SINUESSA, UN APPRODO SOMMERSO DI EPOCA ROMANA: archeolologia, geomorfologia costiera, strategie sostenibili di valorizzazione

La monografia raccoglie i contribuiti di studi e ricerche condotti negli ultimi anni nell’area archeologica marina di Sinuessa nel golfo di Gaeta in Campania. Alla realizza¬zione del volume hanno contribuito diversi autori, spe-cialisti in differenti discipline quali la geo-morfologia co¬stiera, archeologia e beni culturali con la finalità di sugge¬rire agli amministratori e stakeholder del litorale domitio strategie sostenibili per la valorizzazione dell’approdo sommerso di epoca romana

Sinuessa, un approdo sommerso di epoca romana

SINUESSA, UN APPRODO SOMMERSO DI EPOCA ROMANA Archeologia, geomorfologia costiera, strategie sostenibili di valorizzazione. La monografia raccoglie i contribuiti di studi e ricerche condotti negli ultimi anni nell’area archeologica marina di Sinuessa nel golfo di Gaeta in Campania. Alla realizzazione del volume hanno contribuito diversi autori, specialisti in differenti discipline quali la geomorfologia costiera, archeologia e beni culturali con la finalità di suggerire agli amministratori e stakeholder del litorale domitio strategie sostenibili per la valorizzazione dell’approdo sommerso di epoca romana

Il ruolo della co-produzione di servizi nella Pubblica Amministrazione: il sistema dei Beni Culturali

2014-2015This research project is aimed at exploring the rising role of service co-production in the public sector, with a focus on cultural heritage. In several countries, both in Europe and abroad, an increasing involvement of users in service co-production, at both the individual and the collective levels, could be identified. Eventually, co-production is intended at addressing the political, economic and social challenges which have been produced by the crisis of the welfare state. Since ‘70s, the scientific literature has widely discussed the distinguishing attributes of co-production in the fields of education, social services, health care, social safety, and environment protection, claiming that the involvement of users is crucial, on the one hand, to improve service quality, enhancing their ability to meet the growing expectations of users, and, on the other hand, to pave the way for increased sustainability, due to cost reduction and higher effectiveness. This thesis attempts to examine whether significant experiences of co-production have been realized in a particular public context, that is to say cultural heritage, which have been poorly analyzed through the lenses of co-production. Besides, it investigates what kinds of changes the involvement of users could generate on the cultural heritage management. This work is organized as follows. First of all, a brief introduction contextualizes the object of the research. Then, the research design is depicted; a mixed research method has been adopted, in line with the specific characteristics of this research project. In the first chapter, a narrative literature review has been performed, to describe the evolution of the co-production concept and to devise a theoretical framework aimed at providing several insights on the potential role of co-production in the process of public value creation. The second chapter focuses on the relationship between users and providers, examining the specific experiences of co-production experienced by the Royal Palace of Caserta, one of the most renowned cultural site of Italy and included among the UNESCO world heritage sites since 1997. The third chapter analyzes the contribution of service co-production for the purposes of protection and promotion of cultural heritage. The role of co-production is examined in light of the recent legislative reform of the Italian Ministry for cultural heritage and Tourism (MiBACT), which have provided the main cultural sites of Italy with an increased managerial autonomy. Conclusions summarized the role that information technologies and digital tools could play – especially in a social perspective – to pave the way for co-creating relationships, realizing the full potential of innovative forms of participation, including co-production. [edited by Author]XIV n.s

Static regenerative fuel cell system for use in space

The cell stack can be operated as a fuel cell stack or as an electrolysis cell stack. The stack consists of a series of alternate fuel cell subassemblies with intervening electrolysis cell subassemblies, and interspersed cooling plates. The water produced and consumed in the two modes of operation migrates between adjacent cell subassemblies. The component plates are annular with a central hydrogen plenum and integral internal oxygen manifolds. No fluid pumps are needed to operate the stack in either mode

Geomorphological features of the marine area of Sinuessa in Campania, southern Italy

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Reduced primary patency rate in diabetic patients after percutaneous intervention results from more frequent presentation with limb-threatening ischemia

