La costruzione razionale della casa. Scritti e progetti di Giuseppe Pagano

The rational construction of the house. The writings and projects of Giuseppe Pagano Description, themes and research objectives The research aims at analysing the architecture of Giuseppe Pagano, which focuses on the theme of dwelling, through the reading of 3 of his house projects. On the one hand, these projects represent “minor” works not thoroughly known by Pagano’s contemporary critics; on the other they emphasise a particular methodological approach, which serves the author to explore a theme closely linked to his theoretical thought. The house project is a key to Pagano’s research, given its ties to the socio-cultural and political conditions in which the architect was working, so that it becomes a mirror of one of his specific and theoretical path, always in a state of becoming. Pagano understands architecture as a “servant of the human being”, subject to a “utilitarian slavery” since it is a clear, essential and “modest” answer to specific human needs, free from aprioristic aesthetic and formal choices. It is a rational architecture in sensu stricto; it constitutes a perfect synthesis between cause and effect and between function and form. The house needs to accommodate these principles because it is closely intertwined with human needs and intimately linked to a specific place, climatic conditions and technical and economical possibilities. Besides, differently from his public and common masterpieces such as the Palazzo Gualino, the Istituto di Fisica and the Università Commerciale Bocconi, the house projects are representative of a precise project will, which is expressed in a more authentic way, partially freed from political influences and dogmatic preoccupations and, therefore, far from the attempt to research a specific expressive language. I believe that the house project better represents that “ingenuity”, freshness and “sincerity” that Pagano identifies with the minor architecture, thereby revealing a more authentic expression of his understanding of a project. Therefore, the thesis, by tracing the theoretical research of Pagano through the analysis of some of his designed and built works, attempts to identify a specific methodological approach to Pagano’s project, which, developed through time, achieves a certain clarity in the 1930s. In fact, this methodological approach becomes more evident in his last projects, mainly regarding the house and the urban space. These reflect the attempt to respond to the new social needs and, at the same time, they also are an expression of a freer idea of built architecture, closely linked with the place and with the human being who dwells it. The three chosen projects (Villa Colli, La Casa a struttura d’acciaio and Villa Caraccio) make Pagano facing different places, different customers and different economic and technical conditions, which, given the author’s biography, correspond to important historical and political conditions. This is the reason why the projects become apparently distant works, both linguistically and conceptually, to the point that one can define them as ”eclectic”. However, I argue that this eclecticism is actually an added value to the architectural work of Pagano, steaming from the use of a method which, having as a basis the postulate of a rational architecture as essence and logic of building, finds specific variations depending on the multiple variables to be addressed by the project. This is the methodological heritage that Pagano learns from the tradition, especially that of the rural residential architecture, defined by Pagano as a “dictionary of the building logic of man”, as an “a-stylistic background”. For Pagano this traditional architecture is a clear expression of the relationships between a theme and its development, an architectural “fact” that is resolved with purely technical and utilitarian aims and with a spontaneous development far from any aprioristic theoretical principle. Architecture, therefore, cannot be an invention for Pagano and the personal contribution of each architect has to consider his/her close relationship with the specific historical context, place and new building methods. These are basic principles in the methodological approach that drives a great deal of his research and that also permits his thought to be modern. I argue that both ongoing and new collaborations with younger protagonists of the culture and architecture of the period are significant for the development of his methodology. These encounters represent the will to spread his own understanding of the “new architecture” as well as a way of self-renewal by confronting the self with new themes and realities and by learning from his collaborators. Thesis’ outline The thesis is divided in two principal parts, each articulated in four chapters attempting to offer a new reading of the theory and work of Pagano by emphasising the central themes of the research. The first chapter is an introduction to the thesis and to the theme of the rational house, as understood and developed in its typological and technical aspects by Pagano and by other protagonists of the Italian rationalism of the 1930s. Here the attention is on two different aspects defining, according to Pagano, the house project: on the one hand, the typological renewal, aimed at defining a “standard form” as a clear and essential answer to certain needs and variables of the project leading to different formal expressions. On the other, it focuses on the building, understood