Access to Healthcare as a New Commons: Telemedicine as a Strategy for Providing Value-Based Healthcare Services in Rural Areas

Commons is a general term that refers to a resource shared by a group of people. Over the years, scholars have identified two generations of commons. The first generation of commons was about sharing of physical things; the second one is about intangible commons pool resources such as science and culture. These generally can be recognized as "rights" (Hess 2008). Among the various New Commons sectors there is medical and health. In the perspective of guaranteeing the right of Health, the ―Access to Healthcare‖ could be considered as a New Commons provided by worldwide National Healthcare Systems (NHS), However, healthcare sector is characterized by plenty of stakeholders with myriad, often, conflicting goals. The value-based approach (Porte, 2010) attempts to introduce a new universal language in healthcare management around the value for the patient that reconcile all stakeholders‘ interests. The goal of this approach is to improve the outcome and increase the number of treatments. This aim is very difficult to be enriched for rural residents; when patients live in remote areas, providing them with valuable medical care can be considered a hard challenge for the NHS, which has to be addressed also by the employment of new healthcare strategies and technologies. Defined as "a new healthcare delivery process provided when patient and professional are not physically in the same place" (Italian Ministry of Health, 2014), telemedicine could be seen as an answer to this challenge. Accordingly, this study aims at discovering if telemedicine employment can be effectively considered as a successful strategy to improve healthcare in location far from specialized hospital, enhancing the New Commons ―Access to care‖. A statistical-based narrative review of the literature was conducted in the field of telemedicine, with the aim to understand which experiences of telemedicine applications have got successful results as support of healthcare delivering in rural locations. With regards to rural and remote areas, several Authors recognized telemedicine-based strategies as a method to facilitate the access to healthcare in different medical disciplines. In particular, many studies highlight that telemedicine improves patient care by increasing the capacity of the rural clinician to manage patient locally, minimizing time away to support networks and reducing unnecessary transfers. Telemedicine could also be considered a cost-effective method whose outcomes remain similar (if not better) in quality to ―staffed‖ services, whose infrastructural costs could be easily paid-back

Wintertime thermal performance of green façades in a mediterranean climate

The increasing environmental issues have afforded opportunities for a widespread application of green systems in urban areas. Greening the building with green roofs and vertical green systems can be a design and retrofitting strategy to improve building energy performance in summer and in winter. Research efforts have been mainly concentrated on their energy saving function during warm periods. Green façades have a great application potential thanks to the space available in urban environment. The effect of green façades on building energy performance has been studied mainly for warm periods. In order to evaluate the effect during cold periods, an experiment was conducted in Bari, Italy, for two years. Pandorea jasminoides variegated and Rhyncospermum jasminoides were tested as evergreen climbing plants on walls; a third wall was used as control. The night-time temperature of the covered wall was higher than the uncovered wall temperature by up to 3.5°C, thanks to the presence of plants. The thermal barrier function performed by the vegetation layer was analysed. The influence of outdoor air temperature, relative humidity and wind velocity on the façades thermal effect during night-time was investigated. The experimental test demonstrated that both Pandorea jasminoides variegated and Rhyncospermum jasminoides are suitable for green façades in the Mediterranean climatic area during winter. The use of the green façades allowed increasing the thermal performance of the walls during night-time. They also reduced the surface temperature changes throughout the day

Research Trends on Greenhouse Engineering Using a Science Mapping Approach

Horticultural protected cultivation has spread throughout the world as it has proven to be extremely effective. In recent years, the greenhouse engineering research field has become one of the main research topics within greenhouse farming. The main objectives of the current study were to identify the major research topics and their trends during the last four decades by analyzing the co-occurrence network of keywords associated with greenhouse engineering publications. A total of 3804 pertinent documents published, in 1981-2021, were analyzed and discussed. China, the United States, Spain, Italy and the Netherlands have been the most active countries with more than 36% of the relevant literature. The keyword cluster analysis suggested the presence of five principal research topics: energy management and storage; monitoring and control of greenhouse climate parameters; automation of greenhouse operations through the internet of things (IoT) and wireless sensor network (WSN) applications; greenhouse covering materials and microclimate optimization in relation to plant growth; structural and functional design for improving greenhouse stability, ventilation and microclimate. Recent research trends are focused on real-time monitoring and automatic control systems based on the IoT and WSN technologies, multi-objective optimization approaches for greenhouse climate control, efficient artificial lighting and sustainable greenhouse crop cultivation using renewable energy

Optimizing single-photon-source heralding efficiency at 1550 nm using periodically poled lithium niobate

