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Challenges and improvement strategies in the hospitalization of chronic multimorbid patients

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World Journal of Clinical Cases 2025年第3期13卷 35-41页

作者： Andres fontalba-Navas francisco Pozo Muñoz Rogelio Garcia Cisneros maria Jose Garcia Larrosa maria del Mar Callejon Gil Ignacio Garcia Delgado maria Belen Jimenez Martinez Antequera Hospital Northern Málaga Integrated Healthcare AreaAntequera 29200AndalusiaSpain Department of Public Health and Psychiatry University of MálagaMálaga 29010Spain Antequera Hospital Northern Málaga Antequera Integrated Healthcare AreaAntequera 29200MálagaSpain

BACKGROUND Addressing the growing challenge of hospitalizing chronic multimorbid patients,this study examines the strain these conditions impose on healthcare systems at a local level,focusing on a pilot *** diseases and complex patients require comprehensive management strategies to reduce healthcare burdens and improve patient *** proven effective,this pilot model has the potential to be replicated in other healthcare settings to enhance the management of chronic multimorbid *** To evaluate the effectiveness of the high complexity unit(HCU)in managing chronic multimorbid patients through a multidisciplinary care model and to compare it with standard hospital *** The study employed a descriptive longitudinal approach,analyzing data from the Basic Minimum Data Set(BMDS)to compare hospitalization variables among the HCU,the Internal Medicine Service,and other services at Antequera Hospital throughout *** HCU,designed for patients with complex chronic conditions,integrates a patient-centered model emphasizing multidisciplinary care and continuity *** The study employed a descriptive longitudinal approach,analyzing data from the BMDS to compare hospitalization variables among the HCU,the Internal Medicine Service,and other services at Antequera Hospital throughout *** HCU,designed for patients with complex chronic conditions,integrates a patient-centered model emphasizing multidisciplinary care and continuity *** This study demonstrates the effectiveness of the HCU in managing patients with complex chronic diseases through a multidisciplinary *** coordinated care provided by the HCU results in improved patient outcomes,reduced unnecessary hospitalizations,and better management of patient *** superiority of the HCU compared to standard care is evident in key outcomes such as fewer readmissions and higher patient satisfaction,reinforcing its value as a model of ca

关键词： High complexity unit Chronic multimorbidity Patient-centered care Integrated care Healthcare management

Modification of tubular chitosan-based peripheral nerve implants: applications for simple or more complex approaches

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Neural Regeneration Research 2020年第8期15卷 1421-1431页

作者： Nina Dietzmeyer maria f?rthmann Claudia Grothe Kirsten Haastert-Talini Institute of Neuroanatomy and Cell Biology Hannover Medical School Center for Systems Neuroscience (ZSN) Hannover

Surgical treatment of peripheral nerve injuries is still a major challenge in human *** to now,none of the well-developed microsurgical treatment options is able to guarantee a complete restoration of nerve *** restriction is also effective for novel clinically approved artificial nerve *** this review,we compare surgical repair techniques primarily for digital nerve injuries reported with relatively high prevalence to be valuable attempts in clinical digital nerve repair and point out their advantages and *** furthermore discuss the use of artificial nerve grafts with a focus on chitosan-based nerve guides,for which our own studies contributed to their approval for clinical *** the second part of this review,very recent future perspectives for the enhancement of tubular(commonly hollow)nerve guides are discussed in terms of their clinical translatability and ability to form three-dimensional constructs that biomimick the natural nerve *** includes materials that have already shown their beneficial potential in in vivo studies like fibrous intraluminal guidance structures,hydrogels,growth factors,and approaches of cell ***,we highlight upcoming future perspectives comprising co-application of stem cell *** our overview,we conclude that already simple attempts are highly effective to increase the regeneration supporting properties of nerve guides in experimental *** for bringing nerve repair with bioartificial nerve grafts to the next level,*** of defects>3 cm in human patients,more complex intraluminal guidance structures such as innovatively manufactured hydrogels and likely supplementation of stem cells or their secretome for therapeutic purposes may represent promising future perspectives.

