Improving the Scalability of Reduct Determination in Rough Sets

Rough Set Data Analysis (RSDA) is a non-invasive data analysis approach that solely relies on the data to find patterns and decision rules. Despite its noninvasive approach and ability to generate human readable rules, classical RSDA has not been successfully used in commercial data mining and rule generating engines. The reason is its scalability. Classical RSDA slows down a great deal with the larger data sets and takes much longer times to generate the rules. This research is aimed to address the issue of scalability in rough sets by improving the performance of the attribute reduction step of the classical RSDA - which is the root cause of its slow performance. We propose to move the entire attribute reduction process into the database. We defined a new schema to store the initial data set. We then defined SOL queries on this new schema to find the attribute reducts correctly and faster than the traditional RSDA approach. We tested our technique on two typical data sets and compared our results with the traditional RSDA approach for attribute reduction. In the end we also highlighted some of the issues with our proposed approach which could lead to future research.

Criblage génétique et caractérisation fonctionnelle des mutations dans les différentes sous-unités du récepteur GABAA associées à l'épilepsie génétique généralisée

Les épilepsies génétiques généralisées (ÉGGs) sont un groupe de syndromes épileptiques hétérogènes qui se manifestent habituellement durant les périodes de l’enfance et de l’adolescence. Les ÉGGs représentent 30% de toutes les épilepsies. Il n’existe présentement aucun remède à l’épilepsie génétique généralisée. Au sein de ce groupe d’épilepsies, les sujets sont le plus souvent dépourvus de lésions cérébrales, ce qui signifie que les facteurs génétiques jouent un rôle important dans l’étiologie de la maladie. Au cours des dernières années, plusieurs gènes impliqués dans des formes familiales d’ÉGG ont été identifiés. La majorité d'entre elles codent pour des canaux ioniques incluant le récepteur-ligand GABAA (RGABAA). De ce groupe, des mutations ont été identifiées dans quatre sous-unités du récepteur GABAA. Dans un premier temps, l’objectif général de cette thèse vise l’évaluation de la composante génétique de notre cohorte d’ÉGG expliquée par les gènes codant pour les sous-unités du récepteur GABAA. Puis, dans un second souffle, le rôle des variants identifiés est défini et analysé afin de mieux cerner leurs impacts dans la pathogénèse de ce phénotype. La première partie du projet consiste en une analyse exhaustive des mutations existantes dans la partie codante des 19 gènes GABRA pour des patients atteints d’ÉGG. En criblant des familles québécoises avec ÉGG, nous avons identifié 22 variants rares incluant 19 faux-sens et 3 non-sens dans 14 sous-unités du RGABAA. En séquençant ces gènes dans une grande cohorte de cas et de contrôles, nous avons établi le profil des variations rares pour ceux-ci. Ces données suggèrent qu’une proportion significative (8%) des patients atteints d’ÉGG ont des variants rares sur les gènes du RGABAA. La deuxième partie porte directement sur certains gènes identifiés lors de la première partie. De ce groupe, cinq nouvelles mutations ont été découvertes dans des gènes déjà associés à l’épilepsie (GABRA1 et GABRG2). Nous avons constaté l’impact de ces mutations dans les mécanismes génétiques de l’épilepsie, en mesurant les effets des variants sur la structure et la fonction du récepteur GABAA. La troisième partie se concentre sur notre hypothèse, voulant que les RGABAA mutants altèrent l’effet du GABA durant le développement du système nerveux central (SNC). L’objectif principal vise à déterminer la contribution relative de chacune des sous-unités mutées dans le développement du SNC. Ainsi, nous avons démontré qu’une telle perte de fonction a un impact significatif sur le développement des synapses GABAergiques et glutamatergiques ainsi que sur la plasticité des circuits corticaux. Nos résultats nous ont permis de préciser comment les mutations dans les gènes GABRA peuvent mener à l’ÉGG. Éventuellement, la caractérisation moléculaire de ces mutations contribuera à l’élaboration de nouveaux outils diagnostiques et facilitera la mise au point de traitements mieux ciblés pour les gens atteints de cette condition neurologique chronique.

