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Il ruolo della telemedicina nel trattamento delle emorragie in urgenza
No full textIntroduzione:
Il sanguinamento maggiore rappresenta una delle principali cause di morbilità acuta e di accesso ospedaliero, con un rischio che aumenta esponenzialmente nei soggetti anziani, con pluri-comorbidità o in trattamento antitrombotico e/o anticoagulante. L’assenza di strumenti strutturati di sorveglianza precoce e la variabilità dell’anamnesi emorragica rendono complessa l’identificazione tempestiva dei pazienti più vulnerabili. In questo contesto, la telemedicina si configura come una strategia innovativa per abilitare un monitoraggio proattivo e continuo del rischio emorragico.
Obiettivi:
Il progetto HemoAlert ha avuto l’obiettivo di sviluppare e validare un modello di telemedicina integrata per la gestione dei pazienti con rischio emorragico aumentato, valutandone la fattibilità operativa, la sicurezza clinica e la correlazione tra l’autovalutazione digitale del paziente e la valutazione medica del rischio emorragico mediante l’impiego del Bleeding Assessment Tool dell’ISTH-SSC (BAT). Sono stati inoltre analizzati il grado di adesione e la soddisfazione degli utenti.
Metodi:
È stato condotto uno studio osservazionale prospettico di fattibilità su 58 pazienti adulti afferenti a setting chirurgico e internistico con fattori di rischio emorragico documentati. Il percorso prevedeva un modulo informativo sui segni precoci di sanguinamento, la compilazione di un questionario digitale autovalutativo (Google Forms) e una televisita sincrona tramite WhatsApp Business, durante la quale il medico somministrava il BAT ISTH-SSC. La stratificazione del rischio (molto basso, basso, intermedio, alto) ha guidato la frequenza del follow-up. Le analisi statistiche sono state effettuate con IBM SPSS v29, includendo test non parametrici e regressione logistica multivariata.
Risultati:
Il 98,3% dei pazienti ha completato l’intero percorso; il 6,9% è risultato a rischio ≥intermedio. Il punteggio BAT si è confermato predittore indipendente di eventi emorragici (OR 2,78; IC95% 1,24–6,21; p=0,013). L’utilità percepita della piattaforma è stata 4,8 ± 0,4/5, con elevata accettabilità anche nella popolazione >70 anni. Il 98,2% dei casi è stato gestito completamente a distanza, con un solo riaccesso ospedaliero. È stata riscontrata una correlazione significativa tra il questionario autocompilato e il punteggio BAT somministrato dal medico (p<0,001).
Conclusioni:
Il progetto HemoAlert dimostra che una telesorveglianza strutturata del rischio emorragico è tecnicamente fattibile, clinicamente sicura e altamente accettata dai pazienti. L’integrazione del Bleeding Assessment Tool nella televisita consente di standardizzare la valutazione del rischio emorragico, riducendo la variabilità inter-operatore e implementando un follow-up personalizzato e tracciabile. Il modello proposto rappresenta un prototipo operativo di medicina digitale di precisione, coerente con le Linee guida nazionali sulla Telemedicina e con le strategie europee di eHealth, ponendo le basi per futuri studi multicentrici volti a dimostrarne l’impatto sugli esiti clinici e sull’efficienza del supporto digitale in ambito emorragico all’interno del sistema sanitario
Biophysical Features of Outer Membrane Vesicles (OMVs) from Pathogenic Escherichia coli
No full textOuter membrane vesicles (OMVs) blebbing from bacterial outer membrane represent a key weapon in interspecies and interkingdom communication, virulence and spread of antimicrobial resistance. OMV isolation is a fundamental step to the study of their functions; however, the yield, purity, and structural integrity of OMVs can be influenced by the purification procedure. In this work, we compared the efficacy of two commonly used isolation techniques, size-exclusion chromatography (SEC) and differential ultracentrifugation (dUC), in separating and concentrating vesicles produced by Shiga toxin-producing (STEC) and uropathogenic (UPEC) Escherichia coli strains. The obtained OMVs were characterized using a comprehensive multi-analytical approach including scanning and transmission electron microscopy (SEM, TEM), dynamic light scattering (DLS), nanoparticle tracking analysis (NTA), polydispersity index (PDI) and ζ-potential measurements, and protein quantification for purity assessment. dUC-derived samples were characterized by broader particle size distributions, higher protein concentration, and more noticeable contamination by non-vesicular material. In contrast, SEC-derived samples yielded structurally well-preserved and morphologically homogeneous vesicles, higher particle-to-protein ratios, and lower total protein content, showing reduced co-isolation of protein-aggregates. NTA and DLS analyses unveiled polydisperse populations in samples obtained with both isolation methods, with DLS measurements emphasizing the presence of larger or transient aggregates. ζ-potential values were close to neutrality for all samples, coherent with limited electrostatic repulsion and with the aggregation tendencies observed in some preparations. Of interest, a dense proteinaceous matrix was observed in all samples, more pronounced in UPEC samples, suggesting strain-specific biophysical interference. Overall, the two methods provided complementary information, emphasizing the trade-offs between yield, purity and vesicle integrity, exerting also strain-dependent effects. These findings may support informed selection of OMV isolation strategies and reproducible characterization of bacterial vesicles for downstream application in host-pathogen interaction and vesicle-based studies
