Modelli per la pianificazione logistica nei servizi sanitari di emergenza-urgenza

L’individuazione di modelli decisionali per le scelte di natura logistica relative ai servizi sanitari di emergenza-urgenza negli ultimi tempi hanno assunto una maggiore importanza sia per motivazioni di carattere sociale, sia per motivi di carattere economico. La concentrazione delle strutture sanitarie sul territorio e, quindi, l’eliminazione di molti centri di assistenza sanitaria, operata da parte delle Regioni italiane nel quadro della riduzione della spesa del servizio sanitario nazionale, ha fatto crescere l’attenzione degli utenti verso i servizi logistici di emergenza urgenza comunemente definiti come trasporti di pronto soccorso. Di conseguenza, anche i public policy maker devono ora affrontare il problema di conciliare le istanze sociali con quelle di minimizzazione della spesa della logistica per servizi di emergenza urgenza. A quest’ultimo proposito occorre sottolineare che le specificità sociali ed economiche di tale servizio impongono un elevato livello di rigore analitico per quanto concerne, la valutazione, da un lato, dell’andamento tendenziale delle esigenze collettive, dall’altro, della capacità del servizio di rispondere al reale bisogno della domanda nella sua articolazione territoriale. L’emergenza-urgenza costituisce un particolare segmento dell’offerta di servizi sanitari che si caratterizza per l’elevata complessità causata dell’aleatorietà degli eventi e dalla forte interazione spaziale tra il luogo di origine della domanda e il luogo in cui è possibile erogare il relativo servizio. Se poi l’erogazione avviene in un contesto territoriale caratterizzato da una morfologia eterogenea (montana e collinare), appare evidente il grado di complessità a cui si va incontro nella progettazione e gestione del servizio stesso. In tale ambito, il presente lavoro è teso ad illustrare un modello per ottimizzare la localizzazione e il livello di fornitura dei servizi in considerazione delle variabili territoriali (distanze e vie di comunicazione, etc.) e sociali (popolazione, attività economiche, etc.). Il presente lavoro costituisce la base per una futura applicazione empirica relativamente al caso della Regione siciliana (per ora limitata alla sola provincia di Messina). La scelta di questo territorio come base di studio deriva dal fatto che esso presenta peculiarità tali da rendere i modelli di micro-simulazione, che si desidera utilizzare per ottimizzare le scelte decisionali nel campo della logistica di emergenza urgenza, generalizzabili ad altre realtà anche meno complesse di quella da noi presa in considerazione

A reflection on motor overflow, mirror phenomena, synkinesia and entrainment

In patients with movement disorders, voluntary movements can sometimes be accompanied by unintentional muscle contractions in other body regions. In this review, we discuss clinical and pathophysiological aspects of several motor phenomena including mirror movements, dystonic overflow, synkinesia, entrainment and mirror dystonia, focusing on their similarities and differences. These phenomena share some common clinical and pathophysiological features, which often leads to confusion in their definition. However, they differ in several aspects, such as the body part showing the undesired movement, the type of this movement (identical or not to the intentional movement), the underlying neurological condition, and the role of primary motor areas, descending pathways and inhibitory circuits involved, suggesting that these are distinct phenomena. We summarize the main features of these fascinating clinical signs aiming to improve the clinical recognition and standardize the terminology in research studies. We also suggest that the term “mirror dystonia” may be not appropriate to describe this peculiar phenomenon which may be closer to dystonic overflow rather than to the classical mirror movements

REM-Sleep Behavior Disorder in Patients With Essential Tremor: What Is Its Clinical Significance?

