Clinical risk in rehabilitation: an exploratory investigation in Campania Region

BACKGROUND: Clinical risk management is a comprehensive programme that encompasses all the measures implemented to improve the quality of the healthcare service and ensure patient safety, which is based on learning through error. This process is intended to bring about ongoing improvements in clinical practice, starting with risk identification, before moving on to risk assessment and analysis, in order to reduce risks where possible. When clinical risk management is applied in rehabilitation, the first step involves identifying errors by assessing adverse events, which are considered to indicate the existing risk. Our work aims to explore the characteristics of the clinical risk in rehabilitation so as to learn more about its extent, its components, and its implications for the user. METHODS: Our study involved numerous workers operating in four different branches of rehabilitation - speech therapy, physiotherapy, psychomotor education and occupational therapy - at forty-nine private rehabilitation centres in the province of Naples, an area that has not been studied before. A questionnaire was drafted regarding the main errors committed in the rehabilitation sector. It was then distributed and collected in again, after which the results were analysed and outcomes measured. Out of a total of 556 questionnaires distributed, 493 were returned (88.6% response rate.). RESULTS: The study revealed that for all the rehabilitation branches considered, the macro-category of errors linked to technical and professional aspects accounted for the highest percentage of the total errors (39%). In this study, the most frequent errors linked to technical and professional aspects were: wrong dose errors, treatment planning errors and functional assessment errors. CONCLUSIONS: There is an evident need to take action in order to manage the clinical risk in rehabilitation: to promote a concept of errors as opportunities for learning and improvement; to maintain the focus on both individual responsibility and on any systemic failings; to share fundamental values such as transparency, collaboration between workers, communication with patients, and a commitment to ongoing improvements in healthcare quality

Respiratory function in power plant workers exposed to nitrogen dioxide.

BACKGROUND: Power plant workers are potentially exposed to nitrogen dioxide (NO2) and may therefore be at higher risk of pulmonary diseases than the general population. AIMS: To assess the association of NO2 exposure with spirometric abnormalities in power plant workers. METHODS: Forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and forced expiratory ratio (FER = FEV1/FVC) were correlated with demographic characteristics, smoking history and environmental exposure to NO2 in power plant workers exposed to environmental NO2 at work and in a control group of administrative employees. Twenty-four hour environmental NO2 concentrations were measured at each workplace. RESULTS: The concentrations of environmental NO2 ranged from 1.21 to 7.82mg m(-3) with a mean value of 3.91 + 1.51mg m(-3). The results showed that FEV1 and FVC were significantly lower in 347 power plant workers than in the 349 controls (P < 0.001). The FER was significantly correlated with age, environmental NO2 concentration, smoking and height. CONCLUSIONS: Occupational exposure to NO2 emissions in power plants is significantly associated with lung function abnormalities as assessed by spirometry. Spirometric measurements in power plant workers exposed to NO2 emissions may be an effective means of detecting early signs of impaired respiratory health in this group of workers

The cognitive effects of computational thinking: A systematic review and meta-analytic study

In this paper, we review and meta-analyze the findings of experimental studies published between 2006 and 2022 that examined the effects of coding and programming interventions on children's core and higher order executive functions (response inhibition, working memory, cognitive flexibility, planning and problem solving). The systematic review and meta-analysis aimed to address three research questions: 1) Which executive functions are most impacted by the teaching of CT? 2) Which instructional modality (educational robotics/virtual coding/unplugged coding) is most effective in enhancing executive function skills in learners aged 4–16 years? and 3) Does the cognitive effectiveness of coding vary with children's age? A total of 19 studies with 1523 participants met the selection criteria for the systematic review. The meta-analysis included 11 of those studies. The results reveal beneficial effects of structured virtual and tangible coding (educational robotics) activities for preschoolers and first graders, and significant effects of more unstructured virtual coding activities (e.g., Scratch-based) for older students. A multivariate fixed-effects model meta-analysis shows that the teaching of coding significantly improves problem-solving with the highest effect (dppc2 = 0.89), but also planning (dppc2 = 0.36), and inhibition and working memory with lower effects (dppc2 = 0.17, dppc2 = 0.20)

