Waiting times in emergency departments: A resource allocation or an efficiency issue?

Background: In recent years, the flow of patients to the Emergency Departments (ED) of Western countries has steadily increased, thus generating overcrowding and extended waiting times. Scholars have identified four main causes for this phenomenon, related to: continuity of primary care services; availability of specific clinical pathways for chronic patients; ED's personnel endowment; organization of the ED. This study aims at providing a logical diagnostic framework to support managers in investigating specific solutions to be applied to their EDs to cope with high ED waiting times. The framework is based on the ED waiting times and ED admission rate matrix. It was applied to the Tuscan EDs as illustrative example. Methods: To provide the factors to be analyzed once the EDs are positioned into the matrix, a list of issues has been identified. The matrix was applied to Tuscan EDs. Data were collected from the Tuscan performance evaluation system, integrated with specific data on Tuscan EDs' personnel. The Tuscan EDs matrix, the descriptive statistics for each quadrant and the Spearman's rank correlation analysis among waiting times, admission rates and a set of performance indicators were conducted to help managers to read the phenomena that they need to investigate. Results: The combined reading of the correlations and waiting times-admission rates matrix shows that there are no optimal rules for all the EDs in managing admission rates and waiting times, but solutions have to be found considering mixed and personalized strategies. Conclusions: The waiting times-admission rates matrix provides a tool able to support managers in detecting the problems related to the management of ED services. In particular, using this matrix, healthcare managers could be facilitated in the identification of possible solutions for their specific situation

Kinematic and dynamic assessment of trunk exoskeleton

In Industry 4.0, wearable exoskeletons have been proposed as collaborative robotic devices to partially assist workers in heavy and dangerous tasks. Despite the recent researches, proposed prototypes and commercial products, some open issues concerning development, improvements and testing still exist. The current pilot study proposed the assessment of a proper biomechanical investigation of passive trunk exoskeleton effects on the human body. One healthy subject performed walking, stoop and semisquat tasks without, with exoskeleton no support and with exoskeleton with support. 3D Kinematic (angles, translations) and dynamic (interface forces) parameters of both human and exoskeleton were estimated. Some differences were pointed out comparing task motions and exoskeleton conditions. The presented preliminary test revealed interesting results in terms of different human joints coordination, interface forces exchanged at contact points and possible misalignment between human and device. The present study could be considered as a starting point for the investigation of exoskeleton effectiveness and interaction with the user

Gait parameters of elderly subjects in single-task and dual-task with three different MIMU set-ups

The increasing average age of the population emphasizes the strong correlation between cognitive decline and gait disorders of elderly people. Wearable technologies such as magnetic inertial measurement units (MIMUs) have been ascertained as a suitable solution for gait analysis. However, the relationship between human motion and cognitive impairments should still be investigated, considering outcomes of different MIMU set-ups. Accordingly, the aim of the present study was to compare single-task and dual-task walking of an elderly population by using three different MIMU set-ups and correlated algorithms (trunk, shanks, and ankles). Gait sessions of sixteen healthy elderly subjects were registered and spatio-temporal parameters were selected as outcomes of interest. The analysis focused both on the comparison of walking conditions and on the evaluation of differences among MIMU set-ups. Results pointed out the significant effect of cognition on walking speed (p = 0.03) and temporal parameters (p ≤ 0.05), but not on the symmetry of gait. In addition, the comparison among MIMU configurations highlighted a significant difference in the detection of gait stance and swing phases (for shanks-ankles comparison p < 0.001 in both single and dual tasks, for trunk-ankles comparison p < 0.001 in single task and p < 0.01 in dual task). Overall, cognitive impact and MIMU set-ups revealed to be fundamental aspects in the analysis of gait spatio-temporal parameters in a healthy elderly population

Repeated reunions and splits feature the highly dynamic evolution of 5S and 35S ribosomal RNA genes (rDNA) in the Asteraceae family

<p>Abstract</p> <p>Background</p> <p>In flowering plants and animals the most common ribosomal RNA genes (rDNA) organisation is that in which 35S (encoding 18S-5.8S-26S rRNA) and 5S genes are physically separated occupying different chromosomal loci. However, recent observations established that both genes have been unified to a single 35S-5S unit in the genus <it>Artemisia </it>(Asteraceae), a genomic arrangement typical of primitive eukaryotes such as yeast, among others. Here we aim to reveal the origin, distribution and mechanisms leading to the linked organisation of rDNA in the Asteraceae by analysing unit structure (PCR, Southern blot, sequencing), gene copy number (quantitative PCR) and chromosomal position (FISH) of 5S and 35S rRNA genes in ~200 species representing the family diversity and other closely related groups.</p> <p>Results</p> <p>Dominant linked rDNA genotype was found within three large groups in subfamily Asteroideae: tribe Anthemideae (93% of the studied cases), tribe Gnaphalieae (100%) and in the "Heliantheae alliance" (23%). The remaining five tribes of the Asteroideae displayed canonical non linked arrangement of rDNA, as did the other groups in the Asteraceae. Nevertheless, low copy linked genes were identified among several species that amplified unlinked units. The conserved position of functional 5S insertions downstream from the 26S gene suggests a unique, perhaps retrotransposon-mediated integration event at the base of subfamily Asteroideae. Further evolution likely involved divergence of 26S-5S intergenic spacers, amplification and homogenisation of units across the chromosomes and concomitant elimination of unlinked arrays. However, the opposite trend, from linked towards unlinked arrangement was also surmised in few species indicating possible reversibility of these processes.</p> <p>Conclusions</p> <p>Our results indicate that nearly 25% of Asteraceae species may have evolved unusual linked arrangement of rRNA genes. Thus, in plants, fundamental changes in intrinsic structure of rDNA units, their copy number and chromosomal organisation may occur within relatively short evolutionary time. We hypothesize that the 5S gene integration within the 35S unit might have repeatedly occurred during plant evolution, and probably once in Asteraceae.</p