Automatic diagnosis of voltage disturbances in power distribution networks

This thesis proposes a framework for identifying the root-cause of a voltage disturbance, as well as, its source location (upstream/downstream) from the monitoring place. The framework works with three-phase voltage and current waveforms collected in radial distribution networks without distributed generation. Real-world and synthetic waveforms are used to test it. The framework involves features that are conceived based on electrical principles, and assuming some hypothesis on the analyzed phenomena. Features considered are based on waveforms and timestamp information. Multivariate analysis of variance and rule induction algorithms are applied to assess the amount of meaningful information explained by each feature, according to the root-cause of the disturbance and its source location. The obtained classification rates show that the proposed framework could be used for automatic diagnosis of voltage disturbances collected in radial distribution networks. Furthermore, the diagnostic results can be subsequently used for supporting power network operation, maintenance and planning.

Metodologia de análise e diagnóstico de fratura em um componente automotivo sujeito a cargas cíclicas alternadas

The competitiveness of the trade generated by the higher availability of products with lower quality and cost promoted a new reality of industrial production with small clearances. Track deviations at the production are not discarded, uncertainties can statistically occur. The world consumer and the Brazilian one are supported by the consumer protection code, in lawsuits against the products poor quality. An automobile is composed of various systems and thousands of constituent parts, increasing the likelihood of failure. The dynamic and security systems are critical in relation to the consequences of possible failures. The investigation of the failure gives us the possibility of learning and contributing to various improvements. Our main purpose in this work is to develop a systematic, specific methodology by investigating the root cause of the flaw occurred on an axle end of the front suspension of an automobile, and to perform comparative data analyses between the fractured part and the project information. Our research was based on a flaw generated in an automotive suspension system involved in a mechanical judicial cause, resulting in property and personal damages. In the investigations concerning the analysis of mechanical flaws, knowledge on materials engineering plays a crucial role in the process, since it enables applying techniques for characterizing materials, relating the technical attributes required from a respective part with its structure of manufacturing material, thus providing a greater scientific contribution to the work. The specific methodology developed follows its own flowchart. In the early phase, the data in the records and information on the involved ones were collected. The following laboratory analyses were performed: macrography of the fracture, micrography with SEM (Scanning Electron Microscope) of the initial and final fracture, phase analysis with optical microscopy, Brinell hardness and Vickers microhardness analyses, quantitative and qualitative chemical analysis, by using X-ray fluorescence and optical spectroscopy for carbon analysis, qualitative study on the state of tension was done. Field data were also collected. In the analyses data of the values resulting from the fractured stock parts and the design values were compared. After the investigation, one concluded that: the developed methodology systematized the investigation and enabled crossing data, thus minimizing diagnostic error probability, the morphology of the fracture indicates failure by the fatigue mechanism in a geometrically propitious location, a tension hub, the part was subjected to low tensions by the sectional area of the final fracture, the manufacturing material of the fractured part has low ductility, the component fractured in an earlier moment than the one recommended by the manufacturer, the percentages of C, Si, Mn and Cr of the fractured part present values which differ from the design ones, the hardness value of the superior limit of the fractured part is higher than that of the design, and there is no manufacturing uniformity between stock and fractured part. The work will contribute to optimizing the guidance of the actions in a mechanical engineering judicial expertise

Cariostatic effect of fluoride-containing restorative systems associated with dentifrices on root dentin

