Preliminary risk assessment of workplace violence in hospital emergency departments

BACKGROUND

The risk assessment of workplace violence in emergency departments represents a global challenge for both healthcare organizations and workers. Recent studies have revealed increased rates of workplace violence towards physicians and nurses employed in emergency departments and have shown that type II is the most common typology of workplace violence among the four types of workplace violence defined by the National Institute for Occupational Safety and Health. The present study aimed to develop a methodological technique for a preliminary assessment of type II workplace violence risk in emergency departments.

METHODS

The Delphi method was used to develop a questionnaire entitled Emergency Department Workplace Violence-Questionnaire which was composed of two sections: 1) sentinel events, and 2) risk factors. The authors used the Emergency Department Workplace Violence-Questionnaire to evaluate the workplace violence risk among physicians and nurses employed in a hospital emergency department.

RESULTS

The Emergency Department Workplace Violence-Questionnaire was composed of 21 items. The sentinel events section consisted of three company indicators related to workplace violence and identified three areas of risk. The risk factors section identified 18 organizational and environmental factors associated with workplace violence occurrence. The assessment of workplace violence risk in the targeted hospital emergency departments, obtained through the use of the Emergency Department Workplace Violence-Questionnaire, showed a medium risk of workplace violence for both physicians (score=18) and nurses (score=19.5); the analysis found objective risk factors associated with workplace violence and led us to suggest organizational and environmental interventions for reducing the sources of risk among healthcare workers and to prioritize the interventions targeted at the problematical issues detected by the Emergency Department Workplace Violence-Questionnaire. The corrective interventions were focused on an engineering level (i.e. absence of areas for patients/clients to de-escalate, absence of alarm systems) and regarding the organizational environment (i.e. absence of a Workplace Violence Task Force to assess workplace violence risk and develop solutions, working alone).

CONCLUSION

The proposed questionnaire proved to be a valid, structured, and reliable tool for assessing the risk of workplace violence in the targeted emergency departments and allowed for the identification of improvement actions targeted at specific critical issues which could be minimized through strategic interventions.

A Cross Sectional Survey on Breast Self Examination Practice, Utilization of Breast Professional Examination, Mammography and Associated Factors in Romagna, Italy

In 1988, a cross-sectional survey was carried out in the Romagna region (Italy) to evaluate the association between knowledge of breast pathophysiology and preventive attitudes and screening tests practice for breast cancer. A self-administered questionnaire was distributed to a sample of asymptomatic women aged 20–64 years living in the city of Faenza (Northern Italy). Of the 657 responders, 58 % reported that they practiced breast self-examination; 55% had had a professional breast examination, and only 9 % had had a mammogram as a screening test. Logistic regression analysis (including variables such as age, education, employment) was performed to explore the relationship between screening tests practice and factors associated with their use. Breast self-examination practice (n = 590) was associated with preventive attitudes (aOR = 1.67, 95°/o CI = 1.09–2.53) and with a positive history of breast disease (aOR = 3.48, 95 % CI = 1.72–7.04). Professional breast examination (n = 480) was related to preventive attitudes (aOR = 2.37, 95 % CI = 1.51–3.71), knowledge of breast pathophysiology (aOR = 2.07, 95 % CI = 1.31–3.28), and use of oral contraceptives (aOR = 1.81, 95% CI = 1.12–2.91). Mammography use (n = 540) was associated with preventive attitudes (aOR = 3.08, 95 % CI = 1.40–6.76). The results show an inadequate utilization of screening tests in our population. Breast self-examination is strongly related to a positive history of breast disease, and this could reflect the lack of health educational programs aimed at the general population.

