1,728 research outputs found
Severe hypoxemia: which strategy to choose
No full textBackground: Acute respiratory distress syndrome (ARDS) is characterized by a noncardiogenic pulmonary edema with bilateral chest X-ray opacities and reduction in lung compliance, and the hallmark of the syndrome is hypoxemia refractory to oxygen therapy. Severe hypoxemia (PaO2/FiO2 < 100 mmHg), which defines severe ARDS, can be found in 20-30 % of the patients and is associated with the highest mortality rate. Although the standard supportive treatment remains mechanical ventilation (noninvasive and invasive), possible adjuvant therapies can be considered. We performed an up-to-date clinical review of the possible available strategies for ARDS patients with severe hypoxemia. Main results: In summary, in moderate-to-severe ARDS or in the presence of other organ failure, noninvasive ventilatory support presents a high risk of failure: in those cases the risk/benefit of delayed mechanical ventilation should be evaluated carefully. Tailoring mechanical ventilation to the individual patient is fundamental to reduce the risk of ventilation-induced lung injury (VILI): it is mandatory to apply a low tidal volume, while the optimal level of positive end-expiratory pressure should be selected after a stratification of the severity of the disease, also taking into account lung recruitability; monitoring transpulmonary pressure or airway driving pressure can help to avoid lung overstress. Targeting oxygenation of 88-92 % and tolerating a moderate level of hypercapnia are a safe choice. Neuromuscular blocking agents (NMBAs) are useful to maintain patient-ventilation synchrony in the first hours; prone positioning improves oxygenation in most cases and promotes a more homogeneous distribution of ventilation, reducing the risk of VILI; both treatments, also in combination, are associated with an improvement in outcome if applied in the acute phase in the most severe cases. The use of extracorporeal membrane oxygenation (ECMO) in severe ARDS is increasing worldwide, but because of a lack of randomized trials is still considered a rescue therapy. Conclusion: Severe ARDS patients should receive a holistic framework of respiratory and hemodynamic support aimed to ensure adequate gas exchange while minimizing the risk of VILI, by promoting lung recruitment and setting protective mechanical ventilation. In the most severe cases, NMBAs, prone positioning, and ECMO should be considered
TUTELA DEL LAVORO E LIBERTA' D'IMPRESA NEI PROCESSI DI ESTERNALIZZAZIONE
No full textL’elaborato analizza le conseguenze lavoristiche della successione fra imprenditori, muovendo da una ricognizione delle varie tipologie di esternalizzazione con le relative esigenze e principali criticità.
L’indagine si concentra in primo luogo sul trasferimento d’azienda, esaminando la normativa e la giurisprudenza europee per passare poi alla disciplina di diritto interno, alle procedure sindacali e a uno specifico focus sul trasferimento delle aziende in crisi.
Successivamente l’autore si sofferma sull’appalto, prendendone in particolare considerazione gli indici di genuinità, i criteri di distinzione dalla somministrazione illecita di manodopera e la tutela delle maestranze in caso di avvicendamento fra imprese.
Da ultimo, la ricerca approfondisce le c.d. “clausole sociali”, sia di prima che di seconda generazione, valutandone la compatibilità con il diritto eurounitario e con la costituzione nonché riflettendo sui possibili rimedi in caso di loro violazione.The author analyzes the labour consequences of the succession between entrepreneurs, starting from a recognition of the various types of outsourcing with the related needs and main critical issues.
The survey focuses primarily on the transfer of businesses, examining European legislation and case-law and then moving on to internal legislation, trade union procedures and a specific focus on the transfer of companies in crisis.
The author then dwells on the contract, taking into account in particular the indications of authenticity, the criteria of distinction from the illicit administration of labour and the protection of workers in the event of turnover between companies.
Finally, the research deepens the "social clauses", both first and second generation, assessing their compatibility with European law and with the constitution and reflecting on possible remedies in case of their violation
Ultra Low Carbon Vehicles: New Parameters for Automotive Design
No full textAs the influence of vehicle emissions on our environment has become better understood, the UK government has recently placed urgent emphasis on the implementation of low carbon
technologies in the automotive industry through: the UK Low Carbon Industrial Strategy. The overall objective is to offer big incentives to consumers and support for the development of infrastructure and engineering solutions. This scheme however does not consider how the development of functional and experiential user value might drive consumer demand, contributing to the adoption of low carbon vehicles (LCVs) in the mass market.
