Implementing clinical guidelines in an organizational setup

Outcomes research in healthcare has been a topic much addressed in recent years. Efforts in this direction have been supplemented by work in the areas of guidelines for clinical practice and computer-interpretable workflow and careflow models.In what follows we present the outlines of a framework for understanding the relations between organizations, guidelines, individual patients and patient-related functions. The derived framework provides a means to extract the knowledge contained in the guideline text at different granularities, in ways that can help us to assign tasks within the healthcare organization and to assess clinical performance in realizing the guideline. It does this in a way that preserves the flexibility of the organization in the adoption of the guidelines

The puzzling symbiotic X-ray system 4U1700+24

Symbiotic X-ray binaries form a subclass of low-mass X-ray binary systems consisting of a neutron star accreting material from a red giant donor star via stellar wind or Roche lobe overflow. Only a few confirmed members are currently known; 4U 1700+24 is a good candidate as it is a relatively bright X-ray object, possibly associated with the late-type star V934 Her. We analysed the archive {\it XMM}-Newton and Swift/XRT observations of 4U 1700+24 in order to have a uniform high-energy ($0.3-10$ keV) view of the source. We confirmed the existence of a red-shifted O VIII Ly-$\alpha$ transition (already observed in the 2002 {\it XMM}-Newton data) in the high-resolution spectra collected via the RGS instruments. The red-shift of the line is found in all the analysed observations and, on average, it was estimated to be $\simeq 0.009$. We also observed a modulation of the centroid energy of the line on short time scales (a few days) and discuss the observations in the framework of different scenarios. If the modulation is due to the gravitational red-shift of the neutron star, it might arise from a sudden re-organization of the emitting $X$-ray matter on the scale of a few hundreds of km. Alternatively, we are witnessing a uni-polar jet of matter (with typical velocity of $1000-4000$ km s$^{-1}$) possibly emitted by the neutron star in an almost face-on system. The second possibility seems to be required by the apparent lack of any modulation in the observed $X$-ray light curve. We also note also that the low-resolution spectra (both {\it XMM}-Newton and Swift/XRT in the $0.3-10$ keV band) show the existence of a black body radiation emitted by a region (possibly associated with the neutron star polar cap) with typical size from a few tens to hundreds of meters. The size of this spot-like region reduces as the overall luminosity of 4U 1700+24 decreases.Comment: In press on A&

Efficient and stable perovskite large area cells by low-cost fluorene-xantene-based hole transporting layer

Among the new generation photovoltaics, perovskite solar cell (PSC) technology reached top efficiencies in a few years. Currently, the main objective to further develop PSCs is related to the fabrication of stable devices with cost-effective materials and reliable fabrication processes to achieve a possible industrialization pathway. In the n-i-p device configuration, the hole transporting material (HTM) used most is the highly doped organic spiro-fluorene-based material (Spiro-OMeTAD). In addition to the high cost related to its complex synthesis, this material has different issues such as poor photo, thermal and moisture stability. Here, we test on small and large area PSCs a commercially available HTM (X55, Dyenamo) with a new core made by low-cost fluorene-xantene units. The one-pot synthesis of this compound reduces 30 times its cost with respect to Spiro-OMeTAD. The optoelectronic performances and properties are characterized through JV measurement, IPCE (incident photon to current efficiency), steady-state photoluminescence and ISOS stability test. SEM (scanning electron microscope) images reveal a uniform and pinhole free coverage of the X55 HTM surface, which reduces the charge recombination losses and improves the device performance relative to Spiro-OMeTAD from 16% to 17%. The ISOS-D-1 stability test on large area cells without any encapsulation reports an efficiency drop of about 15% after 1000 h compared to 30% for the reference case

Correction to: Morphological analysis and features of the landslide dams in the Cordillera Blanca, Peru

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Learning Opinion Dynamics From Social Traces

