Stewardship antibiotica neonatale: valutazione dell'esposizione antimicrobica nelle sospette early onset sepsis (EOS)

Background: Le early-onset sepsis (EOS) sono infezioni batteriche invasive definite dalla presenza di batteri nel sangue e/o nel liquor cefalorachidiano che esordiscono nelle prime 72 ore di vita e causano in epoca neonatale mortalità e morbilità importanti. Scopo: Determinare l’eccesso di trattamento antibiotico (Overtreatment index=OI) nei neonati di EG ≥34 settimane con sospetta sepsi ad esordio precoce. Metodi: Tutti i nati dal 1.01.2014 al 31.12.2018 di EG ≥34 settimane presso IRCCS Azienda Ospedaliero-Universitaria e l’Ospedale Maggiore di Bologna che hanno ricevuto terapia antibiotica endovenosa nelle prime 168 ore di vita nel sospetto di EOS. Sono stati identificati 2 gruppi: EOS provata (N=7) ed EOS sospetta (N=465). Risultati: L’incidenza di EOS è stata 0.22 su 1000 nati vivi, rispettivamente 0.12/1000 per Streptococcus agalactiae (GBS) e 0.06/1000 per Escherichia coli (E.coli). L’1.75% dei neonati ha ricevuto terapia antimicrobica empirica a largo spettro. L’OI è risultato 68. L’esposizione al trattamento antibiotico nella popolazione è stata di 85 giorni/1000 nati vivi. Tra i fattori di rischio materni, il tampone vagino-rettale (TVR) e l’urinocoltura positiva sono risultati associati al rischio di EOS provata (p=.017, p =.000). I valori di proteina C reattiva (PCR) al T0, T1 e T2 tra i due gruppi sono risultati significativi (p=.000). All’analisi multivariata è stata confermata la significatività delle variabili descritte. (TVR non noto OR=15.1, 95%CI 1.98-115.50, p =.009, urinocoltura positiva OR=30.1, 95%CI 3.6-252.1, p = .002, PCR T0 OR=1.6, 95% CI 1.29-2.07, p = .000.) Conclusioni: L’individuazione precoce di fattori di rischio e la valutazione degli indici di flogosi in neonati sintomatici può ridurre l’OI e la durata della terapia antibiotica in casi di sepsi non confermata. L’uso appropriato degli antibiotici in questa popolazione è particolarmente importante poichè riduce lo sviluppo di germi multiresistenti. Nelle Terapie Intensive Neonatali, i programmi di stewardship antimicrobica dovrebbero guidare la gestione delle sepsi.

Acculturation processes and intergroup relations of adolescents in multicultural societies: the role of family, peer, and school contexts

Acculturation processes and intergroup relations lie at the heart of developing more inclusive social attitudes. Notably, these endeavors are embedded in primary socialization contexts of adolescents, as indicated by developmental and socio-psychological theoretical models reviewed in Chapter 1. Hence, this dissertation investigated how adolescents' acculturation processes and intergroup contact are embedded in family, peer, and school contexts. Accordingly, Chapter 2 indicated the combined effects of the perceived parents' acculturation orientations and classmates' acculturation preferences on adolescents' own acculturation orientations in Italy and Turkey. Chapter 3 showed that adolescents could be classified into one of four latent growth trajectory classes (i.e., ethnic-oriented, national-oriented, dual, and marginalized identities), which could be predicted by social identification with family and classmates. Chapter 4 highlighted that adolescents' cross-ethnic friendships mediated the positive associations of parents' cross-ethnic friendships with adolescents' psychological and social adjustment beyond the positive relationships between parents' and adolescents' friendships. Multiple studies conducted in Chapter 5 confirmed that a newly developed questionnaire (i.e., ICIS-Short Version) is a reliable tool to measure positive and negative contact among ethnic minority and majority adolescents. Chapter 6 revealed that teachers' equal treatment increased positive and decreased negative contact among ethnic minority and majority adolescents. Moreover, Chapter 7 indicated that adolescents’ positive and negative contact in the school context were related over time to higher corresponding positive and negative contact in out-of-school contexts and vice versa, while their positive contact in the school context was linked over time to lower levels of negative contact in the out-of-school contexts. Eventually, Chapter 8 strived to summarize and discuss these findings in light of social inclusivity. Overall, this dissertation tapped into the paramount importance of family, peer, and school contexts to provide a unique resource for adolescents to cope with acculturative challenges that go beyond the normative developmental tasks of adolescence.

