Lean Six Sigma Approach to Implement a Femur Fracture Care Pathway at “San Giovanni di Dio e Ruggi d’Aragona” University Hospital

Timeliness in the treatment of fracture of the femur, through surgery, is crucial in the elderly patient as it reduces the risk of mortality and disability. Here we propose a Lean Six Sigma (LSS) approach to reduce the preoperative length of stay for patients with femur fracture. Through the LSS, a tailored Diagnostic Therapeutic Assistance Path (DTAP) for these has been implemented and monitored over time. In particular, through the analysis, based on the application of the DMAIC cycle conducted on data extrapolated from the information system of the “San Giovanni di Dio e Ruggi d’Aragona” University Hospital of Salerno, the new DTAP was designed and implemented. After the introduction of the DTAP, a significant reduction in the average length of hospital stay was observed, with a preoperative length of stay within 48 h in 65% cases (compared to the previous 9%). In particular, the most significant reduction (over 55%) is obtained for patients aged over 65 years old. Such a result reflects not only the improvement in the care process but it is also compliant with the guidelines of the Italian Ministry of Health, as reported in the New Guarantee System for monitoring the quality of care. © 2021, Springer Nature Switzerland AG

INNOVATIVE DRILLING TECHNOLOGIES FOR ADVANCED MATERIALS

Carbon fibre reinforced polymer (CFRP) composites are among the most widely used composite materials in the aerospace industry, thanks to the high specific mechanical properties offered. These composites combine the fundamental aeronautical requirements of lightness and strength, which have sparked great research interest in improving the properties and the production process of composite materials. CFRP composites can be manufactured in near net shape; however, they often require further machining processes such as drilling, particularly for joining purposes. Fibre orientation plays a fundamental role in CFRP composite materials, affecting the mechanism of chip formation and the quality of the cut surface and making machining of CFRP a challenging task. Proper optimisation of the drilling process can substantially improve CFRP parts quality, which may be affected by several faults generated during the process. In order to simplify the assembly operations and reduce manufacturing costs, efforts are increasingly spent with the aim to optimise CFRP drilling

On the Analysis of the Internet from a Geographic and Economic Perspective via BGP Raw Data

The Internet is nowadays an integral part of the everyone's life, and will become even more important for future generations. Proof of that is the exponential growth of the number of people who are introduced to the network through mobile phones and smartphones and are connected 24/7. Most of them rely on the Internet even for common services, such as online personal bank accounts, or even having a videoconference with a colleague living across the ocean. However, there are only a few people who are aware of what happens to their data once sent from their own devices towards the Internet, and an even smaller number -- represented by an elite of researchers -- have an overview of the infrastructure of the real Internet. Researchers have attempted during the last years to discover details about the characteristics of the Internet in order to create a model on which it would be possible to identify and address possible weaknesses of the real network. Despite several efforts in this direction, currently no model is known to represent the Internet effectively, especially due to the lack of data and the excessive coarse granularity applied by the studies done to date. This thesis addresses both issues considering Internet as a graph whose nodes are represented by Autonomous Systems (AS) and connections are represented by logical connections between ASes. In the first instance, this thesis has the objective to provide new algorithms and heuristics for studying the Internet at a level of granularity considerably more relevant to reality, by introducing economic and geographical elements that actually limit the number of possible paths between the various ASes that data can undertake. Based on these heuristics, this thesis also provides an innovative methodology suitable to quantify the completeness of the available data to identify which ASes should be involved in the BGP data collection process as feeders in order to get a complete and real view of the core of the Internet. Although the results of this methodology highlights that current BGP route collectors are not able to obtain data regarding the vast majority of the ASes part of the core of the Internet, the situation can still be improved by creating new services and incentives to attract the ASes identified by the previous methodology and introduce them as feeders of a BGP route collector

Three Bead Rotating Chain model shows universality in the stretching of proteins

We introduce a model of proteins in which all of the key atoms in the protein backbone are accounted for, thus extending the Freely Rotating Chain model. We use average bond lengths and average angles from the Protein Databank as input parameters, leaving the number of residues as a single variable. The model is used to study the stretching of proteins in the entropic regime. The results of our Monte Carlo simulations are found to agree well with experimental data, suggesting that the force extension plot is universal and does not depend on the side chains or primary structure of proteins

Tell me your portfolio and I will guess who you are: social incentives for more fitting pension funds

Taking as sample, data obtained directly by the pension fund of an Italian multinational containing more than 35 thousand members, it is assessed, through logistic regression models, how demographic characteristics might affect individual risk aversion. The test is useful to identify groups of workers that by nature are more risk averse and could be disadvantaged by the 2006 TFR (severance indemnity) Italian pension reform. For example women controlling for age, income, region and financial literacy prefer lower risky portfolio and they are more likely to switch toward safer sub-funds. This analysis could support the policymaker to calibrate a suitable appendix to the last TFR reform in order to cover gaps in opportunities among different kind of risk takers mitigating the so called \u201csocial security risk\u201d. In the meantime, it is taken the occasion of such a rich dataset to exploit this sizeable shock in order to test forced (or semi-forced) participation, confirming higher risk aversion for forced participants

Using gravity models for the evaluation of new university site locations: a case study

A fundamental aspect of competitive spatial models is the choice behaviour of potential customers to patronize a facility. Most of the models used to describe this phenomenon are essentially based on the adaptation of Newton’s law of gravitation to the economic case (gravity model). This paper shows an application of this model to describe the behaviour of potential students in the choice of a university site. The results provided by the model have been compared with the actual data and show that the gravity model can describe the behaviour of potential students with good approximation

Producing intellectuals: Lagosian books and pamphlets between 1874 and 1922

This thesis explores the connections, networks and debates that characterised Lagosian intellectual life in the late nineteenth and early twentieth centuries, using books and pamphlets as its substrate. At least three hundred books were published or circulated in Lagos between 1874 and 1922. Who were writing and reading these books? Did they constitute a network of intellectuals? It will be argued here that those responsible for Lagosian books and pamphlets formed a heterogeneous and incohesive group, not easily defined and here called the “Lagosian intellectual network”, which included not only authors but readers and other agents of book production. This study uses Arjun Appadurai’s concepts of “disjuncture” and “scapes” to analyse such a complex intellectual network and to appreciate its many dimensions and the fluidity of its relations. The thesis also argues that books should be studied as social facts in themselves: as Karin Barber suggests, more than communicating ideas, books placed their authors in the intellectual network and were sources of social capital. The Lagosian intellectual network is here re-localised in Paul Gilroy’s “black Atlantic” context. The scope is widened from authorship to members of the publishing industry and to readers, while also crossing geographic, religious and ethnic boundaries. Following debates in print, this study contextualises Lagosian intellectual production within a broader print culture project that included West Africa, England, the United States and Brazil. In this way, the thesis uses Lagosian books and pamphlets to discuss what produces an intellectual. In so doing, it outlines and examines the main features of the Lagosian intellectual network, analyses the factors that motivated intellectuals to write, read and debate, and enables an understanding of Lagosian print culture as part of a complex, diverse project in which Lagosian publications were inserted within a wider Atlantic network

Models for the schedule optimization problem at a public transit terminal

This work deals with the proposal of some models for the schedule optimization problem for public transit networks. In particular, we consider the case of a transit terminal where passengers are supposed to split among different lines of a service, or even change mode of transportation in case of intermodal systems. Starting from a given schedule for the transit lines arriving at the terminal, the aim is to decide the optimal schedule for the output lines, in such a way to balance the operative costs of the service and the passenger waiting time at the transit terminal. We propose two different models for this problem, which present strong similarities with some well known combinatorial optimization models. Computational results are also presented, showing the suitability of the models to solve real case studies

DMAIC Approach for the Reduction of Healthcare-Associated Infections in the Neonatal Intensive Care Unit of the University Hospital of Naples ‘Federico II’

Improvements in the obstetrical and neonatal management have allowed children to survive. These enhancements have showed, anyway, a general increased incidence of healthcare-associated infections, one of the most influent causes of morbidity and mortality in neonatal intensive care units. The aim of this paper is to suggest corrective measures to reduce sentinel germs colonization and identify the relationships between bacteria colonization with the number of procedures and the length of hospital stay. The Lean Six Sigma methodology was used to tackle this issue using a tailored Define, Measure, Analyze, Improve, and Control problem-solving strategy. An increased number of procedures and an extended length of hospital stay demonstrated a statistically significant influence on newborns’ possibility to be infected by sentinel germs. These findings could guide the clinical staff to improve the management of neonates in neonatal intensive care units reducing the number of infected patients, their length of hospital stay and the costs for the hospital. © 2021, Springer Nature Switzerland AG