The increasing use of web technologies has changed the way business is done, including in the field of education. In the last decade, the development of electronic learning (e-learning) systems ...became crucial to meet students’ demand. In this study, we adopt a relationship marketing perspective and apply the Kano Model to propose a way to build a non-academic e-learning course that can achieve student satisfaction. We measure the relevance of e-learning requirements from university students’ perspective to identify their expectations about e-learning courses and obtain relevant characteristics that can help to plan an e-learning product capable of achieving high customer satisfaction. Our study is based on interviews of 239 students from the Faculty of Economics at the University of Palermo. Through surveys, we measure users’ satisfaction of e-learning courses and classify quality attribute expectations into Kano Model categories. The indexes we create reveal key elements that can increase or decrease customers’ perceived satisfaction of e-learning courses. This study has specific value for academics who work on new product development in the field of customer satisfaction. Highlighting the correlation between the classification of expectations and satisfaction level, we find practical implications for educational institutions and/or other companies interested in developing and selling e-learning courses based on students’ needs using a customer-oriented approach.
Bicuspid aortic valve (BAV) anatomy has routinely been considered an exclusion in the setting of transcatheter aortic valve implantation (TAVI) because of the large dimension of the aortic annulus ...having a more calcified, bulky, and irregular shape. The study aims to develop a patient-specific computational framework to virtually simulate TAVI in stenotic BAV patients using the Edwards SAPIEN 3 valve (S3) and its improved version SAPIEN 3 Ultra and quantify stent frame deformity as well as the severity of paravalvular leakage (PVL). Specifically, the aortic root anatomy of n.9 BAV patients who underwent TAVI was reconstructed from pre-operative CT imaging. Crimping and deployment of S3 frame were performed and then followed by fluid-solid interaction analysis to simulate valve leaflet dynamics throughout the entire cardiac cycle. Modeling revealed that the S3 stent frame expanded well on BAV anatomy with an elliptical shape at the aortic annulus. Comparison of predicted S3 deformity as assessed by eccentricity and expansion indices demonstrated a good agreement with the measurement obtained from CT imaging. Blood particle flow analysis demonstrated a backward blood jet during diastole, whereas the predicted PVL flows corresponded well with those determined by transesophageal echocardiography. This study represents a further step towards the use of personalized simulations to virtually plan TAVI, aiming at improving not only the efficacy of the implantation but also the exploration of “off-label” applications as the TAVI in the setting of BAV patients.
Graphical abstract
Computational frameworks of TAVI in patients with stenotic bicuspid aortic valve
ObjectivesTo analyse the prevalence of CECR1 mutations in patients diagnosed with early onset livedo reticularis and/or haemorrhagic/ischaemic strokes in the context of inflammation or polyarteritis ...nodosa (PAN). Forty-eight patients from 43 families were included in the study.MethodsDirect sequencing of CECR1 was performed by Sanger analysis. Adenosine deaminase 2 (ADA2) enzymatic activity was analysed in monocyte isolated from patients and healthy controls incubated with adenosine and with or without an ADA1 inhibitor.ResultsBiallelic homozygous or compound heterozygous CECR1 mutations were detected in 15/48 patients. A heterozygous disease-associated mutation (p.G47V) was observed in two affected brothers. The mean age of onset of the genetically positive patients was 24 months (6 months to 7 years). Ten patients displayed one or more cerebral strokes during their disease course. Low immunoglobulin levels were detected in six patients. Thalidomide and anti-TNF (tumour necrosis factor) blockers were the most effective drugs. Patients without CECR1 mutations had a later age at disease onset, a lower prevalence of neurological and skin manifestations; one of these patients displayed all the clinical features of adenosine deaminase 2deficiency (DADA2) and a defective enzymatic activity suggesting the presence of a missed mutation or a synthesis defect.ConclusionsDADA2 accounts for paediatric patients diagnosed with PAN-like disease and strokes and might explain an unrecognised condition in patients followed by adult rheumatologist. Timely diagnosis and treatment with anti-TNF agents are crucial for the prevention of severe complications of the disease. Functional assay to measure ADA2 activity should complement genetic testing in patients with non-confirming genotypes.
