Lean Six Sigma Approach to Implement a Femur Fracture Care Pathway at “San Giovanni di Dio e Ruggi d’Aragona” University Hospital

Timeliness in the treatment of fracture of the femur, through surgery, is crucial in the elderly patient as it reduces the risk of mortality and disability. Here we propose a Lean Six Sigma (LSS) approach to reduce the preoperative length of stay for patients with femur fracture. Through the LSS, a tailored Diagnostic Therapeutic Assistance Path (DTAP) for these has been implemented and monitored over time. In particular, through the analysis, based on the application of the DMAIC cycle conducted on data extrapolated from the information system of the “San Giovanni di Dio e Ruggi d’Aragona” University Hospital of Salerno, the new DTAP was designed and implemented. After the introduction of the DTAP, a significant reduction in the average length of hospital stay was observed, with a preoperative length of stay within 48 h in 65% cases (compared to the previous 9%). In particular, the most significant reduction (over 55%) is obtained for patients aged over 65 years old. Such a result reflects not only the improvement in the care process but it is also compliant with the guidelines of the Italian Ministry of Health, as reported in the New Guarantee System for monitoring the quality of care. © 2021, Springer Nature Switzerland AG

DNA/RNA: Building Blocks of Life Under UV Irradiation

International audienceDuring the last 10 years, intense experimental and theoretical work has proven the existence of ultrafast nonradiative decay routes for UV-excited monomeric nucleic acid bases, accounting for their high photostability. This mechanism has been explained by the occurrence of easily accessible conical intersections connecting the first excited ππ* state with the ground state. However, recent studies of substituent and solvent effects indicate that the situation is more complicated than what was initially thought, notably by the presence of dark excited states. Moreover, the actual shape of the excited-state potential energy surface may induce nonexponential dynamics. Further efforts are needed in order to clarify how various environmental factors affect the structural and dynamical aspects of the nucleic acid base excited states

Femtosecond fluorescence studies of DNA/RNA constituents

International audienceIn this overview, femtosecond fluorescence studies of various DNA constituents are presented, ranging from the monomeric chromophores to different model helices. In order to interpret the experimental results in terms of fundamental processes on the molecular scale they are discussed in the light of recent theoretical calculations. The ultrafast fluorescence decay observed for the monomers is explained by the involvement of highly efficient conical intersections (CI) between the first singlet excited state and the ground state. For the model helices, the picture is more complex, but fluorescence anisotropy data reveal collective effects

DMAIC Approach for the Reduction of Healthcare-Associated Infections in the Neonatal Intensive Care Unit of the University Hospital of Naples ‘Federico II’

Improvements in the obstetrical and neonatal management have allowed children to survive. These enhancements have showed, anyway, a general increased incidence of healthcare-associated infections, one of the most influent causes of morbidity and mortality in neonatal intensive care units. The aim of this paper is to suggest corrective measures to reduce sentinel germs colonization and identify the relationships between bacteria colonization with the number of procedures and the length of hospital stay. The Lean Six Sigma methodology was used to tackle this issue using a tailored Define, Measure, Analyze, Improve, and Control problem-solving strategy. An increased number of procedures and an extended length of hospital stay demonstrated a statistically significant influence on newborns’ possibility to be infected by sentinel germs. These findings could guide the clinical staff to improve the management of neonates in neonatal intensive care units reducing the number of infected patients, their length of hospital stay and the costs for the hospital. © 2021, Springer Nature Switzerland AG

Assessing solvent effects on the singlet excited state lifetime of uracil derivatives: a femtosecond fluorescence upconversion study in alcohols and D2O

The excited state lifetimes of uracil, thymine and 5-fluorouracil have been measured using femtosecond UV fluorescence upconversion in various protic and aprotic polar solvents. The fastest decays are observed in acetonitrile and the slowest in aqueous solution while those observed in alcohols are intermediate. No direct correlation with macroscopic solvent parameters such as polarity or viscosity is found, but hydrogen bonding is one key factor affecting the fluorescence decay. It is proposed that the solvent modulates the relative energy of two close-lying electronically excited states, the bright ΠΠ and the dark nΠ states. This relative energy gap controls the non-radiative relaxation of the ΠΠ state through a conical intersection close to the Frank-Condon region competing with the ultrafast internal conversion to the ground state. In addition, an inverse isotope effect is observed in D2O where the decays are faster than in H2O

Singlet excited state dynamics of uracil and thymine derivatives: A femtosecond fluorescence upconversion study in acetonitrile

