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Background Throughout the world, emergency departments (ED) are characterized by overcrowding and excessive waiting times. Furthermore, the related delays significantly increase patient mortality and make inefficient use of resources to the detriment of the satisfaction of employees and patients. In this work, lean thinking is applied to the ED of Cardarelli Hospital of Naples with the aim of increasing patient flow, improving the processes that contribute to facilitating the flow of patients through the various stages of medical treatment and eliminating all bottlenecks (queue) as well as all activities that generate waste. Methods This project was performed at National Hospital A.O.R.N. A. Cardarelli of Naples. The historical times of access to the ED were analysed from January 2015 to June 2015, for a total of 16,563 records. Subsequently, starting in November 2015, corrective actions were implemented according to the Lean Approach. Data collected after the introduced improvements were collected from April 2016 to June 2016 and compared to those collected during the starting period. Results The results acquired before application of the Lean Thinking strategy illustrated the as-is process with its drawbacks. An analysis of the non-added value activities was performed to identify the procedures that need to be improved. After implementation of the corrective actions, we observed a positive increase in the performance of the ED, quantified as percentages of hospitalized patients according to triage codes and waiting times. Conclusion This work demonstrates the applicability of Lean Thinking to ED processes and its effectiveness in terms of increasing the efficiency of services and reducing waste (waiting times).

Wastewater treatment has long been described as a matter of engineering infrastructure, ensuring that what leaves our cities, industries, or households does not harm the receiving environment [...]

The present pilot study aimed to assess the feasibility of a \"teletriagerheum\" service before the first rheumatology visit and identify potential benefits and disadvantages by comparing a regular visit with a first face-to-face visit preceded by the \"teletriagerheum\" service. A prospective monocentric pilot study was conducted from October to December 2021. Consecutive patients were contacted to investigate their willingness to receive a phone call (\"teletriagerheum\" service) from a physician of the Rheumatology Unit before the first rheumatology visit. The number of definite diagnoses at the first visit in the \"teletriagerheum\" group was compared with patients receiving a regular first visit, as well as socio-demographic characteristics, the reason for the visit, face-to-face visit duration, and the number of additional exams. Overall, 75 patients performed the \"teletriagerheum\" (\"teletriagerheum\" group), and 74 patients were included in the control group. In the \"teletriagerheum\" group, a higher number of conclusive diagnoses was observed (72% vs. 58%, p=0.020) with a higher probability of receiving a conclusive diagnosis compared with the control group, both at univariate [odds ratio (OR) 2.28, p=0.021] and multivariate analyses adjusting for the only differences between the two groups (marital status and information and communication technologies skills; OR 2.95, p=0.007). At the first face-to-face visit, fewer additional tests were prescribed in the \"teletriagerheum\" group; however, the overall number of tests (including those prescribed during teletriage) was higher. A telephone-based telerheumatology service could be an effective triage tool for first visits of new outpatients, enabling more definitive diagnoses, thanks in part to the ability to perform the required investigations in a timely manner in most cases.

Real-time monitoring of energetic-environmental parameters in wastewater treatment plants enables big-data analysis for a true representation of the operating condition of a system, being still frequently mismanaged through policies based on the analysis of static data (energy billing, periodic chemical–physical analysis of wastewater). Here we discuss the results of monitoring activities based on both offline (“static”) data on the main process variables, and on-line (“dynamic”) data collected through a monitoring system for energetic-environmental parameters (dissolved oxygen, wastewater pH and temperature, TSS intake and output). Static-data analysis relied on a description model that employed statistical normalization techniques (KPIs, operational indicators). Dynamic data were statistically processed to explore possible correlations between energetic-environmental parameters, establishing comparisons with static data. Overall, the system efficiently fulfilled its functions, although it was undersized compared to the organic and hydraulic load it received. From the dynamic-data analysis, no correlation emerged between energy usage of the facility and dissolved oxygen content of the wastewater, whereas the TSS removal efficiency determined through static measurements was found to be underestimated. Finally, using probes allowed to characterize the pattern of pH and temperature values of the wastewater, which represent valuable physiological data for innovative and sustainable resource recovery technologies involving microorganisms.

Isotopic analyses are useful tools with a wide range of applications, including environmental studies, archaeology and biomedicine. Founded in 2019 at the University of Campania “Luigi Vanvitelli”, the iCONa laboratory specialises in stable isotope mass spectrometry, with a particular focus on cultural heritage. The laboratory performs carbon, nitrogen and oxygen isotopic analyses, including the most recent advances in compound-specific stable isotope analysis of amino acids (CSIA-AAs). In addition to these analytical services, iCONa provides chemical and physical sample preparation for a variety of sample types. This paper focuses on our applications in the field of cultural heritage, exploring how the analysis of stable isotopes performed on archaeological remains can be used to reconstruct past subsistence strategies and human behaviours. We also discuss the challenges inherent in isotopic analysis and recent methodological advances in the field.

