Il “paziente inglese”: La responsabilità penale nel settore sanitario nel Regno Unito

RiassuntoIl contributo traccia, innanzitutto, una breve panoramica dell’evoluzione e dell’assetto attuale del sistema sanitario nel Regno Unito, al fine di evidenziarne le indubbie peculiarità rispetto a quello nostrano. Successivamente l’attenzione è rivolta alla disciplina della malpractice in ambito civilerisarcitorio e, soprattutto, penale. La disamina, allora, condurrà alla conclusione che la forte limitazione della medical liability che si registra, in entrambe le suddette proiezioni, in questo Paese possa influire negativamente sui livelli qualitativi e l’efficienza del NHS, che non risultano particolarmente elevati. L’obiettivo del saggio è quello di fornire, dunque, spunti di riflessione in ordine all’opportunità, rispetto all’esigenza di tutelare la sicurezza delle cure, di riforme che in Italia da tempo molti invocano ai fini di un sensibile ridimensionamento della responsabilità penale degli operatori sanitari (specie facendo ricorso al paradigma della “colpa grave”) o, in linea opposta, in ordine all’introduzione di una responsabilità da reato della struttura sanitaria, per eventi avversi occorsi al paziente, prevista, per l’appunto, nel Regno Unito.AbstractFirst, the paper develops a brief overview of the evolution and current structure of the NHS, to highlight its undoubted peculiarities compared to ours. Subsequently, attention is paid to the consequences of malpractice in the civil-compensatory and, above all, criminal fields. This to highlight how the strong limitation of medical liability that is recorded, in both projections, in this Country can affect the quality levels and efficiency of the healthcare offer. The objective, then, is also to provide elements in the perspective of evaluating the opportunity, with respect to the need to protect the safety of treatments, of reforms that many in Italy have long been calling for the purpose of significantly reducing the criminal liability of healthcare workers (especially through the paradigm of gross negligence), or, instead, to introduce corporate liability for malpractice

Relationship between the quality of life and the severity of obstructive sleep apnea syndrome

The effects of sleep disorders on the quality of life (QOL) have been documented in the literature. Excessive sleepiness and altered circadian rhythms may negatively affect ability to learn, employment, and interpersonal relations, and directly degrade QOL. The objective of the present study was to evaluate the impact of obstructive sleep apnea syndrome of varying severity on QOL. The study was conducted on 1892 patients aged 18 years or older referred by a physician to the Sleep Institute, São Paulo, with complaints related to apnea (snoring, excessive daytime sleepiness, hyperarousal, and fatigue). They were submitted to overnight polysomnography for the diagnosis of sleep disorders from August 2005 through April 2006. The patients completed the Epworth Sleepiness Scale and QOL SF-36 sleep questionnaires. They were classified as non-physically active and physically active and not-sleepy and sleepy and the results of polysomnography were analyzed on the basis of the apnea hypopnea index (AHI). The apneic subjects showed a reduction in QOL which was proportional to severity. There was a significant decrease in all domains (physical functioning, role physical problems, bodily pain, general health perceptions, vitality, social functioning, emotional problems, general mental health) for apneics with AHI >30, who generally were sleepy and did not participate in physical activities (P < 0.05). The present study provides evidence that the impact of sleep disorders on QOL in apneics is not limited to excessive daytime sleepiness and that physical activity can contribute to reducing the symptoms. Thus, exercise should be considered as an adjunct interventional strategy in the management of obstructive sleep apnea syndrome.Universidade Federal de São Paulo (UNIFESP) Departamento de PsicobiologiaUniversidade Federal de São Paulo (UNIFESP) Centro de Estudos em Psicobiologia e ExercícioInstituto do SonoUNIFESP, Depto. de PsicobiologiaUNIFESP, Centro de Estudos em Psicobiologia e ExercícioSciEL

Laboratory and industrial testing of silica bricks for coke ovens

In order to rationalize the reconstruction of coke ovens' walls in a local steelmaking, a set of laboratory and industrial tests was carried out on silica KN bricks. Two types of bricks that are currently used in oven construction were analyzed, one being less expensive than the other. On the other hand, 25 year-old original bricks were also studied. The results of laboratory tests were analyzed taking into account the requirements of DIN 1089 standard. Additionally, an evaluation of costs was carried out.Fil: Camerucci, Maria Andrea. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones en Ciencia y Tecnología de Materiales. Universidad Nacional de Mar del Plata. Facultad de Ingeniería. Instituto de Investigaciones en Ciencia y Tecnología de Materiales; ArgentinaFil: Tomba Martinez, Analia Gladys. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones en Ciencia y Tecnología de Materiales. Universidad Nacional de Mar del Plata. Facultad de Ingeniería. Instituto de Investigaciones en Ciencia y Tecnología de Materiales; ArgentinaFil: Cavalieri, Ana Lia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones en Ciencia y Tecnología de Materiales. Universidad Nacional de Mar del Plata. Facultad de Ingeniería. Instituto de Investigaciones en Ciencia y Tecnología de Materiales; ArgentinaFil: de Córdova, M.. SIDERAR; ArgentinaFil: Beltrán, D.. SIDERAR; ArgentinaFil: Topolevsky, R.. SIDERAR; Argentin

Effect of processing on physico-chemical characteristics of dietary fibre concentrates obtained from peach (Prunus persica L.) peel and pulp

In order to obtain rich dietary fibre concentrateswith enhanced functional properties frompeach peel and pulp,a treatment with ethanol (96% v/v) was performed previous to drying under 30 °C forced air convection for 7 h or under freeze drying. All the dietary fibre concentrates isolatedwere enriched in cell wall polymers and a high polyphenol content was associated to them. The yield of those proceeding from peel almost doubled the one of concentrates obtained from pulp and high hydration capacities were shown by all the concentrates. Fractions from peel showed the darkest colour. Oil holding capacity (1.81–2.4 g/g) was higher than the one reported in bibliography for peach bagasse (1.02 g/g) and quince wastes (1.59 g/g). Concerning the effect of the drying technique used, it was observed that air drying gave origin to pulp dietary fibre concentrates of lower oil holding capacity and less solid behaviour than freeze drying.Fil: de Escalada Pla, Marina Francisca. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Industrias; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: González, Patricia. Universidad Tecnológica Nacional. Facultad Regional Buenos Aires; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Industrias; ArgentinaFil: Sette, Paula Andrea. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Industrias; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Portillo, Florencia Soledad. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Industrias; ArgentinaFil: Rojas, Ana Maria Luisa. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Industrias; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Gerschenson, Lia Noemi. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Industrias; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Characterization of Acid-Extracted Pectin-Enriched Products Obtained from Red Beet ( Beta vulgaris L. var. conditiva ) and Butternut ( Cucurbita moschata Duch ex Poiret)

Chemical and rheological characteristics of fractions enriched in soluble dietary fiber are reported. These fractions were obtained through acid hydrolysis of butternut (Cucurbita moschata Duch ex Poiret) and red beet (Beta vulgaris L. var. conditiva) cell wall enriched powders. Hydrolysis was performed using citric acid at different pH values and reaction times (2 and 3 h). Yields obtained for butternut fractions were between 21 and 28 g/100 g; for red beet, yields were 24 and 31 g/100 g for pH 1.5 and 11 and 17 g/100 g for pH 2.0 for previously mentioned times; in general, the increase of the yield was directly correlated with the decrease of pH and the increase of reaction time. Products enriched in low methoxyl pectins were obtained in all cases. At the lowest pH assayed, pectins were essentially constituted by homogalacturonan; a significant content of neutral sugars was determined at the higher extraction pH. Neutral sugars were constituted mainly by arabinose, galactose, rhamnose, and glucose in different proportions for each fraction; in general, butternut fractions showed high glucose contents. Flow behavior for 2.00% (w/v) aqueous systems of the different products was evaluated. Data obtained for fractions isolated at pH 1.5 fit to Herschel-Bulkley and Cross models while those isolated at pH 2.0 fit to Ostwald and Cross models. All samples showed low viscosity and, hence, poor thickening properties.Fil: Fissore, Eliana Noemi. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Industrias; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria; ArgentinaFil: Ponce, Nora Marta Andrea. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Centro de Investigaciones en Hidratos de Carbono. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Centro de Investigaciones en Hidratos de Carbono; ArgentinaFil: de Escalada Pla, Marina Francisca. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Industrias; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria; ArgentinaFil: Stortz, Carlos Arturo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Centro de Investigaciones en Hidratos de Carbono. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Centro de Investigaciones en Hidratos de Carbono; ArgentinaFil: Rojas, Ana Maria Luisa. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Industrias; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria; ArgentinaFil: Gerschenson, Lia Noemi. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Industrias; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria; Argentin

Caranguejos que correm, crinóides que caminham, gastrópodes que se alimentam: diversidade comportamental no Lagerstätte do Cabeço da Ladeira e suas implicações evolutivas (Jurássico Médio, Portugal)

