Reorganizing territorial healthcare to avoid inappropriate ED visits: does the spread of Community Health Centres make Walk-in-Clinics redundant?

BACKGROUND: Community care has recently been restructured with the development of Community Health Centres (CHCs), forcing a general rethink on the survival of previous organizational solutions adopted to reduce inappropriate ED access, for example Walk-in-Clinics (WiCs). METHODS: We focus on the Italian Emilia-Romagna Region that has made huge investments in CHC development, whilst failing to proceed at a uniform rate from area to area. Estimating panel count data models for the period 2015-2018, we pursue two goals. First we test the existence of a "CHC effect", choosing five urban cities with different degree of development of the CHC model and assessing whether, all else being equal, patients treated by GPs who have their premises inside the CHC show a lower need to seek inappropriate care (Aim 1). Second, we focus our attention on Walk-in-Clinics, investigating the long-established WiC in the city of Parma that currently coexists with three CHCs recently established in the same catchment area. In this case we try to assess whether, and to what extent, the progressive development of the CHCs in the city of Parma has been affecting the dynamics of WiC access (Aim 2). RESULTS: As regards Aim 1, we show that CHCs reduce the probability of inappropriate patient access to emergency care. As regards Aim 2, in the city of Parma patients whose GP belongs to the CHC are less likely to visit the WiC on a workday, with no significant change during the weekend when CHCs are closed, questioning the need to maintain them both in the same area when the CHC model is fully implemented. CONCLUSIONS: Our results confirm the hypothesis that expanding access to primary care settings diminishes inappropriate ED use. In addition, our findings suggest that where CHCs and WiCs coexist in the same area, it may be advisable to implement strategies that bring WiC activities into step with CHC-based general primary care reforms to avoid duplication

Effectiveness of defatted seed meals from Brassicaceae with or without crude glycerin against black grass ( Alopecurus myosuroides Huds.)

Herbicide resistance has become an increasing problem, and at the same time pesticide usage is declining due to stringent EU pesticide legislation which aims to reduce the impact on environment and human health. For these reasons, new alternative integrated weed management approaches are becoming increasingly relevant. Formulations based on Brassica defatted seed meals (DSMs) and glycerin, have previously been shown to be effective in reducing the germination of lettuce seed. In this work five DSMs, formulated with and without crude glycerin, were chosen for in vitro and glasshouse experiments: i) Brassica nigra, ii) Brassica tournefortii, iii) Eruca sativa, iv) Rapistrum rugosum and v) Sinapis alba. Black-grass (Alopecurus myosuroides), a weed demonstrating extensive herbicide resistance, was used as a target, and the germination inhibition caused on this weed by Brassica defatted seed meals was assessed. In both in vitro and in vivo experiments, the most effective DSM for inhibiting germination of both lettuce and black-grass seeds was the sinigrin containing DSM, Brassica nigra. The aim of the manuscript was to suggest a new high value application for Brassicas derived DSM as a co-products from the vegetable oil production chain. The proposed treatments could represent an interesting and 100% novel natural alternative to the conventional herbicides

Architectures and Key Technical Challenges for 5G Systems Incorporating Satellites

Satellite Communication systems are a promising solution to extend and complement terrestrial networks in unserved or under-served areas. This aspect is reflected by recent commercial and standardisation endeavours. In particular, 3GPP recently initiated a Study Item for New Radio-based, i.e., 5G, Non-Terrestrial Networks aimed at deploying satellite systems either as a stand-alone solution or as an integration to terrestrial networks in mobile broadband and machine-type communication scenarios. However, typical satellite channel impairments, as large path losses, delays, and Doppler shifts, pose severe challenges to the realisation of a satellite-based NR network. In this paper, based on the architecture options currently being discussed in the standardisation fora, we discuss and assess the impact of the satellite channel characteristics on the physical and Medium Access Control layers, both in terms of transmitted waveforms and procedures for enhanced Mobile BroadBand (eMBB) and NarrowBand-Internet of Things (NB-IoT) applications. The proposed analysis shows that the main technical challenges are related to the PHY/MAC procedures, in particular Random Access (RA), Timing Advance (TA), and Hybrid Automatic Repeat reQuest (HARQ) and, depending on the considered service and architecture, different solutions are proposed.Comment: Submitted to Transactions on Vehicular Technologies, April 201

Scattering into Cones and Flux across Surfaces in Quantum Mechanics: a Pathwise Probabilistic Approach

We show how the scattering-into-cones and flux-across-surfaces theorems in Quantum Mechanics have very intuitive pathwise probabilistic versions based on some results by Carlen about large time behaviour of paths of Nelson diffusions. The quantum mechanical results can be then recovered by taking expectations in our pathwise statements.Comment: To appear in Journal of Mathematical Physic

