The management of the Sars-CoV-2 pandemic in Italy, lessons earnt and reflections for the future.

BACKGROUND: Italy and especially Lombardy region was the first European Country hit by the covid 19 pandemic, without a proper preparedness plan. Italy's health-care service is a regionally based National Health Service (NHS) that provides universal coverage, largely free of charge at the point of service. Aim of this paper is to analyse the national and especially the regional strategies put in place to face the pandemic, focusing on the impact of the overlap of the political and health competences among national and regional authority. METHODS: Italian hygiene and preventive medicine society (SITI) realized a questionnaire submitted to National Institute for Health and regional stakeholder to investigate the response to the epidemic analysing the strategies and actions put in place both by the national and regional governments and the regional health authorities. RESULTS: The national survey highlighted several critical points in the management of the covid 19 pandemic in the different regional contexts such as lack of personnel in preventive departments and preparadness. CONCLUSIONS: Lessons learnt during the pandemic should shape the future of the Italian health service. (www.actabiomedica.it).

COVID-19: the end of lockdown what next?

The Corona Virus 19 (COVID 19) epidemic is an infectious disease which was declared as a pandemic and hit all the Countries, all over the world, from the beginning of the year 2020. In Italy the epidemic is particular serious with 169.325 confirmed cases and 21.551 deaths on 20.04.2020. To stop the contagion on March 8 and up to May 3, the Italian Government decided a lockdown for all the Country, the authors suggest how to manage the reopening and restarting of all the activities avoiding a restart of the epidemic.

[Diagnostic and therapeutic therapeutic pathways, including rehabilitative ones or only "discharge" rehabilitation?] / Percorsi diagnostico terapeutici assistenziali anche riabilitativi o riabilitazione "da scarico"?

SUMMARY: Due to epidemiological and social changes related to the increase in the average life expectancy, hospital users are characterized by elderly chronic and comorbid patients who require recurrent hospitalizations often with disability outcomes. In this framework, an innovative clinical and management hospitalization model is the adequate answer to systematically promote the patient independence. Main features are interdisciplinary and integrated care pathways facing both disease and disability biologically and functionally diagnosed by ICD and ICF. The definition, personalization of pathways/protocols and outcome evaluation represent the foundations of this new model for patient care. The digitalization of hospital clinical data and medical knowledge make the model feasible and fitting the recent WHO guideline: recommendations on digital interventions for health system strengthening.

[Digitalisation and clinical care pathways in rehabilitation medicine: a possible integration from the goal-planning and the rehabilitation programme design to the evaluation of clinical outcomes.] / ICF, digitalizzazione e percorsi clinico-assistenziali in medicina riabilitativa: una integrazione possibile dalla definizione degli obiettivi alla stesura del programma riabilitativo, alla valutazione dei risultati.

OBJECTIVES: In the light of the growing complexity featuring the contemporary world, a future challenge is represented by the maintenance of the humanization of healthcare, along with the necessity of a high specificity personalized treatment, in a growing emergency of lack of resources. Furthermore, the ongoing digital revolution spreading in every productive sector involves the health-care system as well, playing a crucial role for the goals of the specialized care-related prevention-treatment-rehabilitation approach of the Rehabilitation Medicine. However, the digitalization of clinical data is not to be considered as a mere tout-court necessity, but it deserves to be planned and carried out with consistent awareness: the digital transformation calls for a theoretical paradigm which, together with a shared language, will be able to embrace its multilevel complexity, taking into account the patient needs, the clinical care pathways and the administrative requests. METHODS: In the present work the potentialities of the WHO ICF model (International Classification of Functioning, Disability and Health) will be described. In particular, will be discussed the role of the ICF in representing the keystone able to connect the ICD-9-CM classification, the clinical care pathways, the individualized rehabilitation project and program and their digital implementation. RESULTS: Hence, each step of the process that led the implementation of the biopsychosocial model in the ICF Maugeri workflows will be presented, as well as the critical issues related to the digitalisation process and the strengths in safeguarding the patients' wellbeing.

Microstructural data of six recent brachiopod species: SEM, EBSD, morphometric and statistical analyses.

Here, we provide the dataset associated with the research article "Mapping of recent brachiopod microstructure: A tool for environmental studies" [1]. We present original data relative to morphometric and statistical analyses performed on the basic shell structural units (the secondary layer fibres) of brachiopod shells belonging to six extant species adapted to different environmental conditions. Based on SEM micrographs of the secondary layer, fibres from ventral and dorsal valves, and from different shell positions, showing regular and symmetrical cross sectional outlines, were chosen for morphometric measurements using Adobe Photoshop CS6, Image-Pro Plus 6.0 and ImageJ. To work out the reliability of the measurements, the most significant parameters were tested for their probability density by distribution plots; for data visualization and dimension reduction, principal component analysis (PCA) was performed using R 3.3.0 [2] and independent-samples t-tests were performed using SPSS Statistics (IBM Version 22.0. Armonk, NY). Besides a quantitative analysis, a qualitative description of the shell microstructure is provided by detailed SEM imaging and EBSD measurements.

Mapping of recent brachiopod microstructure: A tool for environmental studies.

Shells of brachiopods are excellent archives for environmental reconstructions in the recent and distant past as their microstructure and geochemistry respond to climate and environmental forcings. We studied the morphology and size of the basic structural unit, the secondary layer fibre, of the shells of several extant brachiopod taxa to derive a model correlating microstructural patterns to environmental conditions. Twenty-one adult specimens of six recent brachiopod species adapted to different environmental conditions, from Antarctica, to New Zealand, to the Mediterranean Sea, were chosen for microstructural analysis using SEM, TEM and EBSD. We conclude that: 1) there is no significant difference in the shape and size of the fibres between ventral and dorsal valves, 2) there is an ontogenetic trend in the shape and size of the fibres, as they become larger, wider, and flatter with increasing age. This indicates that the fibrous layer produced in the later stages of growth, which is recommended by the literature to be the best material for geochemical analyses, has a different morphostructure and probably a lower organic content than that produced earlier in life. In two species of the same genus living in seawater with different temperature and carbonate saturation state, a relationship emerged between the microstructure and environmental conditions. Fibres of the polar Liothyrella uva tend to be smaller, rounder and less convex than those of the temperate Liothyrella neozelanica, suggesting a relationship between microstructural size, shell organic matter content, ambient seawater temperature and calcite saturation state.

The spermatozoon of a 'living fossil': Tubiluchus troglodytes (Priapulida).

The spermatozoon of Tubiluchus troglodytes, the first priapulid formally described from the Mediterranean Sea has a head composed of an acrosome and a nucleus. The acrosome is divided in two branches coiled around the nucleus. The nucleus is basally columnar, but apically generates two rods helically coiled one around the other. The midpiece is formed by an axoneme with 27 accessory microtubules, surrounded by three mitochondria. An annulus separates the midpiece from the tail that contains a 9 + 2 axoneme surrounded by nine accessory microtubules. The spermatozoon of T. troglodytes is similar to that of the other two species known from the genus, and completely different from the 'primitive' one of the other priapulids. Since Tubiluchus is considered the most basal of the extant priapulids, and the only genus with an internal fertilization, it may be that in priapulids the external fertilization is a derived character.