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At the beginning of the COVID-19 pandemic, Italian emergency departments (EDs) had to hastily implement current surge response plans or create new ones. The objectives of this study are to quantitatively assess ED performance improvements between selected non-pandemic and pandemic periods at Sant’Anna hospital in Como, Italy, and to relate these to adopted and adapted surge response actions.
The average length of stay (LOS), time-to-physician initial assessment (TPIA) and left-without-being seen (LWBS) rates were calculated during two ED periods prior to the pandemic and then three periods during the pandemic in the COVID ED (C-ED) dedicated to treat COVID patients, and the COVID-free ED (NC-ED) dedicated to treat all other patients. Then quantitative data analysis based on hypothesis testing was performed.
A qualitative theme and subtheme data analysis based on the Hospital Surge Preparedness and Response Index (HSPRI) was performed on baseline strategies before each pandemic period and on the actions implemented in the subsequent period.
The LOS increased across all periods, while the TPIA decreased in the first two pandemic periods in comparison to pre-pandemic periods. The NC-ED LOS was lower than the C-ED LOS, and the C-ED TPIA was lower than the NC-ED TPIA in all three pandemic periods. The LWBS decreased between pre-pandemic and pandemic periods, with an increasing trend towards pre-pandemic levels in the last pandemic period. Of the 20 action items listed in the HSPRI, six were implemented in the first pandemic period, eight in the second and one in the third.
The LOS, TPIA and LWBS rates are useful indicators to rapidly obtain an overview of ED performance but failed to provide an exhaustive assessment because ED performance depends on countless external and internal variables. Close collaboration of ED leaders with other healthcare agencies is critical to respond to a pandemic surge.
We report the development, implementation, and results of a sustainable region-wide mass-casualty management prehospital training program implemented by the Regione Lombardia emergency medical services (EMS) agency AREU in Italy.
The educational program learning objectives are: (1) command and control, communications, and resource management; (2) mass casualty triage and the START triage protocol; (3) on-scene management; (4) Regione Lombardia and AREU Mass Casualty standard operating procedures; and (5) inter-agency communications and relations. For each course edition data on participants’ summative assessment, participants’ feedback and costs were collected.
Between June 26, 2013, and December 31, 2020, a total of 84 editions of the provider training event were delivered, training an overall 1329 prehospital providers; 1239 (93%) passed the summative assessment and were qualified as being operationally “ready.” Regarding participant feedback, the overall program was rated 4.4 ± 0.7 out of 5. The overall cost of running the provider program during the study period was €321 510 (circa US $382 000). The average cost per edition was €3828 and €242 per participant.
We have described a simple yet interactive simulation and blended-learning approach, which has yielded good pass rates, good participant satisfaction, and contained costs to systematically train emergency medical service personnel.
Knowledge about the association between alcohol and Barrett’s oesophagus and reflux oesophagitis is conflicting. In this case–control study we evaluated the role of specific alcoholic beverages (red and white wine, beer and liquors) in 339 Barrett’s oesophagus and 462 oesophagitis patients compared with 619 endoscopic controls with other disorders, recruited in twelve Italian endoscopic units. Data on alcohol and other individual characteristics were obtained from structured questionnaires. No clear, monotonic significant dose–response relationship was pointed out for red wine. However, a generalised U-shaped trend of Barrett’s oesophagus/oesophagitis risk due to red wine consumption particularly among current drinkers was found. Similar results were also found for white wine. Liquor/spirit consumption seemed to bring about a 1·14–2·30 risk excess, although statistically non-significant, for current Barrett’s oesophagus/oesophagitis drinkers. Statistically significant decreasing dose–response relationships were found in Barrett’s oesophagus for frequency and duration of beer consumption. Similar, but less clear downward tendencies were also found for oesophagitis patients. In conclusion, although often not statistically significant, our data suggested a reduced risk of Barrett’s oesophagus and oesophagitis with a low/moderate intake of wine and beer consumption. A non-significant increased risk of Barrett’s oesophagus/oesophagitis was observed with a higher intake of any type of heavy alcohol consumption, but no conclusion can be drawn owing to the high number of non-spirit drinkers and to the small number of drinkers at higher alcohol intake levels.
Practical design of high-voltage SiC Schottky rectifiers requires the understanding of the influence of the epitaxial dopant concentration on the reverse and forward characteristics. This work analyzes the correlation between the dopant concentration and the I-V characteristics of Schottky diodes for a critical concentration range where the leakage current variations are more evident. The details of how high temperatures affect the properties of junctions have been carefully described to obtain further improvement in the future by proper device optimization. Dopant concentration of about 1.2 × 1016 cm-3 gives the best results in reverse characteristics without great losses in forward currents.
The growth rate of 4H-SiC epitaxial layer has been increased by a factor 19 (up to 112 μm/h) with respect to the standard process with the introduction of HCl in the deposition chamber. The epitaxial layers grown with the addition of HCl have been characterized by electrical, optical and structural characterization methods. The effects of different deposition parameters on the epitaxial growth process have been described in detail. This process can be very promising for high power devices with a breakdown voltage of 10 kV.
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