Value as the key concept in the health care system : how it has influenced medical practice and clinical decision-making processes

In the last 10 years, value has played a key role in the health care system. In this concept, innovations in medical practice and the increasing importance of patient centeredness have contributed to draw the attention of the medical community. Nonetheless, a large consensus on the meaning of \u201cvalue\u201d is still lacking: patients, physicians, policy makers, and other health care professionals have different ideas on which component of value may play a prominent role. Yet, shared clinical decision-making and patient empowerment have been recognized as fundamental features of the concept of value. Different paradigms of health care system embrace different meanings of value, and the absence of common and widely accepted definition does not help to identify a unique model of care in health care system. Our aim is to provide an overview of those paradigms that have considered value as a key theoretical concept and to investigate how the presence of value can influence the medical practice. This article may contribute to draw attention toward patients and propose a possible link between health care system based on \u201cvalue\u201d and new paradigms such as patient-centered system (PCS), patient empowerment, and P5 medicine, in order to create a predictive, personalized, preventive, participatory, and psycho-cognitive model to treat patients. Indeed, patient empowerment, value-based system, and P5 medicine seem to shed light on different aspects of a PCS, and this allows a better understanding of people under care

Adolescencia y selección de contenidos de biología

Los sistemas biológicos conforman un todo integrado y el conocimiento de los mismos se modifica y enriquece a cada instante. Son tantas las ramas de la biología que los estudian como los marcos conceptuales que las sustentan. Sin embargo todas ellas se relacionan por una serie de principios unificadores, siendo la teoría de la evolución uno de los de mayor significación. El enfoque evolutivo permite superar las descripciones estáticas y fragmentarias y posibilita interpretar los procesos y patrones biológicos en sus distintos niveles de análisis. Concibe, además, la diversidad de la vida como el resultado de su historia y contribuye a explicar el lugar que el ser humano tiene en la naturaleza. Como los modelos y explicaciones de la ciencia no son dogmas, sino explicaciones provisorias sujetas a revisión, es imprescindible incorporar su historia, sus procedimientos y su relación con la sociedad. Sin dejar de considerar lo expuesto y teniendo en cuenta las problemáticas actuales de los adolescentes hemos priorizado cuatro ejes temáticos que se articularán con los contenidos específicos de la materia a fin de favorecer en ellos el surgimiento de una consciencia activa que les permita cuidar de sí mismos y de los otros. Dichos ejes son: Alimentación, Movimiento, Sexualidad, Consumo de sustancias. Los mismos serán tratados desde 1ro a 6to año de manera espiralada con un grado de profundidad y complejidad creciente dependiendo de las inquietudes, cuestionamientos e intereses propios de cada grupo y nivel evolutivo; atendiendo a los conflictos que circunstancialmente pudiesen aparecer.Trabajos del área Ciencias NaturalesDepartamento de Ciencias Exactas y Naturale

Dimensionality and Measurement Invariance of the Italian Version of the EORTC QLQ-C30 in Postoperative Lung Cancer Patients

Background: This study aims to validate and evaluate the psychometric properties and measurement invariance of the Italian version of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30), which is a measure of quality of life (QoL) for lung cancer patients after surgery. Methods: A total of 167 lung cancer patients completed the Italian version of the EORTC QLQ-C30 questionnaire at 30 days after they received a lobectomy. The factor structure of this scale was assessed by performing confirmatory factor analysis (CFA). Measurement invariance was evaluated by considering differential item functioning (DIF) due to age, gender, and type of surgery (i.e., robot- or not robot-assisted). Results: The CFA demonstrated the validity of the factor structure of the EORTC QLQ-C30 in assessing overall health and eight distinct subscales of adverse events and functioning. Moreover, the results highlighted a minimal DIF with only trivial consequences on measurement invariance. Specifically, the DIF did not affect the mean differences of latent scores of QoL between patients undergoing robot-assisted surgery or traditional surgery. Conclusion: These findings supported the validity and suitability of the EORTC QLQ-C30 for the assessment of QoL in lung cancer patients of diverse ages and genders undergoing lobectomy with or without robot-assisted surgery

Dimensionality and Measurement Invariance of the Italian Version of the EORTC QLQ-C30 in Postoperative Lung Cancer Patients

