Nanoscale Photoluminescence Manipulation in Monolithic Porous Silicon Oxide Microcavity Coated with Rhodamine-Labeled Polyelectrolyte via Electrostatic Nanoassembling

Porous silicon (PSi) is a promising material for future integrated nanophotonics when coupled with guest emitters, still facing challenges in terms of homogenous distribution and nanometric thickness of the emitter coating within the silicon nanostructure. Herein, it is shown that the nanopore surface of a porous silicon oxide (PSiO2) microcavity (MC) can be conformally coated with a uniform nm-thick layer of a cationic light-emitting polyelectrolyte, e.g., poly(allylamine hydrochloride) labeled with Rhodamine B (PAH-RhoB), leveraging the self-tuned electrostatic interaction of the positively-charged PAH-RhoB polymer and negatively-charged PSiO2 surface. It is found that the emission of PAH-RhoB in the PSiO2 MC is enhanced (≈2.5×) and narrowed (≈30×) at the resonant wavelength, compared with that of PAH-RhoB in a non-resonant PSiO2 reference structure. The time-resolved photoluminescence analysis highlights a shortening (≈20%) of the PAH-RhoB emission lifetime in the PSiO2 MC at the resonance versus off-resonance wavelengths, and with respect to the reference structure, thereby proving a significant variation of the radiative decay rate. Remarkably, an experimental Purcell factor Fp = 2.82 is achieved. This is further confirmed by the enhancement of the photoluminescence quantum yield of the PAH-RhoB in the PSiO2 MC with respect to the reference structure. Application of the electrostatic nanoassembling approach to other emitting dyes, nanomaterials, and nanophotonic systems is envisaged

Wireless and Flexible Optoelectronic System for In Situ Monitoring of Vaginal pH Using a Bioresorbable Fluorescence Sensor

Here, a miniaturized wireless sensing vaginal ring for the in situ continuous monitoring of vaginal pH and real-time transmission of the pH data to a smartphone is reported, aimed at the diagnosis and management of bacterial vaginosis, a common condition frequently and adversely affecting women. The sensing vaginal ring consists of a bioresorbable pH fluorescence sensor placed on top of a polydimethylsiloxane ring encapsulating a miniaturized driving/readout optoelectronic circuit, data acquisition system, wireless transceiver, and power supply. The pH sensor consists of a micrometer-thick porous silica scaffold conformably coated with a nanometer-thick polymer multilayer stack and is intended to be replaced after 4 days. The sensor fully dissolves in biocompatible by-products eliminating waste management issues; conversely, the ring embedding the circuit is reusable with new sensors. The pH sensor, as well as the sensing vaginal ring, show excellent performance in the continuous measurement of pH in vaginal fluid and can monitor the pH level over the physio-pathological range of 3-7.5 with high linearity, accuracy, and reliability, transmitting the data to a smartphone in real time. The proposed technology can be immediately translated to other diseases, among which wound healing, intragastric activity, and cancer progression, where continuous monitoring of pH is required, as well as to other markers/analytes by engineering the polymer stack with suitable receptors, such as aptamers and other molecular probes

AMD Annals: a model of continuous monitoring and improvement of the quality of diabetes care