as a technique to “produce” architecture, where new technologies and new materials are not merely tools but also essential elements of the architectural work. In this way the villa becomes different from the theme of the common house or from that of the minimalist house, by using rules in the choice of material and in the techniques that are every time different depending on the theme under exploration and on the contingency of place. It is also visible the rigorous rationalism that distinguishes the author's appropriation of certain themes of rural architecture. The pages of “Casabella” and the events of the contemporary Triennali form the preliminary material for the writing of this chapter given that they are primary sources to individuate projects and writings produced by Pagano and contemporary architects on this theme. These writings and projects, when compared, reconstruct the evolution of the idea of the rational house and, specifically, of the personal research of Pagano. The second part regards the reading of three of Pagano’s projects of houses as a built verification of his theories. This section constitutes the central part of the thesis since it is aimed at detecting a specific methodological approach showing a theoretical and ideological evolution expressed in the vast edited literature. The three projects that have been chosen explore the theme of the house, looking at various research themes that the author proposes and that find continuity in the affirmation of a specific rationalism, focussed on concepts such as essentiality, utility, functionality and building honesty. These concepts guide the thought and the activities of Pagano, also reflecting a social and cultural period. The projects span from the theme of the villa moderna, Villa Colli, which, inspired by the architecture of North Europe, anticipates a specific rationalism of Pagano based on rigour, simplicity and essentiality, to the theme of the common house, Casa a struttura d’acciaio, la casa del domani, which ponders on the definition of new living spaces and, moreover, on new concepts of standardisation, economical efficiency and new materials responding to the changing needs of the modern society. Finally, the third project returns to the theme of the, Villa Caraccio, revisiting it with new perspectives. These perspectives find in the solution of the open plant, in the openness to nature and landscape and in the revisiting of materials and local building systems that idea of the freed house, which express clearly a new theoretical thought. Methodology It needs to be noted that due to the lack of an official Archive of Pagano’s work, the analysis of his work has been difficult and this explains the necessity to read the articles and the drawings published in the pages of «Casabella» and «Domus». As for the projects of Villa Colli and Casa a struttura d’acciaio, parts of the original drawings have been consulted. These drawings are not published and are kept in private archives of the collaborators of Pagano. The consultation of these documents has permitted the analysis of the cited works, which have been subject to a more complete reading following the different proposed solutions, which have permitted to understand the project path. The projects are analysed thought the method of comparison and critical reading which, specifically, means graphical elaborations and analytical schemes, mostly reconstructed on the basis of original projects but, where possible, also on a photographic investigation. The focus is on the project theme which, beginning with a specific living (dwelling) typology, finds variations because of the historico-political context in which Pagano is embedded and which partially shapes his research and theoretical thought, then translated in the built work. The analysis of the work follows, beginning, where possible, from a reconstruction of the evolution of the project as elaborated on the basis of the original documents and ending on an analysis of the constructive principles and composition. This second phase employs a methodology proposed by Pagano in his article Piante di ville, which, as expected, focuses on the plant as essential tool to identify the “true practical and poetic qualities of the construction”(Pagano, «Costruzioni-Casabella», 1940, p. 2). The reading of the project is integrated with the constructive analyses related to the technical aspects of the house which, in the case of Casa a struttura d’acciaio, play an important role in the project, while in Villa Colli and in Villa Caraccio are principally linked to the choice of materials for the construction of the different architectural elements. These are nonetheless key factors in the composition of the work. Future work could extend this reading to other house projects to deepen the research that could be completed with the consultation of Archival materials, which are missing at present. Finally, in the appendix I present a critical selection of the Pagano’s writings, which recall the themes discussed and embodied by the three projects. The texts have been selected among the articles published in Casabella and in other journals, completing the reading of the project work which cannot be detached from his theoretical thought. Moving from theory to project, we follow a path that brings us to define and deepen the central theme of the thesis: rational building as the principal feature of the architectural research of Pagano, which is paraphrased in multiple ways in his designed and built works.