Search of sub-parsec massive binary black holes through line diagnosis II

Massive black hole binaries at sub-parsec separations may display in their spectra anomalously small flux ratios between the MgII and CIV broad emission lines, i.e. F_MgII/F_CIV <~ 0.1, due to the erosion of the broad line region around the active, secondary black hole, by the tidal field of the primary. In Paper I by Montuori et al. (2011), we focussed on broad lines emitted by gas bound to the lighter accreting member of a binary when the binary is at the center of a hollow density region (the gap) inside a circum-binary disc. The main aim of this new study is at exploring the potential contribution to the broad line emission by the circum-binary disc and by gaseous streams flowing toward the black hole through the gap. We carry out a post-process analysis of data extracted from a SPH simulation of a circum-binary disc around a black hole binary. Our main result is that the MgII to CIV flux ratio can be reduced to ~ 0.1 within an interval of sub-pc binary separations of the order of a ~ (0.01-0.2)(f_Edd/0.1)^(1/2) pc corresponding to orbital periods of ~ (20-200) (f_Edd/0.1)^(3/4) years for a secondary BH mass in the range M_2 ~ 10^7-10^9 M_sun and a binary mass ratio of 0.3. At even closer separations this ratio returns to increase to values that are indistinguishable from the case of a single AGN (typically F_MgII/F_CIV ~ 0.3-0.4) because of the contribution to the MgII line from gas in the circum-binary disc.Comment: 7 pages, 3 figure, accepted for publication in MNRA

Environmental quality of the operating theaters in Campania Region: long lasting monitoring results

BACKGROUND: The health risk level in the operating theaters is directly correlated to the safety level offered by the healthcare facilities. This is the reason why the national Authorities released several regulations in order to monitor better environmental conditions of the operating theaters, to prevent occupational injuries and disease and to optimize working conditions. For the monitoring of environmental quality of the operating theaters following parameters are considered: quantity of supplied gases, anesthetics concentration, operating theatres volume measurement, air change rate, air conditioning system and air filtration. The objective is to minimize the risks in the operating theaters and to provide the optimal environmental working conditions. This paper reports the environmental conditions of operating rooms performed for several years in the public hospitals of the Campania Region. METHODS: Investigation of environmental conditions of 162 operating theaters in Campania Region from January 2012 till July 2014 was conducted. Monitoring and analysis of physical and chemical parameters was done. The analysis of the results has been made considering specific standards suggested by national and international regulations. RESULTS: The study showed that 75% of the operating theaters presented normal values for microclimatic monitoring, while the 25% of the operating theaters had at least one parameter outside the limits. The monitoring of the anesthetics gases showed that in 9% of measurements of nitrous oxides and 4% of measurements of halogenated was not within the normal values

Heterogeneities along the 2009 L’Aquila normal fault inferred by the b-value distribution

In this study we map the distribution of the b-value of the Gutenberg-Richter law—as well as complementary seismicity parameters—along the fault responsible for the 2009 MW 6.1 L'Aquila earthquake. We perform the calculations for two independent aftershock sub-catalogs, before and after a stable magnitude of completeness is reached. We find a substantial spatial variability of the b-values, which range from 0.6 to 1.3 over the fault plane. The comparison between the spatial distribution of the b-values and the main-shock slip pattern shows that the largest slip occurs in normal-to-high b-values portion of the fault plane, while low b-value is observed close to the main-shock nucleation. No substantial differences are found in the b-value computed before and after the main-shock struck in the small region of the fault plane populated by foreshocks

A Monte Carlo analysis of the velocity dispersion of the globular cluster Palomar 14

