Improving IBD diagnosis and monitoring by understanding preanalytical, analytical and biological fecal calprotectin variability

BACKGROUND: The appropriate clinical use of fecal calprotectin (fCal) might be compromised by incomplete harmonization between assays and within- and between-subjects variability. Our aim was to investigate the analytical and biological variability of fCal in order to provide tools for interpreting fCal in the clinical setting. METHODS: Experiments were conducted to investigate the effects of temperature and storage time on fCal. Thirty-nine controls were enrolled to verify biological variability, and a case-control study was conducted on 134 controls and 110 IBD patients to compare the clinical effectiveness of three different fCal assays: ELISA, CLIA and turbidimetry. RESULTS: A 12% decline in fCal levels was observed within 24 h following stool collection irrespective of storage temperature. Samples were unstable following a longer storage time interval at room temperature. Within- and between-subjects fCal biological variability, at 31% and 72% respectively, resulted in a reference change value (RCV) in the region of 100%. fCal sensitivity in distinguishing between controls and IBD patients is satisfactory (68%), and the specificity high (93%) among young (<65 years), but not among older ( 6565 years) subjects (ROC area: 0.584; 95% CI: 0.399-0.769). Among the young, assays have different optimal thresholds (120 \u3bcg/g for ELISA, 50 \u3bcg/g for CLIA and 100 \u3bcg/g for turbidimetry). CONCLUSIONS: We recommend a standardized preanalytical protocol for fCal, avoiding storage at room temperature for more than 24 h. Different cutoffs are recommended for different fCal assays. In monitoring, the difference between two consecutive measurements appears clinically significant when higher than 100%, the fCal biological variability-derived RCV

"You have to get wet to learn how to swim" applied to bridging the gap between research into personnel scheduling and its implementation in practice

Personnel scheduling problems have attracted research interests for several decades. They have been considerably changed over time, accommodating a variety of constraints related to legal and organisation requirements, part-time staff, flexible hours of staff, staff preferences, etc. This led to a myriad of approaches developed for solving personnel scheduling problems including optimisation, meta-heuristics, artificial intelligence, decision-support, and also hybrids of these approaches. However, this still does not imply that this research has a large impact on practice and that state-of-the art models and algorithms are widely in use in organisations. One can find a reasonably large number of software packages that aim to assist in personnel scheduling. A classification of this software based on its purpose will be proposed, accompanied with a discussion about the level of support that this software offers to schedulers. A general conclusion is that the available software, with some exceptions, does not benefit from the wealth of developed models and methods. The remaining of the paper will provide insights into some characteristics of real-world scheduling problems that, in the author’s opinion, have not been given a due attention in the personnel scheduling research community yet and which could contribute to the enhancement of the implementation of research results in practice. Concluding remarks are that in order to bridge the gap that still exists between research into personnel scheduling and practice, we need to engage more with schedulers in practice and also with software developers; one may say we need to get wet if we want to learn how to swim

Eazidi women's practices of empowerment and capital formation following enslavement by ISIS

This chapter begins by surveying the historical context of rape in Iraq through the narrative of Eazidi women who escaped enslavement by ISIS. It then discusses the theology of rape in Islam, which has motivated ISIS to commit rape and legitimized the rape of Eazidi women. The chapter then theorizes the social capital of Middle Eastern women. The chapter argues that, for the first time, the Eazidi community in Iraq is altering the social consequences of rape by developing empowerment methods that amount to a social revolution within the Eazidi community. This empowerment not only protects Eazidi women survivors from experiencing common post-rape consequences but also increases their capital, in all its Bourdieusian forms

Use of eHealth platforms and apps to support monitoring and management of home-quarantined patients with COVID-19 in the province of Trento, Italy: app development and implementation

Background: Italy was the first country to largely experience the COVID-19 epidemic among other Western countries during the so-called first wave of the COVID-19 pandemic. Proper management of an increasing number of home-quarantined individuals created a significant challenge for health care authorities and professionals. This was especially true when considering the importance of remote surveillance to detect signs of disease progression and consequently regulate access to hospitals and intensive care units on a priority basis. Objective: In this paper, we report on an initiative promoted to cope with the first wave of the COVID-19 epidemic in the Spring/Summer of 2020, in the Autonomous Province of Trento, Italy. A purposefully built app named TreCovid19 was designed to provide dedicated health care staff with a ready-to-use tool for remotely monitoring patients with progressive symptoms of COVID-19, who were home-quarantined during the first wave of the epidemic, and to focus on those patients who, based on their self-reported clinical data, required a quick response from health care professionals. Methods: TreCovid19 was rapidly developed to facilitate the monitoring of a selected number of home-quarantined patients with COVID-19 during the very first epidemic wave. The app was built on top of an existing eHealth platform, already in use by the local health authority to provide home care, with the following functionalities: (1) to securely collect and link demographic and clinical information related to the patients and (2) to provide a two-way communication between a multidisciplinary health care team and home-quarantined patients. The system supported patients to self-assess their condition and update the multidisciplinary team on their health status. The system was used between March and June 2020 in the province of Trento. Results: A dedicated multidisciplinary group of health care professionals adopted the platform over a period of approximately 3 months (from March-end to June 2020) to monitor a total of 170 patients with confirmed COVID-19 during home quarantine. All patients used the system until the end of the initiative. The TreCovid19 system has provided useful insights of possible viability and impact of a technological–organizational asset to manage a potentially critical workload for the health care staff involved in the periodic monitoring of a relevant number of quarantined patients, notwithstanding its limitations given the rapid implementation of the whole initiative. Conclusions: The technological and organizational model adopted in response to the COVID-19 pandemic was developed and finalized in a relatively short period during the initial few weeks of the epidemic. The system successfully supported the health care staff involved in the periodic monitoring of an increasing number of home-quarantined patients and provided valuable data in terms of disease surveillance

Vitamin D prevents pancreatic cancer-induced apoptosis signaling of inflammatory cells

Combined approaches based on immunotherapy and drugs supporting immune effector cell function might increase treatment options for pancreatic ductal adenocarcinoma (PDAC), vitamin D being a suitable drug candidate. In this study, we evaluated whether treatment with the vitamin D analogue, calcipotriol, counterbalances PDAC induced and SMAD4-associated intracellular calcium [Ca2+]i alterations, cytokines release, immune effector function, and the intracellular signaling of peripheral blood mononuclear cells (PBMCs). Calcipotriol counteracted the [Ca2+]i depletion of PBMCs induced by SMAD4-expressing PDAC cells, which conditioned media augmented the number of calcium flows while reducing whole [Ca2+]i. While calcipotriol inhibited spontaneous and PDAC-induced tumor necrosis factor alpha (TNF-\u3b1) release by PBMC and reduced intracellular transforming growth factor beta (TGF-\u3b2), it did not counteract the lymphocytes proliferation induced in allogenic co-culture by PDAC-conditioned PBMCs. Calcipotriol mainly antagonized PDAC-induced apoptosis and partially restored PDAC-inhibited NF-\u3baB signaling pathway. In conclusion, alterations induced by PDAC cells in the [Ca2+]i of immune cells can be partially reverted by calcipotriol treatment, which promotes inflammation and antagonizes PBMCs apoptosis. These effects, together with the dampening of intracellular TGF-\u3b2, might result in an overall anti-tumor effect, thus supporting the administration of vitamin D in PDAC patients