The relationship between health care users’ demand and the health care system’s response: a research on change observed in the health care system, in the hospital and in the territory

The present research study aims at exploring the representation of the health service within a group of hospital physicians and nurses. The objective is to identify how the symbolic dynamic of hospital workers shapes their own praxis. The texts of interviews with 25 hospital workers have been subjected to Emotional Text Analysis (ETA). Five clusters emerge from the analysis where the topic of giving life and avoiding death is central and where the hospital assumes a thaumaturgical and basically omnipotent role. This is in conflict with recognizing the limitations of therapy. Only in the background the culture of curing the patients appears, characterized by aggressive reactivity towards the crisis which leads patients to emergency intervention because crises are ascribed to deviances frommedical prescription. Emergency intervention is ultimately the kind of intervention which the hospital believes it is capable to provide. Another problem is the lack of filters provided by bureaucratized general practitioners, whose cooperation would be essential, but who are supposed to have no longer the necessary relationship with their patients

La rappresentazione del rapporto tra utenti e sistema sanitario: I modelli culturali dei medici di medicina generale - The representation of the relationship between users and healthcare system: Cultural models of general practitioners

The present research study explores the emotional and symbolic representation of the Italian healthcare system and specifically of general medical services reported by a group of Italian general practitioners. General medicine is recently affected by a structural change which could be sustained also by a cultural revolution, however this revolution seems to be oriented to expected values without a clear methodology which promotes and accompanies this cultural change. The present study deals with the lack of practices due to these unrealized expected values and assumes that for intervening it is necessary knowing the existing culture before thinking to change it. Interviews to 36 general practitioners were analyzed by Emotional Text Analysis (AET). Results highlight a factorial space characterized by five clusters. According to respondents’ perspective, healthcare problems refer to two large issues characterized by powerlessness of general practitioners to intervene. On the one hand, there is health emergency, dealt with by first aid and emergency medicine. On the other hand, there is chronicity, especially affecting the elderly, which is dealt with by other workers (nurses, private family assistants, social workers) who care patients at home and replace physicians. The general practitioners’ work is difficult because of many different reasons; but the central theme is the lack of absolute power – based on morality and consciousness – which leads to the perception of catastrophic consequences for medical profession and the physician-patient relationship. Often, general practitioners are in their offices and are not able to go to patients’ home, therefore they cannot create care relationships based on trust and dependence which allow useful and trustworthy interventions. In sum, the core theme emerging from data refers to the general practitioners’ perceived lack of personal and trust-based relationships with patients

La relazione che organizza il contesto sanitario: domanda dell’utenza e risposta dei servizi sanitari, nel territorio e nell’ospedale - The relationship which organizes the healthcare context: users’ demand and response of healthcare services, in the territory and the hospital

Our intent is to present citizens’ demand of health care services in Italy through a research structured in three studies. We used the Emotional Text Analysis (ETA) to lead the three s tudies: the first study regarded the citizens’expectations of the healthcare services, the second study regarded the point of view of the hospital personnel (medical doctors and nurses), the third regarded the point of view of the General Practitioners onthe health care services. These three studies are briefly presented. Data and outcome of an Assumed Similarity Test applied to all experimental subjects of the three studies in order to make a comparison among them, are also presented. The findings of the Emotional Text Analysis show that citizens, potential users of health services, center their requests on their individual subjectivity, and seek answers both to their suffering and to the feeling of alienation that characterizes the being sick feeling that makes them go to a medical doctor. For their part, general practitioners and hospital doctors immediately transform this subjective feeling in an objective medical diagnosis. Here a first gap emerges between patient’s demand and medical response, leavingthe possibility of an alliance on the diagnosis in order to jointly fight the disease. It has long been in place though a change that has expelled the patient also from sharing the diagnostic process, increasingly taken from self-centered dynamics within the healthcare system. This widens the gap between the request of the citizens and the response of the health services, that contributes to that conflictual growth to which defensive medicine gives a dysfunctional answer. The Assumed Similarity Test contributes to the interpretation of the health care dynamic identified in the Emotional Text Analysis; particularly in regard to the unfolding conflict, given by the hypothesis emerging from the data analysis, that a feeling of closeness for the hospital personnel goes along with an emotional stance of overpowering the othe

