Out-of-hours primary care services: Demands and patient referral patterns in a Veneto region (Italy) Local Health Authority

open7PURPOSE: The aim of this study was to describe the characteristics of patients admitted to an out-of-hours (OOH) service and to analyze the related outputs. SETTING: A retrospective population-based cohort study was conducted by analyzing an electronic database recording 23,980 OOH service contacts in 2011 at a Local Health Authority in the Veneto Region (North-East Italy). METHOD: A multinomial logistic regression was used to compare the characteristics of contacts handled by the OOH physicians with cases referred to other services. RESULTS: OOH service contact rates were higher for the oldest and youngest age groups and for females rather than males. More than half of the contacts concerned patients who were seen by a OOH physician. More than one in three contacts related problems managed over the phone; only ≈10% of the patients were referred to other services. Many factors, including demographic variables, process-logistic variables and clinical characteristics of the contact, were associated with the decision to visit the patient's home (rather than provide telephone advice alone), or to refer patients to an ED or to a specialist. Our study demonstrated, even after adjusting, certain OOH physicians were more likely than their colleagues to refer a patient to an ED. CONCLUSION: Our study shows that OOH services meet composite and variously expressed demands. The determining factors associated with cases referred to other health care services should be considered when designing clinical pathways in order to ensure a continuity of care. The unwarranted variability in OOH physicians' performance needs to be addressed.Purpose: The aim of this study was to describe the characteristics of patients admitted to an out-of-hours (OOH) service and to analyze the related outputs. Setting: A retrospective population-based cohort study was conducted by analyzing an electronic database recording 23,980 OOH service contacts in 2011 at a Local Health Authority in the Veneto Region (North-East Italy). Method: A multinomial logistic regression was used to compare the characteristics of contacts handled by the OOH physicians with cases referred to other services. Results: OOH service contact rates were higher for the oldest and youngest age groups and for females rather than males. More than half of the contacts concerned patients who were seen by a OOH physician. More than one in three contacts related problems managed over the phone; only ≈10% of the patients were referred to other services. Many factors, including demographic variables, process-logistic variables and clinical characteristics of the contact, were associated with the decision to visit the patient's home (rather than provide telephone advice alone), or to refer patients to an ED or to a specialist. Our study demonstrated, even after adjusting, certain OOH physicians were more likely than their colleagues to refer a patient to an ED. Conclusion: Our study shows that OOH services meet composite and variously expressed demands. The determining factors associated with cases referred to other health care services should be considered when designing clinical pathways in order to ensure a continuity of care. The unwarranted variability in OOH physicians' performance needs to be addressed.openBuja, Alessandra; Toffanin, R; Rigon, S; Sandona', Paolo; Carraro, D; Damiani, G; Baldo, VincenzoBuja, Alessandra; Toffanin, R; Rigon, S; Sandona', Paolo; Carraro, D; Damiani, G; Baldo, Vincenz

Towards a Model-Based Field-Frequency Lock for Fast-Field Cycling NMR

Fast-field cycling nuclear magnetic resonance (FFC NMR) relaxometry allows to investigate molecular dynamics of complex materials. FFC relaxometry experiments require the magnetic field to reach different values in few milliseconds and field oscillations to stay within few ppms during signal acquisition. Such specifications require the introduction of a novel field-frequency lock (FFL) system. In fact, control schemes based only on current feedback may not guarantee field stability, while standard FFLs are designed to handle very slow field fluctuations, such as thermal derives, and may be ineffective in rejecting faster ones. The aim of this work is then to propose a methodology for the synthesis of a regulator that guarantees rejection of field fluctuations and short settling time. Experimental trials are performed for both model validation and evaluation of the closed-loop performances. Relaxometry experiments are performed to verify the improvement obtained with the new FFL. The results highlight the reliability of the model and the effectiveness of the overall approach

Portable Bio/Chemosensoristic Devices: Innovative Systems for Environmental Health and Food Safety Diagnostics

This mini-review covers the newly developed biosensoristic and chemosensoristic devices described in recent literature for detection of contaminants in both environmental and food real matrices. Current needs in environmental and food surveillance of contaminants require new simplified, sensitive systems, which are portable and allow for rapid and on-site monitoring and diagnostics. Here, we focus on optical and electrochemical bio/chemosensoristic devices as promising tools with interesting analytical features that can be potentially exploited for innovative on-site and real-time applications for diagnostics and monitoring of environmental and food matrices (e.g., agricultural waters and milk). In near future, suitably developed and implemented bio/chemosensoristic devices will be a new and modern technological solution for the identification of new quality and safety marker indexes as well as for a more proper and complete characterization of abovementioned environmental and food matrices. Integrated bio/chemosensoristic devices can also allow an “holistic approach” that may prove to be more suitable for diagnostics of environmental and food real matrices, where the copresence of more bioactive substances is frequent. Therefore, this approach can be focused on the determination of net effect (mixture effect) of bioactive substances present in real matrices