Development of Clinical Decision Support Systems based on Mathematical Models of Physiological Systems

In the last years of research, I focused my studies on different physiological problems. Together with my supervisors, I developed/improved different mathematical models in order to create valid tools useful for a better understanding of important clinical issues. The aim of all this work is to develop tools for learning and understanding cardiac and cerebrovascular physiology as well as pathology, generating research questions and developing clinical decision support systems useful for intensive care unit patients. I. ICP-model Designed for Medical Education We developed a comprehensive cerebral blood flow and intracranial pressure model to simulate and study the complex interactions in cerebrovascular dynamics caused by multiple simultaneous alterations, including normal and abnormal functional states of auto-regulation of the brain. Individual published equations (derived from prior animal and human studies) were implemented into a comprehensive simulation program. Included in the normal physiological modelling was: intracranial pressure, cerebral blood flow, blood pressure, and carbon dioxide (CO2) partial pressure. We also added external and pathological perturbations, such as head up position and intracranial haemorrhage. The model performed clinically realistically given inputs of published traumatized patients, and cases encountered by clinicians. The pulsatile nature of the output graphics was easy for clinicians to interpret. The manoeuvres simulated include changes of basic physiological inputs (e.g. blood pressure, central venous pressure, CO2 tension, head up position, and respiratory effects on vascular pressures) as well as pathological inputs (e.g. acute intracranial bleeding, and obstruction of cerebrospinal outflow). Based on the results, we believe the model would be useful to teach complex relationships of brain haemodynamics and study clinical research questions such as the optimal head-up position, the effects of intracranial haemorrhage on cerebral haemodynamics, as well as the best CO2 concentration to reach the optimal compromise between intracranial pressure and perfusion. We believe this model would be useful for both beginners and advanced learners. It could be used by practicing clinicians to model individual patients (entering the effects of needed clinical manipulations, and then running the model to test for optimal combinations of therapeutic manoeuvres). II. A Heterogeneous Cerebrovascular Mathematical Model Cerebrovascular pathologies are extremely complex, due to the multitude of factors acting simultaneously on cerebral haemodynamics. In this work, the mathematical model of cerebral haemodynamics and intracranial pressure dynamics, described in the point I, is extended to account for heterogeneity in cerebral blood flow. The model includes the Circle of Willis, six regional districts independently regulated by autoregulation and CO2 reactivity, distal cortical anastomoses, venous circulation, the cerebrospinal fluid circulation, and the intracranial pressure-volume relationship. Results agree with data in the literature and highlight the existence of a monotonic relationship between transient hyperemic response and the autoregulation gain. During unilateral internal carotid artery stenosis, local blood flow regulation is progressively lost in the ipsilateral territory with the presence of a steal phenomenon, while the anterior communicating artery plays the major role to redistribute the available blood flow. Conversely, distal collateral circulation plays a major role during unilateral occlusion of the middle cerebral artery. In conclusion, the model is able to reproduce several different pathological conditions characterized by heterogeneity in cerebrovascular haemodynamics and can not only explain generalized results in terms of physiological mechanisms involved, but also, by individualizing parameters, may represent a valuable tool to help with difficult clinical decisions. III. Effect of Cushing Response on Systemic Arterial Pressure. During cerebral hypoxic conditions, the sympathetic system causes an increase in arterial pressure (Cushing response), creating a link between the cerebral and the systemic circulation. This work investigates the complex relationships among cerebrovascular dynamics, intracranial pressure, Cushing response, and short-term systemic regulation, during plateau waves, by means of an original mathematical model. The model incorporates the pulsating heart, the pulmonary circulation and the systemic circulation, with an accurate description of the cerebral circulation and the intracranial pressure dynamics (same model as in the first paragraph). Various regulatory mechanisms are included: cerebral autoregulation, local blood flow control by oxygen (O2) and/or CO2 changes, sympathetic and vagal regulation of cardiovascular parameters by several reflex mechanisms (chemoreceptors, lung-stretch receptors, baroreceptors). The Cushing response has been described assuming a dramatic increase in sympathetic activity to vessels during a fall in brain O2 delivery. With this assumption, the model is able to simulate the cardiovascular effects experimentally observed when intracranial pressure is artificially elevated and maintained at constant level (arterial pressure increase and bradicardia). According to the model, these effects arise from the interaction between the Cushing response and the baroreflex response (secondary to arterial pressure increase). Then, patients with severe head injury have been simulated by reducing intracranial compliance and cerebrospinal fluid reabsorption. With these changes, oscillations with plateau waves developed. In these conditions, model results indicate that the Cushing response may have both positive effects, reducing the duration of the plateau phase via an increase in cerebral perfusion pressure, and negative effects, increasing the intracranial pressure plateau level, with a risk of greater compression of the cerebral vessels. This model may be of value to assist clinicians in finding the balance between clinical benefits of the Cushing response and its shortcomings. IV. Comprehensive Cardiopulmonary Simulation Model for the Analysis of Hypercapnic Respiratory Failure We developed a new comprehensive cardiopulmonary model that takes into account the mutual interactions between the cardiovascular and the respiratory systems along with their short-term regulatory mechanisms. The model includes the heart, systemic and pulmonary circulations, lung mechanics, gas exchange and transport equations, and cardio-ventilatory control. Results show good agreement with published patient data in case of normoxic and hyperoxic hypercapnia simulations. In particular, simulations predict a moderate increase in mean systemic arterial pressure and heart rate, with almost no change in cardiac output, paralleled by a relevant increase in minute ventilation, tidal volume and respiratory rate. The model can represent a valid tool for clinical practice and medical research, providing an alternative way to experience-based clinical decisions. In conclusion, models are not only capable of summarizing current knowledge, but also identifying missing knowledge. In the former case they can serve as training aids for teaching the operation of complex systems, especially if the model can be used to demonstrate the outcome of experiments. In the latter case they generate experiments to be performed to gather the missing data.

