Verso un\u2019architettura digitale unica e sicura per la P.A.: il ruolo di Agid e Consip

This paper presentation explores the development of the new relationship between the public administration and the cyber security in light of the defense of the IT heritage, taking into consideration the key role of AgID and Consip and the complex architecture of cyber security to be implemented by the public entities following the AgID resolutions and the rules adopted during the last few years

Plethysmographic Loops : a Window on the Lung Pathophysiology of COPD Patients

Plethysmographic alveolar pressure-flow (Palv\u2013F) loops contain potentially relevant information about the pathophysiology of chronic obstructive pulmonary disease (COPD), but no quantitative analysis of these loops during spontaneous breathing has ever been performed. The area of the loop\u2019s inspiratory (Ains) and expiratory portion (Aexp), and the difference between the end-expiratory and end-inspiratory alveolar pressure (\u394Palv) were measured in 20 young, 20 elderly healthy subjects, and 130 stable COPD patients. Ains and \u394Palv increased by 55 and 78% from young to elderly subjects, and by 107 and 122% from elderly subjects to COPD patients, reflecting changes in mechanical heterogeneity, lung-units recruitment/derecruitment, and possibly air trapping occurring with aging and/or obstructive disease. Aexp increased by 38% from young to elderly subjects, and by 198% from elderly subjects to COPD patients, consistent with the additional contribution of tidal expiratory flow-limitation, which occurs only in COPD patients and affects Aexp only. In COPD patients, Aexp and \u394Palv showed a significant negative correlation with VC, FEV1, IC, and a significant positive correlation with RV/TLC. The results suggest that the analysis of plethysmographic Palv\u2013F loops provides an insight of the pathophysiological factors, especially tidal expiratory flow-limitation, that affect lung function in COPD patients

Prevalence of Tuberculosis infection among teen-agers in Tuscany

Introduction. In Tuscany, Tuberculosis incidence is more thantriplicate from 1982 to the beginning of the third millennium.The impact of this trend on open population is not known, asupdated studies on Tuberculosis prevalence are not available.Tuberculin skin test provides the currently most widely used toolfor assessing Tuberculosis transmission in a community and theprevalence of infection as well.The objective of this investigation was the evaluation of tuberculin index by means of the Mantoux test in adolescents eighteen-years old.Results. The study was carried out in 21 secondary schools ofSiena and its Province; 1,138 students participated to this survey.The overall prevalence of subjects with a skin reaction size >5 mm was 1.6%; if the standard cut-off of 10 mm was used, the overall prevalence of a positive skin reaction was 0.4%. Riskfactors for a doubtful or positive reaction were previous immunization with BCG and migration from high-endemicity countries. Discussion. In Italy, studies on tuberculin index in young adultsare scanty and controversial: our results show a very low Tuberculosis prevalence and an epidemiological pattern typical ofcountries with low Tuberculosis endemicity.Conclusions. The slightly increase in Tuberculosis incidencehas no impact on the prevalence of latent Tuberculosis infection on our geographical area. We conclude that skin-test screening for Tuberculosis should be addressed to high risk population as migrants from Countries reporting high transmissionrate, those recently exposed to an infectious case and healthworkers

Transvaginal Ultrasonographic Cervical Measurement in Predicting Failed Labor Induction and Cesarean Delivery for Failure to Progress in Nulliparous Women

The aim of this study was to evaluate the value of transvaginal sonographic cervical measurement in predicting failed labor induction and cesarean delivery for failure to progress in nulliparous women. One hundred and sixty-one women scheduled for labor induction underwent transvaginal ultrasonography and digital cervical examinations. Logistic regression demonstrated that cervical length and gestational age at induction, but not the Bishop score, significantly and independently predicted failed labor induction. According to the receiver operating characteristic curves analysis, the best cut-off value of cervical length for predicting failed labor induction was 28 mm, with a sensitivity of 62% and a specificity of 60%. In terms of the likelihood of a cesarean delivery for failure to progress as the outcome variable, logistic regression indicated that maternal height and birth weight, but not cervical length or Bishop score, were significantly and independently associated with an increased risk of cesarean delivery for failure to progress. Transvaginal sonographic measurements of cervical length thus independently predicted failed labor induction in nulliparous women. However, the relatively poor predictive performance of this test undermines its clinical usefulness as a predictor of failed labor induction. Moreover, cervical length appears to have a poor predictive value for the likelihood of a cesarean delivery for failure to progress

