Ricostruzione e valutazione dello stato anteriore

Il 22% della popolazione anziana in Italia ha pi\uf9 di 65 anni, con un costo complessivo per le assicurazioni nel 2017 per i sinistri per macroinvalidit\ue0 e morte pari a 4,6 miliardi di euro. Si pone pertanto per il sistema sanitario nazionale e per i medici legali il problema di come valutare il danno biologico nella persona anziana. Infatti, le tabelle per la valutazione del danno a persona prendono in considerazione l\u2019entit\ue0 della lesione, ma non l\u2019et\ue0 del paziente. Si \ue8 deciso quindi di applicare per la prima volta alla medicina legale la metodologia della Consensus Conference, utilizzata generalmente per dirimere questioni controverse in ambito clinico, al fine di affrontare un tema di fondamentale interesse scientifico e produrre un unico documento contenente indicazioni per valutare in maniera metodologicamente corretta e condivisa il danno biologico nella persona anziana. Ad oggi la mancanza di una condivisione di opinioni su questo tema produce una forte disomogeneit\ue0 di comportamenti sul piano clinico e valutativo e il documento comporter\ue0 grandi ripercussioni sull\u2019attivit\ue0 quotidiana stante il costante invecchiamento della popolazione generale e le grandi problematiche che la fragilit\ue0 dell\u2019anziano crea nella valutazione del danno alla persona

Scienza e coscienza ai tempi dell’emergenza sanitaria da Covid-19

SOMMARIO: 1. Il dilemma etico ai tempi della pandemia da Covid-19 -2. Le Raccomandazioni di etica clinica della SIIARTI del 6 marzo 2020 - 3. I criteri selettivi di accesso ai reparti di terapia intensiva in Svizzera, Quebec (Canada) e Alabama (USA) - 4. Triage in emergenza pandemica. Possibile contrasto di alcuni criteri selettivi con i valori religiosi ed etici del personale sanitario -5. Emergenza sanitaria e “clausola di coscienza” in Italia. Science and conscience at the time of the Covid-19 health emergency ABASTRACT: The Covid-19 pandemic crisis and the saturation of the intensive care wards have made it necessary to prepare patient selection criteria in case of lack of available places. The spread of various "selective criteria", in different regulatory realities, starting in Italy from the Ethical Recommendations of the SIIARTI (Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care) of March 6, 2020, as well as for reasons of distributive justice and appropriate allocation of limited health resources, was also necessary to relieve medical staff from part of the responsibility in the choices to be made, sometimes particularly onerous. The rationale behind the "medicine of catastrophes" documents, however, may conflict with the ethical values of medical personnel, undoubtedly capable of influencing their professional choices. The present contribution aims to verify the configurability of a space within which to give prominence, even in emergency conditions, to the ethical-religious beliefs of health personnel, in accordance with the rules of medical and nursing ethics that allow the individual operator to invoke the "conscience clause" to justify the refusal of services considered contrary to their conscience or their technical-scientific beliefs, even in cases not recognized by laws that expressly provide for "conscientious objection"

Multi-electrode architecture modeling and optimization for homogeneous electroporation of large volumes of tissue

Electroporation is a phenomenon that consists of increasing the permeability of the cell membrane by means of high-intensity electric field application. Nowadays, its clinical application to cancer treatment is one of the most relevant branches within the many areas of electroporation. In this area, it is essential to apply homogeneous treatments to achieve complete removal of tumors and avoid relapse. It is necessary to apply an optimized transmembrane potential at each point of the tissue by means of a homogenous electric field application and appropriated electric field orientation. Nevertheless, biological tissues are composed of wide variety, heterogeneous and anisotropic structures and, consequently, predicting the applied electric field distribution is complex. Consequently, by applying the parallel-needle electrodes and single-output generators, homogeneous and predictable treatments are difficult to obtain, often requiring several repositioning/application processes that may leave untreated areas. This paper proposes the use of multi-electrode structure to apply a wide range of electric field vectors to enhance the homogeneity of the treatment. To achieve this aim, a new multi-electrode parallel-plate configuration is proposed to improve the treatment in combination with a multiple-output generator. One method for optimizing the electric field pattern application is studied, and simulation and experimental results are presented and discussed, proving the feasibility of the proposed approach

The degree of punishable negligence. A comparative analysis with Anglo-American systems.

Nonostante sia tema “perennemente de lege ferenda”, la graduazione della colpa penale rimane, anche a discapito delle recenti riforme in materia di responsabilità sanitaria, uno dei temi aperti del diritto penale contemporaneo. L’abbraccio “dogmatico”, che, quotidianamente, si verifica nelle aule di giustizia tra la colpa penale ed il suo equivalente civilistico, rende ormai ineludibile una riflessione sul modello di punibilità a tappeto della colpa lieve adottato dall’ordinamento italiano. Il presente lavoro, allora, prende le mosse dalle recenti riforme italiane che avevano “promesso” un ripensamento della colpa in ambito sanitario, per rilevarne le criticità di fondo che hanno impedito il conseguimento degli intenti dichiarati. L’attenzione viene poi rivolta alla comparazione e, nella specie, ai sistemi giuridici di Common Law, che prevedono un assetto della responsabilità per colpa del tutto peculiare rispetto a quello tipico degli ordinamenti continentali. L’analisi, incentrata sulla giurisprudenza e la dottrina (principalmente inglesi, statunitensi e neozelandesi), offre indicazioni di estremo interesse per il Civil Lawyer che voglia approcciarsi all’“oscuro” tema del grado della colpa punibile.Despite it is a subject always "de lege ferenda", the degree of punishable negligence is still one of the issues of contemporary criminal law, even after the recent reforms of medical malpractice's responsibility. The theoretical embrace of criminal negligence with the civil one, makes it necessary to rethink our model based on "simple" negligence. This dissertation, then, starts from the recent italian reforms of medical malpractice's responsibility, which had promised a rethinking of the medical negligence. Then, the discourse moves to the comparison with "common law" legal systems, which have a different type of negligence: "Gross Negligence".\ud This analysis of case law and theory (in particular British, American and New Zealand) is very intersting for the civil lawyer who wants to deal with the degree of punishable negligence

Noise Exposure, Self-Reported Speech-in-Noise Percpetion, and the Auditory Brainstem Response in Normal-Hearing Human Ears

Difficulty understanding speech-in-noise (SIN) is a common complaint among many listeners. There is emerging evidence that noise exposure is associated with difficulties in speech discrimination and temporal processing despite normal audiometric thresholds. At present, evidence linking temporary noise-induced hearing loss and selective loss of low spontaneous rate fibers in human ears is limited and inconsistent. Likewise, results of SIN measures in relation to noise-induced cochlear synaptopathy varied across studies. The goals of this study are to further our understanding of the effects of noise exposure on the auditory system and to investigate novel approaches for detecting early noise-induced auditory damage. Data were collected from 30 normal-hearing subjects (18-35 years old) with varying amounts of noise exposure. Auditory brainstem responses (ABR) were recorded to both a click (measure of auditory nerve function) and speech stimulus (/da/; measure of temporal processing). The speech hearing subscale of the Speech, Spatial and Qualities of Hearing Scale (SSQ) was also administered to quantify individual self-reported SIN abilities. The data resulted in mixed findings. Overall click-ABR wave I results provided no evidence for noise-induced synaptopathy in this cohort. However, differences in the wave I amplitude between males and females were observed suggesting noise effects may vary between sexes. Transient components of the speech-ABR showed no evidence of neural slowing but revealed enhanced neural responses in individuals with greater amounts of noise exposure. This later finding may be a manifestation of either musical training or increased central neural gain as a result of pathology. Lastly, individuals with greater amounts of noise exposure reported experiencing more difficulties hearing SIN (as per the SSQ) but ABR data did not show the predicted physiologic evidence to explain the self-perceived SIN deficit

Medico-legal assessment of personal damage in older people: report from a multidisciplinary consensus conference

