Application of a score system to evaluate the risk of malnutrition in a multiple hospital setting

Background: An increased but unpredictable risk of malnutrition is associated with hospitalization, especially in children with chronic diseases. We investigated the applicability of Screening Tool for Risk of Impaired Nutritional Status and Growth (STRONGkids), an instrument proposed to estimate the risk of malnutrition in hospitalized children. We also evaluated the role of age and co-morbidities as risk for malnutrition. Methods. The STRONGkids consists of 4 items providing a score that classifies a patient in low, moderate, high risk for malnutrition. A prospective observational multi-centre study was performed in 12 Italian hospitals. Children 1-18 years consecutively admitted and otherwise unselected were enrolled. Their STRONGkids score was obtained and compared with the actual nutritional status expressed as BMI and Height for Age SD-score. Results: Of 144 children (75 males, mean age 6.5 \ub1 4.5 years), 52 (36%) had an underlying chronic disease. According to STRONGkids, 46 (32%) children were at low risk, 76 (53%) at moderate risk and 22 (15%) at high risk for malnutrition. The latter had significantly lower Height for Age values (mean SD value -1.07 \ub1 2.08; p = 0.008) and BMI values (mean SD-values -0.79 \ub1 2.09; p = 0.0021) in comparison to other groups. However, only 29 children were actually malnourished. Conclusions: The STRONGkids is easy to administer. It is highly sensitive but not specific. It may be used as a very preliminary screening tool to be integrated with other clinical data in order to reliably predict the risk of malnutrition. \ua9 2013 Spagnuolo et al.; licensee BioMed Central Ltd

Sustained low influenza vaccination in health care workers after H1N1 pandemic: A cross sectional study in an Italian health care setting for at-risk patients

Background: Despite consistent recommendations by all Public Health Authorities in support of annual influenza vaccination for at-risk categories, there is still a low uptake of influenza vaccine in these groups including health care workers (HCWs). Aim of this observational two-phase study was to estimate the immunization rates for influenza in four subsequent seasons and for pandemic H1N1 influenza in HCWs of a University Hospital, and to investigate its distribution pattern and the main determinants of immunization. Phase 1 data collection was performed in 2009-2010, during the peak of H1N1 pandemic. Phase 2 data collection, aimed to investigate seasonal influenza vaccination coverage in the three seasons after pandemic, was performed in 2012-2013. Methods: The overall H1N1 vaccination rate was derived by the Hospital immunization registry. In 2010, the personnel of three Departments (Infectious Diseases, Pediatrics and Gynecology/Obstetrics) completed a survey on influenza. A second-phase analysis was performed in 2012 to investigate influenza vaccination coverage in three consecutive seasons. Results: The first-phase survey showed a low coverage for influenza in all categories (17 %), with the lowest rate in nurses (8.1 %). A total of 37 % of health care workers received H1N1 vaccine, with the highest rate among physicians and the lowest in nurses. H1N1 vaccination was closely related to the Department, being higher in the Department of Infectious Diseases (53.7 %) and Pediatrics (42.4 %) than in Gynecology/Obstetrics (8.3 %). The second-phase survey showed the lowest rate of influenza vaccination in 2012/13 season. The main reasons for not being vaccinated were "Unsure of the efficacy of vaccine" and "Feel not at-risk of getting influenza or its complications". Despite recommendations, influenza vaccine uptake remains poor. Conclusion: Immunization is largely perceived as a personal protection rather than a measure needed to prevent disease spreading to at-risk patients. Compulsory vaccination against influenza should be considered as a possible strategy, at least in health institutions where at-risk patients are admitted

Determinants of low measles vaccination coverage in children living in an endemic area