Facile synthesis of 3D flower-like Pt nanostructures on polypyrrole nanowire matrix for enhanced methanol oxidation

Here we report the simple and rapid synthesis of three-dimension Pt flower-like nanostructures (PtNFs) on a polypyrrole nanowires (PPyNWs) matrix. Both PtNFs and PPyNWs are prepared by an electrochemical approach without using any seed, template or surfactant. The morphology and chemical composition of the resulting PtNF/PPyNWs hybrids are characterized by scanning electron microscopy and by X-ray photoelectron spectroscopy, respectively. Taking methanol oxidation as a model catalysis reaction, the electrocatalytic performance of the as-prepared PtNF/PPyNWs system has been evaluated by cyclic voltammetry and chronoamperometry, evidencing that these 3D materials exhibit excellent electrocatalytic activity and high level of poisoning tolerance to the carbonaceous oxidative intermediates. Such electrocatalytic performances can be ascribed to the combined effect of the flower-like structure promoting the exposure of more sites and the polymer nanowires matrix endorsing high dispersion of PtNF on a high electrochemically active surface area, besides the removal of sub-products from electrocatalytic sites.

Platinum nanoflowers on polymer nanowires exhibit catalytic properties ascribed to the effect of high surface area flower-like structures and polymer 3D structure.

Diagnostic accuracy of markers for prodromal Alzheimer's disease in independent clinical series

OBJECTIVE

To capitalize on data from different clinical series to compare sensitivity and specificity of individual biomarkers for predicting mild cognitive impairment (MCI) progression to Alzheimer's disease (AD).

METHODS

Medial temporal atrophy, cortical hypometabolism, and cerebrospinal fluid biomarkers were assessed in 18 patients with mild cognitive impairment (MCI) with prodromal AD (pAD; conversion time, 26 ± 12 months) and 18 stable MCI (sMCI) patients from the Translational Outpatient Memory Clinic cohort, as well as in 24 pAD patients (conversion time, 36 ± 12 months) and 33 sMCI patients from the Alzheimer's Disease Neuroimaging Initiative cohort. Medial temporal atrophy was measured by manual, semi-automated, and automated hippocampal volumetry; cortical hypometabolism was measured using several indices of AD-related hypometabolism pattern; and cerebrospinal fluid markers were amyloid β (Aβ)42 and total tau protein concentrations. For each biomarker, sensitivity for pAD, specificity for sMCI, and diagnostic accuracy were computed.

RESULTS

Sensitivity to predict MCI conversion to AD in the Alzheimer's Disease Neuroimaging Initiative and Translational Outpatient Memory Clinic cohorts was 79% and 94% based on Aβ42, 46% and 28% based on hippocampal volumes, 33% to 66% and 56% to 78% based on different hypometabolism indices, and 46% and 61% based on total tau levels, respectively. Specificity to exclude sMCI was 27% and 50% based on Aβ42, 76% and 94% based on hippocampal volumes, 58% to 67% and 55% to 83% based on different hypometabolism indices, and 61% and 83% based on total tau levels, respectively.

CONCLUSIONS

Current findings suggest that Aβ42 concentrations and hippocampal volumes may be used in combination to best identify pAD.

Lower limb spasticity assessment using an inertial sensor: a reliability study

Spasticity is a common motor impairment in patients with neurological disorders that can prevent functional recovery after rehabilitation. In the clinical setting, its assessment is carried out using standardized clinical scales. The aim of this study was to verify the applicability of inertial sensors for an objective measurement of quadriceps spasticity and evaluate its test-retest and inter-rater reliability during the implementation of the Wartenberg pendulum test. Ten healthy subjects and 11 patients in vegetative state with severe brain damage were enrolled in this study. Subjects were evaluated three times on three consecutive days. The test-retest reliability of measurement was assessed in the first two days. The third day was devoted to inter-rater reliability assessment. In addition, the lower limb muscle tone was bilaterally evaluated at the knee joint by the modified Ashworth scale. The factorial ANOVA analysis showed that the implemented method allowed us to discriminate between healthy and pathological conditions. The fairly low SEM and high ICC values obtained for the pendulum parameters indicated a good test-retest and inter-rater reliability of measurement. This study shows that an inertial sensor can be reliably used to characterize leg kinematics during the Wartenberg pendulum test and provide quantitative evaluation of quadriceps spasticity.