With the emergence of the North East of England as the UK’s first specialised region for the development of ultra-low carbon vehicles (ULCVs), ONE North East, as a development agency for the region's economic and business development, and Northumbria University Ideas-lab have supported a project to facilitate innovation through the collaboration of technology, research and development (R&D) and business. The High Value Low Carbon (HVLC) project aims to envisage
new user value made possible by the integration of low carbon vehicle platforms with new process and network technologies. The HVLC consortium represents vehicle manufacturers and their suppliers as well as technology based companies and through an ongoing process of design concept generation the project offers a hub for innovation led enterprise.
Whilst new technological developments in areas such as power generation, nano materials, hydrogen fuel cells, printed electronics and networked communications will all impact on future automotive design, the mass adoption of low carbon technologies represents a paradigm shift for the motorist. This paper aims to describe how the mapping of new parameters will lead to new transport scenarios that will create the space for new collaborative research on user experiences supported by innovative technologies and related services
Airway driving pressure and lung stress in ARDS patients
No full textBackground: Lung-protective ventilation strategy suggests the use of low tidal volume, depending on ideal body weight, and adequate levels of PEEP. However, reducing tidal volume according to ideal body weight does not always prevent overstress and overstrain. On the contrary, titrating mechanical ventilation on airway driving pressure, computed as airway pressure changes from PEEP to end-inspiratory plateau pressure, equivalent to the ratio between the tidal volume and compliance of respiratory system, should better reflect lung injury. However, possible changes in chest wall elastance could affect the reliability of airway driving pressure. The aim of this study was to evaluate if airway driving pressure could accurately predict lung stress (the pressure generated into the lung due to PEEP and tidal volume). Methods: One hundred and fifty ARDS patients were enrolled. At 5 and 15 cmH2O of PEEP, lung stress, driving pressure, lung and chest wall elastance were measured. Results: The applied tidal volume (mL/kg of ideal body weight) was not related to lung gas volume (r 2 = 0.0005 p = 0.772). Patients were divided according to an airway driving pressure lower and equal/higher than 15 cmH2O (the lower and higher airway driving pressure groups). At both PEEP levels, the higher airway driving pressure group had a significantly higher lung stress, respiratory system and lung elastance compared to the lower airway driving pressure group. Airway driving pressure was significantly related to lung stress (r 2 = 0.581 p < 0.0001 and r 2 = 0.353 p < 0.0001 at 5 and 15 cmH2O of PEEP). For a lung stress of 24 and 26 cmH2O, the optimal cutoff value for the airway driving pressure were 15.0 cmH2O (ROC AUC 0.85, 95 % CI = 0.782-0.922); and 16.7 (ROC AUC 0.84, 95 % CI = 0.742-0.936). Conclusions: Airway driving pressure can detect lung overstress with an acceptable accuracy. However, further studies are needed to establish if these limits could be used for ventilator settings
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Matteo Maria Boiardo (1441-1494)
No full textMatteo Maria Boiardo – contemporary of Sir Thomas Malory and forerunner of Shakespeare, Spenser, Milton, Cervantes, Tolkien, and C.S. Lewis – is best known as the author of the Orlando Innamorato [Orlando in Love], a poem in ottava rima organically merging Carolingian epic and Arthurian romance. He was also a lyric and pastoral poet, playwright, and translator of classical texts into the Italian vernacular. Matteo was active in Italy during the years of 1463 throughout 1494, the year of his death
Uno sguardo all'Est. Lavoro e diritti fondamentali in Russia e negli altri Paesi della Comunità di Stati indipendenti