Ensemble modeling of nanoscale thermal drift in high-precision linear axes for photonic integrated circuit testing
No full textThe consistently growing demand for robust automated assembly, testing and packaging of photonic integrated circuits, is increasingly oriented towards high volume and continuously sets new challenges to overcome concerning throughput and cost-efficiency. Among the predominant positioning error sources in high-precision robots used in this market, thermally induced position drift is often a major cause of deviation from operational conditions required to meet this demand. Environmental temperature fluctuations and the excess heat generated by the machine itself, can induce position drifts upwards of 100 nanometer per minute that prevent axis systems from meeting positional precision and repeatability required for optimal functioning, eventually imposing the integration of expensive temperature control systems and hardware changes that minimize the impact of thermally induced errors. In this paper, a data driven approach for modeling the temperature induced position drift and its dependency on the underlying temperature gradients is proposed. We suggest a formulation that allows to identify temperature gradients calculated over time windows of variable, optimal widths, that capture longer and shorter term drift components, introducing the concept of dynamic-range thermal features . By extracting several features from a single sensor, it is possible to reduce the amount of sensors required for an accurate reconstruction, resulting in significant hardware simplification and robustness towards variable field conditions. Additionally, an auto-weighted voting regression algorithm is proposed to separate the modeling of transient states from static and quasi-static states; an auto-regressive model of the position gradients with exogenous temperature gradients and a linear regression model of temperature gradients, are trained independently and combined in a voting ensemble paradigm. Experimental results are presented to quantify the effects of a model-based position compensation schema. Under high ambient temperature fluctuations of ± 1 degree Celsius, position drift is reduced from 23 nanometer per minute to 8.7 nanometer per minute root mean squared error. The proposed approach is validated in the context of photonic die testing with a heated chuck hosting the chip. Correction actions reduce thermal effects from 53 nanometer per minute to 10 nanometer per minute root mean squared error under normal working conditions. Finally, effects on the optical coupling loss and the system settle time are evaluated. Optical losses over 5 min measurement time of components with mode field diameters under 3 micrometer, can be reduced below 0.05 decibel for chuck temperatures up to 50 degree Celsius and a two-sided optical alignment; for chuck temperatures above 50 degree Celsius, the settle time to reach sufficient stability for optical measurements is reduced from 82 min to 32 min
Technicity between Prediction and Autonomy
No full textThe emergence of digital tools has severely dominated design production in the last 30 years. Whether dealing with architectural, system, or product design, the impact of such technologies has shaped not only the way research and works are conducted but also how to look at the world and the complexity it bears. Chaos and variability are just of the main concepts that, through the rise of new tools designers aim to grasps and comprehend deeper from an ontological perspective to free themselves from the attempt to rationally control every step of the design process and to open up to unpredictability and new cognitive systems. This chapter, starting from a historical perspective related to the growth and development of the concept of Artificial Intelligence, and its impact in contemporary practices, aims to discuss the potentiality of these tools from a generative perspective following Simondon’s ideas of ‘technicity’ highlighting how humans shape their environment through technologies and how the latter reciprocally produce them in the first place. At the end, a pedagogy experiment with students is presented to show the mutual influence between designer and AI-based digital tools in a product design class
Evaluating early precursors of academic skills: Preliminary validation of a touchscreen-based digital assessment in preschoolers
