Cost Measurement in Laparoscopic Surgery: Results from an Activity-Based Costing Application

Activity Based Costing (ABC) techniques are designed to support advanced cost analysis in different organizations. Centred on organization activities and processes, it provides more accurate cost information on cost objects using appropriate cost drivers and constitutes a powerful costing model to improve efficiency and effectiveness in delivering products and services. ABC can be successfully appl ied also in Health Care organizations, where the patient is the main “object” of the activities performed. In addition, in can be fruitfully used in costing the resource consumption of new medical technology devices or surgery processes to assess their eco nomic impact on health care costs. The purpose of this paper is to describe an Activity based costing model designed to measure and control resources consumption and cost when a new technology is applied in health care processes. An ABC model has been defined in relation to laparoscopic technologies applied to surgical cases, designing a health care “activity hierarchy” based on the processes of a specific local unit organization. The output of the application has been a full cost of laparoscopic surgery to be compared with the correspondent DRG current value. As a further result, the paper shows how the ABC model is able to generate different cost figures referred to activity levels or aggregations able to support decision making especially when the introdu ction of a new surgical technology has to be economically assessed. Propositions are finally made to generate discussion about the effectiveness of the existing cost accounting systems in the health care organizations and on the need for the wider diffusio n of ABC techniques in this service sector.Activity-Based Costing; Economic assessment of surgery techniques

Cost measurement in laparoscopic surgery: results from an activity-based costing application

Activity Based Costing (ABC) techniques are designed to support advanced cost analysis in different organizations. Centred on organization activities and processes, it provides more accurate cost information on cost objects using appropriate cost drivers and constitutes a powerful costing model to improve efficiency and effectiveness in delivering products and services. ABC can be successfully applied also in Health Care organizations, where the patient is the main “object” of the activities performed. In addition, in can be fruitfully used in costing the resource consumption of new medical technology devices or surgery processes to assess their economic impact on health care costs. The purpose of this paper is to describe an Activity based costing model designed to measure and control resources consumption and cost when a new technology is applied in health care processes. An ABC model has been defined in relation to laparoscopic technologies applied to surgical cases, designing a health care “activity hierarchy” based on the processes of a specific local unit organization. The output of the application has been a full cost of laparoscopic surgery to be compared with the correspondent DRG current value. As a further result, the paper shows how the ABC model is able to generate different cost figures referred to activity levels or aggregations able to support decision making especially when the introduction of a new surgical technology has to be economically assessed. Propositions are finally made to generate discussion about the effectiveness of the existing cost accounting systems in the health care organizations and on the need for the wider diffusion of ABC techniques in this service sector.Activity-Based Costing, Economic assessment of surgery techniques

A long-lasting quiescence phase of the eruptive variable V1118 Ori

V1118 Ori is an eruptive variable belonging to the EXor class of Pre-Main Sequence stars whose episodic outbursts are attributed to disk accretion events. Since 2006, V1118 Ori is in the longest quiescence stage ever observed between two subsequent outbursts of its recent history. We present near-infrared photometry of V1118 Ori carried out during the last eight years, along with a complete spectroscopic coverage from 0.35 to 2.5 um. A longterm sampling of V1118 Ori in quiescence has never been done, hence we can benefit from the current circumstance to determine the lowest values (i.e. the zeroes) of the parameters to be used as a reference for evaluating the physical changes typical of more active phases. A quiescence mass accretion rate between 1--3 $\times$ 10$^{-9}$ M_{\sun} yr$^{-1}$ can be derived and the difference with previous determinations is discussed. From line emission and IR colors analysis a visual extinction of 1-2 mag is consistently derived, confirming that V1118 Ori (at least in quiescence) is a low-extinction T Tauri star with a bolometric luminosity of about 2.1 L_{\sun}. An anti-correlation exists between the equivalent width of the emission lines and the underlying continuum. We searched the literature for evaluating whether or not such a behaviour is a common feature of the whole class. The anti-correlation is clearly recognizable for all the available EXors in the optical range (H$\beta$ and H$\alpha$ lines), while it is not as much evident in the infrared (Pa$\beta$ and Br$\gamma$ lines). The observed anti-correlation supports the accretion-driven mechanism as the most likely to account for continuum variations.Comment: 6 figures, 5 tables, accepted on Ap

