Pain Intensity, coping and maternal satisfaction in Low-Risk labouring Women: A prospective descriptive correlational study.

OBJECTIVES: The primary aim of the study was to explore pain intensity (PI) and pain coping (PC) scores and the relationship between them. The secondary aim was to explore the correlation between PI and PC scores with labour progress, parity, labour acceleration, labour augmentation and maternal satisfaction. METHODS: A prospective descriptive correlational study was conducted in a maternity hospital in Northern Italy. The sample included 54 low-risk women in active labour at term of pregnancy. A data record sheet was used to collect the relevant variables and the Italian Birth Satisfaction Scale Revised (I-BSS-R) was administered to participants at least 24 h after birth. RESULTS: In the first labour stage, the average PI score was 6.99 (SD = 1.95) and the average PC score was 6.5 (SD = 2.22). During the second labour stage, the average PI score was 7.75 (SD = 1.74) and the average PC score was 4.97 (SD = 2.76). The average PI score trend increased with labour progress. The average PC score improved between 4 and 7 cm of cervical dilatation. A significant positive correlation between PI scores and oxytocin augmentation (p < 0.001) and labour progression (p < 0.001) was noted. A significant positive correlation between PC scores and oxytocin augmentation (p = 0.02) was also observed. No significant differences were found for maternal satisfaction in regard to PI and PC scores. CONCLUSION: coping in labour do not solely depend on PI but also on labour progress and oxytocin augmentation. Additional support to empower women to cope with pain may be required in case of labour augmentation.

Giant thymolipoma in a child: The silent chest mass.

Thymolipoma is a rare benign anterior mediastinal tumour of thymic origin containing both thymic and mature adipose tissues. In most cases it has a silent course and can grow to large sizes before presenting with respiratory symptoms. We report a case of a giant thymolipoma in a 4-year-old girl treated at Chris Hani Baragwanath Academic Hospital, South Africa.

Automatic feedback control by image processing for mixing solutions in a microfluidic device.

Two approaches of an automatic control were studied through mathematical fitting obtained from color mixing saturation curves in polydimethylsiloxane microfluidic devices: The integrative control with variable integral gain and integrative control with constant integral gain. The aim of this work is to control the color percentage decrement when dye is injected. The results indicate that microfluidic systems are very sensitive to changes in flow and the control variable needs to change slowly; that is, it must be small (at least 100 times less than the theoretically calculated values). The control and stabilization of the microfluidic system were achieved for dye percentages above 60%. The controlling color percentage could provide a tool to regulate other parameters' concentration applied to cell culture and alkalinity control (pH) of solutions in microfluidic devices.

Associative learning in peripersonal space: fear responses are acquired in hand-centered coordinates.

Space coding affects perception of stimuli associated to negative valence: threatening stimuli presented within the peripersonal space (PPS) speed up behavioral responses compared with nonthreatening events. However, it remains unclear whether the association between stimuli and their negative valence is acquired in a body part-centered reference system, a main feature of the PPS coding. Here we test the hypothesis that associative learning takes place in hand-centered coordinates and can therefore remap according to hand displacement. In two experiments, we used a Pavlovian fear-learning paradigm to associate a visual stimulus [light circle, the conditioned stimulus (CS)] with an aversive stimulus (electrocutaneous shock) applied on the right hand only when the CS was displayed close (CS+) but when not far from it (CS-). Measuring the skin conductance response (SCR), we observed successful fear conditioning, with increased anticipatory fear responses associated with CS+. Crucially, experiment I showed a remapping of these responses following hand displacement, with a generalization to both types of CS. Experiment II corroborated and further extended our findings by ruling out the novelty of the experimental context as a driving factor of such modulations. Indeed, fear responses were present only for stimuli within the PPS but not for new stimuli displayed outside the PPS. By revealing a hand-centered (re)mapping of the conditioning effect, these findings indicate that associative learning can arise in hand-centered coordinates. They further suggest that the threatening valence of an object also depends on its basic spatial relationship with our body.NEW & NOTEWORTHY Associative fear learning takes place in hand-centered coordinates. Using a Pavlovian fear-learning paradigm, we show that the anticipatory skin conductance response indicating the association between the negative value and an initially neutral stimulus is acquired and then remapped in space when the stimulated body part moves to a different position. These results demonstrate the relationship between the representation of peripersonal space and the encoding of threatening stimuli. Hypotheses concerning the underlying neural network are discussed.

