La flessibilità dell´immediatezza per il vincolo al contraddittorio della formazione delle massime d´esperienza

L'immediatezza va intesa in modo flessibile non come criterio epistemologico servente alla sola decisione del giudice, bensì come metodo funzionale innanzi tutto all'argomentazione di parte. In questo modo anche un verbale altamente particolareggiato o una videoregistrazione possono favorire dinanzi ad un giudice mutato le possibilità argomentative dei contendenti, mentre la rinnovazione dell'attività istruttoria si giustifica solo per introdurre un "novum

Il ragionamento probabilistico dei contendenti e non del giudice dibattimentale

Nel dibattimento penale sono i contendenti e non il giudice ad articolare un ragionamento probabilistico. L'organo giudicante nella stessa fase opera solo un controllo logico-formal

Evaluation oj lung epithelial permeability assessed by the pulmonary clearance of 99mTc-DTPA

A taxa de depuração pulmonar do 99mTc-DTPA constitui-se em um índice da permeabilidade epitelial pulmonar. O interesse crescente nesta técnica diagnóstico decorre de sua natureza não-invasiva, da facilidade de repetições das medidas, de seu relativo baixo custo e, principalmente, de sua elevada sensibilidade em detectar precocemente a lesão pulmonar. Este artigo revisa os princípios básicos e as aplicações desta técnica, procurando dar ênfase a seu uso como método diagnóstico na prática clínica.The pulmonary clearance of 99mTc-DTPA is an index of lung epithelial permeability. The raising interest in this diagnostic technique is due to its noninvasive nature, to the ability of having the measurements easily repeated, to its relatively low cost and, specially, to its high sensitivity to detect a lung injury in an early stage. This article reviews the basic principies and the aplicability of this technique, giving emphasis to its use as a diagnostic method in the clinicai practice

A model for network-based identification and pharmacological targeting of aberrant, replication-permissive transcriptional programs induced by viral infection.

SARS-CoV-2 hijacks the host cell transcriptional machinery to induce a phenotypic state amenable to its replication. Here we show that analysis of Master Regulator proteins representing mechanistic determinants of the gene expression signature induced by SARS-CoV-2 in infected cells revealed coordinated inactivation of Master Regulators enriched in physical interactions with SARS-CoV-2 proteins, suggesting their mechanistic role in maintaining a host cell state refractory to virus replication. To test their functional relevance, we measured SARS-CoV-2 replication in epithelial cells treated with drugs predicted to activate the entire repertoire of repressed Master Regulators, based on their experimentally elucidated, context-specific mechanism of action. Overall, 15 of the 18 drugs predicted to be effective by this methodology induced significant reduction of SARS-CoV-2 replication, without affecting cell viability. This model for host-directed pharmacological therapy is fully generalizable and can be deployed to identify drugs targeting host cell-based Master Regulator signatures induced by virtually any pathogen

Impacto da implantação da terceira fase do protocolo assistencial de asma aguda no setor de adultos do serviço de emergência

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Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London