ObjectiveAlthough patients with diabetes are at increased risk of amputation from peripheral vascular disease, excellent limb-salvage rates have been achieved with aggressive surgical revascularization. It is less clear whether patients with diabetes will fare as well as nondiabetics after undergoing percutaneous lower extremity revascularization, a modality which is becoming increasingly utilized for this disease process. This study aimed to assess differential outcomes in between diabetics and nondiabetics in lower extremity percutaneous interventions.MethodsWe retrospectively studied 291 patients with respect to patient variables, complications, and outcomes for percutaneous interventions performed for peripheral occlusive disease between 2002 and 2005. Tibial vessel run-off was assessed by angiography. Patency (assessed arterial duplex) was expressed by Kaplan-Meier method and log-rank analysis. Mean follow-up was 11.6 months (range 1 to 56 months).ResultsA total of 385 interventions for peripheral occlusive disease with claudication (52.2%), rest pain (16.4%), or tissue loss (31.4%) were analyzed, including 336 primary interventions and 49 reinterventions (mean patient age 73.9 years, 50.8% male). Comorbidities included diabetes mellitus (57.2%), chronic renal insufficiency (18.4%), hemodialysis (3.8%), hypertension (81.9%), hypercholesterolemia (57%), coronary artery disease (58%), tobacco use (63.2%). Diabetics were significantly more likely to be female (55.3% vs 40.8%), and suffer from CRI (23.5% vs 12.0%), a history of myocardial infarction (36.5% vs 18.0%), and <three-vessel tibial outflow (83.5% vs 71.8%), compared with nondiabetics, although all other comorbidities and lesion characteristics were equivalent between these groups. Overall primary patency (± SE) at 6, 12, and 18 months was 85 ± 2%, 63 ± 3% and 56 ± 4%, respectively. Patients with diabetes suffered reduced primary patency at 1 year compared with nondiabetics. For nondiabetics, primary patency was 88 ± 2%, 71 ± 4%, and 58 ± 4% at 6, 12, and 18 months, while for diabetics it was 82 ± 2%, 53 ± 4%, and 49 ± 4%, respectively (P = .05). Overall secondary patency at 6, 12, and 18 months was 88 ± 2%, 76 ± 3%, and 69 ± 3%, and did not vary by diabetes status. One-year limb salvage rate was 88.3% for patients with limb-threatening ischemia, which was also similar between diabetics and nondiabetics. While univariate analysis revealed that female gender, <three-vessel tibial outflow, and a history of tobacco use were all predictive of reduced primary patency (P < .05), none of these factors significantly impacted secondary patency or limb-salvage rate. Furthermore, only limb-threatening ischemia remained a significant predictor of outcome on multivariate analysis, suggesting that the poorer primary patency in diabetics is related primarily to their propensity to present with limb-threatening disease compared with nondiabetics.ConclusionPatients with diabetes demonstrate reduced primary patency rates after percutaneous treatment of lower extremity occlusive disease, most likely due to their advanced stage of disease at presentation. However, despite a higher reintervention rate, diabetics and others with risk factors predictive of reduced primary patency can attain equivalent short-term secondary patency and limb-salvage rates. Therefore, these patient characteristics should not be considered contraindications to endovascular therapy

