Climate-change adaptation: The role of fiscal policy

Climate change and natural disasters have important consequences on fiscal sustainability, especially for developing countries with limited financial resources and underdeveloped institutions. The paper contributes to shed light on the role of fiscal policy in climate-change adaptation, which aims at containing the economic damage of climate change. We use an overlapping generations (OLG) model for a small open economy in which adaptation reflects the extent to which public policies reduce the negative influence of climate change on the capital depreciation rate. Adaptation includes both preventive measures, i.e. investment in infrastructure, and remedial measures, i.e. post-disaster relief and reconstruction. Through model simulations we assess the costs and benefits of both remedial and preventive actions. We find that preventive intervention leads to higher GDP growth rates than either taking no action or waiting until remedial action is necessary. However, the evidence shows that, due to high costs of early adaptation and budgetary constraints, countries tend to focus on late corrective actions, also relying on international assistance. Given the expected increase in climate-related risks, a comprehensive strategy including both preventive and corrective actions would be desirable to strengthen resilience to shocks and alleviate the financial constraints, which particularly affect small countries

Diferenciación de las células troncales embrionarias humanas hacia un linaje beta-pancreático: estudios enfocados a procesos de maduración

Las células troncales embrionarias humana (CTEh) tienen la capacidad de diferenciar hacia todos los tejidos que componen el cuerpo adulto, incluido las células ß del páncreas endocrino. No obstante, un protocolo para la diferenciación de las CTEh hacia células ß-pancreáticas maduras y funcionales que sea eficiente y reproducible no ha sido todavía generado. El objetivo general de este trabajo de tesis ha sido la optimización de un protocolo de diferenciación de las CTEh hacia un fenotipo ß-pancreático que reproduzca las etapas del desarrollo embrionario del páncreas y el estudio del papel del RSV en la etapa de maduración para la obtención de una nueva y más eficaz estrategia de diferenciación. Para ello primero se ha estudiado el efecto del RSV en una línea celular de insulinoma (INS-1E) describiendo la vía de SIRT1/Ucp2 como posible mecanismo de acción. Sucesivamente, basándonos en las vías de señalización y los factores de crecimiento involucrados en el desarrollo embrionario del páncreas se ha diseñado un protocolo de diferenciación capaz de dirigir las CTEh hacia células ß-pancreáticas. Para comprobar la eficacia del protocolo de diferenciación las células han sido recogidas a diferentes etapas del protocolo y han sido caracterizadas mediante Q-PCR para la expresión de factores de transcripción que son claves en el desarrollo de las células ß. Al final del protocolo de diferenciación las células expresan marcadores de páncreas endocrino y células ß maduras como PDX1, GLUT2, GK, NKX2.2, INS, GCG, entre otros. Resultados similares se han obtenidos aplicando el protocolo de diferenciación a otro tipo de células troncales pluripotentes, la línea celular pluripotente inducida (hiPS) MSUH001. También se ha demostrado que el tratamiento con RSV durante la etapa final del protocolo de diferenciación mejora el proceso de maduración de los precursores ß-pancreáticos permitiendo duplicar el número de células productoras de insulina obtenidas. Las células tratadas con RSV presentan un incremento en la expresión de PDX1, un mayor contenido de insulina y son capaces de normalizar transitoriamente la glucemia in vivo tras el trasplante en ratones diabéticos. Finalmente se ha propuesto la activación de las vías de señalización responsables de la activación de la transcripción de PDX1 como mecanismo de acción mediante el cual el RSV mejora el proceso de maduración de las células en proceso de diferenciación. En conclusión en este trabajo de tesis se describe un protocolo de diferenciación de múltiples etapas capaz de diferenciar las células troncales pluripotentes hacia células ß-pancreáticas de forma eficiente y reproducible demostrando la implicación del RSV como factor clave en los procesos de maduración.Peer Reviewe

The sustainable reuse of compost from a new type of olive mill pomace in replacing peat for potted olive tree