This study showcases an attached-biomass system based on twin-layer technology for cultivating Galdieria phlegrea using municipal wastewater, equipped with a smart sensor system for the remote monitoring of operational parameters. From an industrial scale-up perspective, the system offers high scalability, with low impact and operating costs. Mathematical approximation modelling identified the optimal growth conditions across five experiments. The theoretical yield was estimated to reach 1 kgDW/m2 of biomass within two months. Integrated use of isotopic mass spectrometry and spectrophotometric methods allowed us to study the metabolic strategies implemented by the algal community during the best growth condition at different resolutions, showing an increase in the nitrogen concentration over time and a favourable affinity of the organism for nitrogen species that are commonly present in the urban effluent. SEM studies showed a clean algal biofilm (free of foreign organisms), which could guarantee usage in the high economic potential market of biorefineries.

New innovative wireless sensors designed for specific needs of Cultural Heritage field have been developed and their effectiveness has been tested in the rooms of the Royal Palace of Carditello (San Tammaro, Caserta - Italy). The analyses are carried out in the context of the project “RE-SEMIRTO Network of wireless sensors for monitoring the microclimate on the Carditello Real site” funded by the Campania Region (FERS Operational Program Campania 2014-2020 – Axis III. Specific objective 3.3. Action 3.3.2.). The main goal of the ongoing project activities is to provide innovative and user-friendly methods for conservation and valorisation of Cultural Heritage, through simultaneously environmental and archaeometric analyses. Indeed, besides the evaluation e recording by remote system of the parameters related to temperature, moisture, air quality and mechanical vibrations and then the constant control and prevention of the degradation risk, also non-destructive investigations were carried out to identify original, restoration materials and/or degradation products for different kinds of works of art displayed in the monitored site. In particular, at this step, a XVII century oil painting, recently acquired by Italian Minister of Culture in favour of Royal Palace of Carditello, has been analysed and the results are here discussed. This simultaneous approach allows to assess the real conservation state under the current environmental conditions, highlighting which constituent materials (pigments, supports, etc.) of the analysed artwork are most sensitive to the recorded thermohygrometric variations or detected pollution. At last, the project also wants to underline how the scientific data appropriately presented and narrated can be collected into new multimedia tool aimed to visitors for an innovative valorisation of the whole historical site and its artworks.

Nasal polyps (NPs) are benign inflammatory masses causing chronic nasal obstruction, usually associated with underlying chronic rhinosinusitis (CRS), which are rarely reported in childhood. The interest in NPs has recently increased due to new therapeutic options, namely biological agents, such as dupilumab, and an update of the European position paper on this topic was released in 2020, providing a detailed classification for these lesions and also discussing diagnostic and therapeutic approaches also in children. In childhood, NPs usually represent red flags for systemic diseases, such as cystic fibrosis and immunodeficiencies. This review outlines the recent data on NPs in childhood, focusing on predisposing factors for CRS as well as on the potential endotypes in this particular age group, for which further studies are required in order to better clarify their pathogenesis and to identify molecular biomarkers that could help achieve more personalized treatments.

The diagnosis of primary ciliary dyskinesia (PCD) can be challenging in patients with mutations in the HYDIN gene, despite using electron microscopy tomography and ciliary motion analysis. Also, mutational analysis is hindered by a paralogous copy of the gene. Because there is a subtle reduction in bending capacity, occasionally a rotatory movement, but normal beat frequencies, we assessed if the combination of these changes could be diagnostic of PCD with HYDIN gene mutations. We developed a practical predictive tool using artificial intelligence which can be used to select patients who should be evaluated in detail for HYDIN mutations.

Tuberculosis is one of the most common infectious diseases and infectious causes of death worldwide. Over the last decades, significant research effort has been directed towards defining the understanding of the pathogenesis of tuberculosis to improve diagnosis and therapeutic options. Emerging scientific evidence indicates a possible role of the human microbiota in the pathophysiology of tuberculosis, response to therapy, clinical outcomes, and post-treatment outcomes. Although human studies on the role of the microbiota in tuberculosis are limited, published data in recent years, both from experimental and clinical studies, suggest that a better understanding of the gut–lung microbiome axis and microbiome–immune crosstalk could shed light on the specific pathogenetic mechanisms of Mycobacterium tuberculosis infection and identify new therapeutic targets. In this review, we address the current knowledge of the host immune responses against Mycobacterium tuberculosis infection, the emerging evidence on how gut and lung microbiota can modulate susceptibility to tuberculosis, the available studies on the possible use of probiotic–antibiotic combination therapy for the treatment of tuberculosis, and the knowledge gaps and future research priorities in this field.