52 research outputs found
Working procedures of an hot line insulators washing device operating at reduced distance from surface insulators
No full textDevelopment and validation of a high-fidelity neonatal pneumothorax simulator
No full textNeonatal pneumothorax is a clinical emergency procedure that -if not solved within minutes -can lead to major clinical complications, including death. For this reason, advanced management skills are required. High-fidelity simulation represents a valuable training tool for residents that allows to gain experience and confidence thus preserving patient safety. Nevertheless, systems now available on the market and literature prototypes provide poor anatomical and physiological features, thus limiting the realism of the simulation and the training. With the aim to overcome these limitations and allow the training of all aspects of the clinical procedure, an innovative highfidelity neonatal pneumothorax simulator was realized by exploiting two airtight pressurized chambers coupled together with self-sealing needle insertion areas. The simulator assessment phase was carried out involving both expert neonatologists and residents. Before and after the clinical procedure, surveys were used for collecting subjective evaluations. Finally, procedural time was recorded. Based on the obtained results, neonatologists considered the simulator a valid teaching and retraining tool. Moreover, thanks to a simple setting and the possibility to provide real-time feedback, the simulator proved to be a valid tool for training also in critical conditions of personal distancing, e.g., Covid-19 pandemic, which often requires remote operation
Valutazione funzionale ed ecografica della tiroide nel deficit staturale da ritardo intrauterino di crescita
No full textEarly-onset sepsis risk calculator: a review of its effectiveness and comparative study with our evidence-based local guidelines
No full textBackground: According to most early-onset sepsis (EOS) management guidelines, approximately 10% of the total
neonatal population are exposed to antibiotics in the first postnatal days with subsequent increase of neonatal and
pediatric comorbidities. A review of literature demonstrates the effectiveness of EOS calculator in reducing
antibiotic overtreatment and NICU admission among neonates ≥34 weeks’ gestational age (GA); however, some
missed cases of culture-positive EOS have also been described.
Methods: Single-center retrospective study from 1st January 2018 to 31st December 2018 conducted in the
Division of Neonatology at Santa Chiara Hospital (Pisa, Italy). Neonates ≥34 weeks’ GA with birth weight ≤ 1500 g,
34–36 weeks’ GA neonates with suspected intraamniotic infection and neonates ≥34 weeks’ GA with three clinical
signs of EOS or two signs and one risk factor for EOS receive empirical antibiotics. Neonates ≥34 weeks’ GA with
risk factors for EOS or with one clinical indicator of EOS undergo serial measurements of C-reactive protein and
procalcitonin in the first 48–72 h of life; they receive empirical antibiotics in case of abnormalities at blood exams
with one or more clinical signs of EOS. Two hundred sixty-five patients at risk for EOS met inclusion criteria; they
were divided into 3 study groups: 34–36 weeks’ GA newborns (n = 95, group A), ≥ 37 weeks’ GA newborns (n =
170, group B), and ≥ 34 weeks’ GA newborns (n = 265, group A + B). For each group, we compared the number of
patients for which antibiotics would have been needed, based on EOS calculator, and the number of the same
patients we treated with antibiotics during the study period. Comparisons between the groups were performed
using McNemar’s test and statistical significance was set at p < 0.05; post-hoc power analysis was carried out to
evaluate the sample sizes.
Results: 32/265 (12.1%) neonates ≥34 weeks’ GA received antibiotics within the first 12 h of life. According to EOS
calculator 55/265 (20.7%) patients would have received antibiotics with EOS incidence 2/1000 live births (p < 0.0001).
Conclusion: Our evidence-based protocol entails a further decrease of antibiotic overtreatment compared to EOS
calculator. No negative consequences for patients were observed
Herodian Machaerus Fortress (Jordan): Investigation of Mortars Belonging to the Hydraulic Constructions
No full textMachaerus Fortress, overlooking on a hilltop the Transjordan side of the Dead Sea, represents an important example of the Herodian defence structures. It was a model of engineering, considering both its military function and the offered quality-of-life. In fact, this site hosted hydraulic constructions with an estimated capacity of the reservoirs of 3000 m(3) (3.000.000 l) per year, allowing people to have supply of potable water and for all the human activities. Given the unquestionable significance of this archaeological site, a comprehensive characterization of the mortars utilized, especially in the hydraulic structures, is here discussed. Therefore, the present work provides hints for new insights on the construction techniques utilized in this area, interesting both from the historical and from the engineering point of view. Moreover, the results here illustrated constitute a valid support in the decision making of compatible materials to be employed in future restoration works
Endocrine Diseases of Newborn
No full textCongenital hypopituitarism results from a deficiency of any or all of the hormones secreted by the anterior pituitary gland or by the posterior pituitary gland. It is uncommon. The annual incidence ranges from 1 to 42 new cases per million and a prevalence of 300-455 cases per million. Reduced cortisol and/or aldosterone production may be the consequence of primary cortical adrenal deficiency or damage. Isolated cortisol insufficiency may also be a consequence of pituitary/hypothalamic ACTH/CRF deficiency.
