Ethical issues associated with in-hospital emergency from the medical emergency team's perspective: a national survey

Medical Emergency Teams (METs) are frequently involved in ethical issues associated to in-hospital emergencies, like decisions about end-of-life care and intensive care unit (ICU) admission. MET involvement offers both advantages and disadvantages, especially when an immediate decision must be made. We performed a survey among Italian intensivists/anesthesiologists evaluating MET's perspective on the most relevant ethical aspects faced in daily practice

MAXIMAL THEORETICAL STRENGTH: METHODOLOGY AND APPLICATIONS

Introduction: We describe a new experimental method useful in the evaluation of strength, strength training and rehabilitation, and training control. Methods: The Maximal Theoretical Strength (Forza Massima Teorica - FMAXT) method has been developed from the equation F=P(1+a/g), which relates lifted weight (P) to muscular strength (F) used in lifting and to its acceleration (a). The test is carried out with a bench press and a multipower machine (for testing upper and lower limb strength), both equipped with a photocell-system chronometer and linked to a PC that elaborates the data. The test consists of five consecutive lifts from a motionless start, each carried out with increasing weight (P): We obtain, from the acceleration (a) expressed in the lifts (derived from the time measured by the photocells) the corresponding strength (F). F obtained in the previous lift is used as the weight in the next lift. Results: 1) Reporting the five pairs (P-F) on a Cartesian plane, the points draw up on a interpolating straight line (r=0.996) that, when intersecting the bisecting line of the plane itself, determines a condition (F=P) experimentally impossible to reach, because a=0. Such value (FMAXT value) can be calculated only theoretically; it can be considered as an ‘absolute’ strength value and is quantifiable as the average max isometric strength expressed in the totality of the movement. On the strength/velocity Hill’s curve, the FMAXT value is pointed out in the intersection of the curve with the axis of Strength, in correspondence to v=0. (This study phase was carried out with 255 subjects for the upper limbs and 144 for the lower limbs) 2) When the single test is carried out with a double lift, the first starting from a motionless position (evaluation of the unique Contractile Component-expressed strength), followed, without pause, by a second one beginning at the superior deadpoint reached in the first lift and divided into two phases, the falling phase (concentric phase with elastic energy accumulation in muscular Serial Elastic Component) and the second lifting phase (in which is expressed the strength derived from CC plus the CES-accumulated one), the FMAXT findings of the two lifts (motionless and with counter-movement) coincide. (this second study phase was carried out with 120 subjects). Conclusions: From the analysis of FMAXT test results some very significant data for personalized training programming can be obtained. These data are the maxFMAXT itself, the Maximal Concentric Power Peak, the Maximal Eccentric/Concentric Power Peak, the Maximal Elastic Energy Percentage Reutilization Peak. Each peak can be characterized by an absolute value and by a relative percentage FMAXT-related value. In training control, comparing the results of subsequent FMAXT tests, it is possible to evaluate whether the programmed training has or has not produced the supposed adaptive phenomena regarding the contractile and/or elastic component of muscular strength

The bryophyte flora of six gypsum outcrops in the Northern Apennines (Nature 2000 Network, Emilia Romagna Region, Italy).

A study of the bryophyte flora of the gypsum outcrops in six sites of the Nature 2000 Network of the Emilia-Romagna Region was conducted in order to contribute to the conservation of the biodiversity of these sites. Subsequently, the main ecological and chorological aspects of the areas were analyzed, and with this information a series of target species was identified as indicators of the conditions of naturality or of progressive anthropization and deterioration of the areas

Intestinal perforation due to typhoid fever in Karamoja (Uganda).

INTRODUCTION: This is a retrospective analysis of patients operated for typhoid perforation, aiming to analyze epidemiology, clinical-diagnostic and therapeutic aspects, mortality and prognosis. METHODS: 47 patients were operated at Matany Hospital from 2010 to 2016. We examined clinical files to collect data. Microbiological and isthological examinations were unavailable, so etiology was deducted operatively. RESULTS: Median age: 17.85 years, 61.7% of patients were male, 74.47% perforated within two weeks from the onset of symptoms. Every radiological investigation (X-Rays and Ultrasound Scans) resulted positive. 40 patients underwent primary repair, 4 underwent resection. 72.34% experienced postoperative complications, SSI (Surgical Site Infection) occurred in 40.42%. Mortality rate reached 5.56% in patients without organ failure (vs 31.03%) and 11.76% (vs 20.51%) in patients operated within 24 hours from perforation. An MPI (Mannheim Peritonitis Index) score >30 was related with a mortality rate of 36% (vs 3.45%). CONCLUSIONS: Peak of incidence occurs at the end of rainy season. Majority of patients are young men. Main symptoms are fever and signs of intestinal obstruction, with a shorter period before perforation. Primary repair is the technique of choice for single perforations, resection for multiple ones, right colectomy in case of cecal involvement, ileostomy for important peritoneal contamination. SSI are the most frequent complications, enteric fistulas the most severe ones. Mortality rate is around 21.28%. Important prognostic factors are time between perforation and operation and the presence of organ failure. An MPI score >30 is related with a poorer prognosis

