Reference intervals as a tool for total quality management

The more traditional, widespread and practiced method for interpreting the laboratory results is based on the comparison made with reference intervals. Nevertheless, the creation of appropriate reference intervals requires careful planning, monitoring and documentation of every aspect of the study, including the selection of the reference population (encompassing selection of homogeneous groups of reference according to ethnicity, geographical origin and environmental conditions, stratification according to age and gender, definition of health status) along with the use of the most appropriate statistical tools. In the very next future, the longitudinal comparison of laboratory results might probably replace the current use of reference intervals

Segmentation of 3D Models for Cultural Heritage Structural Analysis – Some Critical Issues

Cultural Heritage documentation and preservation has become a fundamental concern in this historical period. 3D modelling offers a perfect aid to record ancient buildings and artefacts and can be used as a valid starting point for restoration, conservation and structural analysis, which can be performed by using Finite Element Methods (FEA). The models derived from reality-based techniques, made up of the exterior surfaces of the objects captured at high resolution, are - for this reason - made of millions of polygons. Such meshes are not directly usable in structural analysis packages and need to be properly pre-processed in order to be transformed in volumetric meshes suitable for FEA. In addition, dealing with ancient objects, a proper segmentation of 3D volumetric models is needed to analyse the behaviour of the structure with the most suitable level of detail for the different sections of the structure under analysis. Segmentation of 3D models is still an open issue, especially when dealing with ancient, complicated and geometrically complex objects that imply the presence of anomalies and gaps, due to environmental agents such as earthquakes, pollution, wind and rain, or human factors. The aims of this paper is to critically analyse some of the different methodologies and algorithms available to segment a 3D point cloud or a mesh, identifying difficulties and problems by showing examples on different structures

Illusory streaks from corners and their perceptual integration

Perceptual grouping appears both as organized forms of real figural units and as illusory or “phantom” figures. The phenomenon is visible in the Hermann grid and in configurations which generate color spreading, e.g., “neon effects.” These configurations, generally regular repetitive patterns, appear to be crossed by illusory bands filled with a brighter shade or a colored tinge connecting the various loci of illusory effects. In this work, we explore a particular new illusion showing a grouping effect. It manifests as illusory streaks irradiating from the vertexes of angular contours and connecting pairs of figures nearby. It is only clearly visible when more than one figure is shown, and takes the shape of a net crossing their corners. Although the grouping effect is vivid, the local source of the illusion is completely hidden. Theories explaining this effect as due to the irradiation of illusory streaks (mainly that of Grossberg and Mingolla, 1985a,b) do not fully explain the figural patterns presented here. Illusory effects have already been documented at the angles of various figures, causing them to alter in amplitude and brightness; however, the figure illustrated here appears to have different features and location. Phenomenological observations and an experiment were conducted to assess the role played by geometric and photometric parameters in this illusion. Results showed that sharp angles, in low contrast with the surround, are the main source of the illusion which, however, only becomes visible when at least two figures are close together. These findings are discussed with respect to theories of contour processing and perceptual grouping, and in relation to other illusions

A multi-layer monitoring system for clinical management of Congestive Heart Failure

BACKGROUND: Congestive Heart Failure (CHF) is a serious cardiac condition that brings high risks of urgent hospitalization and death. Remote monitoring systems are well-suited to managing patients suffering from CHF, and can reduce deaths and re-hospitalizations, as shown by the literature, including multiple systematic reviews. METHODS: The monitoring system proposed in this paper aims at helping CHF stakeholders make appropriate decisions in managing the disease and preventing cardiac events, such as decompensation, which can lead to hospitalization or death. Monitoring activities are stratified into three layers: scheduled visits to a hospital following up on a cardiac event, home monitoring visits by nurses, and patient's self-monitoring performed at home using specialized equipment. Appropriate hardware, desktop and mobile software applications were developed to enable a patient's monitoring by all stakeholders. For the first two layers, we designed and implemented a Decision Support System (DSS) using machine learning (Random Forest algorithm) to predict the number of decompensations per year and to assess the heart failure severity based on a variety of clinical data. For the third layer, custom-designed sensors (the Blue Scale system) for electrocardiogram (EKG), pulse transit times, bio-impedance and weight allowed frequent collection of CHF-related data in the comfort of the patient's home. We also performed a short-term Heart Rate Variability (HRV) analysis on electrocardiograms self-acquired by 15 healthy volunteers and compared the obtained parameters with those of 15 CHF patients from PhysioNet's PhysioBank archives. RESULTS: We report numerical performances of the DSS, calculated as multiclass accuracy, sensitivity and specificity in a 10-fold cross-validation. The obtained average accuracies are: 71.9% in predicting the number of decompensations and 81.3% in severity assessment. The most serious class in severity assessment is detected with good sensitivity and specificity (0.87 / 0.95), while, in predicting decompensation, high specificity combined with good sensitivity prevents false alarms. The HRV parameters extracted from the self-measured EKG using the Blue Scale system of sensors are comparable with those reported in the literature about healthy people. CONCLUSIONS: The performance of DSSs trained with new patients confirmed the results of previous work, and emphasizes the strong correlation between some CHF markers, such as brain natriuretic peptide (BNP) and ejection fraction (EF), with the outputs of interest. Comparing HRV parameters from healthy volunteers with HRV parameters obtained from PhysioBank archives, we confirm the literature that considers the HRV a promising method for distinguishing healthy from CHF patients

