Dental Service in Italy: an organizational change action of the public health service

The purpose of this research is to promote a radical organizational change in public health service in order to improve service quality and image responding to the consumer’s needs. The starting point of the present analysis is the urgent need to compare private dental surgery service and public dental service, in order to identify areas of organizational change in the scope of public service

Training the Moral Self: An 8-Week Mindfulness Meditation Program Leads to Reduced Dishonest Behavior and Increased Regulation of Interoceptive Awareness

Objectives: Recent meta-analyses suggest that mindfulness meditation may enhance prosocial behavior, while evidence regarding moral behavior is still scarce. We combined a randomized controlled mindfulness training design with an ecologically valid moral decision-making task (Temptation to Lie Card Game; TLCG), in which participants were tempted to deceive an opponent to increase their monetary payoff. Method: TLCG and self-report measures (in the domains of attention regulation, body awareness, emotion regulation, and change in the perspective of the self) were administered to participants who underwent the mindfulness meditation training (experimental group, n = 44) or were waitlisted (control group, n = 25) twice: before and after the 8-week training. Results: Concerning moral decision-making, we observed a significant effect involving condition, time, and group. Trained participants deceived significantly less in the post-training as compared with the pre-training phase (p = 0.03), while untrained ones showed no significant change (p = 0.58). In the self-reports, significant effects involving time and group were found for the Multidimensional Assessment of Interoceptive Awareness (MAIA-2) in Self-Regulation, Attention Regulation, Body Listening, and for the Five Facet Mindfulness Questionnaire (FFMQ) in Non-Reactivity to inner experience. Trained participants showed a time-related increase in all subscales scores, while untrained ones did not. Finally, a moderation analysis revealed a significant interaction between weekly mindfulness meditation training minutes and MAIA-2 Attention Regulation (post-training) on moral behavior change. Conclusions: Our preliminary results suggest that mindfulness meditation practice decreases self-serving dishonest behavior and increases awareness of one’s bodily and emotional state. In particular, the amount of mindfulness meditation practice predicted moral behavior change in practitioners who reported the highest regulation of attention towards internal bodily signals. Preregistration: This study is not preregistered

Neuropsychological Functioning in Bilateral versus Unilateral Temporal Lobe Epilepsy

Although relatively specific anatomo-electro-clinical features of temporal lobe epilepsy (TLE) with bilateral ictal involvement (bitemporal epilepsy-BTLE) have been described, differentiating between BTLE and unilateral TLE (UTLE) remains challenging. Surgery is often the treatment of choice for drug-resistant UTLE, whereas its use is more controversial in BTLE. It is currently unclear whether neuropsychological assessment can contribute to the differential diagnosis. We retrospectively reviewed the neuropsychological evaluation of 46 consecutive patients with refractory TLE. Eighteen patients were diagnosed with BTLE on the basis of ictal electro-clinical data, in particular a video EEG recording of at least one seizure simultaneously involving the two temporal lobes without the possibility of lateralizing its onset or at least two different seizures independently arising from the two temporal lobes. Twenty-eight patients were classified as UTLE. Presurgery evaluation data were used in this study. Compared with UTLE, BTLE was associated with a lower intelligence quotient (IQ) and more severe impairment in long-term memory, the latter remaining significant even after controlling for IQ. No significant differences were found between right and left UTLE. In conclusion, BTLE and UTLE are associated with relatively distinct neuropsychological profiles, further supporting their classification as different disorders within the TLE spectrum

