Danno ambientale. Tra private enforcement e pene private.

Il lavoro consiste in una proposta di riforma della tutela ambientale attraverso il ricorso alle nozioni di Private Enforcement e pena privata. Avvalendosi del metodo analitico della cosiddetta analisi economica del diritto, si segnalano le criticità dell'attuale T.U. in materia di danno ambientale, e soprattutto si pone l'accento sulla inefficienza del contollo pubblico. Parallelamente, ci si sofferma sul ruolo delle cosiddette pene private nell'ordinamento italiano e, tramite un excursus storico e comparatistico circa le funzioni della responsabilità civile, si elabora un modello di pena privata da illecito aquiliano che permetta ai privati (private enforcement, appunto) di partecipare, nel quadro dei mutati rapporti fra cittadini ed autorità pubbliche (di cui è espressione il principio di sussidiarietà orizzontale), alla cura dell'interesse generale alla conservazione dell'ambiente. In aggiunta, si ricorrre ad un approfondimento in tema di filosofia ambientale per coniugare la proposta di riforma con le moderne riflessioni della società civile attorno al tema. Non mancano rilievi critici nei confronti del tradizionale modello di responsabilità civile e dei relativi dogmi; quindi, in ultima analisi, la tematica ambientale offre uno spunto per un ripensamento, di più ampio respiro, della tutela aquiliana: essa (quale tecnica di controllo sociale) è sempre più deputata alla svolgimento di molteplici funzioni che trascendono quella meramente compensativa

Assessing malpractice lawsuits for death or injuries due to amniotic fluid embolism

Amniotic fluid embolism (AFE) is a pregnancy complication known to be extremely hard to diagnose, since it manifests itself abruptly and with no warning signs, presenting an incidence rate of about 1 in 40000 deliveries, and maternal morbidity and mortality ranging from 20% to 60%. Although almost a century has gone by since it was first identified (1926) and despite medical research having been conducted on such a syndrome, diagnostic procedures and treatment methods have not yet been clarified enough. Specific biochemical markers have been produced in research laboratories, but their clinical value results to be limited, given how rapid the pathological process moves forward. At the time being, no diagnosis is feasible which may effectively prevent the disease from occurring. Certainly, a multidisciplinary approach might contribute to saving the lives of mother and infant, as well as ensuring better life standards. The paper's authors aim to highlight the medico-legal issues, in light of several rulings from the Italian Constitutional Court as well as lower courts. The authors also advocate for the creation of a nation-wide registry meant to collect all signaled AFE instances so that research on this as yet devastating syndrome can be conducted based on hard data

Euthanasia and physician-assisted suicide for patients with depression. Thought-provoking remarks

Euthanasia and medical assistance in dying entail daunting ethical and moral challenges, in addition to a host of medical and clinical issues, which are further complicated in cases of patients whose decision-making skills have been negatively affected or even impaired by psychiatric disorders. The authors closely focus on clinical depression and relevant European laws that have over the years set firm standards in such a complex field. Pertaining to the mental health realm specifically, patients are required to undergo a mental competence assessment in order to request aid in dying. The way psychiatrists deal and interact with decisionally capable patients who have decided to end their own lives, on account of sufferings which they find to be unbearable, may be influenced by subjective elements such as ethical and cultural biases on the part of the doctors involved. Moreover, critics of medical aid in dying claim that acceptance of such practices might gradually lead to the acceptance or practice of involuntary euthanasia for those deemed to be nothing more than a burden to society, a concept currently unacceptable to the vast majority of observers. Ultimately, the authors conclude, the key role of clinicians should be to provide alternatives to those who feel so hopeless as to request assistance in dying, through palliative care and effective social and health care policies for the weakest among patients: lonely, depressed or ill-advised people

Biomarker-Drug and Liquid Biopsy Co-development for Disease Staging and Targeted Therapy: Cornerstones for Alzheimer's Precision Medicine and Pharmacology.

Systems biology studies have demonstrated that different (epi)genetic and pathophysiological alterations may be mapped onto a single tumor's clinical phenotype thereby revealing commonalities shared by cancers with divergent phenotypes. The success of this approach in cancer based on analyses of traditional and emerging body fluid-based biomarkers has given rise to the concept of liquid biopsy enabling a non-invasive and widely accessible precision medicine approach and a significant paradigm shift in the management of cancer. Serial liquid biopsies offer clues about the evolution of cancer in individual patients across disease stages enabling the application of individualized genetically and biologically guided therapies. Moreover, liquid biopsy is contributing to the transformation of drug research and development strategies as well as supporting clinical practice allowing identification of subsets of patients who may enter pathway-based targeted therapies not dictated by clinical phenotypes alone. A similar liquid biopsy concept is emerging for Alzheimer's disease, in which blood-based biomarkers adaptable to each patient and stage of disease, may be used for positive and negative patient selection to facilitate establishment of high-value drug targets and counter-measures for drug resistance. Going beyond the "one marker, one drug" model, integrated applications of genomics, transcriptomics, proteomics, receptor expression and receptor cell biology and conformational status assessments during biomarker-drug co-development may lead to a new successful era for Alzheimer's disease therapeutics. We argue that the time is now for implementing a liquid biopsy-guided strategy for the development of drugs that precisely target Alzheimer's disease pathophysiology in individual patients

Medical use of cannabis: italian and european legislation

This review illustrates some brief considerations of the medical use of cannabis recently issued in Italy. History and uses of cannabis throughout centuries and different countries are illustrated together with a description of botany and active phytocannabinoids. Then, medical use of cannabis anti-pain treatment for patients resistant to conventional therapies is described in case of chronic neuropathic pain, spasticity, for anticinetosic and antiemetic effect in nausea and vomiting caused by chemotherapy, for appetite stimulating effect in cachexia, anorexia, loss of appetite in cancer patients or patients with AIDS and in anorexia nervosa, hypotensive effect in glaucoma resistant to conventional therapies and for reduction of involuntary body and facial movements in Gilles de la Tourette syndrome. Italian most recent legislation on medical cannabis is detailed with some law proposals, also showing the inconsistent legislation within European Union. Some final considerations of future studies are also reported

Ethical and medico-legal remarks on uterus transplantation: may it solve uterine factor infertility?

