COVID-19 Risk Management: a Survey among Italian physicians

Abstract

The COVID-19 pandemic had a significant global impact on public health. The increasing demand for intensive care and the closure of several health facilities has led to a reduction in the assistance of non-COVID patients. In our study, we investigated what changes health professionals have experienced in their professional activities and how they coped with them. A questionnaire was sent to 146 doctors, focused on three subjects: type of activity carried out during the pandemic; use of personal protective equipment (PPE) and recourse to vaccination; current medical liability profiles related to COVID-19. The questionnaire was completed by 111 doctors. The study showed no significant differences in the questionnaire response as regards the demographic and work variables of the participants (gender, age, area of specialties). Most of doctors assisted potentially positive patients, which also imposed derogations on their safety. Most of the complaints were about the low adequacy of PPE provision and about the compromission of specialist medical care. The interest in safety among participants was revealed by the high compliance to vaccination, with almost complete coverage. The questionnaires showed that most doctors (72,7%) believe that specialist medical care has been impaired during the COVID-19 pandemic. Secondly, a high percentage of participants (79.8%) expressed the need for both civil and criminal limitation of liability in connection with work in the management of SARS-Cov-2 patients. In conclusion, this survey tried to contribute to the identification of the main problems presented by healthcare professionals. Their versatility was a crucial element for the management of the pandemic, but also highlighted the need for health institutions to prepare pandemic plans in the future, with adequate and constant updating. Concerns were raised regarding financial deficits and legal protection. Political decisions must be entrusted to enhance medical assistance and to avoid the increasing phenomenon of defensive medicine.

In search of phosphorus in astronomical environments: The reaction between the CP radical (X2Σ+) and methanimine

Phosphorus is of particular interest in astrochemistry because it is a biogenic element together with hydrogen, carbon, nitrogen, oxygen, and sulfur. However, the chemical evolution of such element in the interstellar medium (ISM) is still far from an accurate characterization, with the chemistry of P-bearing molecules being poorly understood. To provide a contribution in this direction, we have carried out an accurate investigation of the potential energy surface for the reaction between the CP radical and methanimine (CH₂NH), two species already detected in the ISM. In analogy to similar systems, i.e., CH₂NH + X, with X = OH, CN, and CCH, this reaction can occur-from an energetic point of view-under the harsh conditions of the ISM. Furthermore, since the major products of the aforementioned reaction, namely, E- and Z-2-phosphanylidyneethan-1-imine (HN=CHCP) and N-(phosphaneylidynemethyl)methanimine (H₂C=NCP), have not been spectroscopically characterized yet, some effort has been made for filling this gap by means of accurate computational approaches.

Zenker diverticulum in the right side of the neck resembling a thyroid mass at ultrasound

Zenker’s diverticulum represents the most common form of pharyngo-oesophageal diverticula usually occurring on the left side of the neck. Due to its anatomical proximity to the thyroid, it can mimic a thyroid mass. Here we describe the case of an asymptomatic 49-year-old man referred to the Thyroid Clinic of the Policlinico Umberto I Hospital-“Sapienza” University of Rome for thyroid sonography due to a family history of autoimmune thyroid disease. The patient’s thyroid blood tests did not reveal any abnormalities. The sonographic examination showed a dishomogeneus and hypoechoic thyroid gland. In addition, in the third middle of the right lobe, a mass (with a diameter greater than 26 mm), with heterogeneous internal echogenicity, hypoechoic margins and internal hyperechoic spots was recorded, with no appreciable flow at the Doppler evaluation. The TI-RADS score was 4c. Hence, the patient underwent ultrasound-guided fine-needle aspiration cytology that revealed the presence of squamous cells without cytological atypia, erythrocytes, muscular and vegetable fibres, colonies of bacteria in the absence of inflammatory infiltrate. This was consistent with the diagnostic hypothesis of oesophagus diverticulum, which was confirmed by means of a barium-swallow oesophagography. This case report underlines the possibility that a suspicious thyroid mass may result from a Zenker’s diverticulum, even if located on the right side, especially if the lesion has a heterogeneous echo-texture, a hypoechoic rim and internal hyperechoic spots.

