Tissue Mimicking Materials for Multi-Modality Breast Phantoms

The paper proposes two different Tissue Mimicking Material (TMM) techniques for the development of breast phantoms which are suitable for multi-modality imaging. In particular, the focus is on the behavior of dielectric and acoustic properties when fat, sodium chloride and sugar are added to the mixtures

Numerical Evaluation of Microwave Thermal Ablation to Treat Small Adrenocortical Masses

In this paper microwave thermal ablation is numerically evaluated in the context of a treatment for Conn’s Syndrome. This condition is caused by a benign shallow tumour in the cortex of adrenal gland. The modelling and design of microwave applicator to deliver thermal ablation to the adrenal gland requires accurate tissue characterisation. Measuring the dielectric properties of the constituent tissues in the adrenal gland, i.e. cortex and medulla, enables more accurate numerical modelling for electromagnetic and thermal simulations. This study presents an anatomically and dielectrically realistic numerical model of the adrenal gland, and investigates the feasibility of applying controlled heating to small targets in the adrenal cortex. In addition, the use of dielectric contrast between the fat and the cortex of the adrenal gland to focus the thermal energy in the gland has also been studied. Being conscious of limitations of numerical simulation of complex multiphysics problems like the microwave ablative treatment, calculated results provide a preliminary description of the electromagnetic and thermal phenomena involved

Adherence to antibiotic treatment guidelines and outcomes in the hospitalized elderly with different types of pneumonia

Background: Few studies evaluated the clinical outcomes of Community Acquired Pneumonia (CAP), Hospital-Acquired Pneumonia (HAP) and Health Care-Associated Pneumonia (HCAP) in relation to the adherence of antibiotic treatment to the guidelines of the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) in hospitalized elderly people (65 years or older). Methods: Data were obtained from REPOSI, a prospective registry held in 87 Italian internal medicine and geriatric wards. Patients with a diagnosis of pneumonia (ICD-9 480-487) or prescribed with an antibiotic for pneumonia as indication were selected. The empirical antibiotic regimen was defined to be adherent to guidelines if concordant with the treatment regimens recommended by IDSA/ATS for CAP, HAP, and HCAP. Outcomes were assessed by logistic regression models. Results: A diagnosis of pneumonia was made in 317 patients. Only 38.8% of them received an empirical antibiotic regimen that was adherent to guidelines. However, no significant association was found between adherence to guidelines and outcomes. Having HAP, older age, and higher CIRS severity index were the main factors associated with in-hospital mortality. Conclusions: The adherence to antibiotic treatment guidelines was poor, particularly for HAP and HCAP, suggesting the need for more adherence to the optimal management of antibiotics in the elderly with pneumonia

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

New clinical indications for microwave thermal ablation and corresponding challenges in the applicator design

Microwave Thermal Ablation (MTA) procedures for the treatment of solid tumours are spreading due to several advantages of the technique with respect to traditional approaches. The success of MTA treatments, combined with their low invasiveness and fast recovery times, allow developing the technique for different and new clinical indications. This contribution describes two possible new scenarios where MTA procedures could be applied, describing the engineering challenges to be considered and solved

Numerical sensitivity analysis for dielectric characterization of biological samples by open-ended probe technique

Dielectric characterization of biological tissues has become a fundamental aspect of the design of medical treatments based on electromagnetic energy delivery and their pre-treatment planning. Among several measuring techniques proposed in the literature, broadband and minimally-invasive open-ended probe measurements are best-suited for biological tissues. However, several challenges related to measurement accuracy arise when dealing with biological tissues in both ex vivo and in vivo scenarios such as very constrained set-ups in terms of limited sample size and probe positioning. By means of the Finite Integration Technique in the CST Studio Suite® software, the numerical accuracy of the reconstruction of the complex permittivity of a high water-content tissue such as liver and a low water-content tissue such as fat is evaluated for different sample dimensions, different location of the probe, and considering the influence of the background environment. It is found that for high water-content tissues, the insertion depth of the probe into the sample is the most critical parameter on the accuracy of the reconstruction. Whereas when low water-content tissues are measured, the probe could be simply placed in contact with the surface of the sample but a deeper and wider sample is required to mitigate biasing effects from the background environment. The numerical analysis proves to be a valid tool to assess the suitability of a measurement set-up for a target accuracy threshold

Manufacturer Perceptions of the Consequences of Task and Emotional Conflict Within Domestic Channels of Distribution

This study examines manufacturer\u27 perceptions of task and emotional conflict in domestic channels of distribution. Both are expected to depend on three antecedents (centralization, esprit de corps, and communication barriers) and to affect performance relative to competitors and manufacturer\u27s satisfaction directly and indirectly through strategy quality. The results support a positive link between task and emotional conflict and the deleterious effect of emotional conflict on satisfaction and performance