Influence of Magnesium as a Major Contributor of Water Hardness on Some Cardiac Disease Risk Factors

Various ecological studies report a reduction in cardiovascular disease mortality risk with increasing magnesium levels in drinking water. Most of the studies done in this field were epidemiologic studies.The aim of the present study was to examine whether magnesium addition to drinking water can affect risks of cardiac disease. The study included five groups of male albino rats. The rats received either tap water or water containing 5, 10, 20 g of magnesium sulfate per liter. During the whole experiment, all the groups received hypercholesterolemic diet except for the normal control which received normal basal diet. At the end of the experiment, blood was drawn for the determination of plasma magnesium, lipid profile and liver function. In addition, the extent of obesity was determined using the body mass index (BMI). In all groups magnesium addition was associated with higher levels of plasma magnesium. The blood analysis showed a significant decrease in serum total cholesterol, triglycerides, LDL- cholesterol and VLDL- cholesterol, while there was a significant increase in HDL- cholesterol in groups received magnesium sulfate in drinking water, compared with the hypercholesterolemic group received tap water. GOT, GPT and ALP followed the same trend. The addition of MgSO4 to the drinking water results in significant decrease in BMI of the magnesium treated groups relative to the hypercholesterolemic control. These results showed that high magnesium concentration in drinking water is capable of decreasing some cardiac disease risk factors in male albino rats. Keywords: Cardiac disease, hypercholesterolemia, Magnesium, Risk factors, Water

Benchmarking of health technologies distribution models: an investigation of Lombardy’s local health authorities

Purpose – The purpose of this paper is to develop a benchmarking framework for assessing the performance of the distribution models adopted by the local branches of National Health Services (NHSs) for delivering health technologies to patients at a local level, and to derive prescriptions for enhancing design and optimal management of the distribution models. Design/methodology/approach – The authors focussed the study on the distribution of absorbent devices for incontinence, adopting the analytic hierarchy process as a tool for developing the benchmarking framework. The authors applied the framework to the context of the Italian NHS with respect to the Lombard Local Health Authorities, assessing their performance in terms of operational efficiency and service quality. Findings – The developed framework constitutes a novel contribution, and it allows for generating prescriptions. Through its application to the context studied the authors found that a “one-size-fits-all” distribution model cannot be proposed, as regards both efficiency and effectiveness, since process standardization does not provide benefits or savings in all contexts. Rather, a total landed cost approach in the evaluation of the distribution practices must be adopted. Practical implications – This paper offers to managers and decision makers an innovative approach to the design of distribution models for health technologies. It provides policy makers with prescriptions to develop regulations fostering a comprehensive view of the factors for an optimal health technologies distribution at a local level. Originality/value – Given the dearth of scientific publications focussed on the distribution at the local level of health technologies, this paper significantly contributes to the existing body of knowledge and it offers an innovative framework which can be proficiently replicated in manifold contexts

Clinical Features, Short-Term Mortality, and Prognostic Risk Factors of Septic Patients Admitted to Internal Medicine Units: Results of an Italian Multicenter Prospective Study

Only a few studies provided data on the clinical history of sepsis within internal Medicine units.The aim of the study was to assess the short-term mortality and to evaluate the prognostic risk factors in a large cohort of septic patients treated in internal medicine units.Thirty-one internal medicine units participated to the study. Within each participating unit, all admitted patients were screened for the presence of sepsis.A total of 533 patients were included; 78 patients (14.6%, 95%CI 11.9, 18.0%) died during hospitalization; mortality rate was 5.5% (95% CI 3.1, 9.6%) in patients with nonsevere sepsis and 20.1% (95%CI 16.2, 28.8%) in patients with severe sepsis or septic shock. Severe sepsis or septic shock (OR 4.41, 95%CI 1.93, 10.05), immune system weakening (OR 2.10, 95%CI 1.12, 3.94), active solid cancer (OR 2.14, 95% CI 1.16, 3.94), and age (OR 1.03 per year, 95% CI 1.01, 1.06) were significantly associated with an increased mortality risk, whereas blood culture positive for Escherichia coli was significantly associated with a reduced mortality risk (OR 0.46, 95%CI 0.24, 0.88).In-hospital mortality of septic patients treated in internal medicine units appeared similar to the mortality rate obtained in recent studies conducted in the ICU setting

