Bench-to-bedside review: The importance of the precision of the reference technique in method comparison studies - with specific reference to the measurement of cardiac output

Bland-Altman analysis is used for assessing agreement between two measurements of the same clinical variable. In the field of cardiac output monitoring, its results, in terms of bias and limits of agreement, are often difficult to interpret, leading clinicians to use a cutoff of 30% in the percentage error in order to decide whether a new technique may be considered a good alternative. This percentage error of ± 30% arises from the assumption that the commonly used reference technique, intermittent thermodilution, has a precision of ± 20% or less. The combination of two precisions of ± 20% equates to a total error of ± 28.3%, which is commonly rounded up to ± 30%. Thus, finding a percentage error of less than ± 30% should equate to the new tested technique having an error similar to the reference, which therefore should be acceptable. In a worked example in this paper, we discuss the limitations of this approach, in particular in regard to the situation in which the reference technique may be either more or less precise than would normally be expected. This can lead to inappropriate conclusions being drawn from data acquired in validation studies of new monitoring technologies. We conclude that it is not acceptable to present comparison studies quoting percentage error as an acceptability criteria without reporting the precision of the reference technique

Il lavoro intermittente dopo il decreto trasparenza

L’articolo, dopo aver inquadrato la fattispecie del lavoro intermittente, introdotta nel nostro ordinamento nel 2003 e attualmente disciplinata dal d.lgs. n. 81/2015, la raffronta ad altre tipologie lavorative come il lavoro a tempo parziale, la somministrazione di lavoro e il la- voro a termine. Infine, si analizzano le recenti modifiche introdotte dal d.lgs. n. 104/2022, cd. decreto trasparenza al lavoro intermittente

Sindacato e Stato democratico

L’articolo, dopo aver ripercorso i vari momenti dell’evoluzione del rapporto tra sindacato e Stato, si propone di analizzare il ruolo del sindacato nell’attuale Stato democratico. Il sindacato, oltre alla regolazione collettiva di minimi di trattamento salariale ed extra salariale, in quanto corpo intermedio, anello tra società e Stato, contribuisce a consolidare la democrazia

Patterns of distribution and landscape connectivity of the stag beetle in a human-dominated landscape

Urbanisation and the spread of agriculture have resulted in high levels of forest loss, habitat fragmentation and degradation in many regions of the world. In Italy, the Po Plain is the most human-dominated landscape of the country and, after decades of exploitation, old-growth forests have been reduced to small and isolated patches, often threatened by invasive tree species such as the black locust (Robinia pseudoacacia). In these habitats, the occurrence of many forest-dependent species is related to the quality and availability of suitable areas, as well as the connectivity between the remaining forested patches. Thus, recently developed species distribution models have been applied, namely the Ensemble of Small Models (ESMs), to identify areas of occurrence for a rare and protected saproxylic beetle species, the stag beetle Lucanus cervus and the inverse of the resulting distribution maps as resistance maps have been used to estimate landscape connectivity for this species. Response curves suggested that the probability of the stag beetle occurrence increased with habitat diversity, grassland coverage and native forests, especially oak and mixed forests. The other forest coverage, such as those with black locust, beech, chestnut and black cherry, showed a unimodal relationship peaking approximately at 70%, 8%, 55% and 13% respectively. The stag beetle occurrence was unimodal related to distance to watercourses and distance to human settlements and negatively related to shrub-lands, croplands, sparse and dense human settlements. Landscape connectivity showed similar patterns, except for oak forest coverage, which showed a negative relationship to landscape connectivity. In conclusion, stag beetles can persist in a human dominated landscape only in the presence of forest patches, including those with black locust trees. It is also inferred that ESMs may be suitable for modelling rare species distributions and estimating landscape connectivity to promote species conservation

Pharmacokinetics and antinociceptive effects of tramadol and its metabolite O-desmethyltramadol following intravenous administration in sheep

Although sheep are widely used as an experimental model for various surgical procedures there is a paucity of data on the pharmacokinetics and efficacy of analgesic drugs in this species. The aims of this study were to investigate the pharmacokinetics of intravenously (IV) administered tramadol and its active metabolite O-desmethyltramadol (M1) and to assess the mechanical antinociceptive effects in sheep. In a prospective, randomized, blinded study, six healthy adult sheep were given 4 and 6\u2009mg/kg tramadol and saline IV in a cross-over design with a 2-week wash-out period. At predetermined time points blood samples were collected and physiological parameters and mechanical nociceptive threshold (MNT) values were recorded. The analytical determination of tramadol and M1 was performed using high performance liquid chromatography. Pharmacokinetic parameters fitted a two- and a non-compartmental model for tramadol and M1, respectively. Normally distributed data were analysed by a repeated mixed linear model. Plasma concentration vs. time profiles of tramadol and M1 were similar after the two doses. Tramadol and M1 plasma levels decreased rapidly in the systemic circulation, with both undetectable after 6\u2009h following drug administration. Physiological parameters did not differ between groups; MNT values were not statistically significant between groups at any time point. It was concluded that although tramadol and M1 concentrations in plasma were above the human minimum analgesic concentration after both treatments, no mechanical antinociceptive effects of tramadol were reported. Further studies are warranted to assess the analgesic efficacy of tramadol in sheep