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Le assicurazioni della salute: inquadramento sistematico e funzione sociale
No full textMuovendo dall’esame delle relazioni tra diritto alla salute e mercato assicurativo, la tesi si incentra sull’analisi delle c.dd. assicurazioni della salute, categoria nella quale vengono ricondotte le assicurazioni contro gli infortuni e/o le malattie, l’assicurazione per il rischio di non autosufficienza ed altre coperture sanitarie di lunga durata, nonché l’assicurazione di spese mediche. Individuati i tratti caratteristici delle suddette figure, l’indagine si sofferma sulla collocazione delle stesse nella sistematica assicurativa, al preminente scopo di individuarne la disciplina applicabile, prefigurando la possibilità di addivenire ad un inquadramento delle medesime differente rispetto a quello prospettato dalla giurisprudenza dominante; ciò, peraltro, senza trascurare le significative interferenze di siffatte coperture con il sistema della responsabilità civile e della sicurezza sociale. La trattazione successiva è dedicata alla funzione sociale delle assicurazioni della salute, soprattutto nell’odierno contesto di crisi dello Stato sociale e nell’ambito della transizione sostenibile in atto. In quest’ultima prospettiva, si pone in luce come il mercato assicurativo della salute possa essere più inclusivo per l’utente, tanto sul piano soggettivo, tramite un ampliamento della platea dei destinatari dell’offerta assicurativa sanitaria, quanto sul piano oggettivo, verificando il rischio effettivamente coperto nelle polizze attualmente diffuse sul mercato e valutando l’opportunità di una sua estensione.Starting with an examination of the relationship between the right to health and the insurance market, the thesis focuses on the analysis of what is referred to as health insurance, a category that includes insurance against accidents and/or illnesses, insurance against the risk of non-self-sufficiency and other long-term health coverage, as well as insurance for medical expenses. Having identified the characteristic features of the above-mentioned forms of insurance, the study focuses on their place in the insurance system, with the primary purpose of identifying the applicable regulations, and considering the possibility of a different classification from the one established by prevailing case law. This is done without neglecting the significant interaction between such coverage and the civil liability and social security systems. The following discussion focuses on the social function of health insurance, especially in today’s context of the crisis of the welfare state and the ongoing transition towards sustainability. In this latter perspective, it highlights how the health insurance market can be more inclusive for the user, both on a subjective level, by expanding the pool of beneficiaries of health insurance offerings, and on an objective level, by assessing the risks actually covered by policies currently available on the market and evaluating the possibility of extending them
Delivery mode and risk of intraventricular hemorrhage: A retrospective single-center study on 1760 preterm infants of less than 32 weeks
No full textObjective: To evaluate the association between delivery mode and intraventricular hemorrhage (IVH) in infants with a gestational age (GA) < 32 weeks. Study Design: We retrospectively reviewed data of 1760 infants with a GA between 24+0/7 and 31+6/7 weeks/days born between 01.01.2004 and 31.12.2022. We excluded outborn, congenital malformations, infants born by complicated delivery and without antenatal corticosteroid administration. Exposure was the delivery mode: cesarean section (CS) versus vaginal delivery (VD). IVH within the first week of life was the primary outcome. Multiple regression analyses were used to evaluate the association between delivery mode and IVH. CS infants were also match-paired for GA and small for gestational age (SGA) with VD infants. Results: The incidence of IVH was lower in 1046 CS than in 144 VD study infants (IVH I-IV: 14 vs 29 %, p < 0.001; IVH I-II: 10 vs 22 %, p < 0.001; IVH III-IV: 3 vs 8 %, p = 0.008). CS was associated with a lower risk of IVH grades I-IV (aOR: 0.52, p = 0.012) after the adjustment for GA, year of birth, sex, singleton pregnancy, SGA, hypertensive disorders of pregnancy, pH ≤ 7.00 and/or standard base excess (SBE) ≤ -12 mmol/L at cord blood gas analysis, early-onset sepsis, hemodynamically significant patent ductus arteriosus, thrombocytopenia, need of blood transfusion, mechanical ventilation and inotropes/vasoactive amines. Conclusions: CS was associated with lower risk of IVH than VD in infants with a GA between 24+0/7 and 31+6/7 weeks/days, born by uncomplicated delivery and who have received antenatal corticosteroids
