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Telemedicine solutions have been rapidly expanding in recent years and the COVID pandemic has provided an unforeseen testbed of their potential. In Piedmont, a few studies have clearly shown that the deployment of telemedicine results from the intertwining of many factors, including the consideration of access and sustainability issues. Building on these premises, this study analyses the 2019 health mobility to specialist care in Piedmont local health areas. It investigates to what extent telemedicine services might overcome the distance gap between the place of residence of patients and that of delivery of healthcare services, thus reducing the need to move. Medical specialties and the type of examinations which can be delivered digitally were first identified; then the number of patients eligible to telemedicine treatment was estimated. Finally, a few hypotheses regarding the possibility to substitute physical encounters with virtual ones, through tele-visits were formulated and their impact on the reduction of mobility flows and travelled distance examined. To give more practical ground to the discussion, reference is made to the situation of TO3 ASL, where a telemedicine plan has been recently laid out. Les solutions de télémédecine se sont rapidement développées ces dernières années et la pandémie du COVID a été un banc d’essai de leur potentiel. Dans le Piémont, plusieurs études ont clairement montré que le déploiement de la télémédecine résulte de l’imbrication de nombreux facteurs, notamment la prise en compte des questions d’accès et de durabilité. S’appuyant sur ce constat, cette étude examine la mobilité aux soins spécialisés dans les zones locales de santé du Piémont, en 2019. Elle explore dans quelle mesure les services de télémédecine pourraient surmonter la distance entre le lieu de résidence des patients et celui de la prestation des services de santé, réduisant ainsi le besoin de se déplacer. L’analyse d’abord identifie les spécialités médicales et le type d’examens pouvant être effectués par le biais du numérique; ensuite elle estime le nombre de patients éligibles au traitement par télémédecine. Enfin, des hypothèses concernant la possibilité de substituer les rencontres physiques par des rencontres virtuelles sont formulées et les impacts sur la réduction des flux de mobilité et de la distance parcourue examinés. Pour mieux ancrer la discussion à un cas réel, l’analyse fait référence à la situation du bassin de compétence de l’établissement de santé TO3, où un plan de télémédecine a été récemment rédigé.

Introduction Telemedicine (TM) concerns the provision of healthcare, through ICT, regardless of where people involved (professionals and patients) are located. For an ageing population, as in Piedmont, these services can have a fundamental role to respond to health needs of the elderly in which, chronic diseases are more prevalent and whose access to healthcare is more difficult. TM and information technologies are fundamental to ove...

To strengthen management capability of Medical Imaging Equipment (MIE) in the Piedmont region, an approach is proposed which considers MIE distribution across regional sub areas together with their actual use (including utilisation rate, travel distance and waiting times). A number of regional information sources are used consisting of the health technology platform FITeB, the Health Registry and geo-spatial data. First, an overview of the spatial coverage of MIE in the regional local areas (provinces) is presented. Then, patient flows using MIE are examined and travel/time distance to access MIE discussed. The analysis makes reference to a period of time (2013-2017) in which, in order to improve the sustainability of the regional health system, a re-organisation of heath service delivery took place. Results of this study provide some evidence of the change which occurred in the access to MIE medical examinations., Pour mieux gérer les équipements d’imagerie médicale (medical imaging equipment, MIE) dans la région du Piémont, cette étude propose une approche qui prend en compte la distribution des MIE dans les provinces ainsi que leur utilisation (y compris le taux d’utilisation, la distance de déplacement et le temps d’attente). Différentes sources de données régionales sont utilisées, la plateforme des technologies médicales (FITeB), le registre des soins de santé et des données géo-spatiales. D’abord, on donne un aperçu de la couverture spatiale des MIE dans les provinces du Piémont. Ensuite, on examine les flux de patients utilisant les MIE et les distances de voyage /temps pour accéder aux services qui les offrent. L’analyse fait référence à une période, les années 2013-2017, pendant laquelle les services régionaux ont été réorganisés. Quelques aspects des changements dans l’accès aux MIE qui se sont produits suite à cette réorganisation sont discutés.

Telemedicine (TM) allows health professionals to evaluate, diagnose and treat patients in remote locations using Information and Communications Technology (ICT) thus enabling healthcare access and equity. However, the process of digitalisation strongly depends on local contexts. With the ultimate aim of planning an accre-ditation path for TM services, the Regional Health Direction of Piedmont conducted, in 2017, an investigation through a questionnaire to the local Health Units, which explored several domains as defined by the national guidelines. This survey returned a picture of the implementation status of TM services over the regional territories. The results show that a rich experience exists in Piedmont, however the maturity levels of the different services are wide-ranging, suggesting that central governance is needed to ensure a solid framework for appropriate and sustainable services and to make their integration feasible in the regional Health System., La télémédecine (TM) permet aux professionnels de la santé d’évaluer, diagnostiquer et traiter des patients éloignés des services de santé. Toutefois, le processus de numérisation dépend fortement des contextes locaux. Dans le but de mettre en place la procédure pour accréditer les services de TM, la Direction régionale de la santé du Piémont a mené, en 2017, une enquête en soumettant un questionnaire aux agences locales de santé, qui a exploré plusieurs domaines de service comme définis par les directives nationales. Cette enquête a permis de dresser un tableau sur l’état de la mise en œuvre des services de TM sur le territoire régional. Les résultats montrent qu’il existe en Piémont une riche expérience, mais que le niveau de maturité des services est très différent. Ils suggèrent qu’une gouvernance est nécessaire pour assurer des services appropriés et durables, et rendre possible leur intégration dans le système de santé régional.