The attention for the replacement of peat in growing substrates is increasing due to its environmental and economic advantages. The aim of the present work was to evaluate the impact of peat substitution by new type olive mill pomace and its compost on the vegetative activity of potted olive trees. A new type of humid pomace (hP) derived from an innovative two phase extraction system and its derived compost (C-hP) are used as total or partial (50% vol/vol) replacement of peat in olive growing substrate. The main chemical characteristics (moisture, water extractable organic carbon, total nitrogen, C/N ratio and electrical conductivity) of the hP and C-hP were measured. In order to evaluate the effects of the peat substitution on the plants vegetative activity, measurements of mortality, plant height, leaf net photosynthesis and plant growth (through final destructive measurements) were carried out. The use of hP resulted in a significant increase of the salinity of the substrate. The water extractable organic carbon concentration was higher in all substrates where peat was ewplaced and in particular when C-hP was used. The total replacement of peat with hP caused 100% mortality of the plants while C-hP can substitute peat up to 50% without causing a significative reduction of the final plant growth

Patient Safety Walkaround: a communication tool for the reallocation of health service resources: An Italian experience of safety healthcare implementation

The study aims to evaluate the use of Patient Safety Walkaround (SWR) execution model in an Italian Hospital, through the adoption of parametric indices, survey tools, and process indicators.In the 1st meeting an interview was conducted to verify the knowledge of concepts of clinical risk management (process indicators). One month after, the questions provided by Frankel (survey tool) were administered.Each month after, an SWR has been carried trying to assist the healthcare professionals and collecting suggestions and solutions.Results have been classified according to Vincent model and analyzed to define an action plan. The amount of risk was quantified by the risk priority index (RPI).An organizational deficit concerns the management of the operating theatre.A state of intolerance was noticed of queuing patients for outpatient visits. The lack of scheduling of the operating rooms is often the cause of sudden displacements. A consequence is the conflict between patients and caregivers. Other causes of the increase of waiting times are the presence in the ward of a single trolley for medications and the presence of a single room for admission and preadmission of patients.Patients victims of allergic reactions have attributed such reactions to the presence of other patients in the process of acceptance and collection of medical history.All health professionals have reported the problem of n high number of relatives of the patients in the wards.Our study indicated the consistency of SWR as instrument to improve the quality of the care

Il metaverso, uno spazio partecipato: prospettive di apprendimento immersivo per le scuole superiori

The integration of the metaverse into education stands out as one of the most innovative solutions to make learning an immersive and engaging experience. This study aims to evaluate its effectiveness in the context of high schools through a practical case conducted at the Vittorio Emanuele II Classical High School in Palermo. During the project, 37 students participated in the creation of virtual museums dedicated to Euclid and Galileo using the Spatial.io platform. The results show that the metaverse facilitates the understanding of complex concepts, promotes peer collaboration, and increases motivation for learning. However, some challenges remain, particularly regarding the need for specialized teacher training and access to adequate technological resources.L'integrazione del metaverso in ambito educativo si configura come una delle soluzioni più innovative per rendere l'apprendimento un'esperienza immersiva e coinvolgente. Questo studio si propone di valutarne l'efficacia nel contesto delle scuole superiori attraverso un caso pratico condotto presso il Liceo Classico Vittorio Emanuele II di Palermo. Nel corso del progetto, 37 studenti hanno partecipato alla creazione di musei virtuali dedicati a Euclide e Galileo utilizzando la piattaforma Spatial.io. I risultati dimostrano che il metaverso facilita la comprensione di concetti complessi, favorisce la collaborazione tra pari e incrementa la motivazione allo studio. Persistono, tuttavia, alcune criticità legate alla necessità di formazione specifica per i docenti e all'accesso a risorse tecnologiche adeguate

Results of sclerotherapy and mucopexy with haemorrhoidal dearterialization in II and III degree haemorrhoids. A 4 years' single centre experience