Presence, behavior and risk assessment of pharmaceutical products in aquatic ecosystems
No full textI composti farmaceutici (API) rappresentano una crescente preoccupazione per gli ecosistemi marini a causa della loro presenza ubiquitaria e della loro capacità di indurre alterazioni negli organismi non-target. L'obiettivo della presente tesi di dottorato è stato quello di chiarire l'impatto di 15 API e 6 miscele studiando il bioaccumulo e l’insorgenza di effetti in specie aquatiche non-target, con l'intento di sviluppare una procedura di valutazione di rischio ambientale per queste sostanze. Sono stati applicati approcci in vivo, ex vivo e in vitro su vari organismi appartenenti a livelli trofici differenti. I risultati delle esposizioni croniche in vivo hanno evidenziato la capacità dei mitili di accumulare la maggior parte degli API testati, il danneggiamento del sistema immunitario, dei metabolismi lipidico e ossidativo, il persistere delle alterazioni biologiche anche al termine di un periodo di depurazione e l'assenza di interazioni additive/sinergiche nelle miscele. Le stesse vie metaboliche sono state modulate negli studi ex vivo condotti sul mitilo. Il cambiamento climatico aumenta la tossicità degli API: l’acidificazione, esacerbando lo stress ossidativo, e le ondate di calore marine, amplificando risposte immunitarie. I test acuti in vivo e in vitro hanno rivelato che i farmaci psichiatrici risultano essere la classe terapeutica più reattiva, e che nelle miscele la tossicità non è correlata al numero di API combinati, ma alle possibili interazioni che si instaurano tra le singole molecole. I risultati complessivi, integrati attraverso un modello di Weight of Evidence, hanno contribuito allo sviluppo della prima procedura di valutazione del rischio ambientale per i farmaci negli ecosistemi marini.Active Pharmaceutical Ingredients (APIs) represent a growing concern for marine ecosystems due to their ubiquitous occurrence and documented adverse effects on non-target organisms. The overall aim of the present PhD thesis was to clarify the impact of 15 APIs and 6 mixtures in terms of bioaccumulation and onset of adverse effects in non-target aquatic species, toward the development of an environmental risk assessment procedure for these chemicals. In vivo, ex vivo and in vitro approaches were applied using various organisms of different trophic levels. Results from chronic in vivo exposures highlighted mussels’ capability to accumulate most of tested APIs, the impairment of immune system, lipid and oxidative metabolisms, a faster drugs excretion compared to the recovery of the adverse effects, and a lack of additive or synergistic interactions in mixtures. The same metabolic pathways were also modulated in the same species tested through an ex vivo approach. Climate change related stressors increased APIs toxicity: acidification exacerbated the oxidative stress while marine heatwaves amplified immune responses. Acute in vivo and in vitro tests revealed that psychiatric drugs were the most reactive therapeutic class, and that in mixtures toxicity was not related to the number of the combined APIs but rather to the potential interaction among their components. Overall results integrated through a Weight of Evidence model helped the development of the first environmental risk assessment procedure for pharmaceuticals in marine ecosystems
Vibration suppression of suspended cables with three-to-one internal resonances via time-delay feedback
