Pianificazione della sicurezza antincendio negli asili nido

Lo scopo della sicurezza antincendio nelle strutture finalizzate all’attività di asili nido, con riferimento all’incolumità dei bambini, soggetti particolarmente bisognevoli di protezione attiva, rende opportuno un esame puntuale del quadro tecnico normativo, al fine di verificare l’efficacia dei requisiti minimi richiesti e garantire il non superamento dei livelli di accettabilità. Allo stato attuale, l’allegato I al D.P.R. 1 agosto 2011 n. 151 [1] colloca tra le attività soggette ai controlli di prevenzione incendi anche gli asili nido; pertanto, l’attività n° 67 (ex 85) amplia il campo di applicazione dalle scuole di ogni ordine, grado e tipo, collegi, accademie con oltre 100 persone presenti agli Asili nido con oltre 30 persone presenti. Fino all’emanazione della regola tecnica di progettazione, costruzione ed esercizio degli asili nido (D.M. 16/07/2014) [2], per la suddetta attività si sono adottati i metodo e criteri ingegneristici della sicurezza antincendio proposti dalle linee guida dalla direzione regionale del Friuli Venezia Giulia o dal comando provinciale di Palermo. La normativa vigente, risolve formalmente il problema dell’adeguamento legislativo, introducendo l’osservanza della norma tecnica verticale anche per gli asili nido, ma tale provvedimento di fatto non risolve né le condizioni di criticità derivanti dalle caratteristiche psicofisiche degli utenti, né le condizioni di criticità strutturali ed organizzative che edifici storici o ubicati in ambiti urbanistici di particolari specificità possono presentare. Tale deficit può essere superato adottando il Decreto Ministeriale 9 maggio 2007 "direttive per l'attuazione dell'approccio ingegneristico alla sicurezza antincendio” nell’ambito dei procedimenti di prevenzione incendi [3]. In questo articolo viene proposto, nell’ambito della fire safety engineering, un criterio di modellazione del fire design per la determinazione dei parametri termo-fluidodinamici rilevanti per la sicurezza degli esposti in asili nido ed il confronto con le rispettive curva di incendio naturale e nominali di più frequente utilizzo. I fattori determinanti nella difesa dagli incendi in queste attività sono influenzati pesantemente dalle peculiarità che contraddistinguono gli utenti: bambini tra 0 e 3 anni di età, non autosufficienti e bisognevoli di assistenza in condizioni ordinarie e ancor più in caso di emergenza. Gli strumenti di modellazione adottati per la simulazioni sono FDS 5 e Smokeview 5.4.8 prodotti dal National Institute of Standards and Technology (NIST) [4], [5]. Il volume di studio analizzato risulta circoscritto al solo spazio della sala multiattività ed è stato simulato per una durata del fenomeno non superiore ai 15 minuti dopo l’innesco, in considerazione del fatto che la valutazione del flusso di pericolo verso gli esposti è rilevante solo in questa prima fase nella quale viene attivato l’autosoccorso. Sono stati costruiti in FDS tre ambienti con arredo tipico presente in asilo nido [6], differenziati per dimensioni geometriche, aperture di ventilazione e quantitativo di materiale combustibile. Per ognuno dei tre ambienti è stata prevista una duplice simulazione; in un caso, i parametri d’incendio sono stati ricavati dalla simulazione caratterizzata dalla funzione HRR analitica, mentre nell’altro caso la funzione HRR è stata ricavata a posteriori, procedendo ad una simulazione di incendio naturale nel locale realisticamente arredato, condizionata dall’innesco minimo efficace. Dall’andamento delle curve HRR simulate, opportunamente linearizzate, sono state quindi ricavate tre Curva di Incendio Verosimili (CIV). Il confronto tra i parametri d’incendio ha riguardato le curve di rilascio termico [kW-t] costruite sulla base dei risultati delle tre differenti simulazioni esaminate e le corrispondenti curve d’incendio analitiche che costituiscono il riferimento normativo nell’ambito dell’ingegneria antincendio. Le curve naturali di più consolidato utilizzo sono state introdotte allo scopo di procedere alla verifica della resistenza strutturale: l’adozione di questi modelli nell’ambito della ingegneria antincendio finalizzata alla sicurezza degli esposti è avvenuta per analogia, nell’assunto che i fenomeni di intensità rilevante che queste rappresentano garantiscano un’implicita cautela nella scelta del fire design. Lo studio evidenzia invece che la curva analitica, la cui adozione è adatta allo scopo di verificare la resistenza strutturale, genera campi di temperature e di concentrazioni tossiche inferiori a quelli ottenuti con la simulazione completa dell’incendio naturale nelle fasi di innesco e crescita, cioè nelle fasi temporali che richiedono l’attivazione dell’autosoccorso e la gestione dell’esodo. Questo risultato dimostra che l’assunzione del criterio di verifica implicitamente contenuto nelle curve di incendio analitiche non presenta il carattere di cautela che un criterio uniformato dovrebbe contenere. Tale considerazione indica l’opportunità di adottare i modelli di fluido dinamica computazionale allo scopo di dimensionare la curva d’incendio rappresentativa del modello di sollecitazione in esame (HRRCIV); l’adozione del suddetto modello per l’analisi termo-fluido dinamica e d’esodo estesa all’intera struttura garantisce una maggiore verosimiglianza degli scenari d’incendio scelti per la valutazione di sicurezza degli esposti, che nel caso specifico sono risultati più gravosi. Poter disporre di modelli termo-chimici ad hoc per le diverse attività soggette ai controlli di prevenzione incendi rappresenta il punto di partenza per progettare il complesso di misure gestionali e di protezione idonee al raggiungimento del luogo sicuro in tempi compatibili con il superamento dei livelli di letalità nella struttura causati dell’incendio. Questo concetto viene riassunto con la formula ASET>RSET [7]; la combinazione tra sollecitazione termica e concentrazione dei gas tossici rappresenta l’elemento che maggiormente condiziona il tempo disponibile all’esodo

