Atti nazionali inoppugnabili e diritto comunitario tra principio di effettività e competenze di attribuzione

Il lavoro concerne le pronunce in cui la Corte di giustizia affronta ex professo il tema dei rapporti tra il diritto comunitario e gli atti nazionali inoppugnabili . Con quest’ultima espressione ci riferiamo sia alle sentenze nazionali coperte da autorità di cosa giudicata, sia agli atti amministrativi nazionali divenuti inoppugnabili per decorso del prescritto termine decadenziale. Segnatamente, la questione si pone in presenza di una res iudicata nazionale o di una decisione amministrativa nazionale definitiva contrastanti con il diritto comunitario . Si tratta di un tema assai delicato, relativamente al quale la Corte ha finora evitato di enunciare un principio giurisprudenziale unitario suscettibile di applicazione generale. L''approccio dei giudici di Lussemburgo sembra essere piuttosto quello di fornire al giudice del rinvio le indicazioni necessarie per risolvere la causa innanzi ad esso pendente, ancorando i principi giurisprudenziali enunciati alle circostanze della causa a quo. La conseguenza è un quadro giurisprudenziale variegato nel quale risulta poco chiaro il rapporto di ciascuna sentenza con i precedenti giurisprudenziali e, di conseguenza, la sua portata. Ciò, come è ovvio, produce una situazione di incertezza in capo ai giudici nazionali. L''articolo mira a comporre un quadro unitario della giurisprudenza della Corte, raggruppando le sentenze in oggetto in tre distinti filoni giurisprudenziali sulla base del modello di controversia da cui originano. Ciò al fine di vagliare la coerenza di tale corpus giurisprudenziale ed analizzare le singole sentenze che ne fanno parte

Eunice Foote’s Experiments: an Analysis Based on Chemical Engineering

This study presents an analysis of the results of the experiments made by Eunice Foote (EF), around the mid of 19th century, on the temperature increase of common gases (such as air and carbon dioxide) when heated by solar radiation. Eunice Foote (EF) is nowadays presented as a woman researcher whose contribution to scientific development in the 19th century has been largely ignored. EF was the author of an article titled “Circumstances affecting the Heat of the Sun’s Rays” which contains some statements about a higher temperature increase of carbon dioxide with respect to air when heated by the sun's rays. This article is considered by some science historians as the first experimental proof of the greenhouse effect of carbon dioxide, a theme that is mentioned by the media every day. This analysis of EF experiments is carried out numerically using one chemical engineering process simulation software, with the aim of reproducing her results. Simulated results cannot reproduce EF experiments and are used to evidence some incongruencies in the experimental results. In the end, for the same absorbed energy, a simple heat balance on the gases considered shows that the temperature rise of carbon dioxide would be lower than that shown by air

Iloprost treatment in patients with Raynaud's phenomenon secondary to systemic sclerosis and the quality of life: a new therapeutic protocol

Objectives: to evaluate the clinical efficacy and the effects on the quality of life of Iloprost, a prostacyclin analogue, used, according to a new protocol, in patients with Raynaud’s phenomenon secondary to Systemic Sclerosis. Methods: in this randomized study we treated 30 patients with Iloprost given by intravenous infusion, at progressively increasing doses (starting from 0.5 ng/Kg/min up 2 ng/Kg/min) over a period of 6 hours a day for ten days in two consecutive weeks, with repeated cycles at regular intervals of three months for 18 months. The results were compared with those obtained in 30 other patients, who had received the same drug but with different posologic schemes. Results: the total average daily duration of the attacks, the average duration of a single attack and the average daily frequency of the attacks were reduced significantly in all groups of treatment, but the comparison between the groups demonstrated significant differences between patients treated with the new protocol and the others at later times (T12 and T18). The effects on the quality of life, evaluated by SF-36, demonstrate, in the group treated with the new protocol, a marked improvement both regarding the scale relative to the physical aspect of the illness, and especially regarding the scale relative to the mental aspect. Conclusions: in SSc patients, cyclic intravenous Iloprost infusion is efficacious in the treatment of Raynaud’s phenomenon. The protocol that we used, compared with others, is able to determine not only favourable clinical effects but also a marked improvement in the quality of life

Prognostic value of circulating tumor cells in nonmuscle invasive bladder cancer: a CellSearch analysis