Peripersonal and reaching space differ: Evidence from their spatial extent and multisensory facilitation pattern.

Peripersonal space (PPS) is a multisensory representation of the space near body parts facilitating interactions with the close environment. Studies on non-human and human primates agree in showing that PPS is a body part-centered representation that guides actions. Because of these characteristics, growing confusion surrounds peripersonal and arm-reaching space (ARS), that is the space one's arm can reach. Despite neuroanatomical evidence favoring their distinction, no study has contrasted directly their respective extent and behavioral features. Here, in five experiments (N = 140) we found that PPS differs from ARS, as evidenced both by participants' spatial and temporal performance and by its modeling. We mapped PPS and ARS using both their respective gold standard tasks and a novel multisensory facilitation paradigm. Results show that: (1) PPS is smaller than ARS; (2) multivariate analyses of spatial patterns of multisensory facilitation predict participants' hand locations within ARS; and (3) the multisensory facilitation map shifts isomorphically following hand positions, revealing hand-centered coding of PPS, therefore pointing to a functional similarity to the receptive fields of monkeys' multisensory neurons. A control experiment further corroborated these results and additionally ruled out the orienting of attention as the driving mechanism for the increased multisensory facilitation near the hand. In sharp contrast, ARS mapping results in a larger spatial extent, with undistinguishable patterns across hand positions, cross-validating the conclusion that PPS and ARS are distinct spatial representations. These findings show a need for refinement of theoretical models of PPS, which is relevant to constructs as diverse as self-representation, social interpersonal distance, and motor control.

The Burden of Disease and Pathology at a Rapidly Expanding Tertiary Paediatric Surgical Unit in South Africa.

BACKGROUND: The precise burden of paediatric surgical care in South Africa is unknown. In the absence of epidemiological data, hospital-based study is a first step to gauge the burden and profile of paediatric surgical disease. We aim to describe the profile of pathology, pattern of referrals, and complications of paediatric surgical care at Chris Hani Baragwanath Academic Hospital (CHBAH). METHODS: A 1-year retrospective record review for the period 3/1/2019 to 1/1/2020 was conducted by evaluation of the morbidity and mortality databases of the Department of Paediatric Surgery (DPS). Number of admissions, consultations, complications, and surgeries performed were analysed and classified. RESULTS: A total of 11,932 unique patient encounters occurred. Emergencies (79%, 1841/2329) accounted for the majority of admissions. Trauma accounted for 49% (896/1841) of emergency admissions. Elective surgery constituted 52% (1202/2316) and emergency surgery 48% (1114/2316) of all procedures performed. The emergency department (55%, 1271/2329), outpatients department (19%, 447/2329), and peripheral hospitals (16%, 378/2329) were the source of the majority of admissions. A complication rate of 9% (208/2316) was observed. CONCLUSION: The high-volume subspecialist environment at CHBAH presents the ideal environment for delivery of specialist paediatric surgical services and training. Injury prevention, optimal use of existing resources, and additional physical, human and financial resources are required to meet the existing and predicted future burden of paediatric surgical disease.

Design and simulation of an optimized e-linac based neutron source for BNCT research.

The paper is focused on the study of a novel photo-neutron source for BNCT preclinical research based on medical electron Linacs. Previous studies by the authors already demonstrated the possibility to obtain a mixed thermal and epithermal neutron flux of the order of 10(7) cm(-2) s(-1). This paper investigates possible Linac's modifications and a new photo-converter design to rise the neutron flux above 5 10(7) cm(-2) s(-1), also reducing the gamma contamination.

Knowledge and competence with patient safety as perceived by nursing students: The findings of a cross-sectional study.