Ichnology is a powerful tool for understanding the evolutionary paths of animal clades, through the paleobiology of behavior preserved in Lagerstätten such as the Cabeço da Ladeira (Portugal) site. Here, the peritidal carbonates of the Chão das Pias Formation (Middle Jurassic, upper Bajocian) record the development of microbial mats in a tidal flat. Episodically, the flat was expanded during periods of equinoctial spring tides that may have been responsible for the in situ killing of several members of echinoderm clades, and the fine preservation of their endoskeleton, in addition to the behavior of an arthropod-dominated endo- and epifauna. Mat-preserved shallow tiers with a moderate ichnodiversity attributed to the Cruziana ichnofacies include trackways of crabs (Laterigradus lusitanica igen. nov., isp. nov.) and shrimps ( Diplopodichnus isp.); trails of fishes (?Undichna), gastropods (Archaeonassa fossulata), isocrinid crinoids (Krinodromos bentou igen. nov., isp. nov.) and insects (Haplotichnus indianensis); and burrows of shrimps or lobsters (Thalassinoides suevicus) and other arthropods (Asterosoma ludwigae, Gyrochorte comosa), or polychaetes (Rhizocorallium commune ). This is implied already above (igen. nov., etc.) and seems not needed. The crab trackways and gastropod bulldozing trails, extending up to 12.3 m, are among the longest invertebrate cursorial traces ever found in the fossil record. The mortichnial crawling trail of a crinoid is the first evidence of locomotion for this group in the fossil record, and a rare unambiguous example of this ethology. Extensive continuous trackways attributed to amphibious crabs record, with great detail, typical gaits of underwater punting and walking sideways on dry land. The earliest evidences of sidewalking behavior may also be evidence for the development of the crab form during their rise in the Jurassic.A Icnologia é um poderoso instrumento para a compreensão das etapas evolutivas de clados de animais através da paleobiologia do comportamento inscrito em sítios paleontológicos excepcionais, como o Cabeço da Ladeira (Portugal). O Jurássico Médio (Bajociano superior) da Formação de Chão das Pias é formado por uma sequência de carbonatos peritidais que regista o desenvolvimento de tapetes microbianos numa planície de maré. Episodicamente, esta terá tido um desenvolvimento extraordinário através de marés equinociais que poderão ter sido responsáveis pela morte in situ de diversos grupos de equinodermes e pela preservação com excelente detalhe dos seus esqueletos articulados, além das formas de comportamento de uma endo- e epifauna dominada pelos artrópodes. Os níveis superficiais, com uma moderada icnodiversidade preservada pelos tapetes microbianos e atribuível à icnofácies de Cruziana, incluem trilhos de caranguejos (Laterigradus lusitanica nov. igén.) e de outros crustáceos (Diplopodichnus isp.), assim como eventualmente de peixes (?Undichna), pistas de gastrópodes (Archaeonassa fossulata), crinóides isocrinídeos (Krinodromos bentou nov. igén.) e insectos (Haplotichnus indianensis), além de galerias de lagostins ou de lagostas (Thalassinoides suevicus), e de outros artrópodes (Asterosoma ludwigae, Gyrochorte comosa) ou poliquetas (Rhizocorallium commune). Laterigradus lusitanicus e Krinodromos bentou são novos icnogéneros e icnoespécies definidos neste trabalho. Os trilhos de caranguejos e as pistas de gastrópodes são algumas das mais extensas evidências de locomoção encontradas no registo fóssil dos invertebrados até ao momento. A “marcha para a morte” de um crinóide é o primeiro registo fóssil de locomoção para este grupo, e um raro exemplo desta categoria etológica. Extensos trilhos contínuos também evidenciam com grande detalhe os estilos de locomoção “salto com vara” subaquático e “caminhada de lado” em terra emersa característicos dos caranguejos anfíbios. Os mais antigos indícios da locomoção “de lado” poderão ser também a evidência da evolução da forma de caranguejo com a diversificação dos Brachyura durante o Jurássico, um clado bem-sucedido que culminou com a colonização de habitats terrestres devido às suas exaptações motoras

Do Circadian Preferences Influence the Sleep Patterns of Night Shift Drivers?

Objective: the objective of this study was to analyze the effect of individual circadian preferences of drivers with fixed night work schedules on sleep patterns. Subjects and Methods: A total of 123 professional drivers, 32 indifferent preference drivers and 91 morning preference drivers of an intermunicipality and interstate bus transportation company were evaluated. All drivers underwent polysomnographic recordings after their shifts. Furthermore, they filled out a questionnaire that contained sociodemographic and health questions. the Home and Ostberg questionnaire was used to assess the subjects' morningness-eveningness preference. Results: the mean age was 42.54 +/- 6.98 years and 82 (66.66%) of the drivers had worked for = 15 years. A significant effect on rapid eye movement (REM) was observed in the morning preference drivers. They showed an increased sleep latency and an REM sleep percentage of 5% of the total REM time. This reveals a significant effect on sleep architecture associated with work time. Conclusion: the drivers reported that morning preference had a significant effect on their sleep pattern indicating less REM sleep and longer REM sleep latency in the morning preference group. Thus, it is important to evaluate interactions between individual aspects of health and other parameters, such as sleep quality and work organizational factors, to promote night shift workers' health and well-being. (C) 2013 S. Karger AG, BaselUniversidade Federal de São PauloAssociação Fundo de Incentivo à PesquisaCentro Multidisciplinar em Sonolencia e Acidentes (CEMSA)/Fundo de Incentivo a Pesquisa (AFIP)Centro de Estudo em Psicobiologia e Exercicio (CEPE)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Associacao Fundo Incent Pesquisa, Ctr Multidisciplinar Sonolencia & Acidentes, São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilUNESP, Univ Estadual Paulista Julio de Mesquita Fillho, Assis, BrazilUniv Estadual Campinas, Fac Ciencias Aplicadas, Limeira, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc