Long-term prediction of adherence to continuous positive air pressure therapy for the treatment of moderate/severe obstructive sleep apnea syndrome

BACKGROUND: Continuous positive airway pressure (CPAP) therapy is a highly effective treatment for obstructive sleep apnea syndrome (OSAS). However, poor adherence is a limiting factor, and a significant proportion of patients are unable to tolerate CPAP. The aim of this study was to determine predictors of long-term non-compliance with CPAP. METHODS: CPAP treatment was prescribed to all consecutive patients with moderate or severe OSAS (AHI ≥15 events/h) (n = 295) who underwent a full-night CPAP titration study at home between February 1, 2002 and December 1, 2016. Adherence was defined as CPAP use for at least 4 h per night and five days per week. Subjects had periodical follow-up visits including clinical and biochemical evaluation and assessment of adherence to CPAP. RESULTS: Median follow-up observation was 74.8 (24.2/110.9) months. The percentage of OSAS patients adhering to CPAP was 41.4% (42.3% in males and 37.0% in females), and prevalence was significantly higher in severe OSAS than in moderate (51.8% vs. 22.1%; p < 0.001; respectively). At multivariate analysis, lower severity of OSAS (HR = 0.66; CI 95 0.46-0.94) p < 0.023), cigarette smoking (HR = 1.72; CI 95 1.13-2.61); p = 0.011), and previous cardiovascular events (HR = 1.95; CI 95 1.03-3.70; p = 0.04) were the only independent predictors of long-term non-adherence to CPAP after controlling for age, gender, and metabolic syndrome. CONCLUSIONS: In our cohort of patients with moderate/severe OSAS who were prescribed CPAP therapy, long-term compliance to treatment was present in less than half of the patients. Adherence was positively associated with OSAS severity and negatively associated with cigarette smoking and previous cardiovascular events at baseline

Simultaneous Contralateral Vestibular Schwannoma and Middle Ear Paraganglioma Tumor

To the best of our knowledge, only 2 cases of a simultaneous contralateral vestibular schwannoma (VS) and middle ear paraganglioma (MEP) have previously been reported in literature. We report the third case observed in a 43-year-old male, who presented with an 11-year history of right-sided hearing loss and a 1-year history of left-sided pulsatile tinnitus. A magnetic resonance imaging (MRI) showed a VS on the right side and computer tomography (CT) identified a Fisch type A1 paraganglioma on the left side. The VS was treated using a translabyrinthine approach and the MEP was kept under radiological observation for 1 year. Due to the growth of the MEP (Fisch type A2), it was treated with excision via a retroauricular approach. Our case was very challenging because there was a different and important pathology on each side, both carrying a risk of deafness as a consequence of the disease and/or the treatments

The Pricing Behaviour of Firms in the Euro Area: New Survey Evidence

This study investigates the pricing behaviour of firms in the euro area on the basis of surveys conducted by nine Eurosystem national central banks. Overall, more than 11,000 firms participated in the survey. The results are very robust across countries. Firms operate in monopolistically competitive markets, where prices are mostly set following mark-up rules and where price discrimination is a common practice. Our evidence suggests that both time- and state-dependent pricing strategies are applied by firms in the euro area: around one-third of the companies follow mainly time-dependent pricing rules while two-thirds use pricing rules with some element of state-dependence. Although the majority of firms take into account a wide range of information, including past and expected economic developments, about one-third adopts a purely backward-looking behaviour. The pattern of results lends support to the recent wave of estimations of hybrid versions of the New Keynesian Phillips Curve. Price stickiness arises both at the stage when firms review their prices and again when they actually change prices. The most relevant factors underlying price rigidity are customer relationships – as expressed in the theories about explicit and implicit contracts – and thus, are mainly found at the price changing (second) stage of the price adjustment process. Finally, we provide evidence that firms adjust prices asymmetrically in response to shocks, depending on the direction of the adjustment and the source of the shock: while cost shocks have a greater impact when prices have to be raised than when they have to be reduced, reductions in demand are more likely to induce a price change than increases in demand.