No full textEarly identification of cognitive precursors to literacy and numeracy is essential for promoting school readiness and preventing later learning difficulties. Digital assessment tools using touchscreen technology offer advantages of engagement, standardization, and efficiency. This study reports preliminary findings on the Digital Assessment for Preschoolers—Tool (DAP-T), a touchscreen-based battery for preschool children. A sample of 105 children (M = 61.43 months, SD = 10.38; age range = 38–72) completed eight tasks assessing visuomotor integration, literacy (letter knowledge, phonological awareness, notational awareness, Rapid Automatized Naming), and numeracy (non-symbolic quantity comparison, quantity recognition, counting, cardinality). A subsample (n = 47–61, depending on the measure) also completed the paper-based criterion tasks used for concurrent validity analyses. Item difficulty and discrimination, internal consistency (McDonald’s ω), concurrent validity, and factorial structure (SEM) were assessed. Results showed medium-to-low difficulty, age-related performance increases, and good discrimination in most tasks. Reliability was high (ω = 0.713–0.966), and correlations with criterion measures ranged from ρ = 0.52 to 0.95. The DAP-T showed promising psychometric properties as a rapid, standardized tool to detect early difficulties and guide targeted interventions
Multi-analytical insight into the non-volatile phytochemical composition of Coleus aromaticus (Roxb.) Benth
No full textBackground/Objectives: Coleus aromaticus (Lamiaceae), also known as Cuban oregano or Indian borage, is a semi-succulent perennial species widely used in traditional medicine for its therapeutic and nutritional properties. While its essential oils and aromatic fraction have been extensively investigated, the characterization of its non-volatile metabolites remains limited. The aim of this study was to explore the chemical composition of fresh leaves with a focus on the non-volatile fraction. Methods: Fresh leaves of C. aromaticus were cryogenically treated with liquid nitrogen, ground, and subjected to three different extraction procedures: hydroalcoholic maceration, ethyl acetate maceration, and liquid–liquid partitioning to obtain a dichloromethane organic phase and a hydroalcoholic phase. Extracts and fractions were analyzed by HPTLC and HPLC for metabolic profiling. In addition, the Bligh–Dyer method was applied to separate polar and non-polar metabolites, which were subsequently characterized using NMR spectroscopy. Results: Chromatographic analyses highlighted the occurrence and distribution of organic acids, polyphenols (notably flavonoids), and proteinogenic amino acids. Spectroscopic data confirmed the presence of diverse polar and non-polar metabolites, providing a more detailed chemical fingerprint of C. aromaticus. This integrated approach broadened the phytochemical profile of the species beyond the well-documented essential oils. Conclusions: The results contribute to a better understanding of the non-volatile metabolites of C. aromaticus, offering novel insights into its chemical diversity. These findings highlight the potential of this plant as a valuable source of bioactive compounds, supporting its future application in nutraceutical and pharmaceutical research
The right to oblivion in a comparative european prospective
No full textThis paper analyses the “Right to be ‘medically’ forgotten”
– starting
with a brief introduction on how this concept has evolved during the last decades
– with specific regard to the medical field. It focuses on cancer survivors and their
right to live a life without injustices and discriminations caused by the stigma of
the disease. By using the comparative method, this work aims to address the Eu-
ropean perspective on the issue, as well as the need for a more harmonised legal
framework
Harmonic Focus, Ligasure Small Jaw e Thunderbeat Open Fine Jaw negli interventi di tiroidectomia totale in pazienti affetti da carcinoma differenziato della tiroide: analisi comparativa degli outcomes chirurgici.
No full textBackground: Il carcinoma della tiroide è la più frequente neoplasia del sistema endocrino e costituisce circa il 4% di tutte le nuove diagnosi di neoplasia maligna. La chirurgia costituisce il pilastro del trattamento dei pazienti affetti da tale patologia e ne consegue che la tiroidectomia rappresenti l’intervento chirurgico più praticato nell’ambito dell’endocrinochirurgia. Tra le innumerevoli innovazioni tecnologiche di cui si è arricchita la chirurgia della tiroide negli ultimi decenni vi è l’impiego dei dispositivi di dissezione/sintesi vasale (energy-based devices) che rispondono all’esigenza di garantire un adeguato controllo dell’emostasi e ottenere, grazie alla velocizzazione del gesto chirurgico, una riduzione dei tempi operatori. Materiali e metodi: Obiettivo di questo studio prospettico randomizzato è stato quello di comparare Harmonic Focus (gruppo A), Ligasure Small Jaw (gruppo B) e Thunderbeat Open Fine Jaw (gruppo C) negli interventi di tiroidectomia totale eseguiti in pazienti affetti da carcinoma differenziato della tiroide in termini di outcomes chirurgici. Risultati: Un totale di 150 pazienti sono stati sottoposti a tiroidectomia totale per carcinoma differenziato della tiroide: 50 pazienti nel gruppo A (Harmonic Focus), 50 pazienti nel gruppo B (Ligasure Small Jaw), 50 pazienti nel gruppo C (Thunderbeat Open Fine Jaw). I dati demografici e i rilievi istopatologici sono risultati essere omogenei nei tre gruppi in assenza di differenze statisticamente significative. Tra i tre gruppi non sono state rilevate differenze statisticamente significative per quanto riguarda l’incidenza di complicanze, la durata della degenza, la quantità del contenuto dei drenaggi e la richiesta di terapia antalgica aggiuntiva. La differenza nella durata dell’intervento chirurgico è risultata statisticamente significativa tra il Gruppo C e i gruppi sia A (p-value ≈ 0.0047) che B (p-value ≈ 0.02). Altro dato che ha raggiunto la significatività statistica è stato il VAS score e le differenze tra il gruppo A e il gruppo C (p = 0.002) e tra il gruppo B e il gruppo C (p = 0.00002) sono risultate significative. Conclusioni: Nel nostro studio tutti i dispositivi si sono dimostrati sicuri ed efficaci negli interventi di tiroidectomia totale sutureless: l’incidenza di complicanze è stata infatti comparabile tra i tre gruppi. Tuttavia, il Thunderbeat ha dimostrato di garantire tempi operatori più brevi e di essere associato a un minor dolore post-operatorio. Nonostante i limiti del nostro studio, i risultati ottenuti rappresentano un contributo in un ambito ancora poco esplorato e tali evidenze potranno costituire la base per futuri studi volti ad ampliare ed approfondire le osservazioni emerse
Monetary/fiscal policy regimes in post-war Europe
No full textWe analyse the monetary-fiscal policy mix in post-war Europe, focusing on France and Italy, to trace the historical dynamics of debt and inflation. Using a Markov-switching DSGE model, we identify distinct policy regimes: a Passive Monetary-Active Fiscal (PM/AF) regime before the late 1980s/early 1990s, an Active Monetary-Passive Fiscal (AM/PF) regime associated with central bank independence and EMU convergence, and a third regime marked by the ELB and active fiscal measures aimed at recovery. Simulations reveal that the PM/AF regime in France led to price volatility but stabilised debt, while AM/PF curbed inflation at the cost of rising debt. In contrast, Italy’s procyclical fiscal policy in downturns exacerbated imbalances, aggregate volatility, and low growth. We further assess the implications of policy credibility and uncertainty
Mycoremediation of agricultural soil contaminated by Glyphosate and Aminomethylphosphonic acid: an integrated approach
No full textIl glifosato e il suo principale metabolita, l’acido amminometilfosfonico (AMPA), sono tra gli erbicidi più utilizzati e rilevati a livello mondiale, rappresentando una sfida ambientale di grande rilevanza. Questa tesi ha adottato un approccio multidisciplinare per caratterizzare e affrontare il problema, integrando analisi chimiche, studi ecologici e tecnologie innovative.
Le analisi metagenomiche hanno rivelato alterazioni nella composizione delle comunità fungine, con una prevalenza di taxa adattati a condizioni di stress chimico, mentre l’isolamento in condizioni di arricchimento ha portato, per la prima volta, all’isolamento di Clonostachys rosea f. catenulata ed Exophiala alcalophila da suoli contaminati con glifosato e AMPA. Questi funghi hanno dimostrato la capacità di tollerare e potenzialmente utilizzare tali composti come fonte di fosforo, rivelando un potenziale innovativo nell’ambito del micorimedio.
Inoltre, la tesi ha sviluppato biosensori a base di silicio poroso funzionalizzati con PSS:Rhodamina, che hanno mostrato un’elevata capacità di rilevamento della patulina, aprendo nuove prospettive per il monitoraggio ambientale in tempo reale delle micotossine.
Nel complesso, questa ricerca offre nuove prospettive per una gestione sostenibile della contaminazione da glifosato, promuovendo la salute del suolo, la sicurezza alimentare e la tutela della salute dei lavoratori agricoli.Glyphosate and its main metabolite, aminomethylphosphonic acid (AMPA), are among the most widely used and detected herbicides worldwide, representing a significant environmental challenge. This thesis adopted a multidisciplinary approach to characterize and address this issue by integrating chemical analyses, ecological studies, and innovative technologies. Metagenomic analyses revealed alterations in fungal community composition, with a prevalence of taxa adapted to chemical stress conditions, while isolation in enrichment conditions led, for the first time, to the isolation of Clonostachys rosea f. catenulata and Exophiala alcalophila from soils contaminated with glyphosate and AMPA. These fungi demonstrated the ability to tolerate and potentially utilize these compounds as a phosphorus source, revealing novel potential for mycoremediation. In addition, the thesis developed porous silicon–based biosensors functionalized with PSS:Rhodamine, which showed high potential in detecting patulin, opening new perspectives for real-time mycotoxin environmental monitoring.
Overall, this research provides new perspectives for the sustainable management of glyphosate contamination, promoting soil health, food safety, and the protection of agricultural workers’ health