The right to be informed and fear of disclosure: sustainability of a full error disclosure policy at an italian cancer centre/clinic

Background: The aim of this study was to investigate the behaviour of physicians in cases of medical error as well as the nature of the information that should be given to the patient and to ascertain whether it is possible to institute a full error disclosure policy. Data was collected through the completion of anonymous questionnaires by medical directors of the IRCCS CROB (the Oncology Centre of Basilicata, Italy). Methods: An anonymous questionnaire consisting of 15 questions was prepared and administered to all the physicians working at the IRCCS CROB – the Oncology Centre of Basilicata. The main aim of the research was to evaluate the feasibility of adopting a full disclosure policy and the extent to which such a policy could help reduce administration and legal costs. Results: The physicians interviewed unanimously recognize the importance of error disclosure, given that they themselves would want to be informed if they were the patients. However, 50% have never disclosed a medical error to their patients. Fear of losing the patient’s trust (33%) and fear of lawsuits (31%) are the main obstacles to error disclosure. Conclusions: The authors found that physicians were in favour of a full policy disclosure at the IRCCS CROB – the Oncology Centre of Basilicata. Many more studies need to be carried out in order to comprehend the economic impact of a full error disclosure policy

Correlates of calcaneal quantitative ultrasound parameters in patients with diabetes: the study on the assessment of determinants of muscle and bone strength abnormalities in diabetes

OBJECTIVE: Quantitative ultrasound (QUS) provides an estimate of bone mineral density (BMD) and also evaluates bone quality, which has been related to increased fracture risk in people with diabetes. This study aimed at assessing the correlates of calcaneal QUS parameters in diabetic subjects encompassing various degrees of micro and macrovascular complications and a wide-range of peripheral nerve function. METHODS: Four hundred consecutive diabetic patients were examined by QUS to obtain values of broadband ultrasound attenuation (BUA), the speed of sound (SOS), quantitative ultrasound index (QUI), and BMD. RESULTS: Among surrogate measures of complications, sensory and motor nerve amplitude and heart rate response to cough test and standing correlated with QUS parameters at univariate analysis, together with age, body mass index (BMI), waist circumference, lipid profile, and renal function. Multivariate analysis revealed that BUA, SOS, QUI, and BMD were independently associated with age, male gender, hemoglobin A1c, BMI (or fat, but not fat-free mass), and somatic and autonomic nerve function parameters. CONCLUSIONS: These data indicate that peripheral nerve dysfunction is associated with worse QUS parameters, possibly contributing to increased fracture risk in diabetes. The positive relation of QUS measures with adiposity needs further investigation. This trial is registered with ClinicalTrials.gov (NCT01600924)

Radiological evidence of a modern 'martyr's crown': suicide by multiple self-inflicted nail gun shots.

A man attempted suicide by shooting seven nails into his head with a nail gun; five in the right temporal region and two in the left. He subsequently presented at the emergency department with complaints of headache. He was found to be oriented in space and time, with no focal neurological deficits. The patient handed the nail gun to the doctors and informed them that he had earlier attempted suicide. Radiological studies showed the presence of nails arranged like a ‘martyr’s crown’. The man died six days after the surgical removal of the nails. Autopsy was refused by Italian authorities. We conclude that imaging techniques are an adjuvant to forensic medical diagnosis and forensic autopsies

Pyridinium chlorochromate chemistry. New insight into oxidation of tetrahydrofurans

A thorough investigation of the minor oxidation products of two penta-tetrahydrofuran compounds with pyridinium chlorochromate has been carried out. Isolation of ring-B oxygenated spiroketal and degradation products, including polycyclic mono- and bis-lactone compounds, supports the previously postulated involvement of cyclic enolether intermediates in the oxidation of THF and poly-THF substances with PCC. Based on the collected evidence, a new mechanistic route for the PCC-mediated oxidative cleavage of α-hydroxy-THF compounds to γ-lactones has been postulated. The proposed mechanism well agrees with the one reported for the oxidative cleavage of 8-hydroxy-neoisocedranol oxide by RuO4, a fact that further supports our previous observation on the similar oxidizing behaviour shown by PPC and RuO4 towards THFcontaining compounds

Leveraging the network: A stress-test framework based on DebtRank

We develop a novel stress-test framework to monitor systemic risk in financial systems. The modular structure of the framework allows to accommodate for a variety of shock scenarios, methods to estimate interbank exposures and mechanisms of distress propagation. The main features are as follows. First, the framework allows to estimate and disentangle not only first-round effects (i.e. shock on external assets) and second-round effects (i.e. distress induced in the interbank network), but also third-round effects induced by possible fire sales. Second, it allows to monitor at the same time the impact of shocks on individual or groups of financial institutions as well as their vulnerability to shocks on counterparties or certain asset classes. Third, it includes estimates for loss distributions, thus combining network effects with familiar risk measures such as VaR and CVaR. Fourth, in order to perform robustness analyses and cope with incomplete data, the framework features a module for the generation of sets of networks of interbank exposures that are coherent with the total lending and borrowing of each bank. As an illustration, we carry out a stress-test exercise on a dataset of listed European banks over the years 2008-2013. We find that second-round and third-round effects dominate first-round effects, therefore suggesting that most current stress-test frameworks might lead to a severe underestimation of systemic risk

