A discrete event simulation model to support bed management

This is the author accepted manuscript. The final version is available from the publisher via the DOI in this record.In recent years, due to the overcrowding of Emergency Department (ED) and the growing concern in reducing the number of inpatient ward beds, it has become crucial to improve the capacity planning and control activities, which manage the patient flows from EDs to hospital wards. Bed Management has a key role in this context. This study starts by a collaboration with the Local Health Government (LHG) of the Liguria region aimed at studying the impact of supporting bed management with some operational strategies without increasing the bed capacity. A large amount of data was collected over a one-year period at public hospital in Genova and a preliminary observational analysis was conducted to get the main information about the flow of emergency and elective patients from ED to inpatient wards. A Discrete Event Simulation (DES) model has been then developed in order to represent the real system. A scenarios analysis is proposed to assess the best strategy to improve the system performance without increasing bed capacity, by simply synchronizing bed supply and demand. The model can be used as a decision support tool to optimise the use of the available resources as well as to improve the quality of the patient pathway inside the hospital.The authors acknowledge support from the Italian Ministry of Education, University and Research (MIUR), under the grand FIRB n. RBFR081KSB. Data have been made available thanks to a collaboration between ARS Liguria (Dr. Francesco Quaglia and Domenico Gallo) and the Department of Economics and Business, University of Genova

Knee OA management: A cost-effectiveness analysis of platelet-rich-plasma versus hyaluronic acid for the intra-articular treatment of knee OA in France

Objectives: The aim of this work is to carry out an economic evaluation of the intra-articular (i.a.) use of the platelet-rich plasma (PRP) therapy in the short period treatment for knee osteoarthritis (OA). Recently the scientific literature has shown the effectiveness of this treatment. The comparator adopted is the Hyaluronic acid (HA) which represents the standard i.a. therapy. Methods: A cost-effectiveness analysis was performed using a decision tree model. The effectiveness outcomes are reported in terms of Quality Adjusted Life Year (QALY). The costs are reported in Euro (€) currency evaluated in 2016. Deterministic and probabilistic sensibility analyses are reported in order to evaluate the robustness of the results and account for the different sources of uncertainty. Results: The PRP therapy results more costly but also more effective than HA. Using a Willingness to pay thresholds of € 10,000/QALY, the PRP is cost-effective with respect to HA, for patient with moderate to severe knee OA, presenting an Incremental Cost Effectiveness Ratio (ICER) of €760 per QALY

Efecto de la aplicacón del software multisim para desarrollar los aprendizajes de la asignatura de diseño e instalaciones electrónicas de la carrera de Electrónica del Instituto Educactivo Superior Tecnológico Público Carlos Cueto Fernandini - Comas

El objetivo de la investigación fue determinar la influencia de la aplicación del Software Multisim para desarrollar el aprendizaje de la asignatura de Diseño e Instalaciones Electrónicas en la Carrera de Electrónica Industrial. El tipo de investigación es experimental, y su diseño es cuasi experimental. En cuanto a la población estuvo constituida por 82 alumnos; que cursan; el I ciclo de la carrera de Electrónica Industrial, la muestra está constituida por 60 alumnos, divididos en dos grupos de 30 alumnos cada uno. Se aplicó un módulo autoinstructivo para la enseñanza del software Multisim así como una prueba de entrada y salida a modo de pretest y postest. Los resultados a los que se llegó fueron: se acepta la hipótesis general: la aplicación del software Multisim influye significativamente en el desarrollo del aprendizaje de la asignatura de Diseño e Instalaciones electrónica en los alumnos del I ciclo de la carrera industrial del Instituto Superior Tecnológico Carlos Cueto Fernandini del distrito de comas con un valor t= 12,37. Adicionalmente, se acepta la hipótesis especifica Nº 1, la aplicación del Software Multisim influye significativamente en las capacidades cognitivas de la asignatura de Diseño e Instalaciones Electrónicas en los alumnos del I ciclo de la carrera industrial del Instituto Superior Tecnológico Carlos Cueto Fernandini del distrito de comas, con un valor t= 9,36 por otro lado, tenemos que se acepta la hipótesis especifica Nº 2: la aplicación del software Multisim influye significativamente en las capacidades procedimentales de la asignatura de Diseño e Instalaciones Electrónicas en los alumnos del I ciclo de la carrera industrial del Instituto Superior Tecnológico Carlos Cueto Fernandini del distrito de comas, con un valor t= 6,86.Tesi

