Budget impact analysis of apixaban to treat and prevent venous thromboembolism in Italy

BACKGROUND: Venous thromboembolism (VTE), a collective term for deep vein thrombosis (DVT) and pulmonary embolism (PE), is a serious vascular condition associated to high economic and clinical burden. Apixaban, a Novel Oral Anticoagulant (NOAC) has shown non-inferiority efficacy versus the current standard of care (low molecular weight heparin [LMWH]/vitamin K antagonist [VKA]) in the acute treatment and prevention of VTE and a significant reduction in the risk of bleeding.AIM: Evaluate the economic impact of the use of apixaban for treatment and prevention of DVT and PE from the perspective of the Italian National Health System (NHS).METHODS: A budget impact model was adapted in order to compare clinical outcomes and economic consequences associated to apixaban vs. LMWH/VKA and others NOACs over a three-year time horizon in the Italian setting. In the analysis two scenario were compared: status quo scenario without apixaban and an alternative scenario with apixaban. Only direct healthcare costs have been considered.RESULTS: Assuming a population of patients receiving apixaban over the first 3 years equal to 20,957, the introduction of apixaban is associated to an incremental saving of € 821,748 in the first years, € 1,250,454 in the second year, and € 1,866,466 in the third year. The total net saving over the 3-year period is € 3,938,668, which is a 2.47% decrease from the total budget for the status quo scenario without apixaban. This saving is mainly due to reduced VTE events and bleeds by apixaban. Indeed apixaban is associated with less VTE events (both fatal and non-fatal), less major bleeding and less Clinical Relevant Non Major (CRNM) bleeding with a total of 52 fatal events avoided.CONCLUSIONS: The listing of apixaban for the treatment of VTE (both DVT and PE) and the prevention of recurrent VTE provides both significant clinical advantages, in terms of deaths and events avoided, and economical advantages, consisting in a reduction in the total expenditure on the Italian NHS

L’agire educativo nei contesti informali di apprendimento al tempo del Covid-19: il caso della comunità murid

Islamic religious communities are little known by the society that welcomes immigrants, and their role and potential are ignored. In order to discover the educational and orientational aspects of the Islamic sufi com- munities, a case study was carried out in the Senegalese community of the murid using a qualitative research approach. This contribution presents the first results obtained from carrying out in-depth interviews with the managers of three community offices, through which it was possible to explore the community knowledge that made it possible to face and manage the consequences of the Covid-19 health emergency. Data collected shows the educating role of the community that practices a model of inclusion based on collaboration and mutual respect in safeguarding their respective identities.Le comunità religiose islamiche sono poco conosciute dalla società che accoglie gli immigrati e se ne ignorano il ruolo e le potenzialità. Al fine di conoscere gli aspetti educativi e orientativi delle comunità sufi islamiche, si è realizzato uno studio di caso nella comunità senegalese dei murid, utilizzando un approccio di ricerca di tipo qualitativo. Questo contributo presenta i primi risultati ottenuti dalla realizzazione delle interviste in profondità con i responsabili di tre sedi della comunità, attraverso le quali è stato possibile approfondire i saperi comunitari che hanno permesso di affrontare e gestire le conseguenze dell’emergenza sanitaria da Covid 19. Dai dati raccolti emerge il ruolo educante della comunità che pratica un modello di inclusione che si basa sulla collaborazione e sul rispetto reciproco, nella salvaguardia delle rispettive identità

Heart Rate Variability from Wearable Photoplethysmography Systems: Implications in Sleep Studies at High Altitude

The interest in photoplethysmography (PPG) for sleep monitoring is increasing because PPG may allow assessing heart rate variability (HRV), which is particularly important in breathing disorders. Thus, we aimed to evaluate how PPG wearable systems measure HRV during sleep at high altitudes, where hypobaric hypoxia induces respiratory disturbances. We considered PPG and electrocardiographic recordings in 21 volunteers sleeping at 4554 m a.s.l. (as a model of sleep breathing disorder), and five alpine guides sleeping at sea level, 6000 m and 6800 m a.s.l. Power spectra, multiscale entropy, and self-similarity were calculated for PPG tachograms and electrocardiography R-R intervals (RRI). Results demonstrated that wearable PPG devices provide HRV measures even at extremely high altitudes. However, the comparison between PPG tachograms and RRI showed discrepancies in the faster spectral components and at the shorter scales of self-similarity and entropy. Furthermore, the changes in sleep HRV from sea level to extremely high altitudes quantified by RRI and PPG tachograms in the five alpine guides tended to be different at the faster frequencies and shorter scales. Discrepancies may be explained by modulations of pulse wave velocity and should be considered to interpret correctly autonomic alterations during sleep from HRV analysis

Evaluation of a textile-based wearable system for the electrocardiogram monitoring in cardiac patients

n/

Shape Complementarity Optimization of Antibody-Antigen Interfaces: the Application to SARS-CoV-2 Spike Protein

Many factors influence biomolecules binding, and its assessment constitutes an elusive challenge in computational structural biology. In this respect, the evaluation of shape complementarity at molecular interfaces is one of the main factors to be considered. We focus on the particular case of antibody-antigen complexes to quantify the complementarities occurring at molecular interfaces. We relied on a method we recently developed, which employs the 2D Zernike descriptors, to characterize investigated regions with an ordered set of numbers summarizing the local shape properties. Collected a structural dataset of antibody-antigen complexes, we applied this method and we statistically distinguished, in terms of shape complementarity, pairs of interacting regions from non-interacting ones. Thus, we set up a novel computational strategy based on \textit{in-silico} mutagenesis of antibody binding site residues. We developed a Monte Carlo procedure to increase the shape complementarity between the antibody paratope and a given epitope on a target protein surface. We applied our protocol against several molecular targets in SARS-CoV-2 spike protein, known to be indispensable for viral cell invasion. We, therefore, optimized the shape of template antibodies for the interaction with such regions. As the last step of our procedure, we performed an independent molecular docking validation of the results of our Monte Carlo simulations.Comment: 13 pages, 4 figure

Retention of nativelike conformation by proteins embedded in high external electric fields.

