The ELENA Programme in the Province of Chieti - A Public Private Partnership Best Practice Improving Energy Efficiency of Buildings and Public Lighting Systems

Public Private Partnership initiatives and models are proven, scalable and internationally-recognized procurement methods for reducing the operating costs and improve environmental quality of public bodies. However, there are still barriers to overcome. Local communities’ engagement, lack of technical knowledge and financing constraints are just some topics that still need reliable solutions. The governance model that is adopted for the “Chieti Towards 2020” Project, which was funded under the European Local Energy Assistance in the 2012-2014 period, try to operate a "glocal" synthesis between local instances and global issues. A mixed bottom-to-top and top-to-bottom approach involves local communities’ trying to address requirements through centralized, high-level management and coordination activities. To date, the most relevant Project outcomes consist of 87 municipalities involved, a structured database of energy audit and data about 144 buildings and about 46,000 public light points. Moreover, an effective engagement of public and private stakeholders lays the foundation for a strong Energy Performance Contract framework able to leverage financing based on minimum guaranteed energy savings of 20% in respect to baseline values

The ELENA Programme in the Province of Chieti - A Public Private Partnership Best Practice Improving Energy Efficiency of Buildings and Public Lighting Systems

Public Private Partnership initiatives and models are proven, scalable and internationally-recognized procurement methods for reducing the operating costs and improve environmental quality of public bodies. However, there are still barriers to overcome. Local communities’ engagement, lack of technical knowledge and financing constraints are just some topics that still need reliable solutions. The governance model that is adopted for the “Chieti Towards 2020” Project, which was funded under the European Local Energy Assistance in the 2012-2014 period, try to operate a "glocal" synthesis between local instances and global issues. A mixed bottom-to-top and top-to-bottom approach involves local communities’ trying to address requirements through centralized, high-level management and coordination activities. To date, the most relevant Project outcomes consist of 87 municipalities involved, a structured database of energy audit and data about 144 buildings and about 46,000 public light points. Moreover, an effective engagement of public and private stakeholders lays the foundation for a strong Energy Performance Contract framework able to leverage financing based on minimum guaranteed energy savings of 20% in respect to baseline values

A resilience view on health system resilience:a scoping review of empirical studies and reviews

BACKGROUND: Prompted by recent shocks and stresses to health systems globally, various studies have emerged on health system resilience. Our aim is to describe how health system resilience is operationalised within empirical studies and previous reviews. We compare these to the core conceptualisations and characteristics of resilience in a broader set of domains (specifically, engineering, socio-ecological, organisational and community resilience concepts), and trace the different schools, concepts and applications of resilience across the health literature. METHODS: We searched the Pubmed database for concepts related to 'resilience' and 'health systems'. Two separate analyses were conducted for included studies: a total of n = 87 empirical studies on health system resilience were characterised according to part of health systems covered, type of threat, resilience phase, resilience paradigm, and approaches to building resilience; and a total of n = 30 reviews received full-text review and characterised according to type of review, resilience concepts identified in the review, and theoretical framework or underlying resilience conceptualisation. RESULTS: The intersection of health and resilience clearly has gained importance in the academic discourse with most papers published since 2018 in a variety of journals and in response to external threats, or in reference to more frequent hospital crisis management. Most studies focus on either resilience of health systems generally (and thereby responding to an external shock or stress), or on resilience within hospitals (and thereby to regular shocks and operations). Less attention has been given to community-based and primary care, whether formal or informal. While most publications do not make the research paradigm explicit, 'resilience engineering' is the most prominent one, followed by 'community resilience' and 'organisational resilience'. The social-ecological systems roots of resilience find the least application, confirming our findings of the limited application of the concept of transformation in the health resilience literature. CONCLUSIONS: Our review shows that the field is fragmented, especially in the use of resilience paradigms and approaches from non-health resilience domains, and the health system settings in which these are used. This fragmentation and siloed approach can be problematic given the connections within and between the complex and adaptive health systems, ranging from community actors to local, regional, or national public health organisations to secondary care. Without a comprehensive definition and framework that captures these interdependencies, operationalising, measuring and improving resilience remains challenging.</p

Post mortem computed tomography meets radiomics: a case series on fractal analysis of post mortem changes in the brain

