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Cardiovascular diseases are the leading cause of death worldwide. In Italy, acute myocardial infarction (AMI) is a major cause of hospitalization and healthcare costs. AMI is a myocardial necrosis event caused by an unstable ischemic syndrome. The Italian government has defined an indicator called “AMI: 30-day mortality” to assess the quality of the overall care pathway of the heart attacked patient. In order to guarantee high standards, all hospitals had to implement techniques to increase the quality of care pathway. The aim of the paper is to identify the root cause and understand the mortality rate for AMI and redesign the patient management process in order to improve it.

A Lean Six Sigma (LSS) approach was used in this study to analyze the patient flow in order to reduce 30-days mortality rate from AMI registered by Complex Operative Unit (COU) of Cardiology of an Italian hospital. Value stream mapping (VSM) and Ishikawa diagrams were implemented as tools of analysis.

Process improvement using LSS methodology made it possible to reduce the overall times from 115 minutes to 75 minutes, with a reduction of 35%. In addition, the corrective actions such as the activation of a post-discharge outpatient clinic and telephone contacts allowed the 30-day mortality rate to be lowered from 16% before the project to 8% after the project. In this way, the limit value set by the Italian government was reached.

The limitation of the study is that it is single-centered and was applied to a facility with a limited number of cases.

The LSS approach has brought significant benefits to the process of managing patients with AMI. Corrective actions such as the activation of an effective shared protocol or telephone interview with checklist can become the gold standard in reducing mortality. The limitation of the study is that it is single-centered and was applied to a facility with a limited number of cases.

LSS, applied for the first time to the management of cardiovascular diseases in Italy, is a methodology which has proved to be strategic for the improvement of healthcare process. The simple solutions implemented could serve as a guide for other hospitals to pursue the national AMI mortality target.

Coronary artery disease (CAD) is reported as one of the most common sources of death all over the world. The presence of stenosis (plaque) in the coronary arteries results in the restriction of blood supply, leading to myocardial infarction. The current study investigates the influence of multi stenosis on hemodynamic properties in a patient-specific left coronary artery.

A three-dimensional model of the patient-specific left coronary artery was reconstructed based on computed tomography (CT) scan images using MIMICS-20 software. The diseased model of the left coronary artery was investigated, having the narrowing of 90% and 70% of area stenosis (AS) at the left anterior descending (LAD) and left circumflex (LCX), respectively.

The results indicate that the upstream region of stenosis experiences very high pressure for 90% AS during the systolic period of the cardiac cycle. The pressure drops maximum as the flow travels into the stenotic zone, and the high flow velocities were observed across the 90% AS. The higher wall shear stresses occur at the stenosis region, and it increases with the increase in the flow rate. It is found that the maximum wall shear stress across 90% AS is at the highest risk for rupture. A recirculation region immediately after the stenosis results in the further development of stenosis.

The current study provides evidence that there is a strong effect of multi-stenosis on the blood flow in the left coronary artery.

This study aims to examine the association of frontal functioning with subclinical bipolar spectrum by a newly developed convenient method. We investigated subclinical bipolar tendency and frontal lobe activation during word productions using multi-channel near infrared spectroscopy. Participants: 44 healthy university students (mean ages 20.5 years old, and 29 female) gave their written informed consent, and we strictly protected privacy and anonymity was carefully preserved. A 13-items self-report questionnaire (Mood Disorders Questionnaire; MDQ) and a 16-channel near-infrared spectroscopy were used to compare frontal activations between two samples divided by median (4 points) of the total MDQ scores and to analyze correlations between relative changes of cerebral blood volume and bipolarity levels. There was no case suspected as bipolar disorders by MDQ screening (mean 3.4, max 10). Significant differences in lower activations were noted in the right and left pre-frontal cortex (PFC) with higher bipolarity scores using the specific software to analyze the NIRS waveform (P<0.05). Total MDQ were correlated significantly with frontal activation negatively in many channels; therefore, we conducted multiple linear regression to select significant frontal activations using the MDQ as a dependent variable. Stepwise method revealed that activation in left lateral PFC was negatively associated to bipolar tendency, and this regression model was significant (R2=0.10, F=4.5, P=0.04). Differences in frontal functioning suggest that subclinical bipolar tendencies might be related to left lateral PFC activations. It should be confirmed whether the identical pattern can be identified for clinical subjects with bipolar disorders.

This study aims to evaluate a human rights-informed dementia prevention program promoting better health and social care among older adults. In this study, the authors examined whether a dual-task training would improve cognition in healthy older adults.

Individuals attending the systematic health education program for older adults based in Japan were recruited for study inclusion, and divided into a dual-task training group (TG) and a control group (CG). The TG underwent 90 min of a weekly dual-task training for 12 weeks. Severity of dementia was measured using the Mini-Mental State Examination (MMSE) test. Brain function was assessed using a go/no-go task paradigm, during which cerebral blood flow was additionally measured using functional near-infrared spectroscopy to quantify oxyhemoglobin (oxy-Hb).

MMSE total score, number of errors in the go/no-go tasks and oxy-Hb values showed significant improvements in the TG.

Owing to the small number of participants allocated to the CG, the results must be interpreted with caution. Replication and further validation based on large-scale, randomized-controlled trials is warranted.

This study highlights potential benefits of incorporating an early prevention training for dementia into a human rights-friendly health education program.

This study suggests a potential means to reduce costs of social security and health care by introducing a human rights-informed dementia prevention program.

The results suggest that dual-task training may improve cognitive function in healthy older adults, thereby contributing to better health and improvement of social health care, based on a human rights-informed health education program for the prevention of dementia.

This study aims to take a dual-process perspective and argues that peer influence on increasing impulse buying may also operate automatically. If-then plans, which can automate action control, may, thus, help regulate peer influence. This research extends existing literature explicating the deliberate influence of social norms.

Study 1 (N = 120) obtained causal evidence that forming an implementation intention (i.e. an if-then plan designed to automate action control) reduces peer impact on impulse buying in a laboratory experiment with young adults (students) selecting food items. Study 2 (N = 686) obtained correlational evidence for the role of norms, automaticity and implementation intentions in impulse buying using a large sample of high-school adolescents working on a vignette about clothes-shopping.

If-then plans reduced impulse purchases in the laboratory (Study 1). Both reported deliberation on peer norms and the reported automaticity of shopping with peers predicted impulse buying but an implementation intention to be thriftily reduced these links (Study 2).

This research highlights the role of automatic social processes in problematic consumer behaviour. Promising field studies and neuropsychological experiments are discussed.

Young consumers can gain control over automatic peer influence by using if-then plans, thereby reducing impulse buying.

This research helps understand new precursors of impulse buying in understudied European samples of young consumers.