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Solution methods for quasi variational inequalities
No full textWe propose to solve a general quasi-variational inequality by using its Karush-Kuhn-Tucker conditions. To this end we use a globally convergent algorithm based on a potential reduction approach. We establish global convergence results for many interesting instances of quasi-variational inequalities, vastly broadening the class of problems that can be solved with theoretical guarantees. Our numerical testings are very promising and show the practical viability of the approach
Valutazione della salute scheletrica in pazienti affetti da HIV
No full textLa letteratura più recente mostra come la genesi delle alterazioni ossee negli individui HIV positivi sia un fenomeno multifattoriale riconducibile in parte all’azione diretta del virus sulle cellule ossee, in parte all’azione dei farmaci antiretrovirali (HAART) e infine sia da ascrivere agli effetti che l’infezione può avere sul sistema endocrino, determinando un ipogonadismo. Recentemente è stato validato un questionario per l’identificazione dei sintomi correlati all’ipogonadismo: l’aging male symptoms scale (AMS), mai utilizzato nei soggetti HIV positivi. Per l’identificazione dei soggetti a rischio di frattura nella popolazione generale si utilizza il FRAX, un algoritmo sviluppato dall’OMS che stima il rischio di frattura a 10 anni. Non esistono in letteratura studi che valutino il ruolo del FRAX e dell’AMS nell’identificare i pazienti HIV positivi a rischio di frattura. Inoltre non è noto se nei pazienti HIV positivi l’ipogonadismo possa influenzare la risposta alla terapia con farmaci antiriassorbitivi quali i bisfosfonati. Scopo dello studio è stato l’identificazione dei pazienti HIV positivi di sesso maschile, trattati con HAART, a rischio di frattura e la valutazione dell’effetto del risedronato nei pazienti osteoporotici con e senza ipogonadismo sulla densità minerale ossea (BMD) e sui marker del turnover osseo. Sono stati arruolati 50 maschi HIV positivi (età media 48,6±9,4 anni, anni dalla diagnosi 10,1±5,8) e 27 soggetti HIV negativi di pari età e sesso. Tutti i pazienti erano trattati con HAART con soppressione della replicazione virale. La diagnosi di osteoporosi è stata riscontrata nel 24% dei pazienti HIV positivi rispetto al 3,7% dei controlli sani (p=0,05). Sono state riscontrate 9 fratture vertebrali radiologiche nei pazienti HIV positivi, mentre nessuna frattura è stata riscontrata nei controlli (p = 0,04). I pazienti HIV positivi sono stati divisi in due gruppi: pazienti con osteoporosi e/o osteopenia con fratture (gruppo A, n= 23), e pazienti con valori densitometrici normali o osteopenia senza fratture (gruppo B, n=27). Il testosterone libero rivelava un ipogonadismo nel 26% dei pazienti HIV rispetto al 4% dei controlli (p = 0,04); un valore patologico di AMS (≥ 27) è stato riscontrato nel 62% dei pazienti HIV rispetto al 41% dei controlli (p = 0,04). La combinazione dell’AMS e del FRAX identificava i pazienti HIV positivi a rischio di frattura con una sensibilità del 77,3% ed una specificità del 69% (p = 0,02, cut-off 34), migliorando la sensibilità del FRAX (23%) utilizzato come unico strumento nell’identificazione dei pazienti a rischio di frattura. Data l’elevata prevalenza di ipogonadismo nei pazienti HIV positivi è stata intrapresa una terapia con bisfosfonati nei soggetti osteoporotici, dividendo il campione in soggetti ipogonadici e non ipogonadici. Tra i bisfosfonati è stato scelto il risedronato per la sua minor gastrolesività, qualità necessaria in un regime di politerapia normalmente utilizzato nei pazienti HIV positivi. Per 12 mesi entrambi i gruppi hanno assunto colecalciferolo 800 UI e calcio 1 grammo per os al giorno. Il gruppo A ha aggiunto a tale supplementazione il risedronato 75 mg per os, due giorni consecutivi al mese, per ulteriori 12 mesi. Il gruppo B ha continuato ad assumere la stessa supplementazione con calcio e vitamina D per il secondo anno di osservazione. Ogni sei mesi ciascun paziente effettuava prelievi ematochimici, misurazione della BMD ossea lombare e femorale e questionario AMS. Dopo 12 mesi è stato riscontrato un incremento della densità minerale ossea lombare in maniera significativamente maggiore nei pazienti HIV osteoporotici non ipogonadici rispetto agli ipogonadici (5,2% ± 1,0 SE vs 3,1% ± 0,8 SE, p<0,05) insieme ad una riduzione dei marker del turnover. Nel gruppo B, i valori della BMD sono rimasti stabili per i 24 mesi dello studio, mentre si è osservata una riduzione dei marker del turnover.