Ipertensione arteriosa polmonare: stima della casistica italiana e considerazioni sull’impatto sul budget dell’introduzione di tadalafil

This contribution is an attempt to estimate a range of Pulmonary Arterial Hypertension (PAH) prevalence in Italy using international literature and Italian drug market sales data and to evaluate the budget impact of the introduction of tadalafil among the actual drugs with specific indication for this pathology. The final epidemiological figure obtained shows a wide range of prevalence of PAH in Italy (900-3,000 cases). The introduction of tadalafil as PAH treatment should not cause a cost increase for the pharmaceutical budget considering that this new therapy will occupy essentially the patient segment actually treated with sildenafil and that it reduces, in a significant number of patients, the daily cost of PAH therapy through a stable, fixed dose, administration

Comparison of platelet function between sedentary individuals and competitive athletes at rest

BACKGROUND: There are controversial evidences on the effect of different types and workloads of physical exercise on primary hemostasis. In particular, little is known on the chronic influence of a strenuous and regular aerobic training regimen on platelet function. METHODS: The aim of this investigation was to compare platelet function between sedentary controls and trained athletes at rest and to evaluate whether a greater amount of exercise performed in professional cyclists may contribute to increased platelet chronic responsiveness compared to both elite cyclists and sedentary individuals. Platelet's ability to adhere and aggregate was assayed following a 12–24 h resting period in 49 active professional male road cyclists, 40 elite male cyclists and 43 matched sedentary healthy male volunteers, by the platelet function analyzer 100 (PFA-100). RESULTS AND DISCUSSION: Mean values of the collagen-epinephrine test did not differ between controls and athletes (sedentary controls: 111 ± 33 s; elite athletes: 113 ± 26 s, p = 0.93; professional athletes: 120 ± 33 s; p = 0.33), whereas mean values of the collagen-ADP test displayed a slightly but significant trend towards decreased values when comparing sedentary controls (83 ± 21 s) with either elite (77 ± 11 s, p < 0.01) or professional (75 ± 16 s, p < 0.01) athletes. CONCLUSION: The trend towards slightly lower collagen-ADP values are suggestive for a modest but significant chronic activation of primary hemostasis, highlighting the need to set appropriate reference ranges for the PFA-100 when evaluating primary hemostasis in physically active subjects

NextGenerationEU and the European Semester: Comparing National Plans and Country‐Specific Recommendations

This article examines the main features of the Recovery and Resilience Plans (RRPs) that member states have presented to access NextGenerationEU (NGEU) funds, and it explores the relationship between NGEU and the European Semester. Relying on a dataset collected for this purpose, which coded all RRPs and all recommendations received by the member states in the years preceding NGEU, we explore quantitatively the variation in the countries’ resource allocation and reform agendas and the congruence between RRPs and the recommendations issued in the European Semester. Our analysis reveals three key findings. First, substantial variation exists across member states, reflecting the diverse economic and political contexts shaped by a decade of crises. Second, by disaggregating RRPs into the six policy pillars indicated by the Commission, we show differences in the member states’ patterns of intervention. Third, we offer insights into the extent to which member states address the Semester recommendations. The data we present is a relevant tool for understanding NGEU and generating research questions aimed at exploring its nature and its implementation in the years to come