No full textNel contributo l'autore, dopo aver esaminato i diritti fondamentali del lavoro presenti nelle Costituzioni dei Paesi della Comunità di Stati indipendenti, si sofferma sul diritto del lavoro russo. La trattazione, a carattere diacronico, abbraccia i rami principali del diritto del lavoro: il rapporto individuale, le relazioni collettive, il mercato del lavoro. L'autore rileva una sorprendente continuità nelle linee essenziali del diritto del lavoro russo, pur nel susseguirsi di sistemi socioeconomici completamente diversi. Egli conclude che il diritto del lavoro russo appartiene saldamente alla matrice europea della materia.The contribution of the author starts by examining fundamental labour rights recognised by the Constitutions of the Countries of the Community of Independent States. Then the author focuses upon Russian Labour Law, going through the history of the main branches of the discipline: the individual relationship, industrial relations, the labour market. The article finds a surprising continuity in the essential lines of Russian Labour Law, in spite of the completely different socio-economic systems that were experimented in Russia during the twentieth century. The author concludes that Russian Labour Law clearly belongs to the European matrix of the discipline
sj-docx-1-jic-10.1177_08850666231210485 - Supplemental material for Impact of Positive End-Expiratory Pressure and FiO<sub>2</sub> on Lung Mechanics and Intrapulmonary Shunt in Mechanically Ventilated Patients with ARDS Due to COVID-19 Pneumonia
No full textSupplemental material, sj-docx-1-jic-10.1177_08850666231210485 for Impact of Positive End-Expiratory Pressure and FiO2 on Lung Mechanics and Intrapulmonary Shunt in Mechanically Ventilated Patients with ARDS Due
to COVID-19 Pneumonia by Gaetano Florio, Alberto Zanella, Douglas Slobod, Amedeo Guzzardella, Ilaria Protti, Eleonora Carlesso, Arif Canakoglu, Jacopo Fumagalli, Vittorio Scaravilli and
Sebastiano M. Colombo, Alessio Caccioppola, Matteo Brioni, Antonio M. Pesenti, Giacomo Grasselli in Journal of Intensive Care Medicine</p
Corpo, spazio, architettura. Fenomenologia dell’esperienza spaziale Matteo Vegetti, Fabrizia Bandi (eds.), Editrice Morcelliana, Brescia 2024
No full textThe author reviews "Corpo, spazio, architettura: Fenomenologia dell’esperienza spaziale," edited by Matteo Vegetti and Fabrizia Bandi. The book examines the philosophical underpinnings of spatial experience through a phenomenological lens, engaging with both traditional and contemporary notions of how space, body, and architecture interconnect. The author highlights the text\u27s exploration of how architects and designers might integrate phenomenological insights into their work, transforming space from mere physical dimensions into lived, experienced reality. The review appreciates the book’s thematic organization, which starts with foundational theories from Merleau-Ponty and expands through discussions on virtual spaces and the future of architecture in the digital age. Through this anthology, readers gain a comprehensive view of the architectural implications of phenomenological thought, making it a critical resource for anyone involved in the conceptualization and design of space
St. George and the Dragon or the town planner as a story-teller. In conversation with Bernardo Secchi about Il racconto urbanistico / Der heilige Georg und der Drache, oder: Der Stadtplaner als Geschichtenerzähler. Ein Gespräch mit Bernardo Secchi über Il racconto urbanistico
No full textAt the end of the second edition of his Storia dell’architettura italiana, Manfredo Tafuri declares that “one book assumes a crucial relevance”1 in finding a way out of the endemic crisis of modern architecture in the 1980s: Il racconto urbanistico. The publication of this work by the Italian urban planner 2 Bernardo Secchi in 1984 constitutes a unique event in recent European architecture—an event that still has not been appropriately described or analyzed. Matteo D’Ambros and Roberto Zancan met with the author to discuss the circumstances of the book’s publication. In a world of short memory, revisiting the possible contribution of literary studies to architecture and urban planning promises to shed light on the contemporary understanding of the disciplines. / Manfredo Tafuri schreibt am Ende der zweiten Auflage seiner Storia dell’architettura italiana, dass bei der Suche nach einem Ausweg aus der endemischen Krise der modernen Architektur in den 1980er Jahren „einem Buch entscheidende Bedeutung zukommt“1: Il racconto urbanistico. Die Ver öffentlichung dieses Werks des italienischen Stadtplaners 2 Bernardo Secchi im Jahr 1984 ist ein außergewöhnliches Ereignis in der neueren euro päischen Architektur – ein Ereignis, das noch nicht angemessen gewürdigt beziehungsweise analysiert worden ist. Matteo D’Ambros und Roberto Zancan trafen sich mit dem Autor, um über Aspekte rund um die Veröf fentlichung des Buches zu sprechen. In einer Welt mit kurzem Gedächtnis verspricht die erneute Betrachtung des Beitrags der Literaturwissenschaf ten zum Verständnis von Architektur und Stadt, neues Licht auf das berufliche Selbstverständnis zu werfen
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