La rappresentazione del rapporto tra utenti e sistema sanitario: I modelli culturali dei medici di medicina generale - The representation of the relationship between users and healthcare system: Cultural models of general practitioners

The present research study explores the emotional and symbolic representation of the Italian healthcare system and specifically of general medical services reported by a group of Italian general practitioners. General medicine is recently affected by a structural change which could be sustained also by a cultural revolution, however this revolution seems to be oriented to expected values without a clear methodology which promotes and accompanies this cultural change. The present study deals with the lack of practices due to these unrealized expected values and assumes that for intervening it is necessary knowing the existing culture before thinking to change it. Interviews to 36 general practitioners were analyzed by Emotional Text Analysis (AET). Results highlight a factorial space characterized by five clusters. According to respondents’ perspective, healthcare problems refer to two large issues characterized by powerlessness of general practitioners to intervene. On the one hand, there is health emergency, dealt with by first aid and emergency medicine. On the other hand, there is chronicity, especially affecting the elderly, which is dealt with by other workers (nurses, private family assistants, social workers) who care patients at home and replace physicians. The general practitioners’ work is difficult because of many different reasons; but the central theme is the lack of absolute power – based on morality and consciousness – which leads to the perception of catastrophic consequences for medical profession and the physician-patient relationship. Often, general practitioners are in their offices and are not able to go to patients’ home, therefore they cannot create care relationships based on trust and dependence which allow useful and trustworthy interventions. In sum, the core theme emerging from data refers to the general practitioners’ perceived lack of personal and trust-based relationships with patients

La relazione che organizza il contesto sanitario: domanda dell’utenza e risposta dei servizi sanitari, nel territorio e nell’ospedale - The relationship which organizes the healthcare context: users’ demand and response of healthcare services, in the territory and the hospital

Our intent is to present citizens’ demand of health care services in Italy through a research structured in three studies. We used the Emotional Text Analysis (ETA) to lead the three s tudies: the first study regarded the citizens’expectations of the healthcare services, the second study regarded the point of view of the hospital personnel (medical doctors and nurses), the third regarded the point of view of the General Practitioners onthe health care services. These three studies are briefly presented. Data and outcome of an Assumed Similarity Test applied to all experimental subjects of the three studies in order to make a comparison among them, are also presented. The findings of the Emotional Text Analysis show that citizens, potential users of health services, center their requests on their individual subjectivity, and seek answers both to their suffering and to the feeling of alienation that characterizes the being sick feeling that makes them go to a medical doctor. For their part, general practitioners and hospital doctors immediately transform this subjective feeling in an objective medical diagnosis. Here a first gap emerges between patient’s demand and medical response, leavingthe possibility of an alliance on the diagnosis in order to jointly fight the disease. It has long been in place though a change that has expelled the patient also from sharing the diagnostic process, increasingly taken from self-centered dynamics within the healthcare system. This widens the gap between the request of the citizens and the response of the health services, that contributes to that conflictual growth to which defensive medicine gives a dysfunctional answer. The Assumed Similarity Test contributes to the interpretation of the health care dynamic identified in the Emotional Text Analysis; particularly in regard to the unfolding conflict, given by the hypothesis emerging from the data analysis, that a feeling of closeness for the hospital personnel goes along with an emotional stance of overpowering the othe

Cyclic cycle systems of the complete multipartite graph

In this paper, we study the existence problem for cyclic $\ell$-cycle decompositions of the graph $K_m[n]$, the complete multipartite graph with $m$ parts of size $n$, and give necessary and sufficient conditions for their existence in the case that $2\ell \mid (m-1)n$

Intravenous infusion of magnesium sulfate and its effect on horses with trigeminal-mediated headshaking.

BackgroundTrigeminal-mediated headshaking results from low-threshold firing of the trigeminal nerve resulting in apparent facial pain. Magnesium may have neuroprotective effects on nerve firing that potentially dampen signs of neuropathic pain. This hypothesis has not been investigated in horses with trigeminal-mediated headshaking.ObjectiveTo investigate head-shaking behavior in affected horses after IV magnesium sulfate infusion.AnimalsSix geldings with trigeminal-mediated headshaking.MethodsProspective randomized crossover study. Horses were controlled for diet and infused IV with 5% dextrose solution (DS; control solution at 2 mL/kg body weight [BW]) and MgSO4 50% solution (MSS at 40 mg/kg BW). Head-shaking behavior was recorded at times T0 (baseline, before infusion) and T15, T30, T60, and T120 minutes post-infusion. Venous blood variables such as pH, HCO3 - , standard base excess (SBE), Na+ , Cl- , K+ , Ca2+ , Mg2+ , total magnesium (tMg), glucose, and lactate were measured; strong ion difference (SID) and anion gap (AG) were calculated for each time point.ResultsBlood variables including pH, Na+ , Cl- , K+ , SID, AG, lactate, Ca2+ , tMg, and Mg2+ had significant changes with MSS as compared to DS treatment. Glucose, SBE, and HCO3 - did not have significant changes. A 29% reduction in head-shaking rate occurred after MSS treatment but no change occurred after DS treatment.Conclusions and clinical importanceAdministration of MSS IV increased plasma total and ionized magnesium concentrations and significantly decreased head-shaking behavior in horses with trigeminal-mediated headshaking