Impact of a synbiotic food on the gut microbial ecology and metabolic profiles

<p>Abstract</p> <p>Background</p> <p>The human gut harbors a diverse community of microorganisms which serve numerous important functions for the host wellbeing. Functional foods are commonly used to modulate the composition of the gut microbiota contributing to the maintenance of the host health or prevention of disease. In the present study, we characterized the impact of one month intake of a synbiotic food, containing fructooligosaccharides and the probiotic strains <it>Lactobacillus helveticus </it>Bar13 and <it>Bifidobacterium longum </it>Bar33, on the gut microbiota composition and metabolic profiles of 20 healthy subjects.</p> <p>Results</p> <p>The synbiotic food did not modify the overall structure of the gut microbiome, as indicated by Polymerase Chain Reaction-Denaturing Gradient Gel Electrophoresis (PCR-DGGE). The ability of the probiotic <it>L. helveticus </it>and <it>B. longum </it>strains to pass through the gastrointestinal tract was hypothesized on the basis of real-time PCR data. In spite of a stable microbiota, the intake of the synbiotic food resulted in a shift of the fecal metabolic profiles, highlighted by the Gas Chromatography Mass Spectrometry Solid Phase Micro-Extraction (GC-MS/SPME) analysis. The extent of short chain fatty acids (SCFA), ketones, carbon disulfide and methyl acetate was significantly affected by the synbiotic food consumption. Furthermore, the Canonical discriminant Analysis of Principal coordinates (CAP) of GC-MS/SPME profiles allowed a separation of the stool samples recovered before and after the consumption of the functional food.</p> <p>Conclusion</p> <p>In this study we investigated the global impact of a dietary intervention on the gut ecology and metabolism in healthy humans. We demonstrated that the intake of a synbiotic food leads to a modulation of the gut metabolic activities with a maintenance of the gut biostructure. In particular, the significant increase of SCFA, ketones, carbon disulfide and methyl acetate following the feeding period suggests potential health promoting effects of the synbiotic food.</p

Recent outburst of the young star V1180 Cas

We report on the ongoing outburst of the young variable V1180 Cas, which is known to display characteristics in common with EXor eruptive variables. We present results that support the scenario of an accretion-driven nature of the brightness variations of the object and provide the first evidence of jet structures around the source. We monitored the recent flux variations of the target in the Rc, J, H, and K bands. New optical and near-IR spectra taken during the current high state of V1180 Cas are presented, in conjunction with H2 narrow-band imaging of the source. Observed near-IR colour variations are analogous to those observed in EXors and consistent with excess emission originating from an accretion event. The spectra show numerous emission lines, which indicates accretion, ejection of matter, and an active disc. Using optical and near-IR emission features we derive a mass accretion rate of ~3 E-8 Msun/yr, which is an order of magnitude lower than previous estimates. In addition, a mass loss rate of ~4 E-9 and ~4 E-10 Msun/yr are estimated from atomic forbidden lines and H2, respectively. Our H2 imaging reveals two bright knots of emission around the source and the nearby optically invisible star V1180 Cas B, clearly indicative of mass-loss phenomena. Higher resolution observations of the detected jet will help to clarify whether V1180 Cas is the driving source and to determine the relation between the observed knots.Comment: Accepted as Letter in A&A; 4 pages, 3 figure

Early melanoma invasivity correlates with gut fungal and bacterial profiles

7openInternationalItalian coauthor/editorBackground The microbiome is emerging as a crucial player of the immune checkpoint in cancer. Melanoma is a highly immunogenic tumour, and the composition of the gut microbiome has been correlated to prognosis and evolution of advanced melanoma and proposed as a biomarker for immune checkpoint therapy. Objectives We investigated the gut fungal and bacterial compositions in early-stage melanoma and correlated microbial profiles with histopathological features. Methods Sequencing of bacterial 16S rRNA and the fungal internal transcribed spacer region was performed on faecal samples of patients with stage I and II melanoma, and healthy controls. A meta-analysis with gut microbiota data from patients with metastatic melanoma was also carried out. Results We found a combination of gut fungal and bacterial profiles significantly discriminating patients with melanoma from controls. In patients with melanoma, we observed an abundance of Prevotella copri and yeasts belonging to the order Saccharomycetales. We found that the bacterial and fungal community correlated to melanoma invasiveness, whereas the specific fungal profile correlated to melanoma regression. Bacteroides was identified as general marker of immunogenicity, being shared by regressive and invasive melanoma. In addition, the bacterial communities in patients with stage I and II melanoma were different in structure and richer than those from patients with metastatic melanoma. Conclusions The composition of the gut microbiota in early-stage melanoma changes along the gradient from in situ to invasive (and metastatic) melanoma. Changes in the microbiota and mycobiota are correlated to the histological features of early-stage melanoma, and to the clinical course and response to immune therapies of advanced-stage melanoma, through direct or indirect immunomodulation.openVitali, F.; Colucci, R.; Di Paola, M.; Pindo, M.; De Filippo, C.; Moretti, S.; Cavalieri, D.Vitali, F.; Colucci, R.; Di Paola, M.; Pindo, M.; De Filippo, C.; Moretti, S.; Cavalieri, D

Cost Measurement in Laparoscopic Surgery: Results from an Activity-Based Costing Application

Activity Based Costing (ABC) techniques are designed to support advanced cost analysis in different organizations. Centred on organization activities and processes, it provides more accurate cost information on cost objects using appropriate cost drivers and constitutes a powerful costing model to improve efficiency and effectiveness in delivering products and services. ABC can be successfully appl ied also in Health Care organizations, where the patient is the main “object” of the activities performed. In addition, in can be fruitfully used in costing the resource consumption of new medical technology devices or surgery processes to assess their eco nomic impact on health care costs. The purpose of this paper is to describe an Activity based costing model designed to measure and control resources consumption and cost when a new technology is applied in health care processes. An ABC model has been defined in relation to laparoscopic technologies applied to surgical cases, designing a health care “activity hierarchy” based on the processes of a specific local unit organization. The output of the application has been a full cost of laparoscopic surgery to be compared with the correspondent DRG current value. As a further result, the paper shows how the ABC model is able to generate different cost figures referred to activity levels or aggregations able to support decision making especially when the introdu ction of a new surgical technology has to be economically assessed. Propositions are finally made to generate discussion about the effectiveness of the existing cost accounting systems in the health care organizations and on the need for the wider diffusio n of ABC techniques in this service sector

Gut microbiota profiles and characterization of cultivable fungal isolates in IBS patients

Studies so far conducted on irritable bowel syndrome (IBS) have been focused mainly on the role of gut bacterial dysbiosis in modulating the intestinal permeability, inflammation, and motility, with consequences on the quality of life. Limited evidences showed a potential involvement of gut fungal communities. Here, the gut bacterial and fungal microbiota of a cohort of IBS patients have been characterized and compared with that of healthy subjects (HS). The IBS microbial community structure differed significantly compared to HS. In particular, we observed an enrichment of bacterial taxa involved in gut inflammation, such as Enterobacteriaceae, Streptococcus, Fusobacteria, Gemella, and Rothia, as well as depletion of health-promoting bacterial genera, such as Roseburia and Faecalibacterium. Gut microbial profiles in IBS patients differed also in accordance with constipation. Sequence analysis of the gut mycobiota showed enrichment of Saccharomycetes in IBS. Culturomics analysis of fungal isolates from feces showed enrichment of Candida spp. displaying from IBS a clonal expansion and a distinct genotypic profiles and different phenotypical features when compared to HS of Candida albicans isolates. Alongside the well-characterized gut bacterial dysbiosis in IBS, this study shed light on a yet poorly explored fungal component of the intestinal ecosystem, the gut mycobiota. Our results showed a differential fungal community in IBS compared to HS, suggesting potential for new insights on the involvement of the gut mycobiota in IBS. KEY POINTS: Comparison of gut microbiota and mycobiota between IBS and healthy subjects Investigation of cultivable fungi in IBS and healthy subjects Candida albicans isolates result more virulent in IBS subjects compared to healthy subjects

Benzo[a]pyrene modelling over Italy: comparison with experimental data and source apportionment

Abstract This work describes the extension of the Flexible Air quality Regional Model (FARM) to polycyclic aromatic hydrocarbons (PAHs). Modules accounting for the partitioning of these species between gaseous and particulate phases were inserted in a simplified version of the model and in a more state–of–the–art configuration implementing the SAPRC99 gas–phase chemical mechanism coupled with the aero3 aerosol module. Both versions of FARM were applied over Italy for the year 2005. The analysis of model results was focused on benzo[a]pyrene (B[a]P), which is considered a marker substance for the carcinogenic risk of PAHs. Simulated B[a]P concentrations were compared with observed data, collected at background sites mainly located in Po Valley, and with concentrations produced at continental scale by EMEP/MSC–E model. Higher B[a]P yearly average concentrations were simulated by the national modelling system as a result of different factors: the higher resolution adopted by the national modelling system, the greater Italian emissions estimated by the national inventory and the effects induced by the use of a high resolution topography on meteorological fields and thus on the dispersion of pollutants. The comparison between observed and predicted monthly averaged concentrations evidenced the capability of the two versions of FARM model to capture the seasonal behaviour of B[a]P, characterised by higher values during the winter season due to the large use of wood for residential heating, enhanced by lower dispersion atmospheric conditions. The statistical analysis evidenced, for both versions of the model, a good performance and better indicators than those associated to EMEP/MSC–E simulations. A source apportionment was then carried out using the simplified version of the model, which proved to perform similarly to the full chemistry version but with the advantage to be computationally less expensive. The analysis revealed a significant influence of national sources on B[a]P concentrations, with non–industrial combustion employing wood burning devices being the most important sector. The contribution of the industrial sectors is relevant around major industrial facilities, with the largest absolute contribution in Taranto (above 1 ng m −3 ), where steel industries are the largest individual source of PAHs in the country

VIBRATION SIGNATURE ANALYSIS OF REAL AND VIRTUAL DAMAGED GEARS

ABSTRACT A high performance rig designed to test gears (materials and geometries) in extreme load and speed conditions as in aerospace applications was used to test diagnostic systems by the only vibration analysis. The authors of the present report have implemented, in addition to some standard signal analysis techniques, some advanced methodologies (e.g. NA4, NB4), which are applied to the synchronously averaged signal to detect the smallest fault related variations in the tested gear vibration signature. The different techniques have been tested and compared on the signals of a gear that underwent failure, showing the good performance of the latter approaches compared to the more conventional ones. A numerical simulation of the gear meshing was carried out to support the experimental campaign and the benchmarking of the diagnostic tools,. The stiffness computed by a FEM code was employed to simulate the gear system dynamic behavior with a lumped model, which was finally tuned using the experimental signals, to obtain indications on the crack evolution