In conclusione, data l’elevata prevalenza d’ipogonadismo nei soggetti di sesso maschile HIV positivi trattati con terapia HAART e di fragilità scheletrica, uno screening per l’ipogonadismo in questa popolazione dovrebbe essere preso in considerazione. La valutazione contemporanea del FRAX e dell’AMS permette un’identificazione più accurata dei soggetti a rischio di frattura. Questi pazienti dovrebbero essere avvisati del relativo beneficio che possono trarre dalla terapia con bisfosfonati. Sono necessari ulteriori studi per valutare se sia opportuno aggiungere prima o dopo la terapia antiriassorbitiva una terapia con testosterone
La misura dell'efficacia scolastica per mezzo del valore aggiunto: un'indagine longitudinale nella scuola secondaria di primo grado
No full textAlla luce dei cambiamenti all'interno della scuola della società della conoscenza, sono descritti i risultati di un'indagine che ha verificato la validità del modello di valore aggiunto; sono stati analizzati i risultati della competenza in lettura degli studenti della provincia di Bologna nel corso dei tre anni della scuola secondaria di primo grado (anni 2008-2011). Sono stati quindi evidenziati potenzialità e limiti del modello
LA GESTIONE DEL DOLORE CRONICO NON ONCOLOGICO: STUDIO MULTICENTRICO SULLA POPOLAZIONE ADULTA AFFERENTE AI CENTRI DI TERAPIA DEL DOLORE NELLA REGIONE LAZIO
No full textIntroduction
Chronic pain is a complex phenomenon usually associated with psychological stress, which implies
falling back on the National Health Service and reducing work capacities, indeed affecting Activities
of Daily Living. Studies based on efficacy have identified the multidisciplinary approach as the most
effective means to obtain therapeutic results. These programs can be provided by the Centers for Pain
Management (CPMs), where multidisciplinary teams are likely to provide the necessary expertise to
outline the best treatments for the diagnosis and management of chronic pain. To date, very little
information is available on the kind of assistance and support these centers can provide, as well as on
the clinical and socio-demographic characteristics of patients who refer to these facilities.
Aims
The present investigation has the following objectives:
• to describe what kind of assistance the centers for pain management (CPMs) in the Lazio
Region are able to provide;
• to describe the clinical and socio-demographic characteristics of the population referring to the
CPMs;
• to describe the type of pharmacologic, complementary and intervention treatments;
• to describe the clinical characteristics of patients who turn to the two different levels of
available assistance (hub and spoke system).
Methods
In 2011 a non-profit, retrospective and multicentric study was performed on all the CPMs existing in
the Lazio region. All relevant information on the centers was collected. As well, the health records of
patients between the age of 18 and 71 (paper and digitized documents) affected by chronic benign pain
for at least six months were analyzed. Patients suffering from migraine and from cancer pains were
excluded. The study was approved by the Ethic Committee (CE) of each participating center and of
the preeminent CPM (Tor Vergata). An average number of 1600 patients was estimated. All data were
collected in a SPSS database and processed according to a statistical analysis.
Results
Data collected between January 2012 and February 2013 from 1606 patients from all the twenty-six
(26) participating CPMs in the Lazio Region were analyzed.
Centers characteristics: CPMs are generally located in University and General Hospitals (among
these, 2 hubs) and in public or private hospital facilities. They are all equipped with a clinic, some of
them are able to provide Day Hospital surgery and day-beds. CPMs are managed by anesthetists and
in most instances they do not have multidisciplinary staff members. As well, the number of health
professionals, nurses, psychologists and physiotherapists is scarce. CPMs mainly supply patients with
pharmacotherapy, Complementary Alternative Medicine (CAM) and with interventional treatments
which may be complex, as well. The median waiting time is of about 90 days. The clinics are not
homogeneously distributed in the Region; Rome turned out to be the city with a greater range of
offers, while in the provincial areas there is an under-utilization of the existing facilities.
6
Characteristics of the population: Most of the patients referring to the CPMs had been previously
evaluated by the General Practitioner (38%), 34% of them were directed to the pain centers by a
specialist different from an anesthesiologist, while 28% of patients refer to a CPM on their own
choice. 33.1% of patients are male, 66.9% are female (ratio 1:2); the most representative category of
patients was of an age between 65-69. In most cases, marital status, employment and education were
not documented. Almost all patients, regardless of their age, refer to a CPM at an average median time
of 48 months after onset of pain; female patients seem to experience more intense symptoms with
respect to males. The use of stairs was limited in order to guarantee a multi-dimension evaluation.
Localization/multi-localization of pain is different between males and females; as for the nature of the
pain, 45% of patients suffered from a somatic pain, while 21% of neuropathic pain and 31% mixed
nature (somatic and neuropathic).There is a prevalence of muscle-skeletal diseases (low back pain,
lumbar pain and spondyloarthrosis), immediately followed by neuropathic pain. The older the patient
is more are the clinical disturbances at the origin of the pain. In most cases a proper diagnosis is not
made, but pain is always related to the localization of the pain.
Pain relief treatments: Medications are the most widely used treatments for pain relief and
management. Medications for pain may range from selective and non-selective FANS, adjuvants
(anticonvulsants, benzodiazepine, antidepressants), opioids (i.e. tapentadol) and strong opioids, such
as the oxycodone-naloxone combination which may be of help in limiting the irreversible effects of
opioids. The choice of the treatment depends on the diagnosis and nature of the pain.
Medications alone are often not sufficient in the management of chronic pain and may be more
effective when combined with other treatments, such as acupuncture, massages and other
interventional treatments (perinervous injections, epidural, Pulsed Radiofrequency (RFP), trigger
points injections). No significant difference emerged between male and female patients. Associating
pharmacological medications to CAM is an innovative approach in pain management, which differs
from the traditional western model. By doing this, health care providers focus on the total person, not
just the pain, evaluating both the biological and psychological components of the patient. CAM
treatments may also reduce the use of medications and, as a consequence, of their side effects. We
have to keep in mind that in chronic pain the emotional component very often prevails on the
biological one, considering that the latter can be resolved.
Population referring to the hub and spoke centers: Patients referring to the two different models of
pain clinics differ significantly. This depends both on the length of time from the onset of pain and on
the intensity of the pain (spoke). Patients referring to hub centers show a prevalence of mixed and
neuropathic pain. This information proves that patients with a more complex clinical history turn to
hub centers, although these are not always able to offer the advanced and innovative treatments, which
would be necessary for an effective pain relief in patients.
Conclusions
In 2011, the availability of hub and spoke centers was not equally distributed throughout the territory.
Documents providing clinical data and case history of patients were more reliable than the information
obtained with phone interviews. Overall characteristics of patients, as well as the type of assistance
provided are still scarcely recorded, although this information would be helpful especially when
making a complete multidimensional evaluation on how to better manage chronic pain patients.
However, the 2011 network and system seems to be changing: this is demonstrated by the typology of
patients referring to the hub and spoke centers. Female patients usually turn to the CPMs, considering
their different hormonal and biological characteristics and that they may be more sensitive to the pain
threshold level.non
Codicologia dei manoscritti in scrittura umanistica su carta (conservati nelle biblioteche storiche di Roma)
No full textLa presente ricerca si pone l'obiettivo di analizzare, dal punto di vista codicologico e paleografico, un campione rappresentativo della produzione libraria cartacea in scrittura umanistica, e di poterlo così confrontare - cogliendone differenze e analogie - con la coeva produzione umanistica pergamenacea. Lo studio censisce - attraverso la stesura di dettagliate schede di rilevamento - 64 esemplari conservati nelle principali biblioteche storiche di Roma. I risultati emersi rilevano una sostanziale conformità tra le due produzioni librarie sottolineando, altresì, l'importanza della scrittura umanistica quale elemento discriminante nel rapporto tra aspetti codicologici e grafici. La ricerca è, inoltre, corredata da un censimento dei copisti riscontrati all'interno del corpus, nell'intento di rilevare, anche sotto tale aspetto, analogie o meno con gli amanuensi dei coevi manoscritti pergamenacei. Infine, di fondamentale importanza si mostra il rilevamento, e la successiva analisi, delle filigrane che ha permesso di constatare la loro attendibilità quali strumenti ausiliari di datazione e localizzazione in manufatti privi di coordinate cronologiche e topografiche
GENETIC AND MORPHOLOGICAL VARIABILITY OF COMMON PANDORA, PAGELLUS ERYTHRINUS
No full textABSTRACT
In the last decades, recent molecular approaches have lead to fundamental changes
in our understanding of marine population ecology. The classical notion that marine
environments tend to be demographically ‘open’, with high connectivity among
populations of infinite size and generally characterized by low genetic differentiation
(Hauser and Carvalho, 2008) is quite abandoned. In fact, recent genetic studies have
challenged such traditional view, by demonstrating genetic structuring in marine fish
species, even on a limited spatial scale (Knutsen et al., 2003; Jørgensen et al., 2005;
Knutsen et al., 2007). Moreover, it became clear that the degree of dispersion and the
extent of gene flow among marine populations are strongly influenced by
oceanographic discontinuities (transition areas that could determine
phylogeographic discontinuities) suggesting that the picture is much more complex
than previously assumed (Schunter et al., 2011).
In this context, we investigated the distribution of genetic and morphological
variability of Pagellus erythrinus (common pandora), one of the main target species in
Mediterranean commercial fisheries and whose knowledge on biological features is
still limited. The aim of this thesis was to investigate the degree of genetic structure
of common pandora, necessary for a correct management of this resource and, to
increase knowledge of the genetic variability distribution patterns in the Sparidae
family and, more generally, in Mediterranean demersal species. The morphological
analysis aims to investigate the degree of morphological differentiationon a
geographical basis, and its possible concordance/correlation with genetic variability.
Specimens were collected from 16 localities along the Italian (13 sites) and the
Tunisian coasts (2 sites), in the central Mediterranean Sea, and from one location in
the Atlantic Ocean, along the southern coast of Portugal.
Genetic analyses were carried out using three different molecular markers: two
mitochondrial DNA markers, control region (CR, sequence analysis) and cytochrome
b (Cyt b RFLP analysis) and a nuclear one, microsatellites (10 loci).
We identified three different mitochondrial lineageseach including individuals from
almost every sampling sites, without a geographic pattern. Nevertheless, different,
and statistically significant, frequency distribution was found for two of the these
lineages between the Mediterranean Sea and the Atlantic Ocean. The presence of
these long-diverged lineages, that now can be found in sympatry, is attributable to a
period of isolation followed by secondary contact. These events, likely due to climatic
fluctuations of the Pleistocene, left decipherable genetic footprints on
phylogeographic and demographic facets of common pandora history.
Microsatellites showed that present-day dynamics produces a weak but significant
genetic structure (Fst= 0.006, p < 0.05) among the examined localities. One Atlantic
and four Mediterranean subpopulations were identified, which might be explained
by the major oceanographic discontinuities and local currents described in the
investigated area. A certain degree of differentiation was observed for some localities
within the Mediterranean Sea (North Elba and along the Tunisian coasts) for which
phylogeographic breaks have not been reported so far. Further studies will be
necessary to better understand dispersal components in relation both to local
oceanographic conditions and adults mobility .
Data obtained with the two types of molecular markers allow us to assert that the
species in the past has been affected by processes of isolation, and, consequently,
genetic divergence of populations followed bysecondary contact, Under present day
conditions, populations are characterized by high connectivity and dispersal is
limited only in some restricted areas.
Morphological analysis was carried out by a geometric morphometrics approach,
through the detection of 20 landmarks. The analysis revealed morphological
variations in size and shape components, both between sexes and sites. The
variability in size could be due to different local environmental features and to the
hermaphroditism of the species. Differences in shape could be related to a slight
sexual dimorphism. Statistical tests revealed absence of correlation between
morphological and genetic patterns indicating that phenotypic plasticity and
adaptive divergence/convergence are potential mechanisms underlying
morphological differences detected among P. erythrinus
Variazioni temporali nella struttura di vertebratocenosi nei Monti della Tolfa: influenza di cambiamenti climatici e impatto antropico.
No full textThe study of the dietary changes which have intervened over the years in generalist and opportunist predators may provide useful information on the temporal modifications of their prey communities, especially under a climate change scenario. In this study, we analyzed the quantitative changes in the small mammals portion of the diet of two generalist and opportunist predators, the Barn owl (Tyto alba) and the Asp viper (Vipera aspis), in a forest zone in central Italy, for the period respectively 1987-2010 and 1975-2008.
Concerning the Barn Owl, studied through the analysis of its pellets, there was no apparent change over the years, except for an increasing trend of syn-anthropic species Mus musculus domesticus and Rattus rattus. Similarly Microtus savii, a typical rodent of agroteriocoenoses, doesn’t show significant variations over the years. However, since I did not obtain a longitudinal long-term dataset on Barn owl pellets, I tested the methodology through a longitudinal sampling (for 30 years) at two Spanish areas. In this case it was possible to record a significant increase in two termoxerofilic species, Mus spretus and Crocidura russula, during the period analyzed. However, correlating this increase with thermopluviometric data for the same Iberian areas there wasn’t a significant correlation.
As regards the analysis of the diet of the Viper, this issue was also studied through the analysis of ingesta, for a longitudinal period of 20 years. Among the various taxa eaten by vipers, only two showed significantly consistent trends over the years, with Myodes glareolus increasing and Sorex spp. declining in the viper diet. Despite being temperate-zone forest-associated species, hence likely adversed by global warming, Sorex spp. and Myodes glareolus showed opposite trends over the years, thus suggesting that such trends may reflect more local scale perturbations (local forest overgrowth and diminution of logging). I also found a significantly positive relationship between small mammals abundance in the field and their relative frequency of occurrence in the viper’s diet, thus demonstrating that vipers really sampled the small mammal species in relation to their local availability.
However, global warming has certainly had an effect on the activity rhythms of predators: for example, some aspects of the annual phenology of the same populations of Viper studied for the diet have changed over the years according to patterns related to the global warming.
This work therefore show the effectiveness of some indirect sampling methods in the study of temporal variations in small mammals highlighting some relevant limitations.
We also tried to investigate the human impact through mutagenetic tests (micronucleus test on peripheral blood) and investigations in relation to bioaccumulation of trace elements in wild rodents.
For this kind of analysis we made three different trapping sessions of small mammals in two areas: Canale Monterano and Civitavecchia.
These areas are characterized by different conditions of anthropic impact:
- about Civitavecchia (Santagostino) we are in a mostly urbanized and man-made environment in relation with the presence of the largest european energy hub consisting of the Torvaldaliga power plants.
- about Canale Monterano there is a situation of greater naturalness, with agricultural areas, pastures and forest patches.
With regard to the accumulation of trace elements analysis were conducted on the hair of small mammals captured and on the bones from barn owl’s pellets.
The results show some significant differences for the two locations examined, in particular for the site of Canale Monterano readings are significantly higher in bone samples for the following elements Tl, Th and U due to the geology of the area, while, on the hair is confirmed a difference to Tl as well as a higher concentration of Pb in samples of Civitavecchia.
