Una proposta di formazione dagli specializzandi per gli specializzandi: i "gruppi incognitivi"

PREMESSA: Dalla curiosit\ue0 e dai dubbi per questioni che quotidianamente incontriamo nella pratica clinica \ue8 nata l'idea di costruire un gruppo che, attraverso il confronto tra noi Specializzandi e la condivisione di approfondimenti su temi specifici, potesse dare delle risposte e stimolare nuovi interrogativi. Si \ue8 dato cos\uec vita a questo gruppo, chiamato, un po' socraticamente, gruppo incognitivo. Questi gli obiettivi originari: 1. soddisfare, in aggiunta all'offerta del regolare piano accademico, il nostro bisogno di "formazione continua", 2. Confrontarsi tra Specializzandi su questioni pragmatiche, 3. "imparare ad insegnare", attraverso la preparazione di una lezione e quindi la sua esposizione, 4. realizzare un compendio che potesse essere utilizzato "al letto del malato" e quindi fruito anche da chi non avesse la possibilit\ue0 di partecipare agli incontri OBIETTIVO: Tutti gli specializzandi della scuola di Specialit\ue0 in Geriatria sono stati invitati, di volta in volta, a partecipare agli incontri e a preparare una lezione da presentare al gruppo su un argomento di loro scelta. La partecipazione agli incontri era su base volontaria. La possibilit\ue0 di partecipare agli incontri era stata estesa anche a strutturati e studenti di medicina. Per ogni incontro si chiedeva di presentare un file in formato Word, di poche pagine, che sintetizzasse in versione schematica quanto espresso nella lezione. Gli specializzandi hanno utilizzato libri di testo, articoli scientifici e contenuti di Uptodate. Il luogo degli incontri \ue8 stato la biblioteca della scuola di Specialit\ue0 di Geriatria ove avevamo a disposizione un supporto multimediale per la proiezione delle presentazioni. La durata degli incontri \ue8 stata variabile, a seconda della complessit\ue0 dell'argomento e della scelta di colui che esponeva, nella media circa 80 minuti. RISULTATI: Da Ottobre 2014 a Maggio 2015 abbiamo svolto 13 incontri con contenuti trasversali. Di seguito l'elenco degli argomenti: malnutrizione nell'anziano, i criteri di Beers e i farmaci inappropriati nell'anziano, gli inibitori dell'acetilcolinesterasi (nota AIFA e scheda tecnica dei farmaci), algoritmo Advance Life Support, infezioni delle vie urinarie, terapia farmacologica dei disturbi del comportamento e psicologici nella demenza, reverse therapy della emorragie maggiori correlate agli anticoagulanti diretti ed indiretti, tachicardie sopraventricolari e ventricolari, dispnea acuta, polmonite, endocarditi, reazioni cutanee da farmaco (quest'ultimo presentato da una specializzanda in Dermatologia). Ogni incontro era monotematico e veniva presentato da uno o due specializzandi. Di solito l'argomento veniva esposto dalla stessa persona che l'aveva proposto. Tra i limiti di questo progetto l'"autoreferenzialit\ue0" in quanto le informazioni veicolate non sono state passate al vaglio di un specialista in materia, pertanto non sempre siamo riusciti a dare una risposta soddisfacente a tutti gli interrogativi emersi. Questo \ue8 stato comunque di stimolo per ulteriori approfondimenti. CONCLUSIONI: Abbiamo realizzato una compendio che raccoglie i contenuti degli incontri esposti sopra. Come gi\ue0 accennato sopra, ci\uf2 che rende questi contenuti particolarmente fruibili \ue8 la loro pragmaticit\ue0 per la pratica clinica. Abbiamo in previsione di proseguire con un secondo ciclo di incontri da settembre 2015. Tra gli argomenti gi\ue0 in programma: iponatremia, questioni di bioetica, reazioni trasfusionali, principi base di neuroimaging. L'obiettivo con il prossimo anno \ue8 quello di coinvolgere specializzandi di altre Scuole. L'ultimo incontro tenuto da una Specializzanda di Dermatologia ha avuto un impatto molto positivo e desideriamo ripetere l'esperienza

Cross-sectional study of community serostatus to highlight undiagnosed HIV infections with oral fluid HIV-1/2 rapid test in non-conventional settings