In this Communication, we show that proteins embedded in high external electric fields are capable of retaining a nativelike fold pattern. We have tested the metalloprotein azurin, immobilized onto SiO2 substrates in air with proper electrode configuration, by applying static fields up to 106–107V∕m. The effects on the conformational properties of protein molecules have been determined by means of intrinsic fluorescence measurements. Experimental results indicate that no significant field-induced conformational alteration occurs. Such results are also discussed and supported by theoretical predictions of the inner protein fields

Closed-Loop Cardiovascular Interactions and the Baroreflex Cardiac Arm: Modulations Over the 24 h and the Effect of Hypertension

Closed-loop models of the interactions between blood pressure (BP) and heart rate variations allow for estimation of baroreflex sensitivity (feedback effects of BP changes on heart rate) while also considering the feedforward effects of heart rate on BP. Our study is aimed at comparing modulations of feedback and feedforward couplings over 24 h in normotensive and hypertensive subjects, by assessing closed-loop baroreflex models in ambulatory conditions. Continuous intra-arterial BP recordings were performed for 24 h in eight normotensive and eight hypertensive subjects. Systolic BP (SBP) and pulse interval (PI) beat-by-beat series were analyzed by an autoregressive moving average model over consecutive 6-min running windows, estimating closedloop feedback and feedforward gains in each window. The open-loop feedback gain was estimated for comparison. Normotensive and hypertensive patients were compared during wake (18:00–22:00) and sleep (23:00–5:00) periods by a mixed-effect linear model at p \u3c 0.05. In both groups feedback (feedforward) gain averaged values were higher (lower) in sleep than in wake. Moreover, the closed-loop feedback gain was higher in normotensive subjects both in wake and sleep, whereas the closedloop feedforward gain was higher in hypertensive subjects during sleep. By contrast, no significant differences were found between the normotensive and hypertensive groups for the open-loop feedback gain. Therefore, the closed-loop SBP-PI model can detect circadian alterations in the feedforward gain of PI on SBP and derangements of spontaneous baroreflex sensitivity in hypertension not detectable with the open-loop approach. These findings may help to obtain a more comprehensive assessment of the autonomic dysfunction underlying hypertension and for the in-depth evaluation of the benefits of rehabilitation procedures on autonomic cardiovascular modulation

Apprendimento permanente, saperi e competenze strategiche: approcci concettuali nel contesto di collaborazione scientifica tra Brasile e Italia (Lifelong learning, knowledge and Strategic Competence: conceptual approaches in the context of scientific collaboration between Brazil and Italy)

Este ensaio pretende apresentar abordagens sobre a definição dos conceitos de aprendizagem ao longo da vida, conhecimentos e competências, a partir de uma revisão de literatura, com contribuições, entre outros, de Dewey, Bruner, Freire, Schon e Tardif. A partir da análise teórica realizada por pesquisadores italianos e um pesquisador brasileiro, por meio de seus centros/laboratórios de pesquisa, e do acordo de colaboração internacional entre as universidades brasileiras e italianas, este texto aborda, com base na literatura científica, os termos-chave que sustentam a estudos realizados. Dos argumentos expressos, surge a posição comum sobre o conceito de aprendizagem ao longo da vida ou aprendizagem ao longo da vida, que considera a abordagem humanística e a valorização de experiências de diferentes contextos como a família e a escola (em particular o básico e superior). Nessa perspectiva, a aproximação semântica entre os conceitos de competência e conhecimento também é destacada, reconhecida e valorizada como elementos fundamentais para o processo de aprendizagem e para o desenvolvimento do pensamento crítico e reflexivo, e consequentemente transformador em relação aos problemas e aos desafios cotidianos. da vida. Essa contribuição fortalece a rede de pesquisa conjunta, com o objetivo de aprimorar o conhecimento teórico para subsidiar o desenvolvimento de pesquisas na área educacional, além dos muros acadêmicos brasileiros ou italianos

Azurin for Biomolecular Electronics: a Reliability Study

The metalloprotein azurin, used in biomolecular electronics, is investigated with respect to its resilience to high electric fields and ambient conditions, which are crucial reliability issues. Concerning the effect of electric fields, two models of different complexity agree indicating an unexpectedly high robustness. Experiments in device-like conditions confirm that no structural modifications occur, according to fluorescence spectra, even after a 40-min exposure to tens of MV/m. Ageing is then investigated experimentally, at ambient conditions and without field, over several days. Only a small conformational rearrangement is observed in the first tens of hours, followed by an equilibrium state

Solid state molecular rectifier based on self organized metalloproteins

Recently, great attention has been paid to the possibility of implementing hybrid electronic devices exploiting the self-assembling properties of single molecules. Impressive progress has been done in this field by using organic molecules and macromolecules. However, the use of biomolecules is of great interest because of their larger size (few nanometers) and of their intrinsic functional properties. Here, we show that electron-transfer proteins, such as the blue copper protein azurin (Az), can be used to fabricate biomolecular electronic devices exploiting their intrinsic redox properties, self assembly capability and surface charge distribution. The device implementation follows a bottom-up approach in which the self assembled protein layer interconnects nanoscale electrodes fabricated by electron beam lithography, and leads to efficient rectifying behavior at room temperature.Comment: 13 pages including two figures. Accepted for publication in Advanced Material