Search

Background and aimsThere is still limited knowledge regarding the clinical profile and appropriateness of treatment in patients with hypothyroidism hospitalized in Internal Medicine (IM) Departments in Italy. The aim of this study is to evaluate: 1) the characteristics of patients and possible deviations from national and international clinical practice recommendations (CPRs) in evidence-based guidelines (EBGs); 2) the improvement of patient management by means of a standardized educational programme (EP).MethodsA nationwide multicentre study, comprising two replications of a retrospective survey (phases 1 and 3) with an intervening EP (phase 2) in half of the centres and no EP in the other half, was conducted. The EP was based on outreach visits. Centres were assigned to the two arms of the study, labelled the training group (TG) and control group (CG) respectively, by cluster randomization. Four EBGs and 39 CPRs provided the basis on which 22 treatment management indicators were identified (7 referring to the time of hospital admission, 15 to post-admission).ResultsThe 21 participating centres recruited 587 hospitalized patients with hypothyroidism, 421 of which were females (71.7%, mean age 74.1 + 14.4 yrs): 318 in phase 1 and 269 in phase 3. The cause of hypothyroidism was unknown in 282 patients (48%). Evaluation at the time of admission identified satisfactory adherence to CPRs (>50%) for 63.6% of the indicators. In the phase 3, TG centres showed significant improvement vs CG in 4 of the 15 post-admission indicators, while 1 out of 15 was significantly worse.ConclusionsThe EP based on outreach visits significantly improved some indicators in the management of patients with hypothyroidism, with specific reference to appropriateness of TSH dosage and levothyroxine (LT4) treatment modality.Clinical Trial RegistrationClinicalTrials.gov, identifier NCT05314790.

The pandemic context presents remarkable psychological challenges for adolescents and young adults. The aim of the present work was to construct and study the psychometric properties of a scale in Spanish language (W-COV) to measure their worries related to the pandemic. Participants were 5559 people aged between 14 and 25 years old (M = 19.05; SD = 3.28). Self-report data were collected using a cross-sectional and cross-cultural design. Participants were from 5 Spanish-speaking countries. Instruments were W-COV to assess worries about COVID-19 and its consequences; DASS-21 for anxiety, depression and stress; and SWLS for life satisfaction. Exploratory, confirmatory and multi-group factor analyses were conducted to determine the factorial structure of the W-COV and its measurement invariance (configural, metric, scalar and error variance). Correlational and regression analyses were also performed to study convergent and predictive validity. The results suggest that W-COV presents a bifactorial structure: (1) a general factor of worries about COVID-19; and (2) three different factors: worries about health, economic and psychosocial consequences from COVID-19. The internal reliability indices Cronbach's alpha and Omega were adequate. With respect to the invariance results, the instrument can be used interchangeably in the five countries considered, in both genders and in two different age groups (12-17 and 18-25). Regarding validity, W-COV factors were positively associated with anxiety, depression and stress, and negatively predicted life satisfaction. In conclusion, W-COV is a reliable and valid instrument for researchers and health care professionals to assess the psychological impact of the pandemic on mental health of young Ibero-Americans.

Background: Pediatric acute lymphoblastic leukemia (ALL) treatment regimens are lengthy, and there is limited data on the systemic and individual economic burden associated with treatment of ALL. Objective: This study aims to examine healthcare resource utilization (HCRU) and costs accrued during the first year of therapy among pediatric ALL patients, and to compare costs among those who are Commercially and Medicaid insured. Methods: Administrative claims data from 2011-16 were analyzed utilizing IBM MarketScan. Newly-diagnosed ALL patients with at least 12 months of enrollment were studied. Demographics and HCRU and costs were stratified by insurance type. The mean (standard deviation (SD) HCRU and reimbursed costs were measured during the first year post-diagnosis. Multivariable generalized linear models were run for total healthcare costs. Results: 730 (528 Commercial) patients with median age of 6 years were studied. During the 12 months following diagnosis, the mean(SD) inpatient admissions and ER visits for Commercial and Medicaid patients was 6.2(3.7) vs. 6.0(4.6), p=0.6310 and 2.8(6.4) vs. 2.1(2.6),p=0.0380, respectively. Commercial patients experienced more outpatient visits (77.2(28.1) versus 57.4(33.3), p

