Application of the "immunization islands" model to improve quality, efficiency and safety of a COVID-19 mass vaccination site.

Abstract: After SARS-CoV-2 vaccines development came at an unprecedented speed, ensuring safe and efficient mass immunization, vaccine delivery be-came the major public health mandate. Although mass-vaccination sites have been identified as essential to curb COVID-19, their organization and functioning is challenging. In this paper we present the planning, implementation and evalua-tion of a massive vaccination center in Lombardy - the largest Region in Italy and the most heavily hit by the pandemic. The massive hub of Novegro (Milan), managed by the Gruppo Ospedaliero San Donato, opened in April 2021. The Novegro mass-immunization model was developed building a la-yout based on the available scientific evidence, on comparative analysis with other existing models and on the experience of COVID-19 immunization delivery of Gruppo Ospedaliero San Donato. We propose a "vaccine islands" mass-immunization model, where 4 physicians and 2 nurses operate in each island, with up to 10 islands functioning at the same time, with the capacity of providing up to 6,000 vaccinations per day. During the first week of activity a total of 37,900 doses were administered (2,700/day), most of them with Pfizer vaccine (85.8%) and first doses (70.9%). The productivity was 10.5 vaccines/hour/vaccine station. Quality, efficiency and safety were boosted by ad-hoc personnel training, quality technical infrastructure and the presence of a shock room. Constant process monitoring allowed to identify and promptly tackle process pitfalls, including vaccine refusals (0.36%, below expectations) and post-vaccinations adverse reactions (0.4%). Our innovative "vaccine islands" mass-immunization model might be scaled-up or adapted to other settings. The Authors consider that sharing best practices in immunization delivery is fundamen-tal to achieve population health during health emergencies.

Temporal and spatial analysis of astrocyte calcium waves.

In the last decade new ideas were born about the temporal and spatial dynamics of intercellular calcium waves in astrocytes. In this paper we introduce a new approach to analyze the ways in which astrocytes communicate in cultures. We present a method to describe the spatial propagation of Ca(2+) waves in vitro and a technique to compare the activity of different cells in vivo and in vitro under different stimulation conditions. The proposed method resulted to be an interesting way to distinguish different astrocyte clusters, which can be related to the communication characteristics in the network.

Self-similarity behavior characterization of fetal heart rate signal in healthy and intrauterine growth retarded fetuses.

In this paper we deal with the problem of the interpretation of the fetal heart rate (FHR) signal. From literature is known that FHR contains both linear and non linear components. Starting from this consideration we analyzed FHR as a fractal time series and we evaluated its self similarity behavior using the Hurst's coefficient (H). We first evaluated the stationarity of FHR time series and then we estimated H with Detrend fluctuation analysis (DFA) method. We calculated Hurst's coefficient for healthy fetuses and for fetuses affected by Intrauterine grow retardation (IUGR). Results provided H = 0.350 +/- 0.064 (avg +/- std) for healthy patients and H = 0.461 +/- 0.059 for IUGR. It is also shown that IUGR patients exhibit a "less non-stationary" and longer-memory behavior than normals with a reduced information content of FHR signal. We propose for this phenomenon a physiological explanation connected with the abnormal autonomic nervous system development of IUGR patients.