Modifiche dimensionali volumetriche dopo procedura di ridge preservation con due materiali eterologhi: studio multicentrico clinico randomizzato.

In seguito ad estrazione dentaria, la cresta alveolare va incontro a modifiche dimensionali anche importanti. La contrazione dell'alveolo post-estrattivo può compromettere un successivo posizionamento implantare. Le tecniche di ridge preservation possono contenere questo fenomeno favorendo la neoformazione di osso mineralizzato. Il presente lavoro di tesi si propone di confrontare due materiali da innesto (osso corticale suino; osso cortico-spongioso preidratato e collagenato) e la loro capacità di conservare le dimensioni crestali da un punto di vista volumetrico. Lo studio è del tipo multicentrico, clinico, randomizzato. In totale 28 pazienti sono stati sottoposti ad estrazione dentaria e contestuale procedura di ridge preservation. 14 pazienti sono stati distribuiti al gruppo test, 14 al controllo. Per ogni momento del follow up è stata rilevata un'impronta da cui si è ottenuto il relativo modello in gesso. L'acquisizione con scanner 3-D del modello ha consentito la definizione di variabili anatomiche, indici descrittivi e variabili di outcome. Non è stato possibile approssimare la popolazione a una distribuzione normale, pertanto sono stati usati test statistici non parametrici. L'analisi longitudinale intragruppo ha mostrato una sostanziale riduzione dimensionale nel tempo tanto nel gruppo test quanto nel gruppo controllo. L'analisi intergruppo non ci consente di parlare di una reale differenza di performance dei due innesti. Relativamente al gruppo controllo, esistono delle correlazioni positive tra le variabili anatomiche e gli indici al baseline e le variabili di outcome: è possibile, entro certi limiti, prevedere il comportamento dell'osso suino corticale non collagenato. Il materiale test disattende l'aspettativa iniziale, ovvero quella di un maggiore riassorbimento conseguente all'aggiunta di collagene all'innesto. Questi riscontri preliminari necessitano di ulteriori indagini supportate da un maggior numero di pazienti e da tempi di follow up dilatati

Numerical Simulation of Focused Shock Shear Waves in Soft Solids and a Two-Dimensional Nonlinear Homogeneous Model of the Brain

Shear waves that propagate in soft solids, such as the brain, are strongly nonlinear and can develop into shock waves in less than one wavelength. We hypothesize that these shear shock waves could be responsible for certain types of traumatic brain injuries (TBI) and that the spherical geometry of the skull bone could focus shear waves deep in the brain, generating diffuse axonal injuries. Theoretical models and numerical methods that describe nonlinear polarized shear waves in soft solids such as the brain are presented. They include the cubic nonlinearities that are characteristic of soft solids and the specific types of nonclassical attenuation and dispersion observed in soft tissues and the brain. The numerical methods are validated with analytical solutions, where possible, and with self-similar scaling laws where no known solutions exist. Initial conditions based on a human head X-ray microtomography (CT) were used to simulate focused shear shock waves in the brain. Three regimes are investigated with shock wave formation distances of 2.54 m, 0.018 m, and 0.0064 m. We demonstrate that under realistic loading scenarios, with nonlinear properties consistent with measurements in the brain, and when the shock wave propagation distance and focal distance coincide, nonlinear propagation can easily overcome attenuation to generate shear shocks deep inside the brain. Due to these effects, the accelerations in the focal are larger by a factor of 15 compared to acceleration at the skull surface. These results suggest that shock wave focusing could be responsible for diffuse axonal injuries

Effectiveness of the communication model, C.O.N.N.E.C.T., on patient experience and employee engagement: A prospective study

Northwell Health is a large integrated healthcare organization comprised of 66,000+ employees, 23 hospitals and over 650 medical practice locations located geographically across New York State. In an effort to align and structure interactions between patients, families and healthcare professionals, Northwell Health created a communication model, C.O.N.N.E.C.T. This unique, humanistic model is an acronym that stands for: Contact, Opening Greeting, Name/Title, Needs, Explanation, Closing and Thank. This prospective 3-part study explores the impact of the C.O.N.N.E.C.T. model on professional education, engagement and patient experience. A holistic approach was utilized including a pre and post e-learning module assessment, direct observation behavioral competency process and patient experience surveys. Study participants were Patient Access Services/Registrar professionals across three Northwell Health Emergency Departments. The educational intervention produced statistically significant outcomes in overall learned knowledge, applied knowledge utilizing direct behavioral competency and patient experience. There were variations per hospital for patient experience outcomes. Healthcare necessitates an interdisciplinary team-approach and thus, non-clinical professionals also require educational interventions focused on effective patient and family centered communication. Every role, every person and every moment matters