Objective. The aim of this in vitro study was to evaluate the interaction between two sources of fluoride (restorative systems and dentifrices) in inhibiting artificial root caries development. Methods. One hundred and eighty tooth segments were embedded in polyester resin, and sanded flat. Cylindrical cavities 1.0 mm-deep and 1.5 mm-diameter were prepared in root dentin and randomly restored by fluoride-containing restorative systems: Ketac-fil/Espe (Ke), Fuji II LC/GC Corp (Fj), F2000/3M (F2), Surefil/Dentsply (Su) or a control: Filtek Z250/3M (Z2). Ten experimental groups were made to test the association among the five restorative systems and two dentifrices: with F - (Sensodyne Baking Soda) or without F- (Sensodyne Original) (n = 18). After surface polishing, a 1 mm-wide margin around the restorations was demarcated and initial dentin surface Knoop microhardness values (KHNi) were obtained. The specimens were submitted to a pH-cycling model, and to applications of slurries of dentifrice. Afterwards the final dentin surface Knoop microhardness values (KHNf) were measured. Results. The differences between KHNi and KHNf, and the covariate KHNi were considered by the ANCOVA and Tukey's test (α = 0.05). The interaction between restorative system and dentifrice was statistically significant (p = 0.0026). All restorative systems provided some protection against artificial caries challenge when associated with the fluoride-containing dentifrice treatment. The means (standard deviation) of reductions in Knoop hardness values for systems associated with the fluoride-containing dentifrice were: Ke: 40.0(1.02)a, Fj: 41.9(1.02)b, F2: 43.3(1.04)c, Su: 43.5(1.00)c, Z2: 44.0(1.02)c; and with the non-fluoride-containing dentifrice were: Ke: 42.9(1.02)a, Fj: 44.7(1.01)b, F2: 45.2(1.09)bc, Su: 46.0(0.99)c, Z2: 46.6(0.99)c (statistical differences were expressed by different letters). Conclusion. The cariostatic effect shown by the fluoride-containing dentifrice could enhance that shown by Ketac-fil and Fuji II LC, and could mask that shown by F2000. © 2002 Elsevier Science Ltd. All rights reserved.

Avaliação dos riscos assistenciais relacionados ao uso de equipamentos hospitalares na unidade de terapia intensiva de adultos de um hospital público da cidade de São Paulo, Brasil

Pós-graduação em Bases Gerais da Cirurgia - FMB

A Randomized comparative clinical study of two surgical procedures to improve root coverage with the acellular dermal matrix graft

Aim This randomized, controlled, clinical study compared two surgical techniques for root coverage with the acellular dermal matrix graft (ADMG) to evaluate which procedure could provide better root coverage and greater amounts of keratinized tissue. Materials and Methods Fifteen pairs of bilateral Miller Class I or II gingival recessions were treated and assigned randomly to the test group, and the contra-lateral recessions were assigned to the control group. The ADMG was used in both groups. In the control group, the graft and flap were positioned at the level of the cemento-enamel junction (CEJ), and in the test group, the graft was positioned 1 mm apical to the CEJ and the flap 1 mm coronal to the CEJ. The clinical parameters were taken before the surgeries and after 6 months. The gingival recession area, a new parameter, was measured in standardized photographs through a special device and software. Results There were statistically significant differences favouring the proposed technique for all parameters except for the amount of keratinized tissue at 6 months. Conclusions The proposed test technique is more suitable for root coverage procedures with ADMG, and the new parameter evaluated appears valuable for root coverage analysis. (Clinicaltrials.gov Identifier: NCT01175720).

Fine Mapping of qroot-yield-1.06, a QTL for Root, Plant Vigor and Yield in Maize

Root-yield-1.06 is a major QTL affecting root system architecture (RSA) and other agronomic traits in maize. The effect of this QTL has been evaluated with the development of near isogenic lines (NILs) differing at the QTL position. The objective of this study was to fine map qroot-yield-1.06 by marker-assisted searching for chromosome recombinants in the QTL interval and concurrent root phenotyping in both controlled and field conditions, through successive generations. Complementary approaches such as QTL meta-analysis and RNA-seq were deployed in order to help prioritizing candidate genes within the QTL target region. Using a selected group of genotypes, field based root analysis by ‘shovelomics’ enabled to accurately collect RSA information of adult maize plants. Shovelomics combined with software-assisted root imaging analysis proved to be an informative and relatively highly automated phenotyping protocol. A QTL interval mapping was conducted using a segregating population at the seedling stage grown in controlled environment. Results enabled to narrow down the QTL interval and to identify new polymorphic markers for MAS in field experiments. A collection of homozygous recombinant NILs was developed by screening segregating populations with markers flanking qroot-yield-1.06. A first set of lines from this collection was phenotyped based on the adapted shovelomics protocol. QTL analysis based on these data highlighted an interval of 1.3 Mb as completely linked with the target QTL but, a larger safer interval of 4.1 Mb was selected for further investigations. QTL meta-analysis allows to synthetize information on root QTLs and two mQTLs were identified in the qroot-yield-1.06 interval. Trascriptomics analysis based on RNA-seq data of the two contrasting QTL-NILs, confirmed alternative haplotypes at chromosome bin 1.06. qroot-yield-1.06 has now been delimited to a 4.1-Mb interval, and thanks to the availability of additional untested homozygous recombinant NILs, the potentially achievable mapping resolution at qroot-yield-1.06 is c. 50 kb.

