Metodi matematici per l'analisi dell'andatura

Il riconoscimento di una persona è una componente essenziale nella sicurezza o, più nello specifico, nella videosorveglianza. In particolare sono pochissime le tecniche biometriche utilizzabili in una situazione in cui c'è bisogno di un riconoscimento a distanza, o in cui serva poter non interferire con l'attività del soggetto da identificare. L'analisi dell'andatura, della deambulazione, del cammino, è tra queste ed ha un importante potenziale: le informazioni utili possono essere estratte da molti punti di vista diversi e, soprattutto, a distanze maggiori rispetto ad altri approcci biometrici, come l'analisi dell'iride o il riconoscimento facciale. In più, a differenza del riconoscimento tramite impronta digitale, non c'è bisogno di un interazione dell'individuo con l'ambiente. In quest'elaborato vengono presentati, dopo una breve analisi dello stato dell'arte e dopo un'introduzione dei prerequisiti matematici necessari, due metodi per il riconoscimento dell'andatura, il primo basato sulla Teoria dell'Informazione, l'altro sulla Topologia Persistente. Entrambi gli approcci vengono testati su due esperimenti diversi, e il secondo metodo si mostra più performante del primo soprattutto nel secondo esperimento, dove nelle andature gli individui della gallery sono sotto particolari condizioni non note a priori che influenzano l'andatura o la silhouette del soggetto (trasportare oggetti, indossare un particolare abbigliamento...)

Assessing the development and implementation of the Global Trigger Tool method across a large health system in Sicily

Background: The Institute for Healthcare Improvement (IHI) has proposed a new method, the Global Trigger Tool (IHI GTT), to detect and monitor adverse events (AEs) and provide information to implement improvement. In 2015, the Sicilian Health System adopted IHI GTT to assess the number, types and severity levels of AEs. The GTT was implemented in 44 of 73 Sicilian public hospitals and 18,008 clinical records (CRs) were examined. Here we present the standardized application of the GTT and the preliminary results of 14,706 reviews of CRs. Methods: IHI GTT was adapted, developed and implemented to the local context. Reviews of CRs were conducted by 199 professionals divided into 71 review teams consisting of three individuals: two of whom had clinical knowledge and expertise, and a physician to authenticate the AE. The reviewers entered data into a dedicated IT-platform. All 44 of the public hospitals were included, with approximately 300,000 yearly inpatient admissions out of a population of approximately 5 million. In total, 14,706 randomized CRs of inpatients from medicine, surgery, obstetric and ICU wards, from June 2015 to June 2018 were reviewed. Results: In 975 (6.6%) CRs at least one AE was found. Approximately 20,000 patients of the 300,000 discharged each year in Sicily have at least one AE. In 5,574 (37.9%) CRs at least one trigger was found. A total of 1,542 AEs were found. The analysis of ROC curve shows that the presence of two triggers in a CR indicates with high probability the presence of an AE. The most frequent type of AE was in-hospital related infection. Conclusions: The GTT is an efficient method to identify AEs and to track improvement of care. The analysis and monitoring of some triggers is important to prevent AEs. However, it is a labor-intensive method, particularly if the CRs are paper-based

Quantum computing and post-quantum cryptography

One of the main practical implications of quantum mechanical theory is quantum computing, and therefore the quantum computer. Quantum computing (for example, with Shor’s algorithm) challenges the computational hardness assumptions, such as the factoring problem and the discrete logarithm problem, that anchor the safety of cryptosystems. So the scientific community is studying how to defend cryptography; there are two defense strategies: the quantum cryptography (which involves the use of quantum cryptographic algorithms on quantum computers) and the post-quantum cryptography (based on classical cryptographic algorithms, but resistant to quantum computers). For example, National Institute of Standards and Technology (NIST) is collecting and standardizing the post-quantum ciphers, as it established DES and AES as symmetric cipher standards, in the past. In this thesis an introduction on quantum mechanics was given, in order to be able to talk about quantum computing and to analyze Shor’s algorithm. The differences between quantum and post-quantum cryptography were then analyzed. Subsequently the focus was given to the mathematical problems assumed to be resistant to quantum computers. To conclude, post-quantum digital signature cryptographic algorithms selected by NIST were studied and compared in order to apply them in today’s life