The role of the Rocky Mountains in shaping the atmospheric mean state and the response to tropical forcing in idealised simulations.

Understanding the natural and forced variability of the atmospheric general circulation and its drivers is one of the grand challenges in climate science. It is of paramount importance to understand to what extent the systematic error of climate models affects the processes driving such variability. This is done by performing a set of simulations (ROCK experiments) with an intermediate complexity atmospheric model (SPEEDY), in which the Rocky Mountains orography is increased or decreased to influence the structure of the North Pacific jet stream. For each of these modified-orography experiments, the climatic response to idealized sea surface temperature anomalies of varying intensity in the El Niño Southern Oscillation (ENSO) region is studied. ROCK experiments are characterized by variations in the Pacific jet stream intensity whose extension encompasses the spread of the systematic error found in Coupled Model Intercomparison Project (CMIP6) models. When forced with ENSO-like idealised anomalies, they exhibit a non-negligible sensitivity in the response pattern over the Pacific North American region, indicating that the model mean state can affect the model response to ENSO. It is found that the classical Rossby wave train response to ENSO is more meridionally oriented when the Pacific jet stream is weaker and more zonally oriented with a stronger jet. Rossby wave linear theory suggests that a stronger jet implies a stronger waveguide, which traps Rossby waves at a lower latitude, favouring a zonal propagation of Rossby waves. The shape of the dynamical response to ENSO affects the ENSO impacts on surface temperature and precipitation over Central and North America. A comparison of the SPEEDY results with CMIP6 models suggests a wider applicability of the results to more resources-demanding climate general circulation models (GCMs), opening up to future works focusing on the relationship between Pacific jet misrepresentation and response to external forcing in fully-fledged GCMs.

Electrochemiluminescence: insights into the mechanisms and nanomaterial-based applications

Biomarkers are biological indicators of human health conditions. Their ultra-sensitive quantification is of paramount importance in clinical monitoring and early disease diagnosis. Biosensors are simple and easy-to-use analytical devices and, in their world, electrochemiluminescence (ECL) is one of the most promising analytical techniques that needs an ever-increasing sensitivity for improving its clinical effectiveness. Scope of this project was the investigation of the ECL generation mechanisms for enhancing the ECL intensity also through the identification of suitable nanostructures. The combination of nanotechnologies, microscopy and ECL has proved to be a very successful strategy to improve the analytical efficiency of ECL in one of its most promising bioanalytical approaches, the bead-based immunoassay. Nanosystems, such as [Ru(bpy)3]2+-dye-doped nanoparticles (DDSNPs) and Bodipy Carbon Nanodots, have been used to improve the sensitivity of ECL techniques thanks to their advantageous and tuneable properties, reaching a signal increase of 750% in DDSNPs-bead-based immunoassay system. In this thesis, an investigation of size and distance effects on the ECL mechanisms was carried out through the innovative combination of ECL microscopy and electrochemical mapping of radicals. It allowed the discovery of an unexpected and highly efficient mechanistic path for ECL generation at small distances from the electrode surface. It was exploited and enhanced through the addition of a branched amine DPIBA to the usual coreactant TPrA solution for enhancing the ECL efficiency until a maximum of 128%. Finally, a beads-based immunoassay and an immunosensor specific for cardiac Troponin I were built exploiting previous results and carbon nanotubes features. They created a conductive layer around beads enhancing the signal by 70% and activating an ECL mechanism unobserved before in such systems. In conclusion, the combination of ECL microscopy and nanotechnology and the deep understanding of the mechanisms responsible for the ECL emission led to a great enhancement in the signal.

