LE POLITICHE DI SEMPLIFICAZIONE E L'ISTITUTO DELLA SCIA.

Nel presente lavoro di tesi ho trattato le politiche di semplificazione soffermandomi in modo particolare su un istituto tipico della stessa, ovvero la S.C.I.A., acronimo di Segnalazione Certificata di inizio attività. Per analizzare correttamente la semplificazione amministrativa è stato necessario partire da una semplificazione normativa. Sono stati trattati i rapporti che intercorrono tra due tipologie di semplificazione e se le stesse si trovano sullo stesso piano o, al contrario, sono una la conseguenza dell’altra. Alla base del processo semplificativo esiste un procedimento che ha fatto il suo ingresso nello scenario amministrativo italiano soltanto con la legge n. 241/90 poiché, fino ad allora, non esisteva una disciplina generale sul procedimento amministrativo e questo si traduceva nella presenza di norme di settore che disciplinavano alcuni procedimenti, in un’ampia discrezionalità in capo all’Amministrazione e nella mancata possibilità per il cittadino di partecipare al processo amministrativo. Le porte in tale direzione sono state spalancate con la legge del ’90. Gli istituti attuativi della semplificazione amministrativa sono la conferenza dei servizi, il silenzio – assenso e la Scia. Sono state analizzati i vari istituti, le loro caratteristiche peculiari nonché le differenze sostanziali che intercorrono tra gli stessi e come questi sono stati modificati dall’ultima riforma sulla P.A. (Legge Madia)

Impact of protein intake on weaning from mechanical ventilation in ICU patients

Background: In pazienti ventilati meccanicamente, la nutrizione enterale, iniziata entro 24-48 ore dal ricovero in terapia intensiva, ha dimostrato ridurre le complicanze infettive e la durata dell’ospedalizzazione. A causa dell’insufficienza respiratoria associata, il 30% dei pazienti ricoverati nelle terapie intensive richiede ventilazione meccanica. Lo svezzamento ritardato dalla ventilazione meccanica aumenta i costi, i rischi di polmoniti nosocomiali, comorbidità cardiache associate e morte. Uno svezzamento precoce dalla ventilazione spesso implica reintubazione e complicanze associate allo svezzamento prolungato. La gestione della nutrizione rappresenta una sfida per l’intensivista. La malnutrizione causa la diffusione di patologie associate alla disfunzione d’organo, difficoltà di guarigione, riduce l’efficacia del sistema immunitario e si associa ad uno scarso successo di svezzamento dalla ventilazione. La quantità di tessuto muscolare distrutto e la perdita di peso sono inversamente correlati con la sopravvivenza a lungo termine dei pazienti critici. In questa tesi sarà discusso il ruolo del supporto nutrizionale in un setting di malati critici, in associazione allo svezzamento dalla ventilazione meccanica. Obiettivi: 1. Valutazione dello stato nutrizionale (parametri clinici e antropometrici); 2. Differenza di outcome misurato come durata dello svezzamento dalla ventilazione, eventi avversi e uso delle risorse (durata dell’ospedalizzazione e costi per la terapia intensiva). Materiali e metodi: Sono stati arruolati pazienti > 18 anni, ricoverati tra novembre 2016 e novembre 2018. Sono stati raccolti dati antropometrici, dati relativi allo stato nutrizionale come BMI e peso, tipo di nutrizione somministrata (enterale o parenterale), livelli di albumina, proteine totali, parametri clinici come il P/F. Risultati: Sono stati analizzati 30 pazienti (12 femmine). La durata media di ogni degenza è stata 25.6 ± 14.7 giorni. L’84% di pazienti è stato nutrito per via enterale. Non ci sono state alterazioni statisticamente significative nei livelli di albumina e proteine totali durante l’intera degenza in terapia intensiva. Diverse miscele nutrizionali influenzano le risposte cliniche (migliori P/F tra i pazienti alimentati con queste ultime). Le calorie stimate e somministrate sono state adeguate alla fase ventilatoria associata. Il supporto nutrizionale era appropriato, dal momento che BMI e peso sono rimasti invariati nel confronto tra inizio e fine degenza in terapia intensiva. Conclusioni: Applicando una strategia di supporto nutrizionale adeguato alla nostra terapia intensiva non si aumentano i giorni di ospedalizzazione, riducendo l’incidenza di condizioni associate ad uno svezzamento dalla ventilazione difficile o prolungato e le complicanze associate ad esso.Background: In mechanically ventilated ICU patients enteral nutrition started 24 to 48 hours of ICU admission, shown to reduce infectious complications and duration of hospitalization. Due to acute respiratory failure 30% of patients admitted to ICUs require mechanical ventilation. Delayed weaning increases costs, risks of nosocomial pneumonia, cardiac-associated morbidity, and death. Early weaning often results in reintubation, and associated complications due to prolonged ventilation. Nutritional management poses a vital challenge to the intensivist in the ICU. Malnutrition causes widespread organ dysfunction, associated with poor healing, reduce immune competence & poor weaning from ventilator (decreasing the diaphragmatic contractility and depressing the hypoxic drive & ventilatory drive to CO2). The extent of muscle wasting and weight loss in the ICU is inversely correlated with long-term survival of the patients. In this thesis will be discussed the role of the nutritional support in the critical care setting when associated to weaning from mechanical ventilation. Objectives: 1. Assessment of Clinical And Anthropometric nutritional status. 2. Differences in outcomes measuring weaning duration, harm (adverse events) and resource use (ICU and hospital length of stay, cost). Material and methods: Patients >18 y-o, admitted to the ICU from November 2016 to November 2018 were enrolled. Anthropometrics, nutritional status such as BMI and weight, nutritional support such as enteral or parenteral nutrition, albumin and total proteins levels, clinical parametrs such as P/F were recorded for the entire ICU stay. Results: 30 consecutive patients (12 female) were enrolled. The average duration of each admission to the ICU was 24.58 ± 14.7 days. The 84% of patients was enterally fed. Albumine and total proteins were not significantly different throughtout the ICU stay. Different enteral nutrition mixtures influence clinical response (better P/F). Calories estimated and provided were adequate to the ventilatory phase associate. The nutritional support was adequate, since BMI and weight were the same at admission and discharge from the ICU. Conclusions: through an optimal planning of the nutritional supply, in our ICU days of hospitalization were not increased, avoiding the incidence of difficult or prolonged weaning conditions and the consequences associated with it