Using deceased-donor kidneys to initiate chains of living donor kidney paired donations: algorithms and experimentation

We design a flexible algorithm that exploits deceased donor kidneys to initiate chains of living donor kidney paired donations, combining deceased and living donor allocation mechanisms to improve the quantity and quality of kidney transplants. The advantages of this approach have been measured using retrospective data on the pool of donor/recipient incompatible and desensitized pairs at the Padua University Hospital, the largest center for living donor kidney transplants in Italy. The experiments show a remarkable improvement on the number of patients with incompatible donor who could be transplanted, a decrease in the number of desensitization procedures, and an increase in the number of UT patients (that is, patients unlikely to be transplanted for immunological reasons) in the waiting list who could receive an organ.Comment: To be published in AIES 201

Fotografía DE DOS HOMBRES [Material gráfico]

RAMBLA DEL CENTRO 37. BARCELONACopia digital. Madrid : Ministerio de Educación, Cultura y Deporte, 201

A Biomimetic Multichannel Synergistic Calibration for Event-Driven Functional Electrical Stimulation

In this paper, we present the Profile Extraction (PE) algorithm, which allows the computation of a multi-channel profile highly correlated with voluntary muscle activity. This event-based profile can be used as biomimetic control during the calibration phase of a Functional Electrical Stimulation (FES) system. The adoption of the PE technique represents the preliminary step to extend the applicability of our event-driven paradigm to control the coordinated multi-joint movements. Through an experimental campaign, we tested the improvements made by the use of PE in the FES calibration, assessing the reproducibility between the voluntary and stimulated movements. Results show a 2 % increase of the median correlation value for a single-channel exercise and a 3.6 % increase for a dual-channel one. A statistical decrease of normalized Root Mean Square Error has been obtained for the dual-channel exercise (p < 0.05)

Live Demonstration: A Real-Time Bio-Mimetic System for Multichannel FES Control

This demonstration presents a bio-mimetic system for the real-time multichannel control of Functional Electrical Stimulation (FES). The intensities of the FES profiles are directly mapped by processing surface ElectroMyoGraphic (sEMG) signals detected from synergistic muscles, thus achieving a user-comfortable stimulation that follows the monitored physiological patterns. Furthermore, a user-dedicated calibration routine and multiple versatile operating configurations allow the system to be integrated into standard rehabilitation protocols to enhance the restoration of motor functionalities

Prolonged extracorporeal membrane oxygenation therapy for severe acute respiratory distress syndrome in a child affected by rituximab-resistant autoimmune hemolytic anemia: a case report

<p>Abstract</p> <p>Introduction</p> <p>Autoimmune hemolytic anemia in children younger than 2 years of age is usually characterized by a severe course, with a mortality rate of approximately 10%. The prolonged immunosuppression following specific treatment may be associated with a high risk of developing severe infections. Recently, the use of monoclonal antibodies (rituximab) has allowed sustained remissions to be obtained in the majority of pediatric patients with refractory autoimmune hemolytic anemia.</p> <p>Case presentation</p> <p>We describe the case of an 8-month-old Caucasian girl affected by a severe form of autoimmune hemolytic anemia, which required continuous steroid treatment for 16 months. Thereafter, she received 4 weekly doses of rituximab (375 mg/m²/dose) associated with steroid therapy, which was then tapered over the subsequent 2 weeks. One month after the last dose of rrituximab, she presented with recurrence of severe hemolysis and received two more doses of rrituximab. The patient remained in clinical remission for 7 months, before presenting with a further relapse. An alternative heavy immunosuppressive therapy was administered combining cyclophosphamide 10 mg/kg/day for 10 days with methylprednisolone 40 mg/kg/day for 5 days, which was then tapered down over 3 weeks. While still on steroid therapy, the patient developed an interstitial pneumonia with Acute Respiratory Distress Syndrome, which required immediate admission to the intensive care unit where extracorporeal membrane oxygenation therapy was administered continuously for 37 days. At 16-month follow-up, the patient is alive and in good clinical condition, with no organ dysfunction, free from any immunosuppressive treatment and with a normal Hb level.</p> <p>Conclusions</p> <p>This case shows that aggressive combined immunosuppressive therapy may lead to a sustained complete remission in children with refractory autoimmune hemolytic anemia. However, the severe life-threatening complication presented by our patient indicates that strict clinical monitoring must be vigilantly performed, that antimicrobial prophylaxis should always be considered and that experienced medical and nursing staff must be available, to deliver highly specialized supportive salvage therapies, if necessary, during intensive care monitoring.</p