Spektroskopie und Ultraspurenanalyse von Plutonium mittels Resonanzionisations-Massenspektrometrie

Die Resonanzionisations-Massenspektrometrie (RIMS) ist sowohl für spektroskopische Untersuchungen seltener Isotope als auch für den Ultraspurennachweis langlebiger radioaktiver Elemente einsetzbar. Durch die mehrstufige resonante Anregung atomarer Energieniveaus mit anschließender Ionisation mit Laserlicht wird eine sehr hohe Elementselektivität und Ionisationseffizienz erreicht. Der nachfolgende massenselektive Ionennachweis liefert eine gute Isotopenselektivität zusammen mit einer effektiven Untergrundunterdrückung. Ein wichtiger Bestandteil der RIMS-Apparatur ist ein zuverlässig arbeitendes, leistungsstarkes Lasersystem für die Resonanzionisation. Im Rahmen dieser Arbeit wurde ein von einem hochrepetierenden Nd:YAG-Laser gepumptes, aus drei Titan-Saphir-Lasern bestehendes System fertig aufgebaut und in den Routinebetrieb überführt. Die Titan-Saphir-Laser liefern im Durchstimmbereich von 730 - 880 nm eine mittlere Leistung von bis zu 3 W pro Laser bei einer Linienbreite von 2 - 3 GHz. Sie lassen sich computergesteuert in ihren Wellenlängen durchstimmen. Die mittels Resonanzionisation erzeugten Ionen werden dann in einem Flugzeit-Massenspektrometer entsprechend ihrer Masse aufgetrennt und mit einem Kanalplattendetektor nachgewiesen.Als Voraussetzung für die isotopenselektive Ultraspurenanalyse von Plutonium wurden mit diesem Lasersystem die Isotopieverschiebungen eines effizienten, dreistufigen Anregungsschema für Plutonium bestimmt. Die Laserleistungen reichen zur vielfachen Sättigung der ersten beiden Anregungsschritte und zur zweifachen Sättigung des dritten Anregungsschritts aus.Außerdem wurden die Ionisationsenergien von Pu-239 und Pu-244 zur Untersuchung ihrer Isotopenabhängigkeit bestimmt. Die beiden Ionisationsenergien sind im Rahmen der erreichten Genauigkeit bei einem Meßwert von IP239-IP244 = 0,24(82) cm^-1 gleich.Die Nachweiseffizienz der RIMS-Apparatur für Plutonium wurde in Effizienzmessungen zu 10^-5 bestimmt. Durch die gute Untergrundunterdrückung ergab sich daraus eine Nachweisgrenze von 10^6 Atomen bei der Messung eines Plutoniumisotops. Die Bestimmung der Isotopenverhältnisse von Proben mit einer zertifizierten Isotopenzusammensetzung lieferte eine gute Übereinstimmung der Meßwerte mit den angegebenen Zusammensetzungen.Die RIMS-Apparatur wurde zur Bestimmung des Gehalts und der Isotopenzusammensetzung von Plutonium in Meerwasser- und Staubproben eingesetzt.Auf Grund der Isotopenzusammensetzung konnte gezeigt werden, daß das Plutonium bei den meisten Proben aus dem Fallout von oberirdischen Kernwaffentests stammte. Des weiteren wurde Plutonium in Urinproben bestimmt. Die Nachweisgrenzen lagen bei diesen Umweltproben bei 10^6 bis 10^7 Atomen Plutonium und damit um zwei Größenordnungen niedriger als die Nachweisgrenze für Pu-239 bei der alpha-Spektroskopie, der Standardmethode für den Plutoniumnachweis.

O (alpha 4 s) loop-by-loop contributions to heavy quark pair production in hadronic collisions