The Garfagnina goat: a zootechnical overview of a local dairy population

Domestic livestock with a limited distribution are increasingly recognized in the action plans of the European Union as a reason for protecting rural land. The preservation and enhancement of the native germplasm and traits selected through the ages in different areas of farming is the first step in increasing typical products at a time when high quality products are increasingly in demand. This is the first time that a zootechnical overview has been performed on the Italian native goat population named "Garfagnina," which is registered on the Tuscan regional repertory of genetic resources at risk of extinction. The aim of the study was to give added value to this population by focusing on particular traits that could be used for promoting typical products. Data on the size of the local goats, zoometric measures, breeding system, milk quality, and genetic polymorphisms were collected to get insight into the current state of the population of this type of goat. The native goat population is reared in Tuscany in central Italy, mostly for its milk. The local goat farms considered in our study are located in the hills and mountains of the northwestern Tuscan Apennine area. For every farm we measured at least 10% of the reproductive females (273), randomly chosen, and all reproductive males (47) for a total of 320 subjects. Regarding the management of the animals and the feeding system, semi-extensive farming is practiced in all the flocks. From a morphological point of view the animals are relatively homogeneous, especially in terms of zoometric data, whereas they show a wider variability regarding coat. Milk gross and fatty acid composition were similar to that reported in the literature for bulk goat milk. Moreover, the average of somatic cell count and standard plate count found in Garfagnina goat milk indicated good hygienic farm management and correct milking practices, although milking is mainly manual. The average number of globules per milliliter found in Garfagnina goat milk was almost double compared with the literature, whereas the average diameter was lower. Milk coagulation properties were scarce, thus indicating poor cheesemaking aptitude of Garfagnina milk. Selecting haplotypes carrying alleles associated with a higher expression of the specific casein could help improve milk cheesemaking aptitude. Moreover, the rather high frequency of the faint CSN1S1*F allele and the occurrence of CSN2*0 might suggest that Garfagnina goat milk could be used, after an appropriate selection, for direct consumption of milk at low casein content for intolerant human subjects.

The dynamics of Alzheimer's disease biomarkers in the Alzheimer's Disease Neuroimaging Initiative cohort

The aim of this study was to investigate the dynamics of four of the most validated biomarkers for Alzheimer's disease (AD), cerebro-spinal fluid (CSF) Abeta 1-42, tau, hippocampal volume, and FDG-PET, in patients at different stage of AD. Two hundred twenty-nine cognitively healthy subjects, 154 mild cognitive impairment (MCI) patients converted to AD, and 193 (95 early and 98 late) AD patients were selected from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database. For each biomarker, individual values were Z-transformed and plotted against ADAS-cog scores, and sigmoid and linear fits were compared. For most biomarkers the sigmoid model fitted data significantly better than the linear model. Abeta 1-42 time course followed a steep curve, stabilizing early in the disease course. CSF tau and hippocampal volume changed later showing similar monotonous trends, reflecting disease progression. Hippocampal loss trend was steeper and occurred earlier in time in APOE epsilon4 carriers than in non-carriers. FDG-PET started changing early in time and likely followed a linear decline. In conclusion, this study provides the first evidence in favor of the dynamic biomarker model which has recently been proposed.

Metabolic compensation and depression in Alzheimer's disease

BACKGROUND/AIMS

The aim of this study was to map metabolic compensation and depression in Alzheimer's disease (AD) on a voxel-by-voxel basis.

METHODS

Twenty-one healthy elderly subjects and 25 AD patients underwent cerebral MR and FDG-PET imaging. All images were processed with SPM2, and whole-brain gray matter (GM) atrophy and hypometabolism maps were computed. Metabolic compensation and depression were assessed using Biological Parametric Mapping software.

RESULTS

GM atrophy and hypometabolism mapped to similar regions, with varying degrees of severity. Significant metabolic compensation was found in the amygdala, while exceeding hypometabolism was mainly located in the posterior cingulate cortex.

CONCLUSION

Metabolic depression can be due to both distant effects of atrophy and to additional hypometabolism-inducing factors, such as amyloid deposition. Conversely, metabolic compensation could reflect spared synaptic plasticity of the surviving neurons. The investigation of the metabolic compensation mechanism could help in the comprehension of the AD underlying pathology.