Comparison of the economic impact of different wind power forecast systems for producers

Abstract. Deterministic forecasts of wind production for the next 72 h at a single wind farm or at the regional level are among the main end-users requirement. However, for an optimal management of wind power production and distribution it is important to provide, together with a deterministic prediction, a probabilistic one. A deterministic forecast consists of a single value for each time in the future for the variable to be predicted, while probabilistic forecasting informs on probabilities for potential future events. This means providing information about uncertainty (i.e. a forecast of the PDF of power) in addition to the commonly provided single-valued power prediction. A significant probabilistic application is related to the trading of energy in day-ahead electricity markets. It has been shown that, when trading future wind energy production, using probabilistic wind power predictions can lead to higher benefits than those obtained by using deterministic forecasts alone. In fact, by using probabilistic forecasting it is possible to solve economic model equations trying to optimize the revenue for the producer depending, for example, on the specific penalties for forecast errors valid in that market. In this work we have applied a probabilistic wind power forecast systems based on the "analog ensemble" method for bidding wind energy during the day-ahead market in the case of a wind farm located in Italy. The actual hourly income for the plant is computed considering the actual selling energy prices and penalties proportional to the unbalancing, defined as the difference between the day-ahead offered energy and the actual production. The economic benefit of using a probabilistic approach for the day-ahead energy bidding are evaluated, resulting in an increase of 23% of the annual income for a wind farm owner in the case of knowing "a priori" the future energy prices. The uncertainty on price forecasting partly reduces the economic benefit gained by using a probabilistic energy forecast system.

Aurora kinases: new molecular targets in thyroid cancer therapy

Genetic instability, a hallmark of solid tumors including thyroid cancers, is thought to represent the mean by which premalignant cells acquire novel functional capabilities responsible for cancer cell growth and tumour progression. Over the last few years, the knowledge of the molecular processes controlling the mitotic phase of the cell cycle has increased considerably, and different mitotic proteins, whose expression or function has been found altered in human cancer tissues, have been associated to tumour genetic instability and aneuploidy. These include the three members of the Aurora kinase family (Aurora-A, -B and -C), serine/threonine kinases that regulate multiple aspects of chromosome segregation and cytokinesis. The genes encoding the Aurora kinases have been shown to induce cell malignant transformation, and their overexpression has been detected in several tumor derived cell lines and tissues, being often associated with a poor prognosis. Over the last decade, specific inhibitors of Aurora kinases exhibited in preclinical and early phase clinical studies a good therapeutic efficacy against several tumour types, including the highly aggressive anaplastic thyroid cancer and the medullary thyroid cancer. In the present review we'll first focus on the Aurora mitotic functions in normal cells; then we shall describe the main implications of their overexpression in the onset of genetic instability and consequent aneuploidy. We shall finally discuss on the effects of the functional inhibition of Aurora kinases on thyroid cancer cells growth and tumorigenicity.

[Management of patient with Gaves' orbitopathy]

Graves' orbitopathy (GO) is the most common and important extrathyroidal manifestation of Flajani-Basedow-Graves' disease, with autoimmune etiology. In most cases they are mild forms, in 3-5% they are severe and progressive. For therapeutic purposes, it is classified according to the severity (mild, moderate-severe or sight threatening), to the activity (active if clinical activity score is >=3), and to the impact on quality of life. The choice of medical or surgical therapy depends on the activity of the disease. Therapy for mild GO consists of abolition of risk factors, local treatments, oral administration of selenium. Therapy for moderate-severe and active GO consists of administration of intravenous, oral, topic and local (retrobulbar, peribulbar and subconjunctival) glucocorticoids (GC). The therapy of choice, after careful selection of patients, is pulse therapy with intravenous GC, with 79% of response. Orbital radiotherapy is effective in 60% of cases; diabetes mellitus and hypertension are absolute contraindications. Contemporary administration of oral GC and orbital radiotherapy are more effective than single therapies. Marginal and not validated therapies are cyclosporine, somatostatin analogues, TNF-a inhibitors and rituximab. The treatment for dysthyroid optic neuropathy (DON) consists of combination of steroids, orbital radiotherapy and, if necessary, orbital decompression surgery. The surgical therapies are orbital decompression and rehabilitative surgery.