The present state of the theoretical predictions for the hadronic heavy hadron production is not quite satisfactory. The full next-to-leading order (NLO) ${cal O} (alpha_s^3)$ corrections to the hadroproduction of heavy quarks have raised the leading order (LO) ${cal O} (alpha_s^2)$ estimates but the NLO predictions are still slightly below the experimental numbers. Moreover, the theoretical NLO predictions suffer from the usual large uncertainty resulting from the freedom in the choice of renormalization and factorization scales of perturbative QCD.In this light there are hopes that a next-to-next-to-leading order (NNLO) ${cal O} (alpha_s^4)$ calculation will bring theoretical predictions even closer to the experimental data. Also, the dependence on the factorization and renormalization scales of the physical process is expected to be greatly reduced at NNLO. This would reduce the theoretical uncertainty and therefore make the comparison between theory and experiment much more significant. In this thesis I have concentrated on that part of NNLO corrections for hadronic heavy quark production where one-loop integrals contribute in the form of a loop-by-loop product. In the first part of the thesis I use dimensional regularization to calculate the ${cal O}(ep^2)$ expansion of scalar one-loop one-, two-, three- and four-point integrals. The Laurent series of the scalar integrals is needed as an input for the calculation of the one-loop matrix elements for the loop-by-loop contributions. Since each factor of the loop-by-loop product has negative powers of the dimensional regularization parameter $ep$ up to ${cal O}(ep^{-2})$, the Laurent series of the scalar integrals has to be calculated up to ${cal O}(ep^2)$. The negative powers of $ep$ are a consequence of ultraviolet and infrared/collinear (or mass ) divergences. Among the scalar integrals the four-point integrals are the most complicated. The ${cal O}(ep^2)$ expansion of the three- and four-point integrals contains in general classical polylogarithms up to ${rm Li}_4$ and $L$-functions related to multiple polylogarithms of maximal weight and depth four. All results for the scalar integrals are also available in electronic form. In the second part of the thesis I discuss the properties of the classical polylogarithms. I present the algorithms which allow one to reduce the number of the polylogarithms in an expression. I derive identities for the $L$-functions which have been intensively used in order to reduce the length of the final results for the scalar integrals. I also discuss the properties of multiple polylogarithms. I derive identities to express the $L$-functions in terms of multiple polylogarithms. In the third part I investigate the numerical efficiency of the results for the scalar integrals. The dependence of the evaluation time on the relative error is discussed. In the forth part of the thesis I present the larger part of the ${cal O}(ep^2)$ results on one-loop matrix elements in heavy flavor hadroproduction containing the full spin information. The ${cal O}(ep^2)$ terms arise as a combination of the ${cal O}(ep^2)$ results for the scalar integrals, the spin algebra and the Passarino-Veltman decomposition. The one-loop matrix elements will be needed as input in the determination of the loop-by-loop part of NNLO for the hadronic heavy flavor production.

Valutazione dei disturbi cognitivi nei pazienti sottoposti a Rivascolarizzazione Carotidea (Endoarterectomia vs Stenting) mediante dosaggio di marker di danno neuronale, Mini Mental State Examination e Risonanza Magnetica

Scopo del nostro studio è quello di valutare i disturbi cognitivi in relazione al tasso di microembolia cerebrale in due gruppi di pazienti trattati per lesione carotidea asintomatica con endoarterectomia (CEA) o stenting (CAS). Comparando le due metodiche mediante l’utilizzo di risonanza magnetica in diffusione (DW-MRI), neuromarkers (NSE e S100β) e test neuropsicometrici. MATERIALE E METODI: 60 pazienti sono stati sottoposti a rivascolarizzazione carotidea (CEA n=32 e CAS n=28). Sono stati tutti valutati con DW-MRI e Mini-Mental State Examination (MMSE) test nel preoperatorio, a 24 ore, a 6 ed a 12 mesi dall’intervento. In tutti sono stati dosati i livelli sierici di NSE e S100β mediante 5 prelievi seriati nel tempo, quello basale nel preoperatorio, l’ultimo a 24 ore. L’ananlisi statistica è stata effettuata con test t di Student per confronti multipli per valori continui e con test χ2 quadro e Fisher per le variabili categoriche. Significatività P <0,05. RISULTATI: Non vi è stato alcun decesso. Un paziente del gruppo CAS ha presentato un ictus ischemico. In 6 pazienti CAS ed in 1 paziente CEA si sono osservate nuove lesioni subcliniche alla RMN-DWI post-operatoria (21,4% vs 3% p=0,03). Nel gruppo CAS le nuove lesioni presenti alla RMN sono risultate significativamente associate ad un declino del punteggio del MMSE (p=0,001). L’analisi dei livelli di NSE e S100β ha mostrato un significativo aumento a 24 ore nei pazienti CAS (P = .02). A 12 mesi i pazienti che avevano presentato nuove lesioni ischemiche nel post-operatorio hanno mostrato minor punteggio al MMSE, non statisticamente significativo. CONCLUSIONI: I neuromarkers in combinazione con MMSE e RMN-DWI possono essere utilizzati nella valutazione del declino cognitivo correlato a lesioni silenti nell’immediato postoperatorio di rivascolarizzazione carotidea. Quest’ultime dovrebbero essere valutate quindi non solo rispetto al tasso di mortalità e ictus, ma anche rispetto al tasso di microembolia.

Riabilitazione e valutazione di pazienti con deficit neurologici mediante l'utilizzo di realtà virtuale, feedback aumentati, sensori inerziali e tecnologie video a basso costo.

