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The Specialized Care Teams (SCTs) provide additional specialized care supporting an existing local facility or a type 2 or 3 EMTs. The “rescEU EMT” project, funded by European Union, currently under development, aims to become the largest field hospital globally, made of 21 capacities, including EMTs and SCTs. The EMT2-ITA Regione Piemonte is in charge to develop the ICU Truck-based (together with Germany), Portable CT Scan, Dialysis and Oxygen Supply (together with Portugal and Türkiye) SCTs. Even though the WHO is working to publish technical notes for SCTs, at the moment, very few documentation is available.
Objectives:
To describe the process of designing SCTs in a multi-national project.
Method/Description:
The working group was composed by medical doctors, nurses, engineers, technicians coming from the partner countries of the project. This multidisciplinary and multinational team carried out a 3-phase process: (1) a literature review searching for publications, international and national guidelines, legislations relevant for the SCTs under development; (2) the definition of standards of care and deployment’s policies for each SCTs; (3) a market survey to reach a realistic budget estimation and to investigate technologies, materials, and products.
Results/Outcomes:
The main result is the definition of the technical specifications for each SCT to be used during the next procurement phase. The main challenges were the tight deadlines, the harmonization of different medical practices and the level of the care to provide.
Conclusion:
This model can offer valuable guidance and can be applied by other teams involved in the development of SCTs.
This paper investigates the effects of demographic shifts on labor productivity by leveraging variation in the age structure of Italian regions. These effects are analyzed along a first channel – the direct relation between population age and productivity – and a second channel capturing the productivity implications of a more or less dispersed age distribution. We propose an estimation framework that relates regional productivity to the entire age distribution of the working-age population and use instrumental variable techniques to address endogeneity issues. The estimates yield a hump-shaped age-productivity profile peaking between 35 and 40 years. We also document non-linear effects of regional age dispersion on productivity.
Camelina cake (CAM) is a co-product proposed as an alternative protein source; however, piglet data are still limited. This study aimed to evaluate the effect of different doses of CAM in substitution of soyabean meal on the growth, health and gut health of weaned pigs. At 14 d post-weaning (d0), sixty-four piglets were assigned either to a standard diet or to a diet with 4 %, 8 % or 12 % of CAM. Piglets were weighed weekly. At d7 and d28, faeces were collected for microbiota and polyamine and blood for reactive oxygen metabolites (ROM) and thyroxine analysis. At d28, pigs were slaughtered, organs were weighed, pH was recorded on gut, colon was analysed for volatile fatty acids (VFA) and jejunum was used for morphological and gene expression analysis. Data analysis was carried out using a mixed model including diet, pen and litter as factors; linear and quadratic contrasts were tested. CAM linearly reduced the average daily gain from d0–d7, d0–d14, d0–d21 and d0–d28 (P ≤ 0·01). From d0–d7 increasing CAM linearly decreased feed intake (P = 0·04) and increased linearly the feed to gain (P = 0·004). CAM increased linearly the liver weight (P < 0·0001) and affected the cadaverine (P < 0·001). The diet did not affect the ROM, thyroxine, intestinal pH, VFA and morphology. All doses of CAM increased the α diversity indices at d28 (P < 0·05). CAM at 4 % promoted the abundance of Butyricicoccaceae_UCG-008. Feeding with CAM enhanced resilience in the gut microbiome and can be evaluated as a potential alternative protein source with dose-dependent limitations on piglet growth performance.
The prevalence of medical illnesses is high among patients with psychiatric disorders. The current study aimed to investigate multi-comorbidity in patients with psychiatric disorders in comparison to the general population. Secondary aims were to investigate factors associated with metabolic syndrome and treatment appropriateness of mental disorders.
Methods
The sample included 54,826 subjects (64.73% females; 34.15% males; 1.11% nonbinary gender) from 40 countries (COMET-G study). The analysis was based on the registration of previous history that could serve as a fair approximation for the lifetime prevalence of various medical conditions.