A Comparative Study for Cost-Utility Analysis Methods: An Application to a Case Study on Multicomponent Vaccine against Meningococcal B Disease

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Chromosomal Aberrations in Lymphocytes of Healthy Subjects and Risk of Cancer

There is evidence that increased frequency of chromosomal aberration (CA) in peripheral blood lymphocytes is a predictor of cancer, but further data are needed to better characterize CA as marker of cancer risk. From the archives of 15 laboratories we gathered cytogenetic records of 11,834 subjects who were free of cancer at the moment of blood drawing and who underwent cytogenetic examination for preventive purposes in the Czech Republic during 1975–2000. We linked these records to the national cancer registry, revealing a total of 485 cancer cases. Subjects were classified according to the percentiles of CA distribution within each laboratory as low (0–33rd percentile), medium (34–66th percentile), and high (66–100th percentile). Subjects were further classified by occupational exposure and by subclass of CA. We found a significant association between the overall cancer incidence and the presence of chromosome-type aberrations [relative risk (RR) for high vs. low CA level = 1.24; 95% confidence interval (CI), 1.03–1.50] but not chromatid-type aberrations. Stomach cancer showed a strong association with frequency of total CA (RR = 7.79; 95% CI, 1.01–60.0). The predictivity of CA observed in subjects exposed to various classes of carcinogens did not significantly differ from the group of nonexposed subjects. This study contributes to validation of CA as a predictive marker of cancer risk, in particular, of stomach cancer; the association between CA frequency and cancer risk might be limited to chromosome-type aberrations

Singing for people with aphasia (SPA): a protocol for a pilot randomised controlled trial of a group singing intervention to improve well-being

Introduction: The singing for people with aphasia (SPA) intervention aims to improve quality of life and well-being for people with poststroke aphasia. A definitive randomised controlled trial (RCT) is required to assess the clinical and cost effectiveness of SPA. The purpose of this pilot study is to assess the feasibility of such a definitive trial and inform its design. Methods and analysis: A two-group, assessor-blinded, randomised controlled external pilot trial with parallel mixed methods process evaluation and economic evaluation. Forty-eight participants discharged from clinical speech and language therapy will be individually randomised 1:1 to SPA (10 group sessions plus a resource booklet) or control (resource booklet only). Outcome assessment at baseline, 3 and 6 months postrandomisation include: ICEpop CAPability measure for adults, Stroke and Aphasia Quality of Life, EQ-5D-5L, modified Reintegration into Normal Living Index, Communication Outcome After Stroke, Very Short Version of the Minnesota Aphasia Test, Service Receipt Inventory and Care Related Quality of Life. Feasibility, acceptability and process outcomes include recruitment and retention rates, with measurement burden and trial experiences being explored in qualitative interviews (15 participants, 2 music facilitators and 2 music champions). Analyses include: descriptive statistics, with 95% CIs where appropriate; qualitative themes; intervention fidelity from videos and session checklists; rehearsal of health economic analysis. Ethics and dissemination: NHS National Research Ethics Service and the Health Research Authority confirmed approval in April 2017; recruitment commenced in June 2017. Outputs will include: pilot data to inform whether to proceed to a definitive RCT and support a funding application; finalised intervention manual for multicentre replication of SPA; presentations at conferences, public involvement events; internationally recognised peer reviewed journal publications, open access sources and media releases

Group-level progressive alterations in brain connectivity patterns revealed by diffusion-tensor brain networks across severity stages in Alzheimer's disease