Get PDFBased on the time-delay feedback control, the vibration suppression of suspended cables with three-to-one internal resonances are investigated. Initially, the nonlinear differential equation of motion for a suspended cable under time-delay feedback control is considered, and a discrete model is derived using the Galerkin method. Subsequently, the method of multiple scales is employed to perturbatively solve the discrete time-delay differential equation, determining the modulation equations around the first primary resonance. Steady-state and periodic solutions of the modulation equations are detected numerically. Numerical results indicate that the internal resonance enhances the nonlinear dynamical complexity of the controlled suspended cable. It is observed that the time delay and control gain affect the controlled system: in particular, an increase in control gain leads to a reduction in response amplitude. By adjusting the time delay and control gain, the critical excitation can be altered, an aspect that could be very useful from a practical point of view. This research sheds light on the intricate dynamics of suspended cable and provides a theoretical foundation for designing more effective control strategies in engineering applications
Pyroptosis: A Novel Therapeutic Target for Bioactive Compounds in Human Disease Treatment? A Narrative Review
Get PDFBackground/Objectives: Bioactive compounds possess the ability to maintain health and improve diseases by regulating inflammation and cell death processes. Pyroptosis is programmed cell death related to inflammation and exerts a critical role in the development and progression of different types of diseases. This narrative review aims to investigate and discuss the effects of dietary bioactive compounds on pyroptosis in different common human pathologies, such as inflammatory disease, bacterial infection, injury disease, cancer, diabetes and heart disease, etc. Method: Studies published in the major databases until December 2024 in English were considered, for a total of 50 papers. Results: The current evidence demonstrated that the bioactive compounds are able to regulate the pyroptosis process by modulating different inflammasome sensors (NLRP1, NLRP3, and AIM2), caspase family proteins (caspase-1, caspase-3, and caspase-11), and gasdermins (GSDMD and GSDME) in many pathological conditions related to inflammation, including cancer and cardiovascular diseases. Conclusions: Bioactive compounds have powerful potential to be the candidate drug for pyroptosis modulation in inflammatory diseases, even if more clinical studies are needed to confirm the effects and establish efficient doses for humans
Electromagnetic-Quantum Simulations of Graphene-Based Devices for High-Frequency Applications
No full textQuesta dissertazione, intitolata Simulazioni Elettromagnetiche e Quantistiche di Dispositivi Basati su Grafene per Applicazioni in Alta Frequenza, si concentra sullo studio e sulla simulazione di dispositivi basati su grafene per applicazioni al terahertz (THz). La tesi presenta nuove tecniche di modellazione, basate su simulazioni sia quantistiche che elettromagnetiche, per ottimizzare le prestazioni dei diodi al grafene, in particolare per la progettazione di rectenne, e per comprendere i meccanismi che causano l'amplificazione THz. Il lavoro contribuisce a due progetti di ricerca europei, GreEnergy e PLASNANO, che mirano a sviluppare sistemi di energy harvesting ad alta efficienza e sorgenti al THz più potenti per le tecnologie di comunicazione. Nella modellazione dei diodi geometrici, è importante simulare con precisione il trasporto quantistico coerente per ottenere le caratteristiche IV e l'asimmetria dei dispositivi. Questa tesi presenta un metodo basato sull'equazione di Schrödinger tempo-dipendente, che simula il trasporto di elettroni balistici nel grafene come un pacchetto d'onda coerente. Questo modello considera le condizioni iniziali del pacchetto d’onda, inclusa la diffusione spaziale e la quantità di moto media, fornendo informazioni dettagliate sulla propagazione delle onde e sulla distribuzione dell’energia nei diodi al grafene. Inoltre, consente un'analisi completa delle prestazioni e dell'ottimizzazione del sistema rectenna e la progettazione di dispositivi più efficienti per il recupero di energia elettromagnetica. Diverse rectenne sono state ottimizzate accoppiando sia le simulazioni dei diodi geometrici sia le misurazioni dei diodi tunnel MIG (metal insulator graphene) fabbricati con la simulazione dell’antenna. Il loro comportamento è stato simulato nel dominio del tempo per fornire l'efficienza di rettificazione. Per quanto riguarda l'applicazione del grafene nell'amplificazione delle onde terahertz (THz) utilizzando le sue proprietà plasmoniche, questa tesi analizza due meccanismi chiave: l'effetto Čerenkov quantistico e l'emissione tramite Bremsstrahlung. L'effetto Čerenkov quantistico nel grafene è studiato per il suo potenziale di amplificare le onde THz attraverso l'emissione di plasmoni superficiali quando gli elettroni si muovono