Results
About 24.5% reported a history of somatic and 26.14% of mental disorders. Mental disorders were by far the most prevalent group of medical conditions. Comorbidity of any somatic with any mental disorder was reported by 8.21%. One-third to almost two-thirds of somatic patients were also suffering from a mental disorder depending on the severity and multicomorbidity. Bipolar and psychotic patients and to a lesser extent depressives, manifested an earlier (15–20 years) manifestation of somatic multicomorbidity, severe disability, and probably earlier death. The overwhelming majority of patients with mental disorders were not receiving treatment or were being treated in a way that was not recommended. Antipsychotics and antidepressants were not related to the development of metabolic syndrome.
Conclusions
The finding that one-third to almost two-thirds of somatic patients also suffered from a mental disorder strongly suggests that psychiatry is the field with the most trans-specialty and interdisciplinary value and application points to the importance of teaching psychiatry and mental health in medical schools and also to the need for more technocratically oriented training of psychiatric residents.
Airport emergencies are rare but potentially catastrophic; therefore, system preparedness is crucial. Airport emergency plans include the organization of emergency drills on a regular basis, including full-scale exercises, to train and test the entire rescue organization.
Objective:
This report describes a full-scale simulation at Bologna International Airport, Italy, in October 2022, involving local EMS resources.
Methods:
A full-scale aeroplane crash was simulated on the airport ground, activating the Airport emergency plan, and requiring the intervention of supplementary resources (ambulances, medical cars, and other emergency vehicles).
Results:
Twenty-seven simulated patients were evaluated by EMS: START triage assessment was correct for 81.48% of patients; 11.11% were over-triaged and 7.41% were under-triaged. All patients were transported to the hospitals of the area. The simulation ended 2 hours and 28 minutes after the initial alarm.
Conclusion:
The response time proved a good response. Triage accuracy was correct in more than 80% of simulated patients. The availability of a trauma centre within 6 kilometres allowed the transportation of a quota of patients directly from the event, without affecting transportation times. Areas for improvement were identified in the communication within the different agencies and in moving ambulances within the airport runway without airport personnel guidance.
We report on an experimental study of a device comprising an array of submerged, inverted and periodic cylindrical pendula (resonators), whose objective is the attenuation of surface gravity waves. The idea is inspired by the concept of metamaterials, i.e. engineered structures designed to interact with waves and manipulate their propagation properties. The study is performed in a wave flume where waves are excited in a wide range of frequencies. We explore various configurations of the device, calculating the transmitted, reflected and dissipated energy of the waves. If the incoming wave frequencies are sufficiently close to the natural frequency of the pendula, we find a considerable wave attenuation effect. This behaviour is enhanced by the number of resonators in the array. Moreover, the device is also capable of reflecting the energy of selected frequencies of the incoming waves. These frequencies, predicted by a generalized Bragg scattering mechanism, depend on the spacing between the resonators. The presented results show promise for the development of an environmentally sustainable device for mitigating waves in coastal zones.
The new mineral marchettiite (IMA2017-066) is the natural equivalent of ammonium hydrogen urate. It has a simple molecular formula C5H7N5O3 and can be alternatively written as (NH4)C5H3N4O3. Marchettiite was found in a cleft at Mount Cervandone, Devero Valley, Piedmont, Italy, where it occurs as aggregates of opaque pale pink to white, platy prismatic crystals. This mineral has a white streak, dull and opaque lustre, it is not fluorescent and has a hardness of 2–2.5 (Mohs’ scale). The tenacity is brittle and crystals have a good cleavage parallel to {001}. The calculated density is 1.69 g/cm3. Marchettiite is biaxial (–) with 2V of 47.24°; the optical properties of marchettiite were determined by periodic-DFT methods providing the following values: α = 1.372, β = 1.681 and γ = 1.768. No twinning was observed. Electron microprobe analyses gave the following chemical formula: C4.99H6.97N4.91O3.00. Although the small crystal size did not allow refinement of structural data by single-crystal diffraction, we were able to refine the structure by powder micro X-ray diffraction. Marchettiite has space group P$\bar{1}$ and the following unit-cell parameters: a = 3.6533(2) Å, b = 10.2046(7) Å, c = 10.5837(7) Å, α = 113.809(5)°, β = 91.313(8)°, γ = 92.44(1)° and V = 360.312 Å3. The strongest lines in the powder diffraction pattern [d in Å (I)(hkl)] are: 9.784(50)(001); 8.663(80)(01$\bar{1}$); 5.659(100)(011); 3.443(100)(10$\bar{1}$); 3.241(70)(003) and 3.158(100)(1$\bar{1}\bar{1})$. Marchettiite is named after Gianfranco Marchetti, the mineral collector who found this mineral.
