M Riva

Somnambulism in Verdi's Macbeth and Bellini's La Sonnambula

The arts can provide unique ways for determining how people not directly involved in medicine were viewing and informing others about physical and mental disorders. With operas, one need only think about how various perturbations of madness have been portrayed. Somnambulism has long been a particularly perplexing disorder, both to physicians and the laity, and it features in a number of operas. Two mid-nineteenth-century masterpieces are examined in detail in this contribution: Verdis Macbeth and Bellinis La Sonnambula. In the former, the sleepwalking scene is faithful to what Shakespeares had written early in the seventeenth century, a time of witchcraft, superstition, and the belief that nocturnal wanderings might be caused by guilt. In Bellinis opera, in contrast, the victim is an innocent girl who suffers from a quirk of nature, hence eliciting sympathy and compassion. By examining the early literature on somnambulism and comparing this disorder in these operas, we can see how thinking about this condition has changed and, more generally, how music was helping to generate new ways of thinking about specific diseases and medicine.

Work activity and phenylalanine levels in a population of young adults with classic PKU

BACKGROUND Phenylketonuria (PKU) is an inborn error of metabolism characterized by increased blood concentrations of phenylalanine (Phe). OBJECTIVES The aim of the present study was to assess the association between the metabolic compliance of adult patients affected by classic PKU and the characteristics of their present and past occupations. METHODS The study population consisted of working adults, affected by classic PKU, and following a dietary treatment. Univariate linear-mixed models and multivariate analysis were applied to assess the association between Phe blood levels and individual covariates: age, sex, time at diagnosis, educational level and work characteristics. RESULTS A linear relationship was found with age (an average annual increase of 30.56 μMol/L (C.I. 95%: 7.53; 53.60) in the mean Phe blood levels). Full-time work appeared to be associated with a worse metabolic compliance when compared to part-time work (mean Phe blood levels >281.11 μMol/L). Shift work was related to a worse metabolic compliance, with mean Phe plasmatic levels >356.73 μMol/L. CONCLUSIONS Our data suggests that work may influence the metabolic compliance in adults with PKU. In particular, a part-time employment could allow for a better metabolic compliance, while daily work should be preferred to shift work.

954 Pushing and pulling assessment: how to deal with inter-operator variability

Introduction Snook and Ciriello has been the leading methods to assess pushing and pulling for roughly 30 years. ISO11228-2 integrated it providing useful add-ons. On duties, workers apply excessive amount of force, for reasons either related to organisational, technical or legal issues. Therefore, inter-operator variability still remains a main issue to be addressed. Methods 378 pushing and pulling test sessions were organised. Forces were measured by means of a computerised dynamometer (200 Hz, 120 Kg scale). 3 health operators (OH) and 2 very trained technicians (T) moved 2 types of hospital beds carrying simulated loads of patients weighting 70, 90 and 110 Kg, on a maximum distance of 300 m. To assess the speed limit (1 m/second) compliance, a 20 m pushing test was repeated multiple times by each tester. The same 20 m test provided individual threshold to compute initial and sustained forces. Initial force was defined as value lying above the threshold, the hysteresis curve and only for coherent data. To compare the speed suggested by the methods with the real speed performed by operators, a 2 months analysis of the patient transportation recorded missions was carried out. Then the accumulated delay-times were estimated with reference to the mean travel time measured at the suggest speed. Results Initial forces resulted 43% (32%–112%) and sustained forces 37% (23%–101%) higher and statistically significant for OH compared to T. Increased speed saves only 25% (12%–56%) of the travel time, due to elevators waiting, doors opening etc. Conclusion Rapidly grooving hospitals often show tortuous paths, where patient transportation on bed is allowed. ISO11228-2 assessment method contribute to solve complex measures, particularly when dealing very long distance pushing and pulling tasks. Initial forces might be calculated by measuring the threshold of the initial force of each operator on a 20 m test. Mean delay time shows risk excess often leading to increased speed behaviours.