Biomass valorization: Sustainable methods for the production of hemicellulolytic catalysts from thermoanaerobacterium thermostercoris strain buff

Processing and selection of fruits and vegetables generate high quantities of wastes that represent an economic and environmental issue for the agroindustry sector. According to the so-called “biorefinery” approach, this biomass can be exploited for the recovery of value-added molecules. In this study, the residues of industrial processing of tomato (Lycopersicon esculentum variety “Hybrid Rome”), fennel (Foeniculum vulgare), potato (Solanum tuberosum) and carrot (Daucus carota) were used as sole carbon sources to support cheap and sustainable microbial growth as well as the production of secondary metabolites (hydrogen and ethanol) by Thermoanaerobacterium thermostercoris strain BUFF, a thermophilic anaerobic microorganism isolated from buffalo-dung compost. Moreover, the use of hemicellulolytic enzymes of T. thermostercoris was assayed in the bioconversion reaction of the polymer fraction extracted from the rhizome of giant reed (Arundo donax) and of the leaves and stems of cardoon (Cynara cardunculus), dedicated non-food crops employed in energy supply

Exploring Marine Environments for the Identification of Extremophiles and Their Enzymes for Sustainable and Green Bioprocesses

Sea environments harbor a wide variety of life forms that have adapted to live in hard and sometimes extreme conditions. Among the marine living organisms, extremophiles represent a group of microorganisms that attract increasing interest in relation to their ability to produce an array of molecules that enable them to thrive in almost every marine environment. Extremophiles can be found in virtually every extreme environment on Earth, since they can tolerate very harsh environmental conditions in terms of temperature, pH, pressure, radiation, etc. Marine extremophiles are the focus of growing interest in relation to their ability to produce biotechnologically useful enzymes, the so-called extremozymes. Thanks to their resistance to temperature, pH, salt, and pollutants, marine extremozymes are promising biocatalysts for new and sustainable industrial processes, thus representing an opportunity for several biotechnological applications. Since the marine microbioma, i.e., the complex of microorganisms living in sea environments, is still largely unexplored finding new species is a central issue for green biotechnology. Here we described the main marine environments where extremophiles can be found, some existing or potential biotechnological applications of marine extremozymes for biofuels production and bioremediation, and some possible approaches for the search of new biotechnologically useful species from marine environments

Parageobacillus thermantarcticus, an Antarctic Cell Factory: From Crop Residue Valorization by Green Chemistry to Astrobiology Studies

Knowledge of Antarctic habitat biodiversity, both marine and terrestrial, has increased considerably in recent years, causing considerable development in the studies of life science related to Antarctica. In the Austral summer 1986–1987, a new thermophilic bacterium, Parageobacillus thermantarcticus strain M1 was isolated from geothermal soil of the crater of Mount Melbourne (74°22′ S, 164°40′ E) during the Italian Antarctic Expedition. In addition to the biotechnological potential due to the production of exopolysaccharides and thermostable enzymes, successful studies have demonstrated its use in the green chemistry for the transformation and valorization of residual biomass and its employment as a suitable microbial model for astrobiology studies. The recent acquisition of its genome sequence opens up new opportunities for the use of this versatile bacterium in still unexplored biotechnology sectors

Production of succinic acid from Basfia succiniciproducens up to the pilot scale from Arundo donax hydrolysate.

Abstract In the present work the recently isolated strain Basfia succiniciproducens BPP7 was evaluated for the production of succinic acid up to the pilot fermentation scale in separate hydrolysis and fermentation experiments on Arundo donax, a non-food dedicated energy crop. An average concentration of about 17 g/L of succinic acid and a yield on consumed sugars of 0.75 mol/mol were obtained demonstrating strain potential for further process improvement. Small scale experiments indicated that the concentration of acetic acid in the medium is crucial to improve productivity; on the other hand, interestingly, short-term (24 h) adaptation to higher acetic acid concentrations, and strain recovery, were also observed

