Diritto alla salute ed accreditamento all'eccellenza. Un approccio sistemico orientato al Total Quality Management

Nel corso dell’ultimo decennio si è potuto osservare un graduale spostamento della definizione di qualità assistenziale intesa come efficienza organizzativa ad una spiegazione incentrata sull’efficacia del processo di cura e di orientamento all’utente. Con questa premessa, si può configurare l’accreditamento all’eccellenza come un percorso che promuove gli aspetti qualitativi dell’integrazione e della continuità delle cure in risposta alle mutate esigenze dei cittadini. Il miglioramento della qualità professionale richiesto agli operatori sanitari dovrebbe essere orientato non solo ad affinare le competenze tecniche sul campo, ma ad esercitare le stesse entro un sistema organizzativo strutturato in cui si sviluppano processi finalizzati a garantire il servizio assistenziale atteso dall’utenza. Nella realtà italiana, la logica dell’accreditamento all’eccellenza è in linea con un mercato sanitario in cui risulta fondamentale innalzare costantemente il livello di qualità delle prestazioni. Pertanto, promuove un processo di apprendimento organizzativo interno volto al miglioramento continuo delle performance sanitarie e della customer satisfaction, in grado di far crescere l’intero sistema sanitario nazionale pubblico e privato

Saving lives through better communication. Preventing healthcare professionals errors during the donation-transplant process

A shared safety culture among healthcare professionals increases successful donation-transplant outcomes. A perfectly planned integration could reduce the possibility of failed organ transplantation and damage to the patient. Clear and understandable systematic team training projects covering communication aspects linked to practice procedures could improve the quality of the whole process.Una cultura della sicurezza, condivisa tra i professionisti sanitari, incrementa la riuscita del processo donazione- trapianto. Un’integrazione perfettamente pianificata può ridurre la possibilità di fallimento nel trapianto d’organo e di danno al paziente. Progetti formativi chiari e comprensibili rivolti al gruppo di lavoro, orientati ad aspetti comunicativi e connessi a procedure pratiche, possono migliorare la qualità dell’intero processo

Biosynthesis and Analysis of 3-Isobutyl-2-methoxypyrazine in Capsicum annuum (Bell Pepper) Plants

3-Alkyl-2-methoxypyrazines (MPs) are highly odorous compounds occurring in a wide range of raw vegetables. Due to their high odor activity, they have been of great research interest. The most prominent MPs are 3-isopropyl-2-methoxypyrazine (IPMP), 3-sec-butyl2-methoxypyrazine (sBMP) and 3-isobutyl-2-methoxypyrazine (IBMP). While their occurrence has been widely studied, less is known about their biosynthesis. The identification of Vitis vinifera O-methyltransferases (VvOMTs) catalyzing the O-methylation of 3-alkyl2-hydroxy-pyrazines (HPs) gave an important insight into the last step of MP-biosynthesis. However, precursors and earlier biosynthetic steps are still unknown. Different pathways of MP-biosynthesis have been proposed, but none of them has been confirmed yet. The main objective of this study was thus to identify precursors of MPs. For this purpose, in vivo feeding experiments were conducted using stable isotope labeled compounds. Feeding experiments were conducted focusing on the IBMP-biosynthesis in bell pepper fruits (Capsicum annuum L.). Volatiles were extracted by headspace solid-phase microextraction (HS-SPME) and analyzed by comprehensive two-dimensional gas chromatography (GC×GC) coupled to time-of-flight mass spectrometry (ToF-MS). Feeding studies revealed an incorporation of L-leucine and α-ketoisocaproic acid (α-KIC) into IBMP. It could be shown that L-serine plays a key role in the biosynthesis of IBMP not only as a C2-building block, but also as nitrogen source. Indeed, the incorporation of L-serine as well as a C1-unit of glycine and glyoxylic acid into IBMP gave evidence for a metabolic interface of the IBMP-biosynthesis and photorespiration. Besides, the distribution of IBMP within the bell pepper plant was examined. Therefore, a method combining a stable isotope dilution assay (SIDA) with HS-SPME, GC and ToF-MS was developed and validated. IBMP was found in all plant organs. However, unripe bell pepper pericarp turned out to be the main site of IBMP-accumulation. In vivo feeding experiments revealed that IBMP is biosynthesized in all plant parts apart from roots and ripe bell pepper fruits. A long-distance transport of IBMP via the phloem was not detected

Numerical analysis of advection-diffusion problems on 2D general-shaped domains by means of a RBF Collocation Meshless Method