Coupled human and natural system dynamics as key to the sustainability of Lake Victoria's ecosystem services

East Africa’s Lake Victoria provides resources and services to millions of people on the lake’s shores and abroad. In particular, the lake’s fisheries are an important source of protein, employment, and international economic connections for the whole region. Nonetheless, stock dynamics are poorly understood and currently unpredictable. Furthermore, fishery dynamics are intricately connected to other supporting services of the lake as well as to lakeshore societies and economies. Much research has been carried out piecemeal on different aspects of Lake Victoria’s system; e.g., societies, biodiversity, fisheries, and eutrophication. However, to disentangle drivers and dynamics of change in this complex system, we need to put these pieces together and analyze the system as a whole. We did so by first building a qualitative model of the lake’s social-ecological system. We then investigated the model system through a qualitative loop analysis, and finally examined effects of changes on the system state and structure. The model and its contextual analysis allowed us to investigate system-wide chain reactions resulting from disturbances. Importantly, we built a tool that can be used to analyze the cascading effects of management options and establish the requirements for their success. We found that high connectedness of the system at the exploitation level, through fisheries having multiple target stocks, can increase the stocks’ vulnerability to exploitation but reduce society’s vulnerability to variability in individual stocks. We describe how there are multiple pathways to any change in the system, which makes it difficult to identify the root cause of changes but also broadens the management toolkit. Also, we illustrate how nutrient enrichment is not a self-regulating process, and that explicit management is necessary to halt or reverse eutrophication. This model is simple and usable to assess system-wide effects of management policies, and can serve as a paving stone for future quantitative analyses of system dynamics at local scales.

Better than nothing? : dowry in the absence of the legal protection of women's inheritance rights

The practice of dowry is often thought to be the root cause of the unequal treatment of women in India. For women without inheritance rights, however, dowry may function as their only source of protection. Using a nationwide dataset and exploiting a natural experimental situation, this study explores the effects of dowry on women's empowerment in India, a society where women do not have inheritance rights. In such a society, dowry seems to enhance women's status in the marital household. The effects reverse when women have equal inheritance rights as their brothers. Empirical analysis suggests that the outright ban on dowry that ignores the context may not necessarily benefit women.

Posttranscriptional Regulation of Embryonic Neurogenesis by the Exon Junction Complex

The six-layered neuron structure in the cerebral cortex is the foundation for human mental abilities. In the developing cerebral cortex, neural stem cells undergo proliferation and differentiate into intermediate progenitors and neurons, a process known as embryonic neurogenesis. Disrupted embryonic neurogenesis is the root cause of a wide range of neurodevelopmental disorders, including microcephaly and intellectual disabilities. Multiple layers of regulatory networks have been identified and extensively studied over the past decades to understand this complex but extremely crucial process of brain development. In recent years, post-transcriptional RNA regulation through RNA binding proteins has emerged as a critical regulatory nexus in embryonic neurogenesis. The exon junction complex (EJC) is a highly conserved RNA binding complex composed of four core proteins, Magoh, Rbm8a, Eif4a3, and Casc3. The EJC plays a major role in regulating RNA splicing, nuclear export, subcellular localization, translation, and nonsense mediated RNA decay. Human genetic studies have associated individual EJC components with various developmental disorders. We showed previously that haploinsufficiency of Magoh causes microcephaly and disrupted neural stem cell differentiation in mouse. However, it is unclear if other EJC core components are also required for embryonic neurogenesis. More importantly, the molecular mechanism through which the EJC regulates embryonic neurogenesis remains largely unknown. Here, we demonstrated with genetically modified mouse models that both Rbm8a and Eif4a3 are required for proper embryonic neurogenesis and the formation of a normal brain. Using transcriptome and proteomic analysis, we showed that the EJC posttranscriptionally regulates genes involved in the p53 pathway, splicing and translation regulation, as well as ribosomal biogenesis. This is the first in vivo evidence suggesting that the etiology of EJC associated neurodevelopmental diseases can be ribosomopathies. We also showed that, different from other EJC core components, depletion of Casc3 only led to mild neurogenesis defects in the mouse model. However, our data suggested that Casc3 is required for embryo viability, development progression, and is potentially a regulator of cardiac development. Together, data presented in this thesis suggests that the EJC is crucial for embryonic neurogenesis and that the EJC and its peripheral factors may regulate development in a tissue-specific manner.