Shear and bulk viscosities for pure glue matter

Shear $\eta$ and bulk $\zeta$ viscosities are calculated in a quasiparticle model within a relaxation time approximation for pure gluon matter. Below $T_c$ the confined sector is described within a quasiparticle glueball model. Particular attention is paid to behavior of the shear and bulk viscosities near $T_c$. The constructed equation of state reproduces the first-order phase transition for the glue matter. It is shown that with this equation of state it is possible to describe the temperature dependence of the shear viscosity to entropy ratio $\eta/s$ and the bulk viscosity to entropy ratio $\zeta/s$ in reasonable agreement with available lattice data but absolute values of the $\zeta/s$ ratio underestimate the upper limits of this ratio in the lattice measurements typically by an order of magnitude.Comment: 8 pages, 4 figures; the published versio

Large center vortices and confinement in 3D Z(2) gauge theory

We study the role of large clusters of center vortices in producing confinement in 3D Z(2) gauge theory. First, we modify each configuration of a Monte Carlo-generated ensemble in the confined phase by removing the largest cluster of center vortices, and show that the ensemble thus obtained does not confine. Conversely, we show that removing all of the small clusters of center vortices and leaving the largest one only, confinement is preserved, albeit with a string tension significantly smaller than the original one. Remarkably, also the string corrections due to the quantum fluctuations of the confining flux tube are preserved by this transformation.Comment: 8 pages,5 figure

Multi-segments kinematic model of the human spine during gait

The complex biomechanical structure of the human spine requires a deep investigation to properly describe its physiological function and its kinematic contribution during motion. The computational approach allows the segmentation of the human spine into several rigid bodies connected by 3D joints. Despite the numerous solutions proposed by previous literature studies based on both inertial and stereophotogrammetric systems, the modelling of the human spine is characterized by some limitations such as the lack of standardization. Accordingly, the present preliminary study focused on the development of a multi-segments kinematic model of the human spine and its validation during gait trials. Three-dimensional spinal angular patterns and ranges of motion of one healthy young subject were considered as outcomes of interest. They were obtained by applying the YXZ Euler angles convention to the custom model. First, results were compared with those of the standard Plug-in-Gait full-body model, which segments the human spine into pelvis and trunk segments. Then, outcomes of the multi-segments model were compared with those obtained using the Tilt-Twist method. Overall, results stressed the importance of the spine segmentation, the major angular contributions of spinal regions during gait (Medium-Lumbar segments for lateral bending and flexion-extension, Thoracic-Medium segments for axial rotation), and the reliability of the proposed custom model (differences between Euler angles method and Tilt-Twist method lower than 0.5° in most cases). Future analysis on a larger healthy population and in the clinical context might be implemented to optimize, standardize and validate the proposed human spine model

Upper Limbs Musculoskeletal OpenSim Model: Customization and Assessment

Computational modelling is a powerful tool in biomechanical studies. Open-source software OpenSim provides different musculoskeletal models. However, existing upper body models consider only one limb, which could be a limitation in reproducing two-handed tasks. The purpose of this research was to develop a two upper limbs model that can be customized with subject’s anthropometry and muscles properties. The proposed model was composed of thorax, left and right upper limbs. Each limb presents 3 degrees of freedom (shoulder flexion-extension, elbow flexion-extension and prono-supination), 4 flexor and 3 extensor muscles. A preliminary model assessment was done. A subject was asked to execute isometric tests at three elbow angles, holding different loads, while EMG muscle activation was recorded. Simulated and experimental muscles activation were compared considering the right upper limb. Very good results were obtained without external load, whereas differences were observed when increasing the load; but, overall, model performance remained acceptable

Biomechanical role and motion contribution of ligaments and bony constraints in the elbow stability: A preliminary study

In flexion-extension motion, the interaction of several ligaments and bones characterizes the elbow joint stability. The aim of this preliminary study was to quantify the relative motion of ulna respect to humerus in two human elbow specimens and to investigate the constraints role for maintaining the joint stability in different dissections condition. Two clusters of 4 markers were fixed respectively to ulna and humerus, and their trajectory was recorded by a motion capture system during orthopedic maneuver. Considering the medial ulnar collateral posterior bundle (pMUCL) and the coronoid, two dissection sequences were executed. The orthopedic maneuver of compression, pronation and varus force was repeated at 30°, 60°, 90° flexion for the functional investigation of constraints. Ulna deflection was compared to a baseline flexion condition. Respect to intact elbow, the coronoid osteotomy influences the elbow stability at 90° (deflection=11.49±17.39 mm), while small differences occur at 30° and 60°, due to ligaments constraint. The contemporary pMUCL dissection and coronoid osteotomy causes elbow instability, with large deflection at 30° (deflection=34.40±9.10 mm), 60° (deflection=45.41±18.47 mm) and 90° (deflection=52.16±21.92 mm). Surgeons may consider the pMUCL reconstruction in case of unfixable coronoid fracture