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Attivazione di un servizio di telemedicina avanzato e interattivo nei punti nascita e nei reparti di pediatria-neonatologia della Regione Marche: “Fase 1 – Valutazione della confidenza delle famiglie nella cura dei propri figli mediante telemedicina”
Get PDFPremessa: Nei reparti di pediatria-neonatologia, il teleconsulto è considerato la nuova tecnologia di comunicazione applicata alle tradizionali modalità di visita medica personale più in grado di contribuire a migliorare la qualità dell'assistenza e la soddisfazione personale. In aree territoriali eterogenee, economicamente e socialmente difficili, può essere più complicato utilizzare questo servizio. Obiettivo: Valutare la fiducia delle famiglie marchigiane con neonati pretermine nell'affidarsi alla telemedicina, valutando i benefici in termini di impatto ambientale e di costi economici. Metodi: Da gennaio 2024 è stato condotto uno studio prospettico sui familiari di pazienti ricoverati in terapia intensiva neonatale tra il 2017 e il 2023 con età gestazionale tra 30,0 e 31,6 settimane e/o peso alla nascita tra 1250 e 1500 grammi e nessuna complicanza grave, raccogliendo alcune variabili sociodemografiche, per soddisfare gli obiettivi dello studio. Risultati: Su 200 persone, l'88,5% si è dichiarato favorevole all'utilizzo della telemedicina di tipo teleconsulto, mentre il restante 11,5% ha mostrato perplessità sulle capacità di gestione del personale medico ospedaliero che opera negli ospedali periferici territoriali. In percentuale positiva, sono stati calcolati i risparmi in termini di riduzione di CO2, e quindi di impatto ambientale, e in termini di costo economico, dimostrando che nel primo caso la riduzione è di 94.304.220 g/km di CO2 e nel secondo caso di 1.806.588 euro. Conclusioni: Questo studio ha diverse implicazioni teoriche e pratiche e ha dimostrato che la popolazione marchigiana intervistata è favorevole all'utilizzo dello strumento della telemedicina di tipo teleconsulto e che questo ha ricadute positive in termini di impatto ambientale e di costo economico.Background: In pediatrics-neonatology departments, Teleconsultation is considered the new communication technology applied to traditional personal medical examination modalities most likely to help improve the quality of care and personal satisfaction. In heterogeneous, economically and socially difficult territorial areas. it may be more complicated to use this service. Objective: Assess the confidence of families in the Marche region with preterm infants in relying on telemedicine, evaluating the benefits in terms of environmental impact and economic cost. Methods: Since January 2024, a prospective study was conducted on family members of neonatal intensive care unit patients between 2017 and 2023 with gestational age between 30.0 and 31.6 weeks and/or birth weight between 1250 and 1500 grams and no serious complications, collecting some sociodemographic variables, to meet the study objectives. Results: Out of 200 individuals, 88.5% said they were in favor of the use of teleconsultation-type telemedicine, while the remaining 11.5% showed perplexity about the management capabilities of hospital medical personnel operating in peripheral territorial hospitals. On the positive percentage, savings in terms of CO2 reduction, and thus environmental impact, and in terms of economic cost were calculated, showing that in the former case, the reduction is 94,304,220 g/km CO2 and in the latter case 1,806,588 Euro. Conclusions: This study has several theoretical and practical implications and it has shown that the Marche population surveyed is in favor of the use of the teleconsultation-type telemedicine tool and that this has positive spin-offs in terms of environmental impact and economic cost
Topochemical reduction of FeCo-oxide to FeCo-alloy nanosystems into a SiO2 matrix
Get PDFThis study focuses on the synthesis of metallic magnetic nanosystems embedded in mesoporous silica (SiO2), and the impact of matrix porosity, controlled by temperature treatment, on the efficiency of H2 reduction process. The reduction of FeCo oxides to the corresponding alloy nanosystems was first optimized, identifying FeCo with 50 at% Fe as the optimal composition due to its high saturation magnetization (∼242 A m2 kg−1) and oxidation onset temperature (∼440 °C). Then, the FeCo-oxide nanocomposites were synthesized into SiO2via sol-gel self-combustion under thermal treatments, to properly tune the surface area of the silica matrix. By controlling the annealing temperature, the specific surface area (SA) of the matrix decreases from ∼512(1) m2 g−1 to ∼345(1) m2 g−1 when annealed to 900 °C in air. Following topochemical reduction in H2, the structural properties of the obtained FeCo-SiO2 nanocomposites have been analyzed using X-ray powder diffraction and magnetic properties were evaluated to establish a correlation between matrix SA and reduction capability. The decrease of SA leads to incomplete reduction at higher temperatures, with the formation of FeYOX/CoXOY intermediates. This work underscores the critical role of matrix porosity in achieving a delicate balance to ensure both the efficient conversion of nanostructured oxide to their metallic state and the preservation of their magnetic and structural integrity