Novel psychrophiles and exopolymers from permafrost thaw lake sediments

Thermokarst lakes are one of the most abundant types of microbial ecosystems in the circumpolar North. These shallow basins are formed by the thawing and collapse of ice-rich permafrost, with subsequent filling by snow and ice melt. Until now, permafrost thaw lakes have received little attention for isolation of microorganisms by culture-based analysis. The discovery of novel psychrophiles and their biomolecules makes these extreme environments suitable sources for the isolation of new strains, including for potential biotechnological applications. In this study, samples of bottom sediments were collected from three permafrost thaw lakes in subarctic Québec, Canada. Their diverse microbial communities were characterized by 16S rRNA gene amplicon analysis, and subsamples were cultured for the isolation of bacterial strains. Phenotypic and genetic characterization of the isolates revealed affinities to the genera Pseudomonas, Paenibacillus, Acinetobacter, Staphylococcus and Sphingomonas. The isolates were then evaluated for their production of extracellular enzymes and exopolymers. Enzymes of potential biotechnological interest included α and β-glucosidase, α and β-maltosidase, β-xylosidase and cellobiohydrolase. One isolate, Pseudomonas extremaustralis strain 2ASCA, also showed the capability to produce, in the loosely bound cell fraction, a levan-type polysaccharide with a yield of 613 mg/L of culture, suggesting its suitability as a candidate for eco-sustainable alternatives to commercial polymers

Prokaryotic Diversity of the Composting Thermophilic Phase: The Case of Ground Coffee Compost

Waste biomass coming from a local coffee company, which supplied burnt ground coffee after an incorrect roasting process, was employed as a starting material in the composting plant of the Experimental Station of the University of Naples Federico II at Castel Volturno (CE). The direct molecular characterization of compost using 13C-NMR spectra, which was acquired through cross-polarization magic-angle spinning, showed a hydrophobicity index of 2.7% and an alkyl/hydroxyalkyl index of 0.7%. Compost samples that were collected during the early “active thermophilic phase” (when the composting temperature was 63 C) were analyzed for the prokaryotic community composition and activities. Two complementary approaches, i.e., genomic and predictive metabolic analysis of the 16S rRNA V3–V4 amplicon and culture-dependent analysis, were combined to identify the main microbial factors that characterized the composting process. The whole microbial community was dominated by Firmicutes. The predictive analysis of the metabolic functionality of the community highlighted the potential degradation of peptidoglycan and the ability of metal chelation, with both functions being extremely useful for the revitalization and fertilization of agricultural soils. Finally, three biotechnologically relevant Firmicutes members, i.e., Geobacillus thermodenitrificans subsp. calidus, Aeribacillus pallidus, and Ureibacillus terrenus (strains CAF1, CAF2, and CAF5, respectively) were isolated from the “active thermophilic phase” of the coffee composting. All strains were thermophiles growing at the optimal temperature of 60 C. Our findings contribute to the current knowledge on thermophilic composting microbiology and valorize burnt ground coffee as waste material with biotechnological potentialities

Degradative actions of microbial xylanolytic activities on hemicelluloses from rhizome of Arundo donax.

Polysaccharidases from extremophiles are remarkable for specific action, resistance to different reaction conditions and other biotechnologically interesting features. In this article the action of crude extracts of thermophilic microorganisms (Thermotoga neapolitana, Geobacillus thermantarcticus and Thermoanaerobacterium thermostercoris) is studied using as substrate hemicellulose from one of the most interesting biomass crops, the giant reed (Arundo donax L.). This biomass can be cultivated without competition and a huge amount of rhizomes remains in the soil at the end of cropping cycle (10–15 years) representing a further source of useful molecules. Optimization of the procedure for preparation of the hemicellulose fraction from rhizomes of Arundo donax, is studied. Polysaccharidases from crude extracts of thermophilic microorganisms revealed to be suitable for total degradative action and/or production of small useful oligosaccharides from hemicelluloses from A. donax. Xylobiose and interesting tetra- and pentasaccharide are obtained by enzymatic action in different conditions. Convenient amount of raw material was processed per mg of crude enzymes. Raw hemicelluloses and pretreated material show antioxidant activity unlike isolated tetra- and pentasaccharide. The body of results suggest that rhizomes represent a useful raw material for the production of valuable industrial products, thus allowing to increase the economic efficiency of A. donax cultivation