A Collocation Meshless Method based on local Radial Basis Function (RBF) interpolation is employed to solve two-dimensional advection-diffusion problems with particular reference to the incompressible Navier-Stokes equations in their transient form, i.e., unsteady flows, using primitive variables (U,p). A projection scheme is employed to decouple the continuity and momentum equations; particular attention is given to the choice of the required solvers. This approach is applied to the simulation of unsteady flows for two typical test cases, i.e., the lid-driven cavity problem and the flow past a circular cylinder between parallel walls. Numerical results compare very favorably with literature ones, confirming that this approach can be effectively employed in the numerical simulation of unsteady flows on practical geometries where complex node distributions and large number of nodes are required

Two algorithms for fast 2D node generation: application to RBF meshless discretization of diffusion problems and image halftoning

Mesh generation techniques for traditional mesh based numerical approaches such as FEM and FVM have now reached a good degree of maturity. There is no such an acknowledged background when dealing with node generation techniques for meshless numerical approaches, despite their theoretical simplicity and efficiency; furthermore node generation can be put in connection with some well-known image approximation techniques. Two node generation algorithms are here proposed and employed in the numerical solution of 2D steady state diffusion problems by means of a local Radial Basis Function (RBF) meshless method. Finally, such algorithms are also tested for greyscale image approximation through stippling

Solution of incompressible fluid flow problems with heat transfer by means of an efficient RBF-FD meshless approach

The localized radial basis function collocation meshless method (LRBFCMM), also known as radial basis function generated finite differences (RBF-FD) meshless method, is employed to solve time-dependent, 2D incompressible fluid flow problems with heat transfer using multiquadric RBFs. A projection approach is employed to decouple the continuity and momentum equations for which a fully implicit scheme is adopted for the time integration. The node distributions are characterized by non-cartesian node arrangements and large sizes, i.e., in the order of $10^5$ nodes, while nodal refinement is employed where large gradients are expected, i.e., near the walls. Particular attention is given to the accurate and efficient solution of unsteady flows at high Reynolds or Rayleigh numbers, in order to assess the capability of this specific meshless approach to deal with practical problems. Three benchmark test cases are considered: a lid-driven cavity, a differentially heated cavity and a flow past a circular cylinder between parallel walls. The obtained numerical results compare very favourably with literature references for each of the considered cases. It is concluded that the presented numerical approach can be employed for the efficient simulation of fluid-flow problems of engineering relevance over complex-shaped domains

Accurate Stabilization Techniques for RBF-FD Meshless Discretizations with Neumann Boundary Conditions

A major obstacle to the application of the standard Radial Basis Function-generated Finite Difference (RBF-FD) meshless method is constituted by its inability to accurately and consistently solve boundary value problems involving Neumann boundary conditions (BCs). This is also due to ill-conditioning issues affecting the interpolation matrix when boundary derivatives are imposed in strong form. In this paper these ill-conditioning issues and subsequent instabilities affecting the application of the RBF-FD method in presence of Neumann BCs are analyzed both theoretically and numerically. The theoretical motivations for the onset of such issues are derived by highlighting the dependence of the determinant of the local interpolation matrix upon the boundary normals. Qualitative investigations are also carried out numerically by studying a reference stencil and looking for correlations between its geometry and the properties of the associated interpolation matrix. Based on the previous analyses, two approaches are derived to overcome the initial problem. The corresponding stabilization properties are finally assessed by succesfully applying such approaches to the stabilization of the Helmholtz-Hodge decomposition

Feeding patterns, habitat use and ecological characteristics of the roost of the nursery colony of the greater mouse-eared bat (Myotis myotis) in a church in Spodnja Polskava

