Natural and Experimental Slow Slip Observed Along Shallow Hematite Faults

Fault slip relieves stress in the shallow crust by slipping suddenly during earthquakes, but some faults also slip slowly in between earthquakes. Exhumed faults, brought up to the Earth’s surface from depth, preserve a record of fault processes and slip rates informed by fault rock structures, textures, and chemistry. Hematite, a common iron oxide mineral that precipitates on fault surfaces, exhibits crystal textures that potentially indicate past slip rate. Hematite can be dated using the radioisotopic system of (U-Th)/He thermochronometry, which constrains the time when He is trapped within a crystal, a process that is a function of temperature. Exhumed faults that are parallel and connect to the San Andreas Fault (southernmost California) at depth cut crystalline rock and contain networks of small, hematite-coated faults. Here, hematite displays crystal morphology and structures that indicate hematite formed episodically a formation, repeatedly slipped at slow rates. Hematite (U-Th)/He dates show hematite formed at shallow depths

Emergency-department accesses in home care paediatric patients: Occurrence and risks of use in a six-year retrospective investigation in Northern Italy

Objective To assess the determinants of ED use in paediatric patients enrolled in an Integrated Paediatric Home Care (IPHC) program. Methods A retrospective study was conducted using administrative databases on a cohort of patients enrolled in an IPHC program between January 1st, 2012, and December 31st, 2017, in Northern Italy. ED visits that occurred during the IPHC program were considered. Data were collected considering sociodemographic, clinical and organizational variables. A multivariable stepwise logistic regression analysis was performed. The dependent variable to identify possible associations was ED visit. Results A total of 463 ED visits occurred in 465 children, with an incidence rate of 1. The risk of ED visits significantly increased among children involved in the IPHC program after hospital discharge (OR 1.94). Additionally, the risk of ED visits increased significantly as the duration of IPHC increased (OR 5.80 between 101 and 200 days, to OR 7.84 between 201 and 300 days, OR 12.54 between 301 and 400 days and OR 18.67 to more than 400 days). Conclusion The overall results represent a practical perspective to contribute improving both the service quality of IPHC and reducing low acuity and improper ED use

Familiari e badanti: nostri alleati o concorrenti?

Molte Regioni hanno affrontato con vari interventi il sostegno della permanenza a domicilio dei pazienti con malattie croniche invalidanti e bisogni assistenziali complessi. Tali interventi vanno dall\u2019accesso facilitato ai servizi di assistenza domiciliare integrata pubblici o convenzionati, o da forme di assistenza indiretta come l\u2019erogazione di un assegno di cura mensile, ad azioni di formazione rivolte ai soggetti con funzioni di caregiver. Alcune Regioni, in risposta alle richieste delle Associazioni di malati e familiari, hanno assunto delle decisioni per preparare e autorizzare i caregiver a svolgere attivit\ue0 sanitarie. In questo editoriale si propongono alcune riflessioni a partire da una iniziativa della Regione Emilia-Romagna, che ha sollevato un vivace dibattito e che vogliamo utilizzare come occasione per riflettere sui rapporti tra infermieri e caregiver: tematica sulla quale la professione ha molta esperienza nella pratica quotidiana, ma ha ancora molte pagine da scrivere per esplicitare come pensa di relazionarsi nella complessit\ue0 di bisogni e interventi di cui sempre pi\uf9 le famiglie si fanno carico e per cui rivendicano un ruolo pi\uf9 attiv

Predictors and trajectories of ED visits among patients receiving palliative home care services: Findings from a time series analysis (2013-2017)

Background: Current policies recommend integrating home care and palliative care to enable patients to remain at home and avoid unnecessary hospital admission and emergency department (ED) visits. The Italian health care system had implemented integrated palliative home care (IHPC) services to guarantee a comprehensive, coordinated approach across different actors and to reduce potentially avoidable ED visits. This study aimed to analyze the trajectories of ED visit rates among patients receiving IHPC in the Italian healthcare system, as well as the association between socio-demographic, health supply, and clinical factors. Methods: A pooled, cross-sectional, time series analysis was performed in a large Italian region in the period 2013-2017. Data were taken from two databases of the official Italian National Information System: Home Care Services and ED use. A clinical record is opened at the time a patient is enrolled in IHPC and closed after the last service is provided. Every such clinical record was considered as an IHPC event, and only ED visits that occurred during IHPC events were considered. Results: The 20,611 patients enrolled in IHPC during the study period contributed 23,085 IHPC events; ≥1 ED visit occurred during 6046 of these events. Neoplasms accounted for 89% of IHPC events and for 91% of ED visits. Although there were different variations in ED visit rates during the study period, a slight decline was observed for all diseases, and this decline accelerated over time (b = - 0.18, p = 0.796, 95% confidence interval [CI] = - 1.59;1.22, b-squared = - 1.25, p < 0.001, 95% CI = -1.63;-0.86). There were no significant predictors among the socio-demographic factors (sex, age, presence of a non-family caregiver, cohabitant family members, distance from ED), health supply factors (proponent of IHPC) and clinical factors (prevalent disorder at IHPC entry, clinical symptoms). Conclusion: Our results show that use of ED continues after enrollment in IHPC, but the trend of this use declines over time. As no significant predictive factors were identified, no specific interventions can be recommended on which the avoidable ED visits depend

La prova finale per il conseguimento della laurea in infermieristica : studio trasversale

Riassunto Introduzione: il corso di laurea in Infermieristica termina con una prova abilitante (prova pratica e dissertazione di un elaborato). La normativa prescrive il numero di membri della commissione valutatrice, lasciando agli Atenei la scelta delle modalit\ue0 di svolgimento. Le competenze da valutare sono uguali in tutta Italia; \ue8 auspicabile l\u2019adozione di un metodo unico per l\u2019accertamento, dunque servono dati sulle attuali modalit\ue0 di svolgimento della prova. Metodi e strumenti: studio trasversale, condotto tramite questionario somministrato via e-mail a 152 sedi del corso di laurea nel 2011, per indagare la composizione del voto di laurea, le caratteristiche della prova pratica, la soglia di superamento, la valutazione degli elaborati, la composizione della commissione. Risultati: hanno risposto 112 sedi di tutta Italia. 60 considerano i voti degli esami di profitto e quelli di tirocinio; 7 non considerano il tirocinio. L\u2019esperienza Erasmus \ue8 conteggiata da 18 sedi, la lode negli esami da 40. 60 sedi non prevedono una soglia di superamento della prova. In 56 sedi la prova pratica consiste in quiz (da 22 a 80 domande). 44 sedi usano la simulazione in laboratorio, 12 un caso clinico simulato, 10 un piano infermieristico. 7 portano lo studente al letto del malato. Gli elaborati sono di vario tipo e valgono da 5 a 22 punti. Nelle commissioni, il numero di membri \ue8 l\u2019unico dato comune. Conclusioni: la situazione \ue8 lontana da quella auspicata dal Processo di Bologna; la Conferenza Nazionale pu\uf2 avere un ruolo importante nell\u2019uniformare criteri e metodi di svolgimento della prova abilitante