Le nuove strategie aziendali tra specializzazione delle competenze, diffusione e concentrazione dei servizi: un'analisi empirica

I fenomeni di cambiamento istituzionale, organizzativo e operativo stanno conducendo alla necessit\ue0 per le aziende sanitarie di trovare nuovi meccanismi di coordinamento intra-aziendali che garantiscano nel contempo: i) appropriati livelli di specializzazione del lavoro e delle competenze professionali e, di conseguenza, maggiore sicurezza delle prestazioni; ii) adeguati livelli di diffusione dei servizi nei diversi punti erogativi aziendali (ospedali hub & spoke). Il capitolo analizza le scelte strategiche relative alla specializzazione del lavoro e alla diffusione dei servizi di quattro Aziende Sanitarie Pubbliche italiane: ATS Sardegna, AUSL Toscana Centro, AUSL di Reggio Emilia e Azienda ULSS 8 Berica. Tutti e quattro i contesti aziendali hanno avviato processi di riorganizzazione delle interdipendenze tra stabilimenti ospedalieri, in particolare nell\u2019area chirurgica, sotto la spinta di fattori esogeni (standard nazionali, innovazioni tecnologiche, bisogni epidemiologici) ed endogeni (shortage dei medici, clinical competence, volumi attivit\ue0), in parte comuni alle diverse aziende. Le principali logiche e strategie adottate per riorganizzare le interdipendenze sono: i) distribuire il percorso di fruizione dei pazienti nella rete degli stabilimenti; ii) concentrare gli operatori e le attivit\ue0 in funzione di una precisa distribuzione delle attivit\ue0 per tipologia e tasso di specializzazione necessario; iii) far ruotare i team di professionisti tra diversi stabilimenti attraverso la creazione di \ue9quipe itineranti. I casi danno conto di un processo molto avanzato: se in precedenza il mix di competenze (chi), luoghi (dove), problemi da affrontare con l\u2019erogazione di servizi sanitari (che cosa) era tendenzialmente sotto il controllo delle unit\ue0 operative, ora gli elementi del mix diventano progressivamente altrettante variabili su cui l\u2019azienda \ue8 chiamata a decidere nello sforzo di offrire i servizi pi\uf9 adeguati in un quadro di vincoli sempre pi\uf9 stringente. L\u2019adozione, limitata o estesa che sia, di nuove logiche e modalit\ue0 di produzione ed erogazione di servizi implica che le spinte al cambiamento siano riuscite a prevalere rispetto ai fattori di inerzia e alle diverse resistenze. Perch\ue9 ci\uf2 possa avvenire, una adeguata funzione di gestione operativa per rendere evidenti le opportunit\ue0 offerte dalla redistribuzione delle attivit\ue0 e da un migliore utilizzo degli asset produttivi, cos\uec some l\u2019azione dell\u2019azienda e del suo top management per costruire e guidare i processi di cambiamento, sono fondamentali

Molecular dynamics study of Eu3+ in an aqueous solution: Luminescence spectrum from simulated environments

Because doping ions are mainly surrounded by solvent molecules in the early stages of sol—gel processing, the luminescence of rare-earth ions in such an environment is known to be very similar to that observed in aqueous solutions. Thus we performed a molecular dynamics simulation of the trivalent europium in aqueous solution in order to produce a statistical set of environments and to calculate the spectroscopic features thereof. From radial and angular ordering studies, the hydration number of Eu3+ was found to be between eight and nine. The eight-hydrated configurations are nevertheless predominant and present a specific arrangement, according to the geometry of a square antiprism polyhedron. From the whole set of simulated configurations, we computed the ligand field parameters without considering any a priori symmetry. We then calculated the energy splitting of each J manifold and the transition probabilities from the 5D0 emitting state. A simulated luminescent spectrum was finally obtained and compared with the experimental sectrum. In addition to overall good agreement, we were able to analyse the 5D0 → 7F1 transition shape, which revealed a sensitive dependence on the local structure, and especially on the hydration number