关键词： bioartificial nerve graft biological nerve graft cell transplantation cellular products luminal structures peripheral nerve repair

A C-shaped hinge for displacement magnification in MEMS rotational structures

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Microsystems & Nanoengineering 2024年第1期10卷 55-66页

作者： Naga Manikanta Kommanaboina Teferi Sitotaw Yallew Alvise Bagolini maria f.Pantano Department of Civil Environmental and Mechanical EngineeringUniversity of Trentovia Mesiano 7738123 TrentoItaly fondazione Bruno Kessler(fBK) Microsystems Technology(MST)via S.Croce 7738122 TrentoItaly

The design,analysis,fabrication,and characterization of two distinct MEMS rotational structures are provided;these structures include a classical symmetrical lancet structure and a novel symmetrical C-shaped structure provided with a tilted arm,and both are actuated by thermal *** proposed C-shaped structure implemented a curved beam mechanism to enhance the movement delivered by the thermal *** geometrical parameters of our proposed device were optimized using the design of experiment(DOE)***,the analytical modeling based on Castigliano’s second theorem and the simulations based on the finite element method(fEM)were used to predict the behavior of the symmetrical C-shaped structure;the results were in good agreement with each *** MEMS-based rotational structures were fabricated on silicon-on-insulator(SOI)wafers using bulk micromachining technology and deep reactive ion etching(DRIE)*** fabricated devices underwent experimental characterization;our results showed that our proposed MEMS rotational structure exhibited a 28%improvement in the delivered displacement compared to the symmetrical lancet ***,the experimental results showed good agreement with those obtained from numerical *** proposed structures have potential applications in a variety of MEMS devices,including accelerometers,gyroscopes,and resonators,due to their ability to maximize displacement and thus enhance sensitivity.

关键词： shaped displacement structures

Simultaneous nitrification and autotrophic denitrification in fluidized bed reactors using pyrite and elemental sulfur as electron donors

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Water Science and Engineering 2023年第2期16卷 143-153页

作者： maria f.Carboni Sonia Arriaga Piet N.L.Lens National University of Ireland Galway H91 TK33 GalwayIreland Instituto Potosino de Investigación Científica y Tecnológica 78216 San Luis PotosíMexico

In this study, simultaneous nitrification and autotrophic denitrification (SNAD) with either elemental sulfur or pyrite were investigated in fluidized bed reactors in mesophilic conditions. The reactor performance was evaluated at different ammonium (12-40 mg/L of NH4+-N), nitrate (35-45 mg/L of NO3--N), and dissolved oxygen (DO) (0.1-1.5 mg/L) concentrations, with a hydraulic retention time of 12 h. The pyrite reactor supported the SNAD process with a maximum nitrogen removal efficiency of 139.5 mg/(L·d) when the DO concentration was in the range of 0.8-1.5 mg/L. This range, however, limited the denitrification efficiency of the reactor, which decreased from 90.0% ± 5.3% in phases II-V to 67.9% ± 7.2% in phases VI and VII. Sulfate precipitated as iron sulfate (feSO4/fe2(SO4)3) and sodium sulfate (Na2SO4) minerals during the experiment. The sulfur reactor did not respond well to nitrification with a low and unstable ammonium removal efficiency, while denitrification occurred with a nitrate removal efficiency of 97.8%. In the pyrite system, the nitrifying bacterium Nitrosomonas sp. was present, and its relative abundance increased from 0.1% to 1.1%, while the autotrophic denitrifying genera Terrimonas, ferruginibacter, and Denitratimonas dominated the community. Thiobacillus, Sulfurovum, and Trichlorobacter were the most abundant genera in the sulfur reactor during the entire experiment.

