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La rivisitazione della casistica e il suo ruolo nell'etica clinica.
Get PDFThe object of our research is based on a fundamental question: whether it is
possible to offer, in current bioethical debate, a further Foundation of clinical ethics starting
from the retrieval, through serious and in-depth study, of the characteristics and
the method proposed by the casuistry by Albert R. Jonsen.
The interest in the study of casuistry emerged during the drafting of the text “Fino a
quando? La sospensione dei trattamenti sanitari” ("Until when? The suspension of medical
treatment"), co-written with Mario Picozzi and Vanna Consolandi and published by San
Paolo Publishing House in 2012.
During the work, it became necessary to structure the text by following
a methodology that deals with the presentation of the case through a "many voices"
clinical reading, since offering a clinical, ethical and, where appropriate, also a “dialoguing”
(i.e. involving the main protagonists of the therapeutic scene, like doctor, patient, family
members) analysis. This in order to make it possible all the problems concerning the
considered individual case, the assets/moral values at stake, the socio-cultural context of
reference, the network of relationships woven by the involved characters and with which
the latter should be confronted within the context of clinical practice to emerge.
The result of this methodological approach, which cannot leave aside a careful
examination of the real clinical-existential situation of the single case, has stimulated
research and critical reflection about the basis, i.e. the philosophical-theological-historicalsociocultural
roots establishing the theoretical assumptions of casuistic theory
development (understood as a model of ethical reasoning methodology for the analysis of
moral issues in the context of medical ethics), in order to analyze objectively its
peculiar structure and its role, with specific reference to its application in clinical ethics.
It was therefore chosen to articulate the research work by examining in depth the
theoretical path of the main Author and proponent of casuistry, Albert R. Jonsen, retracing,
through his works, the key moments of the origin and development of casuistic model he
proposed as a method of analysis of cases applicable in clinical medical ethics.
To trace the lines of this analysis, we preferred to propose an interpretation of the
reconstruction of the structure of casuistic model that does not simply draw a chronological
and historical frame; on the contrary, a search for "topics" was preferred, focusing on
factors that led Jonsen, in his own studies and work, to rediscover the need to define and
"codify" the structure and how to use that approach to ethical reasoning, as he himself
gives evidence through his main publications: The Birth of Bioethics, The Abuse of
Casuistry, A History of Moral Reasoning and Clinical Ethics. The analysis of his books –
that starting from the survey of historical-cultural-philosophical context led Jonsen to the
discovery of the casuistic method - leads us to examine the role of case studies within the
traditional ethics and its direct application to the resolution of cases of clinical ethics.
Then we focused on the analysis of the main criticisms and reworkings of Jonsen
casuistry by latter international authors; in our view, the question is whether it is sufficient
that casuistry, as model of ethical and clinical reasoning, has simply the value of method,
as it seems considering Jonsen, whose use is therefore always possible, beyond and
regardless of the adopted content reference system.
Therefore, the following question is if it makes sense and it is possible a neutral
method for ethical analysis applied to such a delicate dimension as the clinical one, or if by
choosing this method however involves the endorsement of a certain theoretical
background.
Consequently, we try to propose an alternative to this essential critical element
identified in the perspective of Jonsen, though maintaining and supporting the value of
certain methodological issues identified by Jonsen himself as positive, such as attention to
the concreteness and the completeness in the analysis of clinical and ethical real situation,
which outlines the features of a theoretical reference system based on anthropology and
ultimately on metaphysics personalist Catholic reference.
The appropriately revisited and supported casuistic method, therefore, can be
defined synthetic because it appears effective to legitimate the fragile and flexible link
between the contributions given by individual disciplines and practical case, offering the
chance to build a "proportionate reading" of the assets at stake within the situation
determined by the concrete case, allowing a proper evaluation aimed to outline a high
profile healthcare, which is not only desirable, but possible
Data quality evaluation through data quality rules and data provenance.
Get PDFThe application and exploitation of large amounts of data play an ever-increasing role in today’s research, government, and economy. Data understanding and decision making heavily rely on high quality data; therefore, in many different contexts, it is important to assess the quality of a dataset in order to determine if it is suitable to be used for a specific purpose. Moreover, as the access to and the exchange of datasets have become easier and more frequent, and as scientists increasingly use the World Wide Web to share scientific data, there is a growing need to know the provenance of a dataset (i.e., information about the processes and data sources that lead to its creation) in order to evaluate its trustworthiness. In this work, data quality rules and data provenance are used to evaluate the quality of datasets.