A social network analysis of social cohesion in a constructed pride: Implications for ex situ reintroduction of the African Lion (Panthera leo)

Animal conservation practices include the grouping of captive related and unrelated individuals to form a social structure which is characteristic of that species in the wild. In response to the rapid decline of wild African lion (Panthera leo) populations, an array of conservational strategies have been adopted. Ex situ reintroduction of the African lion requires the construction of socially cohesive pride structures prior to wild release. This pilot study adopted a social network theory approach to quantitatively assess a captive pride's social structure and the relationships between individuals within them. Group composition (who is present in a group) and social interaction data (social licking, greeting, play) was observed and recorded to assess social cohesion within a released semi-wild pride. UCINET and SOCPROG software was utilised to represent and analyse these social networks. Results indicate that the pride is socially cohesive, does not exhibit random associations, and the role of socially influential keystone individuals is important for maintaining social bondedness within a lion pride. These results are potentially informative for the structure of lion prides, in captivity and in the wild, and could have implications for captive and wild-founder reintroductions

Evaluation of vaccination strategies for SIR epidemics on random networks incorporating household structure

This paper is concerned with the analysis of vaccination strategies in a stochastic SIR (susceptible → infected → removed) model for the spread of an epidemic amongst a population of individuals with a random network of social contacts that is also partitioned into households. Under various vaccine action models, we consider both household-based vaccination schemes, in which the way in which individuals are chosen for vaccination depends on the size of the households in which they reside, and acquaintance vaccination, which targets individuals of high degree in the social network. For both types of vaccination scheme, assuming a large population with few initial infectives, we derive a threshold parameter which determines whether or not a large outbreak can occur and also the probability and fraction of the population infected by such an outbreak. The performance of these schemes is studied numerically, focusing on the influence of the household size distribution and the degree distribution of the social network. We find that acquaintance vaccination can significantly outperform the best household-based scheme if the degree distribution of the social network is heavy-tailed. For household-based schemes, when the vaccine coverage is insufficient to prevent a major outbreak and the vaccine is imperfect, we find situations in which both the probability and size of a major outbreak under the scheme which minimises the threshold parameter are \emph{larger} than in the scheme which maximises the threshold parameter

Vestibular Information Is Required for Dead Reckoning in the Rat

Dead reckoning is an on-line form of spatial navigation used by an animal to identify its present location and return directly to a starting location, even after circuitous outward trips. At present, it is not known which of several self-movement cues (efferent copy from movement commands, proprioceptive information, sensory flow, or vestibular information) are used to compute homeward trajectories. To determine whether vestibular information is important for dead reckoning, the impact of chemical labyrinthectomy was evaluated in a test that demanded on-line computation of a homeward trajectory. Rats were habituated to leave a refuge that was visible from all locations on a circular table to forage for large food pellets, which they carried back to the refuge to eat. Two different probe trials were given: (1) the rats foraged from the same spatial location from a hidden refuge in the light and so were able to use visual cues to navigate; (2) the same procedure took place in the dark, constraining the animals to dead reckon. Although control rats carried food directly and rapidly back to the refuge on both probes, the rats with vestibular lesions were able to do so on the hidden refuge but not on the dark probe. The scores of vestibular reflex tests predicted the dead reckoning deficit. The vestibular animals were also impaired in learning a new piloting task. This is the first unambiguous demonstration that vestibular information is used in dead reckoning and also contributes to piloting

SYNTHETIC DATA GENERATION AND TESTING FOR THE SEMANTIC SEGMENTATION OF HERITAGE BUILDINGS

Over the past decade, the use of machine learning and deep learning algorithms to support 3D semantic segmentation of point clouds has significantly increased, and their impressive results has led to the application of such algorithms for the semantic modeling of heritage buildings. Nevertheless, such applications still face several significant challenges, caused in particular by the high number of training data required during training, by the lack of specific data in the heritage building scenarios, and by the time-consuming operations to data collection and annotation. This paper aims to address these challenges by proposing a workflow for synthetic image data generation in heritage building scenarios. Specifically, the procedure allows for the generation of multiple rendered images from various viewpoints based on a 3D model of a building. Additionally, it enables the generation of per-pixel segmentation maps associated with these images. In the first part, the procedure is tested by generating a synthetic simulation of a real-world scenario using the case study of Spedale del Ceppo. In the second part, several experiments are conducted to assess the impact of synthetic data during training. Specifically, three neural network architectures are trained using the generated synthetic images, and their performance in predicting the corresponding real scenarios is evaluated