1,721,185 research outputs found
Over-reassurance and undersupport after a 'false alarm': a systematic review of the impact on subsequent cancer symptom attribution and help seeking
No full textThis literature review examined research into the impact of a previous 'all-clear' or non-cancer diagnosis following symptomatic presentation ('false alarm') on symptom attribution and delays in help seeking for subsequent possible cancer symptoms
Decision-making methods in engineering design: a designer-oriented approach
Full text linkThe use of decisional methods for the solution of engineering design problems has to be tackled on a "human" viewpoint. Hence, fundamental is the identification of design issues and needs that become a designer oriented viewpoint. Decision-based methods are systematically classified in MCDM methods, Structured Design methods and Problem Structuring methods. The results are organised in order to provide a first reference for the designer in a preliminary selection of decision-based methods. The paper shows the heterogeneous use of decision-based methods, traditionally expected to solve only some specific design problems, which have been used also in different design contexts. Moreover, several design issues, which emerged from the review process, have been pointed out and discussed accordingly. This review provided useful results for the enlargement of the state of the art on Decision Based Design methods in engineering design contexts
An Integrated Modular Design and Group Decision-Making Method in Complex Design Environments
No full textThis paper deals with the design of novel products, conceived in a complex design environment, under strict constraints and several disciplines involved in. As an application, the design of micro-bioreactors for tissue-engineering is proposed. To date, in-vitro two-dimensional (2D) culture systems have been widely used to study the mechanisms underlying cell biology. However, 3D culture systems and platforms have showed to better mimic the real tissue environment. The design of a 3D culture system of bioreactor is challenging due to several criteria derived from several disciplines, as biotechnology, engineering, and manufacturing. To this aim, a two-step integrated modular design and group multi-criteria decision-making method is proposed. In step one, a functional analysis is carried out, first, to point out the interfaces between parts and the function of each part in the assembly. Generated design alternatives have been selected by means of a group Fuzzy-TOPSIS technique, in step two. The proposed integrated design method has shown efficient in the early stages of design of novel products in complex design environments
Voluntary HIV testing in Europe
No full textAims: A study was undertaken to examine patterns of voluntary HIV testing among heterosexuals across Europe. Methods: Cross-sectional surveys on sexual behaviour and HIV were performed including probability samples of the general population ages 18-49 years in Greece (n=2,000), Italy (n=2,603), Switzerland (n=2,777), and Norway (n=3,704). Results: Prevalence of lifetime voluntary HIV testing among heterosexuals is 10.1%, 15.5%, 17.4%, and 40.9% in Greece, Italy, Norway, and Switzerland, respectively. Between 49.0% and 89.3% of individuals reporting risk behaviours never sought voluntary testing. Multivariate analysis shows that in some countries the likelihood of HIV testing is significantly higher for individuals aged 24-29 and 30-39 years, compared with younger respondents with the same risky behaviour. Among Swiss men and women higher educational level also significantly increases the probability of testing. Conclusions: The prevalence of voluntary HIV testing among heterosexuals with histories of risk is low. The needs of specific groups should be considered to improve HIV prevention and access to care
Patient and citizen participation in health care decisions in Italy
No full textIn recent years there has been a growing recognition in Western healthcare systems of the importance of considering preferences of patients and the public in tailoring health services and treatment plans. The active collaboration between doctor and patient has recently been encouraged through the shared decision-making model. Aim of the present contribution is to describe the current state of patient and public participation in healthcare in Italy. First, we will briefly outline the organization of the Italian National Health Service; second, we will describe the governmental and institutional initiatives regarding participation; third, some examples of associations and initiatives promoting patient participation will be provided; forth, we will report on research projects on patient participation published in peer-reviewed journals; and finally, we will provide some examples on training activities promoting patient participation. The Italian National Health Plan and many regional and local health authorities in Italy explicitly recognize the importance of patient/citizen participation in healthcare decisions at the macro, meso and micro level of decision-making. However, application of a shared model is still at an early stage in Italy. The reported experiences have yielded positive results and have shown that particular attention should be dedicated to more disadvantaged subgroups of the population, involving patient organisations, enhancing patient/citizen knowledge and adopting approaches that take the specific context into account
Primary care doctors retirements in the context of an ageing population in Italy
No full textBackground. Ongoing shortages in primary care doctors/primary care paediatricians and increasing healthcare needs due to ageing of the population represent a great challenge for healthcare providers, managers, and policymakers. To support planning of primary healthcare resource allocation we analyzed the geographic distribution of primary care doctors/primary care paediatricians across Italian regions, accounting for area-specific number and age of the population. Additionally, we estimated the number of primary care doctors/primary care paediatricians expected to retire over the next 25 years, with a focus on the next five years. Study design. Ecological study. Methods. We gathered the list of Italian general practitioners and primary care paediatricians and combined them with the data from the National Federation of Medical Doctors, Surgeons and Dentists. Using data from the National Institutes of Statistics, we calculated the average number of patients per doctor for each region using the number of residents above and under 14 years of age for general practitioners and primary care paediatricians respectively. We also calculated the number of residents over-65 and over-75 years of age per general practitioner, as elderly patients typically have higher healthcare needs. Results. On average the number of patients per general practitioner was 1,447 (SD: 190), while for paediatricians it was 1,139 (SD: 241), with six regions above the threshold of 1,500 patients per general practitioner and only one region under the threshold of 880 patients per paediatrician. We estimated that on average 2,228 general practitioners and 444 paediatricians are going to retire each year for the next five years, reaching more than 70% among the current workforce for some southern regions. The number of elderly patients per general practitioner varies substantially between regions, with two regions having?