From social infrastructure to civic center. The school as laboratory of collaborative governance models / Du service public au centre civique. À Turin, les écoles deviennent des condensateurs sociaux d’expérimentations urbaines

In the second half of the last century, after World War II, the Italian government defined an important period of public policies and projects to build a national welfare system in order to bridge the social and cultural gaps of a country with many different territorial situations. Half a century later, the complexification of the social and economic organization, which has transformed mass society into a plural society, has brought with it a multiplication and fragmentation of spatial and social needs for which the universal welfare system appears ineffective. The role of the public administration and its relationship to communities and the third sector have changed: increasingly often, alliances are defined to build projects that are closer to different social and cultural demands. This paper will focus on processes in which public service is enriched and regenerated by the care of reference communities: we seem to recognize the premises for a new way of administering public services, in which the public and the private collaborate on an equal level. We will adopt this perspective in observing what happens inside schools, which seems particularly interesting for at least two reasons. First of all, as the symbol of a public welfare service in crisis, it is simultaneously possible to recognize a certain habit of school communities taking part in the redevelopment of this service, through actions to care for the school building and its pertinent spaces. Secondly, the school also plays the role of a territorial actor, coming out of its own enclosures to take over urban space (that is, public gardens, parks, libraries, museums, cycle workshops, etc.) with educational projects at various levels. Turin represents an interesting case study, as a city where both public policies and social practices have integrated themselves, from education to urban regeneration, through institutional actors and local communities

Contact between the components of a knee prosthesis: numerical and experimental study

The aim of this work is the analysis of the contact area in a knee prosthesis using two different approaches. In particular, the interface between the femoral component and the polyethylene insert has been studied both numerically and experimentally. The interest in studying the contact area is related to the fact that the wear of the polyethylene insert, due to the high contact pressures, represents one of the major causes of failure of the total knee prosthesis. The possibility to evaluate the contact area at different loads and mutual position between femur and tibia is, therefore, of fundamental importance to study the service life of a prosthesis and to improve its performance. The finite element numerical approach has required the acquisition, through reverse engineering, and CAD modelling of the prosthetic components. Then the FEM simulations have been developed considering two different load conditions. In order to compare the calculated data, the same load configurations have been used for experimental tests based on ultrasonic method. In this case, some preliminary tests were required to calibrate the system depending on the particular characteristics of materials, geometries and surface finish of the prosthesis.The results show a good correlation between the data obtained with the two different approaches and, consequently, a good level of reliability of the procedures developed for the numerical and experimental evaluation of the contact area. The numerical procedure can be used to determine the area for different angles and loads, but especially in the design phase. The ultrasonic technique can be used to validate the numerical data

Contact between the components of a knee prosthesis: numerical and experimental study

The aim of this work is the analysis of the contact area in a knee prosthesis using two different approaches. In particular, the interface between the femoral component and the polyethylene insert has been studied both numerically and experimentally. The interest in studying the contact area is related to the fact that the wear of the polyethylene insert, due to the high contact pressures, represents one of the major causes of failure of the total knee prosthesis. The possibility to evaluate the contact area at different loads and mutual position between femur and tibia is, therefore, of fundamental importance to study the service life of a prosthesis and to improve its performance. The finite element numerical approach has required the acquisition, through reverse engineering, and CAD modelling of the prosthetic components. Then the FEM simulations have been developed considering two different load conditions. In order to compare the calculated data, the same load configurations have been used for experimental tests based on ultrasonic method. In this case, some preliminary tests were required to calibrate the system depending on the particular characteristics of materials, geometries and surface finish of the prosthesis.The results show a good correlation between the data obtained with the two different approaches and, consequently, a good level of reliability of the procedures developed for the numerical and experimental evaluation of the contact area. The numerical procedure can be used to determine the area for different angles and loads, but especially in the design phase. The ultrasonic technique can be used to validate the numerical data

La società della cura si attiva in patti alla pari

La densità di cambiamenti che in questo inizio di 2020 stanno stravolgendo la nostra vita quotidiana, individuale e collettiva, è storica. La società del rischio teorizzata da decadi appare, a noi sociologhe di oggi, tanto anticipatrice quanto vertiginosamente modificata. In estrema sintesi, da argomenti sociali di inter-dipendenza globale socio-economico-politica à la Beck si è passati nell’arco di pochi giorni ad argomenti di inter-sopravvivenza. Non solo il numero di morti per Coronavirus è scioccante, ma lo sono anche molti comportamenti sociali per la paura di morire. La reazione della maggioranza dei responsabili politici occidentali pare essersi da subito allineata alla misura del rischio accettabile, su basi tecniche, statistiche e mediche. In questo contributo ci agganciamo alle riflessioni ormai trentennali di Luhmann (1998) su “chi comunica” e “chi comprende”. L’approccio partecipativo allo studio delle politiche urbane e territoriali ha più volte evidenziato il rischio che le attitudini tecnocratiche top-down rappresentano per le nostre democrazie

