Introduzione della cartella clinica elettronica nell'ULSS 9 di Treviso - Approccio Metodologico -

Summary Introduction We are now witnessing an increasing interest of Public Health Institutions towards the introduction of ICT. However, although several data/information are available, each Aziende Sanitaria and clinical units often employ individual digital systems that are not connected to each other. With the start of the ESCAPE project the Azienda ULSS 9 in Treviso developed a model for the management of digital signed documents that could be shared between the different clinical units of the Hospitals (Treviso and Oderzo) and the citizens. This first experience of clinical response dematerialization allowed putting the basis for the extension of the process to all the documents associated with hospitalization. In fact, the main objective of this project, named OSCAR (Ospedale Senza CARta), is to extend the digital processes to all the clinical records of patients during his hospital admission, thus helping to move from the Medical Paper (MP), towards the Electronic Health Record (EHR). Objective Only few data are available in the literature about the use of ICT in the Health System. In particular, no methodological approaches have been developed to test the introduction in the clinical use of the Electronic Medical Record (EMR). In particular we need to identify tools for the estimation of risk/benefit ratio, and learn how to manage changes within the organization. The scope is to minimize unfavourable responses associated with CCE introduction. How to develop this new approach is the main object of the present study. Materials and methods We studied the introduction of EMR in the Cardiology Unit. Analysis of the process furnished valuable data about the presence of criticisms that could limit the diffusion of EMR to all the others clinics. The methodological approach was based on the following points which in several cases are connected with “Project Management”: - Study of economic feasibility based on benefit/risk ratio. - Detailed analysis of software-hardware - Development of a training program through both frontal lessons and live demonstrations. We also tested the efficacy of EMR in comparison with the MP. In particular we focused on the following “end points”: - Comparison of MP and EMR in term of quality (such as clarity, complete drawing up, head for reading). In particular we compared 100 consecutive MP (year 2008) with 100 consecutive EMR (year 2012) of the Cardiology Unit. Analysis of quality was based on the compilation of check lists developed according to “Joint Commission International Quality Standards” and “Accreditation Canada”, criteria. - To identify, by the use of a questioner, personnel’ prejudices associated with the introduction of EMR. - Analysis of the risks potentially associated with EMR introduction. The analysis was performed by using FMEA/FMECA approach. - To evaluate the level and the trend of clinical documents digitalization. Results Comparison of quality between MP and EMR showed that the latter was superior in almost all the 34 points of the checklist, reaching the maximum score in 25 over 34. Questioners about satisfaction of the personnel showed a significant difference between medical doctors and nurses. In fact, while the satisfaction score was optimum in 12 over 15 questions for medical doctors, the level reach by nurses was significantly lower in all the items investigated. Risk analysis performed by using FMEA/FMECA before and after EMR introduction allowed to identify errors/risks with high index of priority correlated to both the use of MP and EMR. We were able to demonstrate that these errors/risks were different between MP and EMR. In particular errors with high priority associated to MP used were absent after EMR introduction. On the contrary the following same therapy errors were more evident after EMR introduction. Results were used to perform risk re-analysis through periodic team discussion and implementation of preventive measures. The trend of clinical digitalization was excellent. The high level of participation showed by the personnel involved mainly explains this finding. Discussion and conclusion The present study investigated the efficacy of a novel methodological approach for the EMR introduction in the clinical practice. Success is mainly based on a high level of involvement of Direzione Strategica Ospedaliera that is mandatory to obtain enough economic and personnel support for the project development. EMR showed higher quality level compared to MP according to “Joint Commission International Quality Standards” and “Accreditation Canada”, standards. The analysis of the risks allowed demonstrating that MP and EMR used are associated with profound differences in term of risks related to hospitalization. The excellent trend observed for the introduction of digitalized clinical documents in the different units represents an encouraging observation. This finding suggests that, by using adequate planning, training and appropriate methodological approaches (mainly based on appropriate risks evaluation) digitalization can be introduced in the everyday clinical practice without experiencing significant obstacles and improving the quality of health care

The role of polymorphism at αs1-casein locus on milk fatty acid composition in Girgentana goat

Sixteen lactating Girgentana goats were used to evaluate the effect of polymorphism at αs1-casein locus on milk fatty acids composition. Animals, homogeneous for milk production, days of lactation and body weight, were divided into two groups: eight homozygous for strong allele (AA group) and eight homozygous for weak allele (FF group). The experimental diet, identical for the two groups, consisted of alfalfa hay (1.5 kg), whole barley, whole maize, pelleted sunflower and whole faba bean (0.5 kg each). In spite of identical selected diets, also in terms of fatty acids, milk fatty acid composition resulted different between the two groups. In particular, except for C8:0, short and medium chain fatty acids and odd chain fatty acids resulted in higher percentage in the AA group. Taking in account that the difference reported in our experiment concerns above all de novo synthesized fatty acids, our results seem to confirm the hypothesis that polymorphism at αs1-casein locus can influence milk fatty acid composition in goats