RELATIONSHIP BETWEEN PHYSICAL AND CHEMICAL PROPERTIES OF STRAIGHT AND RECOVERED ASPHALT BINDERS FROM ONTARIO

Thermal and fatigue cracking are the major pavement distresses that contribute to a drastic reduction of the pavement’s service life and performance in Ontario. Chemical oxidation and hardening of asphalt binders deteriorates its physical properties since physical properties of asphalts depend on its chemical composition. This thesis is aimed to establish a relationship between physical and chemical properties of asphalt binders. A secondary objective is to show the strong correlation between CTOD and temperature. All recovered and straight Ministry of Transportation of Ontario (MTO) samples were investigated using conventional Superpave® test method dynamic shear rheometer (DSR) as well as improved MTO test methods such as extended bending beam rheometer (eBBR) and double-edge-notched tension (DENT) test. DENT test was conducted for all Ontario contract samples at three different temperatures based on their performance grade after three hours of thermal conditioning and compared the results in terms of essential work of fracture, plastic work of fracture and CTOD at different temperatures. Good correlation exists between CTOD and temperature according to the DENT data. X-ray fluorescence (XRF) analysis was conducted to detect the presence of heavy metals such as zinc and molybdenum believed to have originated from waste engine oil. Fourier transform infra-red spectroscopy (FTIR) was performed to determine the abundance of functional groups such as carbonyl, sulfoxides, polyisobutylene, etc. XRF and FTIR analysis confirmed that most of the samples contain waste engine oil and/or oxidized residues, which is believed to be a root cause of premature pavement failures.

Physical and Chemical Performance Testing of Ontario Asphalt Pavements

Thermal and fatigue cracking are the two of the major pavement distress phenomena that contribute significantly towards increased premature pavement failures in Ontario. This in turn puts a massive burden on the provincial budgets as the government spends huge sums of money on the repair and rehabilitation of roads every year. Governments therefore need to rethink and re-evaluate their current measures in order to prevent it in future. The main objectives of this study include: the investigation of fatigue distress of 11 contract samples at 10oC, 15oC, 20oC and 25oC and the use of crack-tip-opening-displacement (CTOD) requirements at temperatures other than 15oC; investigation of thermal and fatigue distress of the comparative analysis of 8 Ministry of Transportation (MTO) recovered and straight asphalt samples through double-edge-notched-tension test (DENT) and extended bending beam rheometry (EBBR); chemical testing of all samples though X-ray Fluorescence (XRF) and Fourier transform infrared analysis (FTIR); Dynamic Shear Rheometer (DSR) higher and intermediate temperature grading; and the case study of a local Kingston road. Majority of 11 contract samples showed satisfactory performance at all temperatures except one sample. Study of CTOD at various temperatures found a strong correlation between the two variables. All recovered samples showed poor performance in terms of their ability to resist thermal and fatigue distress relative to their corresponding straight asphalt as evident in DENT test and EBBR results. XRF and FTIR testing of all samples showed the addition of waste engine oil (WEO) to be the root cause of pavement failures. DSR high temperature grading showed superior performance of recovered binders relative to straight asphalt. The local Kingston road showed extensive signs of damage due to thermal and fatigue distress as evident from DENT test, EBBR results and pictures taken in the field. In the light of these facts, the use of waste engine oil and recycled asphalt in pavements should be avoided as these have been shown to cause premature failure in pavements. The DENT test existing CTOD requirements should be implemented at other temperatures in order to prevent the occurrences of premature pavement failures in future.