Correlation between biochemical composition and magnetic resonance appearance of articular cartilage

AbstractObjective: The objective of this study was to find a correlation between magnetic resonance (MR) appearance and biochemical composition of the normal articular cartilage by comparing the laminar aspects with the distribution of the two principal matrix components: proteoglycans and collagen.Design: T2-weighted MR microimages of porcine cartilage-bone plugs, excised from both the habitually loaded and habitually unloaded regions of the proximal end of the humerus, were obtained using a spin-echo sequence. Proteoglycans (PGs) were monitored by histology and by measuring the uronate and the sulfur content of the tissue; a histological method and the chemical determination of hydroxyproline were used for the evaluation of the collagen content.Results: The ‘loaded’ cartilage exhibited the expected MR laminar appearance whereas the ‘unloaded’ tissue appeared to be more homogeneous. The PG content in the ‘loaded’ cartilage, was found to be 2.4 times higher than in the habitually unloaded tissue, exhibiting an increasing trend from the articular surface to the bone. In the ‘unloaded’ cartilage the uronate distribution was more uniform with a higher concentration in the intermediate zone. The mean collagen content of both cartilage regions was found to be about 39% of the tissue dry weight. Histology and hydroxyproline distribution pattern showed that collagen was particularly concentrated at the surface and in a central zone of the ‘loaded’ cartilage whereas in the ‘unloaded’ tissue collagen was evident only at the surface. In accordance with the collagen distribution, transverse relaxation (T2) times in ‘loaded’ cartilage showed a minimum value at the articular surface and another minimum in a central region. On the contrary, the average T2value of the ‘unloaded’ tissue was high at the surface and decreased rapidly in the deeper zones.Conclusion: These results demonstrate that the MR appearance of articular cartilage correlates with the collagen content, but not with that of PGs, of the different zones. Other matrix components might, however, influence the MR appearance by contributing to the macromolecular organization of the tissue

A Perspective on Recent Advances in Phosphorene Functionalization and its Application in Devices

Phosphorene, the 2D material derived from black phosphorus, has recently attracted a lot of interest for its properties, suitable for applications in material science. In particular, the physical features and the prominent chemical reactivity on its surface render this nanolayered substrate particularly promising for electrical and optoelectronic applications. In addition, being a new potential ligand for metals, it opens the way for a new role of the inorganic chemistry in the 2D world, with special reference to the field of catalysis. The aim of this review is to summarize the state of the art in this subject and to present our most recent results in preparation, functionalization and use of phosphorene and its decorated derivatives. In particular, we discuss several key points, which are currently under investigation: the synthesis, the characterization by theoretical calculations, the high pressure behaviour of black phosphorus, as well as decoration with nanoparticles and encapsulation in polymers. Finally, device fabrication and electrical transport measurements are overviewed on the basis of recent literature and new results collected in our laboratories

Developing a new clinical governance framework for chronic diseases in primary care: an umbrella review

OBJECTIVES: Our goal is to conceptualise a clinical governance framework for the effective management of chronic diseases in the primary care setting, which will facilitate a reorganisation of healthcare services that systematically improves their performance. SETTING: Primary care. PARTICIPANTS: Chronic Care Model by Wagner et aland Clinical Governance statement by Scally et alwere taken for reference. Each was reviewed, including their various components. We then conceptualised a new framework, merging the relevant aspects of both. INTERVENTIONS: We conducted an umbrella review of all systematic reviews published by the Cochrane Effective Practice and Organisation of Care Group to identify organisational interventions in primary care with demonstrated evidence of efficacy. RESULTS: All primary healthcare systems should be patient-centred. Interventions for patients and their families should focus on their values; on clinical, professional and institutional integration and finally on accountability to patients, peers and society at large. These interventions should be shaped by an approach to their clinical management that achieves the best clinical governance, which includes quality assurance, risk management, technology assessment, management of patient satisfaction and patient empowerment and engagement. This approach demands the implementation of a system of organisational, functional and professional management based on a population health needs assessment, resource management, evidence-based and patient-oriented research, professional education, team building and information and communication technologies that support the delivery system. All primary care should be embedded in and founded on an active partnership with the society it serves. CONCLUSIONS: A framework for clinical governance will promote an integrated effort to bring together all related activities, melding environmental, administrative, support and clinical elements to ensure a coordinated and integrated approach that sustains the provision of better care for chronic conditions in primary care setting

First Use of Model Predictive Control in Outpatient Wearable Artificial Pancreas

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In pursuit of visual attention: SSVEP frequency-tagging moving targets.

Previous research has shown that visual attention does not always exactly follow gaze direction, leading to the concepts of overt and covert attention. However, it is not yet clear how such covert shifts of visual attention to peripheral regions impact the processing of the targets we directly foveate as they move in our visual field. The current study utilised the co-registration of eye-position and EEG recordings while participants tracked moving targets that were embedded with a 30 Hz frequency tag in a Steady State Visually Evoked Potentials (SSVEP) paradigm. When the task required attention to be divided between the moving target (overt attention) and a peripheral region where a second target might appear (covert attention), the SSVEPs elicited by the tracked target at the 30 Hz frequency band were significantly, but transiently, lower than when participants did not have to covertly monitor for a second target. Our findings suggest that neural responses of overt attention are only briefly reduced when attention is divided between covert and overt areas. This neural evidence is in line with theoretical accounts describing attention as a pool of finite resources, such as the perceptual load theory. Altogether, these results have practical implications for many real-world situations where covert shifts of attention may discretely reduce visual processing of objects even when they are directly being tracked with the eyes

Central processing overlap modulates P3 latency

Two experiments examined the issue of the functional mechanisms exerting a modulatory effect on the latency of the P3. In experiment 1, using a psychological refractory period (PRP) paradigm, two sequential stimuli (T1 and T2) were presented in each trial at varying stimulus onset asynchronies (SOAs), each requiring a speeded choice response. Substantial lengthening of the reaction time to T2 was observed as SOA decreased (i.e., PRP effect). A systematic investigation of the T2-locked P3 component amplitude and latency was undertaken to discover whether either of these P3 parameters was correlated with the PRP effect. The results showed lengthening of the T2-locked P3 component latency as SOA was decreased, and, across subjects, a positive correlation between the PRP effect and P3 latency lengthening. No SOA-dependent P3 amplitude variation was observed. In experiment 2, the P3 component was measured under single-task conditions. P3 amplitude was higher under single-task than under dual-task conditions, but no SOA-dependent latency variations were observed in this experiment. Overall, the results of both experiments support the notion that part of the processing reflected in P3 activity occurs at or after the locus of the PRP effect, thus suggesting strongly that central mechanisms are involved in P3 latency variations

Physical management of grapes andd its impact on wine microbiota in a biodynamic winery

Introduction Carbonic maceration is a traditional winemaking practice, today there are difficulties in its managing because the anaerobiosis stimulates spoilage microorganisms. The work elucidates the reasons of these difficulties and identified some microbial groups rarely associated to winemaking. The ratio of ethanol accumulation, along with physical management of grapes and the supply of oxygen during the early stages of winemaking, are powerful instruments of oenological variability, able to offer new possibilities to winemakers in order to defining the quality of red wines. The work investigates the impact of grapes processing at the beginning of winemaking on the composition of microbiota during the oenological fermentations. Materials and Methods The experiments were conducted in a biodynamic winery to exclude interference due to microbial starters. 3 winemaking protocols, with different pre-fermentative management of grapes, were followed by plate count and Next Generation Sequencing (NGS) on 16S for bacteria and ITS for yeast. Chemical and sensory characterization of wine was performed. Results The grape processing influenced the evolution of microbiota (especially lactic and acetic bacteria) and the fermentation rate. The highest biodiversity was observed in the experiment carried out with whole grapes and carbonic maceration, with the presence of bacterial groups not usually found in winemaking (Bacteroidales, Clostridiales, Oscillospira). The different microbiotas influenced the organic acid profile of wines, the content of biogenic ammines, and the perception of organoleptic descriptors linked to the vine cultivar (Syrah). Conclusions Carbonic maceration impacts on the evolution of the microbiota and the wine features. The absence of addition of starters and sulphur dioxide would seem correlate to the high microbial biodiversity. The differences in microbial populations obtained in the experimental winemaking processes influenced the metabolic pathways for the consumption of sugars and therefore resulted in wines with different chemical and sensory profiles