La Governance nel settore sanitario in ottica Service - Dominant Logic: un’analisi empirica

2015 - 2016PURPOSE: The work, based on an analysis of the scientific contributions aimed at examining the models of governance of the public sector and the service systems, aims to identify the determinants of patient satisfaction in healthcare. The purpose of the work is, in fact, to study the influence of relational capital, perceived quality of service and total quality management on performance perceived by patients the Local Health Authority of Salerno, in order to arrive, then, to examine how it is able to influence their satisfaction. METHODOLOGY In order to pursue the work objectives, a quantitative analysis, has been realized, which, starting from the study of literature on service systems and the main governance models in the public sector, has allowed examining the degree of satisfaction of the subjects involved in the analysis sample. The analysis has been conducted by testing a structural equation model, which allows simultaneously measuring the relationships among a plurality of variables. FINDINGS The work allows confirming the theoretical hypotheses formulated, highlighting the determinants of patient satisfaction in healthcare. In other words, the study demonstrates that relational capital, the perceived service quality and total quality management are able to influence performance of Local Public Health of Salerno and, ultimately, how this impacts positively on patient satisfaction of these firms. CONCLUSION AND IMPLICATIONS The work stands as a useful guide for health professionals involved in the governance of highly complex structures, in which, increasingly, is manifested the need to seek a balance between profitability and care efficiency. Therefore, the work, besiders providing an instrument capable of directing scholars and professionals’ attention toward issues so far still less discussed in the public sector and, in particular, in the health sector, also tries to offer some empirical evidence on these issues in order to guide public health governance towards the definition of shared decision-making policies. LIMITATIONS AND FUTURE RESEARCH However, it has the limit to be based on a poor sample, enough to allow for the generalization of results and make it, therefore, interesting for future research, also to test the model in another territorial area in order to check if the findings for the Campania region are similar to those ones of other italian regions. Keywords: patient satisfaction, perceived service quality, relational capital, Total quality management, Business performance, structural equation models. [edited by author]OBIETTIVO: Il lavoro, partendo da un’analisi dei contributi scientifici tesi ad esaminare i modelli di governance del settore pubblico e i sistemi di servizio, mira ad individuare le determinanti della patient satisfaction in ambito sanitario. Lo scopo del lavoro è, infatti, quello di studiare l’influenza esercitata dal capitale relazionale, dalla qualità percepita del servizio e dalla gestione totale della qualità sulla performance percepita dai pazienti dell’Azienda Sanitaria locale di Salerno, in modo da giungere, poi, ad esaminare come quest’ultima sia in grado di influenzare la soddisfazione degli stessi. METODOLOGIA Al fine di perseguire gli scopi del lavoro, si è proceduto mediante un’analisi quantitativa che, partendo dallo studio della letteratura sui sistemi di servizio e sui principali modelli di governance del settore pubblico, ha consentito di esaminare il grado di soddisfazione dei soggetti rientranti nel campione oggetto dell’analisi. L’analisi è stata condotta, testando un modello di equazioni strutturali, il quale consente di misurare simultaneamente le relazioni esistenti tra una pluralità di variabili. RISULTATI Il lavoro consente di confermare le ipotesi teoriche formulate, ponendo in evidenza le determinanti della patient satisfaction in ambito sanitario. In altre parole, lo studio evidenzia come il capitale relazionale, la qualità percepita del servizio e la gestione totale della qualità siano in grado di influenzare le performance delle Aziende sanitarie locali di Salerno e, in ultimo, come queste ultime impattino positivamente sulla soddisfazione dei pazienti di tali aziende. CONCLUSIONI E IMPLICAZIONI Il lavoro si pone come un’utile guida per gli operatori del settore sanitario impegnati nella governance di strutture particolarmente complesse, nelle quali, sempre più, si manifesta l’esigenza di ricercare un compromesso tra profittabilità ed efficacia delle cure. Pertanto, il lavoro, oltre che porsi come strumento in grado di orientare l’attenzione degli studiosi e dei professionisti verso aspetti finora ancora poco calati nel pubblico settore e, in particolare, in quello sanitario, tenta anche di offrire delle evidenze empiriche su tali temi in modo da orientare la governance sanitaria pubblica verso la definizione di politiche decisionali condivise. LIMITI E PROSPETTIVE FUTURE Esso, tuttavia, presenta il limite di basarsi su un campione di soggetti limitato, tale da non permetterne la generalizzazione dei risultati e rendendo, pertanto, interessante per la ricerca futura, testare il modello anche in un’altra area territoriale in modo da verificare se quanto riscontrato per il territorio campano sia riscontrabile anche in altre regioni del Paese. Keywords: soddisfazione del paziente, qualità del servizio percepita, capitale relazionale, gestione totale della qualità, performance, modelli di equazioni strutturali. [a cura dell'autore]XV n.s