Influenza del trattamento della schizofrenia con neurolettici tipici o olanzapina sui costi sanitari e sugli outcomes lavorativi

The aim of the present study was to evaluate the global treatment cost of schizophrenia with olanzapine or typical neuroleptics, according to Local Health Care Unit point of view. This analysis was performed through naturalistic observation of a cohort of schizophrenic patients referring to Ascoli Piceno ASL Department of Mental Health during 4 years (2001-2004). During year 2003, investigators have identified a cohort of patients who were undergoing treatment switch from typical neuroleptics to olanzapine. These patients, after the switch, are observed prospectively for the next 2 years and retrospectively for the last 2 years of treament. This method allow us to collect data about 4 years of treatment: 2 years of typical neuroleptic treatment followed by 2 years of olanzapine treatment. The present work is presenting the analysis of the first 3 years of observation. The results of our analysis are demonstrating that olanzapine treatment, through a better patient-physician alliance and with rehabilitative activities, allow lower total medical costs for the treatment of schizophrenia than typical neuroleptics. The higher acquisition cost of olanzapine versus typical neuroleptics was compensated by less hospitalizations and territorial medical interventions. During olanzapine treatment patients followed more rehabilitative activities (+71,26%,

Costi del trattamento con oloprazina nelle fasi iniziali della schizofrenia

Objective: In Italy, use of olanzapine in the public sector was limited by law to patients that had failed treatment with conventional antipsychotics, due to the higher purchase price of the drug. This restriction prevented first-episode patients and patients early in the course of their illness from being treated with olanzapine. The present study investigates economic consequences of this policy. Design: The present study retrospectively outlines treatment costs of patients switched to olanzapine during the early stages of schizophrenia as compared to the costs of patients switched during a later stage of the illness. Setting: The study was conducted within Italian Community Mental Health Services. Patients: The cost of pharmacological and non-pharmacological treatment was retrospectively calculated in 25 out-patients with schizophrenia and related disorders over a one-year span. Thirteen patients were switched to olanzapine in the early stage of their illness, prior to drug approval under a compassionate use regimen. Twelve patients started olanzapine under the restriction in a later stage of illness following failed treatment with a conventional antipsychotic. Results: While total treatment costs between the two groups was similar, cost distribution was different. Early Switch patients had higher drug costs and higher rehabilitation costs, while Late Switch patients had higher hospitalisation costs. Conclusions: Small patient numbers and design limitations prevent conclusions being drawn regarding the ultimate impact on outcome and total treatment cost of restriction of olanzapine to second-line use. Despite this, our findings demonstrate that within the context of the Italian CMHS, patients treated with olanzapine while still in the early stages of schizophrenia do not necessarily cost more overall compared to patients who receive olanzapine after failing treatment with a conventional antipsychotic

Plasma D-dimer concentration in patients with systemic sclerosis

BACKGROUND: Systemic sclerosis (SSc) is an autoimmune disorder of the connective tissue characterized by widespread vascular lesions and fibrosis. Little is known so far on the activation of the hemostatic and fibrinolytic systems in SSc, and most preliminary evidences are discordant. METHODS: To verify whether SSc patients might display a prothrombotic condition, plasma D-dimer was assessed in 28 consecutive SSc patients and in 33 control subjects, matched for age, sex and environmental habit. RESULTS AND DISCUSSION: When compared to healthy controls, geometric mean and 95% confidence interval (IC95%) of plasma D-dimer were significantly increased in SSc patients (362 ng/mL, IC 95%: 361–363 ng/mL vs 229 ng/mL, IC95%: 228–231 ng/mL, p = 0.005). After stratifying SSc patients according to disease subset, no significant differences were observed between those with limited cutaneous pattern and controls, whereas patients with diffuse cutaneous pattern displayed substantially increased values. No correlation was found between plasma D-dimer concentration and age, sex, autoantibody pattern, serum creatinine, erythrosedimentation rate, nailfold videocapillaroscopic pattern and pulmonary involvement. CONCLUSION: We demonstrated that SSc patients with diffuse subset are characterized by increased plasma D-dimer values, reflecting a potential activation of both the hemostatic and fibrinolytic cascades, which might finally predispose these patients to thrombotic complications