Sulla nullit\ue0 degli atti amministrativi

Viene studiato il tema della nullit\ue0 in chiave comparatistica, per concludere proponendo una distinzione fra casi in cui la nullit\ue0 discende dalla previsione generale (tedesca) del vizio grave e riconoscibile (la nullit\ue0 generale), ovvero dalla esplicitazione (italiana), sotto la qualifica di nullit\ue0, dei casi di deficit strutturale della fattispecie (nullit\ue0 strutturale, o nullit\ue0-inesistenza), anch\u2019essa in linea di principio caratterizzata dalla riconoscibilit\ue0 del difetto e riportabile quindi ad una generale categoria di nullit\ue0 derivante dall\u2019evidenza di un vizio grave, o nullit\ue0-evidenza, e i casi di nullit\ue0-sanzione, voluta dal legislatore come risultato di un giudizio di particolare disvalore di specifici difetti o modi di essere di una certa fattispecie

Provvedimenti di secondo grado e tutela dell'affidamento

Esamina nell'ambito del diritto amminsitrativo europeo nonch\ue8 dei vari Paesi europei il concetto di affidamento e di riesame della stessa pubblica amministrazione delle proprie precedenti determinazioni. E' esaminato il libero gioco di questi tre principi: il problema della certezza del diritto, la garanzia verso i cittadini, la protezione delle loro aspettative. La comparazione giunge a risultati assai diversi paese per paese. Prefazione. \u2013 Provvedimenti di secondo grado e tutela dell\u2019affidamento (D. Corletto). \u2013 La tutela dell\u2019affidamento del privato nell\u2019ordinamento amministrativo inglese. Il caso delle substantive legitimate expectations (G Ligugnana). \u2013 La riproposizione di istanza di accesso e la certezza dei rapporti amministrativi e delle posizioni giuridiche dei controinteressati (J. Bercelli). \u2013 Il rinvio ai principi dell\u2019ordinamento comunitario ex art.1 l. n. 241/1990: ius receptum o ius novum? (S. Moro)

Prognostic Significance of Changes in Heart Rate Following Uptitration of Beta-Blockers in Patients with Sub-Optimally Treated Heart Failure with Reduced Ejection Fraction in Sinus Rhythm versus Atrial Fibrillation

Background: In patients with heart failure with reduced ejection fraction (HFrEF) on sub-optimal doses of beta-blockers, it is conceivable that changes in heart rate following treatment intensification might be important regardless of underlying heart rhythm. We aimed to compare the prognostic significance of both achieved heart rate and change in heart rate following beta-blocker uptitration in patients with HFrEF either in sinus rhythm (SR) or atrial fibrillation (AF). Methods: We performed a post hoc analysis of the BIOSTAT-CHF study. We evaluated 1548 patients with HFrEF (mean age 67 years, 35% AF). Median follow-up was 21 months. Patients were evaluated at baseline and at 9 months. The combined primary outcome was all-cause mortality and heart failure hospitalisation stratified by heart rhythm and heart rate at baseline. Results: Despite similar changes in heart rate and beta-blocker dose, a decrease in heart rate at 9 months was associated with reduced incidence of the primary outcome in both SR and AF patients [HR per 10 bpm decrease—SR: 0.83 (0.75–0.91), p < 0.001; AF: 0.89 (0.81–0.98), p = 0.018], whereas the relationship was less strong for achieved heart rate in AF [HR per 10 bpm higher—SR: 1.26 (1.10–1.46), p = 0.001; AF: 1.08 (0.94–1.23), p = 0.18]. Achieved heart rate at 9 months was only prognostically significant in AF patients with high baseline heart rates (p for interaction 0.017 vs. low). Conclusions: Following beta-blocker uptitration, both achieved and change in heart rate were prognostically significant regardless of starting heart rate in SR, however, they were only significant in AF patients with high baseline heart rate

Anaesthetic Impairment of Immune Function Is Mediated via GABAA Receptors

GABA(A) receptors are members of the Cys-loop family of neurotransmitter receptors, proteins which are responsible for fast synaptic transmission, and are the site of action of wide range of drugs. Recent work has shown that Cys-loop receptors are present on immune cells, but their physiological roles and the effects of drugs that modify their function in the innate immune system are currently unclear. We are interested in how and why anaesthetics increase infections in intensive care patients; a serious problem as more than 50% of patients with severe sepsis will die. As many anaesthetics act via GABA(A) receptors, the aim of this study was to determine if these receptors are present on immune cells, and could play a role in immunocompromising patients.We demonstrate, using RT-PCR, that monocytes express GABA(A) receptors constructed of α1, α4, β2, γ1 and/or δ subunits. Whole cell patch clamp electrophysiological studies show that GABA can activate these receptors, resulting in the opening of a chloride-selective channel; activation is inhibited by the GABA(A) receptor antagonists bicuculline and picrotoxin, but not enhanced by the positive modulator diazepam. The anaesthetic drugs propofol and thiopental, which can act via GABA(A) receptors, impaired monocyte function in classic immunological chemotaxis and phagocytosis assays, an effect reversed by bicuculline and picrotoxin.Our results show that functional GABA(A) receptors are present on monocytes with properties similar to CNS GABA(A) receptors. The functional data provide a possible explanation as to why chronic propofol and thiopental administration can increase the risk of infection in critically ill patients: their action on GABA(A) receptors inhibits normal monocyte behaviour. The data also suggest a potential solution: monocyte GABA(A) receptors are insensitive to diazepam, thus the use of benzodiazepines as an alternative anesthetising agent may be advantageous where infection is a life threatening problem

Overview of diagnosis and management of paediatric headache. Part I: diagnosis

Headache is the most common somatic complaint in children and adolescents. The evaluation should include detailed history of children and adolescents completed by detailed general and neurological examinations. Moreover, the possible role of psychological factors, life events and excessively stressful lifestyle in influencing recurrent headache need to be checked. The choice of laboratory tests rests on the differential diagnosis suggested by the history, the character and temporal pattern of the headache, and the physical and neurological examinations. Subjects who have any signs or symptoms of focal/progressive neurological disturbances should be investigated by neuroimaging techniques. The electroencephalogram and other neurophysiological examinations are of limited value in the routine evaluation of headaches. In a primary headache disorder, headache itself is the illness and headache is not attributed to any other disorder (e.g. migraine, tension-type headache, cluster headache and other trigeminal autonomic cephalgias). In secondary headache disorders, headache is the symptom of identifiable structural, metabolic or other abnormality. Red flags include the first or worst headache ever in the life, recent headache onset, increasing severity or frequency, occipital location, awakening from sleep because of headache, headache occurring exclusively in the morning associated with severe vomiting and headache associated with straining. Thus, the differential diagnosis between primary and secondary headaches rests mainly on clinical criteria. A thorough evaluation of headache in children and adolescents is necessary to make the correct diagnosis and initiate treatment, bearing in mind that children with headache are more likely to experience psychosocial adversity and to grow up with an excess of both headache and other physical and psychiatric symptoms and this creates an important healthcare problem for their future life

Sulla nullit\ue0 degli atti amministrativi

Pubblicata nella Rivista Internet "www.giustamm.it" il 1 ottobre 200

Vizi "formali" e poteri del giudice amministrativo

Dir\uf2 qualcosa su illegittimit\ue0 formale e annullamento, ragionando sull\u2019art. 21 octies 2\ub0 comma, della legge 7 agosto 1990 n. 241, introdotto dalla legge 11 febbraio 2005 n. 15, secondo il quale \uabnon \ue8 annullabile il provvedimento amministrativo adottato in violazione di norme sul procedimento o sulla forma degli atti qualora per la natura vincolata del provvedimento, sia palese che il suo contenuto dispositivo non avrebbe potuto essere diverso da quello in concreto adottato\ubb. Il comma continua poi con una seconda proposizione: \uabIl provvedimento amministrativo non \ue8 comunque annullabile per mancata comunicazione dell\u2019avvio del procedimento qualora l\u2019amministrazione dimostri in giudizio che il contenuto del provvedimento non avrebbe potuto essere diverso da quello in concreto adottato\ubb.Tanto si \ue8 scritto, che sarebbe davvero difficile presumere di poter dire qualcosa di nuovo su questo argomento. Vorrei provare comunque a proporre una lettura delle disposizioni in questione e del loro possibile funzionamento nel contesto del nostro processo amministrativo. Cercher\uf2 poi di avanzare alcune ipotesi sulle conseguenze che la nuova disposizione pu\uf2 provocare. Anticipando quello che dir\uf2 su questo, mi pare si possa pensare che l\u2019art. 21 octies caratterizza il processo su atti vincolati come un giudizio di spettanza; che introduce una divaricazione importante, e una significativa differenza di regime fra provvedimenti vincolati e provvedimenti discrezionali; che ci costringe a rivedere decennali se non secolari impostazioni in tema di illegittimit\ue0 e invalidit\ue0, e in tema di rapporto fra le due nozioni, e infine che porta (quasi) a compimento il superamento del concetto tradizionale di interesse legittimo. Chiuder\uf2 infine chiedendomi quali siano le possibili conseguenze concrete della nuova disciplina, e la complessiva valutazione che essa merita