Birth in Italy between outcomes, appropriateness and responsibility

Maternal mortality and morbidity related to perinatal events are increasingly rare in advanced countries. Maternal death events represent an indicator of the overall health and development conditions of a country. In Italy, similarly to other industrialized countries, the maternal mortality ratio has been approximately 3 cases per 100,000 live births. However, recently, it has been measured as 11 cases per 100,000 live births, with a severe maternal morbidity rate of 2‰. The neonatal mortality rate has been, instead, constant at approximately 2.4‰ live births, with a rate of childhood cerebral palsy of 2‰. The incidence of caesarean section in Italy is 38% on average. It is the highest in Europe, with significant regional differences. The higher incidence is observed in the birth centres of South-Italy and in those with a fewer number of deliveries. The whole “birth pathway” should be organized and planned on a regional basis according to the models of organizational network of perinatal care by Hub & Spoke and according to the principles ratified by the GL (guidelines) on the Charter of Services N. 2/95, such as: equity, accountability, participation, quality and safety of care, humanization. However, an obstacle to the implementation of this program is represented by the exponential and manufactured increase of medico-legal controversies (+ 250% of complaints over the last 15 years) with over 98% of acquittal in favour of the doctors for the Supreme Court. This issue discredits the entire medical profession and is responsible for the recourse to defensive medicine which drains each year 10bn euros. Therefore, a joined action among the legislature, the professional associations and the civil society is needed.   Proceedings of the 10th International Workshop on Neonatology · Cagliari (Italy) · October 22nd-25th, 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgio

Integrated neurocognitive therapy in chronic schizophrenic inpatients: preliminary data and considerations

RIASSUNTO. Background. Il presente lavoro si propone di approfondire l’efficacia della Terapia Neurocognitiva Integrata (INT) secondo il modello di Roder in un gruppo di schizofrenici cronici in condizione di residenzialità a lungo termine. Questo tipo di trattamento appare particolarmente interessante perché, nell’ottica dei più recenti studi relativi alla schizofrenia come disturbo del neurosviluppo, permette di agire sulle aree neuro- e socio-cognitive, che sono quelle maggiormente deteriorate. In più, il programma INT prevede l’uso di attività assistite con il computer (Cog Pack), anch’esse con comprovata efficacia sulla neurocognizione. Materiali e metodi. Il campione dello studio è formato da 10 pazienti affetti da schizofrenia (diagnosi DSM-5), di cui 5 M e 5 F, età media 52 aa, durata media di malattia 24,9 aa, con Q.I. non <80, in situazione di residenzialità a lungo termine. Il campione ha partecipato per un periodo di 18 mesi al programma INT ed è stato valutato tramite la batteria neurocognitiva RBANS e MCST (versione modificata del WCST per l’indagine delle funzioni esecutive: astrazione, categorizzazione, set shifting) all’inizio del trattamento (T0), dopo 12 mesi (T1) e alla fine dello stesso, dopo 18 mesi (T2). Risultati. Per quanto riguarda la neurocognizione, dall’analisi dei risultati preliminari l’unica significatività statistica riguarda il fattore tempo, relativamente alla memoria immediata misurata con la RBANS a T2. Si evidenzia anche una tendenza al miglioramento nelle valutazioni T1 per le singole funzioni cognitive e per il profilo cognitivo generale. Relativamente alle funzioni esecutive (MCST), pur in assenza di significatività statistica, è presente una generale tendenza al miglioramento (categorie completate, errori perseverativi ed errori non perseverativi). Conclusioni. I dati presentati, pur nel limite di un campione numericamente ridotto, consentono però un’ottimistica visione relativamente all’impiego nella riabilitazione di soggetti schizofrenici in condizioni di residenzialità a lungo termine della INT, confermando sostanzialmente i dati presenti in letteratura. Particolare attenzione va posta anche alla valutazione dei programmi computerizzati, il cui utilizzo può aiutare il funzionamento sociocognitivo generale. È da auspicare che successivi e più ampi studi concorrano a supportare quanto qui preliminarmente presentato e discusso.BACKGROUND: The present paper aims at studying the efficacy of the Integrated Neurocognitive Therapy (INT), according to Roder's model, in a group of chronic schizophrenics in a long term residential condition. This kind of treatment is particularly interesting because, according to the most recent studies concerning schizophrenia as a neurodevelopmental disorder, allows to act on the neuro- and socio- cognitions areas, which are the most deteriorated ones. Moreover the INT program includes also computer aided activities (Cog PacK), which largely proved their efficacy on neurocognition. MATERIALS AND METHODS: The study sample consists of 10 inpatients suffering of Schizophrenia (according to DSM-5), 5 Male and 5 Female, average age 52, disorder average length 24,9 years, with IQ not <80. The sample took part in the 18 months INT program and has been evaluated through the neurocognitive set RBANS and MCST (modified version of WCST for the survey of the executive functions: abstraction, categorization, set shifting at the beginning of the treatment (T0), after 12 months (T1), and at its end, after 18 months (T2). RESULTS: As regards neurocognition, starting from the preliminary result analysis, the only statistical significance refers to time factor concerning the immediate memory measured by RBANS at T2. We can also point out an improvement trend in T1 evaluations for the single cognitive functions and for the general cognitive profile. Concerning the executive functions (MCST), even without any statistical significance, a general improvement trend is present (completed categories, persisting and not persisting mistakes). CONCLUSIONS: The data presented, even in a numerically reduced sample, encourage however an optimistic perspective concerning the INT rehabilitation use in schizophrenic inpatients, substantially confirming the data already present in literature. We have to pay specific attention even in the evaluation of computerized programs, whose use can aid the general sociocognitive functioning. We hope that later and wider studies will support what we have herein preliminarly presented and discussed