Gas Exchange and Injection Modeling of an Advanced Natural Gas Engine for Heavy Duty Applications

The scope of the work presented in this paper was to apply the latest open source CFD achievements to design a state of the art, direct-injection (DI), heavy-duty, natural gas-fueled engine. Within this context, an initial steady-state analysis of the in-cylinder flow was performed by simulating three different intake ducts geometries, each one with seven different valve lift values, chosen according to an estabilished methodology proposed by AVL. The discharge coefficient (Cd) and the Tumble Ratio (TR) were calculated in each case, and an optimal intake ports geometry configuration was assessed in terms of a compromise between the desired intensity of tumble in the chamber and the satisfaction of an adequate value of Cd. Subsequently, full-cycle, cold-flow simulations were performed for three different engine operating points, in order to evaluate the in-cylinder development of TR and turbulent kinetic energy (TKE) under transient conditions. The latest achievements in open source mesh generation and motions were applied, along with time-varying and case-fitted inizialization values for the fields of intake pressure and temperature. Finally, direct-injection of natural gas in the cylinder was incorporated in full-cycle simulations, to evaluate the effects of injection on charge motions and charge homogeneity at the estimated spark timing. Three specific engine operating points were simulated and different combinations of turbochargers and valve lift laws were tested. Results consistency was verified by means of validations with data from 1D simulations and literature

Sudden death in lambda light chain AL cardiac amyloidosis: a review of literature and update for clinicians and pathologists

Light chain (AL) amyloidosis is the most common type of systemic amyloidosis, affecting around 10 people per million per year. In Europe, approximately 5000 new diagnosis per year are reported. Deposition of amyloid fibrils derived from antibody light chains are key pathogenic agents in AL amyloidosis. They can be deposited in multiple organs but cardiac involvement carries a major risk of mortality. The prognosis is poor in cases associated with multiple myeloma. The average survival is around 1 year. Up to half of all patients with cardiac amyloidosis die suddenly; 75% ofthose deaths are due to heart failure. Ventricular arrhythmia is also associated with cardiac amyloidosis and unexpected death. It is crucial to make a diagnosis and start treatment at an early stage. Recent data suggest that cardiac amyloidosis has become a treatable and curable condition with a combination of agents targeting multiple steps of the amyloid cascade. ICD implantation may not be as effective for the therapy of light chain (AL) cardiac amyloidosis as supposed earlier. In cases of unexpected and sudden death, autopsy may show unknown conditions and is valuable to assess existing risks for family members. Even after careful autopsy, a proportion of sudden deaths, ranging from 2 to 54%, remain unexplained and this broad range of values is likely due to the heterogeneity of autopsy protocols. Post mortem diagnosis of cardiac amyloidosis still represents a challenge for forensic pathologists. Detailed morphologic study of the heart and a complete histopathologic study are mandatory. Immunohistochemistry is essential for amyloid subclassification. A review of existing literature is performed by the authors and a methodological approach in post mortem diagnosis of light chain AL cardiac amyloidosis is proposed. Both macroscopic and microscopic findings are discussed

Identification of 5F-Cumyl-PINACA, a Synthetic Cannabinoid, in the Herbal Material Used for Recreational Purposes in the Province of Trieste: Public Health implications

In recent years, the phenomenon of the production and trade of synthetic cannabinoids has grown, becoming a public health issue worldwide. The recent accesses - to the ED of the hospital of Trieste - of people who complained episodes of hallucinations, sensation of poisoning, tachycardia, and air hunger following the inhalation of "Che Sballo platinum", have highlighted the need to perform further analysis on the contents of the packet sold as an air freshener, produced in Koper (Slovenia)

Impact of surfactant polydispersity on the phase and flow behavior in water: the case of Sodium Lauryl Ether Sulfate

This study delves into the impact of molecular polydispersity on the phase behavior of Sodium Lauryl Ether Sulfate (SLES) surfactant, aiming to deepen understanding of its implications for fundamental science and industrial applications. SLE3S is utilized as a model compound: a comprehensive characterization of molecular polydispersity is conducted using Gas Chromatography–Mass Spectrometry and Nuclear Magnetic Resonance spectroscopy, juxtaposing the findings with those for SLE1S. Our comprehensive investigative approach entails: (i) employing Time-Lapse dissolution experiments in microchannel geometries to observe the dissolution and phase transitions; (ii) utilizing polarized light microscopy, confocal microscopy, and Small Angle X-ray Scattering for microstructure identification assessments; (iii) conducting rheological evaluations at various concentrations and temperatures to determine their effects on the surfactant properties. The findings reveal that SLE3S, being more polydisperse, demonstrates complex phase behavior not observed in the less polydisperse SLE1S. Notably, SLE3S exhibits a unique concentration domain, corresponding to a concentration of about 60 %wt, where hexagonal (H), cubic, and lamellar (Lα) phases coexist, resulting in highly viscoelastic heterogeneous mixtures. This behavior is attributed to the local segregation of surfactant components with varying polarity, underscoring the crucial role of molecular polydispersity in the phase behavior of SLES surfactants