The formation of the complex cerebellar cortical circuits follows different phases, with initial synaptogenesis and subsequent processes of refinement guided by a variety of mechanisms. The regularity of the cellular and synaptic organization of the cerebellar cortex allowed detailed studies of the structural plasticity mechanisms underlying the formation of new synapses and retraction of redundant ones. For the attainment of the monoinnervation of the Purkinje cell by a single climbing fiber, several signals are involved, including electrical activity, contact signals, homosynaptic and heterosynaptic interaction, calcium transients, postsynaptic receptors, and transduction pathways. An important role in this developmental program is played by serotonergic projections that, acting on temporally and spatially regulated postsynaptic receptors, induce and modulate the phases of synaptic formation and maturation. In the adult cerebellar cortex, many developmental mechanisms persist but play different roles, such as supporting synaptic plasticity during learning and formation of cerebellar memory traces. A dysfunction at any stage of this process can lead to disorders of cerebellar origin, which include autism spectrum disorders but are not limited to motor deficits. Recent evidence in animal models links impairment of Purkinje cell function with autism-like symptoms including sociability deficits, stereotyped movements, and interspecific communication by vocalization.

In vitro neuronal networks are a simplified and accessible model of the central nervous system. Moreover, they exhibit morphological and physiological properties and activity-dependent path-specific synaptic modification similar to the in vivo tissue. Cortical neurons grown on multi electrode array (MEA) chips have been shown to be a valuable tool to study fundamental properties of neuronal network activity, synaptic plasticity, learning in vitro, and functional pharmacological screening. The variation of spontaneous activity of in vitro neuronal networks coupled to MEAs has been studied using several binary mixtures (inhibitors with different mode of action: Verapamil and Muscimol, Fluoxetine and Muscimol; inhibitors with the same mode of action: Deltamethrin and Permethrin; and an excitatory and an inhibitory compound with different mode of action: Kainic acid and Muscimol) with the aim of characterize and assess their combined effects. Individual dose-response and binary mixtures curves have been generated. Concentration Addition (CA) and Independent Action (IA) frameworks have been used to compare calculated and experimental results. In addition, Nuclear Magnetic Resonance (NMR) spectroscopy has been employed to assess that no chemical reaction or complexation took place between mixtures components, as well as to monitor the presence of potential impurities and, in this case, to evaluate their relative amount in the tested samples. The results suggest that additivity: CA and IA are able to predict in most of the cases the total toxicity of the mixture. The variability of the results makes difficult to assess which of both approaches is the most accurate. The presence of both excitatory and inhibitory effects as in the case of Kainic acid may further complicate the analysis of the experimental datasets and biphasic concentration-dose response curves may be need to analyze the joint effect., JRC.I.6-Systems toxicology

Long-term potentiation (LTP) and depression (LTD) at parallel fibre-Purkinje cell synapses have been described in vitro in the cerebellar cortex, but the physiological roles of these two forms of plasticity have not been well defined. Here we show that, in cerebellar slices taken from rats that had undergone fear conditioning, there was a significant occlusion of electrically induced LTP at parallel fibre-Purkinje cell synapses. This effect was long-lasting and related to associative processes, as LTP was not occluded in unpaired animals. Notably, in conditioned animals the LTP-inducing protocol produced LTD in some cells instead of LTP. Conversely, synaptic depression induced by conjunctive stimulation of parallel fibers and climbing fibres was impaired in tissue taken immediately following aversive stimulation in both paired and unpaired subjects. This effect was not, however, long-lasting as the incidence and extent of LTD returned to normal levels 24 h after behavioural testing. These findings suggest that LTP takes part in the mechanisms underlying aversive associative memories in the cerebellum.

The formation of the complex cerebellar cortical circuits follows different phases, with initial synaptogenesis and subsequent processes of refinement guided by a variety of mechanisms. The regularity of the cellular and synaptic organization of the cerebellar cortex allowed detailed studies of the structural plasticity mechanisms underlying the formation of new synapses and retraction of redundant ones. For the attainment of the monoinnervation of the Purkinje cell by a single climbing fiber, several signals are involved, including electrical activity, contact signals, homosynaptic and heterosynaptic interaction, calcium transients, postsynaptic receptors, and transduction pathways. An important role in this developmental program is played by serotonergic projections that, acting on temporally and spatially regulated postsynaptic receptors, induce and modulate the phases of synaptic formation and maturation. In the adult cerebellar cortex, many developmental mechanisms persist but play different roles, such as supporting synaptic plasticity during learning and formation of cerebellar memory traces. A dysfunction at any stage of this process can lead to disorders of cerebellar origin, which include autism spectrum disorders but are not limited to motor deficits. Recent evidence in animal models links impairment of Purkinje cell function with autism-like symptoms including sociability deficits, stereotyped movements, and interspecific communication by vocalization.