The increase in the complexity and variability of the business environment, due to constant and rapid changes in markets, calls for more flexible and effective production systems. Of the most ...valuable production systems, the Japanese lean production system (LPS) is the best known and studied, but is still not the most widely applied with success outside Japan. The reason for the low level of success of lean production outside its native country is the lack of understanding of the strong interactions which hold between enterprises and business systems. In order to fill this gap in our knowledge, we investigate the systemic interactions according to the viable system view. To develop our analysis, we combine the elements of two of the major viable systems theories: the Viable System Model (VSM) of Stafford Beer, and the Viable System Approach (VSA) of Gaetano Golinelli. We combine these two perspectives to create a cohesive framework that combines the internal structural analysis of VSM with the analysis of links to the environmental suprasystems of VSA. In line with this framework, we examine the peculiar aspects of the Japanese LPS in order to find the relevant correspondences between the Japanese LPS and the Viable Systems perspective. We portray the peculiarities of the lean production system, shedding light on its roots in the Japanese business environment (Dominici
2008
,
2010
), and we show how it has worked as an incubator to create those managerial practices that represent the LPS. We also show how the Japanese kaisha can be effectively represented as a viable system in homeostatic interaction with the Japanese business environment. We conclude with an analysis of the results and summary of the possibilities for further research.
•Persistent SARS-CoV-2 RNA detection resulted in prolonged quarantine.•In less than 3% of clinical samples with a high quantification cycle value (>30), cultivable virus was detected.•NGS analysis ...showed a fragmented genome, indicating no functional residual RNA.
Real-time reverse transcription PCR is currently the most sensitive method to detect severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Defining whether a patient could be contagious or not contagious in the presence of residual SARS-CoV-2 RNA is of extreme importance in the context of public health. In this prospective multicenter study, virus isolation was prospectively attempted in 387 nasal swabs from clinically recovered patients showing low viral load (quantification cycle, Cq, value greater than 30). The median Cq value was 36.8 (range 30.0–39.4). Overall, a cytopathic effect was detected in nine samples, corresponding to a culture positivity rate of 2.3% (9/387). The results of this study help to dissect true virus replication and residual viral RNA detection in recovered patients.
Intrahepatic cholangiocarcinoma (iCCA) is the second most common primary liver tumor, with a median survival of only 13 months. Surgical resection remains the only curative therapy; however, at first ...detection, only one-third of patients are at an early enough stage for this approach to be effective, thus rendering early diagnosis as an efficient approach to improving survival. Therefore, the identification of higher-risk patients, whose risk is correlated with genetic and pre-cancerous conditions, and the employment of non-invasive-screening modalities would be appropriate. For several at-risk patients, such as those suffering from primary sclerosing cholangitis or fibropolycystic liver disease, the use of periodic (6-12 months) imaging of the liver by ultrasound (US), magnetic Resonance Imaging (MRI)/cholangiopancreatography (MRCP), or computed tomography (CT) in association with serum CA19-9 measurement has been proposed. For liver cirrhosis patients, it has been proposed that at-risk iCCA patients are monitored in a similar fashion to at-risk HCC patients. The possibility of using Artificial Intelligence models to evaluate higher-risk patients could favor the diagnosis of these entities, although more data are needed to support the practical utility of these applications in the field of screening. For these reasons, it would be appropriate to develop screening programs in the research protocols setting. In fact, the success of these programs reauires patient compliance and multidisciplinary cooperation.
Gender Medicine in Clinical Radiology Practice Giacobbe, Giuliana; Granata, Vincenza; Trovato, Piero ...
Journal of personalized medicine,
01/2023, Letnik:
13, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Gender Medicine is rapidly emerging as a branch of medicine that studies how many diseases common to men and women differ in terms of prevention, clinical manifestations, diagnostic-therapeutic ...approach, prognosis, and psychological and social impact. Nowadays, the presentation and identification of many pathological conditions pose unique diagnostic challenges. However, women have always been paradoxically underestimated in epidemiological studies, drug trials, as well as clinical trials, so many clinical conditions affecting the female population are often underestimated and/or delayed and may result in inadequate clinical management. Knowing and valuing these differences in healthcare, thus taking into account individual variability, will make it possible to ensure that each individual receives the best care through the personalization of therapies, the guarantee of diagnostic-therapeutic pathways declined according to gender, as well as through the promotion of gender-specific prevention initiatives. This article aims to assess potential gender differences in clinical-radiological practice extracted from the literature and their impact on health and healthcare. Indeed, in this context, radiomics and radiogenomics are rapidly emerging as new frontiers of imaging in precision medicine. The development of clinical practice support tools supported by artificial intelligence allows through quantitative analysis to characterize tissues noninvasively with the ultimate goal of extracting directly from images indications of disease aggressiveness, prognosis, and therapeutic response. The integration of quantitative data with gene expression and patient clinical data, with the help of structured reporting as well, will in the near future give rise to decision support models for clinical practice that will hopefully improve diagnostic accuracy and prognostic power as well as ensure a more advanced level of precision medicine.
