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

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

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

Left Ventricular-Arterial Coupling and Vascular Function in Childhood Cancer Survivors Exposed to Anthracycline Chemotherapy

Background: Cardiovascular (CV) diseases are a cause of increased long-term morbidity and mortality in childhood cancer survivors (CCSs) treated with anthracyclines. These drugs may affect not only the heart, but also the vascular system. Left ventricular-arterial coupling (LVAC) represents a reliable parameter of altered ventricular and vascular performance, with validated prognostic value and never investigated in this setting. Aim of this study was to assess, in CCSs and matched controls, LVAC changes, performed with different echocardiographic modalities, and their relationship with endothelial function. Methods: Twenty survivors treated with anthracyclines for childhood malignancies and a matched control group of 20 healthy subjects were enrolled. Arterial elastance (Ea), end-systolic elastance (Ees), Ea/Ees ratio, as well as three-dimensional (3D) LVAC (assessed by measurement of End Systolic Volume [ESV]/Stroke Volume [SV] ratio) were performed at rest. Endothelial function was evaluated by measurement of flow-mediated dilatation (FMD) of the brachial artery. Results: 3D SV and 3D ESV/SV ratio resulted respectively significantly lower and higher in CCSs than in controls, while Ea, Ees and Ea/Ees ratio were not different among groups. A positive correlation between 3D ESV/SV ratio and cumulative anthracycline doses, as well as with time after drug exposure were also found. Mean FMD was similar in CCSs and controls (8.45 ± 1.79 versus 9.41 ± 3.41, p = 0.34). Conclusions: In conclusion, conventional LVAC parameters were not shown to be significantly different between CCSs and controls; however, 3D SV and LVAC were significantly impaired in our population. In these patients, endothelial function was comparable to controls. Larger validation studies are therefore needed

Governments, decentralisation, and the risk of electoral defeat

<p>In the last three decades several countries around the world have transferred authority from their national to their regional governments. However, not all their regions have been empowered to the same degree and important differences can be observed between and within countries. Why do some regions obtain more power than others? Current literature argues that variation in the redistribution of power and resources between regions is introduced by demand. Yet these explanations are conditional on the presence of strong regionalist parties or territorial cleavages. This article proposes instead a theory that links the government’s risk of future electoral defeat with heterogeneous decentralisation, and tests its effects using data from 15 European countries and 141 regions. The results provide evidence that parties in government protect themselves against the risk of electoral defeat by selectively targeting decentralisation towards regions in which they are politically strong. The findings challenge previous research that overestimates the importance of regionalist parties while overlooking differences between regions.</p