Area metropolitana e citta' diffusa: potenzialita' e limiti di un modello urbano

Recenti proposte parlamentari porpongono di mettere fine ad una discussione sulla città e/o area metropolitana di Roma, confermandone: • una dimensione d’area vasta coincidente con quella della provincia; • la sussidiarietà e la sostenibilità come principi ispiratori ed ordinatori dell’azione di governo del territorio; • le funzioni unitarie e complementari di livello territoriale (programmazione degli interventi per Roma Capitale, le opere di interesse statale, il patrimonio pubblico e privato nazionale ed internazionale, la valorizzazione e la gestione del sistema culturale, ambientale e del turismo, la ricerca e la formazione universitaria, le attività fieristico-congressuali-espositive, l’industria innovativa legata all’ICS); collocando la questione della scelta metropolitana per Roma ad un livello europeo, eppure intermedio tra la scala politica propria della città-capitale e i compiti di programmazione e gestione che il nostro ordinamento costituzionale attribuisce alle province (per l’Europa, le NUT 3). Rispetto a questo obiettivo, Roma non appare in posizione soddisfacente nella mappatura europea delle aree/città capitali metropolitane. Anche se, la spinta al policentrismo impressa dall’Unione potrebbe trovare già una base di corrispondenze nell’organizzazione – soprattutto spontanea - del territorio e dell’economia romana (non solo della Città). Se per un verso, dunque, c’è da augurarsi che attraverso un più stretto recepimento delle indicazioni europee (Cfr. strutture già cooperative su base policentrica), l’area vasta romana, cioè la provincia, diventi nel prossimo periodo 2007-2013 molto più visibile; la mancanza di strumenti appropriati al raggiungimento di questo obiettivo rappresenta un freno alla piena realizzazione di una metropoli diversa dalla semplice somma di progetti ed impostazioni negoziati “dall’alto”, di portata nazionale e regionale, che escludono, ad una lettura “fisica e formale” del territorio, la domanda di integrazione “dal basso”, cioè il riconoscimento, anche economico, delle forme insediative coese riconoscibili romane. In tal senso Roma e la sua provincia rappresentano il livello ideale per una lettura della programmazione territoriale europea, ma anche il livello sussidiario della mediazione tra una visione metropoitana globale e una locale, somma di insediamenti continui, diffusi o nucleari isolati (perirubanizzazione mista ad insediamento puntuale), attualmente privi di orientamento alla governance; lontani cioè da quell’insieme di regole con cui si attua la programmazione spaziale e fisica richiesta dall’Unione, entro cui ogni NUT offre il proprio contributo alla creazione di uno spazio integrato, anche attraverso scelte sussidiarie di metropolitanizzazione (cfr. Territorial Agenda 2007)

Supervised cnn strategies for optical image segmentation and classification in interventional medicine

The analysis of interventional images is a topic of high interest for the medical-image analysis community. Such an analysis may provide interventional-medicine professionals with both decision support and context awareness, with the final goal of improving patient safety. The aim of this chapter is to give an overview of some of the most recent approaches (up to 2018) in the field, with a focus on Convolutional Neural Networks (CNNs) for both segmentation and classification tasks. For each approach, summary tables are presented reporting the used dataset, involved anatomical region and achieved performance. Benefits and disadvantages of each approach are highlighted and discussed. Available datasets for algorithm training and testing and commonly used performance metrics are summarized to offer a source of information for researchers that are approaching the field of interventional-image analysis. The advancements in deep learning for medical-image analysis are involving more and more the interventional-medicine field. However, these advancements are undeniably slower than in other fields (e.g. preoperative-image analysis) and considerable work still needs to be done in order to provide clinicians with all possible support during interventional-medicine procedures

A cloud-based healthcare infrastructure for neonatal intensive-care units

Intensive medical attention of preterm babies is crucial to avoid short-term and long- term complications. Within neonatal intensive care units (NICUs), cribs are equipped with electronic devices aimed at: monitoring, administering drugs and supporting clinician in making diagnosis and offer treatments. To manage this huge data flux, a cloud-based healthcare infrastructure that allows data collection from different devices (i.e., patient monitors, bilirubinometers, and transcutaneous bilirubinometers), storage, processing and transferring will be presented. Communication protocols were designed to enable the communication and data transfer between the three different devices and a unique database and an easy to use graphical user interface (GUI) was implemented. The infrastructure is currently used in the “Women’s and Children’s Hospital G.Salesi” in Ancona (Italy), supporting clinicians and health opertators in their daily activities

Sharing health data among general practitioners: The Nu.Sa. project

Today, e-health has entered the everyday work flow in the form of a variety of healthcare providers. General practitioners (GPs) are the largest category in the public sanitary service, with about 60,000 GPs throughout Italy. Here, we present the Nu.Sa. project, operating in Italy, which has established one of the first GP healthcare information systems based on heterogeneous data sources. This system connects all providers and provides full access to clinical and health-related data. This goal is achieved through a novel technological infrastructure for data sharing based on interoperability specifications recognised at the national level for messages transmitted from GP providers to the central domain. All data standards are publicly available and subjected to continuous improvement. Currently, the system manages more than 5,000 GPs with about 5,500,000 patients in total, with 4,700,000 pharmacological e-prescriptions and 1,700,000 e-prescriptions for laboratory exams per month. Hence, the Nu.Sa. healthcare system that has the capacity to gather standardised data from 16 different form of GP software, connecting patients, GPs, healthcare organisations, and healthcare professionals across a large and heterogeneous territory through the implementation of data standards with a strong focus on cybersecurity. Results show that the application of this scenario at a national level, with novel metrics on the architecture's scalability and the software's usability, affect the sanitary system and on GPs’ professional activities