BACKGROUND: Ensuring safety in health-care settings is provoking improvements both in education and clinical practice. However, the studies available have not offered to date information regarding knowledge and competence on patient safety (PS) developed by nursing students over their academic career. There is no documentation of the amount of close calls and/or adverse events that students may have witnessed and the degree of safety perceived in the attended clinical settings. OBJECTIVES: To describe the perception of nursing students regarding their own knowledge and competence on PS and describe differences, if any, among students attending the first, second and third academic year. DESIGN: A cross-sectional study design was undertaken in 2013. PARTICIPANTS AND SETTING: A convenience sample of 621 nursing students of two bachelors nursing degrees located in two Italian universities, was the population target of the study. Students attending the first, second and third academic year, obtaining admission to the annual clinical competence examination, were eligible. METHODS: The Italian version of the Health Professional Education in Patient Safety Survey (H-PEPSSIta) and open-ended questions was administered to the students after having obtained their informed written consent. RESULTS: A total of 573 students (response rate 92.4%) participated. Around a quarter (28.8%) of students reported having experienced an adverse event or close call during their clinical experience. The settings where they learn were perceived as unsafe by 46.9% of students. PS knowledge and competence as perceived by students, was high (Median=4) in all factors and dimensions of the H-PEPSSIta tool. High PS knowledge and competence was reported by first-year students, moderate by second-year students and higher at the end of the third-year. CONCLUSIONS: Faculties and health-care institutions offering clinical placements have to share the responsibility of well-prepared future nurses, working together to improve PS through dialogue when issues are identified by students.

Contaminant source and release history identification in groundwater: a multi-step approach.

The paper presents a new multi-step approach aiming at source identification and release history estimation. The new approach consists of three steps: performing integral pumping tests, identifying sources, and recovering the release history by means of a geostatistical approach. The present paper shows the results obtained from the application of the approach within a complex case study in Poland in which several areal sources were identified. The investigated site is situated in the vicinity of a former chemical plant in southern Poland in the city of Jaworzno in the valley of the Wawolnica River; the plant has been in operation since the First World War producing various chemicals. From an environmental point of view the most relevant activity was the production of pesticides, especially lindane. The application of the multi-step approach enabled a significant increase in the knowledge of contamination at the site. Some suspected contamination sources have been proven to have minor effect on the overall contamination. Other suspected sources have been proven to have key significance. Some areas not taken into consideration previously have now been identified as key sources. The method also enabled estimation of the magnitude of the sources and, a list of the priority reclamation actions will be drawn as a result. The multi-step approach has proven to be effective and may be applied to other complicated contamination cases. Moreover, the paper shows the capability of the geostatistical approach to manage a complex real case study.

Cost of a population-based programme of chest x-ray screening for lung cancer.

BACKGROUND: After the implementation of a population-based programme of chest x-ray (CXR) screening on smokers in Varese, Italy, lung cancer (LC) mortality was significantly reduced. Analysis of the incremental costs due to this type of screening programme is needed to evaluate its economic impact on the healthcare system. METHODS: In July 1997 a population-based cohort, consisting of all high-risk smokers (n=5,815) identified among 60,000 adult residents from the Varese province, was invited to a LC screening programme (an annual CXR for five years) in a general practice setting, and was observed through 2006. Invitees received National Health Service (NHS) usual care, with the addition of CXRs in screening participants. At the end of observation, among the 245 LCs diagnosed in the entire screening-invited cohort the observed LC deaths were 38 fewer than expected. To estimate the incremental direct cost due to screening in the invited cohort for the period July 1997-2006, we compared the direct cost of screening administration, CXR screens and LC management in the invited cohort and in the uninvited and unscreened controls in NHS usual care setting. RESULTS: Over the 9.5 years, the total incremental direct healthcare costs (including screening organization/administration, CXR screens, additional procedures prompted by false-positive tests, overdiagnosed LCs) were estimated to range from euro 607,440 to euro 618,370 (in euros as of 2012), equating to between euro 15,985- euro 16,273 per patient out of the 38 LC deaths averted. CONCLUSIONS: In a general practice setting, the incremental cost for a CXR screening programme targeted at all high-risk smokers in a population of 60,000 adults was estimated to be about euro 65,000 per annum, approx. euro 16,000 for each LC death averted.