关键词： Pyrite Elemental sulfur Simultaneous nitrification and denitrification Nitrogen removal 16S rRNA

Engineering complex systems applied to risk management in the mining industry

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International Journal of Mining Science and Technology 2017年第4期27卷 611-616页

作者： Domingues maria S.Q. Baptista Adelina L.f. Diogo Miguel Tato CERENA - Centre for Natural Resources and the Environment Faculty of Engineering University of Porto Porto 4200-465 Portugal CLEGI-Centre Lusiada of Research and Development in Engineering and Industrial Management University Lusiada-North Vila Nova de Famalicao 4760-108 Portugal

Related to complexity, there is a wide diversity of concepts, ranging from ‘‘systemic" to ‘‘complex", implying a need for a unified terminology. Per different authors, the main drivers of complexity can be found in human behaviour and uncertainty. This complexity, structural or dynamic can be organizational, technological, or nested in their relationship. ISO international standard 31000:2009 definition of risk management ‘‘coordinated activities to direct and control an organization with regard to risk", when applied to economic sectors, industry, services, project, or activity, it requires the use of models or theories as guidelines. Therefore, as its basic elements comprehend human behaviour and/or uncertainty, risk management to be effective and adapted as much as possible to reality, must be operational within complex systems, as already demonstrated in different R&D environments. Risk management faces demanding challenges when approaching specific and endogenous needs, such as the mining sector. This paper presents a multivariable function analysis methodology approach based on complex system modelling and through real data corresponding to a risk management tool in the mining sector.

关键词： Risk Risk management Complex systems Mining Decision making

Availability assessment of voltage source converter HVDC grids using optimal power flow-based remedial actions

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High Voltage 2020年第5期5卷 523-533页

作者： Mario A.Rios Jeffer L.Vera maria f.Perez Department of Electrical Engineering and Electronics School of EngineeringUniversidad de los AndesCra.1 No.18A-12BogotaColombia

This study proposes a methodology for assessing the availability of voltage source converter high-voltage direct current(HVDC)grids based on the enumeration methodology of contingency analysis with N−2 criteria and makes contributions in the computation of remedial actions and the definition and computation of reliability indices applied for HVDC ***,this study proposes the computation of remedial actions based on an optimal power flow,looking to maintain power exchanges between HVDC and high-voltage alternating current grids,when a contingency occurs on the HVDC grid and converter stations or HVDC lines are out of their operating *** the other hand,an HVDC grid has the function of injecting and extracting power from AC interconnected zones,and then traditionally used nodal reliability indices must be modified to indices that reflect the performance of the HVDC network to fulfil its function of interconnection of *** study defines two sets of availability indices applicable to HVDC grids:(i)loss of power and energy extracted from the DC grid to the AC zones and(ii)loss of power and energy injected to AC zones from the DC *** proposed methodology is applied to perform the availability assessment of the CIGRE B4 DC grid test system and the results are presented.

关键词： power indices optimal

Rat cardiomyocyte H9c2(2-1)-based sulforhodamine B assay as a promising in vitro method to assess the biological component of effluent toxicity

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Journal of Environmental Sciences 2020年第10期32卷 163-170页

作者： Elsa T Rodrigues Susana f Nascimento maria Joao Moreno Paulo J Oliveira Miguel A Pardal University of Coimbra Centre for Functional EcologyDepartment of Life SciencesCalcada Martim de FreitasCoimbra 3000-456Portugal University of Coimbra Coimbra Chemistry CenterDepartment of ChemistryCoimbra 3004-535Portugal Centre for Neuroscience and Cell Biology Uniuersity of CoimbraUC BiotechBiocant ParkCantanhede 3060-197Portugal

