1,721,091 research outputs found
Mechanistic understanding in clinical practice : complementing evidence-based medicine with personalized medicine
No full textIn the last century, medicine has undergone an unprecedented wave of radical changes. From the implementation of surgery up to the development of single gene-targeted therapies, clinical decision making has become increasingly complex to handle. Today, this complexity needs to be rethought in the light of two emerging paradigms: evidence-based medicine (EBM) and personalized medicine (P-Med). The new availability of diverse sources of scientific evidence raises significant issues concerning how clinicians will compare, evaluate and orient their decisions in front of a rapidly growing plethora of therapies, procedures, medical technologies and drugs. In this paper, we compare the background visions behind these two paradigms, evaluating their respective relevance for present and future clinical decision making. In particular, we argue that EBM and P-Med are driven by two diverse modes of reasoning about ‘evidence making’ in medicine. EBM is grounded on statistical notions and epidemiological data, generally gathered through systematic meta-reviews of randomized controlled trials; P-Med, instead, is grounded on mechanistic explanations of molecular interactions, metabolic pathways and biomarkers. While both paradigms are epistemically sound, we argue that they cannot, and should not, be hybridized into a unique model. Rather, they ought to represent two compatible, but alternative ways of informing the clinical practice. Hence, we conclude that clinicians may expect to see their responsibility increasing as they will deal with diverse, but equally compelling, ways of reasoning and deciding about which intervention will qualify as the ‘best one’ in each individual case
Diagnostic algorithm and architecture for high pressure waterjet pumps
No full textStarting from the correlation between electric input, mechanical and fluid-dynamic signals a set of index able to define a suitable “footprint” of a Waterjet system in normal working conditions has been defined.
A on-line and non-intrusive monitoring and diagnostic system for this kind of device has been designed implementing an algorithm
defined on the basis of the proposed “footprints”
Fatigue resistance of Aluminium hybrid lap-joints obtained by means of adhesives and ultrasonic welding
No full textThe ethics of non-inferiority trials : a consequentialist analysis
Full text linkDiscussions about the merits and shortcomings of non-inferiority trials are becoming increasingly common in the medical community and among regulatory agencies. However, criticisms targeting the ethical standing of non-inferiority trials have often been mistargeted. In this article we review the ethical standing of trials of non-inferiority. In the first part of the article, we outline a consequentialist position according to which clinical trials are best conceived as epistemic tools aimed at fostering the proper ends of medicine. According to this view, clinical trials are means to ends, and thus their moral status depends both on how well they perform as means to reach desired ends and on which ends they are meant to achieve. Building upon this normative framework in the next two sections we analyze the specific ethical issues raised by non-inferiority trials. By making it clear that clinical trials are just epistemic tools – i.e. means to certain ends – it is possible not only to clarify the conceptual debate over a fundamental issue in clinical research, but also to identify which ethically relevant considerations ought to be addressed in setting up a non-inferiority trial
Measurements, analysis, and interpretation of the signals from a high-pressure waterjet pump
No full textThe waterjet (WJ) technology, whose characterization involves phenomena belonging to different fields of physics,
presents some particular aspects that make it essential in some manufacturing operations where it is important to cut special or hard-to-machine materials by means of a cold process. In this paper, the relationships between the electric input signals and the mechanical and fluid-dynamic signals have been analyzed with the aim to evaluate the possibility to design an online and nonintrusive monitoring and diagnostic system based only on electric signal
processing. As the second main purpose of this paper, the same methodology, which can also be applied to the characterization
and comparison of the WJ plants’ components, has been tested on the characterization and the following comparison of water orifices (the orifice is one of the most important components for the WJ technology due to the energy transformation which takes place inside) to validate the proposed approach
Constructing the Medical Humanities Gaze
No full textIn the last few decades genomics has completely reshaped the way in which patients and physicians experience and make sense of illness. In this paper we build upon a real case - namely that of breast cancer genetic testing - in order to point to the shortcomings of the paradigm currently driving healthcare delivery. In particular, we put forward a viable analytical model for the construction of a proper decisional process broadening the scope of medical gaze onto human experience of illness. This model revolves around four main conceptual axes: (i) communicating information; (ii) informing decisions; (iii) respecting narratives; (iv) empowering decision-making. These four kernels, we argue, map precisely onto the main pitfalls of the model presently dealing with genetic testing provision. Medical Humanities, we conclude, ought to play a pivotal role in constructing the environment for competent decision-making, autonomous self-determination and respectful narritivization of one's own life
T. Pievani, M. Annoni, Chi fermerà la Regina Rossa? Nicchie evolutive, campagne vaccinali e la strategia cooperativa per battere il Covid-19
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