Breast cancer incidence and mortality in North Sardinia in the period 1992–2010

The aim of this study was to analyze and describe the epidemiological characteristics and trends of breast cancer in Sassari province (Sardinia, Italy) in the period 1992 2010. Data were obtained from the local tumor registry which makes part of a wider registry web, coordinated today by the Italian Association for Tumor Registries. The overall number of breast cancer cases registered was 5,483 (46 males and 5,437 females). The mean age was 64.8 years for males and 60.4 years for females. The standardized incidence rates were 1/100,000 and 106.2/100,000 and the standardized mortality rates 0.3/100,000 and 23.2/100,000 for males and females respectively. An increasing trend in incidence and mortality rates of breast cancer in Sassari province was evidenced in the years under investigation. Relative survival at 5 years from diagnosis was 78.2% (73.1% for males and 78.3% for females

Characterization of ABS specimens produced via the 3D printing technology for drone structural components

AbstractThe Fused Deposition Modelling (FDM) technology is widely used in rapid prototyping. 3D printers for home desktop applications are usually employed to make non-structural objects. When the mechanical stresses are not excessive, this technology can also be successfully employed to produce structural objects, not only in prototyping stage but also in the realization of series pieces. The innovative idea of the present work is the application of this technology, implemented in a desktop 3D printer, to the realization of components for aeronautical use, especially for unmanned aerial systems. For this purpose, the paper is devoted to the statistical study of the performance of a desktop 3D printer to understand how the process performs and which are the boundary limits of acceptance. Mechanical and geometrical properties of ABS (Acrylonitrile Butadiene Styrene) specimens, such as tensile strength and stiffness, have been evaluated. ASTM638 type specimens have been used. A capability analysis has been applied for both mechanical and dimensional performances. Statistically stable limits have been determined using experimentally collected data

WIKI COURSE BUILDER, A SYSTEM FOR MANAGING AND SHARING DIDACTIC MATERIAL AND CONCEPT MAPS

In this article we present an evolution of Wiki course Builder, a system for building courses, sharing and sequencing learning material taken from Wikipedia pages. The system has been expanded through the implementation of two new modules to provide teachers with different tools that optimize the course creation process. Taking advantage of the user model implemented in the system starting from Grasha\u2019s teaching styles, we have implemented a module that visualizes the graph of all the courses created by the teaching community and makes it possible to compare it with others. This graph can be filtered by macro categories of arguments (eg. History, Philosophy...) and by teacher archetypes (eg. expertize delegator ...). The second module is a graphical interface that makes it possible to design and build concept maps for the generation of different courses (alternative learning paths through the map). The comparison between these maps will enrich the model of the teacher who will receive recommendations more refined on the basis of the course method you prefer to make. For the future it will be interesting to extend the user model through the comparison of the concept maps generated by the creation of the course and the clustering of the teachers on the basis of this data. Furthermore, the study of the density of concepts within the materials and the complexity of learning difficulties would complete the user model by optimizing again the recommendation process

Evaluation and the environmental democracy of cities: Strategic Environmental Assessment of urban plans in Italy.