Enhancing elderly patient journey: exploring immersive technology touchpoints and user experience in healthcare
No full textThis study examines the impact of Immersive Technologies (IMTs)on the elderly patients’ journey (PJ), the significance of UserExperience (UX) dimensions in quality care, and the drivers andbarriers to IMTs adoption. Using the Stimuli-Organism-Responseframework, we employed a qualitative multi-method approach.Interviews with 10 physiotherapists and 4 medical researchers,along with focus groups with 12 doctors, contributed to the devel-opment of a new PJ Map. Key findings highlight new ‘IMTs tech-nologies embedded in the PJ’, new ‘UX needs’, and ‘Obstacles andFacilitators to IMTs adoption’. Technologies range from awarenesstools (sensors, IoT) to advanced systems (wearables, AR/VR,robotics). The study emphasizes the role of UX in IMT adoption,offering strategic contributions for healthcare management.Recommendations include hybrid professions, training, patientsupport, and reevaluating the Patient Journey to incorporate tech-nological advancements, improving patient care, engagement, andresource management. Insights guide healthcare providers, policy-makers, and technology developers in advancing IMT integration,enhancing delivery, and addressing workforce shortages involving caregivers
Enhancing Damage Detection Using Reptile Search Algorithm-Optimized Neural Network and Frequency Response Function
No full textPurpose: This study aims to enhance structural damage detection in steel beams by optimizing Artificial Neural Network (ANN) training using the Reptile Search Algorithm (RSA). The hybrid ANN-RSA model is proposed to address limitations such as local optima entrapment and constrained convergence accuracy. Frequency Response Function (FRF) data is utilized as input to improve the precision of damage location prediction. Methods: FRF data was obtained from experimental vibration analysis and validated through Finite Element (FE) modeling. Damage scenarios were simulated by introducing notches of identical dimensions at varying positions on steel beams. The RSA-optimized ANN model's performance was compared against alternative models, including Particle Swarm Optimization (ANN-PSO), Artificial Bee Colony (ANN-ABC), and Genetic Algorithm (ANN-GA). Key metrics like prediction accuracy, regression values, and computational efficiency were evaluated. Results: The hybrid ANN-RSA model demonstrated superior performance, achieving a regression value nearing 1 and reducing prediction errors by approximately 15% compared to ANN-PSO, ANN-ABC, and ANN-GA models. For all damage scenarios, the model exhibited consistent accuracy with error margins below 1%, outperforming competitors in both computational speed and precision. The ANN-RSA model required fewer iterations for convergence, highlighting its computational efficiency. Comparative analysis showed the RSA method effectively optimized ANN parameters, improving damage localization reliability and accuracy. Conclusion: The integration of RSA into ANN training significantly improves the accuracy and computational efficiency of damage prediction in structural health monitoring. The use of FRF data as input ensures minimal information leakage and enhances model precision
Investigating the Interaction between ESG Measurement, Sustainability Reporting, and Management Control Systems
No full textThis study investigates the interaction between Environmental, Social, and Governance (ESG) measurement, sustainability reporting, and management control systems (MCS). With the increasing importance of sustainability measures, organizations are integrating ESG aspects into their practices to enhance transparency and societal impact. The study explores how ESG measurement interacts with sustainability reporting and MCS, focusing on four characteristics: aim (decision-making support or external communication), temporal dimension (ex-ante, ongoing, ex-post), level of formalisation, and organizational aspects. A field study involving seven Italian companies from various industries was conducted. Data collection methods included semi-structured interviews with key informants, direct observations, and documentary research. The findings indicate that ESG measurement is predominantly used for external purposes, such as sustainability reporting and obtaining certifications. While companies exhibit diverse approaches to ESG measurement, the interaction between aim, temporal dimension, level of formalisation, and organizational aspects is critical in shaping their sustainability practices