Deceased donor-initiated Chains: first report of a successful deliberate case and its ethical implications

Background: The utilization of deceased donor kidneys to initiate chains of living donor kidney paired donation (KPD) has been proposed, although the potential gain of this practice needs to be quantified and the ethical implications must be addressed before starting its application. Methods: The gain of implementing deceased donor-initiated chains has been measured through a mathematical algorithm, using retrospective data on the pool of donor/recipient incompatible pairs at a single Center. Allocation rules of chain ending kidneys and characteristics/quality of the chain initiating kidney (CIK) are described. Results: the quantification of benefit analysis showed that with a pool of 69 kidneys from deceased donors and 16 pairs enrolled in the KPD program, over a period of 3 years it is possible to transplant 8/16 recipients (50%). Following the approval of the Bioethical Committee of the Veneto Region and the revision of the allocation policies by the Italian National Transplant Center, the first successful case has been performed. The waiting time of the recipient (male, 53 yo) after entering the program for the CIK with a kidney donor risk index (KDRI) equal to 0.61 and a kidney donor profile index (KDPI) of 3%, was 4 days. His willing donor (female, 53 yo) with a living kidney donor profile index (LKDPI) of 2, donated 2 days later to a chain ending recipient (male, 47 yo,) who had been on dialysis for 5 years. Conclusions: This is the first report of a deliberate deceased donor-initiated chain, which has been successfully performed. This has been made possible thanks to an extensive phase of evaluation of the ethical issues and allocation policy impact. This paper includes a preliminary efficacy assessment and the development a dedicated algorithm

TERT Promoter Mutations Differently Correlate with the Clinical Outcome of MAPK Inhibitor-Treated Melanoma Patients

Resistance is a major challenge in the management of mitogen-activated protein kinase inhibitor (MAPKi)-treated metastatic melanoma. Tumor genetic alterations can cause MAPK pathway reactivation, leading to lack of response and poor outcome. Characterization of the mutational profile in patients with melanoma might be crucial for patient-tailored treatment choices. Mutations in the promoter region of the telomerase reverse transcriptase gene (TERTprom) lead to increased TERT expression and telomerase activity and are frequent in BRAFV600 mutant melanoma. Reportedly, TERTprom, and BRAFV600 mutations cooperate in driving cancer progression and aggressiveness. We evaluated the effect of the TERTprom status on the clinical outcome in 97 MAPKi-treated melanoma patients. We observed that patients with the c.-146C > T mutation showed a significantly worse progression-free survival (PFS) compared to those carrying the c.-124C > T mutation and a two-fold increased risk of progression (median 5.4 vs. 9.5 months; hazard ratio (HR) 1.9; 95% confidence interval (CI) 1.2-3.2; p = 0.013). This trend was also observed for the overall survival (OS); melanoma patients with the c.-146C > T mutation showed a poorer prognosis compared to those with the c.-124C > T mutation (median 13.3 vs. 25.5 months; HR 1.9, 95% CI 1.1-3.3, p = 0.023). Our results disclose a different correlation of the two TERTprom mutations with MAPKi-treated melanoma patient outcome, highlighting a different impact of the pathway blockade

Should all patients with a culture-negative periprosthetic joint infection be treated with antibiotics?:A multicentre observational study

Aims: The aim of this study was to analyze the prevalence of culture-negative periprosthetic joint infections (PJIs) when adequate methods of culture are used, and to evaluate the outcome in patients who were treated with antibiotics for a culture-negative PJI compared with those in whom antibiotics were withheld. Methods: A multicentre observational study was undertaken: 1,553 acute and 1,556 chronic PJIs, diagnosed between 2013 and 2018, were retrospectively analyzed. Culture-negative PJIs were diagnosed according to the Muskuloskeletal Infection Society (MSIS), International Consensus Meeting (ICM), and European Bone and Joint Society (EBJIS) definitions. The primary outcome was recurrent infection, and the secondary outcome was removal of the prosthetic components for any indication, both during a follow -up period of two years. Results: None of the acute PJIs and 70 of the chronic PJIs (4.7%) were culture-negative; a total of 36 culture-negative PJIs (51%) were treated with antibiotics, particularly those with histological signs of infection. After two years of follow -up, no recurrent infections occurred in patients in whom antibiotics were withheld. The requirement for removal of the components for any indication during follow -up was not significantly different in those who received antibiotics compared with those in whom antibiotics were withheld (7.1% vs 2.9%; p = 0.431). Conclusion: When adequate methods of culture are used, the incidence of culture-negative PJIs is low. In patients with culture-negative PJI, antibiotic treatment can probably be withheld if there are no histological signs of infection. In all other patients, diagnostic efforts should be made to identify the causative microorganism by means of serology or molecular techniques