Measles outbreaks were recently reported in Europe due to low immunization rates. In this scenario, identifying the reasons of no vaccination is crucial to set up strategies to improve immunization rate. A cross-sectional study was conducted to investigate the determinants of missed vaccination in children living in Southern Italy, during the 2016 outbreak. A standardized face-to-face questionnaire was used to record demographic data, immunization status, and reasons for missed vaccination. A total of 1141 children (median age 86 months, male 47.2%) was enrolled, 77.8% of the children were adequately vaccinated for age, 6.3% were incompletely vaccinated for age, and 15.9% did not receive any vaccine dose. Vaccination rate and reasons for not vaccinating significantly varied according to age, with children ≤ 24 months showing the lowest rate (67.8%). Reasons for not vaccinating included fear for side effects (51%), presence of underlying chronic conditions (12.2%), skip scheduled appointment (12.2%), refusal of vaccination (10.3%), acute illnesses (7.2%), and allergy to eggs (4.6%). The presence of underlying condition was a risk factor for inadequate immunization (p < 0.0001). Only 4.7% of conditions were true contraindications to vaccine administration. Conclusion: We reported inadequate measles immunization rate in Southern Italy, with lowest rates in children ≤ 2 years or with underlying conditions. Only a minority had true contraindications to vaccine uptake. Implementation strategies addressed to health-care professionals and families should focus on the reported determinants to increase measles vaccination coverage.What is Known:• Measles is a viral, highly communicable disease, preventable by vaccine.• Measles elimination in Europe failed as demonstrated by outbreaks in several countries, due to low immunization rates.What is New:• Inadequate measles immunization rate due to false contraindications in Southern Italy, with lowest rates in children ≤ 2 years.• The presence of underlying disease is a risk factor for inadequate immunization

Search for lepton number and flavour violation in K+ and pi0 decays

The NA62 experiment at CERN collected a large sample of charged kaon decays into final states with multiple charged particles in 2016-2018. This sample provides sensitivities to rare decays with branching ratios as low as 10 −11 . Searches for the lepton number violating K + → π − µ + e+ decay and the lepton flavour violating K + → π + µ − e + and π 0 → µ − e + decays are reported. No evidence for these decays is found and upper limits of the branching ratios are obtained at 90% confidence level. These results improve by one order of magnitude over previous results for these decay modes

New measurement of the radiative decay Ke3g at the NA62 experiment at CERN

The NA62 experiment at CERN reports new results from the study of the radiative kaon decay K+→π0e+νγ (Ke3γ ), using a data sample recorded in 2017 and 2018. Preliminary results with the most precise measurement of the Ke3γ branching ratio, and a T-asymmetry measurement in the Ke3γ decay, are presented

Numerical study on the flow field generated by a double-orifice synthetic jet device

In the last few years Synthetic Jet (SJ) actuators have shown their full potential in controlling and manipulate an incoming crossflow. Indeed, these devices have been able to control separated flows over aerodynamic bodies, delay or anticipate transition to turbulence, suppress or enhance turbulence and control liquid jets and sprays. In many applications arrays of SJ actuators or multiple-orifice (or multi-slot) devices are preferred to single-orifice/single-slot actuators. Multi-orifice strategies have been often employed for the control of separated flows, in order to cover the entire spanwise length of the flow to be controlled or to introduce a spanwise modulation of the control. Moreover, such devices are also employed in cooling applications, since multiple-orifice devices exhibit a larger heat dissipation with respect to a single, centred orifice one. Despite this fact, a great part of the studies concerning the design of a SJ actuator have been based on single-slot or single-orifice configurations. As a consequence, the present work is focused on the interaction between the jets generated by a multiple-orifice actuator. In particular, the external flow field generated by a double-orifice SJ actuator is investigated. The analyzed actuator is sealed at one side by an elastic diaphragm, which is composed of a piezoelectric disk and a flexible shim, and connected to the external environment via two circular orifices. The numerical setup matches the flow parameters of the experiments and the preliminary numerical simulations reported in [1]. A series of numerical simulations are carried out, varying the distance between the orifices. The computational domain includes the entire cavity, the orifices, and the external environment. Differently from [1], the investigation focuses on the development of the external flow field, rather than on the vortex motion near the exit plane and within the cavity. The instantaneous flow field is characterized by the presence of two, in-phase, zero-net-mass-flux jets. These jets become turbulent, converge towards each other and merge. The characteristics of the flow are strongly dependent on the distance between the orifice centers and their momentum [2]. It is important to find a scaling law for the merging point streamwise position as a function of these parameters, since jet merging is responsible for circulation cancellation and could be detrimental for flow control applications. Time-averaged flow fields are obtained, and their features are compared with the (time-averaged) characteristics of three-dimensional, continuous twinjets [3]. Moreover, time and phase-averaged velocity fields and fluctuations are compared with those of single-orifice actuators. Finally, spectral analysis of probes (located along the jets trajectories) and dynamic mode decomposition (DMD) are used to investigate the inner shear-layer interactions and recognize shifts in the dominant frequency along the streamwise direction. The latter analyses are useful to detect the vortical motions which are responsible of the jet convergence, of the entrainment of external fluid and of the far-field behaviour of the jet

Pharmacokinetics and pharmacodynamics of ticagrelor when treating non-ST elevation acute coronary syndromes