Alzheimer’s disease (AD) is a chronically progressive neurodegenerative disease highly correlated to aging. Whether AD originates by targeting a localized brain area and propagates to the rest of the brain across disease-severity progression is a question with an unknown answer. Here, we aim to provide an answer to this question at the group-level by looking at differences in diffusion-tensor brain networks. In particular, making use of data from Alzheimer’s Disease Neuroimaging Initiative (ADNI), four different groups were defined (all of them matched by age, sex and education level): G1 (N1 = 36, healthy control subjects, Control), G2 (N2 = 36, early mild cognitive impairment, EMCI), G3 (N3 = 36, late mild cognitive impairment, LMCI) and G4 (N4 = 36, AD). Diffusion-tensor brain networks were compared across three disease stages: stage I (Control vs. EMCI), stage II (Control vs. LMCI) and stage III (Control vs. AD). The group comparison was performed using the multivariate distance matrix regression analysis, a technique that was born in genomics and was recently proposed to handle brain functional networks, but here applied to diffusion-tensor data. The results were threefold: First, no significant differences were found in stage I. Second, significant differences were found in stage II in the connectivity pattern of a subnetwork strongly associated to memory function (including part of the hippocampus, amygdala, entorhinal cortex, fusiform gyrus, inferior and middle temporal gyrus, parahippocampal gyrus and temporal pole). Third, a widespread disconnection across the entire AD brain was found in stage III, affecting more strongly the same memory subnetwork appearing in stage II, plus the other new subnetworks, including the default mode network, medial visual network, frontoparietal regions and striatum. Our results are consistent with a scenario where progressive alterations of connectivity arise as the disease severity increases and provide the brain areas possibly involved in such a degenerative process. Further studies applying the same strategy to longitudinal data are needed to fully confirm this scenario

Singing for people with aphasia (SPA): results of a pilot feasibility randomised controlled trial of a group singing intervention investigating acceptability and feasibility

Objectives: Pilot feasibility randomised controlled trial (RCT) for the singing groups for people with aphasia (SPA) intervention to assess: (1) the acceptability and feasibility of participant recruitment, randomisation and allocation concealment; (2) retention rates; (3) variance of continuous outcome measures; (4) outcome measure completion and participant burden; (5) fidelity of intervention delivery; (6) SPA intervention costs; (7) acceptability and feasibility of trial and intervention to participants and others involved. Design: A two-group, assessor-blinded, randomised controlled external pilot trial with parallel mixed methods process evaluation and economic evaluation. Setting: Three community-based cohorts in the South-West of England. Participants: Eligible participants with post-stroke aphasia were randomised 1:1 to SPA or control. Intervention: The manualised SPA intervention was delivered over 10 weekly singing group sessions, led by a music facilitator and assisted by an individual with post-stroke aphasia. The intervention was developed using the Information-Motivation-Behavioural skills model of behaviour change and targeted psychosocial outcomes. Control and intervention participants all received an aphasia information resource pack. Outcome measures: Collected at baseline, 3 and 6 months post-randomisation, candidate primary outcomes were measured (well-being, quality of life and social participation) as well as additional clinical outcomes. Feasibility, acceptability and process outcomes included recruitment and retention rates, and measurement burden; and trial experiences were explored in qualitative interviews. Results: Of 87 individuals screened, 42 participants were recruited and 41 randomised (SPA=20, control=21); 36 participants (SPA=17, control=19) completed 3-month follow-up, 34 (SPA=18, control=16) completed 6-month follow-up. Recruitment and retention (83%) were acceptable for a definitive RCT, and participants did not find the study requirements burdensome. High fidelity of the intervention delivery was shown by high attendance rates and facilitator adherence to the manual, and participants found SPA acceptable. Sample size estimates for a definitive RCT and primary/secondary outcomes were identified. Conclusions: The SPA pilot RCT fulfilled its objectives, and demonstrated that a definitive RCT of the intervention would be both feasible and acceptable. Trial registration number: NCT03076736

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049