Measuring parents’ perspective on continuity of care in children with special health care needs

INTRODUCTION: Children with special health care needs are an exponentially growing population needing integrated health care programmes that involve primary, community, hospital and tertiary care services. The aims of the study are (1) to develop and validate the Special Needs Kids Questionnaire (SpeNK-Q) designed to measure parents' perspective on continuity of care for children with special health care needs and (2) to evaluate the continuity of care based on parental experiences in this population. METHODS: SpeNK-Q was derived from a previous qualitative study and was based on Haggerty's constructs of informational, management and relational continuity. Parents of preterm birth children completed the 20-item SpeNK-Q at the second or subsequent planned follow-up visit after the child's hospital discharge. Principal component analysis was used to examine the structure of the instrument. RESULTS: Principal component analysis of 101 questionnaires administered allowed us to identify five factors explaining 60.2% of item variance: informational continuity; coordination of care; continuity of family-paediatrician relationship; family support; information on care plan. CONCLUSIONS AND DISCUSSION: SpeNK-Q proved to be a psychometrically promising instrument. Its utilisation could improve the identification of areas for service development, the delivery of coordinated care and support policy makers in redesigning integrated services

Prenatal tobacco smoke exposure increases hospitalizations for bronchiolitis in infants

BACKGROUND: Tobacco smoke exposure (TSE) is a worldwide health problem and it is considered a risk factor for pregnant women's and children's health, particularly for respiratory morbidity during the first year of life. Few significant birth cohort studies on the effect of prenatal TSE via passive and active maternal smoking on the development of severe bronchiolitis in early childhood have been carried out worldwide. METHODS: From November 2009 to December 2012, newborns born at ≥ 33 weeks of gestational age (wGA) were recruited in a longitudinal multi-center cohort study in Italy to investigate the effects of prenatal and postnatal TSE, among other risk factors, on bronchiolitis hospitalization and/or death during the first year of life. RESULTS: Two thousand two hundred ten newborns enrolled at birth were followed-up during their first year of life. Of these, 120 (5.4%) were hospitalized for bronchiolitis. No enrolled infants died during the study period. Prenatal passive TSE and maternal active smoking of more than 15 cigarettes/daily are associated to a significant increase of the risk of offspring children hospitalization for bronchiolitis, with an adjHR of 3.5 (CI 1.5-8.1) and of 1.7 (CI 1.1-2.6) respectively. CONCLUSIONS: These results confirm the detrimental effects of passive TSE and active heavy smoke during pregnancy for infants' respiratory health, since the exposure significantly increases the risk of hospitalization for bronchiolitis in the first year of lif

Impact of rhinovirus infections in children

Rhinovirus (RV) is an RNA virus that causes more than 50% of upper respiratory tract infections in humans worldwide. Together with Respiratory Syncytial Virus, RV is one of the leading causes of viral bronchiolitis in infants and the most common virus associated with wheezing in children aged between one and two years. Because of its tremendous genetic diversity (>150 serotypes), the recurrence of RV infections each year is quite typical. Furthermore, because of its broad clinical spectrum, the clinical variability as well as the pathogenesis of RV infection are nowadays the subjects of an in-depth examination and have been the subject of several studies in the literature. In fact, the virus is responsible for direct cell cytotoxicity in only a small way, and it is now clearer than ever that it may act indirectly by triggering the release of active mediators by structural and inflammatory airway cells, causing the onset and/or the acute exacerbation of asthmatic events in predisposed children. In the present review, we aim to summarize the RV infection’s epidemiology, pathogenetic hypotheses, and available treatment options as well as its correlation with respiratory morbidity and mortality in the pediatric population