La neuroriabilitazione è un processo attraverso cui individui affetti da patologie neurologiche mirano al conseguimento di un recupero completo o alla realizzazione del loro potenziale ottimale benessere fisico, mentale e sociale. Elementi essenziali per una riabilitazione efficace sono: una valutazione clinica da parte di un team multidisciplinare, un programma riabilitativo mirato e la valutazione dei risultati conseguiti mediante misure scientifiche e clinicamente appropriate. Obiettivo principale di questa tesi è stato sviluppare metodi e strumenti quantitativi per il trattamento e la valutazione motoria di pazienti neurologici. I trattamenti riabilitativi convenzionali richiedono a pazienti neurologici l’esecuzione di esercizi ripetitivi, diminuendo la loro motivazione. La realtà virtuale e i feedback sono in grado di coinvolgerli nel trattamento, permettendo ripetibilità e standardizzazione dei protocolli. È stato sviluppato e valutato uno strumento basato su feedback aumentati per il controllo del tronco. Inoltre, la realtà virtuale permette l’individualizzare il trattamento in base alle esigenze del paziente. Un’applicazione virtuale per la riabilitazione del cammino è stata sviluppata e testata durante un training su pazienti di sclerosi multipla, valutandone fattibilità e accettazione e dimostrando l'efficacia del trattamento. La valutazione quantitativa delle capacità motorie dei pazienti viene effettuata utilizzando sistemi di motion capture. Essendo il loro uso nella pratica clinica limitato, una metodologia per valutare l’oscillazione delle braccia in soggetti parkinsoniani basata su sensori inerziali è stata proposta. Questi sono piccoli, accurati e flessibili ma accumulano errori durante lunghe misurazioni. È stato affrontato questo problema e i risultati suggeriscono che, se il sensore è sul piede e le accelerazioni sono integrate iniziando dalla fase di mid stance, l’errore e le sue conseguenze nella determinazione dei parametri spaziali sono contenuti. Infine, è stata presentata una validazione del Kinect per il tracking del cammino in ambiente virtuale. Risultati preliminari consentono di definire il campo di utilizzo del sensore in riabilitazione.

What are the components that contribute to variability in echocardiographic measurements in aortic stenosis?

INTRODUCTION Echocardiography is the standard clinical approach for quantification of the severity of aortic stenosis (AS). A comprehensive examination of its overall reproducibility and the simultaneous estimation of its variance components by multiple operators, readers, probe applications, and beats have not been undertaken. METHOD AND RESULTS Twenty-seven subjects with AS were scanned over 7 months in the echo-department by a median of 3 different operators. From each patient and each operator multiple runs of beats from multiple probe positions were stored for later analysis by multiple readers. The coefficient of variation was 13.3%, 15.9%, 17.6%, and 20.2% for the aortic peak velocity (Vmax), and velocity time integral (VTI), and left ventricular outflow tract (LVOT) Vmax and VTI respectively. The largest individual contributors to the overall variability were the beat-to-beat variability (9.0%, 9.3%, 9.5%, 9.4% respectively) and that of inability of an individual operator to precisely apply the probe to the same position twice (8.3%, 9.4%, 12.9%, 10.7% respectively). The tracing (inter-reader) and reader (inter-reader), and operator (inter-operator) contribution were less important. CONCLUSIONS Reproducibility of measurements in AS is poorer than often reported in the literature. The source of this variability does not appear, as traditionally believed, to result from a lack of training or operator and reader specific factors. Rather the unavoidable beat-to-beat biological variability, and the inherent impossibility of applying the ultrasound probe in exactly the same position each time are the largest contributors. Consequently, guidelines suggesting greater standardisation of procedures and further training for sonographers are unlikely to result in an improvement in precision. Clinicians themselves should be wary of relying on even three-beat averages as their expected coefficient of variance is 10.3% for the peak velocity at the aortic valve.

"Ho cominciato a perdere le scarpe". La ridefinizione del mondo nelle narrazioni di pazienti affetti da sclerosi multipla

Il lavoro di tesi analizza da un punto di vista metodologico e concettuale le narrazioni di malattia delle persone affette da sclerosi multipla. Lo scopo della ricerca è duplice: da un lato quello di indagare quali siano le trame narrative di coloro che raccontano la diagnosi della loro malattia, e dall’altro di analizzare i vissuti di malattia attraverso le categorie della sociologia della salute e della medicina e dell’antropologia medica.

Fattori eziologici della Sindrome del Tunnel Carpale: una revisione sistematica con meta-analisi degli studi analitici

