Roadmap for large-scale implementation of point-of-care testing in primary care in Central and Eastern European countries: the Hungarian experience

OBJECTIVE: The aim of this study is to give a broad overview of the international best practices regarding the implementation of point-of-care testing (POCT) in primary care (PC) setting and to highlight the facilitators and barriers for widespread national uptake. The study focuses on the managerial and organizational side of POCT, offering a roadmap for implementation as well as highlighting the most important requirements needed to unlock the clinical and economical potential of POCT in the Hungarian healthcare system. METHODS: We conducted an English language scoping literature review between January 2012 and June 2021 to assess the recent trends of POCT implementation in developed countries. Our research focuses on the recent publications of several European and Anglo-Saxon countries where POCT utilization is common. In parallel, we reviewed the Hungarian regulatory framework, ongoing governmental legislation, and strategies influencing the POCT dissemination in the Hungarian PC sector. RESULTS: Among the possible POCT usage in PC, we identified several clinically relevant devices and tests (C-reactive protein, urine, blood glucose, D-dimer, prothrombin time) important in screening and early detection of morbidities representing high disease burden. Based on international literature, general practitioners (GPs) are interested in the shortened diagnostic times, portable devices, and better doctor–patient relations made possible by POCT. There are several concerns, however, regarding initial and operational costs and reimbursement, limited scientific evidence about quality and safety, unclear regulations on quality validation of tests, as well as managerial aspects like PC staff training and IT integration at the GP level. CONCLUSION: As our review highlights, there is considerable interest among GPs to implement POCT as it has the potential to improve quality of care; however, there are many obstacles to overcome before widespread uptake. Further investigation is recommended to elaborate management and quality insurance background and to develop appropriate regulatory framework and financial scheme for GP practices. Preferably this work should involve the local practicing GPs to better tailor the implementation roadmap to country-specific details

Heavy-element yields and abundances of Asymptotic Giant Branch models with a Small Magellanic Cloud metallicity

We present new theoretical stellar yields and surface abundances for asymptotic giant branch (AGB) models with a metallicity appropriate for stars in the Small Magellanic Cloud (SMC, $Z= 0.0028$, [Fe/H] $\approx -0.7$). New evolutionary sequences and post-processing nucleosynthesis results are presented for initial masses between 1$M_{\odot}$ and 7$M_{\odot}$, where the 7$M_{\odot}$ is a super-AGB star with an O-Ne core. Models above 1.15$M_{\odot}$ become carbon rich during the AGB, and hot bottom burning begins in models $M \ge 3.75 M_{\odot}$. We present stellar surface abundances as a function of thermal pulse number for elements between C to Bi and for a selection of isotopic ratios for elements up to Fe and Ni (e.g., $^{12}$C/$^{13}$C), which can be compared to observations. The integrated stellar yields are presented for each model in the grid for hydrogen, helium and all stable elements from C to Bi. We present evolutionary sequences of intermediate-mass models between 4--7$M_{\odot}$ and nucleosynthesis results for three masses ($M=3.75, 5, 7M_{\odot}$) including $s$-process elements for two widely used AGB mass-loss prescriptions. We discuss our new models in the context of evolved AGB stars and post-AGB stars in the Small Magellanic Clouds, barium stars in our Galaxy, the composition of Galactic globular clusters including Mg isotopes with a similar metallicity to our models, and to pre-solar grains which may have an origin in metal-poor AGB stars.Comment: 19 pages, accepted for publication in MNRA

Barium stars as tracers of s-process nucleosynthesis in AGB stars I. 28 stars with independently derived AGB mass