A Vision-guided Dual Arm Sewing System for Stent Graft Manufacturing

This paper presents an intelligent sewing system for personalized stent graft manufacturing, a challenging sewing task that is currently performed manually. Inspired by medical suturing robots, we have adopted a single-sided sewing technique using a curved needle to perform the task of sewing stents onto fabric. A motorized surgical needle driver was attached to a 7 d.o.f robot arm to manipulate the needle with a second robot controlling the position of the mandrel. A learningfrom-demonstration approach was used to program the robot to sew stents onto fabric. The demonstrated sewing skill was segmented to several phases, each of which was encoded with a Gaussian Mixture Model. Generalized sewing movements were then generated from these models and were used for task execution. During execution, a stereo vision system was adopted to guide the robots to adjust the learnt movements according to the needle pose. Two experiments are presented here with this system and the results show that our system can robustly perform the sewing task as well as adapt to various needle poses. The accuracy of the sewing system was within 2mm

Risk factors for bronchiolitis hospitalization during the first year of life in a multicenter Italian birth cohort

BACKGROUND: Respiratory Syncytial Virus (RSV) is one of the main causes of respiratory infections during the first year of life. Very premature infants may contract more severe diseases and 'late preterm infants' may also be more susceptible to the infection. The aim of this study is to evaluate the risk factors for hospitalization during the first year of life in children born at different gestational ages in Italy. METHODS: A cohort of 33-34 weeks gestational age (wGA) newborns matched by sex and age with two cohort of newborns born at 35-37 wGA and > 37 wGA were enrolled in this study for a three-year period (2009-2012). Hospitalization for bronchiolitis (ICD-9 code 466.1) during the first year of life was assessed through phone interview at the end of the RSV season (November-March) and at the completion of the first year of life. RESULTS: The study enrolled 2314 newborns, of which 2210 (95.5 %) had a one year follow-up and were included in the analysis; 120 (5.4 %) were hospitalized during the first year of life for bronchiolitis. Children born at 33-34 wGA had a higher hospitalization rate compared to the two other groups. The multivariate analysis carried out on the entire population associated the following factors with higher rates for bronchiolitis hospitalization: male gender; prenatal treatment with corticosteroids; prenatal exposure to maternal smoking; singleton delivery; respiratory diseases in neonatal period; surfactant therapy; lack of breastfeeding; siblings <10 years old; living in crowded conditions and/or in unhealthy households and early exposure to the epidemic RSV season. When analysis was restricted to preterms born at 33-34 wGA the following variables were associated to higher rates of bronchiolitis hospitalization: male gender, prenatal exposure to maternal smoking, neonatal surfactant therapy, having siblings <10 years old, living in crowded conditions and being exposed to epidemic season during the first three months of life. CONCLUSION: Our study identified some prenatal, perinatal and postnatal conditions proving to be relevant and independent risk factors for hospitalization for bronchiolitis during the first year of life. The combination of these factors may lead to consider palivizumab prophylaxis in Italy

Passive immunoprophylaxis against respiratory syncytial virus in children: Where are we now?

Respiratory syncytial virus (RSV) represents the main cause of acute respiratory tract infections in children worldwide and is the leading cause of hospitalization in infants. RSV infection is a self-limiting condition and does not require antibiotics. However hospitalized infants with clinical bronchiolitis often receive antibiotics for fear of bacteria coinfection, especially when chest radiography is performed due to similar radiographic appearance of infiltrate and atelectasis. This may lead to unnecessary antibiotic prescription, additional cost, and increased risk of development of resistance. Despite the considerable burden of RSV bronchiolitis, to date, only symptomatic treatment is available, and there are no commercially available vaccines. The only licensed passive immunoprophylaxis is palivizumab. The high cost of this monoclonal antibody (mAb) has led to limiting its prescription only for high-risk children: infants with chronic lung disease, congenital heart disease, neuromuscular disorders, immunodeficiencies, and extreme preterm birth. Nevertheless, it has been shown that the majority of hospitalized RSV-infected children do not fully meet the criteria for immune prophylaxis. While waiting for an effective vaccine, passive immune prophylaxis in children is mandatory. There are a growing number of RSV passive immunization candidates under development intended for RSV prevention in all infants. In this review, we describe the state-of-the-art of palivizumab’s usage and summarize the clinical and preclinical trials regarding the development of mAbs with a better cost-effectiveness ratio

