The healthcare organization in COVID-19 age: An evaluation framework for the performance of a telemonitoring model

Telemedicine services (TS) are not only supportive for healthcare professionals, but managers also see them as essential for the provision of an efficient, effective, and sustainable healthcare service. Several systems make TS available in different ways and contexts. However, no commonly accepted framework meets the need to draw conclusions about which TS can efficiently be measured. For this purpose, a framework is proposed in order to define a dynamic method of performance evaluation that can be used to improve the sustainable management of a telemonitoring model for COVID-19 patients. A case study analysis based on the experience of three telemedicine networks in different locations providing telemonitoring services (northern, central, and southern Italy) was performed. A total of four phases (1. Identification of the target population; 2. Identification of health needs; 3. Definition of the operational plan; and 4. Monitoring of the service by indicators), and seven indicators have been identified. Despite the differences raised in the Italian contexts, applying a performance evaluation framework could help the managerial sector to understand if the service is working as intended and what effects the service is producing on the healthcare organization. Considering the long-term field experience, this framework is an easy-to-use tool that will allow healthcare organizations to evaluate the performance of their telemonitoring model, and improve it according to new needs. Providing a healthcare service in an efficient context is fundamental for the sustainability of the health system as a whole

Indicators and criteria for efficiency and quality in public hospitals: A performance evaluation model

In many countries, the public sector is currently characterised by the need to improve its performance. The implementation of performance measurement systems is essential to generate better results, especially in the public health sector. In healthcare practice, clinical indicators are part of a performance measurement system, and are a way of assessing the quality of care by investigating the frequency of specific results. Through a clinical audit process, this study aims to define the criteria and key performance indicators for minimally invasive endovascular surgical treatment. This type of treatment is chosen because aortic pathologies are an important European issue in cardiovascular surgery. A model of criteria and indicators used in a large public Italian hospital was constructed in order to assess the level of performance achieved with this service

Diffusion in a crowded environment

We analyze a pair of diffusion equations which are derived in the infinite system--size limit from a microscopic, individual--based, stochastic model. Deviations from the conventional Fickian picture are found which ultimately relate to the depletion of resources on which the particles rely. The macroscopic equations are studied both analytically and numerically, and are shown to yield anomalous diffusion which does not follow a power law with time, as is frequently assumed when fitting data for such phenomena. These anomalies are here understood within a consistent dynamical picture which applies to a wide range of physical and biological systems, underlining the need for clearly defined mechanisms which are systematically analyzed to give definite predictions.Comment: 4 pages, 3 figures, minor change

Non-Gaussian fluctuations in stochastic models with absorbing barriers

The dynamics of a one-dimensional stochastic model is studied in presence of an absorbing boundary. The distribution of fluctuations is analytically characterized within the generalized van Kampen expansion, accounting for higher order corrections beyond the conventional Gaussian approximation. The theory is shown to successfully capture the non Gaussian traits of the sought distribution returning an excellent agreement with the simulations, for {\it all times} and arbitrarily {\it close} to the absorbing barrier. At large times, a compact analytical solution for the distribution of fluctuations is also obtained, bridging the gap with previous investigations, within the van Kampen picture and without resorting to alternative strategies, as elsewhere hypothesized.Comment: 2 figures, submitted to Phys. Rev. Let

Can a microscopic stochastic model explain the emergence of pain cycles in patients?

A stochastic model is here introduced to investigate the molecular mechanisms which trigger the perception of pain. The action of analgesic drug compounds is discussed in a dynamical context, where the competition with inactive species is explicitly accounted for. Finite size effects inevitably perturb the mean-field dynamics: Oscillations in the amount of bound receptors spontaneously manifest, driven by the noise which is intrinsic to the system under scrutiny. These effects are investigated both numerically, via stochastic simulations and analytically, through a large-size expansion. The claim that our findings could provide a consistent interpretative framework to explain the emergence of cyclic behaviors in response to analgesic treatments, is substantiated.Comment: J. Stat. Mech. (Proceedings UPON2008

Quaternary structure predictions of transmembrane proteins starting from the monomer: a docking-based approach

BACKGROUND: We introduce a computational protocol for effective predictions of the supramolecular organization of integral transmembrane proteins, starting from the monomer. Despite the demonstrated constitutive and functional importance of supramolecular assemblies of transmembrane subunits or proteins, effective tools for structure predictions of such assemblies are still lacking. Our computational approach consists in rigid-body docking samplings, starting from the docking of two identical copies of a given monomer. Each docking run is followed by membrane topology filtering and cluster analysis. Prediction of the native oligomer is therefore accomplished by a number of progressive growing steps, each made of one docking run, filtering and cluster analysis. With this approach, knowledge about the oligomerization status of the protein is required neither for improving sampling nor for the filtering step. Furthermore, there are no size-limitations in the systems under study, which are not limited to the transmembrane domains but include also the water-soluble portions. RESULTS: Benchmarks of the approach were done on ten homo-oligomeric membrane proteins with known quaternary structure. For all these systems, predictions led to native-like quaternary structures, i.e. with C(α)-RMSDs lower than 2.5 Å from the native oligomer, regardless of the resolution of the structural models. CONCLUSION: Collectively, the results of this study emphasize the effectiveness of the prediction protocol that will be extensively challenged in quaternary structure predictions of other integral membrane proteins

Well-posedness of the Kolmogorov two-equation model of turbulence in optimal Sobolev spaces

In this paper, we study the well-posedness of the Kolmogorov two-equation model of turbulence in a periodic domain Td, for space dimensions d = 2,3. We admit the average turbulent kinetic energy k to vanish in part of the domain, i.e. we consider the case k ≥ 0; in this situation, the parabolic structure of the equations becomes degenerate. For this system, we prove a local well-posedness result in Sobolev spaces Hs, for any s > 1+d/2. We expect this regularity to be optimal, due to the degeneracy of the system when k ≈ 0. We also prove a continuation criterion and provide a lower bound for the lifespan of the solutions. The proof of the results is based on Littlewood- Paley analysis and paradifferential calculus on the torus, together with a precise commutator decomposition of the non-linear terms involved in the computations

structural analysis of transversally loaded quasi isotropic rectilinear orthotropic composite circular plates with galerkin method

Abstract Bending analysis of rectilinear orthotropic composite plates have been scarcely investigated taking into account the increasing use of composite materials in structural applications in the last years. This kind of plates are laminates with axisymmetric geometry and they are made up of unidirectionally reinforced layers with different orientations. Transversally loading this kind of circular plates, the deflected mid-surface is not independent from the circumferential coordinate, unlike the case of isotropic circular plate. Nevertheless, the quasi-isotropic stacking sequence makes still possible to introduce the hypothesis of axisymmetry for the mid-surface deflection under transversal load, disregarding the circumferential variation of the vertical displacement connected to the variable bending stiffness. Then, the constitutive equations for this specific family of plates were obtained finding the stress resultants-strains relations in the global cylindrical coordinate system. These expressions, along with the equilibrium equations, made it possible to derive the governing equation of the problem in the frame of Kirchhoff-Love hypothesis of the classical lamination theory. The Galerkin method was applied to solve the governing third order differential equation in terms of mid-surface deflection, introducing appropriate polynomial approximation functions compliant with the boundary conditions. In particular, fully clamped constraint conditions were considered for the outer diameter of the plate in conjunction with an internal rigid core. The characterization of this model allows to define the stiffness matrix terms of a custom composite bolted joint finite element, that is the object of future developments of this work. Results of the original proposed method are presented and compared to those obtained by means of FEA performed with a refined reference model, demonstrating a good agreement