OBIETTIVO: sintetizzare le evidenze disponibili sulla relazione tra i fattori di rischio (personali e lavorativi) e l’insorgenza della Sindrome del Tunnel Carpale (STC). METODI: è stata condotta una revisione sistematica della letteratura su database elettronici considerando gli studi caso-controllo e di coorte. Abbiamo valutato la qualità del reporting degli studi con la checklist STROBE. Le stime studio-specifiche sono state espresse come OR (IC95%) e combinate con una meta-analisi condotta con un modello a effetti casuali. La presenza di eventuali bias di pubblicazione è stata valutata osservando l’asimmetria del funnel plot e con il test di Egger. RISULTATI: Sono stati selezionati 29 studi di cui 19 inseriti nella meta-analisi: 13 studi caso-controllo e 6 di coorte. La meta-analisi ha mostrato un aumento significativo di casi di STC tra i soggetti obesi sia negli studi caso-controllo [OR 2,4 (1,9-3,1); I(2)=70,7%] che in quelli di coorte [OR 2,0 (1,6-2,7); I(2)=0%]. L'eterogeneità totale era significativa (I(2)=59,6%). Risultati simili si sono ottenuti per i diabetici e soggetti affetti da malattie della tiroide. L’esposizione al fumo non era associata alla STC sia negli studi caso-controllo [OR 0,7 (0,4-1,1); I(2)=83,2%] che di coorte [OR 0,8 (0,6-1,2); I(2)=45,8%]. A causa delle molteplici modalità di valutazione non è stato possibile calcolare una stima combinata delle esposizioni professionali con tecniche meta-analitiche. Dalla revisione, è risultato che STC è associata con: esposizione a vibrazioni, movimenti ripetitivi e posture incongrue di mano-polso. CONCLUSIONI: I risultati della revisione sistematica confermano le evidenze dell'esistenza di un'associazione tra fattori di rischio personali e STC. Nonostante la diversa qualità dei dati sull'esposizione e le differenze degli effetti dei disegni di studio, i nostri risultati indicano elementi di prova sufficienti di un legame tra fattori di rischio professionali e STC. La misurazione dell'esposizione soprattutto per i fattori di rischio professionali, è un obiettivo necessario per studi futuri.

From Radio Channel Modeling to a System Level Perspective in Body-Centric Communications

Body-centric communications are emerging as a new paradigm in the panorama of personal communications. Being concerned with human behaviour, they are suitable for a wide variety of applications. The advances in the miniaturization of portable devices to be placed on or around the body, foster the diffusion of these systems, where the human body is the key element defining communication characteristics. This thesis investigates the human impact on body-centric communications under its distinctive aspects. First of all, the unique propagation environment defined by the body is described through a scenario-based channel modeling approach, according to the communication scenario considered, i.e., on- or on- to off-body. The novelty introduced pertains to the description of radio channel features accounting for multiple sources of variability at the same time. Secondly, the importance of a proper channel characterisation is shown integrating the on-body channel model in a system level simulator, allowing a more realistic comparison of different Physical and Medium Access Control layer solutions. Finally, the structure of a comprehensive simulation framework for system performance evaluation is proposed. It aims at merging in one tool, mobility and social features typical of the human being, together with the propagation aspects, in a scenario where multiple users interact sharing space and resources.

La governance del sociosanitario in Emilia Romagna: Esperienze e prospettive

In un contesto dominato da invecchiamento della popolazione, prevalenza della cronicità e presenza crescente di pazienti multiproblematici e non autosufficienti è indispensabile spostare il baricentro delle cure dall'acuzie alla cronicità, e quindi assicurare la continuità e la coerenza fra i diversi setting di cura, sia sanitari che socio-sanitari (ospedale, servizi sanitari territoriali, domicilio, strutture residenziali di Long term care). Dall'analisi della letteratura emerge che il maggiore ostacolo a realizzare questa continuità è rappresentato dalla presenza, caratteristica del sistema di welfare italiano, di molteplici attori e strutture con competenze, obiettivi e funzioni diverse e separate, e la raccomandazione di lavorare per l'integrazione contemporaneamente su più livelli: - normativo-istituzionale - programmatorio - professionale e gestionale Il sistema della "governance" realizzato in Emilia-Romagna per l'integrazione socio-sanitaria è stato valutato alla luce di queste raccomandazioni, seguendo il modello della Realist evaluation per i Social complex interventions: enucleando le "teorie" alla base dell'intervento ed analizzando i diversi step della sua implementazione. Alla luce di questa valutazione, il modello della "governance" è risultato coerente con le indicazioni delle linee guida, ed effettivamente capace di produrre risultati al fine della continuità e della coerenza fra cure sanitarie e assistenza sociale e sanitaria complessa. Resta da realizzare una valutazione complessiva dell'impatto su efficacia, costi e soddisfazione dei pazienti.

Excitability properties of mouse motor axons in the mutant SOD1(G93A) model of amyotrophic lateral sclerosis

Non-invasive excitability studies of motor axons in patients with amyotrophic lateral sclerosis (ALS) have revealed a changing pattern of abnormal membrane properties with disease progression, but the heterogeneity of the changes has made it difficult to relate them to pathophysiology. The SOD1(G93A) mouse model of ALS displays more synchronous motoneuron pathology. Multiple excitability measures of caudal and sciatic nerves in mutant and wild-type mice were compared before onset of signs and during disease progression (4-19 weeks), and they were related to changes in muscle fiber histochemistry. Excitability differences indicated a modest membrane depolarization in SOD1(G93A) axons at about the time of symptom onset (8 weeks), possibly due to deficient energy supply. Previously described excitability changes in ALS patients, suggesting altered sodium and potassium conductances, were not seen in the mice. This suggests that those changes relate to features of the human disease that are not well represented in the animal model.