A multi-robot cooperation framework for sewing personalized stent grafts

This paper presents a multi-robot system for manufacturing personalized medical stent grafts. The proposed system adopts a modular design, which includes: a (personalized) mandrel module, a bimanual sewing module, and a vision module. The mandrel module incorporates the personalized geometry of patients, while the bimanual sewing module adopts a learning-by-demonstration approach to transfer human hand-sewing skills to the robots. The human demonstrations were firstly observed by the vision module and then encoded using a statistical model to generate the reference motion trajectories. During autonomous robot sewing, the vision module plays the role of coordinating multi-robot collaboration. Experiment results show that the robots can adapt to generalized stent designs. The proposed system can also be used for other manipulation tasks, especially for flexible production of customized products and where bimanual or multi-robot cooperation is required

On the surface and beyond. Degradation morphologies affecting plant ash‐based archaeological glass from Kafir Kala (Samarkand, Uzbekistan)

The study focuses on an assemblage of glass finds from the citadel of Kafir Kala, Uzbekistan, located along one of the major Eurasian branches of the “Silk Roads” with a consistent occupation between the 8th and 12th century CE. Glass fragments for this study were selected based on marked surface alterations they showed, with stratified deposits of different thickness and colours. Starting from a preliminary observation under Optical Microscope, fragments were clustered into four main groups based on the surface appearance of the alterations; Scanning Electron Microscopy investigations of the stratigraphy of the alteration products were then carried out, to evaluate micro‐textural, morphological and compositional features. Data from the analyses allowed identifying preferential patterns of development of the various degradation morphologies, linkable to compositional alterations of the glass due to burial environment and the alkali leaching action of the water. Iridescence, opaque weathering (at times associated with black stains), and blackening were identified as recurring degradation morphologies; as all but one sample were made of plant ash‐based glass, results show no specific correlation between glass composition and the occurrence of one or the other degradation pattern, often found together. Framed in a broad scenario, the paper aims to set the basis for the development of a study approach dedicated to the degradation morphologies affecting archaeological glasses, a topic still lacking systematisation and in‐depth dedicated literature

Lessons learnt from case studies : TOOLBOX OF KNOWLEDGE, EXPERIENCES AND GOOD PRACTICES. Outcome of the TRACKs project

The project Transition Children and Kindergarten (TRACKs) is funded by the Erasmus+ European program and it is carried out in partnership with different institutions in three partner countries: Poland, Italy and Belgium. The University institutions are the Jagiellonian University of Krakow in Poland, the University of Bologna in Italy, and the University of Ghent in Belgium. Other local educational organizations collaborating are Artevelde University College in Belgium, the Komensky Institute in Poland, and the Cooperativa Assistenza Disabili Infermi Anziani Infanzia (CADIAI) in Italy. The purpose of our project is to focus on the voices of practitioners \u2013 such as Early Childhood Education and Care (ECEC) professionals currently working with children aged 1 to 6 years old \u2013 and future ECEC professionals, such as early years educators and pre-school teachers still in training. The project\u2019s foundation rests on the dynamic exchange of knowledge and practice between the two target groups in the three countries involved in the project. This transnational exchange between the ECEC professionals across the three European Member States is intended to improve quality of learning, assuming that the international contexts can feed into each other, exchange solutions and practices and respond to shared challenges. A further essential purpose of the project is providing high quality learning opportunities and nurturing environments for all children, especially those coming from multiply marginalized backgrounds, and those that are experiencing social inequalities, poverty and racism. Drawing on the method of video-coaching and video-analysis, the project encourages high-quality interaction of ECEC professionals with children (Fukkink & Lont, 2007; Fukkink & Tavecchio, 2010; Fukkink, Trienekens & Kramer, 2010). The research teams and professionals from the different countries observe the video recordings collectively, or in one-to-one sessions, and reflect on the interactions between professionals and children and among children. This report will shed light on the contextual conditions where such tools and methods were implemented and how. The purpose is to show how the video-coaching methodology can be implemented in different ways in relation to diverse contexts (\u2018no one model fits all\u2019). This will also facilitate reflection by trainers/pedagogical leaders/coordinators who might want to use this methodology in their services/with their teams on how to develop context-appropriate procedures and tools that make it relevant to the settings/professionals within which/with whom they are working