[What criteria are used by home care nurses to decide about frequency of home visits in the follow-up of patients with heart failure?]. / Quali sono i criteri utilizzati dagli infermieri di assistenza domiciliare per decidere la frequenza di accesso nei pazienti con scompenso cardiaco?

BACKGROUND: Factors that directly or indirectly influence nurses' decisions regarding aspects of in-hospital care are well-known. On the other hand, little is known about which elements/criteria are used by home-care nurses to make decisions about the frequency of follow-up visits. OBJECTIVES: The objective of this study was to identify the criteria used for defining the frequency of follow-up visits in patients with heart failure. METHODS: Different study methods were used. A cross-sectional questionnaire study was performed to identify what specific aspects are considered for deciding to provide homecare to patients with heart failure. Three focus groups were then held with homecare nurses with experience with heart failure patients, to discuss and reach a consensus regarding the criteria for frequency of follow-up visits. RESULTS: The criteria that guide decision-making about the frequency of follow-up home visits are: a) clinical condition of the patient, b) presence of a caregiver, c) compliance/adherence to drug therapy, d) characteristics of the patient, e) workload, f) professional experience of the healthcare operator, f) assessment by the patient's general practitioner. CONCLUSIONS: The study identified which factors influence home-care nurses' decision-making in defining the frequency of follow-up for patients with heart failure. The decision-making process is based on the evaluation of multiple factors and also considers the organizational context in which home-care nurses work and their workload. Accurate criteria need to be defined.

Extrarenal testicular Wilms' tumor in a 3-year-old child.

We report an extremely rare case of extrarenal testicular Wilms' tumor in a 3-year-old boy with intrabdominal undescended left testis. The patient was admitted because of pain and vomiting, with evidence of a huge abdominal mass. At surgery a large tumor arising from the intrabdominal testis was found. Histology showed the classical triphasic Wilms' tumor elements: epithelial, mesenchymal and blastemal areas. Extrarenal Wilms' tumors account for only 3% of all Wilms' tumors and just -100 cases have been reported in literature. Testicular origin is anecdotic. We present histomorphological, histogenetic, clinical, diagnostic, prognostic and therapeutic features of this rare tumor.

Induced sputum in the management of COPD: clinical implications.

Sputum induction can be used as a non-invasive technique to investigate airway inflammation in asthma and COPD. We reported the case of a 68 year old man with COPD, stage III GOLD, that underwent sputum induction during two exacerbation episodes. The first cell count showed a typical sputum neutrophilia, whereas the second showed sputum eosinophilia. On the basis of sputum cellularity, we decided to treat the first episode with a course of antibiotics and the second exacerbation with a course of antibiotics and oral steroids. The patient showed improvement in both cases, obtaining clinical stabilisation. The induced sputum cell count could be a useful technique in a clinical setting to evaluate the cellular characteristics of airway inflammation during COPD exacerbation and modulate the antinflammatory therapy.

Becoming a nurse in Italy: a multi-method study on expenditures by families and students.

Potential nursing students and their families are faced with difficult decisions regarding the amount of time and money required to complete the nursing programme and the availability of funds to cover the costs and this seems to have received little no attention to date. With the aim of describing the costs incurred by Italian nursing students and/or their families per academic year and compare cost trends incurred from 2004-05 to 2010-11, a multi-centre qualitative/quantitative study design was adopted. Italian Nursing students attending the first, second and third academic years in 2004-05 and those attending the first, second and third academic years in 2010-11 were eligible. Five hundred and six students were involved: 215 (out of 300 eligible, 71.6%) attended the bachelor's degree in nursing in 2004-05 and 291 (out of 383 eligible, 75.9%) in 2010-11. On an annual basis, the average annual expenditures increased by 12% for nursing education from 2004-05 to 2010-11. Given that qualification as a nurse requires at least three years, and considering inflation, for a student who matriculated in 2005 an average of 2485.7€ per year (7457.0€ in total) was required. Data suggest that students have modified their spending behaviour (limiting lunches at public bars, buying books and photocopies) in order to handle the rise of non-discretionary costs, such as tuition fees and the costs of attending lectures and hospital/district trainings. Policies supporting nursing education in general and for those students who are motivated but unable to undertake the course for economic reasons are urgently needed.

The cost of the objective structured clinical examination on an Italian nursing bachelor's degree course.

The OSCE (Objective Structured Clinical Examination) is considered the most valid and reliable method for assessing the clinical skills of students training for health professions, but its use is limited by the related high costs. We analyzed the cost retrospectively of using an OSCE designed for second-year students (2009) in our degree course, adopting the Reznick et al. guidelines (1993), which recommend assessing both high-end costs and low-end costs. The high-end costs adopting the OSCE amounted to € 145.23 per student, while the low-end costs were € 31.51 per student. Considering the economic crisis and the cost-containment measures applied also in nursing education, strategies for further reducing costs are discussed.

Telephone support: a descriptive study in an Italian oncological Day-Hospital ward.

The past decade has been seen widespread use of telephone and computer technologies to provide a broad array of health behaviours intervention and health services. The purpose of this study is to explore the frequency and the reasons about telephone using in an Italian Day Hospital oncological ward. The study was conducted in 2008 throughout a questionnaire filled by nurses that receive patients telephone calls. We analyzed 100 hours of nurses' work corresponding to about 13 days. The mean of daily calls was 30.5 (SD=6.4). 72.2% were calls effectuated on the morning, the others in the afternoon. Nurses spent 13% of their shiftwork time on telephone: 6.97 hours for calls regards directly patients and 5.8 hours for service calls. General information and information on tests results were the more frequent motivations of patients' calls. The study stress major workload for nurses in telephone answers. A significant patient demand emerged that should be addressed also identifying specific hours during the day.

Socio-demographic survey of first degree healthcare students in the 2007-08 academic year in an Italian university.

This study examines the socio-demographic characteristics of first-year students on first degree healthcare courses at Udine University (Italy). The survey tried to elicit useful information in a field where literature is scarce. Every student starting healthcare courses in the 2007/08 academic year was contacted and asked to fill in a questionnaire. Two hundred and sixty students were identified, belonging to six different courses: Nursing Sciences, Obstetric Sciences, Physiotherapy, Radiography, Neurophysiopathology Techniques, Biomedical Laboratory Techniques. Each questionnaire included 26 items (25 closed and one open) and had four sections: personal data, family data, training background, criteria affecting the decision to attend a healthcare course. The overall response rate was 87% (226 out of 260). Major findings were: women prevail on men (77% vs. 23%), many students chose these courses because some family member worked in the healthcare field (22.1%), 19.9% of students are older than 26 and 7.1% of them are postgraduates, 12% come from foreign countries, and job opportunities and former work experience influenced the choice of course. This database provides an important benchmark for comparing future trends among students in the healthcare profession in terms of socio-demographic characteristics and personal attitudes.

Are Italian nursing students healthy and having protective lifestyle behaviours? A pilot study.

Aim of the study was to investigate the lifestyles of nursing students attending the first year at an Italian school of nursing, before their knowledge of health promotion and health education can condition their behaviour. Research suggests that nurses themselves, in both the acute and primary care settings, perceive that health education is an important part of their role. The study consisted of a self-administered questionnaire with five sections: general data, and questions on nutrition, physical activity, smoking behaviour and alcohol. Response rate was 89.2% (149/167): 87.2% of respondents reported they were satisfied with their health status; 70.5% of students had a normal body mass index; 40.6% of males and 23.1% of females played a sport; 49.7% had never smoked in their life; 50.3% had smoked at least once; 62.7% were smokers and 75.2% of students had drunk alcohol at least once. The students surveyed adopt unhealthy behaviours like smoking, use of alcohol and poor physical activity even if they consider they are in good health. The study stresses the fact that the nursing population needs to be specifically trained to make positive changes. This is important for their education and also for their position as role models for patients they will care for in the future.