Lower Urinary Tract Dysfunction in Pediatric Patients with Multiple Sclerosis: Diagnostic and Management Concerns

background: multiple sclerosis (MS) is increasing in the pediatric population and, as in adults, symptoms vary among patients. in children the first manifestations can sometimes overlap with acute neurological symptoms. urological symptoms have not been much studied in childhood. we shared our experience with MS urological manifestation in children. methods: this article is a retrospective evaluation of all children with MS, according to the Krupp criteria, who also present with urological symptoms. we collected demographic and clinical history, the MR localization of demyelinating lesions, urological symptoms, and exams. results: we report on six MS pediatric cases with urological manifestation. urinary symptoms, characterized by urinary incontinence in five patients and urinary retention in one patient, appeared in a different time frame from MS diagnosis. urodynamic exams showed both overactive and underactive bladder patterns. treatment was defined according to lower urinary tract dysfunction, using clean intermittent catheterization, oxybutynin, and intradetrusor onabotulinum toxin-a injection. a low acceptance rate of invasive evaluation and urological management was observed. conclusions: the MS diagnosis was traumatic for all our patients. we believe it is important to address urological care in young people from the time of diagnosis for prompt management; it could be useful to include a pediatric urologist in multidisciplinary teams

Crack-Like Processes Governing the Onset of Frictional Slip

We perform real-time measurements of the net contact area between two blocks of like material at the onset of frictional slip. We show that the process of interface detachment, which immediately precedes the inception of frictional sliding, is governed by three different types of detachment fronts. These crack-like detachment fronts differ by both their propagation velocities and by the amount of net contact surface reduction caused by their passage. The most rapid fronts propagate at intersonic velocities but generate a negligible reduction in contact area across the interface. Sub-Rayleigh fronts are crack-like modes which propagate at velocities up to the Rayleigh wave speed, VR, and give rise to an approximate 10% reduction in net contact area. The most efficient contact area reduction (~20%) is precipitated by the passage of slow detachment fronts. These fronts propagate at anomalously slow velocities, which are over an order of magnitude lower than VR yet orders of magnitude higher than other characteristic velocity scales such as either slip or loading velocities. Slow fronts are generated, in conjunction with intersonic fronts, by the sudden arrest of sub-Rayleigh fronts. No overall sliding of the interface occurs until either of the slower two fronts traverses the entire interface, and motion at the leading edge of the interface is initiated. Slip at the trailing edge of the interface accompanies the motion of both the slow and sub-Rayleigh fronts. We might expect these modes to be important in both fault nucleation and earthquake dynamics.Comment: 19 page, 5 figures, to appear in International Journal of Fractur

Editorial note for the Geodesy and Geodynamics journal special issue Contemporary Research in Geodynamics and Earth Tides : An account of the 18th Geodynamics and Earth Tides Symposium 2016, Trieste, Italy

This volume aims at conveying the rich and interdisciplinary topics discussed at the 18th Geodynamics and Earth Tides Symposium, Trieste, 2016. For seventeen times the gathering was named the Earth Tides Symposium, when giving tribute to the evolution of the observed signals, the term geodynamics was added to the title.The present volume aims at a full coverage of the Symposium by including the entire list of abstracts that were presented either as oral or poster presentation

Enhancing Egress Drills: Preparation and Assessment of Evacuee Performance

This article explores how egress drills-specifically those related to fire incidents-are currently used, their impact on safety levels, and the insights gained from them. It is suggested that neither the merits of egress drills are well understood, nor the impact on egress performance well characterized. In addition, the manner in which they are conducted varies both between and within regulatory jurisdictions. By investigating their strengths and limitations, this article suggests opportunities for their enhancement possibly through the use of other egress models to support and expand upon the benefits provided. It is by no means suggested that drills are not important to evacuation safety-only that their inconsistent use and the interpretation of the results produced may mean we (as researchers, practitioners, regulators, and stakeholders) are not getting the maximum benefit out of this important tool

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

How doctors generate diagnostic hypotheses: a study of radiological diagnosis with functional magnetic resonance imaging.

In medical practice, diagnostic hypotheses are often made by physicians in the first moments of contact with patients; sometimes even before they report their symptoms. We propose that generation of diagnostic hypotheses in this context is the result of cognitive processes subserved by brain mechanisms that are similar to those involved in naming objects or concepts in everyday life