Chronic oleoylethanolamide treatment decreases hepatic triacylglycerol level in rat liver by a pparγ/srebp-mediated suppression of fatty acid and triacylglycerol synthesis

none11noOleoylethanolamide (OEA) is a naturally occurring bioactive lipid belonging to the family of N-acylethanolamides. A variety of beneficial effects have been attributed to OEA, although the greater interest is due to its potential role in the treatment of obesity, fatty liver, and eating-related disorders. To better clarify the mechanism of the antiadipogenic effect of OEA in the liver, using a lipidomic study performed by1H-NMR, LC-MS/MS and thin-layer chromatography analyses we evaluated the whole lipid composition of rat liver, following a two-week daily treatment of OEA (10 mg kg−1 i.p.). We found that OEA induced a significant reduction in hepatic triacylglycerol (TAG) content and significant changes in sphingolipid composition and ceramidase activity. We associated the antiadipogenic effect of OEA to decreased activity and expression of key enzymes involved in fatty acid and TAG syntheses, such as acetyl-CoA carboxylase, fatty acid synthase, diacylglycerol acyltransferase, and stearoyl-CoA desaturase 1. Moreover, we found that both SREBP-1 and PPARγ protein expression were significantly reduced in the liver of OEA-treated rats. Our findings add significant and important insights into the molecular mechanism of OEA on hepatic adipogenesis, and suggest a possible link between the OEA-induced changes in sphingolipid metabolism and suppression of hepatic TAG level.openRomano A.; Friuli M.; Del Coco L.; Longo S.; Vergara D.; Del Boccio P.; Valentinuzzi S.; Cicalini I.; Fanizzi F.P.; Gaetani S.; Giudetti A.M.Romano, A.; Friuli, M.; Del Coco, L.; Longo, S.; Vergara, D.; Del Boccio, P.; Valentinuzzi, S.; Cicalini, I.; Fanizzi, F. P.; Gaetani, S.; Giudetti, A. M

Regulatory T cells with multiple suppressive and potentially pro-tumor activities accumulate in human colorectal cancer

Tregs can contribute to tumor progression by suppressing antitumor immunity. Exceptionally, in human colorectal cancer (CRC), Tregs are thought to exert beneficial roles in controlling pro-tumor chronic inflammation. The goal of our study was to characterize CRC-infiltrating Tregs at multiple levels, by phenotypical, molecular and functional evaluation of Tregs from the tumor site, compared to non-tumoral mucosa and peripheral blood of CRC patients. The frequency of Tregs was higher in mucosa than in blood, and further significantly increased in tumor. Ex vivo, those Tregs suppressed the proliferation of tumor-infiltrating CD8(+) and CD4(+) T cells. A differential compartmentalization was detected between Helioshigh and Helios(low) Treg subsets (thymus-derived versus peripherally induced): while Helios(low) Tregs were enriched in both sites, only Helios(high) Tregs accumulated significantly and specifically in tumors, displayed a highly demethylated TSDR region and contained high proportions of cells expressing CD39 and OX40, markers of activation and suppression. Besides the suppression of T cells, Tregs may contribute to CRC progression also through releasing IL-17, or differentiating into Tfr cells that potentially antagonize a protective Tfh response, events that were both detected in tumor-associated Tregs. Overall, our data indicate that Treg accumulation may contribute through multiple mechanisms to CRC establishment and progression

AGILE detection of delayed gamma-ray emission from GRB 080514B

GRB 080514B is the first gamma ray burst (GRB), since the time of EGRET, for which individual photons of energy above several tens of MeV have been detected with a pair-conversion tracker telescope. This burst was discovered with the Italian AGILE gamma-ray satellite. The GRB was localized with a cooperation by AGILE and the interplanetary network (IPN). The gamma-ray imager (GRID) estimate of the position, obtained before the SuperAGILE-IPN localization, is found to be consistent with the burst position. The hard X-ray emission observed by SuperAGILE lasted about 7 s, while there is evidence that the emission above 30 MeV extends for a longer duration (at least ~13 s). Similar behavior was seen in the past from a few other GRBs observed with EGRET. However, the latter measurements were affected, during the brightest phases, by instrumental dead time effects, resulting in only lower limits to the burst intensity. Thanks to the small dead time of the AGILE/GRID we could assess that in the case of GRB 080514B the gamma-ray to X-ray flux ratio changes significantly between the prompt and extended emission phase.Comment: A&A letters, in pres

Agile Detection of Delayed Gamma-Ray Emission from the Short Gamma-Ray Burst GRB 090510

