An outbreak of Streptococcus pneumoniae in an Italian nursing home

Streptococcus pneumoniae is the main cause of community-acquired pneumonia worldwide; pneumonia occurs sporadically in most cases, but rare outbreaks have been reported. We  describe an outbreak occurred in a 21-guests nursing home for elders in Aosta (Italy); outbreak occurred in april 2014 over a 2 weeks period, resulting in 12 out 20 guests affected (all with high fever and respiratory symptoms), two deaths (at home), nine patients referred  to Hospital Emergency Room, and eight admissions. Urinary streptococcus antigen was positive in seven out of eight patient tested. None of the nursing home guests were vaccinated against Streptococcus pneumoniae The Hospital Medical Direction and Public Health Service gave support and adopted strategies to contain the outbreak spread. We underline the need for pneumococcal vaccination in nursing homes/ Long-term care facilities; accurate check of hygiene behaviours in those setting is also mandatory. &nbsp

Vascular Wall Imaging of Vulnerable Atherosclerotic Carotid Plaques: Current State of the Art and Potential Future of Endovascular Optical Coherence Tomography

SUMMARY: As stroke is one of the leading causes of death and long-term morbidity worldwide, the research community has studied cardiac embolic sources, as well as vessel wall pathologies. For the latter, attention has been focused on defining morphologic tissue features associated with catastrophic events stemming from the carotid artery. Multiple noninvasive imaging modalities are currently being used to image and classify carotid atherosclerotic plaques, such as MR imaging, CT, and sonography, in an effort to provide clinically relevant predictive metrics for use in patient risk stratification and to define appropriate treatment options. This article compares and contrasts these existing clinical imaging modalities along with discussion of a new endovascular technique originally developed for cardiology, OCT, with which 3D comprehensive high-resolution images of the arterial wall can be acquired. ABBREVIATIONS: AHA ϭ American Heart Association; CE ϭ contrast-enhanced; CI ϭ confidence interval; HR ϭ hazard ratio; MDCTA ϭ multidetector row CT angiography; MRDTI ϭ MR direct thrombus imaging; OCT ϭ optical coherence tomography; TOF ϭ time-of-fligh

Real life turnaround time of blood cultures in the clinical microbiology laboratory: results of the first Italian survey, May 2015

Background and aims: Blood culture (BC) results are essential to guide antimicrobial chemotherapy for patients with sepsis. However, BC is a time-consuming exam, which can take several days. Reducing BCs turn around time (TAT) could impact on multiple outcome parameters and TAT monitoring is an important tool for measurement of microbiology laboratory performance. The aim of this study was to provide an overview of BC TATs among Italian microbiology laboratories. Materials and methods: Five laboratories collected and recorded, for a month period, date and time of the BC processing events. Cumulative TATs were analysed using the GraphPad software. Results: Participating laboratories reported data from 302 sepsis episodes. The median time from when the BC system produced a positive signal until Gram-stain results were reported was 7.6 hours. A rapid molecular identification and antimicrobial susceptibility testing (AST) was performed in 26.5% of BCs. Mean TAT for identification report was significantly lower when a molecular approach was adopted (12 vs. 28.7 hours, P<0.001). Similarly, results of the molecular AST were obtained more than 24 hours in advance compared with phenotypic AST (mean 13.2 vs. 47.6, P<0.001). TATs from BC positivity of laboratories opened 7 days/week were not significantly lower than those of laboratories opened 6 days/week. Conclusions: BC is a time-consuming exam, however, molecular identification and AST methods can drastically reduce time to results. The lack of difference between TATs observed for laboratories working 7 days/week and 6 days/week, coupled with a high rate of BCs turning positive during the night enable to conclude that the most urgent measure to reduce TATs is the expansion of laboratory regular duty hours

Contracts to Promote Optimal Use of Optional Diagnostic Tests in Cancer Treatment

In this study, we examine performance-based payment contracts to promote the optimal use of an optional diagnostic test for newly diagnosed cancer patients. Our work is inspired by three trends: tremendous increases in the cost of new, advanced cancer drugs; development of new diagnostic tests to allow physicians to tailor treatment to patients; and changes in healthcare funding models that reward quality care. We model the interaction between two parties—a healthcare payer and an oncologist, in which the oncologist has private information about patients’ characteristics (adverse selection) and the payer does not know whether the oncologist takes the optimal course of action (moral hazard). We show that, in the presence of information asymmetry, a healthcare payer should never incentivize an oncologist to use a diagnostic test for all patients, even if the diagnostic test is available for free. Moreover, although the oncologist has additional information about a patient\u27s risk, he cannot always benefit from this private information. We also find that social welfare may not increase as a result of a decrease in the oncologist\u27s concerns regarding the health outcome of patients. Finally, we show that it is not always socially optimal to make a diagnostic test compulsory even if such a policy can be implemented for free

Towards specification of a software architecture for cross-sectoral big data applications

The proliferation of Big Data applications puts pressure on improving and optimizing the handling of diverse datasets across different domains. Among several challenges, major difficulties arise in data-sensitive domains like banking, telecommunications, etc., where strict regulations make very difficult to upload and experiment with real data on external cloud resources. In addition, most Big Data research and development efforts aim to address the needs of IT experts, while Big Data analytics tools remain unavailable to non-expert users to a large extent. In this paper, we report on the work-in-progress carried out in the context of the H2020 project I-BiDaaS (Industrial-Driven Big Data as a Self-service Solution) which aims to address the above challenges. The project will design and develop a novel architecture stack that can be easily configured and adjusted to address cross-sectoral needs, helping to resolve data privacy barriers in sensitive domains, and at the same time being usable by non-experts. This paper discusses and motivates the need for Big Data as a self-service, reviews the relevant literature, and identifies gaps with respect to the challenges described above. We then present the I-BiDaaS paradigm for Big Data as a self-service, position it in the context of existing references, and report on initial work towards the conceptual specification of the I-BiDaaS software architecture.This work is supported by the IBiDaaS project, funded by the European Commission under Grant Agreement No. 780787.Peer ReviewedPostprint (author's final draft