Il modello organizzativo dipartimentale nel Servizio sanitario nazionale: risultati dell\u2019indagine nazionale

During the \u201990s the Italian national health service has undergone important reforms. These introduced new organizational and managerial models within hospitals. The main aim of the new organizational model, named clinical directorate, is the coordination of specialized care services. Moreover clinical directorates have been recognised as the context in which clinical governance tools can be developed. The study presents methods and results of a national wide survey of the introduction of clinical directorates in Italian public hospitals and local health units performed in 2005. The survey was conducted by Italian Ministry of Health in collaboration with the Catholic University of the Sacred Heart, Rome

Activity restriction for women with arrested preterm labor: a randomized controlled trial

Objective: This study aimed to test the hypothesis that in women with singleton pregnancy and arrested preterm labor, activity restriction would reduce the rate of preterm birth at <37 weeks of gestation. Study design: This was a parallel-group nonblinded randomized trial conducted at a single center in Italy. Eligible patients were those with a diagnosis of arrested preterm labor, defined as not delivering after 48 hours of hospitalization for threatened preterm labor, with transvaginal ultrasound cervical length ≤25 mm, no other symptoms of possible uterine contractions, and cervical dilatation <3 cm at pelvic examination. Inclusion criteria were singleton pregnancies between 24 0/7 and 33 6/7 weeks of gestation. Participants were randomized in a 1:1 ratio to either activity restriction at the time of discharge or no activity restriction. Women in the intervention group were recommended activity restriction, defined as the following: pelvic rest, prohibition of sexual activity, and reduction of work and/or nonwork activity. The primary endpoint was preterm birth at <37 weeks of gestation. Results: A total of 120 participants were included in the trial; 60 patients were enrolled in the activity restriction group and 60 in the control group. Preterm birth at <37 weeks of gestation occurred in 15 of 60 women (25.0%) in the activity restriction group and 23 of 60 women (38.3%) in the control group (relative risk, 0.65; 95% confidence interval, 0.38-1.12). There was no significant between-group difference in the incidence of preterm birth at <32 weeks and in neonatal outcomes, but the trial was not powered for these outcomes. Conclusion: In singleton gestations with arrested preterm labor, activity restriction, including pelvic rest, prohibition of sexual activity, and reduction of work and/or nonwork activity, does not result in a lower rate of preterm birth at <37 weeks. Given the evidence on the lack of benefits, use of activity restriction in this population should be discouraged

Antibiotic Consumption and Resistance during a 3-Year Period in Sicily, Southern Italy

Antimicrobial resistance (AMR) is one of the biggest issues facing global public health. In 2017, Italy adopted its first National Action Plan on Antimicrobial Resistance 2017&ndash;2020, which works through the synergy between national, regional, and local levels. In the framework of a Regional Action Plan on healthcare-associated infections and AMR prevention, the Sicilian Health Authority of the Sicilian Region, Southern Italy, has implemented a surveillance system of antibiotic consumption in hospitals, in the community, and of resistance rates (RRs) in hospital settings. Data on antibiotic consumption and on antibiotic RRs have been collected from 2015 to 2017 from pharmacies and laboratories of participating hospitals and from community, respectively. Data on antibiotic consumption showed that the most consumed antibiotics in hospitals were fluoroquinolones in 2015, penicillin in 2016, and beta-lactams in 2017. From 2015 to 2017, data on Klebsiella pneumoniae showed significant increasing RRs to all antibiotic classes, except to carbapenems. RRs of third-generation cephalosporins and carbapenems Escherichia coli showed significant decreasing trends. RRs of the other microorganisms did not change significantly during the study period. The results from the present study show that in Sicily, the use of antibiotics and RRs for selected microorganisms are at a high level. Immediate strategies are needed to decrease the inappropriate usage of antibiotics and control the spread of AMR

Cosa c’è di nuovo sulle infezioni correlate all’assistenza nelle strutture residenziali per anziani in Italia? I risultati del progetto europeo HALT2

In the period April May 2013, the European Centre for disease Prevention and Control funded the HALT 2 project to promote the awareness on the healthcare acquired infection (HAI) and antimicrobial use in long term care facilities. During a point prevalence survey a set of indicators were collected in order to describe infection control resources and antimicrobial policy, population care load and risk factors, sites of infections and antimicrobial prescriptions. In Italy participated 235 voluntary facilities in 11 regions including 18418 residents. Most of them were older than 85 years and exposed at various risk factors as catheters or wounds. The observed prevalence of HAI was 3,3%, respiratory, urinary and skin infections were the most reported. Prevalence of antimicrobials was 4%, most of them were third generation cephalosporins, fluoroquinolones or penicillins and inhibitors given for therapy. Although written protocols are widely diffused, a lack of surveillance of infections and best practices was observed. Training of staff was heterogeneous among facilities and usually dedicated to the nursing staff only. Despite the problem is well known, actions are still required to introduce effective tools for the prevention and control in this critical setting in the healthcare net