Task shifting to enhanced physical therapy in musculoskeletal secondary care. An evidence-based narrative review

Background: The World Health Organization defines task shifting as the rational redistribution of tasks among the healthcare workforce teams. The transfer of tasks to physical therapy is well suited for musculoskeletal conditions, either where exercise and physical activity are an important part of the treatment, or to sort the flow of emergency patients.  Methods: What are the benefits, limits and implementation challenges associated to the employment of enhanced physical therapy in the redistribution of secondary healthcare workforce? The aim of this narrative review is to collect evidence from the most recent publications, in order to address clinical studies, policy making and further research.  Results: A clear correlation between healthcare system and type of service was not found, supporting that task shifting can be employed to meet different needs. In emergency departments, enhanced physical therapists are employed to improve the flow of musculoskeletal patients, reduce waiting time, length of stay and free up professionals in support of more complex conditions. Otherwise, enhanced physical therapists are employed to sort the flow of chronic musculoskeletal patients, triaging to orthopaedic surgery, and performing follow-up. Clinical outcomes were equal or better than those achieved by other professionals. Appropriate diagnoses and referrals were also demonstrated, despite two studies show enhanced physical therapy to be effective but dependent by medical support. Specific training is therefore fundamental.  Conclusion: Task shifting is a promising innovation which is worthy introducing in the management of chronic musculoskeletal conditions, when most of the treatments may be repeated under the supervision of medical consultants.&nbsp

Cardiac troponins and physical exercise. It’s time to make a point

The timely diagnosis of acute coronary syndrome (ACS), in particular myocardial infarction (MI), is still one of the most challenging issues in medicine. The introduction into routine laboratory practice of assays for measuring the cardiospecific troponins has dramatically revolutionized the diagnostic ap-proach and the recent development of methods with improved analytical sensibility (i.e., highly sensitivity [HS] assays), has further contributed to improve the negative predictive value of troponin testing but, contextually, has substantially lowered the clinical specificity of these markers. In particu-lar, clinical studies have demonstrated the existence of an exercise-related increase of HS-troponins, with measurable values detectable in up to 94% of athletes undergoing endurance sports. This mea-surable amount of troponin in blood would mirror an increased membrane permeability and early tro-ponin release rather than reflecting a clinically threatening myocardial injury. As such, the measurable amount of cardiac troponins as assessed with the novel HS assays requires major clinical focus (i.e., serial measurement of cardiac biomarkers, detailed clinical history-taking, integration with ECG and imaging findings) to prevent misdiagnosis of ACS and/or MI in otherwise healthy persons

Comparison of 2 Methods for the Calculation of Estimated Glomerular Filtration Rate

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Effects of winter swimming on haematological parameters

Introduction: Winter swimming represents an intensive short-term exposure to cold, and thus it is considered a strong physical stress. Cold-based treatments, i.e. immersions in cold water, are spreading in sport medicine for improving recovery following muscle traumas, although a universal acceptance of that method is not still achieved. Materials and methods: Fifteen healthy subjects (13 males and 2 females) were recruited among the participants to a 150 meters long swimming race in cold water (6 °C). Blood samples were collec-ted the day before and immediately after the race and a panel of haematological parameters was eva-luated. Results: Swimming in cold water induced a significant variation in the blood cell fraction composition compared to the rest condition, as measured the day before the competition. Red blood cells, white blood cells and platelets count increased significantly (4.7%, P = 0.005; 40.6%, P < 0.001 and 25.0%, P < 0.001, respectively). While the relative number of leukocytes did not change significantly, apart from a strong decrease of the eosinophils population (-48.6%; P < 0.001), a strong increase in the total number of neutrophil granulocytes, lymphocytes and monocytes was recorded (42.6%, P = 0.002, 58.2%, P = 0.001 and 27.5%, P = 0.021, respectively). Following normalization on plasma vo-lume change (-2.54%) the results were unchanged, demonstrating that the variations were not due to a mere haemoconcentration. Conclusions: When represented by brief exposure to cold water, winter swimming induces strong non-pathological modifications of haematological homeostasis

Liquiritigenin reduces osteoclast activity in zebrafish model of glucocorticoid-induced osteoporosis

