Impact of COVID-19 on hand surgery in Italy: A comparison between the Northern and the Southern regions.

The aims of this study were to evaluate the impact of the COVID-19 pandemic on emergency and elective hand surgery in four Italian regions that had either a high (Lombardy and Piemonte) or a low (Sicilia and Puglia) COVID-19 case load to discuss problems and to elaborate strategies to improve treatment pathways. A panel of hand surgeons from these different regions compared and discussed data from the centers they work in. The COVID-19 pandemic had an enormous impact on both elective and emergency surgery in Italy, not only in highly affected regions but also - and paradoxically even at a higher extent - in regions with a low COVID-19 case load. A durable and flexible redesign of hand surgery activities should be promoted, while changing and hopefully increasing human resources and enhancing administrative support. Telematics must also be implemented, especially for delivering rehabilitation therapy.

The Fertility Quality of Life Questionnaire (FertiQoL) Relational subscale: psychometric properties and discriminant validity across gender.

STUDY QUESTION: Is the Fertility Quality of Life Questionnaire (FertiQoL)-Relational Scale a valid measure to assess the relational domain regarding quality of life in women and men undergoing infertility treatment? SUMMARY ANSWER: The FertiQoL-Relational scale (FertiQoL-REL) showed good psychometric properties and captured core aspects of couple relationships. WHAT IS KNOWN ALREADY: FertiQoL has become a gold standard for the assessment of infertility-related quality of life in patients undergoing assisted reproduction treatment (ART). Despite its growing importance, no previous studies have examined the convergent validity of the FertiQoL-REL and its discriminant validity across gender. STUDY DESIGN, SIZE, DURATION: Baseline cross-sectional data as part of a longitudinal study of infertile couples undergoing an ART between February 2013 and January 2015. PARTICIPANTS/MATERIALS, SETTING, METHODS: Five hundred and eighty-nine patients (301 females and 288 males), prior to starting an ART in a private clinic, filled in the Fertility Quality of Life Questionnaire (FertiQoL) and several measures of the marital relationship (Dyadic Adjustment Scale, Marital Commitment Inventory and ENRICH Marital Satisfaction Scale) and infertility-related distress (Fertility Problem Inventory). MAIN RESULTS AND THE ROLE OF CHANCE: Confirmatory factor analysis showed that the FertiQoL four-factor solution provided a good fit for the observed data. Reliability of the FertiQoL-REL was higher for women than men. Significant correlations between the FertiQoL-REL scores and all the other measures of marital relationship were found for both women and men. FertiQoL-REL scores did not differ significantly in women and men. The FertiQoL-REL was able to differentiate subjects as regards the Dyadic Adjustment Scale and ENRICH Marital Satisfaction Scale threshold. LIMITATIONS, REASONS FOR CAUTION: Findings are limited because the data were obtained from only one Italian private clinic. WIDER IMPLICATIONS OF THE FINDINGS: FertiQoL-REL threshold scores are useful for identifying those patients undergoing ART who are more likely to report poor or good relationship quality. Clinicians should tailor their counselling strategies to the positive qualities in a couple's relationship, so as to reinforce the overall quality of life, especially among women, and to support patients in tackling the psychological burden, so that they can either continue treatment or choose discontinuation. STUDY FUNDING/COMPETING INTERESTS: This research was supported by funds provided by Centro Andros S.r.l., Palermo, Italy. The authors declare no financial or commercial conflicts of interest in this study. TRIAL REGISTRATION NUMBER: Not necessary.

School-based care: clinical challenges and research opportunities.

PURPOSE: To explore clinical challenges and research opportunities in one school-based clinic in a faculty practice model of health care delivery CLIENT POPULATION: Ninth-through twelfth-graders at an Eastern urban high school, 80% of the students are from ethnic minorities CONCLUSIONS: Clinical, administrative, and research challenges need to be addressed on a larger scale through practice-based research networks across the country in order to have an impact on policy PRACTICE IMPLICATIONS: School-based care required integration of primary care and management of psychosocial and developmental needs. Practice in this setting includes primary, secondary, and tertiary prevention as intervention.