The multiscenario multienvironment BioSecure Multimodal Database (BMDB)

A new multimodal biometric database designed and acquired within the framework of the European BioSecure Network of Excellence is presented. It is comprised of more than 600 individuals acquired simultaneously in three scenarios: 1) over the Internet, 2) in an office environment with desktop PC, and 3) in indoor/outdoor environments with mobile portable hardware. The three scenarios include a common part of audio/video data. Also, signature and fingerprint data have been acquired both with desktop PC and mobile portable hardware. Additionally, hand and iris data were acquired in the second scenario using desktop PC. Acquisition has been conducted by 11 European institutions. Additional features of the BioSecure Multimodal Database (BMDB) are: two acquisition sessions, several sensors in certain modalities, balanced gender and age distributions, multimodal realistic scenarios with simple and quick tasks per modality, cross-European diversity, availability of demographic data, and compatibility with other multimodal databases. The novel acquisition conditions of the BMDB allow us to perform new challenging research and evaluation of either monomodal or multimodal biometric systems, as in the recent BioSecure Multimodal Evaluation campaign. A description of this campaign including baseline results of individual modalities from the new database is also given. The database is expected to be available for research purposes through the BioSecure Association during 2008.

Molecular mechanisms of muscle plasticity with exercise

The skeletal muscle phenotype is subject to considerable malleability depending on use. Low-intensity endurance type exercise leads to qualitative changes of muscle tissue characterized mainly by an increase in structures supporting oxygen delivery and consumption. High-load strength-type exercise leads to growth of muscle fibers dominated by an increase in contractile proteins. In low-intensity exercise, stress-induced signaling leads to transcriptional upregulation of a multitude of genes with Ca2+ signaling and the energy status of the muscle cells sensed through AMPK being major input determinants. Several parallel signaling pathways converge on the transcriptional co-activator PGC-1α, perceived as being the coordinator of much of the transcriptional and posttranscriptional processes. High-load training is dominated by a translational upregulation controlled by mTOR mainly influenced by an insulin/growth factor-dependent signaling cascade as well as mechanical and nutritional cues. Exercise-induced muscle growth is further supported by DNA recruitment through activation and incorporation of satellite cells. Crucial nodes of strength and endurance exercise signaling networks are shared making these training modes interdependent. Robustness of exercise-related signaling is the consequence of signaling being multiple parallel with feed-back and feed-forward control over single and multiple signaling levels. We currently have a good descriptive understanding of the molecular mechanisms controlling muscle phenotypic plasticity. We lack understanding of the precise interactions among partners of signaling networks and accordingly models to predict signaling outcome of entire networks. A major current challenge is to verify and apply available knowledge gained in model systems to predict human phenotypic plasticity.

Audience Effects in COgnitive Task Performance in Capuchin Monkeys (Cebus apella)

Primates as a taxonomic Order have the largest brains corrected for body size in the animal kingdom. These large brains have allowed primates to evolve the capacity to demonstrate advanced cognitive processes across a wide array of abilities. Nonhuman primates are particularly adept at social learning, defined as the modification of behavior by observing the actions of others. Additionally, primates often exploit resources differently depending on their social context. In this study, capuchin monkeys (Cebus apella) were tested on a cognitive task in three social contexts to determine if social context influenced their performance on the task. The three social contexts included: alone, having a dominant individual in an adjacent compartment, and having a subordinate individual in the adjacent compartment. The benefits to this design were thatthe social context was the only variable influencing performance, whereas in previous studies investigating audience effects other animals could physically and directly influence a subject's performance in an open testing situation. Based on past studies, Ipredicted that the presence of a dominant individual would reduce cognitive task performance compared to the other conditions. The cognitive test used was a match-tosample discrimination task in which animals matched combinations of eight geometric shapes. Animals were trained on this task in an isolated context until they reached a baseline level of proficiency and were then tested in the three social contexts in a random order multiple times. Two subjects (Mt and Dv) have successfully completed trials under all conditions. Results indicated that there were no significant difference in taskperformance across the three conditions (Dv x^2 (1) = 0.42, p=0.58; Mt x^2 (1) = 0.02, p=0.88). In all conditions, subjects performed significantly above chance (i.e., 39/60 trials determined by a binomial distribution). Results are contrary to previous studies thatreport low status monkeys 'play dumb' when testing in a mixed social context, possibly because other studies did not account for aggressive interference by dominants while testing. Results of this study suggest that the mere presence of a dominant individualdoes not necessarily affect performance on a cognitive task, but rather the imminence of physical aggression is the most important factor influencing testing in a social context.