Recently the protective role of 25-hydroxyvitamin D (25(OH)D) against viral infections has been hypothesized. We evaluated the association between vitamin D status and SARS-CoV-2 infection ...susceptibility and severity in a cohort of kidney transplanted patients (KTxp).
A total of 61 KTxp with SARS-CoV-2 infection (COV+) were matched with 122 healthy KTxp controls (COV-). Main biochemical parameters at 1, 6, and 12 months before SARS-CoV-2 infection were recorded. Vitamin D status was considered as the mean of two 25(OH)D measures obtained 6 ± 2 months apart during the last year. The severity of SARS-CoV-2 infection was based on the need for hospitalization (HOSP+) and death (D+).
25(OH)D levels were lower in COV+ than in controls 19(12-26) vs. 23(17-31) ng/mL,
= 0.01. No differences among the other biochemical parameters were found. The SARS-CoV-2 infection discriminative power of 25(OH)D was evaluated by ROC-curve (AUC 0.61, 95% CI 0.5-0.7,
= 0.01). 25(OH)D was not significantly different between HOSP+ and HOSP- 17(8-25) vs. 20(15-26) ng/mL,
= 0.19 and between D+ and D- 14(6-23) vs. 20(14-26) ng/mL,
= 0.22 and had no significant correlation with disease length.
During the year preceding the infection, 25(OH)D levels were lower in COV+ KTxp in comparison with controls matched for demographic features and comorbidities. No significant association between vitamin D status and SARS-CoV-2 infection related outcomes was found.
Background
The overuse of antimicrobials favors the dissemination of antimicrobial resistance, as well as invasive fungal diseases and
Clostridium difficile
infections (CDI). In this study, we ...assessed the impact of a mixed educational and semi-restrictive antimicrobial stewardship (AMS) project in a large teaching hospital in Italy.
Methods
The AMS project was conducted from May 2014 to April 2016. It consisted of two initiatives in two consecutive periods: (1) educational activities; (2) semi-restrictive control of antimicrobial prescribing through a computerized software. The primary endpoint was consumption of antibacterials and antifungals. Secondary endpoints were incidence of CDI, methicillin-resistant
Staphylococcus aureus
(MRSA) bloodstream infections (BSI), carbapenem-resistant
Klebsiella pneumoniae
(CRKP) BSI, and
Candida
BSI.
Results
During the study period, a statistically significant reduction in consumption was observed for antibacterials (−1.45 defined daily doses (DDD)/1000 patient-days monthly, 95% confidence intervals CI −2.38 to −0.52,
p
0.004), mainly driven by reductions in the use of fluoroquinolones, third/fourth generation cephalosporins, and carbapenems. No decrease in consumption of antifungals was observed (−0.04 DDD/1000 patient-days monthly, 95% CI −0.34 to +0.25,
p
0.750). A statistically significant trend towards reduction was observed for incidence of CRKP BSI (incidence rate ratio 0.96, 95% CI 0.92–0.99,
p
0.013). No statistically significant variations in trends were observed for CDI, MRSA BSI, and
Candida
BSI.
Conclusions
The mixed AMS project was effective in reducing the use of major antibacterials and the incidence of CRKP BSI. Further research is needed to assess the extent of long-term benefits of semi-restrictive approaches.
This paper offers an assessment of radiomics tools in the evaluation of intrahepatic cholangiocarcinoma.
The PubMed database was searched for papers published in the English language no earlier than ...October 2022.
We found 236 studies, and 37 satisfied our research criteria. Several studies addressed multidisciplinary topics, especially diagnosis, prognosis, response to therapy, and prediction of staging (TNM) or pathomorphological patterns. In this review, we have covered diagnostic tools developed through machine learning, deep learning, and neural network for the recurrence and prediction of biological characteristics. The majority of the studies were retrospective.
It is possible to conclude that many performing models have been developed to make differential diagnosis easier for radiologists to predict recurrence and genomic patterns. However, all the studies were retrospective, lacking further external validation in prospective and multicentric cohorts. Furthermore, the radiomics models and the expression of results should be standardized and automatized to be applicable in clinical practice.
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