55 research outputs found
Fabbisogni e costi standard, un'occasione perduta
No full textThe paper relates to the introduction of the standard requirement and cost concepts in health care financing system. The author, after a reconstruction of the evolution of health service financing in Italy, highlights the criticality of the system. Finally, the author examines the possibility that the standard requirement and cost concepts obtain a different meaning from the original
Welfare sanitario e vincoli economici
No full textLa tesi di dottorato è diretta a mettere in evidenza quali effetti la grave crisi economico-finanziaria del 2008 e le conseguenti esigenze di bilancio abbiano avuto sul sistema di welfare sanitario italiano.
Ciò che emerge è una progressiva contrazione del carattere universale del Servizio sanitario nazionale e un riaccentramento delle competenze in materia.
Con particolare riguardo al primo profilo, le stringenti logiche di contenimento della spesa stanno generando un progressivo ridimensionamento del Servizio sanitario nazionale e una reintroduzione surrettizia di un modello di assistenza sanitaria di stampo assicurativo/contributivo, in cui scompare la considerazione di un quantum di tutela da assicurare indistintamente a tutti gli individui in regime di tendenziale gratuità.
Obiettivo ultimo del lavoro di tesi è quello di dimostrare l’inammissibilità di un simile processo.
Si afferma, infatti, il carattere inalienabile del Servizio sanitario nazionale e, più in generale, del compito di tutela della salute, che deve considerarsi a tutti gli effetti una “funzione” dello Stato e, pertanto, indisponibile.
A tal fine, nella disamina si è concentrata l’attenzione, dapprima, sulla struttura diritto alla tutela della salute di cui all’art. 32 della Costituzione, secondariamente, sull’evoluzione e lo stato dell’arte del “paradigma” finanziario e organizzativo del Servizio sanitario nazionale.
In particolar modo, il primo capitolo, che prende le mosse da una breve ricostruzione dell’evoluzione storica dell’assistenza sanitaria in Italia, è finalizzato a chiarificare di quali innovazioni sia stata foriera la Carta costituzionale rispetto al “bene” salute.
Il secondo capitolo, composto di due sezioni, mira, invece, a verificare l’impatto che la crisi economica e i conseguenti stringenti vincoli di bilancio hanno avuto sul Servizio sanitario nazionale e, in particolare, sui suoi caratteri dell’universalità dell’accesso alle prestazioni e del decentramento organizzativo e finanziario.
A conclusione della trattazione, nel terzo capitolo si svolgono alcune riflessioni in un’ottica comparata, al fine di comprendere quali conseguenze la suddetta crisi abbia avuto sul sistema sanitario di un altro Stato membro dell’Unione europea. Quale Paese per la comparazione è stata scelta la Spagna per due diverse ragioni. Vi è, innanzitutto, un’analogia strutturale con il nostro ordinamento, dal momento che entrambi adottano, pur con differenze sostanziali, un modello di gestione del sistema sanitario decentrato, corrispondente all’opzione per una forma autonomistica di Stato, che la Costituzione spagnola del 1978 ha mutuato dalla Costituzione italiana del 1948.
Da un punto di vista strettamente economico, poi, i due Paesi si sono trovati ad affrontare, al momento dello scoppio della crisi del 2008, una situazione di deficit simile
Sintomatologia depressiva e ansiosa perinatale: comorbilità e fattori predittivi
No full textDepressione e ansia perinatale possono manifestarsi nelle donne nel periodo che va dal concepimento fino ad un anno dopo il parto, specialmente laddove siano presenti specifici fattori di rischio. La letteratura, infatti, riconosce un aumentato rischio psicopatologico in presenza di precedenti disturbi depressivi e/o ansiosi, scarso supporto sociale e occorrenza di eventi di vita stressanti. Alla luce di ciò, viene descritto uno studio longitudinale condotto presso un ospedale dell'Emilia-Romagna, i cui risultati evidenziano come la presenza di depressione e ansia sin dalla gravidanza sia fortemente predittiva di un quadro depressivo-ansioso dopo il parto; anche la carenza di una rete amicale di riferimento e di supporto aumenta il rischio di sintomi ansiosi-depressivi dopo la nascita del bambino
Assessment of otolith variability and micro litter pollution in Antarctic teleostean in relation to Ross Sea water circulation
No full textAntarctica is the continent located in the Earth's southern hemisphere, beyond the 60th parallel of southern latitude. It covers about 14 million square kilometers, most of which is permanently covered by snow and ice. Given its geographical location, this continent has no significant sources of local pollution. Nevertheless, increased human activities have caused an increase in the presence of pollutants in this remote ecosystem. Plastic is one of these, causing bioaccumulation events throughout the food chain. In this context, scientific efforts to improve the current knowledge of underestimated areas are necessary to support the goals of the Ross Sea Region Marine Protected Area (RSRMPA) research and monitoring plan. In this project, the study of Chionodraco hamatus, an endemic predator that has developed specific adaptations to survive in this extreme environment, such as lacking hemoglobin, was planned. This project was suitable for establishing the level of MPs contamination in the Antarctic region of the Ross Sea.