Background: This study aims to validate and evaluate the psychometric properties and measurement invariance of the Italian version of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30), which is a measure of quality of life (QoL) for lung cancer patients after surgery. Methods: A total of 167 lung cancer patients completed the Italian version of the EORTC QLQ-C30 questionnaire at 30 days after they received a lobectomy. The factor structure of this scale was assessed by performing confirmatory factor analysis (CFA). Measurement invariance was evaluated by considering differential item functioning (DIF) due to age, gender, and type of surgery (i.e., robot- or not robot-assisted). Results: The CFA demonstrated the validity of the factor structure of the EORTC QLQ-C30 in assessing overall health and eight distinct subscales of adverse events and functioning. Moreover, the results highlighted a minimal DIF with only trivial consequences on measurement invariance. Specifically, the DIF did not affect the mean differences of latent scores of QoL between patients undergoing robot-assisted surgery or traditional surgery. Conclusion: These findings supported the validity and suitability of the EORTC QLQ-C30 for the assessment of QoL in lung cancer patients of diverse ages and genders undergoing lobectomy with or without robot-assisted surgery

Study of the Interaction Between a High-Pressure Jet and Horizontal Tanks using CFD

Accidental high-pressure flammable gas releases are among the most relevant hazards in the process safety, and consequences could be severe. In the recent decades, there have been numerous efforts to study high-pressure jets in open field (i.e., free jets). Easy-to-use mathematical models have been developed, to rapidly assess the main physical variables involved in safety evaluations. However, in a realistic scenario, the accidental leak may involve either the ground or a piece of equipment. As demonstrated by recent works, when a jet interacts with an obstacle, its behavior can significantly change. Therefore, the mathematical models extrapolated for the free jet scenario could be a source of incorrect predictions. Focusing on the scenario of an accidental high-pressure unignited flammable jet, this work shows how the presence of one or two obstacles, placed at a different distance from the source of the leak, can influence the lower flammability limit cloud extent of methane. Varying the height of the source term, the effect of the interaction among the jet, both the obstacles, and the ground was systematically studied through a Computational Fluid Dynamics analysis

Site effects “on the rock”: the case of Castelvecchio Subequo (L’Aquila, central Italy)

The April 6, 2009 L’Aquila earthquake was responsible for an “anomalous”, relatively high degree of damage (i.e. Is 7 MCS scale) at Castelvecchio Subequo (CS). Indeed, the village is located at source-to-site distance of about 40 km, and it is surrounded by other inhabited centres to which considerably lower intensities, i.e. Is 5-6, have been attributed. Moreover, the damage was irregularly distributed within CS, being mainly concentrated in the uppermost portion of the old village. Geophysical investigations (ambient seismic noise and weak ground motions analyses) revealed that site effects occurred at CS. Amplifications of the ground motion, mainly striking NE-SW, have been detected at the uppermost portion of the carbonate ridge on which the village is built. Geological/structural and geomechanical field surveys defined that the CS ridge is affected by sets of fractures, joints and shear planes – mainly roughly NW-SE and N-S trending – that are related to the deformation zone of the Subequana valley fault system and to transfer faults linking northward the mentioned tectonic feature with the Middle Aterno Valley fault system. In particular, our investigations highlight that seismic amplifications occur where joints set NW-SE trending are open. On the other hand, no amplification is seen in portions of the ridge where the bedrock is densely fractured but no open joints occur. The fracture opening seems related to the toppling tendency of the bedrock slabs, owing to the local geomorphic setting. These investigations suggest that the detected amplification of the ground motion is probably related to the polarization of the seismic waves along the Castelvecchio Subequo ridge, with the consequent oscillation of the rock slabs perpendicularly to the fractures azimuth

Livelli di detezione da stazioni sismiche in pozzo

Nell’ambito di un progetto pilota per l’iniezione e lo stoccaggio di CO2 da effettuarsi nell’area di Cortemaggiore (PC), la Sezione di Milano-Pavia dell’INGV è stata incaricata dell’attività di monitoraggio sismico di superficie. A tale scopo è stata realizzata una rete costituita da 7 stazioni. I sensori sono posizionati in un’area di dimensioni di circa 6x2 km. Tutte le stazioni sono dotate di acquisitore digitale a 24 bit tipo Lennartz M24/NET con ricevitore del segnale di tempo GPS. L’area è caratterizzata da un forte disturbo antropico ed industriale. Per migliorare la qualità del segnale, 4 sensori sono installati in pozzo alla profondità di 100 metri. Per le stazioni in pozzo il sensore usato è il Lennartz LE-3D/BH mentre in superficie viene utilizzato LE-3Dlite MKII. I 2 sensori presentano caratteristiche tecniche simili, con frequenza propria pari ad 1 Hz, limite superiore in frequenza di 80 Hz e range dinamico di 136 dB. In questo lavoro sono stimati i livelli di microtremore sismico e viene valutata la soglia di detezione, ovvero il valore minimo di magnitudo registrabile in funzione della distanza dalla sorgente sismica