>15% more patients aged over 65 years compared to the expected number. Conclusions. The study highlighted that some regions do not currently have the required primary care workforce, and the expected retirements and the ageing of the population will exacerbate the pressure on the already over-stretched healthcare services. A response from healthcare administrations and policymakers is urgently required to allow equitable access to quality primary care across the country
L’importanza della partecipazione dei pazienti e delle famiglie per ottimizzare l’adesione alla terapia e gli esiti di salute
No full textA very simple and effective method for off-design simulation of modern aircraft piston engines
No full textA new generation of aircraft piston engines is currently being introduced on the market. These new engines come directly from the huge experience achieved in the motorcycle and automotive racing and production. However direct use of automotive power unit is not advisable, since car engines work mainly in the first quarter of the power output, while sport motorcycles are used in a very "light" way, with the engines that span several times through the entire range of power outputs and rpm. The other problem is fuel. Aircraft spark ignition engine for ultralight and light aircrafts may continue to use automotive gasoline, while diesel engines for light up to cargo aircraft should use jet(A1) and jp4. However, the large experience obtained from racing/high-performance motorcycles, racing/high-performance cars and common rail engines cannot be ignored. Thousand of hours and billion of Euros have been spent for this development and the results are interesting. This paper tries to calculate the future aircraft engine performance from the many experimental data already available on a certain type of combustion chamber or better from a well defined and experimented cylinder unit. On the other side the "lean-thinking" approach to aircraft engine design may be not applicable. The lean thinking approach tends to prefer the time-to-market to the optimization of the engine unit. With engines that will probably stay on the market for 30 years this approach is not convenient. An important optimization during the design phase is possible with modern CAD tools. Mass and cost reduction may easily reach the 30%. On the other side the "brain storming approach" is not applicable to the heavily-constrained aircraft-engine design, where it is common that inapplicable solutions and ideas seem to be the best during the initial phase even to experts. Our research team developed three different families of engines: the first family uses the cylinder unit of a well proven motorcycle engine, which comes directly from racing and was sold in tenth of thousands in the world market. These spark ignition engines have 4 up to 16 cylinders (Figg. 1, 2), with power from 150 HP to 800 HP. This type of engines have very brilliant power to weight ratios with not superlative fuel consumptions. They are conceived for ultralight aircrafts and helicopters, tilt rotor, tilt shaft and tilt motor power lift V/STOL aircrafts. The second cylinder unit comes directly from the 2 valves FIAT 1900 jtd, that is one of the best two valves turbocharged common rail diesel available on the market. These units span from 4 up to 16 cylinders with power outputs from 175 HP (Fig. 3) up to 1000 HP. They run with jp4, jp8 or jet (A1) and can be bolted directly to the original engine mount of existing light aircraft like Cessna 172/182/337 or can be used in new light aircrafts. The third one is an originally conceived twin combustion chamber diesel family with output power from 600 HP to 4000 HP (hybrid engine) originally conceived for the Hercules C130J, ATR42 or ATR72 aircrafts (Figg. 4, 5). Our hybrid engine is composed by two separate engines: the VD007 diesel and a turboshaft. Each engine moves a separate contra rotating propeller. In ordinary flight the turboshaft works as a turbocharger. In this case the rear propeller is nearly idle. During take off or emergency the turboshaft combustion chamber is activated and additional power is available. In this case pitch is given to the rear propeller that outputs additional useful thrust. All these engines use only the thermo-fluid-dynamics and a few parts of the original cylinder unit, since aircraft application need extended modifications and, in many cases, complete redesign. However on all these engines a large amount of experimental, road and reliability data are available. Their direct application in the aircraft field is a plain mistake, since automotive and motorcycle are very different, but it is not the case to discard all this data that are available for free. For this reason innovative simulation methods were used to obtain engine performance envelope, with the possibility to choose the most convenient off-design solution on a certain aircraft, depending on the use and on the requirements. It is also possible to obtain reliability data for the aircraft FADEC (Full Authority Digital Engine Control) that controls all these new units. It is important to underline that airborne FADECs should be completely different from ground borne FADECs since in the aircraft application recovery strategies are to be chosen by the well trained pilot, while in the automotive field recovery is usually applied automatically in order to preserve engine integrity. A new method for the determination of the engine performance envelope is introduced as an example on the turbo/hybrid diesel unit for the C130J; this engine is called VD007. This approach has been successfully applied on the small diesel jtd family and also to the spark ignition family. © 2008 by the American Institute of Aeronautics and Astronautics, Inc
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