Is it really advantageous to operate proximal femoral fractures within 48 h from diagnosis? – A multicentric retrospective study exploiting COVID pandemic-related delays in time to surgery

Objectives: Hip fractures in the elderly are common injuries that need timely surgical management. Since the beginning of the pandemic, patients with a proximal femoral fracture (PFF) experienced a delay in time to surgery. The primary aim of this study was to evaluate a possible variation in mortality in patients with PFF when comparing COVID-19 negative versus positive. Methods: This is a multicentric and retrospective study including 3232 patients with PFF who underwent surgical management. The variables taken into account were age, gender, the time elapsed between arrival at the emergency room and intervention, pre-operative American Society of Anesthesiology score, pre-operative cardiovascular and respiratory disease, and 10-day/1-month/6-month mortality. For 2020, we had an additional column, “COVID-19 swab positivity.” Results: COVID-19 infection represents an independent mortality risk factor in patients with PFFs. Despite the delay in time-to-surgery occurring in 2020, no statistically significant variation in terms of mortality was detected. Within our sample, a statistically significant difference was not detected in terms of mortality at 6 months, in patients operated within and beyond 48 h, as well as no difference between those operated within or after 12/24/72 h. The mortality rate among subjects with PFF who tested positive for COVID-19 was statistically significantly higher than in patients with PFF who tested. COVID-19 positivity resulted in an independent factor for mortality after PFF. Conclusion: Despite the most recent literature recommending operating PFF patients as soon as possible, no significant difference in mortality was found among patients operated before or after 48 h from diagnosis

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Measurement of the very rare K+→π+ννˉK^+ \to \pi^+ \nu \bar\nu decay

The decay K+→π+νν¯ , with a very precisely predicted branching ratio of less than 10−10 , is among the best processes to reveal indirect effects of new physics. The NA62 experiment at CERN SPS is designed to study the K+→π+νν¯ decay and to measure its branching ratio using a decay-in-flight technique. NA62 took data in 2016, 2017 and 2018, reaching the sensitivity of the Standard Model for the K+→π+νν¯ decay by the analysis of the 2016 and 2017 data, and providing the most precise measurement of the branching ratio to date by the analysis of the 2018 data. This measurement is also used to set limits on BR(K+→π+X ), where X is a scalar or pseudo-scalar particle. The final result of the BR(K+→π+νν¯ ) measurement and its interpretation in terms of the K+→π+X decay from the analysis of the full 2016-2018 data set is presented, and future plans and prospects are reviewed

La CGIL nel contesto internazionale, in A.Pepe, P.Iuso, S.Misiani, Storia del sindacato nell'Italia del '900, III volume

Il profilo del sindacalismo della CGIL negli scenari internazionali ed europei del secondo dopoguerra e fino alla fine degli anni sessanta, attraverso documenti d'archivio e giornali sindacali. In particolare vengono affrontati: il piano Marshall, il problema del processo di integrazione europeo, gli avvenimenti in Ungheria e Cecoslovacchia, il lento procedere verso la nascita dei un sindacalismo confederale europeo (CES

Maturity model to determine the level of cybersecurity culture in industrial organizations (MMCC)

En los últimos cinco años los incidentes de ciberseguridad han incrementado su frecuencia en 40 por ciento en la industria en general. El 80 por ciento de compañías consideran que no tiene una cultura en ciberseguridad implementada en su respectiva empresa y, sólo un 11 por ciento tienen métodos y programas de medición continua de esta cultura. En este trabajo de investigación hemos profundizado en el comportamiento del factor humano como la principal amenaza para la ciberseguridad. Teniendo en cuenta el contexto industrial, la realidad económica, social y política del país, decidimos presentar una alternativa que permita controlar el estado de la cultura de una forma continua, de fácil uso y bajo costo. En base a esta necesidad, proponemos un modelo de madurez para diagnosticar el grado de cultura de ciberseguridad en organizaciones industriales que permite evaluar el estado de la cultura en la empresa a través de sus componentes y poder monitorearlos a través de métricas definidas en este proyecto. El modelo permitirá mostrar resultados, de fácil entendimiento, que nos permitirá sustentar proyectos y programas de mejora en la concienciación de la cultura. Finalmente, se aplicó la herramienta de medición a una empresa del sector minero que opera a lo largo del país. Se desplegaron los cuestionarios para que sean resueltos por especialistas de tecnologías de información y del negocio. Los resultados obtenidos nos muestran el estado actual de la cultura en ciberseguridad de la empresa y de los controles que deberán ajustarse para poder lograr el nivel objetivo trazado, donde se visibilice un cambio en el comportamiento de los empleados en la organización que permitirá fortalecer sus capacidades de ciberseguridad.In the last five years, cybersecurity incidents have increased in frequency by 40 percent in the industry as a whole. Eighty percent of companies believe that there is no cybersecurity culture implemented in their respective company and only 11 percent have methods and programs for continuous measurement of this culture. In this research paper we have delved into the behavior of the human factor as the main threat to cybersecurity. Taking into account the industrial context, the economic, social and political reality of the country, we decided to present an alternative that allows monitoring the state of the culture in a continuous, easy to use and low-cost way. Based on this need, we propose a Maturity Model to determine the level of cybersecurity culture in industrial organizations that allows to evaluate the state of the culture in the company through its components and monitor them through metrics defined in this project. The model will allow us to show results, easy to understand, that will allow us to support projects and improvement programs in culture awareness. Finally, the measurement tool was applied to a company in the mining sector operating throughout the country. The questionnaires were deployed to be solved by information technology and business specialists. The results obtained show us the current state of the company's cybersecurity culture and the controls that must be adjusted in order to achieve the objective level set, where a change in the behavior of the organization's employees can be seen, which will strengthen their cybersecurity capabilities.Trabajo de investigació