Data-driven modelling of compressor stall flutter

Modern aircraft engines need to meet ever more stringent requirements that greatly increase the complexity of design, which strives for enhanced performance, reduced operating costs, emissions and noise simultaneously. The drive for performance leads to the development of thin, lightweight, highly loaded fan and compressor blades which are increasingly more prone to incur high, sustained vibratory stresses and aeroelastic problems such as flutter. The current practice employs preliminary design tools for flutter that are often based on empiricism or simplified analytical models, requiring extensive use of computational fluid dynamics to verify aeroelastic stability. As the industry moves to new designs, fast and accurate prediction tools are needed. In this thesis, data-driven techniques are employed to model the aeroelastic response of compressor blades. Machine learning has been applied to a plethora of engineering problems, with particular success in the field of turbulence modelling. However, conventional, black-box data- driven methods based on simple input parameters require large databases and are unable to generalise. In this work a combination of machine learning techniques and reduced order models is proposed to address both limitations at the same time. Previous knowledge of flutter is introduced in the physics guided framework by formulating relevant, steady state input features, and by injecting results from low-fidelity analytical models. The models are tested on several unseen cascades and it is found that training on even a single geometry yields accurate results. The models developed here allow flutter prediction of fan and compressor flutter stability based on the steady state flow only without a need for any CPU intensive unsteady simulations. Hence, one can predict flutter stability of a given blade for different mechanical properties (mode shape, frequency) at near zero additional cost once the mean flow is known. Moreover, for fan flutter, the model developed here can be integrated with available analytical models of intake to analyse the consequences of intake properties, such as length and acoustic liners location, on the stability of fan blades. The EU goal of climate-neutrality by 2050 requires novel design concepts in aviation which is unachievable without complimentary novel prediction and design tools. The research presented in this thesis will allow one to explore the design space for flutter stability based on steady flow only, and hence offers such an alternative. To the best of the author’s knowledge, no previous research is available on modelling of compressor stall flutter with data-driven techniques.Open Acces

Effective Communication in Nursing: Is it Necessary to Know your own Sociological Bias?

Through a discussion of the nursing literature and sociological theory, this Commonwealth Honors Thesis aims to answer the question; Is it necessary to know your own sociological bias in nurse to nurse communication. The focus begins with the qualifications of effective communication as a concept and then applies that specifically to communication between nurses. In addition, the discussion focuses on the topic of awareness vs. unawareness of sociological bias. The discussion includes passages and inclusion of nine pieces of nursing literature, including articles, books, and textbooks. Through out the researched literature connections were made between sociology and nursing. The result showed that is it absolutely necessary to be self aware of sociological bias in nurse to nurse communication

Intelligent Risk Taking: How to Secure Retirement in a Low Expected Return World

Retirement savers’ ability to consume in retirement is a function of how much they save, how long they invest, and what those investments return over the lifecycle. In this chapter, we examine the rate of return needed to deliver a comfortable retirement based on current savings rates as well as intelligent ways to construct portfolios to achieve this rate of return. Based on reasonable longterm return assumptions, defined contribution portfolios as frequently constructed today are unlikely to achieve this required rate of return. By relaxing existing constraints and taking advantage of well-known and broadly accepted investment themes this required rate of return can be achieved with an exceptionally well-diversified portfolio, which may also lead to a more consistent portfolio across different economic environments