ADP-induced platelet activation via P2Y12 receptor plays a pivotal role in the pathophysiology of arterial thrombosis and acute coronary syndrome. The value of dual antiplatelet therapy with the addition of the thienopyridine clopidogrel to aspirin has been widely established. Prasugrel, another thienopyridine, has demonstrated more potent platelet inhibition and efficacy than clopidogrel, although this drug requires metabolic activation and is associated with increased risk of bleedings. AREAS COVERED: In this article, we discuss the role of ticagrelor in the management of non-ST elevation acute coronary syndromes treatment. We describe the unique pharmacokinetic and pharmacodynamic properties of this drug and the extensive data obtained by preclinical and Phase II and III clinical studies. EXPERT OPINION: Current guidelines recommend ticagrelor, in addition to aspirin, for patients with non-ST-segment elevation acute coronary syndromes at moderate to high-risk regardless of initial therapeutic strategy. Benefit of ticagrelor, as regard mortality, may be related to off-target effects of the drug, especially those involving the metabolism of adenosine. Ticagrelor represents a cost-effective alternative in the spectrum of P2Y12 inhibitors; however, further studies are required to enable the physician to choose the most appropriate antiplatelet agent for each patient

Modal decomposition analysis of unsteady viscous liquid sheet flows

The unsteady dynamics of a gravitational liquid sheet, driven by a continuous harmonic perturbation in the lateral velocity component applied at the inlet section, is analyzed. The topology and the dynamics of the relevant flow structures are characterized by applying POD (Proper Orthogonal Decomposition) and spectral POD (SPOD) modal decompositions on two-dimensional two-phase numerical simulation data obtained with the volume-of-fluid approach. The investigation is carried out by varying the Weber number, the forcing frequency (Strouhal number), and the Reynolds number. The supercritical regime (We > 1) features a traveling perturbation, exhibiting a spatial structure with leading sinuous modes. SPOD spectra confirm the occurrence of a discontinuity in frequency response between the supercritical and subcritical regimes. In the subcritical regime (We < 1), the investigation highlights the excitation of a combined sinuous-varicose motion when the system is driven at resonance frequency for a relatively high Reynolds number (approaching the inviscid limit). The emergence of varicose modes is favored by low Weber numbers. The excitation of these modes occurs when the Weber number is decreased from We = 0.90 down to 0.75, with a progressive shift of the varicose mode from higher harmonics toward the main frequency; it can be considered as a possible mechanism of breakup observed in experiments when the inlet flow rate is progressively reduced. The flow reconstruction based on both POD and SPOD confirms the good capability of SPOD modes to capture dynamically relevant features of the fluid motion in subcritical conditions

Active control of separated flow over 2D back-facing ramp by an array of finite-span slotted synthetic jets

A wind tunnel experimental investigation of the separated flow over a back-facing ramp at 25° slant angle and equipped with an array of slotted synthetic jets (SJs) actuators for active flow control (AFC) has been conducted at height-based, h, Reynolds numbers between 9.41 × 103 ≤ Reh ≤ 2.55 × 104. Both the baseline, i.e. without control, and controlled cases were inspected by means of surface pressure measurements and planar particle image velocimetry (PIV). This study represents a fundamental investigation of the basic mechanisms promoting the mitigation of the separation by means of the SJ technology. The AFC device consists of an array of twelve finite span slotted SJs having aspect ratio equal to 15, all fed by a common resonant cavity. For the baseline cases, it is found that the streamwise extension of the separated region decreases with increasing Reh. This behavior is due to the nature of the boundary layer upstream of the ramp, which is transitional for the lowest Reh and turbulent for the highest one, as is corroborated by velocity PIV measurements within the boundary layer. For Reh = 1.06 × 104, under actuation with momentum coefficient cμ = 2.75 × 10−3 and reduced frequency F+ = 0.34, the boundary layer undergoes an increment of the wall shear stress and acceleration at its edge. Phase-locked PIV measurements unveil that coherent vortical structures energize the boundary layer producing a 65% reduction of the extension of the separation bubble with respect to the corresponding baseline case. However, these benefits degrade by increasing the Reynolds number and for lower levels of cμ and F+. Phase-average flow fields reveal the existence of vortical structures over the ramp which determine characteristic wavy patterns of the streamlines. The scattering of the location of the instantaneous vortices taken at fixed phases proves the existence of concentrations of turbulent structures that participate in the buildup of the turbulence