Drug and therapies currently used to treat human bone diseases have a lot of severe side effects. Liquiritigenin is a flavonoid extracted from Glycyrrhiza glabra roots which has been reported to have positive effects in vitro on osteoblasts activity and bone mineralization as well as inhibitory effect on osteoclasts differentiation and activity in vitro. The present study was aimed to evaluate the in vivo effects of liquiritigenin on bone structure and metabolism in physiological and pathological conditions using Danio rerio as experimental animal model. Treatments with liquiritigenin were performed on embryos to evaluate the osteogenesis during skeletal development. Other treatments were performed on adult fish affected by glucocorticoid-induced osteoporosis to assay the therapeutic potential of liquiritigenin in the reversion of bone-loss phenotype in scale model. Liquiritigenin treatment of zebrafish embryo significantly enhances the osteogenesis during development in a dose-dependent manner. In addition, liquiritigenin inhibits the formation of the osteoporotic phenotype in adult zebrafish model of glucocorticoid-induced osteoporosis preventing osteoclast activation in scales. Interestingly, liquiritigenin does not counteract the loss of osteoblastic activity in scales. The liquiritigenin exhibits in vivo anti-osteoporotic activity on adult fish scale model. It can be considered a good candidate to develop new drugs against osteoporosis

Azimuthal correlation in DIS

We introduce the azimuthal correlation for the deep inelastic scattering process. We present the QCD prediction to the level of next-to-leading log resummation, matching to the fixed order prediction. We also estimate the leading non-perturbative power correction. The observable is compared with the energy-energy correlation in e+e- annihilation, on which it is modelled. The effects of the resummation and of the leading power correction are both quite large. It would therefore be particularly instructive to study this observable experimentally.Comment: 33 pages, 4 figures, JHEP class included. One figure and some clarifications adde

VIRTUAL ACCESS TO HERITAGE THROUGH SCIENTIFIC DRAWING, SEMANTIC MODELS AND VR-EXPERIENCE OF THE STRONGHOLD OF ARQUATA DEL TRONTO AFTER THE EARTHQUAKE

Interactive representation has proven to be an effective tool in various disciplines related to Digital Cultural Heritage (DCH). This study proposes a research method that uses interactive representation to share complex scenarios like the Stronghold of Arquata del Tronto, facilitating novel forms of heritage dissemination. The scan-to-BIM process made it possible to digitise complex structural elements damaged by the 2016 earthquake. The investigation of the complexity paradigm improved the reliability of the semantic model that supports the preservation process. Interoperability and accessibility paradigms were explored to create a more comprehensive and accurate understanding of the built heritage. A web-VR platform was developed to enhance user interaction and simplify virtual environment exploration without using complex hardware (VR headset and controllers), making it possible to experience VR in the browser

Physical Activity and Bone Health: What Is the Role of Immune System? A Narrative Review of the Third Way

Bone tissue can be seen as a physiological hub of several stimuli of different origin (e.g., dietary, endocrine, nervous, immune, skeletal muscle traction, biomechanical load). Their integration, at the bone level, results in: (i) changes in mineral and protein composition and microarchitecture and, consequently, in shape and strength; (ii) modulation of calcium and phosphorous release into the bloodstream, (iii) expression and release of hormones and mediators able to communicate the current bone status to the rest of the body. Different stimuli are able to act on either one or, as usual, more levels. Physical activity is the key stimulus for bone metabolism acting in two ways: through the biomechanical load which resolves into a direct stimulation of the segment(s) involved and through an indirect load mediated by muscle traction onto the bone, which is the main physiological stimulus for bone formation, and the endocrine stimulation which causes homeostatic adaptation. The third way, in which physical activity is able to modify bone functions, passes through the immune system. It is known that immune function is modulated by physical activity; however, two recent insights have shed new light on this modulation. The first relies on the discovery of inflammasomes, receptors/sensors of the innate immunity that regulate caspase-1 activation and are, hence, the tissue triggers of inflammation in response to infections and/or stressors. The second relies on the ability of certain tissues, and particularly skeletal muscle and adipose tissue, to synthesize and secrete mediators (namely, myokines and adipokines) able to affect, profoundly, the immune function. Physical activity is known to act on both these mechanisms and, hence, its effects on bone are also mediated by the immune system activation. Indeed, that immune system and bone are tightly connected and inflammation is pivotal in determining the bone metabolic status is well-known. The aim of this narrative review is to give a complete view of the exercise-dependent immune system-mediated effects on bone metabolism and function

Evaluation of the Coulter Counter S-Plus VI

This article reports an evaluation of the Coulter Counter model S-Plus VI automatic analyser for haematology, and data are presented on linearity, carry-over, precision, accuracy and stability of the instrument, when compared with a model S-Plus IV/D