Background: Circulating tumor cells (CTCs) provide prognostic information in patients with metastatic tumors. Recent studies have shown that CTCs are released in circulation in an early phase of cancer disease so that their presence is under investigation in the adjuvant setting. Few studies investigated the prognostic significance of CTCs enumeration in patients with metastatic and advanced bladder cancer. The current study has analyzed the presence of CTC in patients with nonmuscle-invasive bladder cancer (NMIBC). Patients and methods: Forty-four NMIBC patients were enrolled and included in a 24-month follow-up program. Blood drawings were carried out in all patients at the first diagnosis. CellSearch system (Veridex; LLC, Raritan, NJ) was used for CTCs enumeration. Results: CTC were detectable in 8/44 patients (18%). Presence of CTC was found significantly associated to shorter time to first recurrence (6.5 versus 21.7 months, P < 0.001). Median time to progression was not reached, due to the short follow-up period. CTC presence was found associated to concomitant carcinoma in situ and higher T category. Conclusion: The detection of CTC in this setting of disease may allow to distinguish patients with high risk of recurrence from those with high risk of progression, as well as to early identify patients candidate for adjuvant treatment

Vitamin D supplementation and breast cancer prevention : a systematic review and meta-analysis of randomized clinical trials

In recent years, the scientific evidence linking vitamin D status or supplementation to breast cancer has grown notably. To investigate the role of vitamin D supplementation on breast cancer incidence, we conducted a systematic review and meta-analysis of randomized controlled trials comparing vitamin D with placebo or no treatment. We used OVID to search MEDLINE (R), EMBASE and CENTRAL until April 2012. We screened the reference lists of included studies and used the “Related Article” feature in PubMed to identify additional articles. No language restrictions were applied. Two reviewers independently extracted data on methodological quality, participants, intervention, comparison and outcomes. Risk Ratios and 95% Confident Intervals for breast cancer were pooled using a random-effects model. Heterogeneity was assessed using the I2 test. In sensitivity analysis, we assessed the impact of vitamin D dosage and mode of administration on treatment effects. Only two randomized controlled trials fulfilled the pre-set inclusion criteria. The pooled analysis included 5372 postmenopausal women. Overall, Risk Ratios and 95% Confident Intervals were 1.11 and 0.74–1.68. We found no evidence of heterogeneity. Neither vitamin D dosage nor mode of administration significantly affected breast cancer risk. However, treatment efficacy was somewhat greater when vitamin D was administered at the highest dosage and in combination with calcium (Risk Ratio 0.58, 95% Confident Interval 0.23–1.47 and Risk Ratio 0.93, 95% Confident Interval 0.54–1.60, respectively). In conclusions, vitamin D use seems not to be associated with a reduced risk of breast cancer development in postmenopausal women. However, the available evidence is still limited and inadequate to draw firm conclusions. Study protocol code: FARM8L2B5L

The SURPRISE demonstrator: a super-resolved compressive instrument in the visible and medium infrared for Earth Observation

While Earth Observation (EO) data has become ever more vital to understanding the planet and addressing societal challenges, applications are still limited by revisit time and spatial resolution. Though low Earth orbit missions can achieve resolutions better than 100 m, their revisit time typically stands at several days, limiting capacity to monitor dynamic events. Geostationary (GEO) missions instead typically provide data on an hour-basis but with spatial resolution limited to 1 km, which is insufficient to understand local phenomena. In this paper, we present the SURPRISE project - recently funded in the frame of the H2020 programme – that gathers the expertise from eight partners across Europe to implement a demonstrator of a super-spectral EO payload - working in the visible (VIS) - Near Infrared (NIR) and in the Medium InfraRed (MIR) and conceived to operate from GEO platform -with enhanced performance in terms of at-ground spatial resolution, and featuring innovative on-board data processing and encryption functionalities. This goal will be achieved by using Compressive Sensing (CS) technology implemented via Spatial Light Modulators (SLM). SLM-based CS technology will be used to devise a super-resolution configuration that will be exploited to increase the at-ground spatial resolution of the payload, without increasing the number of detector’s sensing elements at the image plane. The CS approach will offer further advantages for handling large amounts of data, as is the case of superspectral payloads with wide spectral and spatial coverage. It will enable fast on-board processing of acquired data for information extraction, as well as native data encryption on top of native compression. SURPRISE develops two disruptive technologies: Compressive Sensing (CS) and Spatial Light Modulator (SLM). CS optimises data acquisition (e.g. reduced storage and transmission bandwidth requirements) and enables novel onboard processing and encryption functionalities. SLM here implements the CS paradigm and achieves a super-resolution architecture. SLM technology, at the core of the CS architecture, is addressed by: reworking and testing off-the-shelf parts in relevant environment; developing roadmap for a European SLM, micromirror array-type, with electronics suitable for space qualification. By introducing for the first time the concept of a payload with medium spatial resolution (few hundreds of meters) and near continuous revisit (hourly), SURPRISE can lead to a EO major breakthrough and complement existing operational services. CS will address the challenge of large data collection, whilst onboard processing will improve timeliness, shortening time needed to extract information from images and possibly generate alarms. Impact is relevant to industrial competitiveness, with potential for market penetration of the demonstrator and its components

