Planned Admission to an ICU after Lung Resection: A Debatable Issue

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Governance mechanism in public agencies: the Italian practice in an international perspectives

The diffusion of Public Agencies seems to characterise the approach to public management in European countries. Under New Public Management, the role of politics is to provide strategic planning and economic policy target definition, whereas the administration is responsible for the management of public services. Moreover, the separation between politics and administration is strengthened by downsizing and decentralizing the public central administration. The current paper argues that this split necessitates careful attention to the adoption of models of accountability that respond to both citizen and political information needs. Thus, with respect to public agencies, this paper models accountability levels, defines an accountability cycle showing the relations between politics, administration, and citizens, and applies this model to the Italian case

Alessandro Anselmi. Intuizioni sulla forma architettonica

È il 1992 quando Kenneth Frampton cita nella sua terza edizione di Storia dell’architettura moderna, uno dei testi più letti al mondo, il municipio di Rèze-les-Nantes di Alessandro Anselmi. Il capitolo in oggetto riguarda quelle che il critico inglese chiama reflective practices, ovvero le “buone pratiche” di architettura diffuse nei diversi continenti. Le reflective practices, frutto di rapporti illuminati, sono l’espressione di personali ricerche architettoniche in accordo a precisi ideali della committenza. Tra alcuni dei nomi più significativi del contemporaneo, come Holl, Maki, Siza, Ando e Moneo, Frampton inserisce quello di Alessandro Anselmi; maestro indiscusso dell’architettura italiana degli ultimi trenta anni. Membro di spicco e fondatore del GRAU (Gruppo Romano Architetti Urbanisti), Anselmi intraprende la sua ricerca personale a partire dalla Biennale del 1980: è l’epilogo del GRAU e l’inizio del percorso autonomo. Alessandro Anselmi, talentuoso progettista e disegnatore, è anche un architetto impegnato culturalmente sia nel mondo accademico, sia in quello dell’editoria. Redattore di “Controspazio” tra il 1974 e il 1981, docente dallo stesso anno, e membro del comitato scientifico “Area” dal 2000, Anselmi scrive oltre cinquanta saggi dopo l’esperienza con il GRAU. La scrittura, attività costante e parallela alla professione, costituisce un apparato altrettanto importante dell’opera completa. Se la critica fino a oggi si è occupata dell’Anselmi architetto, rimane ancora inesplorata la componente della scrittura. Le monografie e i saggi editi trattano infatti l’opera anselmiana affrontando specifici temi come il rapporto architettura-archeologia, la manipolazione spaziale per superfici e piani, la dimensione paesaggistica dei progetti, il ruolo del disegno nel processo creativo, il valore del “vuoto”, ma anche la militanza e l’ideologia politica. Attualmente non esiste ancora né una antologia di testi commentata né un volume esaustivo delle architetture progettate e costruite dal 1980 al 2013 (anno della sua morte). Anselmi non ha mai avuto la pretesa di sistematizzare le sue riflessioni teoriche. Le relazioni progettuali e i testi editi per pubblicazioni accademiche, o di altro genere, appaiono infatti come un insieme di intuizioni sparse. La ricerca progettuale di Anselmi e il suo lavoro “teorico”, interessano quello che egli stesso reputa il problema centrale della disciplina: la forma architettonica. È proprio attorno a questa tematica che si sviluppa la narrazione in oggetto. Anselmi, ponendo la forma al centro delle questioni teorico-progettuali, ha ribadito la collocazione dell’architettura all’interno del mondo e dei meccanismi delle arti figurative. L’intuizione sulla forma architettonica, in riferimento alla definizione di Arte di Enzo Paci, è dunque l’espressione che sintetizza al meglio il procedere “artistico” di Anselmi architetto e scrittore. Il tentativo della ricerca è dunque quello di ordinare le intuizioni scritte attorno al problema della forma architettonica, utilizzando queste come apparato critico per rileggere le intuizioni progettuali