A meta-analysis on heart rate variability biofeedback and depressive symptoms

Heart rate variability biofeedback (HRVB) has been used for a number of years to treat depressive symptoms, a common mental health issue, which is often comorbid with other psychopathological and medical conditions. The aim of the present meta-analysis is to test whether and to what extent HRVB is effective in reducing depressive symptoms in adult patients. We conducted a literature search on Pubmed, ProQuest, Ovid PsycInfo, and Embase up to October 2020, and identified 721 studies. Fourteen studies were included in the meta-analysis. Three meta-regressions were also performed to further test whether publication year, the questionnaire used to assess depressive symptoms, or the interval of time between T0 and T1 moderated the effect of HRVB. Overall, we analysed 14 RCTs with a total of 794 participants. The random effect analysis yielded a medium mean effect size g = 0.38 [95% CI = 0.16, 0.60; 95% PI = − 0.19, 0.96], z = 3.44, p = 0.0006. The total heterogeneity was significant, QT = 23.49, p = 0.03, I2 = 45%, which suggested a moderate variance among the included studies. The year of publication (χ2(1) = 4.08, p = 0.04) and the questionnaire used to assess symptoms (χ2(4) = 12.65, p = 0.01) significantly moderated the effect of the interventions and reduced heterogeneity. Overall, results showed that HRVB improves depressive symptoms in several psychophysiological conditions in adult samples and should be considered as a valid technique to increase psychological well-being

Empirical Ground-Motion Prediction Equations for Northern Italy Using Weak- and Strong-Motion Amplitudes, Frequency Content, and Duration Parameters

The goals of this work are to review the Northern-Italy ground-motion prediction equations (GMPEs) for amplitude parameters and to propose new GMPEs for frequency content and duration parameters. Approximately 10,000 weak and strong waveforms have been collected merging information from different neighboring regional seismic networks operating in the last 30 yr throughout Northern Italy. New ground-motion models, calibrated for epicentral distances ≤100 km and for both local (ML) and moment magnitude (Mw), have been developed starting from a high quality dataset (624 waveforms) that consists of 82 selected earthquakes with ML and Mw up to 6.3 and 6.5, respectively. The vertical component and the maximum of the two horizontal components of motion have been considered, for both acceleration (peak ground horizontal acceleration [PGHA] and peak ground vertical acceleration [PGVA]) and velocity (peak ground horizontal velocity [PGHV] and peak ground vertical velocity [PGVV]) data. In order to make comparisons with the most commonly used prediction equations for the Italian territory (Sabetta and Pugliese, 1996 [hereafter, SP96] and Ambraseys et al. 2005a,b [hereafter, AM05]) the coefficients for acceleration response spectra (spectral horizontal acceleration [SHA] and spectral vertical acceleration [SVA]) and for pseudovelocity response spectra (pseudospectral horizontal velocity [PSHV] and pseudospectral vertical velocity [PSVV]) have been calculated for 12 periods ranging between 0.04 and 2 sec and for 14 periods ranging between 0.04 and 4 sec, respectively. Finally, empirical relations for Arias intensities (IA), Housner intensities (IH), and strong motion duration (DV) have also been calibrated. The site classification based on Eurocode (hereafter, EC8) classes has been used (ENV, 1998, 2002). The coefficients of the models have been determined using functional forms with an independent magnitude decay rate and applying the random effects model (Abrahamson and Youngs, 1992; Joyner and Boore, 1993) that allow the determination of the interevent, interstation, and record-to-record components of variance. The goodness of fit between observed and predicted values has been evaluated using the maximum likelihood approach as in Spudich et al. (1999). Comparing the proposed GMPEs with SP96 and AM05, it is possible to observe a faster decay of predicted ground motion, in particular for distances greater than 25 km and magnitudes higher than 5.0. The result is an improvement in fit of about one order of size for magnitudes spanning from 3.5 to 4.5