Interleukin‑6 signalling as a valuable cornerstone for molecular medicine (Review)

The biological abilities of interleukin‐6 (IL‐6) have been under investigation for nearly 40 years. IL‐6 works through an interaction with the complex peptide IL‐6 receptor (IL‐6R). IL‐6 is built with four α‐chain nanostructures, while two different chains, IL‐6Rα (gp80) and gp130/IL6β (gp130), are included in IL‐6R. The three‐dimensional shapes of the six chains composing the IL‐6/IL‐6R complex are the basis for the nanomolecular roles of IL‐6 signalling. Genes, pseu‐ dogenes and competitive endogenous RNAs of IL‐6 have been identified. In the present review, the roles played by miRNA in the post‐transcriptional regulation of IL‐6 expression are evaluated. mRNAs are absorbed via the ‘sponge’ effect to dynamically balance mRNA levels and this has been assessed with regard to IL‐6 transcription efficiency. According to current knowledge on molecular and nanomolecular structures involved in active IL‐6 signalling, two different IL‐6 models have been proposed. IL‐6 mainly has functions in inflamma‐ tory processes, as well as in cognitive activities. Furthermore, the abnormal production of IL‐6 has been found in patients with severe acute respiratory syndrome coronavirus 2 (SARS‐coV‐2; also known as cOVId‐19). In the present review, both inflammatory and cognitive IL‐6 models were analysed by evaluating the cytological and histological loca‐ tions of IL‐6 signalling. The goal of this review was to illustrate the roles of the classic and trans‐signalling IL‐6 pathways in endocrine glands such as the thyroid and in the central nervous system. Specifically, autoimmune thyroid diseases, disorders of cognitive processes and SARS‐coV‐2 virus infection have been examined to determine the contribution of IL‐6 to these disease states

Le Soft skills nei futuri insegnanti: Un'indagine esplorativa

Soft skills are of fundamental importance in the performance of all work activities, particularly teaching, because they are strongly related to personal qualities and attitudes and social and management skills. Even in school settings, therefore, soft skills are needed to interpret and understand complex situations in the design of instructional pathways useful for enhancing students’ personal qualities (Ngang, Yie & Shahid, 2015). Difficult to recognize, quantify, assess and develop, this paper aims to investigate the self-perception of them among preschool and elementary school teachers-in-training. Awareness of their own transversal competencies, in addition to promoting personal professional growth in young teachers, prepares them to take this important dimension in their future students and design teaching actions aimed at their enhancement.Le Soft skills sono di fondamentale importanza nell’espletamento di tutte le attività lavorative, in particolare dell’insegnamento, perché fortemente connesse alla qualità e agli atteggiamenti personali e alle abilità sociali e gestionali. Anche in ambiente scolastico, pertanto, le Soft skills sono necessarie per interpretare e comprendere situazioni complesse nella progettazione di percorsi didattici utili a valorizzare le qualità personali degli alunni (Ngang, Yie & Shahid, 2015). Difficili da riconoscere, quantificare, valutare e sviluppare, questo lavoro si propone di indagare sulla autopercezione che ne hanno gli insegnanti della scuola dell’infanzia e della scuola primaria in formazione. La consapevolezza delle proprie competenze trasversali, oltre che favorire la personale crescita professionale nei giovani insegnanti, li prepara a tener conto di questa importante dimensione nei loro futuri alunni e progettare azioni didattiche volte al loro potenziamento

Faces and Identities: is it possible measuring the reliability of the 3D craniofacial approximations

The craniofacial approximation (CFA) is largely used in forensic identification of unknown skeletonized bodies. Despite numerous forensic reports have proved successful in identifying a cadaver, it is very hard to assess the reliability of CFA methods. The present work aims to evaluate the accuracy of CFAs through the comparison of a blind facial approximation with a simultaneous faces array test. The blind CFA was made following the Manchester’s protocol. In our test the CFA was compared with a photographic array of ten faces, included the photo of the individual whom belonged the skull. The positive recognition was evaluated by a total of 320 unfamiliar assessors. During the test a survey was also conducted to evaluate which facial feature mostly drive the process of identification. The true positive recognition showed extremely poor results. Only the 5% of assessors match the CFA with the target individual photo. The nose was judged the most influential facial feature, but it is also the most problematic anatomical district to approximate due to the lack of strong relationships with the bony part of the skull. Our results seem to highlight clear limits in positive recognition for CFA based techniques. However, we should consider that positive recognitions of CFAs are usually made by someone in social proximity with the victim. This latter evidence strongly bias any face array test with unfamiliar assessors, keeping the question of CFA reliability still open