Capital 2.0 capital formation and legal risk in a new global economic order from fiat to exit: including case studies of the proposed transatlantic trade and investment partnership between the United States and the European Union and the financing relation between the United States and the People’s Republic of China

Following the intrinsically linked balance sheets in his Capital Formation Life Cycle, Lukas M. Stahl explains with his Triple A Model of Accounting, Allocation and Accountability the stages of the Capital Formation process from FIAT to EXIT. Based on the theoretical foundations of legal risk laid by the International Bar Association with the help of Roger McCormick and legal scholars such as Joanna Benjamin, Matthew Whalley and Tobias Mahler, and founded on the basis of Wesley Hohfeld’s category theory of jural relations, Stahl develops his mutually exclusive Four Determinants of Legal Risk of Law, Lack of Right, Liability and Limitation. Those Four Determinants of Legal Risk allow us to apply, assess, and precisely describe the respective legal risk at all stages of the Capital Formation Life Cycle as demonstrated in case studies of nine industry verticals of the proposed and currently negotiated Transatlantic Trade and Investment Partnership between the United States of America and the European Union, TTIP, as well as in the case of the often cited financing relation between the United States and the People’s Republic of China. Having established the Four Determinants of Legal Risk and its application to the Capital Formation Life Cycle, Stahl then explores the theoretical foundations of capital formation, their historical basis in classical and neo-classical economics and its forefathers such as The Austrians around Eugen von Boehm-Bawerk, Ludwig von Mises and Friedrich von Hayek and most notably and controversial, Karl Marx, and their impact on today’s exponential expansion of capital formation. Starting off with the first pillar of his Triple A Model, Accounting, Stahl then moves on to explain the Three Factors of Capital Formation, Man, Machines and Money and shows how “value-added” is created with respect to the non-monetary capital factors of human resources and industrial production. Followed by a detailed analysis discussing the roles of the Three Actors of Monetary Capital Formation, Central Banks, Commercial Banks and Citizens Stahl readily dismisses a number of myths regarding the creation of money providing in-depth insight into the workings of monetary policy makers, their institutions and ultimate beneficiaries, the corporate and consumer citizens. In his second pillar, Allocation, Stahl continues his analysis of the balance sheets of the Capital Formation Life Cycle by discussing the role of The Five Key Accounts of Monetary Capital Formation, the Sovereign, Financial, Corporate, Private and International account of Monetary Capital Formation and the associated legal risks in the allocation of capital pursuant to his Four Determinants of Legal Risk. In his third pillar, Accountability, Stahl discusses the ever recurring Crisis-Reaction-Acceleration-Sequence-History, in short: CRASH, since the beginning of the millennium starting with the dot-com crash at the turn of the millennium, followed seven years later by the financial crisis of 2008 and the dislocations in the global economy we are facing another seven years later today in 2015 with several sordid debt restructurings under way and hundred thousands of refugees on the way caused by war and increasing inequality. Together with the regulatory reactions they have caused in the form of so-called landmark legislation such as the Sarbanes-Oxley Act of 2002, the Dodd-Frank Act of 2010, the JOBS Act of 2012 or the introduction of the Basel Accords, Basel II in 2004 and III in 2010, the European Financial Stability Facility of 2010, the European Stability Mechanism of 2012 and the European Banking Union of 2013, Stahl analyses the acceleration in size and scope of crises that appears to find often seemingly helpless bureaucratic responses, the inherent legal risks and the complete lack of accountability on part of those responsible. Stahl argues that the order of the day requires to address the root cause of the problems in the form of two fundamental design defects of our Global Economic Order, namely our monetary and judicial order. Inspired by a 1933 plan of nine University of Chicago economists abolishing the fractional reserve system, he proposes the introduction of Sovereign Money as a prerequisite to void misallocations by way of judicial order in the course of domestic and transnational insolvency proceedings including the restructuring of sovereign debt throughout the entire monetary system back to its origin without causing domino effects of banking collapses and failed financial institutions. In recognizing Austrian-American economist Schumpeter’s Concept of Creative Destruction, as a process of industrial mutation that incessantly revolutionizes the economic structure from within, incessantly destroying the old one, incessantly creating a new one, Stahl responds to Schumpeter’s economic chemotherapy with his Concept of Equitable Default mimicking an immunotherapy that strengthens the corpus economicus own immune system by providing for the judicial authority to terminate precisely those misallocations that have proven malignant causing default perusing the century old common law concept of equity that allows for the equitable reformation, rescission or restitution of contract by way of judicial order. Following a review of the proposed mechanisms of transnational dispute resolution and current court systems with transnational jurisdiction, Stahl advocates as a first step in order to complete the Capital Formation Life Cycle from FIAT, the creation of money by way of credit, to EXIT, the termination of money by way of judicial order, the institution of a Transatlantic Trade and Investment Court constituted by a panel of judges from the U.S. Court of International Trade and the European Court of Justice by following the model of the EFTA Court of the European Free Trade Association. Since the first time his proposal has been made public in June of 2014 after being discussed in academic circles since 2011, his or similar proposals have found numerous public supporters. Most notably, the former Vice President of the European Parliament, David Martin, has tabled an amendment in June 2015 in the course of the negotiations on TTIP calling for an independent judicial body and the Member of the European Commission, Cecilia Malmström, has presented her proposal of an International Investment Court on September 16, 2015. Stahl concludes, that for the first time in the history of our generation it appears that there is a real opportunity for reform of our Global Economic Order by curing the two fundamental design defects of our monetary order and judicial order with the abolition of the fractional reserve system and the introduction of Sovereign Money and the institution of a democratically elected Transatlantic Trade and Investment Court that commensurate with its jurisdiction extending to cases concerning the Transatlantic Trade and Investment Partnership may complete the Capital Formation Life Cycle resolving cases of default with the transnational judicial authority for terminal resolution of misallocations in a New Global Economic Order without the ensuing dangers of systemic collapse from FIAT to EXIT.

