Short Term Advantages of a Public-Private Partnership for Tuberculosis in Guinea Bissau: Reduction of Mortality and increased Diagnostic Capacity

Background: Tuberculosis (TB) is widespread in Africa, but weak health systems in developing countries, often display poor quality of care with delays in case identification, irrational therapy and drug shortage, clinical mismanagement, unnecessary expenditures for patients, reduced adherence and increased mortality. Public-private partnership has demonstrated to increase TB case detection, but less is known about its effects on quality of care, mortality and costs for hospitalized TB patients. Methods: Clinical outcomes and costs for TB patients at the TB National Reference Center of Bissau, in Guine Bissau, West Africa were determined during the first 5 months of the public-private management and compared to the ones of previous years when the hospitals was under  direct Government’s management. Results: 215 (2009) and 194 (2013) patients were admitted, respectively. Improvement (p<0.05) was observed in mortality reduction (21% vs 6%), analysis prescription and diagnosis (39% vs 100%), cause of death determination (50% vs 85%), treatment abandonment (15 vs 1). Direct costs for patients during TB diagnostic pathway and inpatient care were significantly reduced, 475 vs 0 USD. Conclusions: Public-private partnerships displays important short term benefits in National TB reference centers, even in post-conflict and low-resource countries. Further studies could aid in determining the overall long term benefits of  this type of cooperation and the specific characteristic of TB and concomitant hematologic and infectious diseases in TB admitted patients

Intrahepatic persistent fetal right umbilical vein: a retrospective study

Introduction: To appraise the incidence and value of intrahepatic persistent right umbilical vein (PRUV). Methods: This was a single-center study. Records of all women with a prenatal diagnosis of intrahepatic PRUV were reviewed. The inclusion criteria were women with gestational age greater than 13 weeks of gestation. Exclusion criteria were fetuses with situs abnormalities, due to the hepatic venous ambiguity, and extrahepatic PRUV. The primary outcome was the incidence of intrahepatic PRUV in our cohort. The secondary outcomes were associated malformations. Results: 219/57,079 cases (0.38%) of intrahepatic PRUV were recorded. The mean gestational age at diagnosis was 21.8 ± 2.9 weeks of gestations. PRUV was isolated in the 76.7%, while in 23.3% was associated with other major or minor abnormalities. The most common associated abnormalities were cardiovascular abnormalities (8.7%), followed by genitourinary abnormalities (6.4%), skeletal abnormalities (4.6%), and central nervous system abnormalities (4.1%). Within the cardiovascular abnormalities, the most common one was ventricular septal defect (six cases). Conclusion: In most cases PRUV is an isolated finding. Associated minor or major malformations are presented in the 23.3% of the cases, so this finding should prompt detailed prenatal assessment of the fetus, with particular regard to cardiovascular system

Econometric and Machine Learning Methods to Identify Pedestrian Crash Patterns

Walking plays an important role in overcoming many challenges nowadays, and governments and local authorities are encouraging healthy and environmentally sustainable lifestyles. Nevertheless, pedestrians are the most vulnerable road users and crashes with pedestrian involvement are a serious concern. Thus, the identification of pedestrian crash patterns is crucial to identify appropriate safety countermeasures. The aims of the study are (1) to identify the road infrastructure, environmental, vehicle, and driver-related patterns that are associated with an overrepresentation of pedestrian crashes, and (2) to identify safety countermeasures to mitigate the detected pedestrian crash patterns. The analysis carried out an econometric model, namely the mixed logit model, and the association rules and the classification tree algorithm, as machine learning tools, to analyse the patterns contributing to the overrepresentation of pedestrian crashes in Italy. The dataset consists of 874,847 crashes—including 101,032 pedestrian crashes—that occurred in Italy from 2014 to 2018. The methodological approach adopted in the study was effective in uncovering relations among road infrastructure, environmental, vehicle, and driver-related patterns, and the overrepresentation of pedestrian crashes. The mixed logit provided a clue on the impact of each pattern on the pedestrian crash occurrence, whereas the association rules and the classification tree detected the associations among the patterns with insights on how the co-occurrence of more factors could be detrimental to pedestrian safety. Drivers’ behaviour and psychophysical state turned out to be crucial patterns related to pedestrian crashes’ overrepresentation. Based on the identified crash patterns, safety countermeasures have been proposed

Etiological diagnosis, prognostic significance and role of electrophysiological study in patients with Brugada ECG and syncope.