Adhesive junctions or co-infusion of skin and stiffeners represent efficient manufacturing processes for aircrafts composites stiffened panels leading to weight saving, although they have not been widely adopted yet due to certification issues and the lack of well-established design tools and procedures. Airworthiness requirements for composite structures pose major challenges to the certification of adhesively bonded or co-infused stiffened structures. FAA Advisory Circular 20-107B prescribes the methods for substantiating the limit load capacity of any bonded stiffener, the failure of which would result in catastrophic loss of the airplane. Today, composites primary structures that work mostly under compressive loads are designed following the no-buckling criteria up to Ultimate Load. Such a design approach leads to stiffer and heavier structures if compared to letting the compressed skins work in post-buckling until failure. In order to exploit the full structural potentiality of this type of structures under compressive loads new design approaches, mostly based on Finite Element Modelling, have to be developed and validated with experimental results to correctly predict the nonlinear mechanisms of load absorption beyond skin buckling onset. Furthermore state-of-the art Non-Destructive-Techniques and Structural Health Monitoring Systems can be employed for a continuous monitoring of the joints health status. In this context, the joining technique of the stringers to the skin has a particular importance; indeed, although different joining processes barely influence the linear behavior of a stiffened plate until its first instability load, they are responsible for relevant differences in the ultimate failure load. This paper presents numerical and experimental activities carried out to study the behavior of compressed stiffened plates obtained by different manufacturing processes as well as monitoring techniques of the health status of the panels by classical NDT and guided waves based SHM systems. The numerical problem has been modelled with approaches of increasing complexity, from “classical” FE models to predict the first buckling load, to post-buckling analyses up to more refined techniques including the behavior of the skin-stiffener interface.

ethics committees (ECs) protect the rights, safety, and well-being of research participants and ensure the scientific correctness of clinical research. COVID-19 pandemic and the lockdown from 9 March to 16 May 2020 have potentially influenced several activities, including ECs.to assess the impact of COVID-19 outbreak on Italian ECs and their performance during the lockdown.cross-sectional survey.the survey was conducted in mid-June 2020 in Italy contacting all the 90 local ECs.amount and kind of activities performed during the lockdown, characteristics of submitted studies and adoption of standard protocols of evaluation of research applications during the pandemic. Chi-square test was used to estimate the differences between territories with higher incidence (HI) and lower incidence (LI) of COVID-19.258 questionnaires were collected from 46 ECs that participated in the study. Ten were excluded due to missing substantial data. Responses were divided into two groups according to location of EC: the HI (125 responses) and the LI (123 responses). Seventy-five percent of the HI describe an increase in the number of studies submitted, while 53% of the LI does not (p=0.001). Due to the pandemic and its effects on research, the 15% of participants belonging to HI territories reported that consideration and respect of research-related and general ethical principles could have decreased, as well the adoption of standard protocols of evaluation of research applications. EC secretariats located in HI Regions moved to smart working more than in LI ones (75% vs 59%; p=0.001). Where the EC workload increased significantly, it was reported that it was impossible to perform an accurate analysis of the submitted documentation, with the effect of providing a favorable opinion to studies of not excellent quality, though always ensuring the respect of ethical principles and patients' safety.COVID-19 impact on ECs has been heavier in HI territories, but smart working has been effective in ensuring EC activities and the subsequent activation of clinical studies potentially useful to face the pandemic. Clear differences arise between ECs belonging to the Italian Regions that have recorded a HI of COVID-19 cases compared to those located in Regions with a LI of cases. In some EC members' perception, the high number of studies in the most affected Regions together with the emergency experienced during the lockdown may have exposed ECs to the risk of decreasing the adoption of ethical principles and standard protocols of evaluation of research applications.