Model for quality assessment in small farms in Cape Verde

This study aims to perform a holistic quality assessment of Cape Verdean agricultural sector. To achieve this objective, we have constructed an innovative model – SQual4Agri – where the farming units’ internal dimension, external context, and the productivity itself were all brought up together. It includes instruments to assess Farmers' satisfaction toward the quality of services provided by the public departments, quality metrics to assess the organizational items in farming organization plus estimation of production. For the development of the (SQual4Agri) model, the researchers built a specific survey validated by experts in focus groups. After interpreting the collected data, the following phase was to adapt the instrument of the 5 Senses (5Ss) for small agricultural instances, and, finally, adapting the SERVPREF for the evaluation of rural services provided by official authorities. With the application of the SQual4Agri model in the Poilão Dam irrigation perimeter where seventy farmers were involved, we have concluded that it is quite needed and relevant the implementation of quality techniques and methodologies in agricultural production units. Another finding was, there is a lack of Cape Verde Farmers' awareness and information upon benefits with organizational development with special regard to quality issues. This evidence is positively related to findings in prior studies by Simões and Saraiva (2014) and Simões (2018), conducted in the islands of S. Nicolau and Santiago, respectively. The third finding indicates widespread dissatisfaction with the services provided by the Ministry of Agriculture and the Environment of Cape Verde. Despite this dissatisfaction, it is perceived that the farmer is satisfied with his own activity. This contradictory element may show the fatigue and discouragement caused by the difficulties of agriculture in Cape Verde and difficulties in the implementation of public policies in this area. The application of the SQual4Agri model also indicates large potential for public policies changing in the rural contexts with impacts on efficiency, quality, and productivity.info:eu-repo/semantics/acceptedVersio

Discovery of the Pre-Main Sequence Population of the Stellar Association LH 95 in the Large Magellanic Cloud with Hubble Space Telescope ACS Observations

We report the discovery of an extraordinary number of pre-main sequence (PMS) stars in the vicinity of the stellar association LH 95 in the Large Magellanic Cloud (LMC). Using the {\em Advanced Camera for Surveys} on-board the {\em Hubble} Space Telescope in wide-field mode we obtained deep high-resolution imaging of the main body of the association and of a nearby representative LMC background field. These observations allowed us to construct the color-magnitude diagram (CMD) of the association in unprecedented detail, and to decontaminate the CMD for the average LMC stellar population. The most significant result is the direct detection of a substantial population of PMS stars and their clustering properties with respect to the distribution of the higher mass members of the association. Although LH 95 represents a rather modest star forming region, our photometry, with a detection limit $V$ \lsim 28 mag, reveals in its vicinity more than 2,500 PMS stars with masses down to $\sim 0.3$ M{\solar}. Our observations offer, thus, a new perspective of a typical LMC association: The stellar content of LH 95 is found to extend from bright OB stars to faint red PMS stars, suggesting a fully populated Initial Mass Function (IMF) from the massive blue giants down to the sub-solar mass regime.Comment: Accepted for Publication in ApJ Letters - 4 Pages ApJ paper format - 3 figures in low-resolution/grayscal

Discovery of three z>6.5 quasars in the VISTA Kilo-degree Infrared Galaxy (VIKING) survey

Studying quasars at the highest redshifts can constrain models of galaxy and black hole formation, and it also probes the intergalactic medium in the early universe. Optical surveys have to date discovered more than 60 quasars up to z~6.4, a limit set by the use of the z-band and CCD detectors. Only one z>6.4 quasar has been discovered, namely the z=7.08 quasar ULAS J1120+0641, using near-infrared imaging. Here we report the discovery of three new z>6.4 quasars in 332 square degrees of the Visible and Infrared Survey Telescope for Astronomy Kilo-degree Infrared Galaxy (VIKING) survey, thus extending the number from 1 to 4. The newly discovered quasars have redshifts of z=6.60, 6.75, and 6.89. The absolute magnitudes are between -26.0 and -25.5, 0.6-1.1 mag fainter than ULAS J1120+0641. Near-infrared spectroscopy revealed the MgII emission line in all three objects. The quasars are powered by black holes with masses of ~(1-2)x10^9 M_sun. In our probed redshift range of 6.44<z<7.44 we can set a lower limit on the space density of supermassive black holes of \rho(M_BH>10^9 M_sun) > 1.1x10^(-9) Mpc^(-3). The discovery of three quasars in our survey area is consistent with the z=6 quasar luminosity function when extrapolated to z~7. We do not find evidence for a steeper decline in the space density of quasars with increasing redshift from z=6 to z=7.Comment: 14 pages, 9 figures. Published in Ap

Thermal Emission from HII Galaxies: Discovering the Youngest Systems

We studied the radio properties of very young massive regions of star formation in HII galaxies, with the aim of detecting episodes of recent star formation in an early phase of evolution where the first supernovae start to appear. Our sample consists of 31 HII galaxies, characterized by strong Hydrogen emission lines, for which low resolution VLA 3.5cm and 6cm observations were obtained. The radio spectral energy distribution has a range of behaviours; 1) there are galaxies where the SED is characterized by a synchrotron-type slope, 2) galaxies with a thermal slope, and, 3) galaxies with possible free-free absorption at long wavelengths. The latter SEDs were found in a few galaxies and represent a signature of heavily embedded massive star clusters closely related to the early stages of massive star formation. Based on the comparison of the star formation rates determined from the recombination lines and those determined from the radio emission we find that SFR(Ha) is on average five times higher than SFR(1.4GHz). We confirm this tendency by comparing the ratio between the observed flux at 20 cm and the expected one, calculated based on the Ha star formation rates, both for the galaxies in our sample and for normal ones. This analysis shows that this ratio is a factor of 2 smaller in our galaxies than in normal ones, indicating that they fall below the FIR/radio correlation. These results suggest that the emission of these galaxies is dominated by a recent and massive star formation event in which the first supernovae (SN) just started to explode. We conclude that the systematic lack of synchrotron emission in those systems with the largest equivalent width of Hb can only be explained if those are young starbursts of less than 3.5Myr of age.Comment: Accepted for publication in Ap