Atrial fibrillation (AF) is the most important cause of embolic stroke of undetermined source (ESUS). Implantable loop recorder (ILR) demonstrated the highest sensitivity for detecting it. This register was created to confirm the high prevalence of AF in patients after ESUS and to verify possible benefits on clinical outcomes such as TIA (Transient Ischaemic Attack)/stroke recurrence and death using ILR.
Methods:
A total of 278 patients admitted to “Molinette” Hospital in Stroke Unit department between 2011 and 2016, diagnosed with ESUS, underwent ILR implantation if they had at least one risk factor for AF. A total of 165 patients admitted to other departments in the same center for the same pathology, without ILR, represent the control group. We used propensity score to select 132 patients from each group (matching age, sex, CHADS-VASC, and HAS-BLEED baseline characteristics).
Results:
The detection rate of AF episodes was significantly higher in the ILR group (p < 0.001). No significant protective role of ILR for clinical endpoints was found on univariate analysis, although a trend towards significance has been pointed for the composite outcome of death and ischemic events recurrence (OR 0.52, CI 0.26–1.04, p = 0.06). A protective role of ILR was found for deaths (OR 0.4, CI 0.17–0.94, p 0.03) and for the composite outcome (OR 0.41, CI 0.19–0.87, p 0.02) on multivariate analysis in the best subsets.
Conclusion:
With our statistical models, we identified a significant clinical benefit from ILR monitoring, evidenced by a trend of less death and TIA/stroke recurrence and relevant ILR protection for prediction of TIA/stroke recurrence.
Sierra Leone is one of the least developed low-income countries (LICs), slowly recovering from the effects of a devastating civil war and an Ebola outbreak. The health care system is characterized by chronic shortage of skilled human resources, equipment, and essential medicines. The referral system is weak and vulnerable, with 75% of the country having insufficient access to essential health care. Consequently, Sierra Leone has the highest maternal and child mortality rates in the world. This manuscript describes the implementation of a National Emergency Medical Service (NEMS), a project aiming to create the first prehospital emergency medical system in the country. In 2017, a joint venture of Doctors with Africa (CUAMM), Veneto Region, and Research Center in Emergency and Disaster Medicine (CRIMEDIM) was developed to support the Ministry of Health and Sanitation (MOHS) in designing and managing the NEMS system, one of the very few structured, fully equipped, and free-of-charge prehospital service in the African continent. The NEMS design was the result of an in-depth research phase that included a preliminary assessment, literature review, and consultations with key stakeholders and managers of similar systems in other African countries. From May 27, 2019, after a timeframe of six months in which all the districts have been progressively trained and made operational, the NEMS became operative at national level. By the end of March 2020, the NEMS operation center (OC) and the 81 ambulances dispatched on the ground handled a total number of 36,814 emergency calls, 35,493 missions, and 31,036 referrals.
A 61-year-old male presented to our hospital complaining of claudication: bilateral leg weakness impeding mobility. Symptoms started after 100 m of walk and recede after several minutes of rest. The patient was obese, with a body mass index (BMI) of 41 kg/m2 and reported a weight gain of about 55 pounds in the last year. Patient’s comorbidities were dyslipidemia, hypertension, and antithrombin III deficiency. The patient also suffered from chronic low-back pain recently worsened and cervical pain. Pulses in the lower limbs were present. Neurological examination was also unremarkable.
