Origini, evoluzione e declino della Provincia nell'ordinamento italiano.

La presente tesi tratta della istituzione “Provincia” dalle sue origini fino ad oggi. Vengono descritte le prime forme di questa istituzione che, nell’età contemporanea, vede il suo sorgere nel periodo napoleonico. La conformazione giuridica della Provincia viene fissata dalla legge “Rattazzi” del 1859 del Regno di Sardegna, che verrà poi trasfusa nella legge comunale e provinciale del 1865 del neonato Regno di Italia. La Provincia è sempre stata uno strumento di decentramento burocratico dello Stato ed un ente autonomo avente per finalità la cura degli interessi di un determinato territorio e dei suoi abitanti. Il presente lavoro si occupa della Provincia quale ente autonomo e ne traccia i momenti salienti della sua vita, contraddistinta da periodi di maggiore e minore importanza nel contesto politico nazionale e locale e nell’ordinamento giuridico. Viene fatto cenno alla discussione relativa a tale ente avvenuta in sede di Assemblea costituente, dove si registrarono prese di posizione tendenti alla sua soppressione, ma dove, invece, l’istituzione si guadagnò la qualifica di ente di rilievo costituzionale. Pochi anni dopo la fine della seconda guerra mondiale, il Consiglio provinciale, massimo organo dell’ente, riacquista la sua qualità di organo eletto democraticamente a seguito libere elezioni. Si arriva così al 1990 quando la legge n. 142/90 conferisce alla Provincia un nuovo ruolo di ente di programmazione e coordinamento, contribuendo a decretarne in un certo senso la rinascita. Un nuovo riconoscimento di ente costituente, insieme agli enti locali, la Repubblica, viene ottenuto dalla Provincia con la riforma costituzionale del 2001. A decorrere dall’anno 2009 vengono emanate norme tendenti a ridurre i costi della politica. In questo quadro l’ente territoriale che ne fa maggiormente le spese è proprio la Provincia che vede ridurre sensibilmente la sua rappresentatività in termini democratici e l’attribuzione delle sue funzioni. Si arriva in tal modo all’emanazione della legge n. 56/2014 (Del Rio) con la quale, in attesa della riforma costituzionale Renzi-Boschi, viene finalmente definito in maniera organica l’assetto della Provincia quale ente di area vasta. I suoi organi saranno nominati in secondo grado e le sue funzioni saranno ridotte notevolmente. Con l’approvazione della riforma costituzionale da parte dei due rami del Parlamento, che ha concluso il suo iter nell’aprile scorso, la Provincia perde la sua qualità di ente previsto dalla Costituzione. Poiché la legge sarà sottoposta a referendum popolare, sarà l’esito di questo a determinarne la sorte

Could Interferon Still Play a Role in Metastatic Renal Cell Carcinoma? A Randomized Study of Two Schedules of Sorafenib Plus Interferon-Alpha 2a (RAPSODY)

Background: Sorafenib has proven efficacy in metastatic renal cell carcinoma (mRCC). Interferon (IFN) has antiangiogenic activity that is thought to be both dose-and administration-schedule dependent. Objective: To compare two different schedules of IFN combined with sorafenib. Design, setting, and participants: Single-stage, prospective, noncomparative, randomized, open-label, multicenter, phase 2 study on previously untreated patients with mRCC and Eastern Cooperative Oncology Group performance status 0-2. Intervention: Sorafenib 400 mg twice daily plus subcutaneous IFN, 9 million units (MU) three times a week (Arm A) or 3 MU five times a week (Arm B). Outcome measurements and statistical analysis: Primary end points were progression-free survival (PFS) for each arm and safety. Data were evaluated according to an intent-to-treat analysis. Results and limitations: A total of 101 patients were evaluated. Median PFS was 7.9 mo in Arm A and 8.6 mo in Arm B (p = 0.049) and the median duration of response was 8.5 and 19.2 mo, respectively (p = 0.0013). Nine partial responses were observed in Arm A, and three complete and 14 partial responses were observed in Arm B (17.6% vs 34.0%; p = 0.058); 24 and 21 patients (47% and 42%), respectively, achieved stable disease. The most common grade 3-4 toxicities were fatigue plus asthenia (28% vs 16%; p = 0.32) and hand-foot skin reactions (20% vs 18%). Conclusions: Sorafenib plus frequent low-dose IFN showed good efficacy and tolerability. Further investigations should be warranted to identify a possible positioning of this intriguing regimen (6% complete response rate) in the treatment scenario of mRCC. (C) 2012 Published by Elsevier B. V. on behalf of European Association of Urology

A survey of clinical features of allergic rhinitis in adults

Background: Allergic rhinitis (AR) has high prevalence and substantial socio-economic burden.Material/Methods: The study included 35 Italian Centers recruiting an overall number of 3383 adult patients with rhinitis (48% males, 52% females, mean age 29.1, range 18-45 years). For each patient, the attending physician had to fill in a standardized questionnaire, covering, in particular, some issues such as the ARIA classification of allergic rhinitis (AR), the results of skin prick test (SPT), the kind of treatment, the response to treatment, and the satisfaction with treatment.Results: Out of the 3383 patients with rhinitis, 2788 (82.4%) had AR: 311 (11.5%) had a mild intermittent, 229 (8.8%) a mild persistent, 636 (23.5%) a moderate-severe intermittent, and 1518 (56.1%) a moderate-severe persistent form. The most frequently used drugs were oral antihistamines (77.1%) and topical corticosteroids (60.8%). The response to treatment was judged as excellent in 12.2%, good in 41.3%, fair in 31.2%, poor in 14.5%, and very bad in 0.8% of subjects. The rate of treatment dissatisfaction was significantly higher in patients with moderate-to-severe AR than in patients with mild AR (p<0.0001). Indication to allergen immunotherapy (AIT) was significantly more frequent (p<0.01) in patients with severe AR than with mild AR.Conclusions: These findings confirm the appropriateness of ARIA guidelines in classifying the AR patients and the association of severe symptoms with unsuccessful drug treatment. The optimal targeting of patients to be treated with AIT needs to be reassessed

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN