Archivio istituzionale della ricerca - Università dell'Insubria
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En Route Toward Sustainable Polycarbonates via Large Cyclic Carbonates
No full textThis review reports an up-to-date overview of the synthetic methodologies developed for the preparation of large cyclic organic carbonates with >= 6-membered rings (6M-CCs and above), highlighting the most sustainable synthetic pathways employing diols (including renewable-based ones) and nonhazardous carbonyl sources, e.g., linear organic carbonates, in mild operating conditions. The lower thermodynamic stability of 6M-CCs compared to 5-membered ones allows for a straightforward preparation of biocompatible aliphatic polycarbonates (APCs), occurring via ring-opening polymerization (ROP), in the presence of various active organo- and/or biocatalysts. Moreover, ROP processes can be tuned for the selective preparation of copolymers with different thermomechanical properties and can be further applied to structurally complex, larger cyclic carbonate derivatives. Finally, the end-of-life fate of APCs, particularly the recently reported controlled depolymerization strategies, is critically discussed focusing on chemoselectivity toward cyclic carbonate or epoxide monomers. This timely overview highlights the open challenges as well as the opportunities associated with the synthesis of APCs and chemical recycling and highlights their potential as circular and sustainable plastics
Attitudes of physicians, nurses, and the general public toward End-of-Life (EoL) decisions in European countries: an umbrella review
No full textBackground: End-of-life (EoL) decisions represent some of the most ethically complex and emotionally charged aspects of healthcare. Understanding the attitudes of physicians, nurses, and the public toward EoL decisions is crucial for aligning care provided with the personal values and preferences of patients. Aim: To explore the attitudes of physicians, nurses, and the general public toward EoL decisions, including the withdrawal or withholding of life-sustaining treatments, euthanasia, physician-assisted suicide (PAS), palliative sedation, and advance care planning (ACP) within European countries. Design: An umbrella review was conducted, covering the period from January 2010 to June 2024. The search strategy included Medline, CINAHL, and PsycINFO, supplemented by manual searches of reference lists of all included studies to identify additional relevant studies. Results: The search identified 587 papers, 11 of which were included in the synthesis. Of these, six addressed euthanasia and PAS, three focused on ACP, one on the withdrawal of life-sustaining treatments, and one on palliative sedation. In Europe, the general public expressed the highest level of support for EoL practices such as euthanasia and PAS, followed by nurses, while physicians often held a more cautious perspective. For withdrawal of treatment, palliative sedation, and ACP, a critical recurring theme was the need to improve communication between patients and healthcare professionals. Conclusions: The divergence underscores the intricate complexity of navigating ethical, cultural, and professional considerations in EoL care. Effective communication serves as a cornerstone for respecting patient autonomy and ensuring that healthcare decisions align with individual values, goals and preferences
Prognostic Impact of Different Definitions of White-Coat Hypertension
No full textBACKGROUND Different definitions of white-coat hypertension (WCH) may explain its variable outcome across studies. METHODS In an Italian study started in 1986, we followed 3,153 people with (office blood pressure (BP) >=140/90 mmHg) and 457 without office hypertension for a mean of 10.4 years. None had previous cardiovascular disease. All underwent 24-h ambulatory BP (ABP) monitoring. We defined white-coat hypertension (WCH) as an average 24-h ABP < 130/80 mmHg or <125/75 mmHg. The primary outcome was a composite of major adverse cardiovascular events (MACE) and all-cause mortality. RESULTS Baseline office BP was 156/97 mmHg in people with and 127/81 mmHg without hypertension. At follow-up, MACE events were 344 and 23, and all-cause deaths were 318 and 24 in people with and without hypertension, respectively. Compared to normotensive group, MACE risk was not higher in people with WCH and 24-h ABP < 125/75 mmHg (hazard ratio (HR), 0.94; 95% confidence interval (CI), 0.42-2.10). Compared to normotensive group, MACE risk was higher in people with WCH and 24-h ABP < 130/80 mmHg (HR: 1.79; 95% CI, 1.07-2.29). All-cause death did not differ between the normotensive group and people with WCH and 24-h ABP < 125/75 mmHg (HR 1.37; 95% CI, 0.68-2.73), but it was higher than in the normotensive group when WCH was defined by a 24-h ABP < 130/80 mmHg (HR 1.82; 95% CI, 1.55-3.58). CONCLUSIONS WCH defined by an average 24-h ABP < 125/75 mmHg identifies people at low risk of MACE and death in the long term. Even modestly above these threshold values, the risk associated with WCH increases
Poder constituyente permanente. Un desafio para la doctrina constitucional
Get PDFLa finalidad de este artículo es criticar el uso ideológico -por parte de diferentes instancias, académicas y políticas- de la expresión ‘poder constituyente permanente’, para
tratar de legitimar no solo el hiper-reformismo de la Constitución mexicana de 1917, sino hasta para considerar tales
reformas no sujetas a ninguna forma de control de constitucionalidad. El objetivo central, por otra parte, no son las observaciones de Felipe Tena Ramírez, quien acuñó esa expresión,
sino que se dirige principalmente a la doctrina constitucional
sucesiva que, con pocas excepciones, la hizo propia sin someterla a ningún examen razonado y a transmitirla tanto en sus
elaboraciones teóricas como en las aulas universitarias. Con
el resultado, opuesto al de su autor -se percibe en las páginas
finales del ensayo en el que la expone- de considerarla un tabú
indiscutible y de convertir a sus difusores en un valioso apoyo
para la clase política, quizá si darse perfectamente cuenta de
ello
The LINK—Lombardia NeuroIntensive care Network
Get PDFBackground Despite serving over 10 million inhabitants, neurocritical care across the Lombardy region of Italy (from here on Lombardia) remains fragmented and insufficiently mapped, underscoring the need for a structured regional network. This study aimed to evaluate current resources and explore pathways for integration and development.MethodsIn 2024, along with other initiatives, a web-based survey was performed, focusing on hospitals with neurosurgical capabilities and intensive care units (ICUs) to identify variations in service delivery and adherence to evidence-based practices, guiding quality improvement across centers.ResultsResponses were obtained from 19 acute care hospitals with neurosurgical facilities within the regional health service. Ten hospitals (52%) host dedicated neuro-ICUs, including five (26%) that also admit pediatric patients, accounting for a total of 85 beds. In the remaining nine hospitals (47%), neurocritical care is delivered within general ICUs without dedicated beds. Continuous in-house neurosurgical coverage is available in 9 centers (47%), while the others rely on a 24/7 on-call model. All 19 centers (100%) report 24/7 availability of neurologists and neuroradiologists, either in-house or on call. However, access to advanced diagnostic and monitoring technologies remains heterogeneous across sites.Participating centers identified a clear need for standardized protocols and clinical pathways to improve care quality and support evidence-based practices. Priority areas defined by the clinicians include neuroprognostication, end-of-life care and donor management, pediatric neurocritical care, neurointerventional procedures, management of delayed cerebral ischemia following subarachnoid hemorrhage, and post-discharge follow-up. To address these gaps, several multidisciplinary working groups have been established.ResultsResponses were obtained from 19 acute care hospitals with neurosurgical facilities within the regional health service. Ten hospitals (52%) host dedicated neuro-ICUs, including five (26%) that also admit pediatric patients, accounting for a total of 85 beds. In the remaining nine hospitals (47%), neurocritical care is delivered within general ICUs without dedicated beds. Continuous in-house neurosurgical coverage is available in 9 centers (47%), while the others rely on a 24/7 on-call model. All 19 centers (100%) report 24/7 availability of neurologists and neuroradiologists, either in-house or on call. However, access to advanced diagnostic and monitoring technologies remains heterogeneous across sites.Participating centers identified a clear need for standardized protocols and clinical pathways to improve care quality and support evidence-based practices. Priority areas defined by the clinicians include neuroprognostication, end-of-life care and donor management, pediatric neurocritical care, neurointerventional procedures, management of delayed cerebral ischemia following subarachnoid hemorrhage, and post-discharge follow-up. To address these gaps, several multidisciplinary working groups have been established.ConclusionNeurocritical care in Lombardia remains highly heterogeneous, with bed availability significantly below international benchmarks. The establishment of a regional network seeks to enhance the quality and equity of care for neurocritical patients, while also fostering clinical research, data sharing, and multidisciplinary collaboration across centers
Surface Reconstruction From Point Cloud using a Semi-Lagrangian Scheme with Local Interpolator
No full textWe propose a level set method to reconstruct unknown surfaces from point clouds, without assuming that the connections between points are known. We consider a variational formulation with a curvature constraint that minimizes the surface area weighted by the distance of the surface from the point cloud. More precisely we solve an equivalent advection–diffusion equation that governs the evolution of an initial surface described implicitly by a level set function. Among all the possible representations, we aim to compute the signed distance function at least in the vicinity of the reconstructed surface. The numerical method for the approximation of the solution is based on a semi-Lagrangian scheme coupled with a local interpolator. In particular, we resort to a multi-linear interpolator and to a Weighted Essentially Non-oscillatory one, to improve the accuracy of the reconstruction. An analysis of the parameters employed in the model is given, focusing in particular on the effect of the curvature regularization, and on the presence of noisy data. Special attention has been paid to the localization of the method and to the development of fast algorithms that run in parallel, resulting in faster reconstruction and thus the opportunity to easily improve the resolution. Numerical tests in two and three dimensions are presented to evaluate the quality of the reconstruction and the efficiency of the algorithm in terms of computational time
Parallel Alignments between Magnetic Fields and Dense Structures in the Central Molecular Zone
Get PDFThe recent Far-Infrared Polarimetric Large-Area Central Molecular Zone Exploration (FIREPLACE) survey with SOFIA has mapped plane-of-sky magnetic field orientations within the Central Molecular Zone (CMZ) of the Milky Way. Applying the Histogram of Relative Orientations analysis to the FIREPLACE data, we find that the relative orientation between magnetic fields and column density structures is random in low-density regions ( 2x1022 less than or similar to NH2 less than or similar to 1023cm-2 ) but becomes preferentially parallel in high-density regions (greater than or similar to 1023 cm-2). This trend is in contrast with that of the nearby molecular clouds, where the relative orientation transitions from parallel to perpendicular with increasing column densities. However, the relative orientation varies between individual CMZ clouds. Comparisons with magnetohydrodynamic simulations specific to the CMZ conditions suggest that the observed parallel alignment is intrinsic, rather than artifacts caused by the projection effect. The origin of this parallel configuration may arise from the fact that most dense structures in the CMZ are not self-gravitating, as they are in supervirial states, except for the ministarburst region Sgr B2. These findings are consistent with the low star formation efficiency observed in the CMZ compared to that in the Galactic disk