Improving sustainable mobility in university campuses. The case study of Sapienza University

The pursue of sustainable mobility is one of the greatest environmental challenges nowadays. It requires a people mind shift, where the use of private vehicles give way to different modes of public transport like buses, bicycles, car sharing, electric cars, and walking lanes. This new call to make mobility sustainable has already been undertaken by policymakers and public managers in many urban contexts around the world, as well as, more recently, by the managers of university systems. The paper shows the work developed in 2018 for the Sapienza Sustainable University Mobility Plan (SUMP). The study stems from the need to understand and improve, in the sustainability direction, modes of travel for the students and staff of one of the oldest universities in the world, and one of the largest in Europe (112,142 students enrolled and 23,101 between academic staff and no academic staff), with its premises located in a complex and challenging urban context such as the city of Rome. The SUMP has been developed in two phases. The first one investigated travel patterns and the reasons for the modal shift and highlighted the main issues. The second phase defined strategies and interventions to be implemented in the short, medium, and long term to make students and staff's mobility more environmentally sustainable. The methodology used in the fact-finding stage was the online survey that was carried out through the use of a diversified questionnaire for staff and students of the University. The sample of students who participated in the survey amounted to 14,719 units, while the sample of faculty and staff was 9,403. The main questionnaire outcomes showed that the attitudes recorded were largely different between faculty and staff and students. While for the first ones the choice of private vehicles is the first option (36%), for students public transport is the prevailing preference (78%). According to the critical aspects found in this first stage, the SUMP objectives were defined, leading to the identification of macro-areas of intervention and specific actions. At a policy and strategic level, the attention was focused on the guidelines issued by the United Nations, the European Commission, and the Network of Universities for Sustainable Development, of which Sapienza University is a member. For this reason, the identification of strategies and interventions results from the combination of the first phase analysis, the Sapienza Governance objectives, and the national and international context in which the SUMP was drafted. Five macro-areas of intervention have been identified: Smart Strategies, Pedestrian Mobility, Cycling, Local Public Transport, Private Transport, and for each one specific intervention to be implemented in different time frames have been defined

Impact of Candida species colonization and azoles resistance in a neonatal intensive care unit

Background: Candida species are among the top 10 most frequently isolated nosocomial bloodstream pathogens in Europe. In particular, in neonatal intensive care units (NICUs) Candida infections are an emerging concern because of the increasing incidence, the related high morbidity and mortality rates reported. Moreover, the epidemiology of Candida infection rapidly changed in these years leading to the selection of less sensitive strains and species. Surveillance studies are mandatory to identify the local distribution of species, their antifungal susceptibility profiles and the emergence of resistance strains. Material/methods: From December 2012 we performed a cohort prospective surveillance study in our NICU, collecting weekly nasal and rectal swabs. Swabs were placed on Sabouraud agar. Candida growth on agar plates was confirmed by microscopic observation. Furthermore, Candida spp. was identified through Candida chromogenic agar (Candida chromogenic agar, Laboratorios Conda) and API\uae 20C AUX (Biom\ue9rieux). The first isolated non-C.albicans Candida (NCAC) species from colonized patients were tested with the main antifungal agents (YeastOne\uae Y010 Thermo Fisher Scientific) and the obtained MIC values were read according to CLSI. Results: From December 2012 to June 2016 we enrolled 874 neonates and analyzed respectively 2014 nasal and rectal swabs. 20/2014 (0,99%) of nasal swabs and 128/2014 (6,35%) of rectal swabs tested positive for Candida spp. The species distribution is showed in the Graph 1. 89/874 (10,18%) neonates tested positive at least in one swab. 59 isolates of NCAC species were tested with the main antifungal agents. All the tested strains were susceptible to echinocandins and amphotericin B. The susceptibility patterns for azoles are shown in the Table 1. Conclusions: Our study confirm the rule of surveillance in the prevention and control of Candida spp. healthcare related infections especially in an high risk ward such as NICU. In particular, in our NICU fluconazole prophylaxis is administered according to standard protocols from 2009.Antifungal susceptibility testes allowed to identify resistant and mutant strains whom acquired resistance so to obtain both clinical and epidemiological data promptly

Atrial fibrillation in Mediterranean spotted fever

Mediterranean spotted fever (MSF) is a tick-borne acute febrile disease caused by Rickettsia conorii and characterized by fever, maculo-papular rash and a black eschar at the site of the tick bite ('tache noir'). We describe the case of a 58-year-old man affected by MSF who developed atrial fibrillation. The patient presented himself to the hospital after 7 days of fever, malaise and severe headache. Cardiac auscultation revealed a chaotic heart rhythm and an electrocardiogram confirmed atrial fibrillation with a fast ventricular response. Diagnosis of MSF was made after the appearance of a maculo-papular skin rash, and treatment with oral doxycycline was started. An immunofluorescence antibody test confirmed R. conorii infection. The patient recovered after 7 days of treatment. Cardiac arrhythmia is a rare complication of MSF. Inflammation may play a role in the pathogenesis of atrial fibrillation. R. conorii is an intracellular bacterium which could trigger atrial fibrillation. Our patient was previously healthy and had no reported history of cardiac disease. This suggests that heart function should be monitored in MSF patients even in the absence of underlying risk factors