An empirical analysis of conviction patterns, change over the life-course and external influences in relation to sexual offending behaviour

This PhD uses statistical analysis and qualitative interviews to analyse behaviour patterns in the context of causal theories of sexual offending and desistance from it, with a particular emphasis on socio-cultural reasons why people offend, stop offending, or offend at different points in life. This research makes an original contribute to the literature in a number of ways. There are six main findings from this research that contribute to the literature in this area. One of the key findings is that there is substantial heterogeneity of offending behaviour amongst sexual offenders, suggesting that there is no one-size-fits-all approach for prevention, intervention or management. There was support in the research for a link between sexual offending and prolific non-sexual offending, but this only appeared to be one of several different sexual offending pathways. Other groups of offenders displayed considerable specialism in their offending (in terms of type of sexual offence and the fact that they had often only been convicted of sexual offences). This was magnified by the finding that offending rates were generally lower for sexual convictions than for other convictions: in fact, the vast majority of people in the dataset only had convictions for one sexual offence. There was evidence from the qualitative interviews that adverse life events were a contributory factor to sexual offending, and the thesis has found that there is support for both psychological and socio-cultural causes (including gender-based elements), as well as an interaction between the two. It also suggested that there is evidence that sexual offending is not stable over the life-course, and that situational factors appear to be important in terms of determining behavioural change. Implications for prevention, intervention and management of sexual offenders are discussed

DO JURORS HOLD AUDITORS TO A DIFFERENT NEGLIGENCE STANDARD UNDER U.S. GAAP AND IFRS?

In order to fulfill the requirements of East Carolina University’s Honors College, I created the research study described in this paper to examine the effects on auditor liability under United States Generally Accepted Accounting Principles compared to the International Financial Reporting Standards. The Financial Accounting Standards Board and the International Accounting Standards Board have been working towards convergence between U.S. GAAP, a rules-based system, and IFRS, a principles-based system. This research study examines whether potential jurors would hold auditors to a different negligence standard between rules-based and principles-based accounting. This study also explores how juror assessments of auditor responsibility differ when auditor liability is limited, as opposed to, unlimited. An experiment was conducted with students at a large state university representing jurors. I found evidence that auditor liability was held to a higher dollar value under unlimited liability and when relevant accounting standards were rules-based

La distribuzione territoriale delle tecnologie sanitarie: uno studio di casi multiplo

I recenti trend demografici ed economici stanno costringendo i Servizi Sanitari a rivedere le modalità di erogazione dei servizi di cura e di assistenza sanitaria, spostando il baricentro dall'ospedale al territorio: una strategia per contenere i costi senza però compromettere la qualità del servizio. Dopo aver eseguito una review della letteratura con la metodologia della Structured Literature Review (SLR) in merito ai servizi sanitari a livello territoriale, affrontati secondo una prospettiva manageriale, sembra che questo field di ricerca non sia ancora entrato in una fase di maturità, ma stia comunque iniziando a destare interesse negli ultimi dieci anni. In particolar modo, vi sono alcuni ambiti che sono stati scarsamente esplorati, quali l'ambito della logistica, delle performance e delle valutazioni economiche, anche per la difficoltà di formalizzare i processi complessi e multidisciplinari come quelli dei servizi sanitari a livello territoriale. Al fine di colmare questo importante gap letterario, il presente studio si è focalizzato sulla distribuzione delle tecnologie sanitarie a livello territoriale. In particolare, le research question sono state le seguenti: i) Quali modelli di distribuzione delle tecnologie sanitarie sul territorio sono stati sviluppati in Italia dalle Aziende Sanitarie e quali caratteristiche presentano? ii) Quali sono le performance economiche/quantitative dei modelli distributivi esistenti? iii) Quali sono le percezioni delle performance qualitative dei modelli distributivi? Al fine di rispondere alle RQ è stato disegnato un multiple case study che ha coinvolto 12 ASL di Regione Lombardia in merito alle modalità di distribuzione di tecnologie sanitarie dei presidi ad assorbenza per l'incontinenza e per il paziente diabetico. Seguendo l'approccio della metodologia del benchmarking, dopo avere analizzato i processi distributivi, sono stati progettati alcuni Key Performance Indicator (KPI) al fine di confrontare le performance economico/quantitative raggiunte da ogni ASL. A tale proposito si sono raccolti dati quantitativi (popolazione, presidi erogati e risorse economiche coinvolte nei processi di distribuzione), inerenti al periodo 2011-2014. Si sono condotte anche interviste semi-strutturate con i Referenti dei Servizi Protesici e Farmaceutici delle ASL coinvolte, raccogliendo anche le percezioni in merito alle performance di tipo qualitativo. La distribuzione degli ausili per l'incontinenza ha previsto due principali modelli di distribuzione: 1. La distribuzione attraverso le farmacie, in cui il paziente si reca in una farmacia nel territorio LHA e ritira il quantitativo autorizzato di prodotti. 2. Consegna a domicilio: l'ASL indice una gara per identificare il fornitore di prodotti e servizi di logistica. Un vettore logistico consegna i prodotti a domicilio del paziente. Nel periodo osservato, da un punto di vista economico/quantitativo, la consegna a domicilio ha fornito una quantità maggiore di presidi per paziente; la distribuzione attraverso le farmacie invece ha presentato un costo unitario inferiore per paziente; ma entrambi i modelli sono risultati equiparabili in termini di costo unitario del servizio a presidio. Le percezioni delle prestazioni qualitative ha rivelato che la distribuzione attraverso le farmacie è preferibile per tutte le dimensioni indagate (efficienza economica e logistica, la rispondenza alle necessità degli utenti, miglioramento dei processi interni dell'ASL in termini di integrazione). Nel periodo considerato, quindi, è possibile notare come le performance dei modelli distributivi siano cambiati: la spiegazione può essere trovata nell'introduzione della gara regionale per la fornitura e la consegna dei presidi, a cui hanno aderito alcune ASL a partire dal 2012. Il modello previsto dalla gara è stato quello domiciliare: ma è possibile notare come ci sia stato un allineamento delle condizioni di mercato che ha portato a migliori performance anche per il modello distributivo tramite farmacia. In conclusione, sulla base dei risultati ottenuti, sembra che non sia possibile identificare il miglior modello di distribuzione per i prodotti ad assorbenza per l'incontinenza. Dalle interviste con i responsabili delle ASL, è emerso come possa essere individuato nuovo modello di distribuzione che potrebbe assicurare la qualità e la sostenibilità economica del servizio, basato sulla logica del voucher: il paziente potrebbe scegliere non solo il luogo che preferisce per ritirare i prodotti (farmacia, presso la GDO oppure a domicilio), e il tipo e la quantità di presidi, rispettando un tetto economico, definito dall'ASL sulla base delle condizioni cliniche del soggetto . Per quanto concerne invece la distribuzione dei presidi per il paziente diabetico, l'unico modello distributivo permesso in Regione Lombardia è quello tramite farmacie che si è dimostrato essere valido sia in termini di performance economico/quantitative (nel periodo osservato si è registrato un decremento dei costi senza però un decremento proporzionale del numero di presidi distribuiti), sia in termini di percezione delle performance quantitative.Recent demographic and economic developments are forcing National Health Services across Europe to provide care at a local level, as a strategy to contain costs without affecting service quality. A literature review concerning the management of healthcare services at a local level has revealed that research in this field is still in its infancy phase. Logistics/supply chain, performance management and economic evaluations were scarcely explored; this may have been due to the difficulty in finding reliable field data and in formalising complex and multi-disciplinary processes, typical of these research issues. In an attempt to fill literature gaps, the present study focused on the distribution management of health technologies at a local level. In particular, three research questions guided the study: i) What distribution models of health technologies have been developed by Local Health Authorities, and what are their features?; ii) What are the economic/quantitative performances of the distribution models previously identified?; and iii) What is the perception of the related qualitative performances? A multiple case study was designed for the analysis of different alternatives distributing health technologies (i.e. absorbent devices for incontinence, and devices for diabetes) at a local level, involving a sample of 12 Local Health Authorities within a specific Italian Region (Lombardy). After an analysis of distribution processes, using a benchmarking approach, specific Key Performance Indicators were constructed in order to compare the economic/quantitative performances achieved by each Authority. Quantitative data (target population, devices delivered and economic resources involved in the distribution processes), over the period 2011-2014, were collected in order to feed this set of Key Performance Indicators. Semi-structured interviews with LHAs' managers, collecting perceptions and qualitative data, were also conducted. Considering absorbent devices for incontinence, two main distribution models were identified: 1. Distribution through pharmacies: the patient goes to a pharmacy within the Local Health Authority territory and collects the authorised quantity of absorbent devices. 2. Home delivery: the Local Health Authority calls for a tender in order to identify and select provider(s) of products and logistics services. A distributor delivers the authorised quantity of products to the patient's domicile. Over the observed period, from an economic/quantitative point of view, home delivery provided a higher quantity of devices per patient; distribution through pharmacies presented a lower unit cost per patient; both the models, however, were equal in terms of unit cost of the service per device. The Local Health Authorities' managers perception of qualitative performances revealed that distribution through pharmacies is preferable for all the investigated dimensions (economic and logistic efficiency, responsiveness to users' need, and improving the Local Health Authorities' processes). The results of the study showed that, over the studied time frame, the performance of home delivery for absorbent devices changed (i.e. a larger quantity of devices distributed for a similar cost): one possible explanation for this could be founded on the regional tender for the supply and home distribution of devices adopted by some Local Health Authorities that started in 2012. Considering qualitative performances, distribution through pharmacies was the best option. In conclusion, based on the results of the study, while it is not possible to clearly identify the best distribution model for absorbent devices, from the interviews with the Local Health Authorities' managers it emerged that a new distribution model could be implemented, assuring quality and economic sustainability of the service, based on the voucher system: the patient would select the preferable location for the collection of products, and the type and the amount of absorbent devices, respecting a fixed economic sum as defined by the Local Health Authority (based on the clinical conditions of the patient). In Lombardy Region, distribution through pharmacies was the only distribution model identified for devices for diabetes, showing good performance over the studied period: a cost decrease was recorded, without a decrease in the quantity of delivered devices.Discipline manageriali, finanziarie e giuridiche per la gestione integrata d'aziend

