Moduli of quantum Riemannian geometries on <= 4 points

We classify parallelizable noncommutative manifold structures on finite sets of small size in the general formalism of framed quantum manifolds and vielbeins introduced previously. The full moduli space is found for $\le 3$ points, and a restricted moduli space for 4 points. The topological part of the moduli space is found for $\le 9$ points based on the known atlas of regular graphs. We also discuss aspects of the quantum theory defined by functional integration.Comment: 34 pages ams-latex, 4 figure

Is it time to combine untargeted antifungal strategies to reach the goal of 'early' effective treatment?

LETTER TO EDITO

Self help groups in a city of Tuscany: Reconstruction of the second generation model of work for professionals and services

This study is part of a more extensive project aimed to investigate the effectiveness of self-help group participation in improving quality of life in mental disease. The study is taking place in the Tuscany Region, in Italy. In the first qualitative step of analysis researchers are interested in describing the specific features of the psychiatric self-help movement in Tuscany, comparing different realities, networks, kind of groups. Therefore, our aim is to collect exhaustive information to describe how self-help system work in different provinces at the present moment. The implementation of groups for psychiatric problems is quite young in Italy.&nbsp; Because of a lack of specific regulation in the directives of the Italian health care system, every local service has implemented groups differently, sometimes enhancing, sometimes dismissing them. Prato, near Florence, is one of the more interesting context for the birth of psychiatric self-help movement in the region: public health services improved groups since early 90’s, it was one of the first self-help reality linked to services in the entire region. Now we are in a “second generation” of professionals, and the original meaning of groups seems to be transformed, sometimes misunderstood. Our objectives of study head us toward an in depth analysis of self-help phenomenon in Prato

Self help groups in a city of Tuscany: Reconstruction of the second generation model of work for professionals and services

This study is part of a more extensive project aimed to investigate the effectiveness of self-help group participation in improving quality of life in mental disease. The study is taking place in the Tuscany Region, in Italy. In the first qualitative step of analysis researchers are interested in describing the specific features of the psychiatric self-help movement in Tuscany, comparing different realities, networks, kind of groups. Therefore, our aim is to collect exhaustive information to describe how self-help system work in different provinces at the present moment. The implementation of groups for psychiatric problems is quite young in Italy.&nbsp; Because of a lack of specific regulation in the directives of the Italian health care system, every local service has implemented groups differently, sometimes enhancing, sometimes dismissing them. Prato, near Florence, is one of the more interesting context for the birth of psychiatric self-help movement in the region: public health services improved groups since early 90’s, it was one of the first self-help reality linked to services in the entire region. Now we are in a “second generation” of professionals, and the original meaning of groups seems to be transformed, sometimes misunderstood. Our objectives of study head us toward an in depth analysis of self-help phenomenon in Prato

Should we continue to use prediction tools to identify patients at risk of Candida spp. infection? If yes, why?

We read with interest the article from Shanin et al. about the Fungal Infection Risk Evaluation (FIRE) study [1] aiming to 'describe the incidence of IFD in UK critical care units and to develop and validate a clinical risk prediction tool to identify non-neutropenic, critically ill adult patients at risk of IFD'. The investigators should be congratulated for the way they collected a huge amount of data from 96 adult intensive care units (ICUs), managed the FIRE database, and developed and validated the risk model. However, they stated that the prediction model would help to identify patients who may benefit from antifungal prophylaxis and that a number of randomized controlled trials (RCTs) demonstrated a beneficial effect of antifungal prophylaxis and/or empiric treatment in terms of incidence of invasive fungal disease (IFD) and mortality. This statement is not supported by available evidence from RCTs. A recent Cochrane Systematic Review including 22 RCTs evaluating prophylaxis, pre-emptive, and empiric antifungal treatment with any antifungal drugs in 2761 non-neutropenic critically ill patients showed no significant effect on mortality (risk ratio (RR) 0.93, 95 % confidence interval (CI) 0.79 to 1.09) and a significant reduction in the risk of invasive fungal infection (IFI) (RR 0.57, 95 % CI 0.39 to 0.83) [2, 3]. In the subgroup analysis for type of intervention, antifungal prophylaxis was not associated with a significant mortality reduction but with a significant reduction of IFI [4]. This systematic review was the update of the one cited in the manuscript and published in 2006 including 12 RCT and 1606 patients

Opioid use and effectiveness of its prescription at discharge in an acute pain relief and palliative care unit