A CBCT based analysis of the correlation between volumetric morphology of the frontal sinuses and the facial growth pattern in caucasian subjects. A cross-sectional study

open7noBackground: The aim of this study was to evaluate the relationship between frontal sinus shape and facial growth pattern. Methods: The three-dimensional examination was carried out by means of 80 CBCT scans selected from a sample of 1247 records of patients treated, for different reason, at the Department of Biomedical Surgical and Dental Sciences at University of Milan, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico Milan. The sample (age ranges between 12 and 40 years) was divided according to gender and age in four groups (12-17, 18-20, 21-30, 31-40). Left and right frontal sinus volume (VOL), surface (SUP) and linear maximum width (XMAX), depth (ZMAX) and height (YMAX) were calculated using Mimics Research 17.0 (Materialise N.V., Leuven, Belgium). Cephalometric analysis has been performed for all subjects to categorize the patients depending on their facial growth pattern. Univariate and multivariate regression analysis were performed to investigate any association of frontal sinuses measurements (height, width, depth, volume and surface) and cephalometric variables. P value < 0.05 was considered statistically significant. Results: A total of 160 frontal sinuses were measures in 80 patients: 40 men and 40 women, average age of 23.5 ±14.6. Globally the frontal sinuses had the following average dimensions: volumes of 9055.8 ± 6505 mm3 and surfaces of 3820.3 ± 2125 mm2. The statistical analysis showed that frontal sinus volume was statistically significant (p=0.003) greater for male (11,425 mm3) than female (6597.5 mm3). Similarly, the surface showed to be greater in men than in women (p=0.005). No correlation between age and frontal sinuses characteristics has been found. A statistically significant (p<0.05) increase of frontal sinus depth, surface and volume was correlated with SNB angle. In addition, frontal sinus volume increased in subjects with greater anterior skeletal dimension values and with a superior length of the cranial base. Furthermore, a decrease of ANB has been found related to an increase in frontal sinus volume (p=0.04). Conclusions: The present study showed a correlation between frontal sinuses dimensions and craniofacial aspects, despite the inter-individual variability of their morphology. The results suggested that young adults in whom the frontal sinuses have reached their maximum size, while vertical growth continues, a larger frontal sinus may be associated with future vertical growth.openAbate A.; Gaffuri F.; Lanteri V.; Fama A.; Ugolini A.; Mannina L.; Maspero C.Abate, A.; Gaffuri, F.; Lanteri, V.; Fama, A.; Ugolini, A.; Mannina, L.; Maspero, C

Gitelman syndrome associated with chondrocalcinosis and severe neuropathy: a novel heterozygous mutation in SLC12A3 gene

Gitelman syndrome (GS) is an inherited salt-wasting tubulopathy characterized by hypocalciuria, hypokalemia, hypomagnesemia and metabolic alkalosis, due to inactivating mutations in the SLC12A3 gene. Symptoms may be systemic, neurological, cardiovascular, ophthalmological or musculoskeletal. We describe a 70 year-old patient affected by recurrent arthralgias, hypoesthesia and hyposthenia in all 4 limbs and severe hypokalemia, complicated by atrial flutter. Moreover, our patient reported eating large amounts of licorice, and was treated with medium-high dosages of furosemide, thus making diagnosis very challenging. Genetic analysis demonstrated a novel heterozygous mutation in the SLC12A3 gene; therefore, we diagnosed GS and started potassium and magnesium replacement. GS combined with chondrocalcinosis and neurological involvement is quite common, but this is the first case of an EMG-proven severe neuropathy associated with GS. Herein, we underline the close correlation between hypomagnesemia, chondrocalcinosis and neurological involvement. Moreover, we report a new heterozygous mutation in exon 23 (2738G>A), supporting evidence of a large genetic heterogeneity in this late-onset congenital tubulopathy

Erucin exhibits vasorelaxing effects and antihypertensive activity by H2 S-releasing properties.

BACKGROUND AND PURPOSE: Hydrogen sulfide (H2 S)-releasing agents are viewed as potential antihypertensive drugs. Recently, natural isothiocyanates emerged as original H2 S-donor agents. Among them, erucin, present in some edible cruciferous plants, shows suitable H2 S-releasing properties and features of "druggability." The aim of this work was to investigate the erucin-mediated release of H2 S inside vascular cells, its vasorelaxing effects, and activity on BP of normo and hypertensive animals. EXPERIMENTAL APPROACH: Intracellular H2 S-release and the hyperpolarizing effect of erucin were tested using fluorescent dye, in human aortic smooth muscle cells (HASMCs). Its direct vasorelaxing effect and ability to inhibit noradrenaline-induced vasoconstriction were evaluated on endothelium-intact or -denuded rat aortic rings. Its vasodilator properties were tested in coronary arteries using Langendorff-perfused rat hearts. Finally, erucin's antihypertensive activity was evaluated in vivo in normotensive and spontaneously hypertensive rats (SHRs) by recording systolic BP using the tail-cuff method. KEY RESULTS: Erucin induced the release of H2 S inside HASMCs. Moreover, erucin hyperpolarized the membrane of HASMCs membrane in a concentration-dependent manner. It induced vasodilatation of rat aortic rings, in endothelium-denuded vessels. This effect was further improved by the presence of endothelial NO. When pre-incubated with rat aortic rings, erucin induced concentration-dependent inhibition of noradrenaline-induced vasoconstriction. Erucin did not affect basal coronary flow but restored the flow to normal in pre-contracted coronary vessels. Finally, in vivo, erucin decreased systolic BP in SHRs by about 25%, and restored the BP to values observed in normotensive rats. CONCLUSIONS AND IMPLICATIONS: Erucin is an H2 S donor endowed with vasorelaxing and antihypertensive effects