Objective: REM sleep behavior disorder (RBD) is an important risk factor for the dementia development and for the deterioration of autonomic functions in patients with Parkinson's Disease. RBD has also been reported in patients with Essential Tremor (ET). However, its clinical significance in ET remains still unknown. We aimed to investigate clinical, neuropsychological and cardiac autonomic scintigraphic differences between ET patients with and without RBD.Methods: To assess RBD symptoms, RBD Single-Question has been administered in a cohort of 55 patients with a clinical diagnosis of ET. Patients with clinical RBD underwent polysomnography (PSG) confirmation. All patients completed a battery of neuropsychological assessment of memory, executive function, attention, language, and visuospatial function. Cardiac MIBG scintigraphy was performed in order to measure the cardiac autonomic innervation.Results: Ten ET patients (18%) had a PSG-confirmed RBD (ETRBD+). Compared to ET patients without RBD (ETRBD−), significantly reduced scores on memory domain tests such as Rey auditory verbal learning test immediate recall (p = 0.015) and Rey auditory verbal learning test delayed recall (p = 0.004) and phonemic fluency test (p = 0.028) were present in ETRBD+. By contrast, no other significant clinical difference has emerged from the comparison between two ET groups. Similarly, ETRBD+ patients have cardiac MIBG tracer uptake in the normal value range as occurred in those with ETRBD−.Conclusions: This study improves the knowledge on clinical significance of RBD symptoms in ET patients. Our preliminary findings demonstrate that presence of RBD in ET is associated with neurocognitive impairment, but not with cardiac autonomic dysfunction. Further longitudinal studies are needed to investigate whether ET patients with RBD will develop a frank dementia over the time

Knowledge of public health informatics among Italian medical residents: design and preliminary validation of a questionnaire

Background: public health requires strong information skills and competencies, as it is information-intensive and information-driven. Public health informatics has been defined as the “systematic application of information, computer science, and technology to public health practice, research, and learning”. New information and communication technologies offer unprecedented opportunities, such as linking smart-phones and mobiles devices to web based tools for data collection, enabling and enhancing participatory epidemiology. However, being an emerging discipline, despite its potential and importance, public health informatics is often neglected and overlooked, being rarely offered as course. The present study was designed as a pilot study, with the aim of designing and validating a questionnaire on the knowledge of public health informatics among medical residents in public health in Italy.  Methods and Results: thirty-two Italian residents in public health volunteered to take part into the study. Mean age of the sample was 31.44±2.23 years, most responders were males (68.8%), from northern Italy (53.1%), at the third year of residency (34.4%) and currently doing practical training at the clinical management staff/hospital directorate (34.4%). Other places of training were the Prevention Department (21.9%), the Institute of Hygiene (18.8%), the local health units and the territory (12.5%), the occupational health service (6.3%) and the Regional Health Agency (3.1%). Cronbach’s alpha coefficient yielded a value of 0.909, demonstrating excellent psychometric properties of the instrument.  Conclusion: in conclusion, the developed questionnaire seems to be an appropriate and useful tool to detect gaps concerning knowledge, education and practices of public health informatics among residents in public health.&nbsp

The future of interpretive accounting research:A Polyphonic Debate

In 1997-99 the three of us organised a series of European Commission funded conferences aimed at building a network of young researchers in the area of accounting. At the time “young” was defined by the Commission as researchers under 35 years of age (allowing for maternity leave or national service). Over the intervening years our network had grown and we wanted to try and take stock of the field in which we had now been working for a surprising number of years. To that Page 1 of 29 Accepted Manuscript 2 end we put together the above email and a broad invitation list of people who had been at those first meetings, and others of the same generation (or even younger) whom we had met since. About half of those originally contacted managed to make the meeting where we spent a stimulating couple of hours of debate on the topics raised below—so stimulating that we developed a collective desire to leave a trace of the discussion. Writing a traditional paper with so many, so widely dispersed authors was not going to work. Instead we came up with a different form of collective writing that mirrored the original debate, and that might contribute to ongoing debates in this journal concerning the nature and status of our research (e.g. Arrington, 2004; Inanga & Schneider, 2005; Macintosh, 2004). We agreed a process in which each of us in turn would have one week to add a target of 300 words to a rolling document, going through the contributors alphabetically. After two rounds we would see what we had got

Rilievo 3D e monitoraggio dinamico della Torre degli Smeducci e del campanile del Duomo vecchio a San Severino Marche

Le attività della task force del Politecnico nell’Italia Centrale, nelle fasi post sisma del 2016, sono state indirizzate non solo alle aree epicentrali, ma si sono estese anche ad aree del cratere sismico che hanno subito danneggiamenti meno importanti. In queste aree le attività sono state rivolte alla analisi di beni monumentali ad alta vulnerabilità che hanno subito danneggiamenti limitati. In questo contesto si inquadrano le indagini condotte su due torri storiche di San Severino Marche, la Torre del Duomo Vecchio e la Torre degli Smeducci. Tali attività fanno parte di un piano di cooperazione strategica tra il Comune di San Severino Marche, il Politecnico di Torino e di Nagoya City University (Giappone)