più velocemente della velocità di fase della luce nel mezzo. Questo meccanismo è descritto teoricamente utilizzando la regola d'oro di Fermi, dimostrando che un dispositivo in cui il grafene è confinato tra piastre metalliche è adatta per l'emissione Čerenkov. La Bremsstrahlung si basa sull'interazione tra i portatori di carica del grafene e il campo magnetico applicato per ottenere l'amplificazione THz. Partendo dall'equazione di Dirac, si è usato un modello teorico per fornire un'analisi dettagliata del fenomeno e per prevedere il tasso di emissione che è fondamentale per ottimizzare la configurazione del dispositivo e migliorare la generazione di onde elettromagnetiche al THz.This dissertation titled Electromagnetic-Quantum Simulations of Graphene-Based Devices for High-Frequency Application focuses on the investigation and simulation of graphene-based devices for applications in terahertz (THz) frequencies. It presents novel modeling techniques, based on both quantum and electromagnetic simulations, to optimize the performance of graphene diodes, particularly in rectenna design, and to understand the mechanisms beyond THz amplification. The work contributes to two European research projects, GreEnergy and PLASNANO, which aim to develop high-efficiency energy harvesting systems and more powerful THz sources for communication technologies. In modelling geometric diodes, it is important to address coherent quantum transport to accurately obtain the I-V characteristics and the asymmetry of the device. This dissertation presents a Time-Dependent Schrödinger Equation-based method, which simulates ballistic electron transport in graphene as a coherent wave packet. This model considers the wave packet’s initial conditions, including spatial spread and average momentum, allowing detailed insights into wave propagation and energy distribution in graphene diodes. Moreover, it allows a comprehensive analysis of the performance and optimization of the rectenna system and the design of more efficient devices for energy harvesting. Different rectennas have been optimized considering both geometric diode simulation and measurements of manufactured metal insulator graphene diodes, then the coupled behavior has been simulated in the time domain to provide the rectification efficiency. Regarding the application of graphene in terahertz (THz) wave amplification using its plasmonic properties, this dissertation analyzes two key mechanisms: the quantum Čerenkov effect and Bremsstrahlung emission. The quantum Čerenkov effect in graphene is studied for its potential to amplify THz waves through the emission of surface plasmons when electrons move faster than the phase velocity of light in the medium. This mechanism is described theoretically using the Fermi golden rule, demonstrating that a device structure in which graphene is confined between metal plates is suitable for Čerenkov emission. Bremsstrahlung emission relies on the interaction between graphene's charge carriers and the external magnetic bias to achieve THz amplification. Starting from the Dirac equation, a theoretical model is used to provide a detailed analysis and to predict the emission rates which is fundamental to optimize device configurations for enhancing THz wave generation
Ginger Status Report
Get PDFThe GINGER project is based on ring lasers and is under construction at the underground Gran Sasso laboratories, as part of the underground geophysical obser- vatory of Gran Sasso (UGGS). Large frame ring lasers are top sensitivity instruments to measure angular rotation rate, in particular when attached to the Earth crust they can measure with very high precision the Earth angular velocity. This kind of measurements when the precision is of the order of 1 part in 109, are certainly relevant for geophysics and geodesy, for instance to measure the fast variation of the length of Day (LoD), but are also relevant for fundamental physics, since are affected by de Sitter and Lense-Thirring effects and can be used to investigate Lorentz’s violations. Ring lasers ensure long-term continuous operation with record sensitivity. The limit of 1 part in 109 of the Earth’s rotation rate has already been demonstrated, and recent sensitivity study has shown that the ring laser shot noise limit is at least a factor 10 better than expected. GINGER and its status report will be described
A procedure for addressing the soil-abutment interaction problem in the safety assessment of bridges