The Impact of COVID-19 on Plastic Surgery Residency Training

Abstract: Nowadays didactic and surgical activities for residents in the surgery field are less and less due to an increasing burden of documentation and \u201cnon-educational work.\u201d Considering the current lockdown due to the COVID-19 pandemic, it has never been so important to find different ways to allow residents to improve their knowledge. We asked all plastic and esthetic surgery residents in our country to fill out a questionnaire to investigate changes in their didactical activity and analyze problems about their professional growth in the last few months. From the results of such questionnaires, we found that most of the residents feel the decrease in surgical activities during this time is a detrimental factor for their training and that even if all the schools have changed their didactical activities no school has introduced the use of virtual simulators to compensate for the decrease in surgical practice. Actually, the majority of residents use webinars to keep updated, stating that such technologies are useful but not sufficient to analyze plastic surgery topics in depth during COVID-19 lockdown. Virtual interactive tools are well known in different clinical and surgical specialties, and they are considered as a valid support, but it seems that in plastic surgery they are not so used. According to the most recent studies about residents\u2019 didactical program, we have investigated the potential of Anatomage Table in combination with Touch Surgery application as physical and mental aids to bypass the decreased number and kind of surgical interventions performed in this particular time. Anatomage is an academic user-friendly touch screen table; it is used by both medical students and residents to learn human anatomy and to master surgical anatomy. Touch Surgery is an application available on smartphones and tablets that gives the possibility to watch real and virtually designed surgical videos, accompanied by explanatory comments on the surgical phases; they are interactive and give the possibility to check what you have learned through tests administered after virtual classes. In our opinion, these tools represent reliable solutions to improve plastic residents\u2019 training, mostly during the COVID-19 pandemic. Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266

DEEP CONVOLUTIONAL NEURAL NETWORKS FOR SENTIMENT ANALYSIS OF CULTURAL HERITAGE

Abstract. The promotion of Cultural Heritage (CH) goods has become a major challenges over the last years. CH goods promote economic development, notably through cultural and creative industries and tourism. Thus, an effective planning of archaeological, cultural, artistic and architectural sites within the territory make CH goods easily accessible. A way of adding value to these services is making them capable of providing, using new technologies, a more immersive and stimulating fruition of information. In this light, an effective contribution can be provided by sentiment analysis. The sentiment related to a monument can be used for its evaluation considering that if it is positive, it influences its public image by increasing its value. This work introduces an approach to estimate the sentiment of Social Media pictures CH related. The sentiment of a picture is identified by an especially trained Deep Convolutional Neural Network (DCNN); aftewards, we compared the performance of three DCNNs: VGG16, ResNet and InceptionResNet. It is interesting to observe how these three different architectures are able to correctly evaluate the sentiment of an image referred to a ancient monument, historical buildings, archaeological sites, museum objects, and more. Our approach has been applied to a newly collected dataset of pictures from Instagram, which shows CH goods included in the UNESCO list of World Heritage properties.</p

Autologous micrografts and methotrexate in plantar erosive lichen planus: healing and pain control. A case report

Erosive lichen planus is an uncommon variant of lichen planus. We report a case of long-standing and refractory plantar ELPs causing disabling and opiate-resistant pain treated with 'classic' meshed skin graft combined with RigeneraVR micrografts. After approximately 9 months follow-up, no clinical recurrence or pain were observed. Erosive lichen planus (ELP) is an uncommon variant of lichen planus, involving oral cavity and genitalia and, less often plantar areas, where it usually presents with chronic erosions of the soles, along with intense, disabling pain and progressive loss of toenails. An abnormal immune cellular response (CD8+ lymphocytes and macrophages) and the consequent altered production of multiple mediators (interleukin-12, interferon-gamma, tumor necrosis factor-alpha, RANTES and MMP-9), seem to play a crucial role in the pathogenesis, although the etiology remains uncertain. From a histological point of view, ELP shows keratinocyte apoptosis, intense inflammatory response and basal epithelial keratinocytes TNF-alpha overexpression. Several therapies have been proposed, with variable and controversial results. While topical corticosteroids and topical calcineurin inhibitors are the treatments of choice for localized forms, short pulses of systemic glucocorticoids, phototherapy, and systemic immunosuppressants are recommended for generalized cases. Surgery has been reported as a possible therapeutic option in refractory and stable cases with localized lesions, either alone or with cyclosporine. Herein, we report a case of longstanding and refractory plantar ELPS causing disabling and opiate-resistant pain treated with 'classic' meshed skin graft combined with RigeneraVR micrografts

Determinants of surgeon choice in cases of suspected implant rupture following mastectomy or aesthetic breast surgery: Clinical implications

Implant ruptures may be diagnosed by physical examination, ultrasound (US), and magnetic resonance imaging (MRI). The absence of standard guidelines to approach to implant ruptures may cause unnecessary surgical revisions in the absence of radiological confirmation of prosthetic damages.The purpose of this study was to analyze the diagnostic procedures applied to patients with suspected prosthetic rupture and surgeon choices to perform a revision or to plan a clinical and radiological follow-up.We conducted a retrospective study on 62 women submitted to revision surgery due to radiological diagnosis of suspected implant rupture, following mastectomy or aesthetic reconstruction, and admitted to a Plastic Surgery Department between 2008 and 2018.Seventy-three implants, believed to be ruptured, were explanted. One-third of these were intact and unnecessarily explanted. US associated with MRI evaluation resulted in the most helpful diagnostical method.A standardized clinical and radiological approach is essential to manage breast implant ruptures successfully. An innovative protocol is proposed in order to: ensure the appropriate management of implant ruptures and prevent unnecessary surgical revisions; reduce the risk of claims for medical malpractice in cases of unsatisfactory final aesthetic results or worse than before