Cat Taming in the Western Mediterranean. Issues, Problematics and Unpredictability in the Light of Bio-archaeological Approaches to a Museum Specimen

The vast wealth of cultural artifacts and ancient biological samples can today be investigated using a great variety of methods and technologies. The result is a growing diffusion of studies on DNA, isotopes and morphometrics, and the exponential growth of publications and bio-archaeological discoveries of inestimable value for different areas of interpretation, such as phylogeny, history and archaeology. This paper describes the morphological and molecular study of a rare specimen of Felis from an Early Bronze Age horizon. The report offers the opportunity for a brief discussion on cat taming, on the origin of this practice and on the archaeological importance of this specimen for the reconstruction of taming practices in the Western Mediterranean Basin.Il vasto patrimonio culturale di manufatti e di reperti biologici antichi può attualmente essere investigato con molte metodologie e tecnologie. Ne deriva una crescente diffusione di studi sul DNA, isotopici e morfogeometrici e una crescita esponenziale delle pubblicazioni e dei risultati bio-archeologici di inestimabile valore per ambiti interpretativi diversi, filogenetici, storici, archeologici. Il presente lavoro descrive uno studio morfologico e molecolare di un raro reperto di Felis proveniente da un orizzonte del Bronzo Antico. Il report offre per altro l’occasione per una breve disamina sull’addomesticamento del gatto, la provenienza di tale pratica e sull’importanza zooarcheologica della relazione con Homo nel Mediterraneo occidentale

The last of the large-sized tortoises of the Mediterranean islands

Altres ajuts: CERCA Programme/Generalitat de CatalunyaAltres ajuts: Operational Programme Research, Development and Education Project (CZ.02.2.69/0.0/0.0/16_027/0008360)Archaeological investigations carried out in the cave Zubbio di Cozzo San Pietro, Bagheria, Sicily, revealed the presence of a few skeletal elements of a large-sized tortoise in a funerary area dating to the Copper/Bronze Age. The tortoise has been AMS-dated revealing an age of 12.5 ± 0.5 kyr BP and therefore it pre-dates the funerary activities. The morphology of the retrieved skeletal elements differs from that of the only native tortoise currently living in Sicily, Testudo hermanni. The tortoise's size significantly exceeds the size range of extant Te. hermanni and all Testudo spp., as well as that of their known fossils, and suggests a shell length of 50-60 cm. Repeated efforts to obtain DNA sequences from the tortoise of Zubbio di Cozzo San Pietro failed, but the morphology of the femur is distinct enough to allow us to erect a new taxon, Solitudo sicula gen. et sp. nov., based on a parsimony analysis. It belongs to a hitherto unrecognized clade that includes other large-sized tortoises from Mediterranean islands, like Malta and Menorca. A review of the pertinent taxa indicates that the remains here described represent the geologically youngest large-sized tortoise of the Mediterranean area

Effect of bovine lactoferrin on chlamydia trachomatis infection and inflammation.

Chlamydia trachomatis is an obligate, intracellular pathogen responsible for the most common sexually transmitted bacterial disease worldwide, causing acute and chronic infections. The acute infection is susceptible to antibiotics, whereas the chronic one needs prolonged therapies, thus increasing the risk of developing antibiotic resistance. Novel alternative therapies are needed. The intracellular development of C. trachomatis requires essential nutrients, including iron. Iron-chelating drugs inhibit C. trachomatis developmental cycle. Lactoferrin (Lf), a pleiotropic iron binding glycoprotein, could be a promising candidate against C. trachomatis infection. Similarly to the efficacy against other intracellular pathogens, bovine Lf (bLf) could both interfere with C. trachomatis entry into epithelial cells and exert an anti-inflammatory activity. In vitro and in vivo effects of bLf against C. trachomatis infectious and inflammatory process has been investigated. BLf inhibits C. trachomatis entry into host cells when incubated with cell monolayers before or at the moment of the infection and down-regulates IL-6/IL-8 synthesized by infected cells. Six out of 7 pregnant women asymptomatically infected by C. trachomatis, after 30 days of bLf intravaginal administration, were negative for C. trachomatis and showed a decrease of cervical IL-6 levels. This is the first time that the bLf protective effect against C. trachomatis infection has been demonstrated

Effect of the αs1-casein genotype and its interaction with diet degradability on milk production, milk quality, metabolic and endocrinal response of Girgentana goats

We studied interaction between diet degradability and genotype at CSN1S1 locus in lactating goats.•We evaluated productive, metabolic and hormonal response of goats at different αs1-casein genotype.•Little effect of diet degradability and interaction with genotype on production and quality.•Higher milk yield, casein percentage and lower urea in goats with strong alleles at CSN1S1 locus.•Higher tyroid hormones in goats with strong alleles