Concerning the first topic, the applied solution consists in the identification of types of data constraints that can be useful as data quality rules and in the development of a software tool to evaluate a dataset on the basis of a set of rules expressed in the XML markup language. We selected some of the data constraints and dependencies already considered in the data quality field, but we also used order dependencies and existence constraints as quality rules. In addition, we developed some algorithms to discover the types of dependencies used in the tool. To deal with the provenance of data, the Open Provenance Model (OPM) was adopted, an experimental query language for querying OPM graphs stored in a relational database was implemented, and an approach to design OPM graphs was proposed
Biodiversity for the protein sources utilized in feeds for intensive fish culture.
Get PDFThe reduction of dependence on fishmeal (FM) in is compulsory for a sustainable growth of aquaculture. Concerning the protein component, feed companies turned towards the use of alternative protein sources, as vegetable meal (VM), that today vary in the range 48-68% in commercial aquafeeds.
Nevertheless, elevate VM in the diet may not always be tolerated by fish, resulting in gut inflammations and histological damages, with reduced digestive functionalities and integrity. Microbiota composition is influenced by the diet. The digestive apparatus adjusts to changing of diet composition, with the mucosal defence system providing the gastro intestinal tract (GIT) with mucopolysaccarides that protect the intestine walls from injurious agents; moreover, a damaged fish gut may become an important infection route for microbial pathogens in fish.
The GIT contributes to body health in many ways: of particular interest in this context is the emerging concept of "gut health". It covers multiple positive aspects of the gastrointestinal tract, such as the absence of gastrointestinal illness, normal and stable intestinal microbiota, and effective immune status, that are also able to determine a state of well-being. Among protective nutraceuticals that are produced with anaerobic bacteria fermentation and may be add to feed as well, the short chain fatty acids play a relevant role. Among them, butyrate could have a pivotal role in the context of "nutritional welfare”: in particular, acting as an anti-inflammatory agent, providing an enterocytes trophic action, acting as promoter of oligopeptides transport, promoting production of antinflammatory cytokines, thus positively acting on fish growth.
Also the molecular biomarkers, that may early describe the progression of any intestine damages, could be useful tools to tune an appropriate nutritional strategy.
In feeding challenges, a scoring system has been set up to assess the diet-related histological changes in different gut tracts; such system showed that histological changes occur early, within the first 10 days after the new diet administration. The intestine conditions shown a sort of adaptation trend after 40-50 days trial, after which the score trends tend to recover toward the initial level. We speculate that, as long as such changes are reversible, healthy fish is able to respond quickly at diet variation returning toward the initial condition within 1-2 months. However, we have to take in account several parameters (growth performances, histological changes, molecular biomarker levels, gut microflora biodiversity, rearing condition etc.) to compose a comprehensive picture on the animal nutritional welfare.
The present work has enabled to evaluate the zootechnical performances of four diets at different level fishmeal substitution with protein vegetable sources. The result showed that seabass may be fed with aquafeed containing around 20% of fishmeal without relevant difference in growth performance from feed richer in FM.
The great importance of biodiversity concept, in fishing resources for feed as well as in maintaining the fish gut microbiota in good condition, is evident with this study
Economia e istituzioni a Como sotto gli Asburgo: il ruolo di Giambattista Giovio.
Get PDFLo studio ricostruisce la carriera politica di uno dei protagonisti del patriziato comasco in età asburgica, Giambattista Giovio. Per analizzare compiutamente il cursus honorum del conte, sono state analizzate le dinamiche di governo locale investigando il funzionamento della maggiore magistratura cittadina, il Consiglio generale (o decurionale), le caratteristiche e le prerogative della élite dirigente e il suo rapporto con il potere centrale. Ne sono emerse le caratteristiche genetiche del patriziato comasco, saldamente ancorato al mondo commerciale con un legame che non si era mai interrotto nel corso dei secoli (pur mutando nelle forme), che lo fecero portatore di interessi economici non antagonisti con quelli del ceto mercantile. E il dinamismo economico concorre a spiegare l’insolito quadro del centralismo asburgico costellato, per Como, da quelle che ho chiamato eccezioni che lasciarono aperti alcuni spazi nell’amministrazione civica che il Consiglio generale riuscì, con la sola eccezione dei quattro anni di «terremoto giuseppino» a mantenere.
Giovio impersona, alla luce della documentazione qui riunita, il miglior rappresentante dell’uomo colto, poligrafo instancabile e dedito al bene pubblico dell’Antico Regime, prodigo verso tutti ma fiero del suo rango, ben consapevole dei suoi privilegi e delle sue responsabilità e capace, non ultimo, di ampliare considerevolmente il proprio patrimonio. Queste capacità che lo renderanno il protagonista dei difficili anni Novanta, gli saranno riconosciute dai funzionari dei regimi che negli anni si susseguono. Apprezzato da tutti gli imperatori Asburgo, fu riabilitato non a caso nella stagione dell’impero napoleonico, quando cioè il regime si istituzionalizzò lo Stato riassume l’aspetto tradizionale
Museo dell'Istituto di Medicina Legale di Firenze. Ricerca preliminare per un eventuale percorso museale.