The aim of this study was to present how opioids are used in an acute pain relief and palliative care unit (APRPCU), where many patients with difficult pain conditions are admitted from GPs, home palliative care programs, oncology departments, other hospitals or emergency units, and other regional places. From a consecutive sample of cancer patients admitted to an APRPCU for a period of 6 months, patients who had been administered opioids were included in this survey. Basic information was collected as well as opioid therapy prescribed at admission and, subsequently, during admission and at time of discharge. Patients were discharged once stabilization of pain and symptoms were obtained and the treatment was considered to be optimized. One week after being discharged, patients or relatives were contacted by phone to gather information about the availability of opioids at dosages prescribed at time of discharge. One hundred eighty six of 231 patients were specifically admitted for uncontrolled pain, with a mean pain intensity of 6.8 (SD 2.5). The mean dose of oral morphine equivalents in patients receiving opioids before admission was 45 mg/day (range 10–500 mg). One hundred seventy five patients (75.7 %) were prescribed around the clock opioids at admission. About one third of patients changed treatment (opioid or route). Forty two of 175 (24 %), 27/58 (46.5 %), 10/22 (45.4 %), and 2/4 (50 %) patients were receiving more than 200 mg of oral morphine equivalents, as maximum dose of the first, second, third, and fourth opioid prescriptions, respectively. The pattern of opioids changed, with the highest doses administered with subsequent line options. The mean final dose of opioids, expressed as oral morphine equivalents, for all patients was 318 mg/day (SD 798), that is more than six times the doses of pre-admission opioid doses. One hundred eighty six patients (80.5 %) were prescribed a breakthrough cancer pain (BTcP) medication at admission. Sixty five patients changed their BTcP prescription, and further 27 patients changed again. Finally, eight patients were prescribed a fourth BTcP medication. Of 46 patients available for interview, the majority of them (n=39, 84 %) did not have problems with their GPs, who facilitated prescription and availability of opioids at the dosages prescribed at discharge. For patients with severe distress, APRPCUs may guarantee a high-level support to optimize pain and symptom intensities providing intensive approach and resolving highly distressing situations in a short time by optimizing the use of opioids

Ion pairing in model electrolytes: A study via three particle correlation functions

A novel integral equations approach is applied for studying ion pairing in the restricted primitive model (RPM) electrolyte, i. e., the three point extension (TPE) to the Ornstein-Zernike integral equations. In the TPE approach, the three-particle correlation functions $g^{[3]}({\bf r}_{1},{\bf r}_{2},{\bf r}_{3})$ are obtained. The TPE results are compared to molecular dynamics (MD) simulations and other theories. Good agreement between TPE and MD is observed for a wide range of parameters, particularly where standard integral equations theories fail, i. e., low salt concentration and high ionic valence. Our results support the formation of ion pairs and aligned ion complexes.Comment: 43 pages (including 18 EPS figs) - RevTeX 4 - J. Chem. Phys. (in press

Efficacy and Safety of Using High-Flow Nasal Oxygenation in Patients Undergoing Rapid Sequence Intubation.

Objective: To assess the efficacy and safety of high-flow nasal oxygen (HFNO) therapy in patients undergoing rapid sequence intubation (RSI) for emergency abdominal surgery. Methods: HFNO of 60 L.min\ue2\u88\u921at an inspiratory oxygen fraction of 1 was delivered 4 min before laryngoscopy and maintained until the patient was intubated, and correct intubation was verified by the appearance of the end-tidal CO2(EtCO2) waveform. Transcutaneous oxygenation (SpO2), heart rate and non-invasive mean arterial pressure were monitored at baseline (T0), after 4 min on HFNO (T1) and at the time of laryngoscopy (T2) and endotracheal intubation (ETI) (T3). An SpO2of <3% from baseline was recorded at any sampled time. The value of EtCO2at T3 was registered after two mechanical breaths. The apnoea time was defined as the time from the end of propofol injection to ETI. RSI was performed with propofol, fentanyl and rocuronium. Results: Forty-five patients were enrolled. SpO2levels showed a statistically significant increase at T1, T2 and T3 compared with those at T0 (p<0.05); median SpO2% (interquartile range) was 97% (range, 96%-99%) at T0, 99% (range, 99%-100%) at T1, 99% (range, 99%-100%) at T2 and 99% (range, 99%-100%) at T3. Minimal SpO2was 96%; no patient showed an SpO2of <3% from baseline; mean EtCO2at the time of ETI was 36\uc2\ub14 mmHg. Maximum apnoea time was 12 min. Conclusion: HFNO is an effective and safe technique for pre-oxygenation in patients undergoing rapid sequence induction of general anaesthesia for emergency surgery