OBJECTIVE: in recent years, several initiatives have been launched by the Associazione medici diabetologi (AMD) in the context of a national quality improvement program.These activities include: identification of specific indicators of quality of diabetes care, development of a software to calculate such indicators by using routine clinical data, creation of a network of diabetes clinics and analysis and publication of the results in ad hoc reports (AMD Annals). Through the best performer approach, each centre could compare its own performance not only with the theoretical targets suggested by existing guidelines, but also with the results achieved by the best centres operating within the same healthcare system.We evaluated whether the involvement of diabetes clinics into the AMD Annals initiative improved the quality of care over 4 years. DESIGN: a controlled before and after study was performed to compare data collected from 2004 to 2007 by two groups of centres: group A included centres that had been involved in the project since the first edition of AMD Annals; group B included centres only involved in the last edition. SETTING AND PARTICIPANTS: overall, 124 diabetes clinics provided data on over 100,000 type 2 diabetes patients/year seen from 2004 to 2007. MAIN OUTCOME MEASURES: process indicators included the proportion of patients with at least one measurement of HbA1c, blood pressure and lipid profile during the previous 12 months. Intermediate outcomes included percentages of patients with levels of HbA1c ≤ 7%, blood pressure ≤ 130/85 mmHg and LDL-cholesterol <100 mg/dl (favourable indicators), and the percentages of patients with levels of HbA1c ≥ 9%, blood pressure ≥ 140/90 mmHg and LDL-cholesterol ≥ 130 mg/dl (unfavourable indicators). Percentages of patients treated with insulin, two or more antihypertensive agents, and statins were also evaluated. A multilevel analysis adjusted for age, gender, diabetes duration, and clustering effect was applied to investigate the changes in the indicators between the two groups of centres during 4 years. RESULTS: lipid profile monitoring increased more in group A (+6.2% from 2004 to 2007) than in group B (+2.4%), while HbA1c and blood pressure monitoring did not change over time in both groups. As for the outcomes considered, the percentage of patients with HbA1c ≤ 7% increased by 6% in group A and by 1.3%in group B, while the proportion of patients achieving the blood pressure target increased in group A (+6.4%), but not in group B (-1.4%). A reduction in the percentage of patients with blood pressure ≥ 140/90 mmHg was found in group A (-7.3%) but not in group B (-0.9%). Marked improvements in the proportion of patients with LDL-cholesterol at target were documented in both groups (group A: +10.5%; group B: +12.2%.) The proportion of patients treated with insulin increased in group A only (+5.8%), while the use of statins grew by 20%in both groups.The proportion of individuals treated with two or more antihypertensive drugs increased by 3.6% in group A and by 1.6% in group B. CONCLUSION: the AMD Annals approach can be considered as a case model for quality improvement activities in chronic diseases and a tool to evaluate the level of adoption/acceptance of guidelines in clinical practice. The considerable success documented was obtained without allocation of extra resources or financial incentives but simply through a physician-led effort made possible by the commitment of the specialists involved

[AMD Annals: a model of continuous monitoring and improvement of the quality of diabetes care].

OBJECTIVE: in recent years, several initiatives have been launched by the Associazione medici diabetologi (AMD) in the context of a national quality improvement program.These activities include: identification of specific indicators of quality of diabetes care, development of a software to calculate such indicators by using routine clinical data, creation of a network of diabetes clinics and analysis and publication of the results in ad hoc reports (AMD Annals). Through the best performer approach, each centre could compare its own performance not only with the theoretical targets suggested by existing guidelines, but also with the results achieved by the best centres operating within the same healthcare system.We evaluated whether the involvement of diabetes clinics into the AMD Annals initiative improved the quality of care over 4 years. DESIGN: a controlled before and after study was performed to compare data collected from 2004 to 2007 by two groups of centres: group A included centres that had been involved in the project since the first edition of AMD Annals; group B included centres only involved in the last edition. SETTING AND PARTICIPANTS: overall, 124 diabetes clinics provided data on over 100,000 type 2 diabetes patients/year seen from 2004 to 2007. MAIN OUTCOME MEASURES: process indicators included the proportion of patients with at least one measurement of HbA1c, blood pressure and lipid profile during the previous 12 months. Intermediate outcomes included percentages of patients with levels of HbA1c ≤ 7%, blood pressure ≤ 130/85 mmHg and LDL-cholesterol <100 mg/dl (favourable indicators), and the percentages of patients with levels of HbA1c ≥ 9%, blood pressure ≥ 140/90 mmHg and LDL-cholesterol ≥ 130 mg/dl (unfavourable indicators). Percentages of patients treated with insulin, two or more antihypertensive agents, and statins were also evaluated. A multilevel analysis adjusted for age, gender, diabetes duration, and clustering effect was applied to investigate the changes in the indicators between the two groups of centres during 4 years. RESULTS: lipid profile monitoring increased more in group A (+6.2% from 2004 to 2007) than in group B (+2.4%), while HbA1c and blood pressure monitoring did not change over time in both groups. As for the outcomes considered, the percentage of patients with HbA1c ≤ 7% increased by 6% in group A and by 1.3%in group B, while the proportion of patients achieving the blood pressure target increased in group A (+6.4%), but not in group B (-1.4%). A reduction in the percentage of patients with blood pressure ≥ 140/90 mmHg was found in group A (-7.3%) but not in group B (-0.9%). Marked improvements in the proportion of patients with LDL-cholesterol at target were documented in both groups (group A: +10.5%; group B: +12.2%.) The proportion of patients treated with insulin increased in group A only (+5.8%), while the use of statins grew by 20%in both groups.The proportion of individuals treated with two or more antihypertensive drugs increased by 3.6% in group A and by 1.6% in group B. CONCLUSION: the AMD Annals approach can be considered as a case model for quality improvement activities in chronic diseases and a tool to evaluate the level of adoption/acceptance of guidelines in clinical practice. The considerable success documented was obtained without allocation of extra resources or financial incentives but simply through a physician-led effort made possible by the commitment of the specialists involved