La continuità assistenziale nella gestione delle lesioni da pressione: un opuscolo informativo per la collaborazione ospedale-territorio

Il progetto consiste nella creazione di un opuscolo informativo, all'interno del quale sono spiegate le principali informazioni relative la gestione del paziente portatore di Lesioni da Pressione. Le nozioni espresse sono alla base del percorso terapeutico, in quando sono indirizzate a lettori non esperti nel campo delle medicazioni difficili. Viste le esigenze del pubblico di assistere a questa tipologia di pazienti, in molti casi in maniera autonoma per quanto riguarda la medicazione vera e proprio, si è ritenuto necessario fornire del materiale per aumentare le conoscenze dei caregiver informali. Lo scopo ultimo è proprio quello di fornire un metodo semplice e sicuro di apprendimento per i cittadini che si occupano della gestione del paziente e delle relative medicazioni; considerando sempre un affiancamento da parte di professionisti. Gli obiettivi che ci si pone con il progetto sono: valutare e visualizzare quelli che sono gli aspetti importanti per i soggetti aventi Lesioni da Pressione, questo comprende la definizione, prevenzione, classificazione e trattamento; l'importanza della continuità assistenziale per questa tipologia di paziente; informare il cittadino su cosa sono le lesioni da pressione (quali sono le accortezze quotidiane da dover attuare per evitare il peggioramento o lo stallo della condizione) ed infine il trattamento vero e proprio tramite l'insegnamento delle medicazioni difficili e della loro applicazione in base ai diversi casi (essendo un argomento vasto e materia di specializzazione in ambito infermieristico si tratterà in maniera semplificata in modo da dare informazioni basilari ma utili). Per la creazione dell'opuscolo è stata effettuata una revisione della letteratura che vede la consultazione di due linee guida, undici articoli e due testi

Site characterization of station IV.LAV9 (LANUVIO) of Italian National Seismic Network

Final report illustrating array measurements performed at IV.LAV9 station of the Italian national seismic network. This report is part of the Project: DPC-INGV 2016 agreement All. B2 Task B: Seismic characterization of accelerometric sites

Partial response to first generation SSA guides the choice and predict the outcome of second line therapy in acromegaly

Treatment of acromegaly resistant to first generation somatostatin analogues (first gen-SSA) is often difficult. We aimed to investigate the role of partial response and resistance to first gen-SSA in the choice of second line treatments and their outcomes

Local site effects estimation at Amatrice (Central Italy) through seismological methods

We present the results of seismological and geophysical investigations performed by the “Istituto Nazionale di Geofisica e Vulcanologia” team operating in Amatrice village (Central Italy), in the emergency phases following the Mw 6.0 event of August 24th 2016, that caused severe damage in downtown and surrounding areas. Data from seven seismic stations equipped with both weak and strong motion sensors are analyzed in terms of standard spectral ratio to empirically define amplification function using a bedrock reference site. Ambient vibration spectral ratios between horizontal and vertical component of motion are also evaluated in a large number of sites, spread out in the investigated area, to recover the resonance frequency of the soft soil outcropping layers and to generalize the results obtained by earthquake data. Ambient noise vibration are also used for applying a 2D array approach based on surface waves techniques in order to define the near-surface velocity model and to verify its lateral variation. The results allows to better understand the amplification factors in the investigated area, showing spatial variation of site effects despite of the homogeneous shallow geological condition indicated by the microzonation studies available at moment of the described field campaign. The analysis reveals a diffuse amplification effect which reaches its maximum values in downtown area with a resonant frequency of about 2 Hz. The obtained results were used to integrate the microzonation studies and they can be used for urban planning and reconstruction activities.Published5713–57394T. Sismicità dell'ItaliaJCR Journa

Results from shallow geophysical investigations in the northwestern sector of the island of Malta

We performed geophysical investigations in the northwestern sector of the island of Malta to reconstruct velocity-depth models and provide shear-wave velocity profiles. We have chosen two sites, one located in Rabat (Malta) and another in the Golden Bay area. We used both active (seismic and electrical 2D-tomography, Multichanel Analysis of Surface Waves – MASW) and passive (2D arrays and single-station measurements using ambient noise) geophysical methods. Consistently with previous studies performed in this part of Malta, we have found that both sites are characterised by site resonance in the frequency range 1-2 Hz as an effect of the local lithostratigraphic succession that shows an impedance contrast at about 60-90 m depth. This resonance effect can have important implications on both seismic hazard as well as seismic risk evaluation of the region since the amplified frequency range coincides with the resonance frequencies typical of 5–10 storey buildings which are very diffuse in the Maltese Islands, especially after intense recent urbanization.Published41-484T. Sismologia, geofisica e geologia per l'ingegneria sismicaJCR Journa