Analysis of technological accidents triggered by natural events (Natech) in the perspective of climate change

The severe accidents deriving from the impact of natural events on industrial installations have become a matter of growing concern in the last decades. In the literature, these events are typically referred to as Natech accidents. Several peculiarities distinguish them from conventional industrial accidents caused by internal factors, such as the possible occurrence of multiple simultaneous failures, and the enhanced probability of cascading events. The research project provides a comprehensive overview of Natech accidents that occurred in the Chemical and Process Industry, allowing for the identification of relevant aspects of Natech events. Quantified event trees and probability of ignition are derived from the collected dataset, providing a step forward in the quantitative risk assessment of Natech accidents. The investigation of past Natech accidents also demonstrated that wildfires may cause technological accidents. Climate change and global warming are promoting the conditions for wildfire development and rapid spread. Hence, ensuring the safety of industrial facilities exposed to wildfires is paramount. This was achieved defining safety distances between wildland vegetation and industrial equipment items. In addition, an innovative methodology for the vulnerability assessment of Natech and Domino scenarios triggered by wildfires was developed. The approach accounted for the dynamic behaviour of wildfire events and related technological scenarios. Besides, the performance of the emergency response and the related intervention time in the case of cascading events caused by natural events were evaluated. Overall, the tools presented in this thesis represent a step forward in the Quantitative Risk Assessment of Natech accidents. The methodologies developed also provide a solid basis for the definition of effective strategies for risk mitigation and reduction. These aspects are crucial to improve the resilience of industrial plants to natural hazards, especially considering the effects that climate change may have on the severity of such events.

Decentralized systems for the protection and portability of personal data

The General Data Protection Regulation (GDPR) has been designed to help promote a view in favor of the interests of individuals instead of large corporations. However, there is the need of more dedicated technologies that can help companies comply with GDPR while enabling people to exercise their rights. We argue that such a dedicated solution must address two main issues: the need for more transparency towards individuals regarding the management of their personal information and their often hindered ability to access and make interoperable personal data in a way that the exercise of one's rights would result in straightforward. We aim to provide a system that helps to push personal data management towards the individual's control, i.e., a personal information management system (PIMS). By using distributed storage and decentralized computing networks to control online services, users' personal information could be shifted towards those directly concerned, i.e., the data subjects. The use of Distributed Ledger Technologies (DLTs) and Decentralized File Storage (DFS) as an implementation of decentralized systems is of paramount importance in this case. The structure of this dissertation follows an incremental approach to describing a set of decentralized systems and models that revolves around personal data and their subjects. Each chapter of this dissertation builds up the previous one and discusses the technical implementation of a system and its relation with the corresponding regulations. We refer to the EU regulatory framework, including GDPR, eIDAS, and Data Governance Act, to build our final system architecture's functional and non-functional drivers. In our PIMS design, personal data is kept in a Personal Data Space (PDS) consisting of encrypted personal data referring to the subject stored in a DFS. On top of that, a network of authorization servers acts as a data intermediary to provide access to potential data recipients through smart contracts.

Characterization of pyrolysis and oxidation processes of biomaterials, biomasses and biofuels