Opinion dynamics - the research field dealing with how people's opinions form and evolve in a social context - traditionally uses agent-based models to validate the implications of sociological theories. These models encode the causal mechanism that drives the opinion formation process, and have the advantage of being easy to interpret. However, as they do not exploit the availability of data, their predictive power is limited. Moreover, parameter calibration and model selection are manual and difficult tasks. In this work we propose an inference mechanism for fitting a generative, agent-like model of opinion dynamics to real-world social traces. Given a set of observables (e.g., actions and interactions between agents), our model can recover the most-likely latent opinion trajectories that are compatible with the assumptions about the process dynamics. This type of model retains the benefits of agent-based ones (i.e., causal interpretation), while adding the ability to perform model selection and hypothesis testing on real data. We showcase our proposal by translating a classical agent-based model of opinion dynamics into its generative counterpart. We then design an inference algorithm based on online expectation maximization to learn the latent parameters of the model. Such algorithm can recover the latent opinion trajectories from traces generated by the classical agent-based model. In addition, it can identify the most likely set of macro parameters used to generate a data trace, thus allowing testing of sociological hypotheses. Finally, we apply our model to real-world data from Reddit to explore the long-standing question about the impact of backfire effect. Our results suggest a low prominence of the effect in Reddit's political conversation.Comment: Published at KDD202

Cocirculation of Hajj and non-Hajj strains among serogroup W meningococci in Italy, 2000 to 2016

In Italy, B and C are the predominant serogroups among meningococci causing invasive diseases. Nevertheless, in the period from 2013 to 2016, an increase in serogroup W Neisseria meningitidis (MenW) was observed. This study intends to define the main characteristics of 63 MenW isolates responsible of invasive meningococcal disease (IMD) in Italy from 2000 to 2016. We performed whole genome sequencing on bacterial isolates or single gene sequencing on culturenegative samples to evaluate molecular heterogeneity. Our main finding was the cocirculation of the Hajj and the South American sublineages belonging to MenW/ clonal complex (cc)11, which gradually surpassed the MenW/cc22 in Italy. All MenW/cc11 isolates were fully susceptible to cefotaxime, ceftriaxone, ciprofloxacin, penicillin G and rifampicin. We identified the fulllength NadA protein variant 2/3, present in all the MenW/cc11. We also identified the fHbp variant 1, which we found exclusively in the MenW/cc11/Hajj sublineage. Concern about the epidemic potential of MenW/cc11 has increased worldwide since the year 2000. Continued surveillance, supported by genomic characterisation, allows high-resolution tracking of pathogen dissemination and the detection of epidemicassociated strains

NIGER-DELTA: ENVIRONMENT, OGONI CRISIS AND THE STATE

Among the well agreed-on benefits of a guideline computerisation, with respect to the traditional text format, there are the disambiguation, the possibility of looking at the guideline at different levels of detail and the possibility of generating patient-tailored suggestions. Nevertheless, the connection of guidelines with patient records is still a challenging problem, as well as their effective integration into the clinical workflow. In this paper, we describe the evolution of our environment for representing and running guidelines. The main new features concern the choice of a commercial product as the middle layer with the electronic patient record, the consequent possibility of gathering information from different legacy systems, and the extension of this "virtual medical record" to the storage of process data. This last feature allows managing exceptions, i.e. decisions that do not comply with guidelines

Genome-based study of a spatio-temporal cluster of invasive meningococcal disease due to Neisseria meningitidis serogroup C, clonal complex 11

SummaryObjectivesTo describe a spatio-temporal cluster of invasive meningococcal disease (IMD) due to serogroup C meningococci, occurred in a restricted area of Tuscany between January and October 2015, and the results of whole genome sequencing (WGS).MethodsSurveillance activities and public health measures were implemented in the Region. Bacterial isolates from IMD cases were characterized by the National Reference Laboratory of the Istituto Superiore di Sanità (ISS), and WGS was performed on available strains. The kSNP software was used to identify core genome SNPs.ResultsOverall, 28 IMD cases due to meningococcus C were identified up to 31st October, 2015. Of them, 26 were due to meningococcus C:P1.5-1,10-8: F3-6:ST-11 (cc11) and 2 to C:P1.5-1,10-8: F3-6:ST-2780 (cc11). WGS of 13 meningococci isolated during the outbreak occurred in Tuscany in 2015 showed higher similarity when compared with those of 47 C: P1.5-1,10-8: F3-6:ST-11 (cc11) invasive strains from sporadic cases previously detected in Italy.ConclusionsA highly aggressive meningococcal C strain was involved in the cluster of severe IMD occurred in Tuscany, a Region with high vaccine coverage among children. Whether this was due to low herd immunity related to the short duration of vaccine protection needs further investigation