Evaluation on the Use of Italian High-Speed Rail to Support Transportation Network for Transplantation Activities

Abstract Background One of the main activities connected with transplantation is the rapid and timely transportation of patients, medical teams, and human organs from donation to transplantation centers under the compliance of national guidelines and principles of quality, performance, and safety. High-speed transportation on a railway network is becoming relevant both in terms of performance and extensiveness of the service. Methods and Objectives Our study explores the feasibility of adopting a high-speed rail network for the transportation of those organs with large cold ischemia time and those less influenced by transportation-related perturbations (ie, temperature, speed, vibrations), assessing savings and relative performance improvement. In this study, only kidneys have been considered; the transplantation database has been integrated with the national high-speed railway network and timetables. A function is implemented that allocates to air transportations those records with 1 of the 2 ends situated on islands, remote regions, and abroad, while rail transportation is preferred where constraints on capacity and compliance with cold ischemia time are met. Road transportation is still feasible for those records involving 2 adjacent regions and for intraregional transportation. Results The opportunity of integrated road-rail transportation in place of air or all-road transportation allows users to lower generalized costs and reduce driven distance for personnel and vehicles allocated to a regional transplantation center's fleet and staff. Savings in fleet and staff usage can serve to improve the performances at the local level. Conclusions The knowledge and analysis of transportation alternatives for human organs with less stringent safety and preservation criteria allow a more efficient allocation of resources both at the local and national level—without compromising quality and reliability of the system

Mappatura delle competenze Infermieristiche per lo sviluppo organizzativo: analisi nazionale degli Infermieri coinvolti nel Processo di Donazione e Trapianto

The constant evolution of the health care system has led to a thorough reorganization of the system itself and an improvement in terms of the quality of treatment provided. Many articles in the literature confirm that the answer to increased quality of standards and efficient levels of organization are undoubtedly due to true and efficient team work, without any of the professionals involved having to change their area of expertise. This rapid evolution of the treatment process has required the improvement and definement of technical-specialist skills on the part of the nursing staff; personnel who have proved to be the real link in the technical-communicative processes. In relation to this important aspect, it has become essential to design, at present based on more than ten-years of experience, a profile of "job description" skills for the nursing staff engaged in the world of donations and transplants, in order to give companies objective and measurable elements on the skills profile that can be identified for this specific area and a clear recognition of the profession itself.La costante evoluzione del sistema sanitario ha portato, negli ultimi anni, ad una vera e propria riorganizzazione del sistema stesso e un miglioramento in termini di qualità dell’assistenza erogata. Molti lavori presenti in letteratura confermano che la risposta ad elevati standard di qualità e a livelli efficienti di organizzazione sono inevitabilmente dovuti ad un vero e proprio lavoro d’équipe, senza che nessuno dei professionisti convolti debba modificare il proprio ambito di competenze. Questa rapida evoluzione del processo di cura, ha richiesto l’aumento e la definizione di competenze tecnico-specialistiche da parte del personale infermieristico; personale che ha dimostrato di essere il vero link nei processi tecnico-comunicativi. In relazione a questo importante aspetto, è diventato indispensabile disegnare, sulla base della presente esperienza più che decennale, un profilo di competenze “job description” del personale infermieristico impegnato nel mondo delle donazioni e dei trapianti, al fine di dare alle Aziende elementi oggettivi e misurabili sul profilo di competenze da individuare per questo ambito specifico e un giusto riconoscimento della professionalità stessa

Hifocus Helix™ Electrode Insertion: Surgical Approach.

Cochlear implants have been used for almost 30 years as a device for the rehabilitation of individuals with severe-to-profound hearing loss. One of the important aspects of cochlear implantation is the type of electrode selected and proper insertion of the electrode array in scala tympani to minimize cochlear damage. The HiFocus Helix™ electrode is a precurved design aimed at placing the electrode contacts close to the spiral ganglion cells in the modiolus. The prescribed insertion techniques are intended to minimize the likelihood of damage to the basilar membrane or lateral wall of the cochlea. To describe the first insertion of a HiFocus Helix™ electrode in Brazil exposing surgical particularities and device details in a patient with profound hearing loss, due to Mondini's dysplasia. No problems were encountered during the surgical procedure. The patient experienced improvement in hearing thresholds and speech perception. The HiFocus Helix™ electrode proved easy to insert and provided expected hearing benefits for the patient. This manuscript indicates that the HiResolution™ Bionic Ear System with HiFocus Helix™ electrode comprise a cochlear implant system that is practical and beneficial for the treatment of severe-to-profound hearing loss.830

Acute Delta Hepatitis in Italy spanning three decades (1991–2019): Evidence for the effectiveness of the hepatitis B vaccination campaign

Updated incidence data of acute Delta virus hepatitis (HDV) are lacking worldwide. Our aim was to evaluate incidence of and risk factors for acute HDV in Italy after the introduction of the compulsory vaccination against hepatitis B virus (HBV) in 1991. Data were obtained from the National Surveillance System of acute viral hepatitis (SEIEVA). Independent predictors of HDV were assessed by logistic-regression analysis. The incidence of acute HDV per 1-million population declined from 3.2 cases in 1987 to 0.04 in 2019, parallel to that of acute HBV per 100,000 from 10.0 to 0.39 cases during the same period. The median age of cases increased from 27 years in the decade 1991-1999 to 44 years in the decade 2010-2019 (p < .001). Over the same period, the male/female ratio decreased from 3.8 to 2.1, the proportion of coinfections increased from 55% to 75% (p = .003) and that of HBsAg positive acute hepatitis tested for by IgM anti-HDV linearly decreased from 50.1% to 34.1% (p < .001). People born abroad accounted for 24.6% of cases in 2004-2010 and 32.1% in 2011-2019. In the period 2010-2019, risky sexual behaviour (O.R. 4.2; 95%CI: 1.4-12.8) was the sole independent predictor of acute HDV; conversely intravenous drug use was no longer associated (O.R. 1.25; 95%CI: 0.15-10.22) with this. In conclusion, HBV vaccination was an effective measure to control acute HDV. Intravenous drug use is no longer an efficient mode of HDV spread. Testing for IgM-anti HDV is a grey area requiring alert. Acute HDV in foreigners should be monitored in the years to come

DMTs and Covid-19 severity in MS: a pooled analysis from Italy and France

We evaluated the effect of DMTs on Covid-19 severity in patients with MS, with a pooled-analysis of two large cohorts from Italy and France. The association of baseline characteristics and DMTs with Covid-19 severity was assessed by multivariate ordinal-logistic models and pooled by a fixed-effect meta-analysis. 1066 patients with MS from Italy and 721 from France were included. In the multivariate model, anti-CD20 therapies were significantly associated (OR = 2.05, 95%CI = 1.39–3.02, p < 0.001) with Covid-19 severity, whereas interferon indicated a decreased risk (OR = 0.42, 95%CI = 0.18–0.99, p = 0.047). This pooled-analysis confirms an increased risk of severe Covid-19 in patients on anti-CD20 therapies and supports the protective role of interferon

Complex interwoven polymeric frames from the self-assembly of silver(I) cations and sebaconitrile

Interesting interwoven polymeric frames have been obtained from the self-assembly of the flexible long-chain bidentate sebaconitrile (sebn, 1,10- decanedinitrile) and different silver salts. Out of the eight products isolated and characterized, six present a metal-to-ligand ratio of 1:2 and contain interpenetrated three-dimensional (3D) or two-dimensional (2D) structural motifs, that is [Ag(sebn)2](BF4) (1), [Ag(sebn)2](ClO4) (2), [Ag(sebn)2](PF6) (3), [Ag(sebn)2](SbF6) (4), [Ag(sebn)2](AsF6) (5b) and [Ag(sebn)2](CF3SO3) (6b). The remaining two derivatives, [Ag(sebn)](AsF6) (5a) and [Ag(sebn)](CF3SO3) (6a), present one-dimensional (1D) polymeric chains. Depending on the counterions and on the conformation of the ligands, different frameworks are obtained. These include the eight-fold interpenetrated diamondoid frame of 1 and 2, the fourfold interwoven 3D four- connected frame topologically related to the prototypical SrAl2of 3 and 5b, and the first example of an infinitely catenated 2D multiple layer in 4 and 6b. A unique example of self-organization of 1D chains, propagating in three directions to form a 3D entangled array, is observed in 5a