The association of indwelling urinary catheter with delirium in hospitalized patients and nursing home residents: an explorative analysis from the "Delirium Day 2015"

Backround: Use of indwelling urinary catheter (IUC) in older adults has negative consequences, including delirium. Aim: This analysis, from the "Delirium Day 2015", a nationwide multicenter prevalence study, aim to evaluate the association of IUC with delirium in hospitalized and Nursing Homes (NHs) patients. Methods: Patients underwent a comprehensive geriatric assessment, including the presence of IUC; inclusion criteria were age > 65 years, being Italian speaker and providing informed consent; exclusion criteria were coma, aphasia, end-of-life status. Delirium was assessed using the 4AT test (score ≥ 4: possible delirium; scores 1-3: possible cognitive impairment). Results: Among 1867 hospitalized patients (mean age 82.0 ± 7.5 years, 58% female), 539 (28.9%) had IUC, 429 (22.9%) delirium and 675 (36.1%) cognitive impairment. IUC was significantly associated with cognitive impairment (OR 1.60, 95% CI 1.19-2.16) and delirium (2.45, 95% CI 1.73-3.47), this latter being significant also in the subset of patients without dementia (OR 2.28, 95% CI 1.52-3.43). Inattention and impaired alertness were also independently associated with IUC. Among 1454 NHs residents (mean age 84.4 ± 7.4 years, 70.% female), 63 (4.3%) had IUC, 535 (36.8%) a 4AT score ≥ 4, and 653 (44.9%) a 4AT score 1-3. The multivariate logistic regression analysis did not show a significant association between 4AT test or its specific items with IUC, neither in the subset of patients without dementia. Discussion: We confirmed a significant association between IUC and delirium in hospitalized patients but not in NHs residents. Conclusion: Environmental and clinical factors of acute setting might contribute to IUC-associated delirium occurrence

"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 ± 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys

Italian guidelines for primary headaches: 2012 revised version

The first edition of the Italian diagnostic and therapeutic guidelines for primary headaches in adults was published in J Headache Pain 2(Suppl. 1):105–190 (2001). Ten years later, the guideline committee of the Italian Society for the Study of Headaches (SISC) decided it was time to update therapeutic guidelines. A literature search was carried out on Medline database, and all articles on primary headache treatments in English, German, French and Italian published from February 2001 to December 2011 were taken into account. Only randomized controlled trials (RCT) and meta-analyses were analysed for each drug. If RCT were lacking, open studies and case series were also examined. According to the previous edition, four levels of recommendation were defined on the basis of levels of evidence, scientific strength of evidence and clinical effectiveness. Recommendations for symptomatic and prophylactic treatment of migraine and cluster headache were therefore revised with respect to previous 2001 guidelines and a section was dedicated to non-pharmacological treatment. This article reports a summary of the revised version published in extenso in an Italian version

Conceptual Design of a Soft X‐ray SASE‐FEL Source

FELs based on SASE are believed to be powerful tools to explore the frontiers of basic sciences, from physics to chemistry to biology. Intense R&D programs have started in the USA and Europe in order to understand the SASE physics and to prove the feasibility of these sources. The allocation of considerable resources in the Italian National Research Plan (PNR) brought about the formation of a CNR‐ENEA‐INFN‐University of Roma "Tor Vergata" study group. A conceptual design study has been developed and possible schemes for linac sources have been investigated, bringing to the SPARX proposal. We report in this paper the results of a preliminary start to end simulation concerning one option we are considering based on an S‐band normal conducting linac with high brightness photoinjector integrated in a RF compressor