Cities stand up as a major concern for environmental governance and democracy, and an ideal target for theoretical investigations and practical innovations alike. Our work is concerned with reconstructing the links between democracy and the environment, by targeting urban governance and tapping into the institutional practices of Urban Planning and Strategic Environmental Assessment (SEA). SEA is a major policy tool, and its interplay with planning unravels key issues in both urban governance and environmental democracy, including coping with fundamental risks, voicing non-human agents, managing commons, addressing environmental justice. The observations we present in this paper rest on two parallel approaches. First, we carried out a content review of 12 SEA reports concerning urban plans in Italy. Second, we were involved in two case studies concerning urban planning and SEA in the towns of Monopoli and Magenta. We point to some key reflections with the aim of opening up the discussion. Participation often languishes in institutional arenas, yet it thrives in other forms that affect decision-making. Negotiation around individual planning processes should be framed in the general governance arrangements that are constantly reshaped through interactions among fluid trans-organizational networks. Legally binding measures have an ambivalent relation with environmental governance strategies, and they are handled with difficulty by deliberative planning approaches. In mainstreaming new policy tools (such as SEA), procedural aspects are usually stressed, whereas a focus on process and desired outcomes could foster, respectively, capacity building and salience

Evaluation and the environmental democracy of cities: Strategic Environmental Assessment of urban plans in Italy.

Cities stand up as a major concern for environmental governance and democracy, and an ideal target for theoretical investigations and practical innovations alike. Our work is concerned with reconstructing the links between democracy and the environment, by targeting urban governance and tapping into the institutional practices of Urban Planning and Strategic Environmental Assessment (SEA). SEA is a major policy tool, and its interplay with planning unravels key issues in both urban governance and environmental democracy, including coping with fundamental risks, voicing non-human agents, managing commons, addressing environmental justice. The observations we present in this paper rest on two parallel approaches. First, we carried out a content review of 12 SEA reports concerning urban plans in Italy. Second, we were involved in two case studies concerning urban planning and SEA in the towns of Monopoli and Magenta. We point to some key reflections with the aim of opening up the discussion. Participation often languishes in institutional arenas, yet it thrives in other forms that affect decision-making. Negotiation around individual planning processes should be framed in the general governance arrangements that are constantly reshaped through interactions among fluid trans-organizational networks. Legally binding measures have an ambivalent relation with environmental governance strategies, and they are handled with difficulty by deliberative planning approaches. In mainstreaming new policy tools (such as SEA), procedural aspects are usually stressed, whereas a focus on process and desired outcomes could foster, respectively, capacity building and salience

The impact of financial difficulties on earnings management strategies: The case of Italian non-listed firms

This study investigates the impact of the degree of financial distress on the earnings management activities of Italian non-listed firms. The extant literature provides mixed evidence on this relationship for listed firms. We find a positive (negative) relationship between financial distress risk and income-decreasing (income-increasing) earnings management, suggesting that firms tend to manage earnings downward as financial distress risk (proxied by Altman's Z-Score) increases. Consistent with the Jensen control hypothesis, stressed firms are more likely to reveal their weak financial performance to stakeholders in order to renegotiate their debt on better terms and to signal the manager's willingness to deal with these problems to stakeholders (e.g. lenders and auditors). In two robustness tests, we test the power of the Kothari et al. (2005) model for decomposing total accruals and we also analyse a reduced firm sample representing over 80% of the population. We employ a linear regression model controlling for heteroschedasticity and autocorrelation using the Petersen method. The dependent variable is continuous and proxies negative discretionary accruals (DA) by setting positive (DA) to zero since we hypothesise that managers of distressed firms are more likely to manage earnings downward than healthy firms. Distress is proxied by the Altman Z-score measure for non-listed firms. Our research has several implications for academics, practitioners, lenders, and national standard setters, showing that, i

No effects of oral vitamin D supplementation on non-alcoholic fatty liver disease in patients with type 2 diabetes: a randomized, double-blind, placebo-controlled trial