Get PDFmissin
MYSCE, a new Monte Carlo code for star cluster simulations. Axion-like particles and very-high energy astrophysics
Get PDFThis thesis focuses on two different topics: (i) star clusters, as favourite environments for the formation of black holes of very high mass, and (ii) the implications of axionlike particles for very-high energy astrophysics by considering -ray observations from blazars.
In the first part of this thesis we develop a new Monte Carlo code MYSCE (Montecarlo Young Star Cluster Evolution) which improves and solves some problems of the original scheme presented by Hénon. We use our code to simulate star clusters and to inquire if an episode of gas infall during the cluster lifetime can lead to the formation of an intermediate mass black hole and/or a super massive black hole seed.
In the second part of this thesis we explore axion-like particles in an astrophysical context. We describe their origin and properties within extensions of the Standard Model of elementary particle physics. We show how axion-like particles can in principle solve the cosmic opacity problem for distant blazars and naturally explain the emission of very-high energy photons from at spectrum radio quasar
Mappaggio ad alta densità dell'attività focale delle vene polmonari: analisi dell'innesco della fibrillazione atriale parossisitica nell'uomo.
Get PDFScopo: Analizzare le caratteristiche dell’attività focale originante dalle vene polmonari (VP) innescante la fibrillazione atriale (FA) nell’uomo, mediante mappaggio tridimensionale (3D) ad alta densità.
Metodi e risultati: L’attività focale della VP è stata registrata mediante catetere basket (64 elettrodi) ed il segnale endocavitario analizzato con sistema di mappaggio computerizzato (QMS2). Sono stati analizzati 40 pazienti e registrata attività focale in 23 VP. L’attività focale innescante la FA è stata registrata in 17 VP. La sequenza di acquisizioni nello stesso paziente e nella stessa VP mostra un pattern di attivazione riproducibile. Il pattern di attivazione più frequente risulta essere multifocale, prossimale alla giunzione atrio-venosa e breaktrough non correlata. La localizzazione dell’attività focale è prevalente in sede anteriore e inferiore della vena.
L’attività focale innescante la FA è caratterizzata da attività fibrillato ria nelle zone di più precoce attivazione seguita da potenziali discreti nelle zone più tardive. L’attività focale delle VP non innescante la FA presenta zone di minor precocità di attivazione con minore sincronizzazione dei foci aritmici.
Conclusioni: il mappaggio tridimensionale con catetere basket risulta essere un ottimo strumento di mappaggio endocavitario utile per la comprensione di aspetti anatomici e funzionali dell’attività focale delle VP innescanti la fibrillazione atriale nell’uomo
Lo specchio de' governanti di Antonio Masucci, O.F.M.Conv. Per un'ermeneutica simbolica di un trattato politico del Seicento. The mirror of rulers from Antonio Masucci,O.F.M.Conv. A symbolic approach to hermeneutics of a political treatise of the Seventeenth century.
No full textOggetto della mia indagine è un trattato di morale politica del Seicento intitolato Specchio de’ governanti il cui autore è un frate francescano, vissuto a Napoli, Antonio Masucci. Il presupposto è stato svolgere, attraverso un approccio di ermeneutica simbolica, un parallelismo tra due periodi di crisi, quella “barocca” del XVII secolo e quella della società contemporanea.
Dopo una necessaria premessa sulla metodologia di ricerca, la simbolica e i concetti di simbolo, ho ritenuto opportuno ricostruire il percorso del contributo della cristianità alla formazione della coscienza, individuale e collettiva, europea e, per quanto riguarda il piano politico, nel cammino di evoluzione del moderno concetto di sovranità politica dal Medioevo sino alla modernità.
Ricostruito tale percorso storico-teorico e, approfondito lo scenario socio-culturale italiano del Seicento, con riferimento anche alle riflessioni sulla “ragion di Stato” e sulla sovranità dei principati italiani, ho ottenuto gli strumenti adatti per affrontare l’analisi del testo di riferimento.
L’opera era finalizzata ad ammonire i governanti dell’epoca sui loro errrori al fine di istruirli ad un miglioramento. Il testo è di stile barocco, quindi denso di ripetizioni e cenni dotti tratti da diverse fonti a cominiciare dalla Sacra Scrittura, ritenuta primaria fonte del diritto.