The aims of the project focuse on the analysis of the variability of the chemical structure of the otoliths to better understand the life of the fishes and the characterization of microplastics, where present, in the gastrointestinal tract of the samples, in correlation with the analysis of microbiome. The results obtained would implement the studies previously carried out on the monitoring of the MPA of Ross Sea and represent an increase in knowledge on the effects of microplastics have on Antarctic fish and the correlations with microplastics
Dante's masterplot and the alternative narrative models in the Commedia
No full textThis thesis investigates the narrative models in Danteâs Commedia with the aim of opening up the poem to alternatives to the dominant narrative embedded in the text, which it terms Danteâs masterplot. This is the teleological trajectory which allows the poet to subjugate earlier works or earlier parts of the poem to the revisionist gaze of its endpoint. The thesis analyses the masterplotâs workings in the text and its role in the interpretation of the poem, and documents its overwhelming success in influencing readings of the Commedia. It then explores three competing narrative models that resist and counter its monopoly, which are enacted by (i) paradoxes, (ii) alternative endings and parallel lives; and (iii) the future. Paradoxes are used to neutralise the teleological hierarchy and thus allow Dante to represent contradictory ideas and experiences in the temporal medium of language. Through counterfactuals and twin episodes, Dante establishes in his poem a number of storylines that detour from and run parallel to the main narrative; this allows him to make room for an affective space within the text, which suspends narrative necessity and moral normativity. The future tense poses a problem case for the masterplot in that it indefinitely postpones the endpoint on which teleology relies, and thus exposes the poem, and its authorâs, vulnerability to time and circumstance. By focusing on non-linear modes of storytelling, the thesis questions interpretations of the Commedia that favour one normative master-truth, and highlights instead the manifold poetic, theological and ethical tensions which, due to the masterplotâs influence, are often overlooked. The thesis concludes with a proposal that, alongside the traditional notions of Danteâs characteristic plurality of linguistic registers and styles, Danteâs narrative pluralism can and should come to play a key role in contemporary and future readings of the Commedia
Análisis estratégico de los procesos madurados y la adopción de la Norma ISO 9004: una propuesta teórica para el sector vidrio templado
No full textThe objective of this study was to propose theoretical reflections on the strategic analysis of the maturity of the processes and the implementation of the ISO 9004:2018 standard, as tools to offer the best quality of products and services that meet the demands of the market. tempered glass, responding to the complex scenarios present in Venezuela through standardization and quality management of its processes. The methodological orientation is located in a descriptive bibliographic study, where different literatures are consulted to develop theoretical guidelines on the use of the Capability Maturity Model (CMM) as a tool in the strategic analysis of internal conditions, and the guidelines of the ISO 9004:2018 standard that directs these companies towards sustained business quality. It is concluded that given the dynamics of these scenarios, quality management continues to be the best strategy to satisfy the needs of customers and stakeholders, supported by the application of tools such as the CMM to identify errors that must be resolved a priori and then implement strategic planning directed by the philosophy of continuous improvement described in this standard, in order to offer tempered glass with the thickness, perforations and types of hardware according to the use required by customers, which will allow them to improve their competitive position in this market.El presente estudio tuvo como objetivo proponer unas reflexiones teóricas sobre el análisis estratégico de la madurez de los procesos y la implementación de la norma ISO 9004:2018, como herramientas para ofrecer la mejor calidad de productos y servicios que cumplan con las demandas del mercado de vidrio templado, dando respuesta a los complejos escenarios presentes en Venezuela a través de la estandarización y la gestión de la calidad de sus procesos. La orientación metodológica se ubica en un estudio bibliográfico de tipo descriptivo, donde se consultan distintas literaturas para desarrollar lineamientos teóricos sobre el uso del Modelo de Madurez de Capacidades (CMM) como herramienta en el análisis estratégico de las condiciones internas, y los lineamientos de la Norma ISO 9004:2018 que direccionen a estas empresas hacia una calidad sostenida del negocio. Se concluye que ante la dinámica de estos escenarios, la gestión de la calidad sigue siendo la mejor estrategia para satisfacer las necesidades de los clientes y stakeholders, sustentado en la aplicación de herramientas como el CMM para identificar los errores que deben resolverse a priori y luego implementar una planificación estratégica direccionada por la filosofía de mejora continua descrita en esta norma, para así ofrecer un vidrio templado con el espesor, las perforaciones y los tipos de herraje de acuerdo al uso que requieran los clientes, lo que les permitirá mejorar su posición competitiva en este mercado