Monitoring Risk Factors and Improving Adherence to Therapy in Patients With Chronic Kidney Disease (Smit-CKD Project): Pilot Observational Study

Background: Chronic kidney disease is a major public health issue, with about 13% of the general adult population and 30% of the elderly affected. Patients in the last stage of this disease have an almost uniquely high risk of death and cardiovascular events, with reduced adherence to therapy representing an additional risk factor for cardiovascular morbidity and mortality. Considering the increased penetration of mobile phones, a mobile app could educate patients to autonomously monitor cardiorenal risk factors. Objective: With this background in mind, we developed an integrated system of a server and app with the aim of improving self-monitoring of cardiovascular and renal risk factors and adherence to therapy. Methods: The software infrastructure for both the Smit-CKD server and Smit-CKD app was developed using standard web-oriented development methodologies preferring open source tools when available. To make the Smit-CKD app suitable for Android and iOS, platforms that allow the development of a multiplatform app starting from a single source code were used. The integrated system was field tested with the help of 22 participants. User satisfaction and adherence to therapy were measured by questionnaires specifically designed for this study; regular use of the app was measured using the daily reports available on the platform. Results: The Smit-CKD app allows the monitoring of cardiorenal risk factors, such as blood pressure, weight, and blood glucose. Collected data are transmitted in real time to the referring general practitioner. In addition, special reminders improve adherence to the medication regimen. Via the Smit-CKD server, general practitioners can monitor the clinical status of their patients and their adherence to therapy. During the test phase, 73% (16/22) of subjects entered all the required data regularly and sent feedback on drug intake. After 6 months of use, the percentage of regular intake of medications rose from 64% (14/22) to 82% (18/22). Analysis of the evaluation questionnaires showed that both the app and server components were well accepted by the users. Conclusions: Our study demonstrated that a simple mobile app, created to self-monitor modifiable cardiorenal risk factors and adherence to therapy, is well tolerated by patients affected by chronic kidney disease. Further studies are required to clarify if the use of this integrated system will have long-term effects on therapy adherence and if self-monitoring of risk factors will improve clinical outcomes in this population

Site effects estimation and their effects on strong ground motion at Amatrice village (Central Italy)

We present a summary of seismological and geophysical investigations at Amatrice (Central Italy), a village seated on an alluvial terrace and severely stroke by the Mw 6.0 event of August 24th 2016. The high vulnerability alone could not explain the heavy damage (X-XI MCS), whereas the vicinity of the seismic source and the peculiar site effects should be claimed to understand the ground motion variability. After the first mainshock, we investigated the Amatrice terrace for microzonation purposes together with several Italian institutions (Priolo et al., Bull. Earthquake Eng. 2019). In particular: (i) we installed 7 seismic stations as a part of the 3A network (DOI: 10.13127/SD/ku7Xm12Yy9; Cara et al., Sci. Data 2019); we performed (ii) an extensive campaign of 60 single-station ambient noise measurements (downtown stations recorded also few earthquakes), and (iii) several 2D passive seismic arrays aimed at obtaining Vs profiles down to a depth of few tens of meters (Milana et al., Bull. Earthquake Eng. 2019). Earthquake recordings were used to empirically evaluate ground motion amplification effects through spectral ratio approaches, and noise data were collected for defining the spatial distribution of the resonance frequencies. Data analysis reveals a diffuse amplification effect that reaches its maximum values in downtown area with a resonant frequency (f0) of about 2 Hz. Seismic amplification is also characterized by spatial variation and directional amplification, mainly in downtown to the west side of the alluvial terrace, and related to both stratigraphic and topographic effects. This effect tends to decrease and almost vanishes in the central part of the terrace, and it increases again moving towards its eastern edge with a clear shift of f0 towards higher frequencies. Empirical transfer functions were then used to recover the ground motion that could have hit the historical center of Amatrice during the August 24th mainshock, through the convolution with the only record in the vicinity (IT.AMT station experienced a PGA of 0.87 g). The reconstructed peak values are much greater than expected from ground motion models, showing that detailed studies on local site response can largely modify the seismic hazard assessment.PublishedSan Francisco, California (USA)4T. Sismicità dell'Italia5T. Sismologia, geofisica e geologia per l'ingegneria sismic

Sub-surface characterization of the Anphiteatrum Flavium Area (Rome, Italy) through single-station ambient vibration measurements

The Amphiteatrum Flavium in Rome (Italy) is one of the most known monument in the world. With the aim of understand the seismic response of the area where the Amphiteatrum Flavium is build and investigate possible soil-structure interactions, we performed a seismic experiment in 2014, based on ambient vibration (AMV) recordings. The measurements were performed at the original ground level, on the foundation and at different floors of the monument. Data were analyzed in terms of standard Fourier analysis (FAS) and horizontal-to-vertical spectral ratio technique (H/V). Moreover, we performed an active P-wave seismic tomography analysis of the foundation materials to better understand their influence on the recorded signals. Our results point out that there is a strong temporal and spatial stability of the H/V curves, suggesting a uniform seismic response at the monument site. Conversely, spectral amplitudes of AMV show relevant temporal and spatial variability at the investigated site, due to the daily variations of AMV levels and to the low-pass filtering effect of the stiff Amphiteatrum Flavium foundation that strongly attenuates the signals for frequencies above 4 Hz, i.e. those mostly originated by traffic vibrations. Moreover, we observe that the main vibration frequencies of the super-structure are not present as energetic peaks in the spectra of the ground-motion recorded at its base

Site effect studies following the 2016 Mw 6.0 Amatrice Earthquake (Italy): the Emersito Task Force activities

On August 24, 2016, at 01:36 UTC a MW 6.0 earthquake struck an extensive area of the Central Apennines (Italy) be-tween the towns of Norcia and Amatrice. Due to the mainshock magnitude and the widespread damaging level of build-ings in the epicentral area, the Emersito task force has been mobilized by the Istituto Nazionale di Geofisica e Vulcanologia (INGV). The aim of Emersito is to carry out and coordinate the monitoring of local site effects, caused by geological and geomorphological settings. During the first days of the seismic emergency, Emersito installed a tempo-rary seismic network for site effect studies at 4 municipalities close to the epicentral area (Amandola, Civitella del Tronto, Montereale and Capitignano), using 22 stations equipped with both velocimetric and accelerometric sensors. The selection of the sites where stations have been installed was mainly driven by the proximity to the epicentral area (without interfere with the rescue operations) and by peculiar geologic and geomorphologic settings (topographic irregu-larities, fault zones, alluvial plains). Preliminary analyses performed on ambient noise and aftershocks signals show that directional amplification effects may have occurred at stations installed on the top of topographic irregularities. We also observed the lengthening and amplification of the seismograms and a variability of the peaked frequency across the sedi-mentary basin between Montereale and Capitignano, probably related to a different thickness of the deposits. Further analyses are necessary to assess the correlation with surface geology.Published4T. Sismologia, geofisica e geologia per l'ingegneria sismica1SR. TERREMOTI - Servizi e ricerca per la Società1IT. Reti di monitoraggioJCR Journa

Current worldwide nuclear cardiology practices and radiation exposure: results from the 65 country IAEA Nuclear Cardiology Protocols Cross-Sectional Study (INCAPS)

Aims To characterize patient radiation doses from nuclear myocardial perfusion imaging (MPI) and the use of radiation-optimizing ‘best practices' worldwide, and to evaluate the relationship between laboratory use of best practices and patient radiation dose. Methods and results We conducted an observational cross-sectional study of protocols used for all 7911 MPI studies performed in 308 nuclear cardiology laboratories in 65 countries for a single week in March-April 2013. Eight ‘best practices' relating to radiation exposure were identified a priori by an expert committee, and a radiation-related quality index (QI) devised indicating the number of best practices used by a laboratory. Patient radiation effective dose (ED) ranged between 0.8 and 35.6 mSv (median 10.0 mSv). Average laboratory ED ranged from 2.2 to 24.4 mSv (median 10.4 mSv); only 91 (30%) laboratories achieved the median ED ≤ 9 mSv recommended by guidelines. Laboratory QIs ranged from 2 to 8 (median 5). Both ED and QI differed significantly between laboratories, countries, and world regions. The lowest median ED (8.0 mSv), in Europe, coincided with high best-practice adherence (mean laboratory QI 6.2). The highest doses (median 12.1 mSv) and low QI (4.9) occurred in Latin America. In hierarchical regression modelling, patients undergoing MPI at laboratories following more ‘best practices' had lower EDs. Conclusion Marked worldwide variation exists in radiation safety practices pertaining to MPI, with targeted EDs currently achieved in a minority of laboratories. The significant relationship between best-practice implementation and lower doses indicates numerous opportunities to reduce radiation exposure from MPI globall