An update of the evolving epidemic of blaKPC carrying Klebsiella pneumoniae in Sicily, Italy, 2014: Emergence of multiple Non-ST258 Clones

Background: In Italy, Klebsiella pneumoniae carbapenemase producing K. pneumoniae (KPC-Kp) strains are highly endemic and KPC producing CC258 is reported as the widely predominating clone. In Palermo, Italy, previous reports have confirmed this pattern. However, recent preliminary findings suggest that an epidemiological change is likely ongoing towards a polyclonal KPC-Kp spread. Here we present the results of molecular typing of 94 carbapenem non susceptible K. pneumoniae isolates detected during 2014 in the three different hospitals in Palermo, Italy. Methods and Results: Ninety-four consecutive, non replicate carbapenem non susceptible isolates were identified in the three largest acute general hospitals in Palermo, Italy, in the six-month period March-August 2014. They were characterized by PCR for β-lactam, aminoglycoside and plasmid mediated fluoroquinolone resistance genetic determinants. The mgrB gene of the colistin resistant isolates was amplified and sequenced. Clonality was assessed by pulsed field gel electrophoresis and multilocus sequence typing. Eight non-CC258 sequence types (STs) were identified accounting for 60% of isolates. In particular, ST307 and ST273 accounted for 29% and 18% of isolates. CC258 isolates were more frequently susceptible to gentamicin and non-CC258 isolates to amikacin. Colistin non susceptibility was found in 42% of isolates. Modifications of mgrB were found in 32 isolates. Conclusions: Concurrent clonal expansion of some STs and lateral transmission of genetic resistance determinants are likely producing a thorough change of the KPC-Kp epidemiology in Palermo, Italy. In our setting mgrB inactivation proved to substantially contribute to colistin resistance. Our findings suggest the need to continuously monitor the KPC-Kp epidemiology and to assess by a nationwide survey the possible shifting towards a polyclonal epidemic

Use of Cepheid Xpert Carba-R\uae for Rapid Detection of Carbapenemase-Producing Bacteria in Abdominal Septic Patients Admitted to Intensive Care Unit.

Abstract Early institution of effective antibiotic therapy and source control are pivotal to improve survival of abdominal septic patients. Xpert\uae Carba-R is a real time polymerase chain reaction assay for rapid detection and differentiation of five genes (blaKPC, blaVIM, blaOXA-48, blaIMP-1, blaNDM) responsible for carbapenem resistance. We performed an observational study investigating the clinical usefulness and applicability of Xpert\uae Carba-R to detect carbapenem resistance in abdominal septic patients admitted to intensive care unit. We compared the results of Xpert\uae Carba-R with standard microbiological culture. We collected a set of two rectal/stomia swabs and two swabs from abdominal drainage fluid for each patient. We included 20 patients for a total of 45 comparisons between the two methods. In our clinical setting, the overall performance of Xpert\uae Carba-R for detection of carbapenem resistance in the presence of genes detectable and non-detectable by the method was: sensitivity 50% (95% CI 24.6-75.3); specificity 93.1% (95% CI 77.2-99.1); positive predictive value (PPV) 80% (95% CI 44.4-97.5); negative predictive value (NPV) 77.1% (95% CI 56.9-89.6). The inter-rater agreement was 0.47 (SE 0.14; 95% CI 0.20-0.74). When considering the only 5 mechanisms of resistance detected by both methods, the overall diagnostic performance was: sensitivity 100% (95% CI 69.1-100), specificity 94.2 (95% CI 80.8-99.3), PPV 83.3 (95% CI 59.6-97.9) and NPV 100% (95% CI 89.4-100). The inter-rater agreement was 0.88 (SE 0.08; 95% CI 0.71-1). Xpert\uae Carba-R may be considered an additional diagnostic tool for early diagnosis of carbapenem resistance in abdominal septic patients. Clinicians should be aware of their epidemiology before its introduction in the diagnostic protocol of their intensive care units

Successful control of an outbreak of colonization by Klebsiella pneumoniae carbapenemase-producing K.\ua0pneumoniae sequence type 258 in a neonatal intensive care unit, Italy

This article reports an outbreak of colonization by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp) sequence type (ST) 258 in a neonatal intensive care unit (NICU) in Palermo, Italy. KPC-Kp ST258 was detected by an active surveillance culture programme. Between 18th September and 14th November 2012, KPC-Kp was isolated from 10 out of 54 neonates admitted in the outbreak period. No cases of infection were recorded. Male sex was associated with colonization, whereas administration of ampicilline-sulbactam plus gentamicin was protective. Infection control interventions interrupted the spread of KPC-Kp without the need to close the NICU to new admissions. (C) 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved