Improving Childbirth and Maternal Care - How to Foster the Use of Good Practices for Patient Safety

Despite the global effort toward improving childbirth and maternity care, there are still complications (hemorrhage, infections, and high blood pressure) that may arise unexpectedly. To end preventable mortality, every woman needs skilled care at birth. The aim of this chapter is to present some solutions implemented by Frontline professionals and healthcare organizations made available through the Italian Observatory on Good Practices for Patient Safety, a national program to improve patient safety by promoting diffusion and active dissemination of evidence-based practices

Physical activity intervention for elderly patients with reduced physical performance after acute coronary syndrome (HULK study): Rationale and design of a randomized clinical trial

Background: Reduced physical performance and impaired mobility are common in elderly patients after acute coronary syndrome (ACS) and they represent independent risk factors for disability, morbidity, hospital readmission and mortality. Regular physical exercise represents a means for improving functional capacity. Nevertheless, its clinical benefit has been less investigated in elderly patients in the early phase after ACS. The HULK trial aims to investigate the clinical benefit of an early, tailored low-cost physical activity intervention in comparison to standard of care in elderly ACS patients with reduced physical performance. Design: HULK is an investigator-initiated, prospective multicenter randomized controlled trial (NCT03021044). After successful management of the ACS acute phase and uneventful first 1 month, elderly (≥70 years) patients showing reduced physical performance are randomized (1:1 ratio) to either standard of care or physical activity intervention. Reduced physical performance is defined as a short physical performance battery (SPPB) score of 4-9. The early, tailored, low-cost physical intervention includes 4 sessions of physical activity with a supervisor and an home-based program of physical exercise. The chosen primary endpoint is the 6-month SPPB value. Secondary endpoints briefly include quality of life, on-treatment platelet reactivity, some laboratory data and clinical adverse events. To demonstrate an increase of at least one SPPB point in the experimental arm, a sample size of 226 patients is needed. Conclusions: The HULK study will test the hypothesis that an early, tailored low-cost physical activity intervention improves physical performance, quality of life, frailty status and outcome in elderly ACS patients with reduced physical performance

Search for a Light Charged Higgs Boson Decaying to a W Boson and a CP-Odd Higgs Boson in Final States with eμμ or μμμ in Proton-Proton Collisions at √s=13 TeV

A search for a light charged Higgs boson (H+) decaying to a W boson and a CP-odd Higgs boson (A) in final states with eμμ or μμμ is performed using data from pp collisions at √s=13  TeV, recorded by the CMS detector at the LHC and corresponding to an integrated luminosity of 35.9  fb−1. In this search, it is assumed that the H+ boson is produced in decays of top quarks, and the A boson decays to two oppositely charged muons. The presence of signals for H+ boson masses between 100 and 160 GeV and A boson masses between 15 and 75 GeV is investigated. No evidence for the production of the H+ boson is found. Upper limits at 95% confidence level are obtained on the combined branching fraction for the decay chain, t→bH+→bW+A→bW+μ+μ−, of 1.9×10−6 to 8.6×10−6, depending on the masses of the H+ and A bosons. These are the first limits for these decay modes of the H+ and A bosons.Peer reviewe

Search for dark matter particles produced in association with a Higgs boson in proton-proton collisions at √s = 13 TeV

© 2020, The Author(s). A search for dark matter (DM) particles is performed using events with a Higgs boson candidate and large missing transverse momentum. The analysis is based on proton- proton collision data at a center-of-mass energy of 13 TeV collected by the CMS experiment at the LHC in 2016, corresponding to an integrated luminosity of 35.9 fb−1. The search is performed in five Higgs boson decay channels: h → b b ¯ , γγ, τ+τ−, W+W−, and ZZ. The results from the individual channels are combined to maximize the sensitivity of the analysis. No significant excess over the expected standard model background is observed in any of the five channels or in their combination. Limits are set on DM production in the context of two simplified models. The results are also interpreted in terms of a spin-independent DM-nucleon scattering cross section and compared to those from direct-detection DM experiments. This is the first search for DM particles produced in association with a Higgs boson decaying to a pair of W or Z bosons, and the first statistical combination based on five Higgs boson decay channels. [Figure not available: see fulltext.].SCOAP

Correspondence regarding "Ventilatory efficiency in athletes, asthma and obesity": different ventilatory phenotypes during exercise in obesity?

Patients with obesity may have different ventilatory phenotypes during exercise related to an interaction of expiratory flow limitation, mechanical constraints and adaptations of chemoreception and metabolic setpoints. https://bit.ly/3JBs86

Effectiveness of Text Messaging as an Incentive to Maintain Physical Activity after Cardiac Rehabilitation: A Randomized Controlled Pilot Study

Although the efficacy of cardiac rehabilitation (CR) is proven, the need to improve patients’ adherence has emerged. There are only a few studies that have investigated the effect of sending text messages after a CR period to stimulate subjects’ ongoing engagement in regular physical activity (PA). A randomized controlled pilot trial was conducted after CR, sending a daily PA text message reminder to an intervention group (IG), which was compared with a usual care control group (CG) during three months of follow-up. Thirty-two subjects were assessed pre- and post-study intervention with GPAQ, submaximal iso-watt exercise testing, a 30 s sit-to-stand test, a bilateral arm curl test, and a final survey on a seven-point Likert scale. A statistically significant difference in the increase of moderate PA time (Δ 244.7 (95% CI 189.1, 300.4) minutes, p < 0.001) and in the reduction of sedentary behavior time (Δ −77.5 (95% CI 104.9, −50.1) minutes, p = 0.004) was shown when the IG was compared with the CG. This was associated with an improvement in heart rate, blood pressure, and patients’ Borg rating on the category ratio scale 10 (CR10) in iso-watt exercise testing (all p < 0.05). Furthermore, only the IG did not show a worsening of the strength parameters in the follow-up leading to a change of the 30 s sit-to-stand test with a difference of +2.2 (95% CI 1.23, 3.17) repetitions compared to CG (p = 0.03). The telemedical intervention has been appreciated by the IG, whose willingness to continue with regular PA emerged to be superior compared to the CG. Text messages are an effective and inexpensive adjuvant after phase 2 CR that improves adherence to regular PA. Further studies are needed to confirm these results in a larger patient population and in the long term

Can exercise test intensity and modality affect the prevalence of arrhythmic events in young athletes?