Navadnega netopirja (Myotis myotis) v Sloveniji najbolj ogroža uničevanje kotišč, medtem ko so ostali dejavniki, slabo poznani. Za analizo stanja vrste na nekem območju je ključno poznavanje populacijskega trenda. Eden izmed pomembnih, a pogosto spregledanih dejavnikov, ki vpliva na populacijsko dinamiko, je razpoložljivost prehranjevalnih habitatov. Z radiotelemetričnim spremljanjem navadnih netopirjev iz zatočišča v cerkvi sv. Štefana na Spodnji Polskavi smo skušali določiti vzorce v izbiri prehranjevališč navadnih netopirjev glede na rabo tal v okolici zatočišča. Hkrati smo spremljali mikroklimatske lastnosti samega kotišča s pomočjo avtomatskih beležnikov temperature in relativne vlage ter ugotavljali druge splošne značilnosti kotišča. Razlike med pričakovano in dejansko rabo tal so bile statistično značilne, kar kaže na selektivno izbiro prehranjevalnih habitatov, predvsem gozda. S tem smo potrdili hipotezo, da bo prednostno prehranjevalno območje netopirjev v listopadnih gozdovih z malo podrasti. Na primeru šestih spremljanih netopirjev je bil na prehranjevališčih najpogostejši gozd (40 %), sledile so njive (35,9 %) in trajni travniki (13,8 %). Gozd je bil v 67 % prehranjevališč prevladujoč habitatni tip, od teh je v devetih primerih predstavljal več kot 50 % površine prehranjevališča. S spremljanjem mikroklimatskih razmer smo potrdili hipotezo, da temperaturne razmere kotišča sicer sledijo zunanjim spremembam, vendar je kotišče značilno toplejše. Zbrani podatki predstavljajo dobro izhodišče za oblikovanje smernic za upravljanje tako z zatočiščem kot njegovo okolico.The greater mouse-eared bat (Myotis myotis) in Slovenia is endangered mainly by destruction of roosts, while other factors are poorly known. For analysis of the state the species in a given area is in, it is crucial to know its population trend. One of the important but very often neglected factors that influence population dynamics is the availability of feeding habitats. By using radio telemetry on greater mouse-eared bats from the roost in the church sv. Štefan in Spodnja Polskava (SE Slovenia) we investigated their feeding patterns considering different land uses in the vicinity of the roost. Moreover, we collected data on microclimatic conditions within the roost using data-loggers, as well as other roost characteristics. Differences between the expected and realized habitat uses were significant, which points to selective use of feeding habitats, especially forests. Our results supported the hypothesis that bats will select for deciduous woodlands with little undergrowth. Land use categories that were most frequent among the feeding locations were forest (40 %), followed by fields (35,9 %) and permanent meadows (13,8 %). In 67 % of feeding locations, forest was the main habitat type, in nine occasions it covered more that 50 % of the surface. Results on microclimatic conditions supported the hypothesis that temperatures of the roost follow the ones outside, but they were significantly higher. We used collected data as a basis to propose the guidelines for managing the roost as well as the surrounding habitats

Accurate RBF-FD meshless numerical simulation of thermo-fluid problems for generic 3D geometries

In contrast to traditional mesh-based methods for the numerical solution of boundary value problems, e.g., Finite Element (FEM) and Finite Volume (FVM), in the recent period many meshfree approaches have been proposed in order to avoid those typical issues due to the mesh. For example, the quality of the mesh greatly affects the reliability of the final solution in the case of CFD problems and the human intervention of a professional is often still needed when dealing with complex-shaped domains. This in turn increases both cost and time required for the reliable simulation of problems of engineering relevance. Meshless methods, on the other side, usually rely on a simpler distribution of nodes and do not require the storage of connectivity information. Among others, one of the most promising meshless methods in terms of accuracy and flexibility is the one based on the Radial Basis Function – Finite Difference (RBF-FD) scheme. RBF-FD methods, however, are usually affected by severe ill conditioning issues when Neumann boundary conditions are employed. This fact is the main responsible for the appearance of large discretization errors near the boundary and for the lack of stability of traditional time integration schemes. In order to address this issue, some new algorithms for the robust treatment of boundary conditions have been developed and successfully employed to solve fluid flow problems with heat transfer. Furthermore, it is well acknowledged that the efficient resolution of boundary layers arising in this class of problems requires an adequate spatial discretization in the neighbourhood of the boundary, i.e., increased node/mesh density along the direction of large gradients only. In the context of the RBF-FD method, this result is achieved through an anisotropic node generation algorithm, thus enabling the efficient simulation of a greater variety of CFD problems. The method described above is successfully employed for the accurate solution of a representative 3D heat transfer problem with incompressible fluid flow

Distributed Lagrange Multiplier Functions for Fictitious Domain Method with Spectral/hp Element Discretization

A fictitious domain approach for the solution of second-order linear differential problems is proposed; spectral/hp elements have been used for the discretization of the domain. The peculiarity of our approach is that the Lagrange multipliers are particular distributed functions, instead of classical \u3b4 Dirac (impulsive)multipliers. In this paper we present the formulation and the application of this approach to 1D and 2D Poisson problems and 2D Stokes flow (biharmonic equation)