in keeping with the spirit of the albertine statute constitutionalisation of the national unification

This chapter deals with the difficult process of constitutionalisation which characterised Italian Unification. Constitutionalisation is a long-term phenomenon which had the purpose of giving constitutional forms to the Nation. The promulgation of the Albertine Statute is more the start than the arrival of this phenomenon. The focus of this investigation is, therefore, to study the Constitution through its evolution paying particular attention to the process of legal integration within the structures of the Albertine Statute and to the amendment mechanisms of the constitutional text. The preamble of the Albertine Statute speaks of «perpetual and irrevocable fundamental law». The word «perpetual» meant the prohibition of revoking constitutional concession, while the word «irrevocable» was intended as a pact between the Sovereign and the Nation. Over the years, very few were the changes to the letter of the Albertine Statute. The interpretation and the practice represented the most important mechanisms of constitutional change (implicit constitutional changes). A primary role was acknowledged to non-written norms. In this perspective, it may well be said that the Italian Constitution consisted in something more than the written text and dwelt in the spirit and not in the letter of the Albertine Statute

POS1406 DEVELOPMENT OF A DIAGNOSTIC ALGORITHM FOR THE DIFFERENTIAL DIAGNOSIS OF INTERSTITIAL LUNG DISEASE: PRELIMINARY DATA FROM A MULTICENTER RETROSPECTIVE CASE-CONTROL STUDY

Background: Interstitial lung diseases (ILDs) represent a heterogeneous group of disorders with different treatment and prognosis. ILD may be the presenting or the dominant manifestation of a connective tissue disease (CTD). Multidisciplinary team (MDT) discussion is currently the diagnostic standard. However, there is no consensus on how MDT diagnosis is validated and on the core elements of discussion. Objectives: To explore the performance of a diagnostic algorithm for the differential diagnosis of ILD based on clinical, serological and radiological data, supporting clinician decision-making. Methods: In this retrospective study, analysis was performed on clinical, serological and radiological features at diagnosis and 1-year follow-up in 71 patients, including 41 with CTD-ILD and 30 with idiopathic interstitial pneumonias (IIPs). In order to identify robust hallmarks, we conducted the Receiver Operating Characteristic (ROC) curve analyses in logistic regression, to discriminate significantly different features between CTD-ILD and non-CTD-ILD groups. Results: Out of 71 patients 46% were women, with a mean age of 66±11 years. History of smoking (8.8% current and 39.8% former smokers), was more associated with IIPs. 54% of patients had dyspnea on exertion and 39% dry cough, both more frequently associated with IIPs (p = 0.016). Among radiological features, NSIP pattern was more frequent in CTD-ILD, while UIP was associated with IIP. Lung fibrosis extent was greater in IIP (p = 0.063), in which CT is generally performed in symptomatic patients at diagnosis and rarely for screening purpose. Baseline features with good performance (OR p-value ≤ 0.05) were eligible as potential candidate discriminators: age, sex, smoking habit, rheumatological signs and symptoms, autoantibodies, ILD patterns were selected, to build a multivariate model with high discrimination accuracy (AUC 0.971). The model has a sensitivity of 100% and specificity of 89.7%. The most relevant correlations between population features and CTD-ILD are presented in Table 1. Conclusion: Our study shows that the most important variables in the differential diagnosis between CTD-ILD versus IIPs include, as expected, autoimmune features (rheumatological symptoms and serological data). Questionnaire tool containing these specific hallmarks may be relevant during MDT discussion, limiting the number of misdiagnosed CTD-ILDs and potentially avoiding further unnecessary investigations. However, only prospective cohort studies of early onset ILD are needed to fully validate the relative importance of clinical, serological, functional and radiological data

The Modeling of Time-Dependent Deformation and Fracturing of Brittle Rocks Under Varying Confining and Pore Pressures

International audienceA numerical hydro-mechanical model for brittle creep is proposed to describe the time-dependent deformation of heterogeneous brittle rock under constant confining and pore pressures. Material heterogeneity and a local material degradation law are incorporated into the model at the mesoscale which affects the mechanical behavior of rocks to capture the co-operative interaction between microcracks in the transition from distributed to localized damage. The model also describes the spatiotemporal acoustic emissions in the rock during the progressive damage process. The approach presented in this contribution differs from macroscopic approaches based on constitutive laws and microscopic approaches focused on fracture propagation. The model is first validated using experimental data for porous sandstone and is then used to simulate brittle creep tests under varying constant confining and pore pressures and applied differential stresses. We further explore the influence of sample homogeneity on brittle creep. The model accurately replicates the classic creep behavior observed in laboratory brittle creep experiments. In agreement with experimental observations, our model shows that decreasing effective pressure, increasing the applied differential stress, and decreasing sample homogeneity increase the creep strain rate and decrease the time-to-failure, respectively. The model shows that complex macroscopic time-dependent behavior can be explained by the microscale interaction of elements. The fact that the simulations are able to capture a similar hydro-mechanical time-dependent response to that of laboratory experiments implies that the model is an appropriate tool to investigate the complex time-dependent behavior of heterogeneous brittle rocks under coupled hydro-mechanical loading