The treatment of wastewaters is crucial to maintain the ecological status of receiving waters,and thereby guarantee the protection of aquatic life and human *** quality evaluation is conventionally based on physicochemical parameters,but increasing attention has been paid to integrate physicochemical and biological ***,the regulatory use of fish in biological testing methods has been subject to various ethical and cost concerns,and in vitro cell-based assays have thus become an important topic of ***,the present study intends:(a) to evaluate the efficiency of two different sample pre-concentration techniques (lyophilisation and solid phase extraction) to assess the toxicity of municipal effluents on rat cardiomyoblast H9c2(2-1) cells,and (b) maximizing the use of the effluent sample collected,to estimate the environmental condition of the receiving *** gathered results demonstrate that the H9c2(2-1) sulforhodamine B-based assay is an appropriate in vitro method to assess biological effluent toxicity,and the best results were attained by lyophilising the sample as *** to its response,the H9c2(2-1) cell line might be a possible alternative in vitro model for fish lethal testing to assess the toxicity of municipal *** physicochemical status of the sample suggests a high potential for eutrophication,and iron exceeded the permissible level for wastewater discharge,possibly due to the addition of ferric chloride for wastewater *** general,the levels of carbamazepine and sulfamethoxazole are higher than those reported for other countries,and both surpassed the aquatic protective values for long-term exposure.

关键词： Municipal wastewater treatment plant effluent Lyophilisation Solid phase extraction Cell-based assays H9c2(2-1)cell line SRB assay

New strategies for colorectal cancer screening

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World Journal of Gastroenterology 2013年第12期19卷 1855-1860页

作者： maria Di Lena Elisabetta Travaglio Donato f Altomare Department of Emergency and Organ Transplantation University Aldo Moro of Bari

Colorectal cancer (CRC) is still one of the leading causes of cancer-related death in Western countries, despite major improvements in its treatment. The dramatically high social and economic impact of CRC on human health makes the identification of a reliable screening tool of paramount importance. Current screening methods, such as the fecal occult blood test and colonoscopy do not adequately meet the ideal requisites of a screening test because, even if they are effective, they are limited first by too low specificity and sensitivity, or second by high invasiveness, costs and risk. Nowadays extended efforts are made by researchers to look for more reliable and effective screening tests based on a systems biology approach, using biological samples easily available, such as urine, breath, serum and feces. The effectiveness and reliability of several new attempts to screen these patients by non-invasive analysis of their biological samples using genomic (genetic and epigenetic alteration), transcriptomic (miRNA), proteomic (cancer-related antigens, new antibodies against tumor-associated antigens, mutated proteins) and metabolomic (volatile organic metabolites) methods are discussed in this review. Among the most interesting new screening tools, fecal fluorescent long-DNA, fecal miRNA and metabolomic evaluation in breath and/ or serum seem to be most promising.

关键词： Colorectal cancer Screening fecal occult blood test Systems biology Metabolomics Proteomic microRNA Volatile organic compounds

The heterogeneity of CAfs and immune cell populations in the tumor microenvironment of pancreatic adenocarcinoma

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Journal of Cancer Metastasis and Treatment 2022年第1期8卷 126-139页

作者： maria Diab Bassel f.El-Rayes Department of Hematology and Oncology Winship Cancer Institute of Emory UniversityAtlantaGA 30322USA Division of Hematology and Oncology University of AlabamaBirminghamAL 35294 USA

Over the past decade,researchers have identified and characterized the diverse cell populations within the tumor microenvironment of pancreatic *** interplay between these cells in the TME either promotes or inhibits the malignant behavior of pancreatic cancer ***-associated fibroblasts,previously thought to be one main subset,can now be broadly subclassified into three main types:inflammatory,myofibroblastic,and antigen-presenting,with the former and the latter two exerting pro-tumoral and anti-tumoral functions,*** cells include myeloid-derived suppressor cells and tumor-associated ***-derived suppressor cells can be further divided into polymorphonuclear and monocytic and exhibit pro-tumoral ***-associated macrophages exhibit M1(anti-tumoral)or M2(pro-tumoral)phenotypes,which are present in a dynamic fashion between the two *** constituents of the immune make-up of the tumor microenvironment include T and B cells and less described subsets which include natural killer cells,γδT cells,and group 2 innate lymphoid *** review provides an overview of the studies that lead to the discovery of those cellular populations and highlights the recent efforts to utilize them as therapeutic targets in pancreatic cancer.

关键词： Tumor microenvironment pancreatic cancer cancer-associated fibroblast myeloid cells T cells