Estimating the post-mortem interval is a fundamental, albeit challenging task in forensic sciences. To this aim, forensic practitioners need to assess post-mortem changes through a plethora of different methods, most of which are inherently qualitative, thus providing broad time intervals rather than precise determinations. This challenging problem is further complicated by the influence of environmental factors, which modify the temporal dynamics of post-mortem changes, sometimes in a rather unpredictable fashion. In this context, the search for quantitative and objective descriptors of post-mortem changes is highly demanded. In this study, we used computed tomography (CT) to assess the post-mortem anatomical modifications occurring in the time interval 0–4&nbsp;days after death in the brain of four corpses. Our results show that fractal analysis of CT brain slices provides a set of quantitative descriptors able to map post-mortem changes over time throughout the whole brain. Although incapable of producing a direct estimation of the PMI, these descriptors could be used in combination with other more established methods to improve the accuracy and reliability of PMI determination

Elimination of T cell reactivity to pancreatic β cells and partial preservation of β cell activity by peptide blockade of LFA-1:ICAM-1 interaction in the NOD mouse model

In insulin dependent diabetes mellitus (T1D), self-reactive T cells infiltrate pancreatic islets and induce beta cell destruction and dysregulation of blood glucose. A goal is to control only the self-reactive T cells, leaving the remainder of the T cell population free to protect the host. One approach is blockade of the second signal for T cell activation while allowing the first (antigen-specific) signal to occur. This work proposes that small peptides that block interaction of second signals delivered through the counter receptors LFA-1:ICAM-1 will induce attacking T cells (receiving the antigen signal) to become anergic or undergo apoptosis. In NOD mice, the peptides eliminated T cell reactivity against pancreatic antigens and reduced cellular infiltration into islets, which retained stronger density of insulin staining at five weeks after cessation of therapy. In in vitro studies the peptides induced nonresponsiveness during activation of T cells from mice and from human peripheral blood

Estimation of the time of death by measuring the variation of lateral cerebral ventricle volume and cerebrospinal fluid radiodensity using postmortem computed tomography

Using postmortem CT (PMCT), changes in the volume of the lateral cerebral ventricles (LCVs) and modifications of the radiodensity of cerebrospinal fluid (CSF) have been examined to identify a possible relationship between these changes and the time of death. Subsequent periodical CT scans termed “sequential scans” for ten corpses at known time of death were obtained, and a 3D segmentation of the entire LCV was carried out to measure its volume and radiodensity over time from ~ 5.5- h up to 273-h postmortem. A linear decrease of the LCV volume for all the cases was observed in the investigated time range, together with an overall logarithmic increase of radiodensity. Although a larger sampling should be performed to improve the result reliability, our finding suggests that the postmortem variation of CSF radiodensity can be a potentially useful tool in determining postmortem interval, a finding that is worthy of further investigation

Cross-reactive neutralizing antibody epitopes against Enterovirus 71 identified by an in silico approach

Currently, infections of hand, foot and mouth disease HFMD) due to Human Enterovirus 71 (EV71) cannot be prevented or treated, as there are no suitable vaccines or antiviral drugs. This study aimed to identify potential vaccine candidates for EV71 using in silico analysis of its viral capsid proteins. A combined in silico approach utilizing computational hidden Markov model (HMM), propensity scale algorithm, and artificial learning, identified three 15-mer structurally conserved B-cell epitope candidates lying within the EV71 capsid proteins. Peptide vaccine candidates incorporating a target B-cell epitope and a promiscuous T-cell epitope from the related polio virus were synthesized using solid-phase Fmoc chemistry. Inbred BALB/C mice which were inoculated with two 10μg doses of the synthetic peptide, generated anti-peptide antibodies. Purified IgG isolated from pooled sera of the inoculated mice neutralized EV71 infections in vitro. Furthermore, these neutralizing antibodies were cross-reactive against other members of the Picornaviridae family, demonstrating greater than 50% virus neutralization. This indicates that the current approach is promising for the development of synthetic peptide-based vaccine candidates against Picornaviridae. Development of effective vaccines is of paramount importance in managing the disease in the Asia Pacific regions where this virus is endemic and has significant social, economic and public health ramifications