From liability to asset: A large health system’s approach to transforming hospital food

Historically, hospitals are infamous for poor food quality. Valuing food as a tenant of health and well-being, Northwell Health, New York’s largest healthcare system, is transforming its hospital food program to become an asset and market competition differentiator. By focusing on structure, workforce, procurement and process, Northwell has improved patient experience performance “Quality of Food” by 61 percentile rank points within three years with minimal impact on budgetary cost. Experience Framework This article is associated with the Environment & Hospitality lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

Comparação da performance clínica de restaurações diretas e indiretas: revisão sistemática

Objetivo: Avaliar a performance clínica de restaurações diretas e indiretas, em dentes posteriores, realizadas em resina composta. Metodologia: Pesquisa bibliográfica de artigos publicados nas bases de dados eletrónicas PubMed e ScienceDirect. A identificação e exclusão da evidência seguiu os critérios PRISMA, tendo sido estipulados fatores de inclusão e de exclusão específicos para a seleção dos artigos. A avaliação metodológica dos estudos foi realizada através da Critical Appraisal Skills Program (CASP) checklist. Resultados: Dos 234 estudos identificados, 10 foram incluídos. Os estudos sugerem que os dois tipos de restauração apresentam um desempenho clínico similar, independentemente do tipo de dente e do período de seguimento. Conclusão: Não há evidência de diferenças estatísticas significativas em termos de performance clínica entre as restaurações de tipo direto e indireto. As restaurações diretas são a escolha de eleição em muitas situações clínicas, em detrimento das restaurações indiretas.Objective: To evaluate the clinical performance of direct and indirect composite resin restorations in posterior teeth. Methodology: Bibliographic search of articles published in PubMed and ScienceDirect electronic databases. The identification and exclusion of evidence followed PRISMA criteria, and specific inclusion and exclusion factors were stipulated for article selection. The studies’ methodological assessment was performed using the Critical Appraisal Skills Program (CASP) checklist. Results: Of the 234 articles identified, 10 were included. The studies suggest that the two types of restoration show similar clinical performance, regardless of tooth type and follow-up period. Conclusion: There is no evidence of statistically significant differences in clinical performance between direct and indirect type restorations. Direct restorations are the choice of preference in many clinical situations over indirect restorations

Leveraging the intersectionality of healthcare and hospitality to diversify workforce talent and enhance patient experience

As healthcare becomes more of a consumerism-based industry, organizations and leaders are embracing innovative approaches and models to drive patient choice and brand loyalty. Northwell Health, New York State’s largest comprehensive health system, has integrated hospitality as a core pillar within its dynamic patient experience strategy. This informative case report highlights Northwell’s pragmatic approach to designing, implementing, and sustaining an experiential internship program entitled, Hospitality in Healthcare Internship. The program has resulted in action-oriented patient experience performance improvement opportunities as well as create a robust pipeline of hospitality-minded talent into the organization. Experience Framework This article is associated with the Environment & Hospitality lens of The Beryl Institute Experience Framework (https://theberylinstitute.org/experience-framework/). Access other PXJ articles related to this lens. Access other resources related to this lens

Development and reliability of a patient experience inventory tool for hospitals

This study explores the development and reliability testing of the newly developed Patient Experience Inventory for Hospitals (PXI-H). Created as an organizational self-assessment patient experience tool, it guides healthcare leaders in evaluating attitudes and behaviors as well as structures and programs impacting patient experience within a hospital setting. The PXI-H is organized within four pillars: Leadership, Education and Development, Data and Analytics and Patient-and-Family Centeredness, which were determined to be internally consistent based on examining coefficient alphas and the item-total correlations. Principal component analysis also determined items with highest loadings aligned onto the pillars in which there were assigned, confirming the hypothesized factor structure. Experience Framework This article is associated with the Policy & Measurement lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens

Focalisation non linéaire des ondes de choc de cisaillement dans les solides incompressibles

Shear shock waves in quasi-incompressible soft solids have been observed experimentally only twelve years ago. They differ from compression shock waves because their nonlinearity is cubic instead of quadratic. Velocities of shear waves are small, of the order of the meter per second, and thus induce a strong nonlinear behavior over small distances. This allows to counter-balance the quite strong absorption in such media. To our knowledge, these shear shock waves have been studied only for plane waves. However, focusing is a fundamental phenomenon in the wave physics and its applications. This is why our objective is to investigate the focusing of shear waves theoretically, numerically, and experimentally. This work was in particular motivated by a potential application in biomechanics. We have hypothesized that shear shock waves could play a role in the formation of some traumatic brain injuries, the geometry of the skull producing the focusing effect. These hypotheses have governed our studies for the choice of the different parameters such as the frequency, the amplitude and the geometry. The focusing has been demonstrated in a biological tissue-mimicking gel. Comparisons with the theoretical and numerical model have shown a good agreement. Further studies should concern the possible formation of lesions by shear shock waves.Les ondes de choc de cisaillement dans les solides quasi-incompressibles sont un type d'onde peu exploré car accessible à la mesure seulement depuis une douzaine d'années. Elles se distinguent des ondes de choc de compression par leur non-linéarité cubique au lieu de quadratique. Les faibles vitesses des ondes de cisaillement, de l'ordre du mètre par seconde, permettent notamment d'atteindre des régimes assez fortement non linéaires sur de faibles distances, et de contrebalancer l'absorption relativement importante dans ces milieux. A notre connaissance, ces ondes ont été étudiées presque exclusivement en ondes planes. Or, la focalisation est un phénomène fondamental dans la physique des ondes et ses applications. C'est cette focalisation que l'on s'est attaché à étudier spécifiquement ici, tant du point de vue théorique et numérique, qu'expérimental. L'objectif était de mettre en évidence la focalisation des ondes de choc de cisaillement. Ce travail est en particulier motivé par son application potentielle en biomécanique. On a ici fait l'hypothèse que les ondes de choc de cisaillement pourraient jouer un rôle dans la formation de certaines lésions cérébrales suite à un traumatisme crânien, la géométrie du crâne induisant leur focalisation. Ces considérations nous ont conduits à dimensionner les phénomènes étudiés en conséquence, en termes de fréquence, d'amplitude et de géométrie. La focalisation a ainsi été montrée dans le cas d'un gel simulant un tissu biologique. Les comparaisons avec le modèle théorique et numérique se sont avérées favorables. Pour approfondir l'analyse de l'hypothèse, il resterait à prouver que ces ondes de choc peuvent induire des lésions

Effects of the 6th September 2002 earthquake: damage amplification in the south-eastern sector of Palermo explained by GIS technology

During the 6th September 2002 earthquake the highest damage level in Palermo was observed in the SE sector. This is a recent urbanization area where reinforced concrete structures predominate. A detailed analysis of soil properties in Palermo was carried out by City-GIS to investigate a possible role of nearsurface geology on earthquake effects. City-GIS is a tool dedicated to natural hazard evaluation in urban areas. The availability of high density of well log data (stratigraphic and geotechnical) allowed a realistic modeling of surface geology and physical-mechanical properties that control the seismic response. In wide zones of the above mentioned sector of Palermo, outcropping terrains are composed of thin calcarenite layers, lying above remarkably thick siltyclayey sands that overlay the Numidian Flysch, commonly considered the bedrock of Quaternary sediments. Since silty-clayey sands feature greater deformability properties (Young's modulus) and smaller resistance properties (undrained cohesion and shear resistance angle) than Numidian Flysch, these zones of the SE sector exhibit high values of the acoustic impedance contrast. Moreover, a quite wide portion of the study area, crossed by the Oreto River, is characterized by very thick alluvial deposits. Here, the significant lateral variations of the lithostratigraphic geometry may be an additional cause of strong site effects