Normal cervical changes in parous women during the second half of pregnancy - a prospective, longitudinal ultrasound study

OBJECTIVE: To determine what constitutes normal cervical changes during the second half of pregnancy in parous women delivering at term. DESIGN: The study comprises 21 healthy, pregnant parous women who all gave birth at term. They were examined with transvaginal ultrasound every two weeks from 24 gestational weeks until delivery. Cervical length and width were measured. The inner cervical os was assessed as being closed or open, the length and width of any opening were measured, and dynamic cervical changes (i.e. opening and closing of the inner cervical os during examination) were noted. RESULTS: Median cervical length was 41 mm (range 26-55) at the first examination and 29 mm (range 8-56) at the last examination. The corresponding figures for cervical width were 38 mm (range 29-47) and 46 mm (range 38-64). Cervical length decreased in 18 women but remained unchanged in three. Three patterns of change in cervical length were observed: in 12 women there was a steady, continuous decrease in cervical length (median decrease rate 1.1 mm/week, range 0.6-2.4); in four women the decrease rate accelerated towards the end of pregnancy, the median decrease rate after the change being 3.0 mm/week (range 1.5-4.8); and in two women there was a sudden drop in cervical length at term. Cervical width increased in 16 women but remained unchanged in five. Two patterns of change in cervical width were seen: 14 women manifested a steady continuous increase in cervical width (median 0.8 mm/week, range 0.4-1.8); in two women the increase rate accelerated from around 34 gestational weeks, the increase rate after the change being 4.1 and 5.9 mm/week, respectively. Opening of the internal cervical os was observed at least once in 11 (52%) women and was seen as early as at 24 and 25 gestational weeks in two women. The opening was always V-shaped (median length 6 mm, range 4-17; median width 7 mm, range 3-20). Dynamic changes of the internal cervical os were seen in three women (14%) at 25, 30 and 41 gestational weeks, respectively. CONCLUSION: The cervix of parous women decreases in length and increases in width from midpregnancy to term, but the pattern of change varies between individuals. Knowledge of the different patterns of normal change forms the basis of transvaginal ultrasound studies of pathological cervical changes during pregnancy

L\u2019avvalimento infragruppo della certificazione di qualit\ue0: operativit\ue0 e limiti in caso di sostituzione di una impresa del raggruppamento

Nel quadro del nuovo Codice dei contratti pubblici \ue8 sorta l\u2019esigenza di verificare la possibilit\ue0 di sostituire, nell\u2019ambito di un raggruppamento temporaneo di imprese, una delle imprese componenti di tale raggruppamento che abbia messo a disposizione di un\u2019altra componente della compagine, mediante ricorso all\u2019avvalimento ex art. 89 del Codice predetto, un requisito di capacit\ue0 speciale di natura soggettiva quale la certificazione di qualit\ue0, prescritto dalla lex specialis di gara in capo a tutte le imprese riunite e di cui l\u2019ausiliata beneficiaria del detto avvalimento risultava sprovvista. Il presente contributo si propone di affrontare tale tema fornendo degli spunti operativi, nella consapevolezza che lo stesso assume una specifica complessit\ue0 e impone un\u2019indagine accurata sulla peculiare declinazione che conosce l\u2019istituto dell\u2019avvalimento di che trattasi ove chiamato ad operare nel contesto di un raggruppamento temporaneo di operatori economici (avvalimento cd. \u201cinfragruppo\u201d), tenendo altres\uec in debita considerazione le modalit\ue0 e i limiti stabiliti dalla disciplina normativa in tema di modifica del raggruppamento e, in particolare, quanto stabilito dall\u2019art. 89, comma 3, del Codice circa la sostituzione di uno degli operatori membri del RTI