Perinatal outcomes in twin late preterm pregnancies: results from an Italian area-based, prospective cohort study

Background Multiple gestations represent a considerable proportion of pregnancies delivering in the late preterm (LP) period. Only 30% of LP twins are due to spontaneous preterm labor and 70% are medically indicated; among this literature described that 16-50% of indicated LP twin deliveries are non-evidence based. As non-evidence-based delivery indications account for iatrogenic morbidity that could be prevented, the objective of our observational study is to investigate first neonatal outcomes of LP twin pregnancies according to gestational age at delivery, chorionicity and delivery indication, then non evidence-based delivery indications. Methods Prospective cohort study among twins infants born between 34 + 0 and 36 + 6 weeks, in Emilia Romagna, Italy, during 2013-2015. The primary outcome was a composite of adverse perinatal outcomes. Results Among 346 LP twins, 84 (23.4%) were monochorionic and 262 (75.7%) were dichorionic; spontaneous preterm labor accounted for 85 (24.6%) deliveries, preterm prelabor rupture of membranes for 66 (19.1%), evidence based indicated deliveries were 117 (33.8%), while non-evidence-based indications were 78 (22.5%). When compared to spontaneous preterm labor or preterm prelabor rupture of membranes, pregnancies delivered due to maternal and/or fetal indications were associated with higher maternal age (p < 0.01), higher gestational age at delivery (p < 0.01), Caucasian race (p 0.04), ART use (p < 0.01), gestational diabetes (p < 0.01), vaginal bleeding (p < 0.01), antenatal corticosteroids (p < 0.01), diagnosis of fetal growth restriction (FGR) (p < 0.01), and monochorionic (p < 0.01). Two hundred twenty-six pregnancies (65.3%) had at least one fetus experiencing one composite of adverse perinatal outcome. Multivariate analysis confirmed that delivery indication did not affect the composite of adverse perinatal outcomes; the only characteristic that affect the outcome after controlling for confounding was gestational age at delivery (p < 0.01). Moreover, there was at least one adverse neonatal outcome for 94% of babies born at 34 weeks, for 73% of those born at 35 weeks and for 46% of those born at 36 weeks (p < 0.01). Conclusion Our study suggests that the decision to deliver or not twins in LP period should consider gestational age at delivery as the main determinant infants' prognosis. Delivery indications should be accurately considered, to avoid iatrogenic early birth responsible of preventable complications

Моделирование магнетронной распылительной системы методом конечных элементов

В работе проведено моделирование магнетронной распылительной системы методом конечных элементов и методом Галеркина. Получены распределения концентрации и скоростей носителей заряда, распределение электрического потенциала и магнитного поля, рассмотрены временные зависимости физических величин. Разработано программное обеспечение для моделирования сложных физических задач. Проведена верификация расчетного алгоритма на примере решения модельных задач. Отличительной особенностью исследуемой модели от существующих является учет нестационарного и конвективного слагаемых в уравнении для переноса скорости электрона и максимально точная реализация всех слагаемых в дифференциальном уравнении (в рамках метода Галеркина).The dissertation examines the modeling of a magnetron sputtering system by finite element analysis and Galerkin method. The model makes it possible to calculate the concentration, velocity, temperature, electrical potential and magnetic field. The methods and the code developed according to the model are usable for modeling complex physical tasks. The work also includes analysis and verification of results

Una giustizia diversa. Il modello riparativo la questione penale

Il volume muove dalla critica del concetto classico di giustizia fondato sulla corrispettività dei comportamenti ed espresso dall’immagine della bilancia. Su questa base, si argomenta che l’agire in rapporto al male non può consistere nella ripetizione del male, ma deve assumere i contorni di una progettazione pur sempre secondo il bene di tutte le parti coinvolte, che tenda a rendere nuovamente giusti rapporti interpersonali e sociali segnati dal male: nel solco della c.d. giustizia riparativa (restorative justice). Le buone ragioni di quest’ultima vengono approfondite attraverso apporti di carattere multidisciplinare (giuridico, teologico, filosofico, pedagogico, letterario, psicologico). Se ne considerano le potenzialità, soprattutto, con riguardo alle esigenze di riforma dei sistemi sanzionatòri penali e, in tale ambito, con riguardo a una comprensione non semplificatoria delle dinamiche di prevenzione dei reati. Si evidenzia, peraltro, che il tema affrontato, se trova nella problematica penale il contesto più facilmente percepibile, rappresenta un nodo culturale cardine della nostra civiltà, che investe le questioni della guerra e della pace, dei rapporti politici, delle relazioni intersoggettive