The definition of the lower normal limit of blood glucose is controversial. A common definition of hypoglycaemia is a plasma glucose level < 35 mg/dL in term or < 40 mg/dl in premature infants, although some studies have suggested 47-55 mg/dl.
The definition of the upper normal limit of blood glucose in the newborn remains uncertain. A blood glucose level higher than 125 mg/dl or plasma glucose level > 150 mg/dl, regardless gestational age or postnatal age, are usually considered abnormal
MEchatronic REspiratory System SImulator for Neonatal Applications (MERESSINA) project: a novel bioengineering goal
No full textRosa T Scaramuzzo,1,2 Massimiliano Ciantelli,1 Ilaria Baldoli,3 Lisa Bellanti,3 Marzia Gentile,1 Francesca Cecchi,3 Emilio Sigali,1 Selene Tognarelli,3 Paolo Ghirri,1–4 Stefano Mazzoleni,3 Arianna Menciassi,3 Armando Cuttano,1 Antonio Boldrini,1–4 Cecilia Laschi,3 Paolo Dario3 1Centro di Formazione e Simulazione Neonatale "NINA," UO Neonatologia, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy; 2Istituto di Scienze della Vita, 3The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy; 4Università di Pisa, Pisa, Italy Abstract: Respiratory function is mandatory for extrauterine life, but is sometimes impaired in newborns due to prematurity, congenital malformations, or acquired pathologies. Mechanical ventilation is standard care, but long-term complications, such as bronchopulmonary dysplasia, are still largely reported. Therefore, continuous medical education is mandatory to correctly manage devices for assistance. Commercially available breathing function simulators are rarely suitable for the anatomical and physiological realities. The aim of this study is to develop a high-fidelity mechatronic simulator of neonatal airways and lungs for staff training and mechanical ventilator testing. The project is divided into three different phases: (1) a review study on respiratory physiology and pathophysiology and on already available single and multi-compartment models; (2) the prototyping phase; and (3) the on-field system validation. Keywords: simulation, lung, newborn, continuous medical education, respiratory syste
Compatibility of niobium, vanadium and P22 steel in high temperature flowing LiPb
No full textThe LiPb loops of the WCLL BB (Water Cooled Lithium-Lead Breeding Blanket) have the primary aim of routing tritium-rich LiPb from the Breeding Blanket to the Tritium Extraction System of DEMO Reactor. Besides, the loops maintain LiPb in the desired conditions and purify it from corrosion and activated products and from helium generated by the neutron transmutation of lithium. For some of these tasks the loops need special functional materials. Among them, niobium and vanadium are widely considered for the tritium extraction technologies for their high permeability to tritium. In addition, the loops will be made of structural materials capable of withstanding the operative conditions and the aggressive environment. The current reference material for the piping is the ASTM A335 Grade P22. This paper investigates the compatibility at 500 °C of niobium, vanadium and P22 with LiPb flowing at 0.5 m/s. This velocity is the maximum foreseen in the LiPb loops, while the temperature was chosen following a conservative approach, as the maximum expected temperature is 450 °C in the BB and 330 °C in the LiPb loops. The specimens of the three materials were exposed for 1,000, 2,000 and 4,000 h in IELLLO LiPb facility at ENEA Brasimone Research centre. After the exposure, the specimens were examined by SEM-EDX, both in cross-section and surface view, XRD analyses were performed in order to investigate potential corrosion compounds formed. Weight loss analyses were also performed on niobium specimens, after chemical cleaning from adherent LiPb. The analyses highlighted the impact of corrosion products and their interaction with refractory metals (Ni and Fe) and P22 steel (Cr, after redeposition)
Education in neonatology by simulation: between reality and declaration of intent
No full textAn unexpected event is not rare in Neonatology and can be dramatic: the operators must act with the right skills and abilities in the shortest time. Often it is a team effort and each member must be trained adequately. According to the "Swiss cheese" model by J. Reason, an accident is never the consequence of a single error, but the very final result of a chain of misunderstandings, irregularities or negligence (cheese holes): several holes allow the final medical error. Therefore, we should avoid those holes in our work. The clinical risk is always around the corner. The legal issues are becoming more and more relevant and lead to a defensive medicine, which is definitely not the best practice. For this reason, raising the safety standards is mandatory. With this purpose, after a decade of experience in "traditional" training courses, we started testing a new strategy of continuous education in Neonatology by means of high-fidelity simulation. Since 2008, we have arranged and managed a Center for Neonatal Simulation and Advanced Training in the Neonatology Unit of the University Hospital of Pisa. We have already delivered courses to pediatricians, neonatologists, anesthesiologists, gynecologists, emergency doctors, midwives and nurses, using an advanced Laerdal SimNewB simulator to teach diagnostic and therapeutic skills or communication strategies. The model has been proposed to the Italian Society of Neonatology and it has been decided to create a Task Force to discuss our model and encourage to use it in other Italian areas
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