Pre-participation screening is performed to identify underlying cardiac conditions that may also lead to sudden cardiac death. Our aim is to compare submaximal Harvard Step Test (HST) with incremental Maximal Exercise Test (MET) on treadmill to induce and detect arrhythmias in younger athletes. A total of 1000 athletes (mean age 14.6 +/- 4.7 years) were evaluated, 500 with MET and 500 with HST, all with continuous ECG monitoring until three minutes of recovery. Pre-test evaluation includes medical history, clinical evaluation and resting electrocardiogram. Ventricular and/or supraventricular arrhythmias were observed in 2.6% of athletes performing HST and in 8.4% during MET (p < 0.001). Incidence of arrhythmias remained higher for MET also considering separately exercise phase (0.8% vs. 5.2%; p < 0.001) and recovery phase (2.0% vs. 6.0%; p < 0.01). No gender differences were observed. Results suggest that MET induces more arrhythmias than submaximal HST, regardless of test phase. Higher test intensity and longer exercise duration might influence test outcomes, making MET more arrhythmogenic

Head Injury Assessment in Italian rugby union: a two-seasons prospective analysis

Background: In Italy, to the best of our knowledge, there is no literature relating to injury and concussion epidemiology in rugby union. Therefore, the primary aim of this study is to describe the incidence of sport-related concussion in Italian rugby union and the associated management of Head Injury Assessment (HIA). Methods: This is an observational prospective study, analysing the Italian elite rugby championship (Top 12 and Coppa Italia) for two seasons (2018/2019 and 2019/2020). Twelve male teams of the Italian elite rugby championship were included. The diagnosis of traumatic brain injury was provided by a team doctor with HIA, while no match day doctor or video analysis was available. A concussion expert of Italian Rugby Federation reviewed all the HIAs. The outcome of interest were: incidence, playing situation and mechanism responsible for traumatic brain injury. Results: In the study period, 47 HIAs were performed during matches (45.3/1000 player-match-hours) and 7 concussions were diagnosed by team doctors (6.75/1000 player-match-hours). After the concussion expert HIAs' review, the thirty-three percent of 16 diagnoses were made later, during follow-up, or based on clinical suspicion. Most symptoms complained about by players were neck pain and headache, in 14.6% and 13.4% of HIA, respectively. Concussions were predominately the result of tackling (46.5%) for the tackler (90.9%). Conclusions: The incidence of concussion in Italian Rugby appears to be low compared to that of rugby outside Italy, which is likely due to the learning curve of HIA and the absence of video analysis and match day doctors during competitions. The implementation of educational projects may be fundamental to promoting HIA process

Early repolarization in adolescent athletes: A gender comparison of ECG and echocardiographic characteristics

Background The early repolarization pattern (ERp) is an electrocardiographic finding previously associated with arrhythmic risk in adults. The purpose of this study is to evaluate the prevalence and characteristics of ERp in a group of adolescent athletes according to gender. Furthermore, potential associations with clinical, electrocardiographic, and echocardiographic parameters are explored. Methods In this cross-sectional study young athletes (age &lt; 18 years) were consecutively enrolled during the annual pre-participation evaluation, undergoing also transthoracic echocardiography assessment from January 2015 to March 2020. Results The prevalence of ERp was 27% in the whole population. Athletes with ERp were more frequently men practicing endurance sports. Women with ERp showed lower heart rate at rest, greater posterior, and relative ventricular wall thickness than those without ERp. Men with ERp presented higher systolic blood pressure at peak exercise, greater septal wall thickness, and indexed left ventricular mass than those without ERp. Both genders with ERp showed increased QRS voltage and narrower QRS duration. The ERp phenotype in men was more frequently notched with higher amplitude and ascending ST segment. Women's ERp presented more frequently a slurred morphology, especially in the inferior leads, and horizontal ST slope. No differences emerged in the occurrence of arrhythmias at rest and during maximal exercise test between groups, even considering higher risk phenotypes. Conclusions ERp is an ECG finding compatible with normal cardiac adaptations to training in young athletes. ERp demonstrated gender differences regarding phenotypes previously associated with increased cardiovascular risk, not showing any differences in arrhythmias during maximal exercise test

DALL’ACIDIFICAZIONE DEI MARI AL TEMA DELLE MICROPLASTICHE: ATTIVITÀ LABORATORIALI E INTERATTIVE PER TUTTI

In questo articolo saranno descritte alcune attività interattive e laboratori esplorativi sul tema “La Chimica e il mare” progettati e realizzati in diversi ambiti non formali: dai laboratori per bambini, presso il Museo, sull’effetto dell’acidificazione dei mari sui coralli e sulle conchiglie, alle attività di divulgazione delle recenti ricerche nel campo delle microplastiche durante la Notte Europea dei Ricercatori 2019. Gli autori ringraziano il progetto “Il «marine litter»: dall’analisi del problema a possibili soluzioni per una economia circolare” (PRA 2017-2018)