Search

Pain is the primary reason for admission to the Emergency Department (ED). However, the management of pain in this setting is often inadequate because of opiophagia, fear of excessive sedation, and fear of compromising an adequate clinical assessment.An intersociety consensus conference was held in 2010 on the assessment and treatment of pain in the emergency setting. This report is the Italian Intersociety recommendations on pain management in the emergency department setting.The list of level A recommendations includes: 1) use of IV acetaminophen for opioid sparing properties and reduction of opioid related adverse events; 2) ketamine-midazolam combination preferred over fentanyl-midazolam fentanyl-propofol in pediatric patients; 3) boluses of ketamine IV (particularly in the population under the age of 2 years and over the age of 13) can lead to impairment of the upper airways, including the onset of laryngospasm, requiring specific expertise and skills for administration; 4) the use of ketamine increases the potential risk of psychomotor agitation, which can happen in up to 30% of adult patients (this peculiar side effect can be significantly reduced by concomitant systemic use of benzodiazepines); 5) for shoulder dislocations and fractures of the upper limbs, the performance of brachial plexus block reduces the time spent in ED compared to sedation; 6) pain relief and the use of opioids in patients with acute abdominal pain do not increase the risk of error in the diagnostic and therapeutic pathway in adults; 7) in newborns, the administration of sucrose reduces behavioural responses to blood sampling from a heel puncture; 8) in newborns, breastfeeding or formula feeding during the procedure reduces the measures of distress; 9) in pediatric patients, non-pharmacological techniques such as distraction, hypnosis and cognitive-behavioural interventions reduce procedural pain caused by the use of needles; 10) in pediatric patients, preventive application of eutectic mixtures of prilocaine and lidocaine allows arterial and venous samples to be taken in optimum conditions; 11) in pediatric patients, the combination of hypnotics (midazolam) and N2O is effective for procedural pain, but may be accompanied by loss of consciousness.The diagnostic-therapeutic pathway of pain management in emergency should be implemented, through further interdisciplinary trials, in order to improve the EBM level of specific guidelines.

The disease phase in thyroid eye disease (TED) is commonly assessed by clinical investigation of cardinal signs of inflammation and using the clinical activity score (CAS). Although CAS is the current gold standard, the clinical assessment would benefit if a more objective tool were available.The aim of this work was to explore the clinical value of a novel thermal imaging analysis technique to objectively quantify the thermal characteristics of the eye and peri-orbital region and determine the disease phase in TED.This was a cross-sectional study comparing consecutive patients with active TED (CAS ≥ 3/7) attending a tertiary center, with a group of consecutive patients with inactive TED (CAS3).Thermal images were acquired from 30 TED patients, 17 with active disease and 13 with inactive disease.Patients underwent standard ophthalmological clinical assessments and thermal imaging.Five novel thermal eye parameters (TEP) were developed to quantify the thermal characteristics of the eyes in terms of the highest level of inflammation (TEP1), overall level of inflammation (TEP2), right-left asymmetry in the level of inflammation (TEP3), maximum temperature variability across the eyes (TEP4), and right-left asymmetry in the temperature variability (TEP5).All five TEP were increased in active TED. TEP1 gave the largest accuracy (77%) at separating the two groups, with 65% sensitivity and 92% specificity. A statistical model combining all five parameters increased the overall accuracy, compared to using only one parameter, to 93% (94% sensitivity and 92% specificity). All five of the parameters were also found to be increased in patients with chemosis compared to those without.The potential diagnostic value of this novel thermal imaging analysis technique has been demonstrated. Further investigation on a larger group of patients is necessary to confirm these results.

The recent stand by in post – Kyoto negotiations highlights the difficulties arising at the international level in agreeing on policies to reduce greenhouse gas emissions. Developed countries complain that mitigation actions implying a disproportionate abatement effort on their part, while not involving emerging economies would be ineffective. Developing regions, on the other hand, refuse to join international agreements claiming that they are not responsible for the today’s CO2 concentrations and defending their right to fast economic growth. In this context, distributional aspects of climate change are becoming more and more relevant. However, the existing literature mainly focuses on the distribution of emissions rather than on that of damages . In this paper we use CGE models to asseess the robustness of the result by Tol et al. 2004 that inequality in the distribution of impacts:”will deteriorate for more than a century before becoming more equalitarian”.

In this paper we investigate the effects of emigration on growth in developing countries.We present a model in which productivity increases either through imitation or innovation, and both activities use the same types of human capital as inputs, albeit with different intensities.Heterogenous agents accumulate human capital responding to economic incentives, and might be able to emigrate.When no migration of skilled workers is allowed, backwards countries converge to the technological frontier.The possibility of migration, however, distorts the optimal accumulation of human capital and slows down, or even hinders, development.This effect is stronger the farther away a developing country is from the technological frontier.Thus, technologically backward countries are more likely to suffer from a negative brain drain effect.Among these countries, those which implement appropriate policies, subsidizing the accumulation of the most useful type of human capital, improve their growth performance.They converge faster, and possibly to a higher productivity level than countries where such policies are neglected.

Is technological change good for the environment in a globalized world, or does it rather lead to more pollution? Do climate policies represent worthy attempts to preserve the environment for future generations, or are they just pointless burdens on economic systems? Do efforts to increase the level of education in developing countries lead to faster economic growth, or are they just a waste of already scarce resources? These are some of the themes investigated in this dissertation: the aim of this work is to contribute some answers to questions that touch our life, every day. The focus of this thesis is on the interrelations between technological change, environmental policy and environmental quality, on the one hand; and between technological change, human capital accumulation and economic development, on the other. This work points out that, to understand these complex phenomena, we need to take into account both the general equilibrium features of the problems, i.e. the feed-backs between technological change and inputs (such as resources and skills) supply; and the dynamic issues involved, i.e. the evolution over time of the level, and of the composition of technology and inputs.

The increase in carbondioxide emissions by some countries in reaction to an emission reduction by countries with climate policy (carbon leakage) is seen as a serious threat to unilateral climate policy.Using a two-country model where only one of the countries enforces an exogenous cap on emissions, this paper analyzes the effect of technical change that can be directed towards the clean or dirty input, on carbon leakage.We show that, as long as technical change cannot be directed, there will always be carbon leakage through the standard terms-of-trade effect.However, once we allow for directed technical change, a counterbalancing induced technology effect arises and carbon leakage will generally be lower.Moreover, we show that when the relative demand for energy is sufficiently elastic, carbon leakage may be negative: the technology effect induces the unconstrained region to voluntarily reduce its own emissions.

This paper investigates the effect of socio-economic status on interregional mobility and mortality among cancer patients. The cohort under analysis comprises patients residing in Sicily (Italy), who were diagnosed with lung and colon cancer between 2010 and 2011. The data was collated from the hospital discharge records of the Sicilian Region and the Regional register of the causes of death, by considering all those patients for whom information relating to socio-economic status was available. First, graphical models were applied to highlight the multivariate structure of association among socio-economic status, interregional mobility and 3-year mortality. Secondly, mediation analysis quantified the direct and indirect effect of socio-economic status relating to mortality. The results revealed that socio-economic status is associated directly and indirectly with mortality due to lung cancer, mediated by interregional mobility. On the other hand, the association of socio-economic status with mortality from colon cancer is only indirect, and also mediated by interregional mobility. The authors of this research hold that the extent of patient mobility and its relation to mortality call for a reconsideration of health policy.