In Canada, recreational use of cannabis was legalized in October 2018. This policy change along with recent publications evaluating the efficacy of cannabis for the medical treatment of epilepsy and media awareness about its use have increased the public interest about this agent. The Canadian League Against Epilepsy Medical Therapeutics Committee, along with a multidisciplinary group of experts and Canadian Epilepsy Alliance representatives, has developed a position statement about the use of medical cannabis for epilepsy. This article addresses the current Canadian legal framework, recent publications about its efficacy and safety profile, and our understanding of the clinical issues that should be considered when contemplating cannabis use for medical purposes.
We present the synthesis and the characterization of a novel cellulose-based electroactive hydrogel obtained through a simple water-based process. Its swelling and electroactive properties are here studied especially in low salinity water solutions. By combining smart materials and three-dimensional printing technique, we assessed that hydrogels can be shaped as natural algae and their motion can be controlled with electric signals to mimic natural seaweed movements under the effect of water flow. This could constitute a first step toward the development of hybrid habitats where artificial smart algae could cohabit with real living organisms or microorganisms.
Surface electroencephalogram (EEG) recording remains the gold standard for noninvasive assessment of electrical brain activity. It is the most efficient way to diagnose and classify epilepsy syndromes as well as define the localization of the epileptogenic zone. The EEG is useful for management decisions and for establishing prognosis in some types of epilepsy. Electroencephalography is an evolving field in which new methods are being introduced. The Canadian Society of Clinical Neurophysiologists convened an expert panel to develop new national minimal guidelines. A comprehensive evidence review was conducted. This document is organized into 10 sections, including indications, recommendations for trained personnel, EEG yield, paediatric and neonatal EEGs, laboratory minimal standards, requisitions, reports, storage, safety measures, and quality assurance.
This paper describes the design, realization, and application of a custom temperature sensor devoted to the monitoring of the temperature differential between the leaf and the air. This difference is strictly related to the plant water stress and can be used as an input information for an intelligent and flexible irrigation system. A wireless temperature sensor network can be thought as a decision support system used to start irrigation when effectively needed by the cultivation, thus saving water, pump fuel oil, and preventing plant illness caused by over-watering.
This work proposes a chipless radio frequency identification approach based on the working principle of the harmonic radar. A frequency multiplication stage is performed by a non-linearity (i.e. a Shottky diode) on the tag in order for the tag answer to be insulated from the interrogation signal, thus avoiding the need for clutter cancellation techniques. Firstly, the performance of a simple one-bit harmonic tag relying on a low-power frequency doubler is analyzed and then a novel crack sensor, implemented by adding a disposable band-stop filter, is presented. Both solutions demonstrate tag-to-reader operational distances beyond 1 m. The characterizing blocks (namely the frequency doubler and the filter) are fabricated on cellulose substrates (i.e. regular photographic paper), thus being conformal to their implementation for applications in the new paradigm of Internet of Things.
This paper proposes a combined harvesting system to improve the efficiency and flexibility of autonomous wireless network nodes, supplied by means of wireless power transfer technique. In particular, a mixed system for electromagnetic (EM) and thermal energy harvesting (EH), conceived for passive nodes of wireless sensor networks and radio frequency (RF) identification tags, is described. The proposed system aims at increasing the effectiveness and the efficiency of the EH system by integrating an antenna and a rectifier with a thermo-electric generator (TEG) able to perform thermal EH. The energy provided by the thermal harvester is exploited twice: to increase the rectifier efficiency by providing a voltage usable to improve the bias condition of the rectifying diode, and to provide additional dc energy, harvested for free. Ultimately, a great efficiency improvement, especially at low incident RF power, has been observed. The design methodology and the EM performance of a quarter-wavelength patch antenna, integrated with the TEG are resumed. Then, a test campaign to evaluate the thermal EH performance has been carried out. Afterward, a rectifier with variable bias voltage, operating at the same frequency of the antenna, has been opportunely designed to exploit the harvested thermal energy to bias the diode. A measurement campaign has been then carried out to test the efficiency increment obtained and to validate the proposed solution.