This result is very interesting because it is directly attributable to the higher vehicular traffic and industrial pollution of Civitavecchia. The other important data concerne the concentrations of Mn, which could be due to use of fungicides in agriculture.
With regard to micronucleus test, on erythrocytes from circulating blood, analysis showed a generalized genetic damage (from 0 to 8 MN in 1000 MNE) for both locations, according to the Mackey & MacGregor (1979) index used as reference (MNE/1000 ≥ 2), suggesting an alteration of the overall environmental situatio
The determination of the Hermean gravity and topography from radio science and laser altimeter data of the mission BepiColombo
No full textThe thesis is about the use of laser altimetric crossover observables in the orbit determination process, in the frame of the BepiColombo radio science experiment. Numerical simulations have been carried out with the JPL’s orbit determination program (ODP), in order to evaluate the crossover contribution in the trajectory reconstruction when accurate radio measurements are provided, and to device the best strategy to retrieve Mercury’s gravity field and topography. The software used was the JPL’s ODP, exploiting a batch sequential filter
The role of environmental context in the vulnerability to relapse into heroin and cocaine addiction: a pre-clinical investigation
No full textBackground: We have recently observed an unforeseen dissociation in the effect of environmental context on cocaine versus heroin self-administration (SA) in rats. Rats that were transferred to the SA chambers only for the test sessions (Non Residents) took more cocaine than rats housed in the SA chambers (Residents). The contrary was found for heroin. The aim of the present study was to investigate the influence of context on the ability of different doses of cocaine and heroin priming to reinstate cocaine- vs. heroin-seeking in rats that had been trained to self-administer both drugs and had then extinguished lever pressing behavior.
Methods: Resident (N=65) and Non-Resident (N=64) rats with double-lumen intra-jugular catheters were trained to self-administer cocaine (400 μg/kg/infusion) and heroin (25 μg/kg/infusion) on alternate days for 10 consecutive days (3 hours/session/day). After extinction of lever pressing behavior, independent groups of rats were given a non-contingent intra-venous (i.v.) infusion of heroin (25, 50, or 100 μg/kg) or cocaine (400, 800, or 1600 μg/kg) and drug seeking was quantified by counting non-reinforced lever presses.
Results: All Resident and Non-Resident rats acquired heroin and cocaine SA and extinguished lever pressing behavior for both drugs. When given cocaine primings only Non Resident rats exhibited reinstatement of cocaine-seeking and, in contrast, when given heroin primings only Resident rats exhibited reinstatement of heroin-seeking.
Conclusions: We report that the susceptibility to relapse into drug seeking behavior is drug- and setting-specific, confirming the crucial role played by drug, set, and setting interactions in drug addictio
Il diritto al ricongiungimento familiare e la sua tutela multilivello
No full textL’unità familiare rappresenta, ovviamente, uno dei diritti primari della persona e il ricongiungimento familiare può ascriversi all’insieme di garanzie giuridiche poste a tutela della famiglia, intesa quale nucleo naturale e fondamentale della società. Il diritto a farsi accompagnare o a ricongiungersi ai membri della propria famiglia costituisce il presupposto da cui dipende la possibilità per lo straniero di esercitare il proprio diritto alla vita familiare. Il ricongiungimento familiare è il mezzo mediante il quale si realizza l’unità familiare, ovvero si consente a chi risiede o soggiorna regolarmente in uno Stato di essere raggiunto dai familiari provenienti da altri Paesi.Il presente scritto si prefigge, in particolare, l’obiettivo di contribuire al chiarimento delle modalità operative utilizzate dall’attuale sistema giuridico comunitario europeo per la tutela del diritto all’unità familiare, e in particolare al diritto al ricongiungimento familiare dell’individuo. Si tratta di un argomento finora abbastanza trascurato nella letteratura giuridica, non soltanto italiana, e alquanto peculiare in quanto inerente ad una questione generale di portata ben più ampia della tutela vita familiare dello straniero, considerato anche l’incidenza che principi e norme comunitarie possono spiegare sullo specifico diritto al ricongiungimento familiare degli individui