The urgent need for alternative solutions mitigating the impacts of human activities on the environment has strongly opened new challenges and opportunities in view of the energy transition. Indeed, the automotive industry is going through a revolutionary moment in its quest to reduce its carbon footprint, with biofuels being one of the viable alternatives. The use of different classes of biofuels as fuel additives/standalone components has attracted the attention of many researchers. Despite their beneficial effects, biofuel’s combustion can also result in the production of undesirable pollutants, requiring complete characterization of the phenomena occurring during their production and consumption. Industrial scale-up of biomass conversion is challenging owing to the complexity of its chemistry and transport phenomena involved in the process. In this view, the role of solid-phase and gas-phase chemistry is paramount. Thus, this study is devoted to detailed analysis of physical-chemical phenomena characterizing biomass pyrolysis and biofuel oxidation. The pyrolysis mechanism has been represented by 20 reactions whereas, the gas-phase kinetic models; manually upgraded model (KiBo_MU) and automated model (KiBo_AG), comprises 141 species and 453 reactions, and 631 species and 28329 reactions, respectively. The accuracy of the kinetic models was tested against experimental data and the models captured experimental trends very well. While the development and validation of detailed kinetic mechanisms is the main deliverable of this project, the realized procedure integrating schematic classifications with methodologies for the identification of common decomposition pathways and intermediates represents an additional source of novelty. Besides, the fundamentally oriented nature of the adopted method allows the identification of most relevant reactions and species under the operating conditions different industrial applications, paving the way for reduced kinetic mechanisms. Ultimately, the resulting detailed mechanisms can be used to integrate with more complex fluid dynamics model to accurately reproduce the behavior of real systems and reactors.

An analysis of the regulatory chill hypothesis: environmental protection in international investment law

The goal of this thesis has been to find out whether ISDS and international investment law exert a chilling effect on more stringent environmental standards at the domestic level. Due to the lack of consistent empirical and statistical evidence uncovered during the analysis, this thesis largely dismisses the regulatory chill hypothesis. However, two exceptions are identified: first, there is evidence of the efforts made by domestic industrial groups and trade unions to prevent the implementation of stricter environmental standards; second, it has become apparent that unfounded beliefs, e.g. about ISDS, held by lawmakers and regulators can play an important role in chilling stricter environmental standards. For these reasons, a new and narrower definition of the regulatory chill phenomenon has been proposed, one that only encompasses those instances in which lawmakers, governments and government agencies refrain from adopting the laws and regulations that they deem the most appropriate because they believe that doing so would lead to adverse consequences at the international trade and investment level, despite a lack of consistent and robust evidence supporting their concerns. The second part of this thesis focusses on what could be done in international economic law to promote environmentally friendly FDI, while preventing the few instances in which regulatory chill may take place due to ill-founded beliefs held by lawmakers and regulators. Following an analysis that highlights the paramount role played by public participation and responsive institutions to achieve an appropriate level of environmental protection, this study ends with a proposal that recommends the adoption of a clause within IIAs that makes pre-investment environmental screening mandatory and free from ISDS oversight.

Phenotypic and molecular investigation of circulating tumor cells (CTCs) isolated from breast cancer patients at single cell resolution

Despite the paramount advances in cancer research, breast cancer (BC) still ranks one of the leading causes of cancer-related death worldwide. Thanks to the screening campaign started in developed countries, BC is often diagnosed at early stages (non-metastatic BC, nmBC), but disease relapse occurrence even after decades and at distant sites is not an uncommon phenomenon. Conversely, metastatic BC (mBC) is considered an incurable disease. The major perpetrators of tumor spread to secondary organs are circulating tumor cells (CTCs), a rare population of cells detectable in the peripheral blood of oncologic patients. In this study, CTCs from patients diagnosed with luminal nmBC and mBC (hormone receptor positive, Human Epidermal Growth Factor Receptor 2 (HER2) negative) were characterized at both phenotypic and molecular levels. To better understand the molecular mechanisms underlying their biology and their metastatic potential, next-generation sequencing (NGS) analyses were performed at single-cell resolution to assess copy number aberrations (CNAs), single nucleotide variants (SNVs) and gene expression profiling. The findings of this study arise hints in CTC detection, and pave the way to new application in CTC research.