Cluster-based Vibration Analysis of Structures with GSP

This article describes a divide-and-conquer strategy suited for vibration monitoring applications. Based on a low-cost embedded network of microelectromechanical accelerometers, the proposed architecture strives to reduce both power consumption and computational resources. Moreover, it eases the sensor deployment on large structures by exploiting a novel clustering scheme, which consists of unconventional and nonoverlapped sensing configurations. Signal processing techniques for inter- and intracluster data assembly are introduced to allow for a fullscale assessment of the structural integrity. More specifically, the capability of graph signal processing is adopted for the first time in vibration-based monitoring scenarios to capture the spatial relationship between acceleration data. The experimental validation, conducted on a steel beam perturbed with additive mass, reveals high accuracy in damage detection tasks. Deviations in spectral content and mode shape envelopes are correctly revealed regardless of environmental factors and operational uncertainties. Furthermore, an additional key advantage of the implemented architecture relies on its compliance with blind modal investigations, an approach that favors the implementation of autonomous smart monitoring systems

deep learning based production forecasting in manufacturing a packaging equipment case study

Abstract We propose a Deep Learning (DL)-based approach for production performance forecasting in fresh products packaging. On the one hand, this is a very demanding scenario where high throughput is mandatory; on the other, due to strict hygiene requirements, unexpected downtime caused by packaging machines can lead to huge product waste. Thus, our aim is predicting future values of key performance indexes such as Machine Mechanical Efficiency (MME) and Overall Equipment Effectiveness (OEE). We address this problem by leveraging DL-based approaches and historical production performance data related to measurements, warnings and alarms. Different architectures and prediction horizons are analyzed and compared to identify the most robust and effective solutions. We provide experimental results on a real industrial case, showing advantages with respect to current policies implemented by the industrial partner both in terms of forecasting accuracy and maintenance costs. The proposed architecture is shown to be effective on a real case study and it enables the development of predictive services in the area of Predictive Maintenance and Quality Monitoring for packaging equipment providers

Risk-adjusted econometric model to estimate postoperative costs: An additional instrument for monitoring performance after major lung resection

ObjectivesThe objectives of this study were to develop a risk-adjusted model to estimate individual postoperative costs after major lung resection and to use it for internal economic audit.MethodsVariable and fixed hospital costs were collected for 679 consecutive patients who underwent major lung resection from January 2000 through October 2006 at our unit. Several preoperative variables were used to develop a risk-adjusted econometric model from all patients operated on during the period 2000 through 2003 by a stepwise multiple regression analysis (validated by bootstrap). The model was then used to estimate the postoperative costs in the patients operated on during the 3 subsequent periods (years 2004, 2005, and 2006). Observed and predicted costs were then compared within each period by the Wilcoxon signed rank test.ResultsMultiple regression and bootstrap analysis yielded the following model predicting postoperative cost: 11,078 + 1340.3X (age > 70 years) + 1927.8X cardiac comorbidity − 95X ppoFEV1%. No differences between predicted and observed costs were noted in the first 2 periods analyzed (year 2004, $6188.40 vs$6241.40, P = .3; year 2005, $6308.60 vs$6483.60, P = .4), whereas in the most recent period (2006) observed costs were significantly lower than the predicted ones ($3457.30 vs$6162.70, P < .0001).ConclusionsGreater precision in predicting outcome and costs after therapy may assist clinicians in the optimization of clinical pathways and allocation of resources. Our economic model may be used as a methodologic template for economic audit in our specialty and complement more traditional outcome measures in the assessment of performance

Susceptibility of the C2 canine mastocytoma cell line to the effects of tumor necrosis factor-related apoptosis-inducing ligand (TRAIL)

In the context of bipartite bosonic systems, two notions of classicality of correlations can be defined: P-classicality, based on the properties of the Glauber-Sudarshan P-function; and C-classicality, based on the entropic quantum discord. It has been shown that these two notions are maximally inequivalent in a static (metric) sense -- as they coincide only on a set of states of zero measure. We extend and reinforce quantitatively this inequivalence by addressing the dynamical relation between these types of non-classicality in a paradigmatic quantum-optical setting: the linear mixing at a beam splitter of a single-mode Gaussian state with a thermal reference state. Specifically, we show that almost all P-classical input states generate outputs that are not C-classical. Indeed, for the case of zero thermal reference photons, the more P-classical resources at the input the less C-classicality at the output. In addition, we show that the P-classicality at the input -- as quantified by the non-classical depth -- does instead determine quantitatively the potential of generating output entanglement. This endows the non-classical depth with a new operational interpretation: it gives the maximum number of thermal reference photons that can be mixed at a beam splitter without destroying the output entanglement.Comment: 13 pages, 10 figure