Análisis estratégico de los procesos madurados y la adopción de la Norma ISO 9004: una propuesta teórica para el sector vidrio templado
No full textThe objective of this study was to propose theoretical reflections on the strategic analysis of the maturity of the processes and the implementation of the ISO 9004:2018 standard, as tools to offer the best quality of products and services that meet the demands of the market. tempered glass, responding to the complex scenarios present in Venezuela through standardization and quality management of its processes. The methodological orientation is located in a descriptive bibliographic study, where different literatures are consulted to develop theoretical guidelines on the use of the Capability Maturity Model (CMM) as a tool in the strategic analysis of internal conditions, and the guidelines of the ISO 9004:2018 standard that directs these companies towards sustained business quality. It is concluded that given the dynamics of these scenarios, quality management continues to be the best strategy to satisfy the needs of customers and stakeholders, supported by the application of tools such as the CMM to identify errors that must be resolved a priori and then implement strategic planning directed by the philosophy of continuous improvement described in this standard, in order to offer tempered glass with the thickness, perforations and types of hardware according to the use required by customers, which will allow them to improve their competitive position in this market.El presente estudio tuvo como objetivo proponer unas reflexiones teóricas sobre el análisis estratégico de la madurez de los procesos y la implementación de la norma ISO 9004:2018, como herramientas para ofrecer la mejor calidad de productos y servicios que cumplan con las demandas del mercado de vidrio templado, dando respuesta a los complejos escenarios presentes en Venezuela a través de la estandarización y la gestión de la calidad de sus procesos. La orientación metodológica se ubica en un estudio bibliográfico de tipo descriptivo, donde se consultan distintas literaturas para desarrollar lineamientos teóricos sobre el uso del Modelo de Madurez de Capacidades (CMM) como herramienta en el análisis estratégico de las condiciones internas, y los lineamientos de la Norma ISO 9004:2018 que direccionen a estas empresas hacia una calidad sostenida del negocio. Se concluye que ante la dinámica de estos escenarios, la gestión de la calidad sigue siendo la mejor estrategia para satisfacer las necesidades de los clientes y stakeholders, sustentado en la aplicación de herramientas como el CMM para identificar los errores que deben resolverse a priori y luego implementar una planificación estratégica direccionada por la filosofía de mejora continua descrita en esta norma, para así ofrecer un vidrio templado con el espesor, las perforaciones y los tipos de herraje de acuerdo al uso que requieran los clientes, lo que les permitirá mejorar su posición competitiva en este mercado
Influence of environmental stress on virulence gene expression in Vibrio anguillarum
No full textThe aim of the research presented in this thesis was the study of the environmental stress influence on the expression of virulence genes in the fish pathogen Vibrio anguillarum. Analyses were carried out by means of Real Time PCR methodology. The study includes three different chapters; the first one is related to a general screening of virulence gene expression induced by changes in temperatures salinity and iron depletion. Results showed that the most evident response was related to angR and fatA (plasmidic genes) under iron starvation condition. The chapter 2 concerns the empA protease expression, production and induction by the same stress analyzed in the first chapter, Results showed the influence of salinity on the production of metallo-protease in vibrio anguillarum.
Finally the third chapter is related to new methodology to quantify vibrio anguillarum cells directly in infected fish tissues. Results showed that a direct quantification can be obtained using toxR as a target gene, while 16SrDNA could be a good target to increase the sensitivity of detection
Interrupted and unfinished : the open-ended Dante of the "Commedia"
No full textThis essay interprets Dante's "Commedia" as an 'open work' (Eco). It grounds its open-endedness in its representations of interruption: from fictional obstacles in the protagonist's path in the "Inferno" to the narrator's anxiety over unfinishedness in the "Paradiso". Taking its cue from Boccaccio's creative rewriting of Dante's life, the essay resists the pressure of 'total coherence' embedded in (and often projected onto) the "Commedia", in order to reclaim the material vulnerability of the text and of its author
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