The excited state properties of uracil, thymine and four analogous uracil compounds have been studied in acetonitrile by steady-state and time-resolved spectroscopy. The excited state lifetimes were measured using femtosecond UV fluorescence upconversion. The excited state lifetimes of uracil and its 1- and 3-methyl substituted derivatives are well described by one ultrafast (6100 fs) component. Five substituted compounds show a more complex behavior, exhibiting longer excited state lifetimes and bi-exponential fluorescence decays. These longer decays are substantially faster in acetonitrile than in aqueous solution showing that the excited state deactivation mechanism is in part governed by the solvent

From 3D to 4D passive seismic tomography: The sub-surface structure imaging of the Val d’Agri region, southern Italy

Local earthquakes (passive seismic) tomography (LET) is a well established tool for the imaging of the sub-surface structure. Alternative to active seismics, the main advantages of using natural sources are the better sounding in deeper portions of the upper crust, the relatively low cost, and the direct availability of S-waves. The main drawback is the achievable model resolution, which is limited by the density of the seismic network and the distribution of elastic sources, rather than the elastic wave frequency. Recently, 4D variations (in space and time) of velocity anomalies have been recognized in active volcanoes (Patanè et al., 2006) and normal faulting systems and ascribed to the medium response to transient geological processes, like dyke intrusions or fluid pressure increase on fault planes. In this paper we show how LET contributes to the imaging of the upper crust in a very attractive region like the Val d’Agri in southern Italy, which hosts both significant oil fields and seismogenic structures. We show that LET allows to improve the definition of the crust structure, at depths larger than those sampled by conventional seismic profiles, and detect the space-time dependency of elastic properties in response to local variations of fluid pressur

Computing the absorption and emission spectra of 5-methylcytidine in different solvents: a test-case for different solvation models

International audience; The optical spectra of 5-methylcytidine in three different solvents (tetrahydrofuran, acetonitrile, and water) is measured, showing that both the absorption and the emission maximum in water are significantly blue-shifted (0.08 eV). The absorption spectra are simulated based on CAM-B3LYP/TD-DFT calculations but including solvent effects with three different approaches: (i) a hybrid implicit/explicit full quantum mechanical approach, (ii) a mixed QM/MM static approach, and (iii) a QM/MM method exploiting the structures issuing from molecular dynamics classical simulations. Ab-initio Molecular dynamics simulations based on CAM-B3LYP functionals have also been performed. The adopted approaches all reproduce the main features of the experimental spectra, giving insights on the chemical−physical effects responsible for the solvent shifts in the spectra of 5-methylcytidine and providing the basis for discussing advantages and limitations of the adopted solvation models

Caratterizzazione della risposta sismica nella città di Benevento.

L'ampiezzà de1 moto del suolo, ed il suo contenuto in frequenza, alla súpeúcie della TerIa dípede dale caratte stiche della, sorgente sismica e dalle proprietà meccaniche del úezzo in cui si propagano le onde sismiche. In pa.rtico lare, gli strati pmssimi alla superficie possono modifrcare in modo sigdficativo il segnale sismlco. InJatti la presenza, di uno strato con un fo e contraato di im pedenza, spetto ad un basarnento sottostànte prÌò indurc etretti di risonanza alterando sensibilmente il livelo di anpiezza, il conterùto in Îrequenza e la, durata delle oscilla.zioni del suolo. Un esempio estîemo di questo fenomeno è stato evidenziatoi n occasiored el terremoto di Michoacan,M essico,d el 1985.Q uesto evento, pur essendo a-r.venuto ad alcune centinaia di chilometri da.lla capitale, ha, eccitato con il pe.iodo proprio di oscillnzioÈe( cilca 2 secondi)i depositi di riempimento di un antico lago prosciugato, su cui è costruita parte di Città, del Messico, pmvocaùdo iI crollo di nurerosi edifici e misliaia di morti (Singh et al., 198

Comparing Two Approaches for Thyroidectomy: A Health Technology Assessment through DMAIC Cycle

Total thyroidectomy is very common in endocrine surgery and the haemostasis can be obtained in different ways across surgery; recently, some devices have been developed to support this surgical phase. In this paper, a health technology assessment is conducted through the define, measure, analyse, improve, and control cycle of the Six Sigma methodology to compare traditional total thyroidectomy with the surgical operation performed through a new device in an overall population of 104 patients. Length of hospital stay, drain output, and time for surgery were considered the critical to qualities in order to compare the surgical approaches which can be considered equal regarding the organizational, ethical, and security impact. Statistical tests (Kolmogorov–Smirnov, t test, ANOVA, Mann–Whitney, and Kruskal–Wallis tests) and visual management diagrams were employed to compare the approaches, but no statistically significant difference was found between them. Considering these results, this study shows that the introduction of the device to perform total thyroidectomy does not guarantee appreciable clinical advantages. A cost analysis to quantify the economic impact of the device into the practice could be a future development. Healthy policy leaders and clinicians who are requested to make decisions regarding the supply of biomedical technologies could benefit from this research