Emergency Department as an epidemiological observatory of Human Mobility: the experience of the Moroccan population

We conducted a retrospective study of the accesses to the Emergency Department registered from January 2000 to December 2014 in 5 major hospitals in the Metropolitan Area of Rome. We extrapolated data relating to patients of Moroccan origin from about 5 million total accesses, so we compared with Italians data which, in the same period, came to ED. The Moroccan population is distinguished by a larger number of diagnoses belonging to the ICD-9 code of Infectious Diseases and, more precisely, to Respiratory Infectious Diseases. There are also no differences in the assignment of such diagnoses to Moroccans with Italian citizenship, and this led to think that this could play an important role in the use of the ED and moreover that enrollment to the National Health Service may reduce its inappropriate use. Regarding to Degenerative Disorders, the result of our analysis is quite emblematic, showing that the accesses to the ED is due to Cardiovascular Diseases: 6.33% of Italians' accesses against 1.81% of Moroccans and 2.36% of Moroccans with Italian citizenship. The main explanation for this difference is, obviously, due to the age of the population: about 60% of Moroccans who accessed to ED was less than 40 years old. It is interesting how, in the field of ​​Cardiovascular Diseases, Moroccans have a lower percentage of diagnosis compared to Italians for acute diseases and a greater percentage of diagnoses for chronic diseases, suggesting once again that accesses to ED for migrants often is due to the inability to use the general services of the National Health Service. In conclusion, from the point of view of the Emergency Department, Migration Medicine still has Infectious Diseases as the main reason for access. Degenerative Disorders remain a prerogative of the Italians, but we could certainly assume that the Moroccan population would develop at some point with the aging

Solar neutrino variability and its implications for solar physics and neutrino physics

Recent coordinated power-spectrum analyses of radiochemical solar neutrino data and the solar irradiance have revealed a highly significant, high-Q common modulation at 11.85 yr-1. Since the stability of this frequency points to an explanation in terms of rotation, this result may be attributable to non-spherically-symmetric nuclear burning in a solar core with sidereal rotation frequency 12.85 yr-1. The variability of the amplitude (on a timescale of years) suggests that the relevant nuclear burning is variable as well as asymmetric. Recent analysis of Super-Kamiokande solar neutrino data has revealed r-mode-type modulations with frequencies corresponding to a region with sidereal rotation frequency 13.97 yr-1. If this modulation is attributed to the RSFP (Resonant Spin Flavor Precession) process, it provides a measurement of the rotation rate deep in the radiative zone. These two results suggest that the core rotates significantly more slowly than the radiative zone. If one accepts an upper limit of 7 MG for the Sun's internal magnetic field, an RSFP interpretation of the Super-Kamiokande results leads to a lower limit of 10-12 Bohr magnetons for the neutrino transition magnetic moment.Comment: 12 pages, 3 figure

Low energy high angular resolution neutral atom detection by means of micro-shuttering techniques: the BepiColombo SERENA/ELENA sensor

The neutral sensor ELENA (Emitted Low-Energy Neutral Atoms) for the ESA cornerstone BepiColombo mission to Mercury (in the SERENA instrument package) is a new kind of low energetic neutral atoms instrument, mostly devoted to sputtering emission from planetary surfaces, from E ~20 eV up to E~5 keV, within 1-D (2x76 deg). ELENA is a Time-of-Flight (TOF) system, based on oscillating shutter (operated at frequencies up to a 100 kHz) and mechanical gratings: the incoming neutral particles directly impinge upon the entrance with a definite timing (START) and arrive to a STOP detector after a flight path. After a brief dissertation on the achievable scientific objectives, this paper describes the instrument, with the new design techniques approached for the neutral particles identification and the nano-techniques used for designing and manufacturing the nano-structure shuttering core of the ELENA sensor. The expected count-rates, based on the Hermean environment features, are shortly presented and discussed. Such design technologies could be fruitfully exported to different applications for planetary exploration.Comment: 11 page

Chapter 16 - Cross-cutting investment and finance issues

This is the first time an assessment report by the Intergovernmental Panel on Climate Change (IPCC) contains a chapter dedicated to investment and finance to address climate change. This reflects the growing awareness of the relevance of these issues for the design of efficient and effective climate policies

Development of Disposables and Accessories for ROSES and Their In Vitro Experimentation

This paper describes the development of the disposables and accessories for ROSES (Robotic System for Endovascular Surgery). Initially developed exclusively for transcatheter percutaneous coronary angioplasty, it was later modified, initially leaving the components for angioplasty substantially unchanged to extend its use to endovascular transcatheter surgery. These disposables are used to translate gear rotations into catheter or guide wire advancement or retraction and rotation of their body through friction wheels. The use of a new cart was necessary for endovascular surgery, to which a system to measure forces opposed by the patient’s body to catheter advancement was added. Moreover, since some endovascular catheters present with large diameters, minor mechanical modifications were also performed on the robot actuator (RA), previously defined as a slave, in order to allow large catheters to be pushed, such as those needed for the repair of some big aneurysms or for TAVI. However, in doing this, the possibility of separating the disposables into two components, upper and lower, was found, which allows the extraction of the disposable without having to remove the catheter or guide wire already positioned. Finally, the disposables, whose development is illustrated here, were subjected to various versions and tests and the results are reported