The RAS-Lung project: implementing blood and tissue genotyping in KRAS-Positive non-small cell lung cancer treatment

Background: The frontline management of non-oncogene addicted non-small cell lung cancer (NSCLC) involves immunotherapy (ICI) alone or combined with chemotherapy (CT-ICI). As therapeutic options expand, refining NSCLC genotyping gains paramount importance. The dynamic landscape of KRAS-positive NSCLC presents a spectrum of treatment options, including ICI, targeted therapy, and combination strategies currently under investigation. Methods: The two-year RASLUNG project, featuring both retrospective and prospective cohorts, aimed to analyze the predictive and prognostic impact of KRAS mutations on tumor tissue and circulating DNA (ctDNA). Secondary objectives included assessing the roles of co-mutations and longitudinal changes in KRAS mutant copies concerning treatment response and survival outcomes. An external validation study confirmed the prognostic or predictive significance of co-mutations. Results: In the prospective cohort (n=24), patients with liver metastases exhibited significantly elevated ctDNA levels(p=0.01), while those with >3 metastatic sites showed increased Allele Frequency (AF) (P=0.002). Median overall survival (OS) was 7.5 months, progression-free survival (PFS) was 4.0 months, and the objective response rate (ORR) was 33.3%. Higher AF correlated with an increased risk of death (HR 1.04, p = 0.03), though not progression. Notably, a reduction in plasma DNA levels was significantly associated with objective response(p=0.01). In the retrospective cohort, KRAS and STK11 mutations co-occurred in 14/21 patients (p=0.053). STK11 mutations were independently detrimental to OS (HR 1.97, p=0.025) after adjusting for various factors. KRAS tissue AF did not correlate with OS or PFS. Within the validation dataset, STK11 mutations were significantly associated with an increased risk of death in univariate (HR 2.01, p<0.001) and multivariate models (HR 1.66, p=0.001) after adjustments. Conclusion: The RAS-Lung Project, employing innovative genotyping techniques, underscores the significance of comprehensive NSCLC genotyping. Tailored next-generation sequencing (NGS) and ctDNA monitoring may offer potential benefits in navigating the evolving landscape of KRAS-positive NSCLC treatment.

NLG-Metricverse: An End-to-End Library for Evaluating Natural Language Generation

Driven by recent deep learning breakthroughs, natural language generation (NLG) models have been at the center of steady progress in the last few years. However, since our ability to generate human-indistinguishable artificial text lags behind our capacity to assess it, it is paramount to develop and apply even better automatic evaluation metrics. To facilitate researchers to judge the effectiveness of their models broadly, we suggest NLG-Metricverse—an end-to-end open-source library for NLG evaluation based on Python. This framework provides a living collection of NLG metrics in a unified and easy- to-use environment, supplying tools to efficiently apply, analyze, compare, and visualize them. This includes (i) the extensive support of heterogeneous automatic metrics with n-arity management, (ii) the meta-evaluation upon individual performance, metric-metric and metric-human correlations, (iii) graphical interpretations for helping humans better gain score intuitions, (iv) formal categorization and convenient documentation to accelerate metrics understanding. NLG-Metricverse aims to increase the comparability and replicability of NLG research, hopefully stimulating new contributions in the area.

Experimental and numerical characterization of flame instability in hydrogen-containing flames

In the framework of the energy transition, the acquisition of proper knowledge of fundamental aspects characterizing the use of alternative fuels is paramount as well as the development of optimized know-how and technologies. In this sense, the use of hydrogen has been indicated as a promising route for decarbonization at the end-users stage in the energy supply chain. However, the elevated reactivity and the low-density at atmospheric conditions of hydrogen pose new challenges. Among the others, the dilution of hydrogen with carbon dioxide from carbon capture and storage systems represents a possible route. However, the interactions between these species have been poorly studied so far. For these reasons, this thesis, in collaboration between the University of Bologna and Technische Universität Bergakademie of Freiberg in Saxony (Germany), investigates the laminar flame of hydrogen-based premixed gas with the dilution of carbon dioxide. An experimental system, called a heat flux burner, was adopted ad different operating conditions. The presence of the cellularity phenomenon, forming the so-called cellular flame, was observed and analysed. Theoretical and visual methods have allowed for the characterization of the investigated flames, opening new alternatives for sustainable energy production via hydrogen transformation.