Computer simulation as a component of catheter-based training

IntroductionComputer simulation has been used in a variety of training programs, ranging from airline piloting to general surgery. In this study we evaluate the use of simulation to train novice and advanced interventionalists in catheter-based techniques.MethodsTwenty-one physicians underwent evaluation in a simulator training program that involved placement of a carotid stent. Five participants were highly experienced in catheter-based techniques (>300 percutaneous cases), including carotid angioplasty and stenting (CAS); the remaining 16 participants were interventional novices (<5 percutaneous cases). The Procedicus VIST simulator, composed of real-time vascular imaging simulation software and a tactile interface coupled to angiographic catheters and guide wires, was used. After didactic instruction regarding CAS and use of the simulator, each participant performed a simulated CAS procedure. The participant's performance was supervised and evaluated by an expert interventionalist on the basis of 50 specific procedural steps with a maximal score of 100. Specific techniques of guide wire and catheter manipulation were subjectively assessed on a scale of 0 to 5 points based on ability. After evaluation of the initial simulated CAS procedure, each participant received a minimum of 2 hours of individualized training by the expert interventionalist, with the VIST simulator. Each participant then performed a second simulated CAS procedure, which was graded with the same scale. After completion, participants assessed the training program and its utility via survey questionnaire.ResultsThe average simulated score for novice participants after the training program improved significantly from 17.8 ± 15.6 to 69.8 ± 9.8 (P < .01), time to complete simulation decreased from 44 ± 10 minutes to 30 ± 8 minutes (P < .01), and fluoroscopy time decreased from 31 ± 7 minutes to 23 ± 7 minutes (P < .01). No statistically significant difference in score, total time, or fluoroscopy time was noted for experienced interventionalists. Improvement was noted in guide wire and catheter manipulation skills in novices.. Analysis of survey data from experienced interventionalists indicated that the simulated clinical scenarios were realistic and that the simulator could be a valuable tool if clinical and tactile feedback were improved. Novices also thought the simulated training was a valuable experience, and desired further training time.ConclusionsAn endovascular training program using the Procedicus VIST haptic simulator resulted in significant improvement in trainee facility with catheter-based techniques in a simulated clinical setting. Novice participants derived the greatest benefit from simulator training in a mentored program, whereas experienced interventionalists did not seem to derive significant benefit

Gross hematuria caused by a congenital intrarenal arteriovenous malformation: a case report

<p>Abstract</p> <p>Introduction</p> <p>We report the case of a woman who presented with gross hematuria and was treated with a percutaneous embolization.</p> <p>Case presentation</p> <p>A 48-year-old Caucasian woman presented with gross hematuria, left flank pain, and clot retention. The patient had no history of renal trauma, hypertension, urolithiasis, or recent medical intervention with percutaneous instrumentation. The patient did not report any bleeding disorder and was not taking any medication. Her systolic and diastolic blood pressure values were normal at presentation. The patient had anemia (8 mg/dL) and tachycardia (110 bpm). She underwent color and spectral Doppler sonography, multi-slice computed tomography, and angiography of the kidneys, which showed a renal arteriovenous malformation pole on top of the left kidney.</p> <p>Conclusions</p> <p>The feeding artery of the arteriovenous malformation was selectively embolized with a microcatheter introduced using a right transfemoral approach. By using this technique, we stopped the bleeding, preserved renal parenchymal function, and relieved the patient's symptoms. The hemodynamic effects associated with the abnormality were also corrected.</p

Detection of mammaglobin mRNA in peripheral blood is associated with high grade breast cancer: Interim results of a prospective cohort study

<p>Abstract</p> <p>Background</p> <p>We sought to examine the detection rate of cancer cells in peripheral blood (PBL) and in bone marrow (BM) using an established 7-gene marker panel and evaluated whether there were any definable associations of any individual gene with traditional predictors of prognosis.</p> <p>Methods</p> <p>Patients with T1-T3 primary breast cancer were enrolled into a prospective, multi-institutional cohort study. In this interim analysis 215 PBL and 177 BM samples were analyzed by multimarker, real-time RT-PCR analysis designed to detect circulating and disseminated breast cancer cells.</p> <p>Results</p> <p>At a threshold of three standard deviations from the mean expression level of normal controls, 63% (136/215) of PBL and 11% (19/177) of BM samples were positive for at least one cancer-associated marker. Marker positivity in PBL demonstrated a statistically significant association with grade II-III (vs. grade I; p = 0.0083). Overexpression of the mammaglobin (<it>mam</it>) gene alone had a statistically significant association with high tumor grade (p = 0.0315), and showed a trend towards ER-negative tumors and a high risk category. There was no association between marker positivity in PBL and the pathologic (H&E) and/or molecular (RT-PCR) status of the axillary lymph nodes (ALN).</p> <p>Conclusion</p> <p>This study suggests that molecular detection of circulating cancer cells in PBL detected by RT-PCR is associated with high tumor grade and specifically that overexpression of the <it>mam </it>gene in PBL may be a poor prognostic indicator. There was no statistically significant association between overexpression of cancer-associated genes in PBL and ALN status, supporting the concept of two potentially separate metastatic pathways.</p