Kinetic and structural model for the binding of formate to the rapid form of cytochrome c oxidase.

The binding of formate to the rapid form of cytochrome c oxidase from bovine heart has been examined at pH 8.8 and high ionic strength. The optical changes included (1) a transient decrease at 414 nm, followed by a biphasic increase, and (2) an isosbestic wavelength. The apparent blue shift in the Soret envelope, following the transient, was consistent with a 430-->414 transition in cytochrome a3, described previously for acid jump conditions in the absence of formate [Papadopoulos, P. G., Walter, S. A., Li, J., & Baker, G. M. (1991) Biochemistry 30, 840-850]. A two-step binding mechanism was implied by the biphasic increase, but the k(obs) values for each phase, when plotted against formate concentration, were unable to statistically discriminate two rival kinetic models. Both models postulated a rapid 430 + L<-->414.L step (where L = HCOOH + HCOO-), but they differed in whether the slower step depended on L. The equilibrium dissociation constant, KDapp, for the overall binding reaction was 0.3 mM. An analysis of the rival mechanisms indicated this value to be consistent with a step that was independent of L. A slow 414.L<-->414'.L conversion was therefore postulated, and the Keq for this step was found to be approximately 9. The analysis to this point assumed that cytochrome alpha 3 was entirely in the 430 state at the time of formate addition. Modeling of the transient could not be achieved, however, unless cytochrome a3 was present as a rapid equilibrium mixture of 414 and 430 states. The 414, 414.L, and 414'.L states were assumed to be electronically identical to account for the isosbestic wavelength.(ABSTRACT TRUNCATED AT 250 WORDS)

Implanted ports. Technologic advances and nursing care issues.

The IVAD has an established role in the care of patients requiring frequency or long-term vascular access. IVADs are used in all types of settings including hospitals, ambulatory clinics, and the home. Nurses are responsible for identifying patients who would benefit from an IVAD, conducting preoperative teaching and postoperative assessment, accessing the port, administering medications, performing site care, maintaining patency, teaching self-care, and troubleshooting. An abundance of controversial issues in the management of IVADs offers a wide range for potential research studies. In addition, the impact of evolving technology will continue to influence the care issues surrounding IVADs. Continual appraisal of new information is essential for nurses to remain current and competent in meeting the needs of patients with IVADs.

Evaluation of ligand exchange as a model of heterogeneity within the binuclear core of cytochrome c oxidase.

Dilution of detergent-solubilized cytochrome c oxidase has been found to increase the pH sensitivity of the a3-CuB site. Comparison of a large number of preparations, each purified at pH 8.8, showed either one or two exponential reactivity with cyanide, indicating that pH was not the only factor regulating kinetic heterogeneity within the binuclear core. Differences in heme a concentration during the soluble stages of purification were shown to have a substantial effect on the distribution of both optical and kinetic states within the isolated enzyme. Similar dilution effects were also inducible after purification. In particular, the apparent pKa of the Soret band maximum was shifted to higher pH following dilution of the enzyme. The resulting increase in the 414-nm conformer was also associated with enhanced conversion to the slow cyanide-binding form, suggesting that a single protonation event may give rise to both optical and kinetic changes. Two lines of evidence were contrary to this: First, by appropriate choice of experimental conditions it was possible to observe 30-50% of the cytochrome a3 centers in the 414-nm state with no associated evidence of the slow conformer. Second, the addition of formate at pH 8.8 induced conversion to both slow and 414-nm conformers, but the rates and extents of conversion were not correlated. Separate structural events are therefore proposed to modulate the optical and kinetic properties of the binuclear core. Since acidic pH has the well-established ability to induce both rapid-->slow and 430-->414-nm conversions, we suggest that the effects of dilution and formate are to mimic an acid jump by facilitating proton uptake into the binuclear core.