Keeping it modern, making it sustainable. Monitoring and energy retrofitting the Urbino University Colleges

This paper presents a research to balance building conservation, users’ comfort and energy efficiency of a masterpiece of XX century architecture. The Urbino University Colleges were designed by architect Giancarlo de Carlo and built since 1962 to 1983 beside the Renaissance city. They host more than 1,000 students within 5 dormitories and 62,000 m2 surface. Authors discuss some outcomes from the “Keeping it modern” research program financed by the Getty Foundation in 2016, which aims at providing the Colleges with a sustainable conservation plan. The goal is to lower heating and operational costs to allow funds in conservation activities. Specific issues regard: the striking dimensions of the complex, the constructive features (brickwork walls, exposed concrete structures, single-glazed windows) and the lack of data about the hygrothermal performances. The research thus includes a hygrothermal analysis, a proposal for the energy retrofitting, a building-HVAC model, a test on a pilot site. Authors have monitored surface temperatures, indoor air temperature and humidity for one year, even mapping their distribution through a digital psychrometer. Thermal imaging has been used to detect heat losses, thermal bridges and heat gains due to the solar radiation. Data have fed a building-HVAC model, which was a reference to design an appropriate strategy for retrofitting and improving the energy efficiency of the complex. Some solutions are being implemented on a pilot site. The building performances before and after retrofitting are compared. Results provide indications to merge conservation and sustainability of a XX century heritage building. In conclusion, the solid knowledge of each case confirms being required to support a retrofit proposal of a heritage building, moreover in case of a XX century building, as the cultural value of such a huge heritage is often disregarded to improve its energy performance

Bayes pulmonary embolism assisted-diagnosis: a new expert system for clinical use

Background: The diagnosis of pulmonary embolism demands flexible decision models, both for the presence of clinical confounders and for the variability of local diagnostic resources. As Bayesian networks fully meet this requirement, Bayes Pulmonary embolism Assisted Diagnosis (BayPAD), a probabilistic expert systems focused on pulmonary embolism, was developed. Methods: To quantitatively validate and improve BayPAD, the system was applied to 750 patients from a prospective study done in an Italian tertiary hospital where the true pulmonary embolism status was confirmed using pulmonary angiography or ruled out with a lung scan. The proportion of correct diagnoses made by BayPAD (accuracy) and the correctness of the pulmonary embolism probabilities predicted by the model (calibration) were calculated. The calibration was evaluated according to the Cox regression-calibration model. Results: Before refining the model, accuracy was 88.6%. Once refined, accuracy was 97.2% and 98%, respectively, in the training and validation samples. According to Cox analysis, calibration was satisfactory, despite a tendency to exaggerate the effect of the findings on the probability of pulmonary embolism. The lack of some investigations (like Spiral computed tomographic scan and Lower limbs doppler ultrasounds) in the pool of available data often prevents BayPAD from reaching the diagnosis without invasive procedures. Conclusions: BayPAD offers clinicians a flexible and accurate strategy to diagnose pulmonary embolism. Simple to use, the system performs case-based reasoning to optimise the use of resources available within a particular hospital. Bayesian networks are expected to have a prominent role in the clinical management of complex diagnostic problems in the near future

Measuring self-care in the general adult population : Development and psychometric testing of the Self-Care Inventory

Background Self-care is important at all stages of life and health status to promote well-being, prevent disease, and improve health outcomes. Currently, there is a need to better conceptualize self-care in the general adult population and provide an instrument to measure self-care in this group. Therefore, the aim of this study was to develop and evaluate the Self-Care Inventory (SCI), a theory-based instrument to measure self-care in the general adult population. Methods Based on the Middle Range Theory of Self-Care, the 20-item SCI was developed with three scales: Self-Care Maintenance (8 items), Self-Care Monitoring (6 items), and Self-Care Management (6 items). A cross sectional study with a US-based sample (n = 294) was conducted to test the SCI. Internal validity was assessed with Confirmatory Factor Analysis. Internal consistency reliability was assessed with Cronbach alpha for unidimensional scales or composite reliability and the global reliability index for multidimensional scales. Construct validity was investigated with Pearson correlation to test the relationship between general self-efficacy, positivity, stress, and self-care scores. Results The Self-Care Maintenance and Management scales were multidimensional and the Self-Care Monitoring scale was unidimensional. The global reliability index for multidimensional scales was 0.85 (self-care maintenance) and 0.88 (self-care management). Cronbach alpha coefficient of the self-care monitoring scale was 0.88. Test-retest reliability was 0.81 (self-care maintenance), 0.91 (self-care monitoring), and 0.76 (self-care management). The General Self-Efficacy Scale was positively related to all three self-care scale scores: self-care maintenance r = 0.46, p < 0. 001, self-care monitoring r = 0.31, p < 0. 001, and self-care management r = 0.32, p < 0. 001. The positivity score was positively related to self-care maintenance (r = 0.42, p < 0. 001), self-care monitoring (r = 0.29, p < 0. 001), and self-care management (r = 0.34, p < 0. 001) scores. The perceived stress was positively related to the self-care management (r = 0.20, p < 0. 001) score. Conclusions The SCI is a theoretically based instrument designed to measure self-care in the general adult population. Preliminary evidence of validity and reliability supports its use in the general adult population