IntroductionHaemorrhoidal disease (HD) affects a considerable portion of the adult population. The aim of this study is to confirm the safety and efficacy of the treatments and to report the long-term outcomes of Sclerotherapy (ST) and Mucopexy and Haemorrhoidal Dearterialization (MHD) performed over the last 4 years in a single tertiary centre. The secondary outcome is to evaluate the usefulness of both techniques and to demonstrate how those can be associated as a bridge to surgery.Materials and methodsPatients affected by second–third-degree haemorrhoids and undergoing ST or non-Doppler guided MHD between 2018 and 2021 were enrolled. Safety and efficacy, recurrence rate, Haemorrhoid Severity Score (HSS) and pain resulting from both techniques were evaluated.ResultsOut of 259 patients, 150 underwent ST. Further, 122 (81.3%) patients were male and 28 (18.7%) were female. The mean age was 50.8 (range 34–68) years. Most of the patients (103, 68.6%) were affected by second-degree HD, while 47 (31.4%) were affected by third-degree HD. The overall success rate was 83.3%. The median pre-operative HSS score was 3 (IQR 0–4, p = 0.04) and at 2 year the median HSS was 0 (IQR 0–1, p = 0.03). No intraoperative complications and no drug-related side effects occurred. The mean follow-up for ST was 2 years (range 1–4; SD ±0.88). MHD was performed on 109 patients. In detail, 80 patients (73.4%) were male while 29 patients (26.6%) were female. The mean age in this group was 51.3 (range 31–69). Further, 72 patients (66.1%) were affected by third-degree HD and 37 (33.9%) by second-degree HD. The median HSS score was 9 (IQR 8–10, p = 0.001) preoperatively two years after treatment was 0 (IQR 0–1, p = 0.004). Major complications occurred in three patients (2.75%). The overall success rate was 93.5% (second degree 89.2% vs. third degree 95.8%). The mean follow-up for MHD was 2 years (range 1–4; SD ±0.68).ConclusionsThe results confirm the usefulness of those techniques, which can be considered safe and easily repeatable procedures, with a low recurrence rate after 2 years of median follow-up

Handover checklist: testing a standardization process in an Italian hospital

Objectives: This study aimed to standardize and rationalize the handover, a critical and essential moment in common health care practices, through the realization of an efficient and standardized checklist, which could be used daily to ensure complete, thorough and effective handover. The principal purpose of the implementation of the handover is to reduce errors due to superficial and insufficient communication. Methods: The "operative group" defined the phases to the realization of the delineated aims: at first, the direct observation and the consequent realization of a handover checklist model and then, the experimental phases (trials). The handover checklist model was used for a month and it was daily and duly completed by the doctors who took part in the trial. To prove the success of the study, three questionnaires were distributed on different occasions. Results: Analyzing the answers to the questionnaires, the importance of the handover has come to light and that for the most part, the doctors consider it an essential and irreplaceable moment in daily health care work. Moreover, it became obvious that the use of the handover checklist guaranteed a considerable improvement in the traditional handover in terms of security, completeness, care continuity and clarity. The handover checklist was completely appreciated by the majority of the participant doctors who agree with the definitive introduction of it in their unit. Conclusions: Our study indicated the consistency of the handover checklist as an instrument to implement the handover and, indirectly, to improve the quality of the care

Short-Term Results of Sclerotherapy with 3% Polidocanol Foam for Symptomatic Second- and Third-Degree Hemorrhoidal Disease

Background: Hemorrhoidal disease (HD) is defined as the symptomatic enlargement and/or distal displacement of anal cushions and is one of the most common proctological diseases. Sclerotherapy (ST) with 3% polidocanol foam induces an inflammatory reaction with sclerosis of the submucosal tissue and consequent suspension of the hemorrhoidal tissue. The aim of this study was to evaluate the short-term effectiveness and safety of ST with 3% polidocanol foam for the treatment of symptomatic second- and third-degree HD. Methods: A total of 66 patients with symptomatic second- and third-degree HD underwent a single ST session between March 2017 and July 2018. A visual analog scale score was used to assess post-operative pain and patient satisfaction. The symptoms severity and anal continence were investigated through the Hemorrhoid Severity Score (HSS) and Vaizey score, respectively, at baseline, at 4 weeks and after 1 year. Results: Fifty-seven out of 66 patients were male (86.3%), and the mean age was 52 (29–75; SD ± 12) years. The mean operative time was 4.5 (2–6; SD ± 1.23) minutes. No intraoperative complications and no drug-related side effects occurred. The overall success rate was 78.8% (52/66 patients) after a single ST session and 86% after two ST sessions (57/66 patients). The mean treatment effect, obtained comparing preoperative and 12 months symptom scores in each patient, showed a median change of 8 (p < 0.001). All patients resumed their normal daily activities the day after the procedures. Conclusions: ST with 3% polidocanol foam is a safe, cost-effective and repeatable conservative treatment