Early Diagnosis of Pulmonary Embolism: Review and Cost-Effectiveness Analysis

Pulmonary embolism (PE) is a serious, life-threatening thrombotic disease, which results in considerable health and economic consequences each year for the United States. These consequences include a toll of 83,000 deaths and an economic impact between 1,5 and 5 billion. Approaches to strategy selection by physicians and other health-care specialists are based mainly upon cost, technology availability, and cultural tolerance regarding radiation exposure. The purpose of this study was to determine the most cost-effective diagnostic strategy with patients suspected of PE among several strategies currently used by examining their detection failure rates. This objective was met by (a) assessing parameter estimates and their uncertainty using triangular and 7 distributions, (b) conducting a cost-effectiveness analysis, and (c) testing the model for errors using sensitivity analysis. Cost-effectiveness analysis based upon a decision tree model revealed that among the investigated strategies for patients with suspected PE the most cost-effective strategy appears to be strategy 3, composed of a clinical decision rule (CDR), a D-dimer test (DD), a compression ultrasonography test (CUS), and a computed tomography pulmonary angiography (CT). Strategy 5, composed by a CDR, DD, a CT, a CUS, and an invasive pulmonary angiography (PA) appeared to be a cost-effective method, but it was more expensive than strategy 3 and included an invasive pulmonary angiography (PA). The results of a Monte Carlo simulation sensitivity analysis were robust over a number of distributions regarding the PE diagnostic test costs, sensitivities, specificities, and strategy effectiveness. Additionally, the results of this investigation were valid over an extensive range of one-way, two-way, and three-way sensitivity analyses regarding PE diagnostic test costs. Overall, the proposed analyses identified uncertainty and eliminated error; thus, it provides a practical approach to help medical professionals estimate uncertainty in the diagnosis of PE. Although this research has broadened the ability to identify uncertainty and eliminate error, further research is needed to validate these findings in a prospective clinical trial before the delivery of a clinical recommendation

Understanding the Experiences of Women with Anorexia Nervosa Who Complete an Exposure Therapy Protocol in a Naturalistic Setting

Anorexia Nervosa (AN) is a serious mental health concern in the United States, with the highest mortality rate of all mental disorders. Females comprise the vast majority of people with AN, although the number of males with the condition is rising. Anorexia Nervosa has a high relapse rate and is often enduring, which makes it challenging to treat successfully; therefore, the mental health profession is in need of innovative therapeutic approaches. Exposure therapy has a growing evidence base for the treatment of eating disorders, including AN; however, there are very few studies that explore body image/mirror exposure specifically in patients with AN. Further, the existing quantitative and qualitative research studies present several methodological limitations, which prompts in depth exploration of this intervention for its specific use with anorexic patients. Using Interpretative Phenomenological Analysis (IPA), the present study explored the experiences of women diagnosed with AN who participated in a novel application of body image/mirror exposure therapy in a naturalistic setting, focusing on the meaning they attributed to the intervention as part of their recovery from AN. The findings may support enhancement of the treatment protocol and inform future outcome studies on the efficacy of using body image/mirror exposure for AN

Lessons from Studies in Middle-Aged and Older Adults Living in Mediterranean Islands: The Role of Dietary Habits and Nutrition Services

Background. Islands in the Mediterranean basin share particular habits and traditions and greater life expectancy than other European regions. In this paper, particular interest has been given to the effect of the Mediterranean diet, as well as nutritional services on CVD risk, on Mediterranean islands. Methods. Published results from observational studies were retrieved from electronic databases (Pubmed and Scopus) and summarized. Results. Prevalence of CVD risk factors is increased. Adherence to the Mediterranean diet was moderate, even among the elderly participants. Furthermore, the presence of a dietician was associated with higher adherence to the Mediterranean dietary pattern and consequently lowers CVD risk. Conclusion. Adherence to the Mediterranean diet is reduced, while the prevalence of CVD risk factors is increasing at alarming rates. Public health nutrition policy has the opportunity to improve the health and quality of life of people living in isolated insular areas of the Mediterranean basin

The role of Mediterranean diet in the epidemiology of metabolic syndrome; converting epidemiology to clinical practice