How to Design a Qualitative Health Research Study. Part 1: Design and Purposeful Sampling Considerations

In this first part of the article, we aim to provide health researchers with an understanding of how to design a qualitative health research study, including: topic identification, design selec- tion, and engagement in reflexivity. We offer practical guidance for writing an overarching question using a novel framework that helps develop a clearly articulated question that includes the following elements: emphasis, purposeful sampling, phenomenon of interest, and context. We then expand on specific methodological issues: study designs, contexts, sampling, and recruitment. Finally, we provide examples of qualitative health research studies that illustrate the application of different research designs. In part two of this article, we will discuss how to prepare for going into the field, how to generate, manage and analyse data, and plan for the dissemination of qualitative health research. Keywords: Research Methodology, Qualitative Research, Qualitative Health Research, Research Design, Purposeful Sample, RecruitmentCome Disegnare uno Studio di Ricerca Sanitaria Qualitativa. Parte 1: Considerazioni sui Disegni e sul Campionamento PropositivoAttraverso le nostre esperienze di insegnamento della ricerca qualitativa agli studenti in varie discipline sanitarie, abbiamo concluso che molti ricercatori alle prime armi richiedono un supporto chiaro, pratico e focalizzato per sviluppare protocolli di ricerca. In questa prima parte di articolo, miriamo a fornire ai ricercatori sanitari una comprensione di come proget- tare uno studio qualitativo sulla ricerca sanitaria, tra cui: identificazione dell'argomento, sele- zione del disegno e del coinvolgimento nella riflessività. Offriamo una guida pratica per scri- vere una domanda utilizzando una nuova framework che aiuta a sviluppare una domanda chiaramente articolata che include i seguenti elementi: enfasi, campionamento propositivo, fenomeno di interesse e contesto. Quindi, esponiamo questioni metodologiche specifiche: disegno di studio, contesti, campionamento e reclutamento. Infine, forniamo esempi di studi qualitativi di ricerca sanitaria tratti dalla letteratura. Nella seconda parte dell'articolo, discu- teremo come prepararsi per andare sul campo, come generare, gestire e analizzare i dati e pianificare la diffusione della ricerca qualitativa sanitaria. Parole Chiave: Metodologia della ricerca, Ricerca Qualitativa, Ricerca Sanitaria Qualitativa, Disegni di Ricerca, Campionamento Propositivo, Reclutamento

Sodium Nitroprusside Toxicity in a Young Infant Following Cardiac Surgery

Adverse effects associated with sodium nitroprusside (SNP) administration are rarely observed in children. Monitoring of metabolic changes appears to be the most sensitive and accurate indicator of early toxicity. We report a case of acute toxicity in a 3-month-old boy treated with high-dose SNP infusion for systemic hypertension after elective coarctectomy, who developed seizures and severe lactic acidosis. We suggest blood lactate levels and base excess levels should be carefully monitored during SNP treatment in children, in order to detect early signs of toxicity, particularly when using high infusion rates

Enlarged vascular foramina and lytic lesions in vertebral bodies: a diagnostic dilemma

Among the skeletal material from the sites of Alghero, Mesumundu and Sant’Antioco di Bisarcio (Sassari, Sardinia) and dated back to the period comprises between the 13th and the late 16th century 5 subadult individuals aged between 5 and 15 years and a mature male showed peculiar osteolytic phenomena of the vertebral bodies. These lesions have the appearance of enlarged vascular foramina, affecting several vertebrae mainly of the thoracic and lumbar spine, sometimes with involvement of the sacrum; on the same vertebral body several lesions are generally visible. In the literature similar features have been attributed to brucellosis or tuberculosis. As for the Sardinian skeletal material, an imaging study on the vertebrae of the adult individual was carried out in order to evaluate the appearance of the lesions within the body. Computed Tomography evidenced internal irregular elongated cavitations, sometimes joined together; erosive rounded lesions, whose presence is not detectable externally, were also showed. The molecular analysis has so far been performed on the subadult from Sant’Antioco di Bisarcio, but at initial analysis the DNA resulted degraded. Therefore, the nature of these lesions remains unclear, as it is not sure if they should be referred to tuberculosis, brucellosis or other pathological conditions [hemolytic anemias (eg. Thalassemia), lymphomas, multiple myeloma and infection by Echinococcus]. Further molecular analyses will be carried out on the remains belonging to the other five individuals in an attempt to clarify the etiology of the above mentioned lesions

How to Design a Qualitative Health Research Study. Part 2: Data Generation and Analysis Considerations

In the first part of this article, we introduced methodological issues associated with study design, research questions, contexts, sampling, and recruiting for qualitative health research studies. Here, in this second part of the article, we continue providing health researchers with information on how to design a qualitative health research study and we aim to prepare novice researchers for entering the field. Specifically, by providing considerations for selecting data gathering strategies, differentiation of types of qualitative data and practical tips on how to go into the field. Then, we will briefly discuss data management, analysis and dissemination.Keywords: Research Methodology, Qualitative Research, Qualitative Health Research, Research Design, Data gathering, Data analysis. Come disegnare uno studio di ricerca sanitaria qualitativa. Parte 2: Considerazioni su generazione e analisi dei datiNella prima parte di questo articolo, abbiamo introdotto questioni metodologiche associate alla progettazione dello studio, domande di ricerca, contesto, campionamento e reclutamento per studi di ricerca qualitativa sanitaria. In questa seconda parte dell'articolo, continuiamo a fornire ai ricercatori della salute informazioni su come progettare uno studio di ricerca qualitativa sanitaria e ci proponiamo di preparare i ricercatori alle prime armi per andare sul campo. In particolare, fornendo considerazioni per la selezione della strategia di raccolta dati, differenziazione dei tipi di dati qualitativi e consigli pratici su come andare sul campo. Dopodiché, discuteremo brevemente la gestione, l'analisi e la diffusione dei dati.Parole Chiave: Metodologia della ricerca, Ricerca Qualitativa, Ricerca Sanitaria Qualitativa, Disegni di Ricerca, Raccolta Dati, Analisi dei dat

Calibration Belt for Quality-of-Care Assessment Based on Dichotomous Outcomes

Prognostic models applied in medicine must be validated on independent samples, before their use can be recommended. The assessment of calibration, i.e., the model's ability to provide reliable predictions, is crucial in external validation studies. Besides having several shortcomings, statistical techniques such as the computation of the standardized mortality ratio (SMR) and its confidence intervals, the Hosmer–Lemeshow statistics, and the Cox calibration test, are all non-informative with respect to calibration across risk classes. Accordingly, calibration plots reporting expected versus observed outcomes across risk subsets have been used for many years. Erroneously, the points in the plot (frequently representing deciles of risk) have been connected with lines, generating false calibration curves. Here we propose a methodology to create a confidence band for the calibration curve based on a function that relates expected to observed probabilities across classes of risk. The calibration belt allows the ranges of risk to be spotted where there is a significant deviation from the ideal calibration, and the direction of the deviation to be indicated. This method thus offers a more analytical view in the assessment of quality of care, compared to other approaches

SATURN: A Technological Demonstration Mission for Distributed SAR Imaging

The OHB-Italia S.p.A-led consortium is in the midst of Phase B of SATURN (Synthetic AperTure radar cUbesat foRmation flyiNg), part of ALCOR, an Italian Space Agency (ASI) programme promoting the development of the next generation Italian CubeSats. SATURN is a demonstration mission that features Multiple-Input-Multiple-Output (MIMO) technology applied to a Swarm of CubeSats equipped with Synthetic Aperture Radar (SAR) for Earth Observation. MIMO is based on cooperative active sensors, where each one transmits signals and receives the illuminated common area backscatter related to the entire swarm, increasing measurement performances with a trend approximatively equal to the square of the number of sensors. The complete SATURN constellation features 16 mini-swarms, each of 3 CubeSats, spread over 4 SSOs equally spaced by 3 hours of local time. The constellation is designed to provide an average revisit time of 1.5 h and an interferometric revisit time of 1 day worldwide. The aim of this demonstration mission is to verify MIMO technology applied to SAR on a mini-swarm of 3 CubeSats in close formation on a Low Earth Down-Dusk Sun Synchronous Orbit. Using OHB-I’s M3Multi Mission Modular platform equipped with a miniaturized SAR Instrument, developed by ARESYS S.r.l. and Airbus Italia S.p.A., our mission is able to achieve a resolution of 5x5 m over a 30 km swath. Thus, SATURN enables low-cost, scalable SAR missions for affordable access to space for public and private entities, overcoming the single point of failure of one large and complex satellite. Subsequent swarms, deploying from 3 to 48 CubeSats, are expected to bring technological innovations and improve Italy’s competitiveness in the European and global Earth Observation scenario