Biometry and fetal weight estimation by two-dimensional and three-dimensional ultrasonography: an intraobserver and interobserver reliability and agreement study

Objective To evaluate and compare the intraobserver and interobserver reliability and agreement for the biparietal diameter (BPD), abdominal circumference (AC), femur length (FL) and estimated fetal weight (EFW) obtained by two-dimensional ultrasound (2D-US) and three-dimensional ultrasound (3D-US). Methods Singleton pregnant women between 24 and 40 weeks were invited to participate in this study. They were examined using 2D-US in a blinded manner, twice by one observer, intercalated by a scan by a second observer, to determine BPD, AC and FL. In each of the three examinations, three 3D-US datasets (head, abdomen and thigh) were acquired for measurements of the same parameters. We determined EFW using Hadlock's formula. Systematic errors between 3D-US and 2D-US were examined using the paired t-test. Reliability and agreement were assessed by intraclass correlation coefficients (ICCs), limits of agreement (LoA), SD of differences and proportion of differences below arbitrary points. Results We evaluated 102 singleton pregnancies. No significant systematic error between 2D-US and 3D-US was observed. The ICC values were higher for 3D-US in both intra- and interobserver evaluations; however, only for FL was there no overlap in the 95% CI. The LoA values were wider for 2D-US, suggesting that random errors were smaller when using 3D-US. Additionally, we observed that the SD values determined from 3D-US differences were smaller than those obtained for 2D-US. Higher proportions of differences were below the arbitrarily defined cut-off points when using 3D-US. Conclusion 3D-US improved the reliability and agreement of fetal measurements and EFW compared with 2D-US.

Politiche di sviluppo e questione etnica. La cooperazione italiana IN Bosnia Erzegovina

The globalization process of the last twenty years has changed the world through international flows of people, policies and practices. International cooperation to development is a part of that process and brought International Organizations (IOs) and Non Governmental Organizations (NGOs) from the West to the rest of the world. In my thesis I analyze the Italian NGOs that worked in Bosnia Herzegovina (BH) to understand which development projects they realized and how they faced the ethnic issue that characterized BH. I consider the relation shaped between Italian NGOs and Bosnian civil society as an object of ethnic interests. In BH, once part of former Yugoslavia, the transition from the communist regime to a democratic country has not been completed. BH’s social conditions are characterized by strong ethnic divisions. The legacy of the early 1990s crisis was a phenomenon of ethnic identities created before the war and that still endure today. The Dayton Peace Agreement signed in 1995 granted the peace and reinforced the inter-ethnic hate between the newly recognized three principal ethnicities: Serbs, Croats and Bosniak. Through the new constitution, the institutions were characterized by division at every level, from the top to the bottom of society. Besides it was the first constitution ever written and signed outside the own country; that was the root of the state of exception that characterized BH. Thus ethnic identities culture survived through the international political involvement. At the same time ethnic groups that dominated the political debate clashed with the international organization’s democratic purpose to build a multicultural and democratic state. Ethnic and also religious differences were the instruments for a national statement that might cause the transition and development projects failure. Fifteen years later social fragmentation was still present and it established an atmosphere of daily cultural violence. Civil society suffered this condition and attended to recreate the ethnic fragmentation in every day life. Some cities became physically divided and other cities don’t tolerated the minority presence. In rural areas, the division was more explicit, from village to village, without integration. In my speech, the anthropology for development – the derivative study from applied anthropology – constitutes the point of view that I used to understand how ethnic identities still influenced the development process in BH. I done ethnographic research about the Italian cooperation for development projects that were working there in 2007. The target of research were the Italian NGOs that created a relation with Bosnian civil society; they were almost twenty divided in four main field of competences: institutional building, education, agriculture and democratization. I assumed that NGOs work needed a deep study because the bottom of society is the place where people could really change their representation and behavior. Italian NGOs operated in BH with the aim of creating sustainable development. They found cultural barricade that both institutions and civil society erected when development projects have been applied. Ethnic and religious differences were stressed to maintain boundaries and fragmented power. Thus NGOs tried to negotiate development projects by social integration. I found that NGOs worked among ethnic groups by pursuing a new integration. They often gained success among people; civil society was ready to accept development projects and overcome differences. On the other hand NGOs have been limited by political level that sustained the ethnic talk and by their representation of Bosnian issue. Thus development policies have been impeded by ethnic issue and by cooperation practices established on a top down perspective. Paradoxically, since international community has approved the political ethnic division within DPA, then the willing of development followed by funding NGOs cooperation projects was not completely successful.

