Information and communication technologies nella gestione integrata del diabete mellito: stato dell'arte, progetto Metabo come caso di studio

Il Diabete, modello paradigmatico delle malattie croniche, sta assumendo negli ultimi anni le proporzioni di una pandemia, che non ha intenzione di arrestarsi, ma del quale, con l’aumento dei fattori di rischio, aumentano prevalenza e incidenza. Secondo stime autorevoli il numero delle persone con diabete nel 2035 aumenterà fino a raggiungere i 382 milioni di casi. Una patologia complessa che richiede lo sforzo di una vasta gamma di professionisti, per ridurre in futuro in maniera significativa i costi legati a questa patologia e nel contempo mantenere e addirittura migliorare gli standard di cura. Una soluzione è rappresentata dall'impiego delle ICT, Information and Communication Technologies. La continua innovazione tecnologica dei medical device per diabetici lascia ben sperare, dietro la spinta di capitali sempre più ingenti che iniziano a muoversi in questo mercato del futuro. Sempre più device tecnologicamente avanzati, all’avanguardia e performanti, sono a disposizione del paziente diabetico, che può migliorare tutti processi della cura, contenendo le spese. Di fondamentale importanza sono le BAN reti di sensori e wearable device, i cui dati diventano parte di un sistema di gestione delle cure più ampio. A questo proposito METABO è un progetto ICT europeo dedicato allo studio ed al supporto di gestione metabolica del diabete. Si concentra sul miglioramento della gestione della malattia, fornendo a pazienti e medici una piattaforma software tecnologicamente avanzata semplice e intuitiva, per aiutarli a gestire tutte le informazioni relative al trattamento del diabete. Innovativo il Clinical Pathway, che a partire da un modello Standard con procedimenti semplici e l’utilizzo di feedback del paziente, viene progressivamente personalizzato con le progressive modificazioni dello stato patologico, psicologico e non solo. La possibilità di e-prescribing per farmaci e device, e-learning per educare il paziente, tenerlo sotto stretto monitoraggio anche alla guida della propria auto, la rendono uno strumento utile e accattivante.

Contextual Information and Memory for Unfamiliar Tunes in Older and Younger Adults

We examined age differences in the effectiveness of multiple repetitions and providing associative facts on tune memory. For both tune and fact recognition, three presentations were beneficial. Age was irrelevant in fact recognition, but older adults were less successful than younger in tune recognition. The associative fact did not affect young adults' performance. Among older people, the neutral association harmed performance; the emotional fact mitigated performance back to baseline. Young adults seemed to rely solely on procedural memory, or repetition, to learn tunes. Older adults benefitted by using emotional associative information to counteract memory burdens imposed by neutral associative information.

Finite Element Modeling of Shell Shape in the Freshwater Turtle Pseudemys concinna Reveals a Trade-Off between Mechanical Strength and Hydrodynamic Efficiency

Aquatic species can experience different selective pressures on morphology in different flow regimes. Species inhabiting lotic regimes often adapt to these conditions by evolving low-drag (i.e., streamlined) morphologies that reduce the likelihood of dislodgment or displacement. However, hydrodynamic factors are not the only selective pressures influencing organismal morphology and shapes well suited to flow conditions may compromise performance in other roles. We investigated the possibility of morphological trade-offs in the turtle Pseudemys concinna. Individuals living in lotic environments have flatter, more streamlined shells than those living in lentic environments; however, this flatter shape may also make the shells less capable of resisting predator-induced loads. We tested the idea that ‘‘lotic’’ shell shapes are weaker than ‘‘lentic’’ shell shapes, concomitantly examining effects of sex. Geometric morphometric data were used to transform an existing finite element shell model into a series of models corresponding to the shapes of individual turtles. Models were assigned identical material properties and loaded under identical conditions, and the stresses produced by a series of eight loads were extracted to describe the strength of the shells. ‘‘Lotic’’ shell shapes produced significantly higher stresses than ‘‘lentic’’ shell shapes, indicating that the former is weaker than the latter. Females had significantly stronger shell shapes than males, although these differences were less consistent than differences between flow regimes. We conclude that, despite the potential for many-to-one mapping of shell shape onto strength, P. concinna experiences a trade-off in shell shape between hydrodynamic and mechanical performance. This trade-off may be evident in many other turtle species or any other aquatic species that also depend on a shell for defense. However, evolution of body size may provide an avenue of escape from this trade-off in some cases, as changes in size can drastically affect mechanical performance while having little effect on hydrodynamic performance.

Better Memory and Neural Efficiency in Young Apolipoprotein E 4 Carriers

The apolipoprotein E (APOE) epsilon4 allele is the major genetic risk factor for Alzheimer's disease, but an APOE effect on memory performance and memory-related neurophysiology in young, healthy subjects is unknown. We found an association of APOE epsilon4 with better episodic memory compared with APOE epsilon2 and epsilon3 in 340 young, healthy persons. Neuroimaging was performed in a subset of 34 memory-matched individuals to study genetic effects on memory-related brain activity independently of differential performance. E4 carriers decreased brain activity over 3 learning runs, whereas epsilon2 and epsilon3 carriers increased activity. This smaller neural investment of epsilon4 carriers into learning reappeared during retrieval: epsilon4 carriers exhibited reduced retrieval-related activity with equal retrieval performance. APOE isoforms had no differential effects on cognitive measures other than memory, brain volumes, and brain activity related to working memory. We suggest that APOE epsilon4 is associated with good episodic memory and an economic use of memory-related neural resources in young, healthy humans.

Internet information and medical consultations: experiences from patients' and physicians' perspectives

OBJECTIVE: Many patients use the Internet to obtain health-related information. It is assumed that health-related Internet information (HRII) will change the consultation practice of physicians. This article explores the strategies, benefits and difficulties from the patients' and physicians' perspective. METHODS: Semi-structured interviews were conducted independently with 32 patients and 20 physicians. Data collection, processing and analysis followed the core principles of Grounded Theory. RESULTS: Patients experienced difficulties in the interpretation of the personal relevance and the meaning of HRII. Therefore they relied on their physicians' interpretation and contextualisation of this information. Discussing patients' concerns and answering patients' questions were important elements of successful consultations with Internet-informed patients to achieve clarity, orientation and certainty. Discussing HRII with patients was appreciated by most of the physicians but misleading interpretations by patients and contrary views compared to physicians caused conflicts during consultations. CONCLUSION: HRII is a valuable source of knowledge for an increasing number of patients. Patients use the consultation to increase their understanding of health and illness. Determinants such as a patient-centred consultation and timely resources are decisive for a successful, empowering consultation with Internet-informed patients. PRACTICAL IMPLICATIONS: If HRII is routinely integrated in the anamnestic interview as a new source of knowledge, the Internet can be used as a link between physicians' expertise and patient knowledge. The critical appraisal of HRII during the consultation is becoming a new field of work for physicians.