Uterus transplantation was firstly tested with animal trials sixty-five years ago. Despite several successful attempts in human subjects, the different procedures still lay at the experimental stage, in need of further studies and investigations before they can be considered as standard clinical practices. Uterus transplant cannot be regarded as a life-saving procedure, but rather a method to restore woman ability to procreate, when lost, thus improving her quality of life. Uterus transplant is a complex surgical procedure and presents significant health threats. Medical staff should therefore always obtain informed consent from patients, emphasizing such risks. Before that, women undergoing uterine transplants should be thoroughly informed about the hazards inherent to the procedure and especially about the dangers of immunosuppressant drugs, administered after the surgery which may injure the fetus, eventually formed in the restored organ and even lead to its death, thus nullifying the purpose of the transplant itself. Therefore, the risk-benefit ratio of uterus transplantation needs to be carefully assessed and described

Is the team leading surgeon criminally liable for his collaborators’ errors? judges confirm responsibility and condemn an otorhinolaryngologist

In current healthcare, delivery of medical and surgical treatment takes place in a multidisciplinary manner. This raises the problem of distinguishing the conditions under which the person who has properly carried out his duties, respecting the related leges artis, can be held responsible for damages materially caused by another member of the medical team. Jurisprudence has developed the so-called “principle of trust” for which every member of the team can rely on the fact that other members are acting in compliance with the leges artis of their specialisation. The Supreme Court has limited the application of this principle. The authors examine the jurisprudence on responsibility of the team in otolaryngology and conclude that individual liability should be limited to the specific expertise of the individual specialist

The role of technology in improving the Customer Experience in the banking sector: a systematic mapping study

Information Technology (IT) has revolutionized the way we manage our money. The adoption of innovative technologies in banking scenarios allows to access old and new financial services but in a faster and more secure, comfortable, rewarding and engaging way. The number, the performances and the seamless integration of these innovations is a driver for banks to retain their customers and avoid costly change of hearts. The literature is rich in works reporting on the use of technology with direct or indirect impact on the experience of banking customers. Some mapping studies about the adoption of technologies in the field exist, but they are specific to particular technologies (e.g., only Artificial Intelligence), or vice versa too generic (e.g., reviewing the adoption of technologies to support any kind of banking process). So a specific research effort on the crossed domain of technology and Customer Experience (CX) is missing. This paper aims to overcome the following gaps: the lack of a comprehensive map of the research made in the field in the past decade; a discussion on the current research trends of top publications and journals is missing; the next research challenges are yet to be identified. To face these limitations, we designed and submitted 7 different queries to pull papers out of 4 popular scientific databases. From an initial set of 6,756 results, we identified a set of 89 primary studies that we thoroughly analyzed. A selection of the top 20% works allowed us to seek the most performant technologies as well as other promising ones that have not been experimented yet in the field. Main results prove that the combined study of technology and CX in the banking sector is not approached systematically and thus the development of a new specific research line is needed

Ethics and/or aesthetics? reflections on cosmetic surgery for adolescents

Cosmetic surgery entails various ethical issues, even more so in cases involving adolescent patients. Cosmetic surgeons need to take into account how modern societies consider physical appearance an essential component of everyday life, as well as the vulnerability of youths and adolescents. For that reason, it is imperative to thoroughly assess the psychological and emotional states, in addition to the motivations, of minor patients. That goal can be achieved through the use of the DAS-59, (the Derriford Appearance Scale)1 , an effective and dependable tool devised to evaluate the psychological difficulties and distress experienced by people living with problems of appearance. Prior to undergoing cosmetic surgery procedures, adolescents should be required to go through adequate counseling, over multiple sessions and extended to their family members as well, on account of the complex issues inherent in evaluating the risk-benefit ratio and a prospective patient's decision-making capability. A concerted effort on the part of surgeons, psychiatrists or psychologists is key in determining the real motivations behind a minor's decision to opt for cosmetic surgery in the first place. Possible psychiatric conditions may in fact prevent a minor from making a free, informed decision. From an ethical standpoint, cosmetic surgery procedures should be geared to serve the best interest of the minor patient, who may experience distress over his or her body image, from a health and psychological balance perspective and improve his or her social, affective and working life. Besides, cosmetic surgery should not be overly invasive compared to its potential benefits. Those procedures aimed at achieving ″ideal beauty″ are not desirable and ought to be banned. By virtue of such criteria, the authors have set out to evaluate the ethical admissibility of some aesthetic treatments. Thus, doctors should not consent to any request coming from their patients, but rather, intervene only in presence of an objective physical flaw or deformity, e.g. protruding ears, which have a potential to negatively affect social life and interactions

Homogeneous Hamiltonian operators and the theory of coverings

A new method (by Kersten, Krasil'shchik and Verbovetsky), based on the theory of differential coverings, allows to relate a system of PDEs with a differential operator in such a way that the operator maps symmetries/conserved quantities into symmetries/conserved quantities of the system of PDEs. When applied to a quasilinear first-order system of PDEs and a Dubrovin-Novikov homogeneous Hamiltonian operator the method yields conditions on the operator and the system that have interesting differential and projective geometric interpretations