Background: Non-alcoholic fatty liver disease (NAFLD) is the most common hepatic disorder worldwide, reaching prevalence up to 90 % in obese patients with type 2 diabetes (T2D), and representing an independent risk factor for cardiovascular mortality. Furthermore, the coexistence of T2D and NAFLD leads to higher incidence of diabetes’ complications and additive detrimental liver outcomes. The existence of a close association between NAFLD and hypovitaminosis D, along with the anti-inflammatory and insulin-sensitizing properties of vitamin D, have been largely described, but vitamin D effects on hepatic fat content have never been tested in a randomized controlled trial. We assessed the efficacy and safety of 24-week oral high-dose vitamin D supplementation in T2D patients with NAFLD. Methods: This randomized, double-blind, placebo-controlled trial was carried out at the Diabetes Centre of Sapienza University, Rome, Italy, to assess oral treatment with cholecalciferol (2000 IU/day) or placebo in T2D patients with NAFLD. The primary endpoint was reduction of hepatic fat fraction (HFF) measured by magnetic resonance; as hepatic outcomes, we also investigated changes in serum transaminases, CK18-M30, N-terminal Procollagen III Propeptide (P3NP) levels, and Fatty Liver Index (FLI). Secondary endpoints were improvement in metabolic (fasting glycaemia, HbA1c, lipids, HOMA-IR, HOMA-β, ADIPO-IR, body fat distribution) and cardiovascular (ankle-brachial index, intima-media thickness, flow-mediated dilatation) parameters from baseline to end of treatment. Results: Sixty-five patients were randomized, 26 (cholecalciferol) and 29 (placebo) subjects completed the study. 25(OH) vitamin D significantly increased in the active treated group (48.15 ± 23.7 to 89.80 ± 23.6 nmol/L, P < 0.001); however, no group differences were found in HFF, transaminases, CK18-M30, P3NP levels or FLI after 24 weeks. Vitamin D neither changed the metabolic profile nor the cardiovascular parameters. Conclusions: Oral high-dose vitamin D supplementation over 24 weeks did not improve hepatic steatosis or metabolic/cardiovascular parameters in T2D patients with NAFLD. Studies with a longer intervention period are warranted for exploring the effect of long time exposure to vitamin D

A New Integrated Approach for the Prediction of the Load Independent Power Losses of Gears: Development of a Mesh-Handling Algorithm to Reduce the CFD Simulation Time

To improve the efficiency of geared transmissions, prediction models are required. Literature provides only simplified models that often do not take into account the influence of many parameters on the power losses. Recently some works based on CFD simulations have been presented. The drawback of this technique is the time demand needed for the computation. In this work a less time-consuming numerical calculation method based on some specific mesh-handling techniques was extensively applied. With this approach the windage phenomena were simulated and compared with experimental data in terms of power loss. The comparison shows the capability of the numerical approach to capture the phenomena that can be observed experimentally. The powerful capabilities of this approach in terms of both prediction accuracy and computational effort efficiency make it a potential tool for an advanced design of gearboxes as well as a powerful tool for further comprehension of the physics behind the gearbox lubrication

3D FDM production and mechanical behavior of polymeric sandwich specimens embedding classical and honeycomb cores

Abstract Desktop 3D FDM (Fused Deposition Modelling) printers are usually employed for the production of nonstructural objects. In recent years, the present authors tried to use this technology also to produce structural elements employed in the construction of small UAVs (Unmanned Aerial Vehicles). Mechanical stresses are not excessive for small multirotor UAVs. Therefore, the FDM technique combined with polymers, such as the ABS (Acrylonitrile Butadiene Styrene) and the PLA(Poly Lactic Acid), can be successfully employed to produce structural components. The present new work is devoted to the production and preliminary structural analysis of sandwich configurations. These new lamination schemes could lead to an important weight reduction without significant decreases of mechanical properties. Therefore, it could be possible, for the designed application (e.g., a multifunctional small UAV produced via FDM), to have stiffener and lighter structures easy to be manufactured with a low-cost 3D printer. The new sandwich specimens here proposed are PLA sandwich specimens embedding a PLA honeycomb core produced by means of the same extruder, multilayered specimens with ABS external layers and an internal homogeneous PLA core using different extruders for the two materials, sandwich specimens with external ABS skins and an internal PLA honeycomb core using different extruders for the two materials, and sandwich specimens where two different extruders have been employed for PLA material used for skins and for the internal honeycomb core. For all the proposed configurations, a detailed description of the production activity is given.Moreover, several preliminary results about three-point bending tests, different mechanical behaviors and relative delamination problems for each sandwich configuration will be discussed in depth