No full textThe paper proposes a methodology for assessing the seismic soil-foundation-abutment response in the spirit of the sub-structure approach. The methodology is suitable for conventional bridge abutments characterized by massive structural components and accommodates for various structural and soil configurations, from both stratigraphic and topographic perspectives. The abutment is assumed to be rigid, which is a generally acceptable hypothesis given the typical geometry of conventional bridge abutments with walls, orthogonal wingwalls, and a concrete deep or strip foundation. The methodology aligns with codes, which foresees a linear behaviour for the abutments and suggest a low behaviour factor to account for dissipative capabilities due to the backfills and the radiation phenomena in the soil. The soil is assumed to perform elastically, but the overall soil nonlinearity induced by seismic wave propagation can be incorporated into the method using a linear equivalent representation of soil properties. The methodology is applied to a real case study in order to demonstrate its effectiveness in addressing the soil-structure interaction problem and to provide practical suggestions for the method implementation, including possible simplifications
Enhancing supply chain resilience through the supply network approach
Get PDFPurposeThis study aims to investigate the efficacy of the supply network approach in bolstering supply chain resilience amidst escalating global uncertainty. With enterprises worldwide facing increasing threats that disrupt supply chains, this research explores how firms enhance supply network resilience during crises.Design/methodology/approachUsing a multi-case study design, this research thoroughly examines interactions within firms’ supply networks to uncover new insights on supply network approach and how firms enhance supply network resilience against global uncertainty. The selection of cases was methodologically aligned to represent diverse industries and geographical locations to ensure a comprehensive analysis.FindingsThis study’s findings reveal how firms develop supply network resilience during global crises. The supply network perspective provides a deeper understanding of how firms manage supply chain interactions, interdependencies and strategic positions to survive and thrive during crises. The conceptual framework developed here provides insights that can foster improved coordination and facilitate effective temporary organising. The framework highlights the need for firms to proactively seize opportunities and mitigate risks within their global supply chains during crises to boost overall resilience.Originality/valueOffering novel insights into the domain of supply chain networks, this study underscores novel perspectives of the supply network approach when firms develop supply chain resilience during global crises. Highlighting the adaptive responses of firms that integrate these approaches enriches the understanding of strategic manoeuvres firms can use to navigate global uncertainty and secure supply chain continuity
Early onset metastatic colorectal cancer patients as a distinctive clinical and molecular phenomenon
No full textBackground: Despite a reduction of both incidence and mortality from CRC, recent studies have shown an increase in the incidence of early-onset CRC (EO-CRC). Data on this setting are limited. The aim of our study was to evaluate the clinical and molecular profiles of metastatic EO-CRC patients in order to identify differences compared to a late-onset CRC (LO-CRC) control group. Methods: We retrospectively collected data from 1272 metastatic colorectal cancers from 5 different Italian Institutions. The main objective was to the evaluate clinical outcome for EO-CRC patients in comparison to patients included in the control group. Results: In the overall population, mOS was 34,7 in EO-CRC pts vs 43,0 months (mo) (p < 0,0001). In the RAS/BRAF mutated subgroup mOS in EO-CRC pts was 30,3 vs 34,0 mo (p = 0,0156). In RAS/BRAF wild-type EO-CRC mOS was 43,0 vs 50,0 mo (p = 0,0290). mPFS was 11,0 in EO-CRC pts vs 14,0 mo (p < 0,0001). Conclusion: Findings indicate a general worse prognosis for patients with early-onset colorectal cancer compared to late-onset patients. Interestingly this seems to occur regardless of the molecular status. These observations might have a considerable impact on clinical practice and research