Antipsychotics and Torsadogenic Risk: Signals Emerging from the US FDA Adverse Event Reporting System Database

Background: Drug-induced torsades de pointes (TdP) and related clinical entities represent a current regulatory and clinical burden. Objective: As part of the FP7 ARITMO (Arrhythmogenic Potential of Drugs) project, we explored the publicly available US FDA Adverse Event Reporting System (FAERS) database to detect signals of torsadogenicity for antipsychotics (APs). Methods: Four groups of events in decreasing order of drug-attributable risk were identified: (1) TdP, (2) QT-interval abnormalities, (3) ventricular fibrillation/tachycardia, and (4) sudden cardiac death. The reporting odds ratio (ROR) with 95 % confidence interval (CI) was calculated through a cumulative analysis from group 1 to 4. For groups 1+2, ROR was adjusted for age, gender, and concomitant drugs (e.g., antiarrhythmics) and stratified for AZCERT drugs, lists I and II (http://www.azcert.org, as of June 2011). A potential signal of torsadogenicity was defined if a drug met all the following criteria: (a) four or more cases in group 1+2; (b) significant ROR in group 1+2 that persists through the cumulative approach; (c) significant adjusted ROR for group 1+2 in the stratum without AZCERT drugs; (d) not included in AZCERT lists (as of June 2011). Results: Over the 7-year period, 37 APs were reported in 4,794 cases of arrhythmia: 140 (group 1), 883 (group 2), 1,651 (group 3), and 2,120 (group 4). Based on our criteria, the following potential signals of torsadogenicity were found: amisulpride (25 cases; adjusted ROR in the stratum without AZCERT drugs = 43.94, 95 % CI 22.82-84.60), cyamemazine (11; 15.48, 6.87-34.91), and olanzapine (189; 7.74, 6.45-9.30). Conclusions: This pharmacovigilance analysis on the FAERS found 3 potential signals of torsadogenicity for drugs previously unknown for this risk

Ground-based and satellite observations of high-latitude auroral activity in the dusk sector of the auroral oval

On 7 December 2000, during 13:30-15:30 UT the MIRACLE all-sky camera at Ny Alesund observed auroras at high-latitudes (MLAT similar to 76) simultaneously when the Cluster spacecraft were skimming the magnetopause in the same MLT sector (at similar to 16:00-18:00 MLT). The location of the auroras (near the ionospheric convection reversal boundary) and the clear correlation between their dynamics and IMF variations suggests their close relationship with R1 currents. Consequently, we can assume that the Cluster spacecraft were making observations in the magnetospheric region associated with the auroras, although exact magnetic conjugacy between the ground-based and satellite observations did not exist. The solar wind variations appeared to control both the behaviour of the auroras and the magnetopause dynamics. Auroral structures were observed at Ny Alesund especially during periods of negative IMF B-Z. In addition, the Cluster spacecraft experienced periodic (T similar to 4 - 6 min) encounters between magnetospheric and magnetosheath plasmas. These undulations of the boundary can be interpreted as a consequence of tailward propagating magnetopause surface waves. Simultaneous dusk sector ground-based observations show weak, but discernible magnetic pulsations (Pc 5) and occasionally periodic variations (T - 2 - 3 min) in the high-latitude auroras. In the dusk sector, Pc 5 activity was stronger and had characteristics that were consistent with a field line resonance type of activity. When IMF BZ stayed positive for a longer period, the auroras were dimmer and the spacecraft stayed at the outer edge of the magnetopause where they observed electromagnetic pulsations with T similar to 1 min. We find these observations interesting especially from the viewpoint of previously presented studies relating poleward-moving high-latitude auroras with pulsation activity and MHD waves propagating at the magnetospheric boundary layers

Outcome Predictors of Pediatric Extracorporeal Cardiopulmonary Resuscitation

Extracorporeal cardiopulmonary resuscitation (ECPR) allows clinicians to potentially rescue pediatric patients unresponsive to traditional cardiopulmonary resuscitation (CPR). Clinical and laboratory variables predictive of survival to hospital discharge are beginning to emerge. In this retrospective, historical cohort case series, clinical, and laboratory data from 31 pediatric patients (<21 years of age) receiving ECPR from March 2000 to April 2006 at our university-affiliated, tertiary-care children’s hospital were statistically analyzed in an attempt to identify variables predictive of survival to hospital discharge. Seven patients survived to hospital discharge (23%), and 24 patients died. Survival was independent of gender, age, and CPR duration. ECPR survival was, however, associated with a lower pre-ECPR phosphorus concentration (P = 0.002) and a lower pre-ECPR creatinine concentration (P = 0.05). A classification tree analysis, using, in part, a pre-ECPR phosphorus concentration threshold and a CPR ABG base excess concentration threshold, yielded a 96% nominal accuracy of predicting survival to hospital discharge or death. A large, multicenter, prospective cohort study aimed at validating these predictive variables is needed to guide appropriate ECPR patient selection. This study reveals the potential survival benefit of ECPR for pediatric patients, regardless of CPR duration prior to ECPR cannulation