Epidemiology of intensive care unit-acquired sepsis in Italy: results of the SPIN-UTI network

BACKGROUND: Sepsis is the major cause of mortality from any infectious disease worldwide. Sepsis may be the result of a healthcare associated infection (HAI): the most frequent adverse events during care delivery especially in Intensive Care Units (ICUs). The main aim of the present study was to describe the epidemiology of ICU-acquired sepsis and related outcomes among patients enrolled in the framework of the Italian Nosocomial Infections Surveillance in ICUs - SPIN-UTI project. STUDY DESIGN: Prospective multicenter study. METHODS: The SPIN-UTI network adopted the European protocols for patient-based HAI surveillance. RESULTS: During the five editions of the SPIN-UTI project, from 2008 to 2017, 47.0% of HAIs has led to sepsis in 832 patients. Overall, 57.0% episodes were classified as sepsis, 20.5% as severe sepsis and 22.5% as septic shock. The most common isolated microorganisms from sepsis episodes were Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa. The case fatality rate increased with the severity of sepsis and the mean length of ICU-stay was significantly higher in patients with ICU-acquired sepsis than in patients without. CONCLUSION: Our study provides evidence that ICU-acquired sepsis occurs frequently in Italian ICU patients and is associated with a high case fatality rate and increased length of stay. However, in order to explain these findings further analyses are needed in this population of ICU patient

Spectral and polarimetric characterization of the Gas Pixel Detector filled with dimethyl ether

The Gas Pixel Detector belongs to the very limited class of gas detectors optimized for the measurement of X-ray polarization in the emission of astrophysical sources. The choice of the mixture in which X-ray photons are absorbed and photoelectrons propagate, deeply affects both the energy range of the instrument and its performance in terms of gain, track dimension and ultimately, polarimetric sensitivity. Here we present the characterization of the Gas Pixel Detector with a 1 cm thick cell filled with dimethyl ether (DME) at 0.79 atm, selected among other mixtures for the very low diffusion coefficient. Almost completely polarized and monochromatic photons were produced at the calibration facility built at INAF/IASF-Rome exploiting Bragg diffraction at nearly 45 degrees. For the first time ever, we measured the modulation factor and the spectral capabilities of the instrument at energies as low as 2.0 keV, but also at 2.6 keV, 3.7 keV, 4.0 keV, 5.2 keV and 7.8 keV. These measurements cover almost completely the energy range of the instrument and allows to compare the sensitivity achieved with that of the standard mixture, composed of helium and DME.Comment: 20 pages, 11 figures, 5 tables. Accepted for publication by NIM

Inquinamento microbiologico delle sale operatorie: analisi critica di due decenni di sorveglianza

Obiettivo dello studio è stato quello di analizzare i risultati delle campagne di monitoraggio microbiologico delle sale operatorie effettuate negli ultimi due decenni presso il Policlinico di Roma, al fine di descrivere l’andamento nel tempo dei livelli di contaminazione riscontrati e di valutare eventuali cambiamenti significativi. Sono stati presi in esame i campionamenti microbiologici dell’aria effettuati all’interno di 14 blocchi operatori tra il 1992 ed il 2010. I risultati dei campionamenti sono stati aggregati in quattro periodi di tempo (1992-1996; 1996-2000; 2001-2005; 2006-2010) ed è stato analizzata la distribuzione nel tempo dei risultati dei campionamenti rispetto al limite proposto all'ISPESL per le sale at-rest (≤35 UFC/mc). La stessa analisi è stata ripetuta dopo la stratificazione per livello di rischio delle sale operatorie (AR e BR). Al fine di verificare il livello di significatività delle variazioni temporali nelle distribuzioni dei risultati si è fatto ricorso al test del x2 per il trend. Si è osservato un significativo trend in diminuzione del numero di sale con livelli di contaminazione superiori a quello indicato (x2 per trend=8,94; p<0,025). Tale riduzione ha riguardato soprattutto le sale operatorie AR (x2 per trend=7,33; p<0,05). I risultati ottenuti fanno ritenere che le misure adottate nelle sale ad AR siano risultate efficaci. Una maggiore attenzione dovrà essere posta alle sale operatorie a BR

Diabetes Mellitus Due to Liver Cirrhosis in 33-Year-Old Female

Impaired glucose metabolism can occur in patient with chronic liver disease, either it is impaired glucose tolerance or diabetes mellitus (DM). DM due to liver cirrhosis is known as hepatogenous diabetes (HD). HDis different from type 2 DM in clinical signs and management.A 33-year-old female came with chief complaint of fatigue since three days before admission. Patient also complained of nausea, vomiting, and increased abdominal circumference since one year ago. Patient wasdiagnosed with DM two months ago. From physical examination, anemic and ascites without signs of cirrhosis were obtained. Laboratory test showed mild anemia with hemoglobin levels 6.5 g/dL, elevated serum bilirubinand liver enzymes, decreased serum albumin, prolonged prothrombin time and elevated random blood glucose. Serologic test showed chronic hepatitis B with HBV DNA 1.61 x 104 copy/mL. The abdominal ultrasound resultshowed liver cirrhosis with ascites.The patient was diagnosed with hepatogenous diabetes in liver cirrhosis due to chronic hepatitis B infection and anemia of chronic disease. The management of this patient was quite complex especially in administrationof oral antidiabetic agent which could affect the liver function

The pricing behaviour of firms in the euro area : new survey evidence

This study investigates the pricing behaviour of firms in the euro area on the basis of surveys conducted by nine Eurosystem national central banks. Overall, more than 11,000 firms participated in the survey. The results are very robust across countries. Firms operate in monopolistically competitive markets, where prices are mostly set following mark-up rules and where price discrimination is a common practice. Our evidence suggests that both time- and state-dependent pricing strategies are applied by firms in the euro area: around one-third of the companies follow mainly time-dependent pricing rules while two-thirds use pricing rules with some element of state-dependence. Although the majority of firms take into account a wide range of information, including past and expected economic developments, about one-third adopts a purely backward-looking behaviour. The pattern of results lends support to the recent wave of estimations of hybrid versions of the New Keynesian Phillips Curve. Price stickiness arises both at the stage when firms review their prices and again when they actually change prices. The most relevant factors underlying price rigidity are customer relationships - as expressed in the theories about explicit and implicit contracts - and thus, are mainly found at the price changing (second) stage of the price adjustment process. Finally, we provide evidence that firms adjust prices asymmetrically in response to shocks, depending on the direction of the adjustment and the source of the shock: while cost shocks have a greater impact when prices have to be raised than when they have to be reduced, reductions in demand are more likely to induce a price change than increases in demand.price setting, nominal rigidity, real rigidity, inflation persistence, survey data.

Development and tests of a new prototype detector for the XAFS beamline at Elettra Synchrotron in Trieste

The XAFS beamline at Elettra Synchrotron in Trieste combines X-ray absorption spectroscopy and X-ray diffraction to provide chemically specific structural information of materials. It operates in the energy range 2.4-27 keV by using a silicon double reflection Bragg monochromator. The fluorescence measurement is performed in place of the absorption spectroscopy when the sample transparency is too low for transmission measurements or the element to study is too diluted in the sample. We report on the development and on the preliminary tests of a new prototype detector based on Silicon Drift Detectors technology and the SIRIO ultra low noise front-end ASIC. The new system will be able to reduce drastically the time needed to perform fluorescence measurements, while keeping a short dead time and maintaining an adequate energy resolution to perform spectroscopy. The custom-made silicon sensor and the electronics are designed specifically for the beamline requirements.Comment: Proceeding of the 6YRM 12th-14th Oct 2015 - L'Aquila (Italy). Accepted for publication on Journal of Physics: Conference Serie