The influence of the new ECMWF Ensemble Prediction System resolution on wind power forecast accuracy and uncertainty estimation

Abstract. The importance of wind power forecasting (WPF) is nowadays commonly recognized because it represents a useful tool to reduce problems of grid integration and to facilitate energy trading. If on one side the prediction accuracy is fundamental to these scopes, on the other it has become also clear that a reliable estimation about their uncertainty is paramount. In fact prediction accuracy is unfortunately not constant and can depend on the location of a particular wind farm, on the forecast time and on the atmospheric situation. Previous studies indicated that the spread of power forecasts derived from the Ensemble Prediction System (EPS) in use at the European Centre for Medium-Range Weather Forecast (ECMWF) could be used as indicator of a three-hourly, three days ahead, wind power forecast's accuracy. In this paper a new application of the EPS, whose horizontal resolution was increased on January 2010 from T399/T255 (60 km) to T639/T319 (32 km), shows an improvement in the results implying that the power spread has actually enough correlation with the error calculated on the deterministic forecast in order to be used as an accuracy predictor. The periods for this comparison are from January 2008 until October 2008 (T399/T255) and from January 2011 until October 2011 (T639/T319). Moreover we have focused our attention on the influence of the new EPS configuration on the performance of a deterministic WPF conducted with the ensemble mean: the results show that increasing the EPS resolution yields a single-valued WPF whose performance is comparable with that of the new ECMWF deterministic high-resolution meteorological model, whose spatial resolution increased from T799 (25 km) to T1279 (15 km).

An application of ensemble/multi model approach for wind power production forecasting

Abstract. The wind power forecasts of the 3 days ahead period are becoming always more useful and important in reducing the problem of grid integration and energy price trading due to the increasing wind power penetration. Therefore it's clear that the accuracy of this forecast is one of the most important requirements for a successful application. The wind power forecast applied in this study is based on meteorological models that provide the 3 days ahead wind data. A Model Output Statistic correction is then performed to reduce systematic error caused, for instance, by a wrong representation of surface roughness or topography in the meteorological models. For this purpose a training of a Neural Network (NN) to link directly the forecasted meteorological data and the power data has been performed. One wind farm has been examined located in a mountain area in the south of Italy (Sicily). First we compare the performances of a prediction based on meteorological data coming from a single model with those obtained by the combination of models (RAMS, ECMWF deterministic, LAMI). It is shown that the multi models approach reduces the day-ahead normalized RMSE forecast error (normalized by nominal power) of at least 1% compared to the singles models approach. Finally we have focused on the possibility of using the ensemble model system (EPS by ECMWF) to estimate the hourly, three days ahead, power forecast accuracy. Contingency diagram between RMSE of the deterministic power forecast and the ensemble members spread of wind forecast have been produced. From this first analysis it seems that ensemble spread could be used as an indicator of the forecast's accuracy at least for the first three days ahead period.

The coeliac iceberg in Italy. A multicentre antigliadin antibodies screening for coeliac disease in school-age subjects

BACKGROUND

Recent studies suggest that coeliac disease (CD) is one of the commonest, life-long disorders in Italy. The aims of this multicentre work were: (a) to establish the prevalence of CD on a nationwide basis; and (b) to characterize the CD clinical spectrum in Italy.

PATIENTS AND METHODS

Fifteen centres screened 17,201 students aged 6-15 years (68.6% of the eligible population) by the combined determination of serum IgG- and IgA-antigliadin antibody (AGA) test; 1289 (7.5%) were IgG and/or IgA-AGA positive and were recalled for the second-level investigation; 111 of them met the criteria for the intestinal biopsy: IgA-AGA positivity and/or AEA positivity or IgG-AGA positivity plus serum IgA deficiency.

RESULTS

Intestinal biopsy was performed on 98 of the 111 subjects. CD was diagnosed in 82 subjects (75 biopsy proven, 7 not biopsied but with associated AGA and AEA positivity). Most of the screening-detected coeliac patients showed low-grade intensity illness often associated with decreased psychophysical well-being. There were two AEA negative cases with associated CD and IgA deficiency. The prevalence of undiagnosed CD was 4.77 x 1000 (95% CI 3.79-5.91), 1 in 210 subjects. The overall prevalence of CD, including known CD cases, was 5.44 x 1000 (95% CI 4.57-6.44), 1 in 184 subjects. The ratio of known to undiagnosed CD cases was 1 in 7.

CONCLUSIONS

These findings confirm that, in Italy, CD is one of the most common chronic disorders showing a wide and heterogeneous clinical spectrum. Most CD cases remain undiagnosed unless actively searched.