Il filo di Arianna - Una ricerca multi ed interdisciplinare per il superamento degli handicap che la x fragile propone

Il seguente lavoro di tesi verte sulla ricerca-azione formazione triennale “Il Filo di Arianna” realizzata in convenzione tra Associazione Italiana Sindrome X Fragile e Dipartimento Di Scienze dell’Educazione – Università di Bologna, finalizzata alla superamento degli handicap che la X fragile propone. La ricerca ha un fuoco in Pedagogia Speciale e un carattere multidisciplinare e inter istituzionale grazie alla sinergia con l’area neuroriabilitativa (Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Pisana di Roma) e l’area della Psicologia Clinica (Ospedale Bambin Gesù di Roma). Il lavoro di tesi descrive il percorso per giungere alle linee guida di intervento scaturite dalla ricerca, per il potenziamento cognitivo ed affettivo di bambini e persone con x fragile nei contesti di casa, scuola e tempo libero.

Demokratie, good governance und Entwicklung: Eine quantitative Analyse für 191 Staaten im Zeitraum 1996 bis 2005

Das Jahr 1989 markiert nicht nur den Beginn entscheidender geopolitischer Veränderungen, sondern gleichzeitig den Ursprung eines bedeutsamen Wandels in der internationalen Entwicklungszusammenarbeit. Mit der viel beachteten Studie ‚Sub-Saharan Africa – From Crisis to Sustainable Growth’ initiierte die Weltbank eine Debatte über die Relevanz institutioneller Faktoren für wirtschaftliche Entwicklung, die in den folgenden Jahren unter dem Titel ‚Good Governance’ erhebliche Bedeutung erlangte. Nahezu alle zentralen Akteure begannen, entsprechende Aspekte in ihrer praktischen Arbeit zu berücksichtigen, und entwickelten eigene Konzepte zu dieser Thematik. Wenn auch mit der Konzentration auf Institutionen als Entwicklungsdeterminanten eine grundlegende Gemeinsamkeit der Ansätze festzustellen ist, unterscheiden sie sich jedoch erheblich im Hinblick auf die Einbeziehung politischer Faktoren, so dass von einem einheitlichen Verständnis von ‚Good Governance’ nicht gesprochen werden kann. Während die meisten bilateralen Akteure sowie DAC und UNDP Demokratie und Menschenrechte explizit als zentrale Bestandteile betrachten, identifiziert die Weltbank einen Kern von Good Governance, der unabhängig von der Herrschaftsform, also sowohl in Demokratien wie auch in Autokratien, verwirklicht werden kann. Die Implikationen dieser Feststellung sind weit reichend. Zunächst erlaubt erst diese Sichtweise der Bank überhaupt, entsprechende Aspekte aufzugreifen, da ihr eine Berücksichtigung politischer Faktoren durch ihre Statuten verboten ist. Bedeutsamer ist allerdings, dass die Behauptung der Trennbarkeit von Good Governance und der Form politischer Herrschaft die Möglichkeit eröffnet, Entwicklung zu erreichen ohne eine demokratische Ordnung zu etablieren, da folglich autokratische Systeme in gleicher Weise wie Demokratien in der Lage sind, die institutionellen Voraussetzungen zu verwirklichen, welche als zentrale Determinanten für wirtschaftlichen Fortschritt identifiziert wurden. Damit entfällt nicht nur ein bedeutsamer Rechtfertigungsgrund für demokratische Herrschaft als solche, sondern rekurrierend auf bestimmte, dieser zu attestierende, entwicklungshemmende Charakteristika können Autokratien nun möglicherweise als überlegene Herrschaftsform verstanden werden, da sie durch jene nicht gekennzeichnet sind. Die Schlussfolgerungen der Weltbank unterstützen somit auch die vor allem im Zusammenhang mit der Erfolgsgeschichte der ostasiatischen Tigerstaaten vertretene Idee der Entwicklungsdiktatur, die heute mit dem Aufstieg der Volksrepublik China eine Renaissance erlebt. Der wirtschaftliche Erfolg dieser Staaten ist danach auf die überlegene Handlungsfähigkeit autokratischer Systeme zurückzuführen, während Demokratien aufgrund der Verantwortlichkeitsbeziehungen zwischen Regierenden und Regierten nicht in der Lage sind, die notwendigen Entscheidungen zu treffen und durchzusetzen. Die dargestellte Sichtweise der Weltbank ist allerdings von verschiedenen Autoren in Zweifel gezogen worden, die auch für ein im Wesentlichen auf technische Elemente beschränktes Good Governance-Konzept einen Zusammenhang mit der Form politischer Herrschaft erkennen. So wird beispielsweise vertreten, das Konzept der Bank bewege sich ausdrücklich nicht in einem systemneutralen Vakuum, sondern propagiere zumindest implizit die Etablierung demokratischer Regierungsformen. Im Übrigen steht die aus den Annahmen der Weltbank neuerlich abgeleitete Idee der Entwicklungsdiktatur in einem erheblichen Widerspruch zu der von multilateralen wie bilateralen Akteuren verstärkt verfolgten Förderung demokratischer Herrschaft als Mittel für wirtschaftliche Entwicklung sowie der fortschreitenden Verbreitung der Demokratie. Besteht nun doch ein Einfluss der Herrschaftsform auf die Verwirklichung von Good Governance als zentraler Entwicklungsdeterminante und kann zudem davon ausgegangen werden, dass Demokratien diesbezüglich Vorteile besitzen, dann ist eine Entwicklungsdiktatur keine denkbare Möglichkeit, sondern im Gegenteil demokratische Herrschaft der gebotene Weg zu wirtschaftlichem Wachstum bzw. einer Verbesserung der Lebensverhältnisse. Aufgrund der mit den Schlussfolgerungen der Weltbank verbundenen bedeutsamen Implikationen und der bisher weitestgehend fehlenden ausführlichen Thematisierung dieses Gegenstands in der Literatur ist eine detaillierte theoretische Betrachtung der Zusammenhänge zwischen den zentralen Elementen von Good Governance und demokratischer Herrschaft notwendig. Darüber hinaus sollen die angesprochenen Beziehungen auch einer empirischen Analyse unterzogen werden. Gegenstand dieser Arbeit ist deshalb die Fragestellung, ob Good Governance eine von demokratischer Herrschaft theoretisch und empirisch unabhängige Entwicklungsstrategie darstellt.