Out-of-equilibrium thermodynamics of quantum optomechanical systems

Weaddress the out-of-equilibrium thermodynamics of an isolated quantum system consisting of a cavity optomechanical device. Weexplore the dynamical response of the system when driven out of equilibrium by a sudden quench of the coupling parameter and compute analytically the full distribution of the work generated by the process.Weconsider linear and quadratic optomechanical coupling, where the cavity field is parametrically coupled to either the position or the square of the position of a mechanical oscillator, respectively. In the former case we find that the average work generated by the quench is zero, whilst the latter leads to a non-zero average value. Through fluctuations theorems we access the most relevant thermodynamical figures of merit, such as the free energy difference and the amount of irreversible work generated.Wethus provide a full characterization of the out-of-equilibrium thermodynamics in the quantum regime for nonlinearly coupled bosonic modes. Our study is the first due step towards the construction and full quantum analysis of an optomechanical machine working fully out of equilibrium.We are grateful to M Aspelmeyer for discussions and encouragements. This work was supported by the UK EPSRC (EP/L005026/1 and EP/J009776/1), the John Templeton Foundation (grant ID 43467), the EU Collaborative Project TherMiQ (Grant Agreement 618074), and the Royal Commission for the Exhibition of 1851. Part of this work was supported by COST Action MP1209 ‘Thermodynamics in the quantum regime’.peer-reviewe

Overdentures on implants placed in bone augmented with fresh frozen bone

Introduction In the last decade several studies have been performed to evaluate the clinical outcome of one or two stage loaded implants supporting overdentures. Aim Since fresh frozen bone (FFB) has an ever-increasing number of clinical applications and few reports are available on implants inserted into FFB, we performed a retrospective study on fixtures inserted in FFB and bearing overdentures. Methods In the period between December 2003 and December 2006, 17 patients (14 females and 3 males with a median age of about 56 years) were grafted and 60 implants inserted thereafter. A total of 17 overdentures were delivered: 8 in the mandible and 9 in the maxilla. Multiple implant systems were used: 22 Double etched, 7 SLA, 9 Anodic oxidized, and 22 CaPo4 ceramic-blasted. Implant diameter ranged from 3.25 to 4.3 mm and length from 11.5 to 16.0 mm. Implants were inserted to replace 23 incisors, 9 cuspids, 20 premolars and 8 molars. Results No implants were lost (i.e. survival rate = 100%) and no differences were detected among the studied variables. Kaplan Meier algorithm and Cox regression did not reveal any statistical differences among the studied variables also as regards the success rate. Conclusion Implants inserted FFB and bearing overdentures have a high survival rate and success rates, which are comparable to those of implants inserted in non-grafted bone. FFB bone is a reliable material for alveolar ridge augmentation. No difference was detected among removable prostheses supported by 2 or more implants

Development of a patient-centered aggregate score to predict survival after lung resection for non–small cell lung cancer

ObjectiveThe objective of this analysis was to develop a survival aggregate score (SAS), including objective and subjective patient-based parameters, and assess its prognostic role after major anatomic resection for non–small cell lung cancer.MethodsA total of 245 patients underwent major lung resections for non–small cell lung cancer with preoperative evaluation of quality of life (Short-Form 36v2 survey) and complete follow-up. The Cox multivariable regression and bootstrap analyses were used to identify prognostic factors of overall servival, which were weighted to construct the scoring system and summed to generate the SAS.ResultsCox regression analysis showed that the factors negatively associated with overall survival and used to construct the score were 36-item short-form health survey physical component summary score less than 50 (hazard ratio [HR], 1.7; P = .008), aged older than 70 years (HR, 1.9; P = .002), and carbon monoxide lung diffusion capacity less than 70% (HR, 1.7; P = .01). Patients were grouped into 4 risk classes according to their SAS. The 5-year overall survival was 78% in class SAS0, 59% in class SAS1, 42% in class SAS2, and 14% in class SAS3 (log-rank test, P < .0001). SAS maintained its association with overall survival in patients with stages pT1 (log-rank test, P = .01), pT2 (log-rank test, P = .02), or pT3-4 (log-rank test, P = .001), and in those with stages pN0 (log-rank test, P = .0005) or pN1-2 (log-rank test, P = .02). The 5-year cancer-specific survival was 83% in class SAS0, 71% in class SAS1, 63% in class SAS2, and 17% in class SAS3 (log-rank test, P < .0001).ConclusionsThis system may be used to refine stratification of prognosis for clinical and research purposes