Short gamma-ray bursts (GRBs), typically lasting less than 2 s, are a special class of GRBs of great interest. We report the detection by the AGILE satellite of the short GRB 090510 which shows two clearly distinct emission phases: a prompt phase lasting ~ 200 msec and a second phase lasting tens of seconds. The prompt phase is relatively intense in the 0.3-10 MeV range with a spectrum characterized by a large peak/cutoff energy near 3 MeV, in this phase, no significant high-energy gamma-ray emission is detected. At the end of the prompt phase, intense gamma-ray emission above 30 MeV is detected showing a power-law time decay of the flux of the type t^-1.3 and a broad-band spectrum remarkably different from that of the prompt phase. It extends from sub-MeV to hundreds of MeV energies with a photon index alpha ~ 1.5. GRB 090510 provides the first case of a short GRB with delayed gamma-ray emission. We present the timing and spectral data of GRB 090510 and briefly discuss its remarkable properties within the current models of gamma-ray emission of short GRBs.Comment: Accepted by the Astrophysical Journal Letters on September 11, 200

AGILE Observations of the Gravitational Wave Event GW150914

We report the results of an extensive search in the AGILE data for a gamma-ray counterpart of the LIGO gravitational wave event GW150914. Currently in spinning mode, AGILE has the potential of covering with its gamma-ray instrument 80 % of the sky more than 100 times a day. It turns out that AGILE came within a minute from the event time of observing the accessible GW150914 localization region. Interestingly, the gamma-ray detector exposed about 65 % of this region during the 100 s time intervals centered at -100 s and +300 s from the event time. We determine a 2-sigma flux upper limit in the band 50 MeV - 10 GeV, $UL = 1.9 \times 10^{-8} \rm \, erg \, cm^{-2} \, s^{-1}$ obtained about 300 s after the event. The timing of this measurement is the fastest ever obtained for GW150914, and significantly constrains the electromagnetic emission of a possible high-energy counterpart. We also carried out a search for a gamma-ray precursor and delayed emission over timescales ranging from minutes to days: in particular, we obtained an optimal exposure during the interval -150 / -30 s. In all these observations, we do not detect a significant signal associated with GW150914. We do not reveal the weak transient source reported by Fermi-GBM 0.4 s after the event time. However, even though a gamma-ray counterpart of the GW150914 event was not detected, the prospects for future AGILE observations of gravitational wave sources are decidedly promising.Comment: 20 pages, 6 figures. Submitted to the Astrophysical Journal Letters on April 1, 201

The CMS ECAL Barrel HV system

The CMS electromagnetic calorimeter (ECAL) comprises 75848 scintillating lead tungstate crystals. 61200 crystals are contained in the ECAL Barrel section and are read out by avalanche photodiode (APD) with internal gain of about 50. This gain is achieved with a high voltage (HV) of about 400 Volts. The gain stability requirement implies a supply voltage stable to within 0.01%. We describe our experience with the installed Barrel HV power supply system, which has been used for data taking since 2008

AGILE detection of a strong gamma-ray flare from the blazar 3C 454.3

We report the first blazar detection by the AGILE satellite. AGILE detected 3C 454.3 during a period of strongly enhanced optical emission in July 2007. AGILE observed the source with a dedicated repointing during the period 2007 July 24-30 with its two co-aligned imagers, the Gamma-Ray Imaging Detector and the hard X-ray imager Super-AGILE sensitive in the 30 MeV-50 GeV and 18-60 keV, respectively. Over the entire period, AGILE detected gamma-ray emission from 3C 454.3 at a significance level of 13.8-$\sigma$ with an average flux (E$>$100 MeV) of $(280 \pm 40) \times 10^{-8}$ photons cm$^{-2}$ s$^{-1}$. The gamma-ray flux appears to be variable towards the end of the observation. No emission was detected by Super-AGILE in the energy range 20-60 keV, with a 3-$\sigma$ upper limit of $2.3 \times 10^{-3}$ photons cm$^{-2}$ s$^{-1}$. The gamma-ray flux level of 3C 454.3 detected by AGILE is the highest ever detected for this quasar and among the most intense gamma-ray fluxes ever detected from Flat Spectrum Radio Quasars.Comment: Accepted by Astrophysical Journal Letters; 14 pages, 3 EPS Figures, 1 Tabl