Analysis of the implementation of an innovative IT solution to improve waiting times, communication with primary care and efficiency in Rheumatology

Objective To describe in detail an innovative program based on telemedicine for semi-automated prioritization of referrals from Primary Care (PC) to Rheumatology, for reproducibility purposes, and to present the results of the implementation study. Methods The context and situation were carefully analyzed, paying attention to all processes in place, referral numbers, waiting times, and number of complementary tests prior to discharge from Rheumatology. The composition of the team, aims, users, scope, and implementation phases were defined. Eight process indicators were established and measured before and 32 months after the program implementation. Results The program, which includes IT circuits, algorithms based on response to specific guideline-based checklists, e-consultation, and appointments based on priority, was fully implemented in our health area after a pilot study in two PC centers. After implementation, 6185 rheumatology referrals showed an e-consultation response delay of 8.95 days, and to first face-to-face visit (after e-consultation) of 12.6 (previous delay before program implementation was 83.1 days). Resolution by e-consultation reached 20% (1195 patients did not need seeing the rheumatologist to have the problem solved), and 1369 patients (32%) were discharged after the first visit. The overall resolution rate was 44.0% (2564 discharges/5830 e-consultations). From a random sample of 100 visits, only 10% of patients needed additional complementary tests to make a diagnosis and decision by Rheumatology (20.9% decrease from previous period). Conclusion A careful analysis of the situation and processes, with implementation of simple IT circuits, allows for the improvement of the efficiency and resolution of problems in Rheumatology.

Low-Temperature Hydrothermal Systems Response to Rainfall Forcing: An Example From Temperature Time Series of Fumaroles at La Soufrière de Guadeloupe Volcano

Volcanoes with highly-developed and shallow hydrothermal systems may be subject to sudden increases of their surface steam emission at vents in response to either deep forcing (e.g. increase of heat flux coming from the magma chamber) or external forcing (e.g. sudden decrease of atmospheric pressure or variation of meteoric water input). Because the vent plumbing has a limited heat and mass transfer capacity, the rise of steam pressure accompanying the increase of flux may destabilize the system in order to augment its net transfer capacity. This reorganization may, for instance, take the form of an enlargement of existing conduits and vents or to the creation of new ones. In such a case, local and extremely dangerous blast phenomena are likely to occur with devastating consequences several hundreds of meters around. Even volcanoes with a moderate activity and considered safe by the local population are exposed to such abrupt and dangerous events. The detection of early warning signals through temperature monitoring in the vents is of a primary importance and a main difficulty is to correctly interpret temperature jumps in order to reduce false alarms. We analyze time series of the temperature measured in three fumaroles located at the top of La Soufrière volcano in Guadeloupe, which are characterized by their relatively low temperature around 99°C, slightly above the boiling temperature of water at this altitude. Thanks to the long duration of the records from January to August 2017 and to their short 1-s sampling interval, a multiscale analysis can be performed over several orders of magnitude. We show that, despite their complex and sometimes erratic appearance, the temperature variations observed in the vents contain components highly correlated with rain input variations. Some remarkable patterns recurrently appear at different periods and we show that the main temperature variations of more than 10°C are related to the rainfall intensity. Our results illustrate the importance of external forcing on the otherwise complex and possibly chaotic dynamics of the shallow hydrothermal system of La Soufrière. They also reveal that a careful analysis of rainfall forcing must be done to be able to draw any conclusion concerning changes caused by the underlying hydrothermal system.

Luther i den moderna lutherdomens tjänst

There are plenty of misconceptions about how the Luther Renais­sance in Sweden relates to Albrecht Ritschl and nineteenth-century German Luther research. This article sheds new light on the importance of Ritschl's groundbreaking Luther interpretation to the first generation of the Swedish Luther Renaissance, as represented by its leading voices – Einar Billing and Nathan Söderblom. I demonstrate that there are substantial similarities between how Ritschl, Billing, and Söderblom approach and make use of Luther's thought. They all combine a careful analysis of Luther's theology with an interest in understanding his role in history. And despite their high regard of Luther as the great Protestant reformer, Ritschl, Billing, and Söderblom at times show a considerable distance to his thinking. It is also evident that they found solutions to contemporary questions and challenges in Luther's writings. Their constructive use of Luther is, I further argue, closely related to a positive reception of histor­ical criticism and an ambition to make Lutheranism relevant to modern society. This to a large extent explains why Ritschl, Billing, and Söderblom have a freer attitude towards Luther than many of their Lutheran col­leagues, and also why they emphasize those aspects of his theology that they consider especially fruitful for modern society.

World Experience in the Use Serogroup B Meningococcal Vaccines (literature review)

Relevance. The success of vaccine prophylaxis of meningococcal infection depends on the composition and properties of vaccine preparations and the strict implementation of recommendations on vaccine prophylaxis tactics by the territorial epidemiological characteristics of meningococcal infection. Despite the high burden of B-meningococcal infection, especially among young children, the design of B-meningococcal vaccines has faced serious difficulties. Aim. The literature review presents the history of the development of B-meningococcal vaccines and provides characteristics of two immunologically effective and safe new generation B-meningococcal vaccine preparations. Conclusion. The licensing of the two new B-meningococcal vaccines presented in the review (Bexsero and Trumenba) was based on immunogenicity and safety. The inclusion of vaccines in national vaccination programs requires careful analysis, including analysis of the antigenic characteristics of circulating strains.

The Importance of Entrepreneurship in Micro and Small Enterprises in Uncertainty and Barrier Scenarios

Economic, political, and technological uncertainties require organizations to prepare adequately for new events that occur each day. Economic crisis, changes in the policies of each country and technological developments are classic examples of these changes in organizations. Seasonality is one of the economic phenomena that occur, and different forms of management are required. The seasonality that is described as a systematic and temporal imbalance of the tourist phenomenon that does not need to be regular, caused by the climate or by the vacation periods, and is based on the consumer behavior that can be expressed in terms of the number of visitors, traffic, highways, jobs, and tickets at attractions. Therefore, through a careful analysis of seasonality, it is possible that the losses are predicted, and the negative impact is not so grotesque on the company. For this, it is good that the manager uses the cost assessment methods to assume the seasonality of sales and thus be able to guard against the negative effects of the same. The objective of this research is to understand how owners of micro and small businesses in coastal cities consider themselves entrepreneurs or not and how they deal with obstacles such as seasonality through cost management. The methodology used was based on an exploratory and bibliographic research with a qualitative approach, seeking to analyze the triad: Entrepreneurship, Seasonality and Cost Management. The field research was applied through a semi-structured questionnaire to the sample of 100 Microentrepreneurs in the trade of goods and services in Caraguatatuba and São Sebastião, central cities of the North Coast of São Paulo. The main results show that most of the interviewed entrepreneurs perceive a certain impact caused by seasonality, understand the use of Cost Management to improve their processes and are adapted to one of the main costing methods highlighted by the bibliography.

Overview of Memory NK Cells in Viral Infections: Possible Role in SARS-CoV-2 Infection

NK cells have usually been defined as cells of the innate immune system, although they are also involved in adaptative responses. These cells belong to the innate lymphocyte cells (ILC) family. They remove unwanted cells, tumoral cells and pathogens. NK cells are essential for viral infection clearance and are involved in tolerogenic responses depending on the dynamic balance of the repertoire of activating and inhibitory receptors. NK plasticity is crucial for tissue function and vigilant immune responses. They directly eliminate virus-infected cells by recognising viral protein antigens using a non-MHC dependent mechanism, recognising viral glycan structures and antigens by NCR family receptors, inducing apoptosis by Fas-Fas ligand interaction, and killing cells by antibody-dependent cell cytotoxicity via the FcγIII receptor. Activating receptors are responsible for the clearance of virally infected cells, while inhibitory KIR receptor activation impairs NK responses and facilitates virus escape. Effective NK memory cells have been described and characterised by a low NKG2A and high NKG2C or NKG2D expression. NK cells have also been used in cell therapy. In SARS-CoV-2 infection, several contradicting reports about the role of NK cells have been published. A careful analysis of the current data and possible implications will be discussed.

The Lived Experiences of Queer* Teachers in İstanbul within the Scope of Institutionalized Heteronormativity and Neoliberal School Policies

Even though the challenges that Queer* employees face in the workplace because of their intersecting identities of gender, sexuality, race, and class continue to be one of the rarely studied topics in social sciences, there has been a resurgence of interest in recent years, concerning how Queer* teachers experience the conflation of their sexual and professional identities. Informed by the recognition that schools are one of the most representative prototypes of gendered organizations with their ever-adapting regimes of inequality, this study is motivated by the question of how Queer* teachers in İstanbul deal with the enduring institutionalized homophobia, which has only got worse in terms of its silencing and pathologizing mechanisms. Claiming one of the fundamental functions of schools to establish strictly heteronormative spaces of learning, where any form of gender nonconformity or sexual dissidence stands before disciplinary punishment or reprimand from other students and teachers, I have examined the current working conditions of Queer* teachers in İstanbul within the contexts of schools, which compel Queer* teachers to abide by their institutionalized rules and norms of compulsory heterosexuality. This study attempts to learn what kind of experiences Queer* teachers in İstanbul articulate regarding the conundrum of being forced into presenting themselves as non-sexualized and non-gendered professional figures, as neoliberal policies and capitalist expectations of a rigid separation between professional identities and personal lives of workers continue to negatively affect the occupational well-being of Queer* teachers. A careful analysis of the interviews has revealed that the Queer* teachers in İstanbul are burdened with the aesthetic labor they are constantly expected to perform due to the emergent neoliberal schemes of professionalism and that they suffer under closely monitoring mechanisms of heteronormative school policies and work climates.

Problem solving in the physics classroom. An analysis with secondary school students

The teaching of science, and specifically physics, has been associated with the acquisition of knowledge with a particular emphasis on problem solving, as an activity that brings students closer to the methodology and meaningful learning of science. However, problem solving is perhaps one of the sources of failure in physics teaching, which requires a careful analysis of this didactic activity. Therefore, the aim of this work is to analyze the development of students’ problem-solving skills in a physics course. An analysis is presented using the quasi-experimental method through the application of a pre-test – post-test, for which a methodological intervention was used based on the problem-solving competence, which focused on identifying errors and difficulties by the students themselves and thus favoring the learning and development of this competence, which allowed the academic progress of the students to be analyzed. It is concluded that the intervention supported by problem solving improves students’ performance, in addition to the positive assessment they make of the process, as well as its influence on the change in pedagogical practice.

Reflective backward analysis to assess the operational performance and eco-efficiency of two industrial districts

PurposeThe best strategy to apply for the future cannot disregard a careful analysis of the past and is the one capable of seizing opportunities from outside. Manufacturing sectors are characterized by sudden changes, and in this work, we analyze the ceramic tiles sector characterized by a mature technology in which innovation has played a key role.Design/methodology/approachThis study aims to provide a sectorial analysis based on a historical data set (2004–2019) to highlight how an industry is performing both operationally and in terms of eco-efficiency. For this purpose, from a methodological point of view, the data envelopment analysis (DEA) was used.FindingsThe results of the analysis show that the Spanish ceramics industry shows a growing economic trend by taking advantage of lower industrial costs, while the Italian industry is characterized by a modest decline partially mitigated by exports. The industrial districts are an aggregation of companies that in the ceramic sector has allowed to combine innovation, sustainability and digitalization and is a model toward the maximization of sustainable efficiency because it is a place of aggregation of resources and ideas.Originality/valueThis study experiments with an innovative way of addressing traditional industry analysis, namely, integrating the reflective management approach with DEA-based backward analysis. This provides decision makers with the basis for new interpretations of variable trends.

Primary extraskeletal osteosarcoma of small bowel mesentery presenting with acute bowel obstruction

Extraskeletal osteosarcoma of the small bowel mesentery is an exceedingly rare condition. It is an aggressive malignant neoplasm of mesenchymal origin characterized by osteoid formation. Final diagnosis is often made by histopathological analysis. However, we believe that prospective radiological diagnosis may be possible through careful analysis of densities (ossification) within the mesenteric mass. To the best of our knowledge, there is no current literature describing the radiological approach to making a prospective diagnosis of this condition. We present the 12th case of extraskeletal osteosarcoma worldwide and describe a radiological approach that is potentially useful in making a prospective diagnosis.