Context. Barium (Ba) stars are polluted by material enriched in the slow neutron capture (s-process) elements synthesised in the interior of their former asymptotic giant branch (AGB) companion star, which is now a white dwarf.Aims. We aim to compare individual Ba star abundance patterns to AGB nucleosynthesis model predictions to verify if the AGB model mass is compatible with independently derived AGB mass, which was previously estimated using binary parameters and Gaia parallax data.Methods. We selected a sample of 28 Ba stars for which both self-consistent spectroscopic observation and analysis were performed and, additionally, stellar mass determinations, via positioning the star on the Hertzsprung-Russell (HR) diagram and comparing with evolutionary tracks are available. For this sample of stars, we considered both previously (Y, Zr, Ce, and Nd) and recently derived (Rb, Sr, Nb, Mo, Ru, La, Sm, and Eu) elemental abundances. Then, we performed a detailed comparison of these s-process elemental abundances to different AGB nucleosynthesis models from the Monash and the FRUITY theoretical data sets. We simplified the binary mass transfer by calculating dilution factors to match the [Ce/Fe] value of each star when using different AGB nucleosynthesis models, and we then compared the diluted model abundances to the complete Ba-star abundance pattern.Results. Our comparison confirms that low-mass (with initial masses roughly in the range 2-3 M-circle dot), non-rotating AGB stellar models with C-13 as the main neutron source are the polluters of the vast majority of the considered Ba stars. Out of the 28 stars, in 21 cases the models are in good agreement with both the determined abundances and the independently derived AGB mass, although in 16 cases higher observed abundances of Nb, Ru, Mo, and/or Nd, Sm than predicted were present. For three stars, we obtain a match to the abundances only by considering models with masses lower than those independently determined. Finally, four stars show much higher first s-process peak abundance values than the model predictions, which may represent the signature of a physical (e.g. mixing) and/or nucleosynthetic process that is not represented in the set of models considered here

Origin of Large Meteoritic SiC Stardust Grains in Metal-rich AGB Stars

Stardust grains that originated in ancient stars and supernovae are recovered from meteorites and carry the detailed composition of their astronomical sites of origin. We present evidence that the majority of large (μm-sized) meteoritic silicon carbide (SiC) grains formed in C-rich asymptotic giant branch (AGB) stars that were more metal-rich than the Sun. In the framework of the slow neutron captures (the s process) that occur in AGB stars, the lower-than-solar ${}^{88}$ Sr/ ${}^{86}$ Sr isotopic ratios measured in the large SiC grains can only be accompanied by Ce/Y elemental ratios that are also lower than solar and predominately observed in metal-rich barium stars - the binary companions of AGB stars. Such an origin suggests that these large grains represent the material from high-metallicity AGB stars needed to explain the s-process nucleosynthesis variations observed in bulk meteorites. In the outflows of metal-rich, C-rich AGB stars, SiC grains are predicted to be small (≃0.2 μm); large (≃μm-sized) SiC grains can grow if the number of dust seeds is 2-3 orders of magnitude lower than the standard value of 10-13 times the number of H atoms. We therefore predict that with increasing metallicity, the number of dust seeds might decrease, resulting in the production of larger SiC grains

The role of primary care during the pandemic: shared experiences from providers in five European countries

BACKGROUND: The COVID-19 pandemic necessitated wide-ranging adaptations to the organisation of health systems, and primary care is no exception. This article aims to collate insights on the role of primary care during the pandemic. The gained knowledge helps to increase pandemic preparedness and resilience. METHODS: The role of primary care during the pandemic in five European countries (Austria, Denmark, France, Hungary, Italy) was investigated using a qualitative approach, namely case study, based on document analysis and semi-structured interviews. In total, 31 interviews were conducted with primary care providers between June and August 2022. The five country case studies were subjected to an overarching analysis focusing on successful strategies as well as gaps and failures regarding pandemic management in primary care. RESULTS: Primary care providers identified disruptions to service delivery as a major challenge emerging from the pandemic which led to a widespread adoption of telehealth. Despite the rapid increase in telehealth usage and efforts of primary care providers to organise face-to-face care delivery in a safe way, some patient groups were particularly affected by disruptions in service delivery. Moreover, primary care providers perceived a substantial propagation of misinformation about COVID-19 and vaccines among the population, which also threatened patient-physician relationships. At the same time, primary care providers faced an increased workload, had to work with insufficient personal protective equipment and were provided incongruous guidelines from public authorities. There was a consensus among primary care providers that they were mostly sidelined by public health policy in the context of pandemic management. Primary care providers tackled these problems through a diverse set of measures including home visits, implementing infection control measures, refurbishing used masks, holding internal meetings and relying on their own experiences as well as information shared by colleagues. CONCLUSION: Primary care providers were neither well prepared nor the focus of initial policy making. However, they implemented creative solutions to the problems they faced and applying the learnings from the pandemic could help in increasing the resilience of primary care. Attributes of an integrated health system with a strong primary care component proved beneficial in addressing immediate effects of the pandemic