Hospital-based Health Technology Management: Analysing the Procurement Process from a Network Perspective

From a practical perspective, the UK, like so many other countries, is struggling to have a complete HTM implementation. The sources suggest that British health care managers face financial and personnel availability pressures, and this makes it difficult to follow the instructions provided by the various organizations for the implementation of HTM activities including procurement. It is worth mentioning that the guidelines and decision-making frameworks provided by national organizations and various authors, mainly follow a project-based approach, characterized by linear HTM implementation/decision-making, and usually focusing on purely technical and legislative aspects of HTM. However, the health care sector, as well as procurement of medical devices, is characterised by complexity, constitutes an interconnected network of actors, parties and policies, and it is mainly context-dependent. Therefore, in addition to technical and legislative advice, it would be sensible to train health care managers in recognising the presence of internal networking relationships, and how to negotiate with all the actors involved in the different procurement, or more in general HTM, activities. From an academic perspective, almost all the articles analysing procurement aim to identify potential challenges, mainly related to financial and technical concerns, and subsequently provide decision-making frameworks to indicate the right path to follow when deciding which device to purchase. Very few articles perform a satisfactory analysis of the main actors involved during the procurement process and their responsibilities. Moreover, no attempts have been made to look at hospital-based procurement from a networking perspective and apply ‘Management in Networks’ theories and strategy to understand and improve it. Considering the aforementioned practical and academic issues, this study wants to investigate how hospital-based procurement could be analysed under the network point of view. Therefore, this dissertation wants to propose a new way of looking at hospital-based procurement, taking into account the presence of potential internal networks and interactions proper of an interconnected world. More specifically, this thesis project aims to provide a satisfactory description of the main procurement activities performed within the hospital, inform about who are the actors involved, how they interact, how/if they follow specif guidelines, and the main challenges encountered. Once the author will arrive at a satisfactory description of hospital-based procurement, she will analyse this last one under the paradigms of an interconnected world, explaining how the various networking strategies and paradigms can be used to understand and analyse hospital-based procurement. Finally, this research will identify factors that could be addressed by health care decision-makers to manage technology successfully. In particular, this study intends to identify valuable strategies for technology management decision-making and activities, to detect which one should be addressed by hospitals, and to establish technology management system priorities for health care managers and clinical engineers.Management of Technology (MoT

Derrida: Deconstruction of the Ethical-Legal-Political. Methodological Clarification

The answer the urgent question of what is happening today we require categories that can be open and welcoming towards these epoch-changing times and consequences thereof. To Nietzsche’s ethical turning point, the unprecedented ethical-political crisis and the new soft totalitarianism, Derrida responds with the experience of the absolute precedence of ethics of E.Levinas. At the heart of his ethics of hospitality and deconstruction we encounter justice and law. It is precisely this dimension of the structural aporetic reciprocal interpenetration between “ethical” and “juridical” that leads to a new idea of the “political”, the highest form of which is “democracy to come”.</jats:p

Nanoeterostrutture a base di oro e ossidi di ferro: effetto dei parametri sintetici su morfologia e dimensione

In questo lavoro di tesi sono state sintetizzate nanoparticelle eterostrutturate composte da oro e ossidi magnetici. È stato studiato l’effetto di vari parametri sintetici, come il tipo di precursori, il solvente utilizzato e i tensioattivi aggiunti sulla morfologia e sulla dimensione del prodotto. Le nanoparticelle sintetizzate sono state caratterizzate tramite diverse tecniche analisi: microscopia elettronica, diffrazione di raggi X di polveri, spettroscopia di emissione atomica, magnetometria e spettroscopia UV-VIS. Una selezione delle nanoparticelle sintetizzate è stata trasferita in fase acquosa e su di esse sono state eseguite misure di ipertermia magnetica. In this work heterostructured nanoparticles composed of gold and magnetic oxides were synthesized. We studied the effect of various synthetic parameters, such as the type of precursors, the solvent and the surfactants on the morphology and size of the product. The synthesized nanoparticles were characterized by different analysis techniques: electron microscopy, X-ray diffraction of dust, atomic emission spectroscopy, magnetometry and UV-VIS spectroscopy. A selection of the synthesized nanoparticles was transferred to aqueous phase and magnetic hyperthermia measurements were performed on them