We present the results of a detailed analysis of the projected velocity dispersion of the globular cluster Palomar 14 performed using recent high-resolution spectroscopic data and extensive Monte Carlo simulations. The comparison between the data and a set of dynamical models (differing in fraction of binaries, degree of anisotropy, mass-to-light ratio M/L, cluster orbit and theory of gravity) shows that the observed velocity dispersion of this stellar system is well reproduced by Newtonian models with a fraction of binaries f_b<30% and a M/L compatible with the predictions of stellar evolution models. Instead, models computed with a large fraction of binaries systematically overestimate the cluster velocity dispersion. We also show that, across the parameter space sampled by our simulations, models based on the Modified Newtonian Dynamics theory can be reconciled with observations only assuming values of M/L lower than those predicted by stellar evolution models under standard assumptions.Comment: 13 pages, 13 figures, accepted for publication by Ap

Fasting Neurotensin Levels in Pediatric Celiac Disease Compared with a Control Cohort

Background and Aims. Neurotensin (NT) is a gut hormone secreted by specific endocrine cells scattered throughout the epithelial layer of the small intestine, which has been identified as an important mediator in several gastrointestinal functions and disease conditions. Its potential involvement in celiac disease (CD) has been investigated, but there are conflicting findings. The aim of this study was to evaluate serum NT levels in children with CD at diagnosis, compared to a control group, and to investigate whether NT correlated in CD patients with symptoms, antibody response, and intestinal mucosal damage. Materials and Methods. Children (1-16 years old) undergoing gastrointestinal endoscopy for CD or for other clinical reasons were included in this study. Patients with CD diagnosed according to the 2012 European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guidelines without biopsy were also recruited. Fasting serum samples were analyzed for NT levels using ELISA. Logistic regression, Wilcoxon rank sum, and Spearman's rank tests were used for statistical analysis. Results. Thirty children (18 females, 2.2-15.9 years old) were enrolled. Of 25 patients who underwent endoscopy, 9 were CD patients, 13 were controls, and 3 were excluded due to nonspecific inflammation at duodenal biopsy. CD was diagnosed in 5 patients without biopsy. NT median was higher in CD patients compared to controls (13.25 (IQR 9.4-17.5) pg/ml vs. 7.8 (IQR 7.6-10) pg/ml; p=0.02). No statistically significant association between NT and clinical, serological, or histological data of CD was observed in this CD cohort. Conclusions. To our knowledge, this is the first study that evaluates NT in CD children from Italy. Results show that NT is higher in the serum of CD children at diagnosis compared to controls. However, larger-scale studies are required to validate these findings. Whether serum NT levels can be an adjunctive marker for pediatric CD remains currently elusive

The challenge of treatment in potential celiac disease

Potential celiac disease (PCD) is defined by the presence of positive serum antibodies, HLA-DQ2/DQ8 haplotypes, and a normal small intestinal mucosa (Marsh grade 0-1). This condition occurs in one-fifth of celiac disease (CD) patients and usually represents a clinical challenge. We reviewed genetic, histologic, and clinical features of this specific condition by performing a systematic search on MEDLINE, Embase, and Scholar database. Accordingly, we identified different genetic features in patients with PCD compared to the classical forms. Frequently, signs of inflammation (deposits of immunoglobulin A (IgA) and/or increased number of intraepithelial lymphocytes) can be clearly identify in the mucosa of PCD patients after an accurate histological assessment. Finally, the main challenge is represented by the treatment: the gluten-free diet should be considered only in the presence of gluten-dependent symptoms in both children and adults. What is known: (i) potential celiac disease (PCD) occurs in one-fifth of all celiac diseases (CD), and (ii) despite the absence of classical lesions, clear signs of inflammation are often detectable. What is new: (i) patients with PCD show different genetic features, and (ii) the presence of gluten-dependent symptoms is the main determinant to initiate the gluten-free diet, after a complete diagnostic work-up

Clustering in gravitating N-body systems

We study gravitational clustering of mass points in three dimensions with random initial positions and periodic boundary conditions (no expansion) by numerical simulations. Correlation properties are well defined in the system and a sort of thermodynamic limit can be defined for the transient regime of cluste ring. Structure formation proceeds along two paths: (i) fluid-like evolution of density perturbations at large scales and (ii) shift of the granular (non fluid) properties from small to large scales. The latter mechanism finally dominates at all scales and it is responsible for the self-similar characteristics of the clustering.Comment: 7 pages, 3 figures. Accepted for publication in Europhys. Let