Institutional Processes and Discursive Strategies: Rhetoric and Vocabulary Analysis of CSR and Sustainability

The candidate tackled an important issue in contemporary management: the role of CSR and Sustainability. The research proposal focused on a longitudinal and inductive research, directed to specify the evolution of CSR and contribute to the new institutional theory, in particular institutional work framework, and to the relation between institutions and discourse analysis. The documental analysis covers all the evolution of CSR, focusing also on a number of important networks and associations. Some of the methodologies employed in the thesis have been employed as a consequence of data analysis, in a truly inductive research process. The thesis is composed by two section. The first section mainly describes the research process and the analyses results. The candidates employed several research methods: a longitudinal content analysis of documents, a vocabulary research with statistical metrics as cluster analysis and factor analysis, a rhetorical analysis of justifications. The second section puts in relation the analysis results with theoretical frameworks and contributions. The candidate confronted with several frameworks: Actor-Network-Theory, Institutional work and Boundary Work, Institutional Logic. Chapters are focused on different issues: a historical reconstruction of CSR; a reflection about symbolic adoption of recurrent labels; two case studies of Italian networks, in order to confront institutional and boundary works; a theoretical model of institutional change based on contradiction and institutional complexity; the application of the model to CSR and Sustainability, proposing Sustainability as a possible institutional logic.