Ageing of the global population represents a challenge for national healthcare systems and healthcare professionals, including medico-legal experts, who assess personal damage in an increasing number of older people. Personal damage evaluation in older people is complex, and the scarcity of evidence is hindering the development of formal guidelines on the subject. The main objectives of the first multidisciplinary Consensus Conference on Medico-Legal Assessment of Personal Damage in Older People were to increase knowledge on the subject and establish standard procedures in this field. The conference, organized according to the guidelines issued by the Italian National Institute of Health (ISS), was held in Bologna (Italy) on June 8, 2019 with the support of national scientific societies, professional organizations, and stakeholders. The Scientific Technical Committee prepared 16 questions on 4 thematic areas: (1) differences in injury outcomes in older people compared to younger people and their relevance in personal damage assessment; (2) pre-existing status reconstruction and evaluation; (3) medico-legal examination procedures; (4) multidimensional assessment and scales. The Scientific Secretariat reviewed relevant literature and documents, rated their quality, and summarized evidence. During conference plenary public sessions, 4 pairs of experts reported on each thematic area. After the last session, a multidisciplinary Jury Panel (15 members) drafted the consensus statements. The present report describes Conference methods and results, including a summary of evidence supporting each statement, and areas requiring further investigation. The methodological recommendations issued during the Conference may be useful in several contexts of damage assessment, or to other medico-legal evaluation fields

Accertamenti coattivi e tutela della libertà corporale nel processo penale

[Abstract non disponibile

Encodage neuronal des sons de parole : développements méthodologiques, générateurs neuronaux et application au malentendant appareillé

To date, six million French are hearing impaired. To address this public health issue, efficient tools for exploration of the hearing function are essentials. Speech ABR (Speech Auditory Brainstem Response) is a promising tool, being a fine electrophysiological marker of the neuronal encoding of speech. Though, its methodology remains underdeveloped, its neural origin is still uncertain, and it has never been recorded in hearing aid users. The first axis of this thesis focuses on the neural generators of Speech ABR. The development of a methodology for recording topographies of this response, up to now described as strictly subcortical, first suggested the possibility of a cortical generator. A stereo-electroencephalography study then confirmed the existence of Speech ABR activity in bilateral primary auditory cortices. This result sheds a new light on the representation of speech sounds within the auditory nervous system. The second axis concerns the study of Speech ABR in hearing aid users. After having developed a methodology of acoustic stimulation directly through hearing aids, we investigated neural plasticity induced by hearing aid use. Results show an improvement in the identification of amplified phonemes, linked to an altered cortical representation and a rebalanced frequency encoding. This very first evidence of neural plasticity as soon as the first four months of hearing aid use opens up new therapeutic hopesA ce jour, six millions de français sont atteints de troubles de l'audition. Face à ce problème de santé publique, des outils performants d'exploration de la fonction auditive sont indispensables. La Speech ABR (Speech Auditory Brainstem Response ou Réponse du tronc cérébral auditif à la parole) est un outil prometteur, comme marqueur électrophysiologique fin de l'encodage neuronal de la parole. Cependant, sa méthodologie reste peu développée, son origine neuronale incertaine et elle n'a jamais été enregistrée chez le malentendant porteur d'aides auditives. Le premier axe de cette thèse porte sur les générateurs neuronaux de la Speech ABR. Le développement d'une méthodologie de recueil topographique de cette réponse jusqu'alors décrite comme strictement sous-corticale, a d'abord suggéré la possibilité d'un générateur cortical. Une étude en stéréo-électroencéphalographie a ensuite confirmé l'existence d'une activité Speech ABR dans les cortex auditifs primaires bilatéraux. Ce résultat apporte un éclairage nouveau sur la représentation des sons de parole par système nerveux auditif. Le second axe concerne l'étude de la Speech ABR chez le malentendant appareillé. Après avoir développé une méthodologie de stimulation acoustique directement au travers des aides auditives, nous avons étudié la plasticité neuronale induite par le port d'aides auditives. Les résultats montrent une amélioration de l'identification des phonèmes amplifiés, liée à une représentation corticale modifiée et à un encodage fréquentiel rééquilibré. Ces toutes premières preuves de plasticité neuronales dès les 4 premiers mois d'utilisation des aides auditives ouvrent de nouveaux espoirs thérapeutique