BACKGROUND: Syncope is considered a risk factor for life-threatening arrhythmias in Brugada patients. Distinguishing a benign syncope from one due to ventricular arrhythmias is often difficult, unless an ECG is recorded during the episode. Aim of the study was to analyze the characteristics of syncopal episodes in a large population of Brugada patients and evaluate the role of electrophysiological study (EPS) and the prognosis in the different subgroups. METHODS AND RESULTS: One hundred ninety-five Brugada patients with history of syncope were considered. Syncope were classified as neurally mediated (group 1, 61%) or unexplained (group 2, 39%) on the basis of personal and family history, clinical features, triggers, situations, associated signs, concomitant therapy. Most patients underwent EPS; they received ICD or implantable loop-recorder on the basis of the result of investigations and physician's judgment. At 62±45months of mean follow-up, group 1 showed a significantly lower incidence of arrhythmic events (2%) as compared to group 2 (9%, p<0.001). Group 2 patients with positive EPS showed the highest risk of arrhythmic events (27%). No ventricular events occurred in subjects with negative EPS. CONCLUSION: Etiological definition of syncope in Brugada patients is important, as it allows identifying two groups with different outcome. Patients with unexplained syncope and ventricular fibrillation induced at EPS have the highest risk of arrhythmic events. Patients presenting with neurally mediated syncope showed a prognosis similar to that of the asymptomatic and the role of EPS in this group is unproven

Neapolitan volcanic area Tide Gauge Network (Southern Italy): Ground Displacements and Sea-Level Oscillations

Abstract. In this study, we investigate the oscillations of relative sea level through the analysis of tide gauge records about 10-year long collected in the Gulfs of Pozzuoli and Napoli (Southern Italy). The main goal of this study is to provide a suitable resolution model of the sea tides including low frequency (seiches), tidal bands and non-linear tides. The spectral analyses of the tide gauge records lead us to identify a number of seiche periods some of them already known from the literature and some other unknown. Furthermore, we target a non-conventional purpose of the tidal analysis, namely extracting from the tide gauge records the volcano-tectonic signal (vertical ground displacement) in the resurgent Campi Flegrei caldera. We suggest a method to filter out the volcano-tectonic signal (bradyseism) from the tide gauge records by deconvolving it from two records, one collected in the active volcanic area (Pozzuoli) and the other one collected in a tectonically stable station (Napoli), located beyond the caldera rim. Finally, we retrieve the relative mean sea level change in the Gulf of Naples and compare it with the trend found in five tide gauges spread along the Italian coast

Multipolar expansions for scattering and optical force calculations beyond the long wavelength approximation

We review three different approaches for the calculation of electromagnetic multipoles, namely the Cartesian primitive multipoles, the Cartesian irreducible multipoles and the spherical multipoles. We identify the latter as the best suited to describe the scattering of electromagnetic radiation, as exemplified for an amorphous silicon sphere. These multipoles are then used to calculate the optical force acting on semiconductor, dielectric or metallic particles in a wide wavelength range, from the dipolar down to the Mie regimes

I-21 Current therapeutic guidelines in Duchenne Muscular Dystrophy to prolong life

Duchenne's myopathy is an X-linked disease with well defined evolutionary phases, characterized by degradation of the walking function, development of evolutive scoliosis and progressive decline of the respiratory function leading patients to premature death. In 1985 Y. Rideau in France carried out a new global therapeutic strategy for treatment of lower limb deformities, scoliosis deformity and progressive restrictive syndrome. The indication for surgery at the lower limbs is made very early, at the onset of the first signs of disease. The procedures are carried out at the same time and always bilaterally; they include: (i) hip section of superficial flexors; (ii) iliotibial band resection; (iii) subcutaneous tenotomy of semitendineous and gracilis; (iv) subcutaneous lengthening of Achilles tendons. In the post-operative period, the patient begins exercises of active and passive mobility in few days and after three weeks recovers his performances; ambulation will remain almost normal for several years. A comparison of two groups of patients, the first precociously operated on the lower limbs, the other one not operated, shows better performances in the operated group. The indications for surgical treatment of Duchenne scoliosis must be made after the loss of ambulation and not too late, to avoid the concurrent respiratory restrictive syndrome makes the patient inoperable. Over ten years ago, in Poitiers, a specific instrumentation for Duchenne scoliosis was created, providing for cylindrical rods fixed by peduncular screws at the sacro-lumbar level. On the dorso-lumbar level, the rod becomes flat to allow more flexibility of the trunk. The complications observed in a group of 55 patients operated for scoliosis, consisted in 2 cases of breaking of rods and 1 superficial infection. The surgery approach in DMD has the double aim to prolong the time of the autonomous ambulation and to avoid the evolution of scoliosis, limiting the harmful effects of the scoliosis on the respiratory function. However, the surgery alone is unable to prolong the life expectancy in these patients, without treating the restrictive respiratory syndrome, first by nasal ventilation and then by elective tracheotomy, essential for the survival of the patient