We explore the feasibility of using high conversion-efficiency periodically-poled crystals to produce photon pairs for photon-counting detector calibrations at 1550 nm. The goal is the development of an appropriate parametric down-conversion (PDC) source at telecom wavelengths meeting the requirements of high-efficiency pair production and collection in single spectral and spatial modes (single-mode fibers). We propose a protocol to optimize the photon collection, noise levels and the uncertainty evaluation. This study ties together the results of our efforts to model the single-mode heralding efficiency of a two-photon PDC source and to estimate the heralding uncertainty of such a source.Comment: 14 pages, 2 tables and 3 figures, final version accepted by Metrologi

A Pilot Study on Biochemical Profile of Follicular Fluid in Breast Cancer Patients

Breast cancer (BC) is the most common type of cancer among women in almost all countries worldwide and is one of the oncological pathologies for which is indicated fertility preservation, a type of procedure used to help keep a person's ability to have children. Follicular fluid (FF) is a major component of oocyte microenvironment, which is involved in oocyte growth, follicular maturation, and in communication between germ and somatic cells; furthermore, it accumulates all metabolites during oocytes growth. To obtain information about changes on fertility due to cancer, we aimed at investigating potential biomarkers to discriminate between FF samples obtained from 16 BC patients and 10 healthy women undergoing in vitro fertilization treatments. An NMR-based metabolomics approach was performed to investigate the FF metabolic profiles; ELISA and western blotting assays were used to investigate protein markers of oxidative and inflammatory stress, which are processes closely related to cancer. Our results seem to suggest that FFs of BC women display some significant metabolic alterations in comparison to healthy controls, and these variations are also related with tumor staging

Reduced Deadtime and Higher Rate Photon-Counting Detection using a Multiplexed Detector Array

We present a scheme for a photon-counting detection system that can be operated at incident photon rates higher than otherwise possible by suppressing the effects of detector deadtime. The method uses an array of N detectors and a 1-by-N optical switch with a control circuit to direct input light to live detectors. Our calculations and models highlight the advantages of the technique. In particular, using this scheme, a group of N detectors provides an improvement in operation rate that can exceed the improvement that would be obtained by a single detector with deadtime reduced by 1/N, even if it were feasible to produce a single detector with such a large improvement in deadtime. We model the system for continuous and pulsed light sources, both of which are important for quantum metrology and quantum key distribution applications.Comment: 6 figure

Avalanche Photo-Detection for High Data Rate Applications

Avalanche photo detection is commonly used in applications which require single photon sensitivity. We examine the limits of using avalanche photo diodes (APD) for characterising photon statistics at high data rates. To identify the regime of linear APD operation we employ a ps-pulsed diode laser with variable repetition rates between 0.5MHz and 80MHz. We modify the mean optical power of the coherent pulses by applying different levels of well-calibrated attenuation. The linearity at high repetition rates is limited by the APD dead time and a non-linear response arises at higher photon-numbers due to multiphoton events. Assuming Poissonian input light statistics we ascertain the effective mean photon-number of the incident light with high accuracy. Time multiplexed detectors (TMD) allow to accomplish photon- number resolution by photon chopping. This detection setup extends the linear response function to higher photon-numbers and statistical methods may be used to compensate for non-linearity. We investigated this effect, compare it to the single APD case and show the validity of the convolution treatment in the TMD data analysis.Comment: 16 pages, 5 figure

Role of Lipophilicity in the Activity of Hexameric Cyclic Peptoid Ion Carriers

Two families of hexameric cyclic peptoids decorated with linear N-alkyl and alternated N-alkyl/N-benzyl side chains (2 a\u2013d and 3 a\u2013c, respectively) were designed and synthesized in order to correlate their logP values (from 2.55 to 6.83) to their ionophoric activities. The present contribution confirms the general ability of hexameric cyclic peptoids to behave as efficient cation carriers, corroborates their preference for Na+ ion, among the tested alkali metals, and suggests a Na+/H+ antiport transport mechanism (rate limited by the transport of the proton) for these new ionophores. Our observations indicate that in order to attain an efficient ionophoric activity, a narrow range of liphophilicity is required (4<5). Moreover, to gain information on the solid state stucture of ionophoric cyclic peptoids with linear N-side chains, X-ray crystallographic studies were performed on exemplar compound 2 a. Crystal structure of compound 2 a confirms the tendency of ionophoric cyclopeptoids with linear N-side chains to form layered assemblies

Extended Adjuvant Endocrine Treatment in Luminal Breast Cancers in the Era of Genomic Tests

In patients with early-stage endocrine receptor-positive (ER+) breast cancer (BC), adjuvant endocrine therapy (ET) for 5 years is the standard of care. However, for some patients, the risk of recurrence remain high for up to 15 years after diagnosis and extended ET beyond 5 years may be a reasonable option. Nevertheless, this strategy significantly increases the occurrence of side effects. Here we summarize the available evidence from randomized clinical trials on the efficacy and safety profile of extended ET and discuss available clinical and genomic tools helpful to select eligible patients in daily clinical practice