SN 2017gmr: An Energetic Type II-P Supernova with Asymmetries

We present high-cadence UV, optical, and near-infrared data on the luminous Type II-P supernova SN 2017gmr from hours after discover through the first 180 days. SN 2017gmr does not show signs of narrow high-ionization emission lines in the early optical spectra, yet th optical light-curve evolution suggests that an extra energy source fro circumstellar medium (CSM) interaction must be present for at least days after explosion. Modeling of the early light curve indicates a ∼50 R ☉ progenitor radius, consistent with a rather compact re supergiant, and late-time luminosities indicate that up to 0.130 ± 0.02 M ☉ of 56Ni are present, if the light curve i solely powered by radioactive decay, although the 56Ni mas may be lower if CSM interaction contributes to the post-platea luminosity. Prominent multipeaked emission lines of Hα and [O I] emerg after day 154, as a result of either an asymmetric explosion o asymmetries in the CSM. The lack of narrow lines within the first 2 day of explosion in the likely presence of CSM interaction may be an exampl of close, dense, asymmetric CSM that is quickly enveloped by th spherical supernova eject

The RADIOSTAR Project

© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).Radioactive nuclei are the key to understanding the circumstances of the birth of our Sun because meteoritic analysis has proven that many of them were present at that time. Their origin, however, has been so far elusive. The ERC-CoG-2016 RADIOSTAR project is dedicated to investigating the production of radioactive nuclei by nuclear reactions inside stars, their evolution in the Milky Way Galaxy, and their presence in molecular clouds. So far, we have discovered that: (i) radioactive nuclei produced by slow (107Pd and 182Hf) and rapid (129I and 247Cm) neutron captures originated from stellar sources —asymptotic giant branch (AGB) stars and compact binary mergers, respectively—within the galactic environment that predated the formation of the molecular cloud where the Sun was born; (ii) the time that elapsed from the birth of the cloud to the birth of the Sun was of the order of 107 years, and (iii) the abundances of the very short-lived nuclei 26Al, 36Cl, and 41Ca can be explained by massive star winds in single or binary systems, if these winds directly polluted the early Solar System. Our current and future work, as required to finalise the picture of the origin of radioactive nuclei in the Solar System, involves studying the possible origin of radioactive nuclei in the early Solar System from core-collapse supernovae, investigating the production of 107Pd in massive star winds, modelling the transport and mixing of radioactive nuclei in the galactic and molecular cloud medium, and calculating the galactic chemical evolution of 53Mn and 60Fe and of the p-process isotopes 92Nb and 146Sm.Peer reviewedFinal Published versio

Comparative Research on the Metropolitan Administration and Service in Porto

The Porto Metropolitan Area (Área Metropolitana do Porto, AMP) is a framework of cooperation between 17 municipalities and several districts. This metropolitan area has a specific, inter-municipal model of urban governance. In our research, we found that cooperation is significant mainly in sectors where the central legislature has essentially made this mandatory, by designing the AMP and defining its powers. In addition to AMP, only partial cooperation has been established in the field of waste management, and in the field of human public services and in the performance of public authority, there is essentially a set of autonomous organisational solutions. However, despite all this fragmentation, the above system ensures the satisfactory functioning of the metropolitan agglomeration. This also underlines the importance of transport management in urban areas, since this functioning system is based on an integrated and intermodal transport system