Le pressioni sui servizi sanitari (demografiche, epidemiologiche, sociali, pandemia COVID-19) e la risposta del sistema ospedaliero. Il caso studio del Policlinico S. Orsola di Bologna

I sistemi sanitari sono messi sotto stress da fattori diversi che possono essere sintetizzati schematizzando il problema in pressioni sistemiche e pressioni pandemiche leggendole secondo due vettori paralleli: fattori modificabili e fattori non modificabili. I fattori non modificabili sono legati alla condizione socio-demografica di una popolazione (reddito pro-capite, livello di istruzione) e alle caratteristiche individuali dei pazienti che accedono ai servizi (condizioni di moltimorbidità, fragilità, età, sesso) mentre i fattori modificabili sono legati al modello organizzativo del servizio regionale e Aziendale. I fattori modificabili sono quelli che leggendo i fattori non modificabili possono adattarsi al contesto specifico e con gradi di flessibilità variabile rispondere alle domande emergenti. Il tradizionale approccio ospedaliero, ancora in gran parte basato su modelli organizzativi funzionalmente e strutturalmente chiusi, costruiti attorno alle singole discipline, non si è rivelato in grado di rispondere adeguatamente da solo a questi bisogni di salute complessi che necessitano di una presa in carico multidisciplinare e coordinata tra diversi setting assistenziali. La pandemia che ha portato in Italia ad avere più di 8 milioni di contagiati ha esacerbato problemi storici dei sistemi sanitari. Le Regioni e le Aziende hanno fronteggiato un doppio binario di attività vedendo ridursi l’erogazione di servizi per i pazienti non Covid per far fronte all’incremento di ricoveri di pazienti Covid. Il Policlinico S. Orsola ha in questa congiuntura storica sviluppato un progetto di miglioramento del percorso del paziente urgente coinvolgendo i professionisti e dando loro strumenti operativi di analisi del problema e metodi per identificare risposte efficaci. Riprendendo infine la distinzione tra pressioni modificabili e non modificabili il lavoro mostra che dall’analisi delle cause profonde dei nodi critici del percorso del paziente si possono identificare soluzioni che impattino sugli aspetti organizzativi (modificabili) personalizzando l’approccio per il singolo paziente (non modificabile) in un’ottica patient centred.