The submerged portion of undiagnosed HIV infection in Italy is about 30% of subjects found seropositive. This fact represents one of the most important public health problems hindering the control of infection progression. This means we need to fight unawareness and social stigma and promote easy and friendly access to HIV test. We developed a Prevention Program called \u201cEASY test Project\u201d, offering a new rapid HIV test on oral fluid, to evaluate the acceptability of an alternative, free and anonymous test available in different settings (on board a \u201cMotor Home\u201d at public events, Points of Care, STDs outpatient prevention units and GP surgeries). From December 2008 to December 2012 we performed 7,865 HIV saliva tests, with 50 new infections found (0.6% of the total) out of 140,000 informed subjects. From the self-reported characteristics of respondents, the population approaching the EAST test project was represented by males (70%) aged between 20 and 50 years, 61% with a medium-high education level, 62% homosexuals (MSM), 88% reported unsafe sexual behaviours, and 48% had never undergone an HIV screening test. In five years of the Prevention Program, 100% of subjects interviewed gave a general favorable consent in approaching rapid and not invasive screening, immediate return of the result, and a timely specialized approach and treatment of HIV positive subjects. Results from our study confirm that the rapid and alternative test may contribute to HIV prevention strategies and to the control of the spread of infection and HIV disease progression by reaching a larger population, particularly when and where regular screening procedures are difficult to obtain or are not preferred

Speed of Sound Results in 2,3,3,3-Tetrafluoropropene (R-1234yf) and trans-1,3,3,3-Tetrafluoropropene (R-1234ze(E)) in the Temperature Range of (260 to 360) K

Speed of sound measurements in high purity samples of two novel candidate refrigerants, 2,3,3,3-tetrafluoropropene (R-1234yf) and trans-1,3,3,3-tetrafluoropropene (R-1234ze(E)), are reported along five isotherms in the temperature range of (260 to 360) K and for pressures up to 10 MPa. The experimental technique is based on a double-reflector pulse-echo overlap method. The acoustic path lengths were obtained by a comparison with measurements in pure water carried out at atmospheric conditions. The speed of sound experimental results are characterized by an overall estimated uncertainty of less than of 0.1 %

La dimensió autobiogràfica de la Crònica de Muntaner

Ponència a càrrec de Jaume Aurell de la Universitat de Navarra, que explica la crònica de Ramon Muntaner com una manera de fer història des d'una perspectiva autobiogràfic

Vehicular Communication Systems : Enabling Technologies, Applications, and Future Outlook on Intelligent Transportation

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Application of acoustic methods for a non-destructive evaluation of the elastic properties of several typologies of materials

In solid phase materials, differently from what happens in the fluid phase, elastic waves propagate both through longitudinal and transverse waves. From the speed of propagation of longitudinal and transverse waves, it is possible to evaluate important elastic properties of the solids under study, namely the Young's modulus, the Poisson's coefficient, the bulk modulus and the shear modulus. This work suggests an accurate method for measuring wave propagation speeds in homogeneous and non-homogeneous materials with the purpose to evaluate their mechanical properties and the associated uncertainty. First of all, to assess the performance of the proposed methodology, based on the "pulse-echo" technique, in terms of accuracy and precision, measurements of wave propagation speeds have been carried out, in atmospheric conditions, in well-known homogeneous and isotropic materials, such as copper, aluminum, stainless steel and also polymethyl methacrylate (Plexiglas (R)), Teflon (R) and optical glass BK7. These results were compared with the values reported in literature (if present), showing how published speed of sound data are very disperse and not so reliable owing to the lack of a precise uncertainty evaluation and of the temperature value associated to the measurement. Then, the same experimental apparatus was used for measuring speed of sound as a function of temperature (from 274.15 to 313.15 K) for 304 stainless steel and oxygen free copper, showing a good accuracy of the results also for temperature conditions far from ambient. Finally, the same procedure was applied to a non-homogeneous solid, obtaining some very preliminary results in typical mediterranean building material, as Carrara marble

Factors influencing adverse skin responses in rats receiving repeated subcutaneous injections and potential impact on neurobehavior.

Repeated subcutaneous (s.c.) injection is a common route of administration in chronic studies of neuroactive compounds. However, in a pilot study we noted a significant incidence of skin abnormalities in adult male Long-Evans rats receiving daily s.c. injections of peanut oil (1.0 ml/kg) in the subscapular region for 21 d. Histopathological analyses of the lesions were consistent with a foreign body reaction. Subsequent studies were conducted to determine factors that influenced the incidence or severity of skin abnormalities, and whether these adverse skin reactions influenced a specific neurobehavioral outcome. Rats injected daily for 21 d with food grade peanut oil had an earlier onset and greater incidence of skin abnormalities relative to rats receiving an equal volume (1.0 ml/kg/d) of reagent grade peanut oil or triglyceride of coconut oil. Skin abnormalities in animals injected daily with peanut oil were increased in animals housed on corncob versus paper bedding. Comparison of animals obtained from different barrier facilities exposed to the same injection paradigm (reagent grade peanut oil, 1.0 ml/kg/d s.c.) revealed significant differences in the severity of skin abnormalities. However, animals from different barrier facilities did not perform differently in a Pavlovian fear conditioning task. Collectively, these data suggest that environmental factors influence the incidence and severity of skin abnormalities following repeated s.c. injections, but that these adverse skin responses do not significantly influence performance in at least one test of learning and memory