Institutional Complexity and Technology Transfer: A Theoretical and Empirical Analysis

This Doctoral Thesis unfolds into a collection of three distinct papers that share an interest in institutional theory and technology transfer. Taking into account that organizations are increasingly exposed to a multiplicity of demands and pressures, we aim to analyze what renders this situation of institutional complexity more or less difficult to manage for organizations, and what makes organizations more or less successful in responding to it. The three studies offer a novel contribution both theoretically and empirically. In particular, the first paper “The dimensions of organizational fields for understanding institutional complexity: A theoretical framework” is a theoretical contribution that tries to better understand the relationship between institutional complexity and fields by providing a framework. The second article “Beyond institutional complexity: The case of different organizational successes in confronting multiple institutional logics” is an empirical study which aims to explore the strategies that allow organizations facing multiple logics to respond more successfully to them. The third work “ How external support may mitigate the barriers to university-industry collaboration” is oriented towards practitioners and presents a case study about technology transfer in Italy.

A threshold hypothesis of institutional change: collective action in the Italian Alps during the 13th - 19th centuries.

This dissertation is about collective action issues in common property resources. Its focus is the “threshold hypothesis,” which posits the existence of a threshold in group size that drives the process of institutional change. This hypothesis is tested using a six-century dataset concerning the management of the commons by hundreds of communities in the Italian Alps. The analysis seeks to determine the group size threshold and the institutional changes that occur when groups cross this threshold. There are five main findings. First, the number of individuals in villages remained stable for six centuries, despite the population in the region tripling in the same period. Second, the longitudinal analysis of face-to-face assemblies and community size led to the empirical identification of a threshold size that triggered the transition from informal to more formal regimes to manage common property resources. Third, when groups increased in size, gradual organizational changes took place: large groups split into independent subgroups or structured interactions into multiple layers while maintaining a single formal organization. Fourth, resource heterogeneity seemed to have had no significant impact on various institutional characteristics. Fifth, social heterogeneity showed statistically significant impacts, especially on institutional complexity, consensus, and the relative importance of governance rules versus resource management rules. Overall, the empirical evidence from this research supports the “threshold hypothesis.” These findings shed light on the rationale of institutional change in common property regimes, and clarify the mechanisms of collective action in traditional societies. Further research may generalize these conclusions to other domains of collective action and to present-day applications.

Whole brain radiotherapy with a conformational external beam radiation boost for lung cancer patients with 1-3 brain metastasis: a multi institutional study

To determine the outcome of patients with brain metastasis (BM) from lung cancer treated with an external beam radiotherapy boost (RTB) after whole brain radiotherapy (WBRT).

Excellent agreement between genetic and hydrogen breath tests for lactase deficiency and the role of extended symptom assessment

Clinical manifestations of lactase (LCT) deficiency include intestinal and extra-intestinal symptoms. Lactose hydrogen breath test (H2-BT) is considered the gold standard to evaluate LCT deficiency (LD). Recently, the single-nucleotide polymorphism C/T(-13910) has been associated with LD. The objectives of the present study were to evaluate the agreement between genetic testing of LCT C/T(-13910) and lactose H2-BT, and the diagnostic value of extended symptom assessment. Of the 201 patients included in the study, 194 (139 females; mean age 38, range 17-79 years, and 55 males, mean age 38, range 18-68 years) patients with clinical suspicion of LD underwent a 3-4 h H2-BT and genetic testing for LCT C/T(-13910). Patients rated five intestinal and four extra-intestinal symptoms during the H2-BT and then at home for the following 48 h. Declaring H2-BT as the gold standard, the CC(-13910) genotype had a sensitivity of 97% and a specificity of 95% with a of 0.9 in diagnosing LCT deficiency. Patients with LD had more intense intestinal symptoms 4 h following the lactose challenge included in the H2-BT. We found no difference in the intensity of extra-intestinal symptoms between patients with and without LD. Symptom assessment yielded differences for intestinal symptoms abdominal pain, bloating, borborygmi and diarrhoea between 120 min and 4 h after oral lactose challenge. Extra-intestinal symptoms (dizziness, headache and myalgia) and extension of symptom assessment up to 48 h did not consistently show different results. In conclusion, genetic testing has an excellent agreement with the standard lactose H2-BT, and it may replace breath testing for the diagnosis of LD. Extended symptom scores and assessment of extra-intestinal symptoms have limited diagnostic value in the evaluation of LD.

Surgery for complications of trans-catheter closure of atrial septal defects: a multi-institutional study from the European Congenital Heart Surgeons Association

This study aims to analyse the collective experience of participating European Congenital Heart Surgeons Association centres in the surgical management of complications resulting from trans-catheter closure of atrial septal defects (ASDs).