Patient's punctuality in an outpatient clinic: the role of age, medical branch and geographical factors.

BACKGROUND: The efficiency of the management of an outpatient clinic largely depends on the administration of patient flows and waiting times increase costs and affect clinical quality. In this study, we verify if the visit acceptance times are influenced by demographic or geographical factors in a large cohort of patients referred to a city and suburban private outpatient multidisciplinary clinic. METHODS: We included all scheduled visits of patients aged from 18 to 75 years who arrived in 2021, 2022 and 2023 in our private outpatient clinics, consisting of 34 medical clinics scattered in Milan metropolitan city and hinterland. The variables collected were age, visit time, check-in time, address of the medical clinic and its distance from the closest underground station, patient typology (new business vs. follow-up patient), and the medical branch of the visit. Outcome is'punctuality', defined as check-in time minus visit time (in minutes). RESULTS: We considered a sample of 410.808 visits from January 2021 to April 2023. The majority of patients check-in early (84.4%) and we found that the percentage of punctual patients increases linearly with age. Earlier hours in the morning show the worst punctuality pattern as well as Blood Draws in the analysis of different medical branches. We also observed that patients who already had some activity recorded in our systems show the worst pattern of punctuality. No particular differences emerged considering the geographical location of the clinics. CONCLUSIONS: Younger patients have worse punctuality than older patients. Moreover, earlier hour slots are the most disadvantaged and the medical specialty has an influence on the arrival habits. This data should be considered for better clinical quality and efficiency.

Degradation dynamics of microRNAs revealed by a novel pulse-chase approach.

The regulation of miRNAs is critical to the definition of cell identity and behavior in normal physiology and disease. To date, the dynamics of miRNA degradation and the mechanisms involved in remain largely obscure, in particular, in higher organisms. Here, we developed a pulse-chase approach based on metabolic RNA labeling to calculate miRNA decay rates at genome-wide scale in mammalian cells. Our analysis revealed heterogeneous miRNA half-lives, with many species behaving as stable molecules (T1/2> 24 h), while others, including passenger miRNAs and a number (25/129) of guide miRNAs, are quickly turned over (T1/2= 4-14 h). Decay rates were coupled with other features, including genomic organization, transcription rates, structural heterogeneity (isomiRs), and target abundance, measured through quantitative experimental approaches. This comprehensive analysis highlighted functional mechanisms that mediate miRNA degradation, as well as the importance of decay dynamics in the regulation of the miRNA pool under both steady-state conditions and during cell transitions.

Dominance of Metric Correlations in Two-Dimensional Neuronal Cultures Described through a Random Field Ising Model.

We introduce a novel random field Ising model, grounded on experimental observations, to assess the importance of metric correlations in cortical circuits in vitro. Metric correlations arise from both the finite axonal length and the heterogeneity in the spatial arrangement of neurons. The experiments consider the response of neuronal cultures to an external electric stimulation for a gradually weaker connectivity strength between neurons, and in cultures with different spatial configurations. The model can be analytically solved in the metric-free, mean-field scenario. The presence of metric correlations precipitates a strong deviation from the mean field. Null models of the same networks that preserve the distribution of connections recover the mean field. Our results show that metric-inherited correlations in spatial networks dominate the connectivity blueprint, mask the actual distribution of connections, and may emerge as the asset that shapes network dynamics.

Correlations in avalanche critical points.

Avalanche dynamics and related power-law statistics are ubiquitous in nature, arising in phenomena such as earthquakes, forest fires, and solar flares. Very interestingly, an analogous behavior is associated with many condensed-matter systems, such as ferromagnets and martensites. Bearing it in mind, we study the prototypical random-field Ising model at T=0. We find a finite correlation between waiting intervals and the previous avalanche size. This correlation is not found in other models for avalanches but it is experimentally found in earthquakes and in forest fires. Our study suggests that this effect occurs in critical points that are at the end of a first-order discontinuity separating two regimes: one with high activity from another with low activity.

Polarity, cell division, and out-of-equilibrium dynamics control the growth of epithelial structures.

The growth of a well-formed epithelial structure is governed by mechanical constraints, cellular apico-basal polarity, and spatially controlled cell division. Here we compared the predictions of a mathematical model of epithelial growth with the morphological analysis of 3D epithelial structures. In both in vitro cyst models and in developing epithelial structures in vivo, epithelial growth could take place close to or far from mechanical equilibrium, and was determined by the hierarchy of time-scales of cell division, cell-cell rearrangements, and lumen dynamics. Equilibrium properties could be inferred by the analysis of cell-cell contact topologies, and the nonequilibrium phenotype was altered by inhibiting ROCK activity. The occurrence of an aberrant multilumen phenotype was linked to fast nonequilibrium growth, even when geometric control of cell division was correctly enforced. We predicted and verified experimentally that slowing down cell division partially rescued a multilumen phenotype induced by altered polarity. These results improve our understanding of the development of epithelial organs and, ultimately, of carcinogenesis.

Yielding and irreversible deformation below the microscale: surface effects and non-mean-field plastic avalanches.

Nanoindentation techniques recently developed to measure the mechanical response of crystals under external loading conditions reveal new phenomena upon decreasing sample size below the microscale. At small length scales, material resistance to irreversible deformation depends on sample morphology. Here we study the mechanisms of yield and plastic flow in inherently small crystals under uniaxial compression. Discrete structural rearrangements emerge as a series of abrupt discontinuities in stress-strain curves. We obtain the theoretical dependence of the yield stress on system size and geometry and elucidate the statistical properties of plastic deformation at such scales. Our results show that the absence of dislocation storage leads to crucial effects on the statistics of plastic events, ultimately affecting the universal scaling behavior observed at larger scales.