic field, they are comparable to the largest event of this type discovered so far at 775 CE. These strong events serve as accurate time markers for the synchronization with floating tree-ring and ice core records and provide critical information on the previous occurrence of extreme solar events which may threaten modern infrastructure

Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study

Background Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave. Methods This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs. Results Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI − 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI − 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates. Conclusions Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021)

Transverse Energy Flow in the Underlying Event in the Proton-Proton Collisions at √s = 7 TeV with the ATLAS Calorimeter

The European Organization for Nuclear Research (CERN) operates the world's largest and highest energy proton-proton collider at a center of mass energy of √s = 7 TeV, the Large Hadron Collider (LHC). ATLAS is one of the four detectors operating at the LHC. The Underlying Event (UE), which is an unavoidable background at any hadron collider, includes particles from various sources generated in each proton collision. The particle flow in the underlying event is characterized by low transverse energies reflecting the long range character of the individual processes generating them. This regime cannot be described by the usual perturbative models provided by Quantum Chromodynamics (QCD), the theory of the strong force. To model this flow, phenomenological models have to be applied, as provided by Monte Carlo simulations. In this work I define new discriminating variables to constrain these UE models in the new kinematical regime available at LHC. Using calorimeter data from the ATLAS experiment, several Monte Carlo models are tested by comparing the data to these predictions for three different final states (minimum bias, di-jet and direct photon production). The experimental data are fully unfolded to the hadron level within the full acceptance of the ATLAS detector, thus for the first time including the forward direction in hadron collisions. The final results are presented in the context of previous measurements on the characteristics of the strong force in the proton, in deep inelastic lepton-proton scattering

Extreme solar particle storms and links to solar activity inferred from cosmogenic radionuclides in ice cores

During solar storms, large amounts of solar energetic particles (SEP) are accelerated into the interplanetary medium and sometimes hit Earth. These events, known as SEP events, can have harmful impacts on our modern society by affecting spacecrafts and potentially astronauts in space. The first directly observed solar storm was the Carrington event in 1859 which is linked to disruptions of the telegraph system and an aurora oval at unusually low latitudes. The most extreme form of SEP events can be detected in cosmogenic radionuclide records from ice cores and tree rings. Cosmogenic radionuclides are produced by the interaction between high-energy galactic cosmic rays (GCRs), the dominant source of production, and SEPs with atmospheric atoms. The flux of GCRs is modulated by the strength of the Sun’s and the Earth’s magnetic fields, which vary through time. Measuring cosmogenic radionuclides in ice cores (10Be and 36Cl) and tree rings (14C) thus allows us to reconstruct the history of the Sun’s and the Earth’s magnetic fields, and of SEP events. This thesis aims to detect new SEP events over the Holocene and to discuss their timing within the 11-year solar cycle, and to test the use of excess meltwater from continuous flow analysis (CFA) to measure cosmogenic radionuclides. The 10Be record from CFA excess meltwater from the EGRIP S6 core is presented. By comparing the data to another 10Be record from discrete samples from the same core we show that the CFA excess meltwater samples are a valuable alternative to discrete samples for the measurement of cosmogenic radionuclides and, thus, solar activity reconstructions. This result opens the possibility of obtaining continuous 10Be records with a more time-efficient sample preparation.10Be and 36Cl data from Greenland and Antarctica support the occurrence of three extreme SEP events 9125 years BP, 7350 years BP and 7208 years BP. Furthermore,we show that the Carrington event cannot be detected in high-resolution 10Be and 36Cl data from Greenland, in agreement with previous studies.Finally, two proposed solar storms in 1052 CE and 1279 CE are also investigated with 10Be and 36Cl data from Greenland, which do not support the occurrenceof SEP events