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

Long-term effects of functional appliances in treated versus untreated patients with Class II malocclusion: A systematic review and meta-analysis

Objective To assess the cephalometric skeletal and soft-tissue of functional appliances in treated versus untreated Class II subjects in the long-term (primarily at the end of growth, secondarily at least 3 years after retention). Search methods Unrestricted electronic search of 24 databases and additional manual searches up to March 2018. Selection criteria Randomised and non-randomised controlled trials reporting on cephalometric skeletal and soft-tissue measurements of Class II patients (aged 16 years or under) treated with functional appliances, worn alone or in combination with multi-bracket therapy, compared to untreated Class II subjects. Data collection and analysis Mean differences (MDs) and 95% confidence intervals (95% CIs) were calculated with the random-effects model. Data were analysed at 2 primary time points (above 18 years of age, at the end of growth according to the Cervical Vertebral Maturation method) and a secondary time point (at least 3 years after retention). The risk of bias and quality of evidence were assessed according to the ROBINS tool and GRADE system, respectively. Results Eight non-randomised studies published in 12 papers were included. Functional appliances produced a significant improvement of the maxillo-mandibular relationship, at almost all time points (Wits appraisal at the end of growth, MD -3.52 mm, 95% CI -5.11 to -1.93, P < 0.0001). The greatest increase in mandibular length was recorded in patients aged 18 years and above (Co-Gn, MD 3.20 mm, 95% CI 1.32 to 5.08, P = 0.0009), although the improvement of the mandibular projection was negligible or not significant. The quality of evidence was \u2018very low\u2019 for most of the outcomes at both primary time points. Conclusions Functional appliances may be effective in correcting skeletal Class II malocclusion in the long-term, however the quality of the evidence was very low and the clinical significance was limited

Preliminary approach on early post mortem stress and quality indexes changes in large size bluefin tuna (Thunnus thynnus)

Bluefin tuna (Thunnus thynnus) is very appreciated on Japan and USA market for the preparation of sushi and sahimi. The market price of the fresh product can vary from 8 to 33 Euro/kg (gate farm/producers prices) according to size, shape, fat level, meat colour, consistency and freshness (absence of "hyake"), all parameters strictly connected to feeding quality and quantity, rearing and killing stress factors and refrigeration times and conditions after death. Excessive levels of stress during the slaughtering can affect meat quality, contributing to significantly decrease of tuna's price. The present trial was carried out to evaluate the possible harvesting/slaughtering stress effect on reared bluefin tuna meat quality, starting from the examination of the most important stress and quality parameters changes during the early post mortem period

Targeted photodestruction of human colon cancer cells using charged Dougherty chlorine6immunoconjugates

The goal of this study was to develop a strategy for the selective destruction of colorectal cancer cells. Towards this end, photoimmunoconjugates were prepared between the anti-colon cancer monoclonal antibody 17.1A and the photosensitizer (PS) chlorine6(ce6). Polylysine linkers bearing several ce6molecules were covalently attached in a site-specific manner to partially reduced IgG molecules, which allowed photoimmunoconjugates to bear either cationic or anionic charges. The conjugates retained immunoreactivity as shown by enzyme-linked immunosorbent assays and by competition studies with native antibody. The overall charge on the photoimmunoconjugate was an important determinant of PS delivery. The cationic photoimmunoconjugate delivered 4 times more ce6to the cells than the anionic photoimmunoconjugate, and both 17.1A conjugates showed, in comparison to non-specific rabbit IgG conjugates, selectivity for antigen-positive target cells. Illumination with only 3 J cm−2of 666 nm light reduced the number of colony forming cells by more than 90% for the cationic 17.1A conjugate and by 73% for the anionic 17.1A conjugate after incubation with 1 μM ce6equivalent of the respective conjugates. By contrast, 1 μM free ce6gave only a 35% reduction in colonies. These data suggest photoimmunoconjugates may have applications in photoimmunotherapy where destruction of colorectal cancer cells is required. © 2000 Cancer Research Campaig

Biopolymers for a more sustainable leather

Content: A novel class of bio-based polymers have been developed within the LIFE BIOPOL European project aiming to replace traditional re-tanning and fat-liquoring products reducing environmental impacts and increasing the safety of leather. The purpose of the project is to enhance the recovery and reuse of different bio-derived by-products from leather and agro-industrial sector to produce eco-friendly and renewable bio-polymers with high re-tanning and fat-liquoring characteristics. The LIFE BIOPOL project aims to make bio-based polymers in order to reduce the following parameters in re-tanning phase: - 20-30% COD, - 50-60% of inorganic salts (Sulphates and Chlorides), - 90% of Cr (III) salts, - 20% of water used in the leather process. Other important goals of the project are: - reduction 70-90% of hazardous and environmental polluting substances normally found in conventional chemicals, - reactivity enhancement of 30-40% of the new biopolymers compared to the current leather - application technology, - reduction of 70-80% of the Product Environmental Footprint of the new biopolymers related to the state of the art. The vegetal biomasses and the tanned hides by-products were pretreated in order to obtain suitable building blocks for the production of bio-based polymers. Several protocols involving polymerization were used in order to achieve the synthesis of the biopolymers, which have been carried out at lab scale. Macromolecular characterization of the biopolymers was performed in order to rationalize the synthetic strategy and practical application of the products giving important parameters such as molecular weight and chemical composition of the new biopolymers. Performances of new bio-based polymers have been inspected and compared with traditional chemicals through application on different types of leather. The benefits of the new products within leather making process were evaluated through chemical analyses of re-tanning and fat-liquoring effluents. The upgrade of the developed chemistry will be performed within a new devised prototype plant specifically designed and built-up for producing the bio-based polymers at industrial scale Take-Away: Production of leather making biopolymers from biomasses and industrial by-products through Life Cycle Designed Processe

Charge Management for Gravitational Wave Observatories using UV LEDs

Accumulation of electrical charge on the end mirrors of gravitational wave observatories, such as the space-based LISA mission and ground-based LIGO detectors, can become a source of noise limiting the sensitivity of such detectors through electronic couplings to nearby surfaces. Torsion balances provide an ideal means for testing gravitational wave technologies due to their high sensitivity to small forces. Our torsion pendulum apparatus consists of a movable Au-coated Cu plate brought near a Au-coated Si plate pendulum suspended from a non-conducting quartz fiber. A UV LED located near the pendulum photoejects electrons from the surface, and a UV LED driven electron gun directs photoelectrons towards the pendulum surface. We have demonstrated both charging and discharging of the pendulum with equivalent charging rates of $\sim$$10^5 e/\mathrm{s}$, as well as spectral measurements of the pendulum charge resulting in a white noise level equivalent to $3\times10^5 e/\sqrt{Hz}$.Comment: 5 pages, submitted to PR

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