La responsabilità degli amministratori in caso di omesso o tardivo accertamento del verificarsi di una causa di scioglimento
No full textFactors associated with reaching maintenance therapy in patients with advanced biliary tract cancer treated with durvalumab: Real-world results from a multicenter and multinational study
No full textStandard of care first-line systemic treatment for advanced biliary tract cancer includes chemo-immunotherapy with gemcitabine, cisplatin, and durvalumab, followed by maintenance durvalumab monotherapy. The present work aims to investigate the differences in baseline clinical and molecular characteristics between patients with early progression during chemo-immunotherapy and those who reach durvalumab maintenance therapy. The study population included patients with unresectable, locally advanced, or metastatic BTC who received treatment at 38 clinical Institutions in 12 countries from July 2021 to December 2023. The primary objective of the study was to investigate whether baseline clinical and molecular characteristics differed between patients with early progression during chemo-immunotherapy versus those reaching durvalumab maintenance therapy. Four hundred forty-eight patients were included in this study. Two hundred twenty-seven patients (50.7%) received maintenance with durvalumab monotherapy, whereas 221 (49.3%) did not receive maintenance therapy due to PD during first-line chemo-immunotherapy before completing 8 cycles. Results show that patients who received maintenance were more likely to be older (≥70 years), have an ECOG = 0, locally advanced disease, and a neutrophil-to-lymphocyte ratio (NLR) <3. A higher proportion of patients with BAP1 mutations received maintenance, while TP53 mutations were more common in those who progressed early. According to the present analysis, a substantial proportion of patients (50.7%) with advanced BTC who were treated with chemotherapy plus durvalumab proceeded to receive maintenance therapy with durvalumab monotherapy, with a median treatment duration of 4.4 cycles. Patients ≥70 years, with ECOG PS 0, with locally advanced disease, and with NLR <3 had a higher likelihood of receiving maintenance therapy
Brain donation rules in Italy and worldwide: overview of a cutting-edge topic for human brain research
Get PDFNeuropathological examination of the brain and its biochemical analyses are fundamental to neuroscience studies and public health decisions, but are dependent on the effectiveness of regulations and operational protocols. The article discusses opportunities and limits of Italian regulation on body donation in relation to the specific requirements of neuropathology and brain sciences, in comparison with the regulations of other countries. Some crucial issues emerge, widely shared in the various regulatory contexts. The main aspect is the willingness to donate, consciously expressed by the subject by signing an informed consent or through the formulation of advanced directives. The donation of a single organ, the brain in particular, does not necessarily imply the donation of the entire body, which should be considered separately. In the specific case of the brain, particular attention is given to reducing the post-mortem interval, in order to obtain tissues suitable for research. Consequently, the centres that deal with the brain and brain banking must have experience and expertise in handling nervous tissue, and do not necessarily have to deal with the management of the entire body. These aspects, still little addressed in Italy, are the basis to develop an effective brain banking activity, which can only develop by integrating post-mortem body donation with specific rules for brain banking without which Italian neuroscience will be penalised in the coming years
Cardiovascular events in patients with gout initiating urate-lowering therapy with or without colchicine for flare prophylaxis: a retrospective new-user cohort study using linked primary care, hospitalisation, and mortality data
Get PDFBackground: Initiating urate-lowering therapy can trigger gout flares. Gout flares have been associated with a temporally increased risk of cardiovascular events. Therefore, we aimed to estimate the risk of cardiovascular events in patients with gout initiating urate-lowering therapy with flare prophylaxis using colchicine (the drug recommended for gout flare prohphylaxis by many international societies) compared with no prophylaxis. Methods: We did a retrospective new-user cohort study using data from the Clinical Practice Research Datalink Aurum, an English primary-care database linked to hospitalisation and mortality records. People with gout initiating urate-lowering therapy for the first time were eligible for inclusion. We compared people prescribed flare prophylaxis with colchicine with those not prescribed any gout flare prophylaxis. Colchicine prophylaxis (defined as prescription for ≥21 days) prescribed on the same date as urate-lowering therapy was the exposure of interest. A composite of fatal and non-fatal myocardial infarction or stroke within 180 days after urate-lowering therapy initiation regardless of any previous cardiovascular event was the primary outcome. Propensity score overlap weighting was used to balance covariates across study groups. We used Cox regression and performed intention-to-treat and per-protocol analyses, the latter with an inverse probability of censoring weighting. The association was measured using hazard ratio and risk difference with 95% CIs. Members of The UK Gout Society were involved in prioritising the research question. Findings: Of the 111 460 patients eligible for the study, 99 800 patients with gout initiating urate-lowering therapy were included. 25 511 (25·6%) of 99 800 patients were female, 74 289 (74·4%) were male, 84 928 (85·1%) patients were White and the mean age was 62·8 years (SD 15·5). 4063 (4·1%) patients had previous cardiovascular events and 16 028 (16·1%) patients were prescribed colchicine prophylaxis. Patients with colchicine prophylaxis had significantly lower risk of cardiovascular events compared with those without prophylaxis. The weighted rates of cardiovascular events were 28·8 per 1000 person-years (95% CI 25·2 to 33·2) in patients with colchicine prophylaxis and 35·3 per 1000 person-years (33·0 to 37·9) in those without prophylaxis (weighted rate difference –6·5 [95% CI –9·4 to –3·6] per 1000 person-years and weighted hazard ratio 0·82 [0·69–0·94]) in the intention-to-treat analysis. Findings were similar across analytical approaches, stratified analyses, and for secondary outcomes. Interpretation: In patients with gout initiating urate-lowering therapy, the risk of cardiovascular events was reduced in those prescribed colchicine prophylaxis compared with no prophylaxis. These findings provide an additional argument for using colchicine for gout flare prophylaxis. Funding: Foundation for Research in Rheumatology
Identification of glutamate-related disease-dependent alterations in subventricular NSCs of the 3xTg Alzheimer’s disease model, could they be involved in attempting damage repair?
No full textAlzheimer’s disease (AD) is an age-related neurodegenerative disorder characterised by several factors, such as impaired glutamate neurotransmission affecting crucial functions. Neural stem cells (NSCs) are present in the adult brains of all mammalian species and contribute to the continuous generation of neural cells throughout life. The disruption of glutamate levels during the development of AD could impact NSCs’ functionality, influencing their response to the microenvironment. In this work, we isolated adult neural stem cells from both triple transgenic (3xTg)-AD mice and age-matched wild type (WT) mice in order to gather information on any differences between them, particularly concerning the potential mechanisms involved in the internalisation of glutamate and its utilisation for energy production. The 3xTg model offers the ability to recapitulate human pathology with both plaque and tangle hallmarks that are involved in the process of glutamate release. In vitro culture 3xTg NSCs showed a slight morphological difference compared to WT cells and a massive reduction of proliferation and viability. Furthermore, 3xTg NSCs displayed an increase in the expression of glutamate transporters and glutamine synthetase, while glutamate dehydrogenase did not show any reduction, which is typical in AD brains. Data obtained from this basic research study suggest a possible involvement of glutamate in the cellular energy balance, indicating an attempted response of NSCs to the cytotoxic microenvironment in the early stage of AD pathology. This finding is of great interest, as it corroborates the hypothesis that targeting the glutamatergic system could be an extremely promising strategy for new therapeutics in AD