Il concetto cardine dell’opera è la giustizia, espressione della volontà divina ma anche della natura razionale quindi valevole per tutti gli uomini.
Il testo contiene, inoltre, diversi concetti simbolici, tra cui il centrale è quello dello specchio: espressione dell’Intelligenza creatrice della divinità, quindi strumento di edificazione del governante che, a sua volta, è definito come “specchio del suo popolo”, assumendo valore simbolico.
Object of my study is a treatise on political morality of the seventeenth century titled Mirror of the rulers whose author is a franciscan friar, who lived in Naples, Antonio Masucci. The assumption has been to carry out, through a symbolic approach to hermeneutics, a parallelism between two periods of crisis, the “baroque” of the seventeenth century and that of contemporary society.
After a necessary premise in research methodology, the symbolic and the concepts of symbol, I decided to trace the path of the contribution of christianity to the formation of european conscience, individual and collective, and, as regards the political level, in the process of evolution of the modern concept of political sovereignty from the Middle Ages until the modern times.
Reconstructed this historical-theoretical way and, after having described socio-cultural context of Italian seventeenth century, with reference to the reflections on “reason of State” and the sovereignty of the Italian principalities, I got the tools to deal with the analysis of the text reference.
The work was intended to warn the rulers of their mistakes in order to instruct them to an improvement. The text is baroque style, so full of repetitions and references taken from different sources, to start by Sacred Scripture, which is considered the primary source of law.
The key concept is the justice, expression of the divine will and of a rational nature then valid for all men.
The text also contains several symbolic concepts, including the central one is the mirror: Intelligence creative expression of divinity, and tool of improvement of the ruler who is defined as a “mirror of its people”, assuming symbolic value
Content based image indexing and retrieval using a textual approach in visual online shopping.
No full textIn this study a new Content-Based Image and Indexing Retrieval engine based on the textual representation of the extracted features is proposed. We discuss about the advantages in the use of the proposed method both from the point of view of the quality of the results than the efficiency and the ease in the integration of the visual features in a real context. Furthermore, one of the main aspects of the proposed method consists in the use of an object detection phase which is essential to extract the visual information only from
the Object of Interest within the image.
The main contributions of this work consist in the development of a new color feature based on the Human Visual Perception able to extract a limited set of representative colors from the whole RGB space, and the development of a new feature able to extract the Visual Attributes in the domain of fashion based on the Human Pose estimation. Moreover a prototype based on the results of this study has been proposed, which is designed as an engine for the online shopping, focusing on the fashion domain which is the most promising field to test the extraction of visual information.
As an additional contribution of this study, given the increasing amount of mobile devices and the consequently interest in the mobile shopping, an extension of the proposed prototype has been developed as a mobile application able to perform a simple query by similarity
DNA methylation profiling identifies different prognostic clusters of pancreatic neuroendocrine tumors.
Get PDFThe occurrence and clinical relevance of global DNA hypomethylation and the hypermethylation of gene promoter regions in Pancreatic neuroendocrine tumours (PanNETs) are still largely unknown. The aim of this study was to evaluate the incidence of both epigenetic alterations in PanNETs in order to assess the relation of specific methylation profiles to chromosomal instability and tumour phenotypes.
We analyzed a well-characterized series of 58 PanNETs using DNA from formalin fixed paraffin embedded tissues. Methylation-Sensitive Multiple Ligation-dependent Probe Amplification was performed to assess simultaneously the methylation status of 33 tumour suppressor genes and copy number alterations of 53 chromosomal regions. Global DNA methylation was quantified for Long Interspersed Nucleotide Element-1 using bisulfite pyrosequencing.
Unsupervised hierarchical clustering resulted in three prognostically different hypermethylation groups of PanNETs (p=0.004) with significantly higher methylation levels in cluster 3 that was associated with poor prognosis compared with clusters 1 and 2.
PanNETs were hypomethylated compared to normal pancreas. In average a modest degree of DNA hypomethylation was observed in cluster 1 and 3 tumours, most of which showed low levels of copy number alterations. By contrast, cluster 2 was a group of highly hypomethylated PanNETs showing the highest degree of chromosomal instability. DNA demethylation was strongly correlated with poor prognosis (p<0.0001) and remained the only independent significant predictor of outcome in multivariate analysis that included stage, grading, Ki67 proliferative index and DNA hypermethylation clusters (p=0.006).
The combination of global DNA demethylation and gene hypermethylation analyses allows to define biologically and prognostically distinct subsets of PanNETs. Both alterations can be found in these tumors and each one can promote tumorigenesis by independent processes