High concordance between trained nurses and gastroenterologists in evaluating recordings of small bowel video capsule endoscopy (VCE)

Background & Aims: The video capsule endoscopy (VCE) is an accurate and validated tool to investigate the entire small bowel mucosa, but VCE recordings interpretation by the gastroenterologist is time-consuming. A pre-reading of VCE recordings by an expert nurse could be accurate and cost saving. We assessed the concordance between nurses and gastroenterologists in detecting lesions on VCE examinations. Methods: This was a prospective study enrolling consecutive patients who had undergone VCE in clinical practice. Two trained nurses and two expert gastroenterologists participated in the study. At VCE pre-reading the nurses selected any abnormalities, saved them as “thumbnails” and classified the detected lesions as a vascular abnormality, ulcerative lesion, polyp, tumor mass, and unclassified lesion. Then, the gastroenterologist evaluated and interpreted the selected lesions and, successively, reviewed the entire video for potential missed lesions. The time for VCE evaluation was recorded. Results: A total of 95 VCE procedures performed on consecutive patients (M/F: 47/48; mean age: 63 ± 12 years, range: 27−86 years) were evaluated. Overall, the nurses detected at least one lesion in 54 (56.8%) patients. There was total agreement between nurses and gastroenterologists, no missing lesions being discovered at a second look of the entire VCE recording by the physician. The pre-reading procedure by nurse allowed a time reduction of medical evaluation from 49 (33-69) to 10 (8-16) minutes (difference:-79.6%). Conclusions: Our data suggest that trained nurses can accurately identify and select relevant lesions in thumbnails that subsequently were faster reviewed by the gastroenterologist for a final diagnosis. This could significantly reduce the cost of VCE procedure

A minimum-time obstacle-avoidance path planning algorithm for unmanned aerial vehicles

In this article, we present a new strategy to determine an unmanned aerial vehicle trajectory that minimizes its flight time in presence of avoidance areas and obstacles. The method combines classical results from optimal control theory, i.e. the Euler-Lagrange Theorem and the Pontryagin Minimum Principle, with a continuation technique that dynamically adapts the solution curve to the presence of obstacles. We initially consider the two-dimensional path planning problem and then move to the three-dimensional one, and include numerical illustrations for both cases to show the efficiency of our approach

Prognostic Evaluation of Vimentin Expression in Correlation with Ki67 and CD44 in Surgically Resected Pancreatic Ductal Adenocarcinoma

Purpose: Radical surgical resection with adjuvant chemotherapy or chemo-radiotherapy is the most effective treatment for pancreatic ductal adenocarcinoma (PDAC). However, relatively few studies investigate the prognostic significance of biological markers in PDAC. This study aims to look into the expressions of vimentin, Ki67, and CD44 in PDAC surgical specimens and their potential prognostic implications in survival. / Method: The study was designed as retrospective, and vimentin, Ki67, and CD44 expressions were evaluated by immunohistochemistry in 53 pancreatic ductal adenocarcinoma cases. Overall survival was assessed by the Kaplan–Meier method. / Results: Patients’ median age was 68 years. The median survival was 18 months. The tumors were T3-4 in 40/53 (75.5%), and metastases in lymph nodes were found in 42 out of 53 (79.2%) cases. On multivariate analysis, the size of primary tumor (p < 0 001), the surgical resection margin status (p = 0 042), and vimentin expression (p = 0 011) were independently correlated with overall survival. / Conclusions: Long-term survival after resection of PDAC is still about 15%. Vimentin expression is a potential independent adverse prognostic molecular marker and should be included in histopathological reports. Also, CD44 expression correlates with high Ki67, vimentin positivity, and N stage and may represent a potential target of novel therapeutic modalities in pancreatic adenocarcinoma patients

Gli interventi educativi per i pazienti con scompenso cardiaco: una sintesi della letteratura

Patient education is recognized as a central component of heart failure care and reduces hospital readmissions. Nurses have an important role in providing patient education and modifying self-care behaviors. The aim of this article is to examine characteristics of educational interventions for heart failure patients, their measured outcomes and the role of nurses in providing education. We conducted a literature review of the last 10 years and considered 30 articles. Multisession motivational interventions, repeated over time and with different follow-up interventions seem to produce the best results. However, some aspects remain controversial

Monitoring of masonry historical constructions: 10 years of static monitoring of the world's largest oval dome

This paper presents the analyses conducted on the data acquired by the monitoring system of the “Regina Montis Regalis” Basilica of Vicoforte (Italy) in the decade 2004–2014. The Basilica is a building of great historical, architectural, and structural significance, owing its fame to its impressive masonry oval dome, the world's largest of this shape (internal axes of 37.23 by 24.89 m). The dome-drum system of the Basilica has suffered over the years of significant structural problems, partly due to the settlements of the building induced progressively by newly built masses and also to the sliding of the underground. In 1983, concerns over the severe settlements and cracking phenomena affecting the structure prompted the decision to undertake strengthening interventions. A special hooping system, consisting of 56 tie bars, placed around the oval perimeter of the dome, was thus conceived to limit the crack opening. The monitoring system of the Basilica installed in the early 1980s underwent several renovations, and in 2004, its acquisition procedure was automatized. One hundred twelve instruments, consisting of temperature sensors, crackmeters, load cells, pressure cells, wire gauges, hygrometer, piezometers, and hydrometer, are currently installed on the Basilica. This study is primarily focused on data acquired by the crackmeters, the extensometers along the main axes of dome, and the load cells placed at the ends of the tie bars. The main aim of the reported analysis is to evaluate the possible progression of the cracks on the Basilica, and the structural performance of the strengthening interventions put in place in 1985–1987

Linguistic diversity, multilingualism, and cognitive skills: A study of disadvantaged children in India

Multilingualism and linguistic diversity are the norm in India. Although studies have shown a relation between bilingualism and cognitive gains, linguistic diversity has so far been ignored as a potential factor affecting cognitive skills. This study aims to fill this gap by examining how cognitive skills—as measured by the n-back and Raven’s Colored Progressive Matrices tasks—are affected by multilingualism and/or sociolinguistic diversity in a large cohort of socioeconomically disadvantaged primary school children in two urban sites of India: Delhi and Hyderabad. We present a questionnaire estimating sociolinguistic diversity and show that this measure assesses a distinct construct, as compared to a child’s multilingualism. Children were classified as growing up monolingually or bilingually, depending on whether they grew up with one or more languages in the home. Regarding cognitive performance, bilinguals were found to outperform monolinguals on the n-back task, as well as on the Raven’s task. In addition, a socially and linguistically diverse environment seems to enhance cognitive performance for children who are not multilingual themselves. Finally, several contextual factors such as city were found to influence cognitive performance. Overall, this shows that cognitive tasks are subject to contextual effects and that bilingualism and linguistic diversity can enhance cognitive performance of children in disadvantaged contexts.</jats:p