Smallmullen7164

Background In health, it is important to promote the effectiveness, efficiency and adequacy of the services provided; these concepts become even more important in the era of the COVID-19 pandemic, where efforts to manage the disease have absorbed all hospital resources. The COVID-19 emergency led to a profound restructuring-in a very short time-of the Italian hospital system. Some factors that impose higher costs on hospitals are inappropriate hospitalization and length of stay (LOS). The length of stay (LOS) is a very useful parameter for the management of services within the hospital and is an index evaluated for the management of costs. Methods This study analyzed how COVID-19 changed the activity of the Complex Operative Unit (COU) of the Neurology and Stroke Unit of the San Giovanni di Dio e Ruggi d'Aragona University Hospital of Salerno (Italy). The methodology used in this study was Lean Six Sigma. Problem solving in Lean Six Sigma is the DMAIC roadmap, characterized by five operational phases. To add even more value to the processing, a single clinical case, represented by stroke patients, was investigated to verify the specific impact of the pandemic. Results The results obtained show a reduction in LOS for stroke patients and an increase in the value of the diagnosis related group relative weight. Conclusions This work has shown how, thanks to the implementation of protocols for the management of the COU of the Neurology and Stroke Unit, the work of doctors has improved, and this is evident from the values of the parameters taken into consideration.

Blue spaces have been a key part of human evolution, providing resources and helping economies develop. To date, no studies have been carried out to explore how they may be linked to paediatric oncological diseases.

To explore the possible relationship of residential proximity to natural and urban blue spaces on childhood leukaemia.