Benchmarking Logistics Facilities: A Rating Model to Assess Building Quality and Functionality

Logistics real estate has been experiencing a recent rebirth led by the growth of retailing and e-commerce. Although these sectors are looking for facilities matching their logistics needs, the identification of the most suitable building becomes a challenging task. To date, from both the practitioner’s and academic perspectives there is a lack of models for assessing the quality of logistics facilities together with functionality (i.e. whether a warehouse is suitable for hosting a given logistics activity). The aim of this paper is to fill this gap by developing a rating model for assessing the quality and functionality of logistics facilities. A three-pronged methodology was adopted. First, a Systematic Literature Network Analysis (SLNA) was carried out on a sample of logistics buildings to identify the relevant features that must be taken into consideration when assessing logistics real estate. Second, a Delphi method involving experts in the field was used to fine-tune the list of features that emerged from the SLNA process and to evaluate the importance of each feature from a company perspective. The rating model was developed and validated through pilot tests on 27 logistics facilities. The rating model is divided into four sections: location, technical specifications, external spaces and internal areas. As an output, the model determines the building quality and main functionality, together with a gap analysis to detect the weakest emerging elements. This research fills an identified research gap in the logistics real estate literature. Specifically, it offers a quantitative and shared evaluation method, which can be used to estimate a building quality and functionality, thus extending the scope of the previous assessment methods available