Characteristics and Outcomes of Patients Discharged Directly Home From the Pediatric Intensive Care Unit

Introduction: Patients admitted to the pediatric intensive care unit (PICU) typically transfer to an acute care floor prior to discharge (ACD). Various circumstances, including rapid clinical improvement, technology dependence, or capacity constraints, may lead to discharge directly to home from a PICU (DDH). This practice has been studied in adult intensive care units, but research is lacking for PICU patients. Methods: We aimed to describe characteristics and outcomes of patients requiring PICU admission who experienced DDH versus ACD. We conducted a retrospective cohort study of patients ≤18 years old admitted to our academic, tertiary care PICU between 1/1/15 and 12/31/20. Patients who died or were transferred to another facility were excluded. Baseline characteristics (including home ventilator dependence) and markers of illness severity, specifically the need for vasoactive infusion or new mechanical ventilation, were compared between groups. Admission diagnoses were categorized using the Pediatric Clinical Classification System (PECCS). Our primary outcome was hospital readmission within 30 days. Results: Of 4042 PICU admissions during the study period, 768 (19%) were DDH. Baseline demographic characteristics were similar, although DDH patients were more likely to have a tracheostomy (30% vs 5%, P < .01) and require a home ventilator at discharge (24% vs 1%, P < .01). DDH was associated with being less likely to have required a vasoactive infusion (7% vs 11%, P < .01), shorter median length of stay (LOS) (2.1 days vs 5.9 days, P < .01) and increased rate of readmission within 30 days of discharge (17% vs 14%, P < .05). However, repeat analysis after removing ventilator-dependent patients at discharge (n = 202) showed no difference in rates of readmission (14% vs 14%, P = .88). Conclusions: Direct discharge home from the PICU is a common practice. DDH and ACD groups had similar 30-day readmission rate when patient admissions with home ventilator dependence were excluded

64Cu production by 14 MeV neutron beam

64Cu is an emerging radionuclide of great interest in personalized nuclear medicine. It is produced by a cyclotron via the reaction 64Ni(p,n)64Cu. This production method increased during the last decades, because small biomedical cyclotrons can be easily installed close to the nuclear medicine department of a hospital. As a matter of fact, 64Ni is a very expensive target material. For this reason, an alternative 64Cu production method was investigated at ENEA by using the quasi-monochromatic 14 MeV fusion neutron beam made available at the Frascati Neutron Generator (FNG) located at the ENEA - Frascati Research Center. In particular, two nuclear reactions were studied: 65Cu(n,2n)64Cu and 64Zn(n,p)64Cu. The radiochemical analysis of the activated samples was performed at the ENEA-NMLNWM laboratory located in ENEA-Casaccia Research Center. The activity measurements were carried out at the ENEA-INMRI, located in the ENEA-Casaccia Research Center, with high metrological level conditions and by assuring their traceability to the 64Cu primary activity standard here developed and maintained. A prediction of the 64Cu production by means of the high-brilliance 14 MeV neutron source named Sorgentina is also discussed

Universal principles of human communication: preliminary evidence from a cross-cultural communication game

The present study points to several potentially universal principles of human communication. Pairs of participants, sampled from culturally and linguistically distinct societies (Western and Japanese, N = 108: 16 Western-Western, 15 Japanese-Japanese and 23 Western-Japanese dyads), played a dyadic communication game in which they tried to communicate a range of experimenter-specified items to a partner by drawing, but without speaking or using letters or numbers. This paradigm forced participants to create a novel communication system. A range of similar communication behaviors were observed among the within-culture groups (Western-Western and Japanese-Japanese) and the across-culture group (Western-Japanese): They (a) used iconic signs to bootstrap successful communication, (b) addressed breakdowns in communication using other-initiated repairs, (c) simplified their communication behavior over repeated social interactions, and (d) aligned their communication behavior over repeated social interactions. While the across-culture Western-Japanese dyads found the task more challenging, and cultural differences in communication behavior were observed, the same basic findings applied across all groups. Our findings, which rely on two distinct cultural and linguistic groups, offer preliminary evidence for several universal principles of human communication