A population-based case-control study was conducted in four regions of Spain across the period 2000-2018. A total of 936 incident cases and 5616 controls were included, individually matched by sex, year of birth and place of residence. An exposure proxy with four distances (250 m, 500 m, 750 m, and 1 km) to blue spaces was built using the geographical coordinates of the participants' home residences. Odds ratios (ORs) and 95% confidence intervals (95%CIs) for blue-space exposure were calculated for overall childhood leukaemia, and the acute lymphoblastic (ALL) and acute myeloblastic leukaemia (AML) subtypes, with adjustment for socio-demographic and environmental covariates.ffects on childhood leukaemia incidence; consequently, it is necessary to continue studying these spaces-while taking into account more individualised data and other possible environmental risk factors.In self-directed learning, students take the initiative to identify learning goals, choose learning strategies, and evaluate learning outcomes. This study aimed to explore the effects of a self-directed clinical practicum on nursing students' self-confidence and satisfaction with the clinical practicum. This mixed-methods study used a non-equivalent control group with a pre- and post-test quasi-experimental design and content analysis. Participants were 111 nursing students (experimental group = 55, control group = 56). Quantitative (self-confidence and satisfaction with the clinical practicum) and qualitative (reflective diaries) data were collected. The experimental group had significantly increased scores for self-confidence and satisfaction with the clinical practicum compared with the control group. Four themes regarding the experience of the self-directed clinical practicum were identified perceived linking of academic knowledge and practice, perceived development of nursing competency, enjoying the clinical practicum, and establishing nursing identity as a student. The self-directed clinical practicum developed as part of this study was found to be an effective education method for nursing students.This study was aimed at establishing whether loneliness among hotel employees in the workplace affects their psychological and emotional experiences by empirically investigating their perceptions of negative situations. A self-administered questionnaire was distributed to 300 hotel employees, after which confirmatory factor analysis was conducted to reassess the reliability and validity of the measured questionnaire items. A model of workplace loneliness, psychological detachment, and emotional exhaustion was developed and examined through structural equation modeling. The results showed that the hotel employees experienced workplace loneliness and expressed a desire to be psychologically detached from their jobs for recovery. Workplace loneliness also contributed to emotional exhaustion. Theoretical and practical implications, as well as limitations and future research directions, are discussed.The aims of this study were to investigate the efficacy of heart rate variability biofeedback (HRVBFB) intervention in terms of reducing craving, severity of dependence, and rate of positive methamphetamine urine testing in men taking part in a methamphetamine use disorder outpatient treatment program. Sixty-one adult men received either HRVBFB treatment plus treatment as usual (TAU) over four weeks or TAU only. Men receiving HRVBFB showed significantly greater reductions in craving, dependence severity, and the rate of positive methamphetamine urine testing at the end of the intervention and four weeks of follow-up. The analyses further showed that the levels of craving and dependence severity at treatment entry were predictive of changes in craving and dependence severity at the end of treatment and follow-up, respectively. The baseline status of a positive methamphetamine urine test only predicted a positive methamphetamine urine test at the end of treatment, not at the end of the follow-up period. Our results showed HRVBFB intervention has merits as an adjunct treatment to ameliorate cravings and reduce the severity of dependence experienced by persons with methamphetamine use disorder. An added value of HRVBFB intervention is the fact that it can be easily and affordably implemented in everyday life.This work aims to implement a forecast model that, combined with the use of active instrumentation for a rather limited time, and with the knowledge of a set of data referring to the environmental parameters of the place to be monitored, can estimate the concentration of indoor radon activity for longer time periods. This model has been built through the MATLAB program, exploiting the theories of time series and, in particular, ARMAX models, to reproduce the variation in the concentration of radon activity. The model validation has been carried out by comparing real vs. simulated values. In addition, analytic treatment of input data, such as temperature, pressure, and relative humidity, can reduce the influence of sudden transients allowing for better stability of the model. The final goal is to estimate the annual radon activity concentration on the basis of spot measurements carried out by active instrumentation, such to avoid the need to measure for an entire calendar year by the use of passive detectors. The first experimental results obtained in conjunction with active radon measurement demonstrates the applicability of the method not only for forecasting future average concentrations, but also for optimizing remedial actions.Street-level built environment factors, for example, walking infrastructure, building density, availability of public transport, and proliferation of fast-food outlets can impact on health by influencing our ability to engage in healthy behaviour. Unhealthy environments are often clustered in deprived areas, thus interventions to improve the built environments may improve health and reduce inequalities. The aim of this review was to identify whether street-level built environment interventions can improve children's health in high income countries. A secondary aim was to describe key built environment elements targeted in interventions and research gaps. A systematic review of published literature was conducted by a multi-disciplinary team. Ten intervention papers were included. Physical activity or play was the only health outcome assessed. Most interventions described temporary changes including closure of streets to traffic (N = 6), which were mainly located in deprived neighbourhoods, or the addition of technology to 'gamify' active travel to school (N = 2). Two studies reported permanent changes to street design. There was limited evidence that closing streets to traffic was associated with increases in activity or play and inconclusive evidence with changes to street design and using technology to gamify active travel. Our ability to draw conclusions was hampered by inadequate study designs. Description of interventions was poor. Rigorous evaluation of built environment interventions remains challenging. We recommend a multi-disciplinary approach to evaluation, explicit reporting of built environment indicators targeted in interventions and offer solutions to others working in this area.Phytoremediation can be applied successfully to solve the serious worldwide issue of arsenic (As) and cadmium (Cd) pollution. However, the treatment of biomass containing toxic elements after remediation is a challenge. In this study, we investigated the effective use of biomass resources by converting the As hyperaccumulator P. Adenosine 5′-diphosphate cell line vittata into biochar to adsorb toxic elements. Plant biomass containing As was calcined at 600, 800, and 1200 °C, and its surface structure and adsorption performances for As(V) and Cd were evaluated. Pyrolysis at 1200 °C increased the specific surface area of the biochar, but it did not significantly affect its adsorption capacity for toxic elements. The calcined biochar had very high adsorption capacities of 90% and 95% for As(V) and Cd, respectively, adsorbing 6000 mmol/g-biochar for As(V) and 4000 mmol/g-biochar for Cd. The As(V) adsorption rate was improved by FeCl3 treatment. However, the adsorption capacity for Cd was not significantly affected by the NaOH treatment. In conclusion, it was found that after phytoremediation using P. vittata biomass, it can be effectively used as an environmental purification material by conversion to biochar. Furthermore, chemical modification with FeCl3 improves the biochar's adsorption performance.Early identification and adequate treatment of children who stutter is important, since it has an impact on speech development. Considering the importance of aiding pediatricians to recognize children at risk for developing persistent stuttering, the aim of the present study was to correlate speech fluency characteristics of children, whose parents reported stuttering behaviors, to the risk factors of persistent stuttering. The participants were 419 children aged 20 to 1111 years, who were divided into two groups children with stuttering complaints (CSC), composed of children whose parents reported the presence of stuttering behaviors; and children with no stuttering complaint (CNSCs), composed of children with no stuttering behaviors. Risk variables were gathered based on a questionnaire answered by parents involving the following variables sex, presence of family history of stuttering, whether stuttering behaviors were observed for more than 12 months, whether stuttering behaviors began before 5 years of age, increased effort to speak (i.