Transforming the Hospitality Industry into E-Business

The emergence of a technology-intensive economy requires the transformation of business models in the hospitality industry Established companies can face technological, cultural, organizations and relationship barriers in moving from a traditional business model to an e-business model. The authors suggest that market, learning, and business process orientations at the organizational level can help remove some of the barriers toward e-business and facilitate the development of e-business within existing organizational infrastructures

Search for an Instability on a Quenched-Liquid Interface

We searched for signs of an instability on the interface between the two phases of a binary-liquid mixture, isobutyric acid and water, after the mixture was quenched further into the two-phase region. Such an instability would be the liquid-liquid analog of the Mullins-Sekerka instability seen in quenched alloys. Never is any dramatic growth observed, but under conditions of small dimensionless quench depth (theta\u3c1.5×10−3), the intensity of light scattered from the interface grows for small values of the momentum transfer k

Description of cryptococcosis following SARS-COV-2 infection: A disease survey through the Mycosis Study Group Education and Research Consortium (MSG-19)

BACKGROUND: Invasive fungal infections have been described throughout the COVID-19 pandemic. Cryptococcal disease after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been reported in several isolated case reports and 1 larger case series. We sought to describe cryptococcal infections following SARS-CoV-2 through establishing a database to investigate underlying risk factors, disease manifestations, and outcomes. METHODS: We created a crowdsourced call for cases solicited through the Mycoses Study Group Education and Research Consortium, the Centers for Disease Control and Prevention Emerging Infectious Diseases Network, and infectious diseases Twitter groups. Data were collected in a web-based and secure REDCap survey without personal identifiers. RESULTS: Sixty-nine cases were identified and submitted by 29 separate institutional sites. Cryptococcosis was diagnosed a median of 22 days (interquartile range, 9-42 days) after SARS-CoV-2 infection. Mortality among those with available follow-up was 72% (26/36) for the immunocompetent group and 48% (15/31) for the immunocompromised group (likelihood ratio, 4.01; P = .045). We observed a correlation between disease manifestation (central nervous system infection, proven/probable disseminated disease, and respiratory) and mortality (P = .002). CONCLUSIONS: The mortality rate of 59% for patients with cryptococcosis following SARS-CoV-2 is higher than that of modern Cryptococcus cohorts. There was an association between immunocompromised status and cryptococcal disease manifestations as well as mortality. Moreover, our series emphasizes the need for clinical and laboratory assessment of opportunistic infections beyond 30 days when concerning symptoms develop

Cauliflower mosaic virus ORF VII is not required for aphid transmissibility

Des mutants du virus de la mosaïque du chou-fleur ont été construits in vitro. La transmissibilité de ces mutants par les pucerons a été testée. Pour que la transmission par pucerons soit possible il faut un ORF II intact, alors que l'ORF VII n'est pas nécessaire. (Résumé d'auteur

Left ventricular trabeculations in cardiac MRI: reference ranges and association with cardiovascular risk factors in UK Biobank

Background The extent of left ventricular (LV) trabeculation and its relationship with cardiovascular (CV) risk factors is unclear. Purpose To apply automated segmentation to UK Biobank cardiac MRI scans to (a) assess the association between individual characteristics and CV risk factors and trabeculated LV mass (LVM) and (b) establish normal reference ranges in a selected group of healthy UK Biobank participants. Materials and Methods In this cross-sectional secondary analysis, prospectively collected data from the UK Biobank (2006 to 2010) were retrospectively analyzed. Automated segmentation of trabeculations was performed using a deep learning algorithm. After excluding individuals with known CV diseases, White adults without CV risk factors (reference group) and those with preexisting CV risk factors (hypertension, hyperlipidemia, diabetes mellitus, or smoking) (exposed group) were compared. Multivariable regression models, adjusted for potential confounders (age, sex, and height), were fitted to evaluate the associations between individual characteristics and CV risk factors and trabeculated LVM. Results Of 43 038 participants (mean age, 64 years ± 8 [SD]; 22 360 women), 28 672 individuals (mean age, 66 years ± 7; 14 918 men) were included in the exposed group, and 7384 individuals (mean age, 60 years ± 7; 4729 women) were included in the reference group. Higher body mass index (BMI) (β = 0.66 [95% CI: 0.63, 0.68]; P < .001), hypertension (β = 0.42 [95% CI: 0.36, 0.48]; P < .001), and higher physical activity level (β = 0.15 [95% CI: 0.12, 0.17]; P < .001) were associated with higher trabeculated LVM. In the reference group, the median trabeculated LVM was 6.3 g (IQR, 4.7–8.5 g) for men and 4.6 g (IQR, 3.4–6.0 g) for women. Median trabeculated LVM decreased with age for men from 6.5 g (IQR, 4.8–8.7 g) at age 45–50 years to 5.9 g (IQR, 4.3–7.8 g) at age 71–80 years (P = .03). Conclusion Higher trabeculated LVM was observed with hypertension, higher BMI, and higher physical activity level. Age- and sex-specific reference ranges of trabeculated LVM in a healthy middle-aged White population were established