The New Sorgentina Fusion Source-NSFS: 14 MeV neutrons for fusion and beyond

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Gestione sostenibile delle foreste Mediterranee e uso energetico delle biomasse forestali residuali

he book describes the reasons that led the Regional Department of Rural and Territorial Development to take part in the PROFORBIOMED Project. They can be summarized by the need to dispose of a tool for the sustainable management of all the state-owned forests of the Region. As a matter of fact, the Project aims at developing a model of sustainable forest management, through the recovery and reuse of wood scraps from ordinary silvicultural operations, to be used for the production of power and heat inside of a process adopting natural renewable energy sources. The main actions taken and the methodologies adopted are described, as well as the principles and instruments required for the setting up and execution of the work. Some of the most relevant are: the drafting of “Forest Management Plans”, the “Short Supply Chain” and the “Biomass Traceability Protocol”, together with the application of “Best Practices” of Management and the “Monitoring of impacts” caused by the woody biomass extraction procedures. The “forest – wood – energy” chain developed and proposed is exclusively related to the territory pertaining to one municipality, and with CHP plants fed with biomass exclusively produced within the territory of each municipality, in strict compliance with the “sustainable forest management” principles, as well as with the fundamental principle of “short supply chain”. For these reasons the CHP plans proposed shall be sized according to the biomass available in each municipality, with the possibility of integrating residual forest biomass with other waste wood resources potentially available in the territory and coming from prunings in agricultural activities. Therefore, the replicable model prepared and proposed by PROFORBIOMED aims at appraising from the economic point of view a waste product, such is currently considered the residual forest biomass from the forests of Sicily, and at the same time significantly improving the natural environment, thanks to the reduction in oil consumption

Prognostic significance of normalized FDG-PET parameters in patients with multiple myeloma undergoing induction chemotherapy and autologous hematopoietic stem cell transplantation: a retrospective single-center evaluation

Purpose: The purpose of this study was to determine retrospectively, through a single-center evaluation, whether FDG PET-CT normalized semi-quantitative parameters may predict response to induction chemotherapy (iChT) and hematopoietic stem cell transplantation (HSCT), as well as disease progression and progression-free survival in multiple myeloma (MM) patients, thus becoming a tool of personalized medicine. Methods: Patients undergoing iChT and HSCT with baseline and post-treatment FDG PET-CTs from January 2008 to July 2015 were included. The following baseline and post-treatment parameters were obtained: SUVmax, SUVmean, SUVpeak, MTVsum, TLGsum, rPET (lesion SUVmax/liver SUVmax) and qPET (lesion SUVpeak/liver SUVmean). Baseline-to-post-treatment changes (Δ) were also calculated. Metabolic and clinical laboratory progression or response at follow-up were noted; time-to-metabolic-progression (TMP) was defined as the interval from post-treatment scan to eventual progression at follow-up FDG PET-CTs. Possible association between each functional parameter and metabolic/clinical-laboratory progression or response was determined. Kaplan-Meier curves allowed to depict the TMP trend according to FDG PET-CT parameters. Results: Twenty-eight patients were included. Significantly higher ΔrPET and ΔqPET values were observed in ten patients with “metabolic response”, with respect to 18 patients having “metabolic progression” (median 0.62 [IQR 0.32 – 1.34] vs median 0.00 [IQR -0.25 – 0.49] for ΔrPET; P = 0.045; median 0.51 [IQR 0.32 – 1.13] vs median 0.00 [IQR -0.31 – 0.67] for ΔqPET; P = 0.035). Neither normalized nor non normalized parameters differed significantly between the 20 patients with “clinical-laboratory response” and the eight patients with “clinical-laboratory progression”. ΔrPET value lower than 0.38 and ΔqPET value lower than 0.27 predicted a significantly shorter TMP (P = 0.003 and P = 0.005, respectively). Conclusions: Normalized semi-quantitative parameters are effective in predicting persistent response to treatment and shorter TMP in patients with MM undergoing iChT and HSCT