Metabolic syndrome is a collection of associated conditions such as dyslipidemia, high blood pressure, impaired glucose tolerance and tendency to develop fat around the abdomen. It is now well known that individuals with the metabolic syndrome are at high risk for atherosclerosis and, especially, coronary heart disease. However, it has been suggested that people with the metabolic syndrome may benefit from aggressive lifestyle modification, through diet and exercise. In this review we summarize scientific evidence regarding the effect of Mediterranean diet on the development of metabolic syndrome

Organizational Culture and Motivation in the Public Sector. The Case of the City of Zografou

AbstractIn an era of increasingly diminishing public funding for local government organizations, motivating public employees is becoming a nearly impossible mission, with managers searching for non-monetary reward practices, to maintain or even increase motivation and performance of their subordinates. The purpose of this study is to investigate the motivational dynamics of the employees of a public sector organization and their relationship to its culture. The Competing Values Model was employed to diagnose the organizational culture and to illuminate the relationship of culture and motivation in the organization studied. The research has shown that the dominant culture type is Hierarchy (Bureaucracy) while motivation level was found to be low, demonstrating a negative association between the two variables. Also found was a positive relationship between the desired culture (clan) and motivation. The findings point to the need of a re-examination of the existing organizational culture by the local government and the creation of one that is closer to the one with greater motivating potentia

Diet, lifestyle factors and hypercholesterolemia in elderly men and women from Cyprus

BACKGROUND: We sought to investigate the single and combined effect of Mediterranean diet, being physically active, moderate alcohol use, and non-smoking on clinical status of 150 elderly people from Cyprus. METHODS: The study comprises individuals enrolled in surveys from Greece and Cyprus. This work includes 53 apparently men and 97 women, aged 65 to 100 years, from various areas of Cyprus. The cohort study was conducted between 2004 and 2005. A diet score that assesses the inherent characteristics of the Mediterranean diet was developed (range 0–55) and then a healthy index was calculated that evaluated four lifestyle habits (range 0 – 4), i.e. non-smoking, alcohol intake, physical activity and adherence to the Mediterranean diet (i.e. above the median of the score). RESULTS: 65% participants had hypercholesterolemia (total serum cholesterol > 200 mg/dl or use of lipid lowering agents). Moreover, 32% of the participants reported physically active, 5% reported smoking habits and 4% that they have stopped smoking during the past decade, while 8% reported alcohol drinking. A positive association was observed between prevalence of hypercholesterolemia and smoking habits (odds ratio = 4.3, p = 0.03), while an inverse association was observed between hypercholesterolemia, alcohol drinking (odds ratio = 0.3, p = 0.04) and adherence to a Mediterranean diet (odds ratio = 0.77, p = 0.02), controlled for age, sex, and other factors. CONCLUSION: Adherence to a Mediterranean diet and healthful lifestyle is associated with reduced odds of having hypercholesterolemia among elderly people

Experimental investigation of the particle oscillation instability in a single-axis acoustic levitator

Single-axis acoustic levitators are employed in biomedicine, chemistry and physics experiments due to their ability to trap in mid-air objects of a wide range of materials and sizes. Although this type of levitator has been studied for decades, there are effects that are not well understood. One of these effects is the particle oscillation instability, in which the levitating particle starts to oscillate with increasing amplitude until it is ejected out of the levitator. Most of the operations performed with acoustic levitation require high accuracy regarding the positioning of the particle, thus a lack of stability severely hinders the experiments. In this paper, we present an experimental setup that consists of a single-axis levitator, a mechanized stage to control the separation between the emitter and the reflector, a scale to measure the radiation force and a high-speed camera. We experimentally investigate the effect of the distance between the emitter and the reflector on the apparatus resonant frequency and on levitation stability. In accordance with previous theoretical studies, three types of levitation behavior were experimentally identified: stable levitation, oscillation of constant amplitude and unstable oscillation. We also show that the type of levitation behavior can be controlled by changing the distance between the emitter and the reflector.This research was supported by the Sao Paulo Research Foundation - FAPESP (Grant No. 2017/27078-0) and by the European Union's Horizon 2020 research and innovation programme under the FET-Open Scheme with grant agreement No 737087. Gianluca Memoli's time is partially funded by his UKRI fellowship (EP/S001832/1)