Body packing by rectal insertion of cocaine packets: a case report

Background: Body packing is used for international drug transport, immediate drug concealment during a police searching or introducing drugs inside prisons. Despite the high level of specialization of dealers who have started to manufacture more complex packs, up to 5% of patients could develop intoxication due to pack rupture. Bowel obstruction is another acute complication. Case presentation: A 27-year-old black male patient was sent to the hospital by court order for clinical evaluation and toxicological examination. The patient was conscious, oriented, had good color, normal arterial pressure and heart rate, and no signs of acute intoxication. Abdominal examination revealed discrete pain upon deep palpation and a small mass in the left iliac fossa. A plain abdominal radiograph revealed several oval structures located in the rectum and sigmoid. Fasting and a 50 g dose of activated charcoal every six hours were prescribed. After three days, the patient spontaneously evacuated 28 cocaine packs. Conclusion: Adequate clinical management and prompt identification of potential complications are of fundamental importance in dealing with body packing.

The Evolution of Diet and Microhabitat Use in Pseudoboine Snakes

Reflecting their exceptional radiation, snakes occur in different habitats and microhabitats and are able to eat numerous types of prey. The availability of good and comprehensive phylogenies for different snake’s lineages together with natural history data provides an opportunity to explore how ecological traits diversified during their radiation. In the present study, we describe the diet and microhabitat variation (arboreal or non-arboreal) in the tribe Pseudoboini and explore how these traits evolved during the tribe’s diversification. We analyzed specimens deposited in scientific collections and gathered information on diet and microhabitat use available in the literature and provided by other researchers. We also mapped diet and microhabitat data onto a phylogeny of the tribe using the principle of parsimony. Pseudoboine snakes feed mainly on lizards and small mammals, and of the 22 species for which a minimum number of prey records was obtained, nine are diet generalists, six are lizard specialists, three are small mammal specialists, two are snake specialists, one is a lizard egg specialist, and one is a bird egg specialist. The highly diverse feeding habits of pseudoboines seem to have evolved mainly in the terminal taxa. Among those species that had enough microhabitat data (17 species), Drepanoides anomalus, Siphlophis cervinus, S. compressus, and S. pulcher frequently use the vegetation. Our results indicate that an increase in arboreality evolved several times during the diversification of the tribe, and that the Siphlophis clade seems to have maintained the high degree of arboreality from its ancestor. Species that frequently use vegetation are either lizard or lizard egg specialists, indicating that these habits might be associated in the evolution of pseudoboines.

Analysis of genetic lineages and their correlation with virulence genes in enterococcus faecalis clinical isolates from root canal and systemic infections

Introduction: Enterococcus faecalis is a member of the mammalian gastrointestinal microbiota but has been considered a leading cause of hospital-acquired infections. In the oral cavity, it is commonly detected from root canals of teeth with failed endodontic treatment. However, little is known about the virulence and genetic relatedness among E. faecalis isolates from different clinical sources. This study compared the presence of enterococcal virulence factors among root canal strains and clinical isolates from hospitalized patients to identify virulent clusters of E. faecalis. Methods: Multilocus sequence typing analysis was used to determine genetic lineages of 40 E. faecalis clinical isolates from different sources. Virulence clusters were determined by evaluating capsule (cps) locus polymorphisms, pathogenicity island gene content, and antibiotic resistance genes by polymerase chain reaction. Results: The clinical isolates from hospitalized patients formed a phylogenetically separate group and were mostly grouped in the clonal complex 2, which is a known virulent cluster of E. faecalis that has caused infection outbreaks globally. The clonal complex 2 group comprised capsule-producing strains harboring multiple antibiotic resistance and pathogenicity island genes. On the other hand, the endodontic isolates were more diverse and harbored few virulence and antibiotic resistance genes. In particular, although more closely related to isolates from hospitalized patients, capsuleproducing E. faecalis strains from root canals did not carry more virulence/antibiotic genes than other endodontic isolates. Conclusions: E. faecalis isolates from endodontic infections have a genetic and virulence profile different from pathogenic clusters of hospitalized patients’ isolates, which is most likely due to niche specialization conferred mainly by variable regions in the genome.

O comportamento de instrução dos trinadores de jovens de futebol em competição

[POR] O objetivo deste estudo centra-se na análise do comportamento de instrução dos treinadores de jovens em competição. O segundo objetivo é efetuar a comparação entre treinadores que orientam equipas na etapa direção (n=6) e especialização (n=3) da formação de jovens jogadores. Os nove treinadores observados, dirigiam equipas de juniores “A” (17-18 anos), “B” (15-16 anos) e “C” (13-14 anos).

Strutture a pareti portanti in C. A. caratterizzate da elevate prestazioni sismiche

Per quanto riguarda le costruzioni in conglomerato cementizio armato gettato in opera, i sistemi strutturali più comunemente utilizzati sono quelli a telaio (con trasmissione di momento flettente), a setti portanti o una combinazione di entrambi. A partire dagli anni ’60, numerosissimi sono stati gli studi relativamente al comportamento sismico di strutture in c.a. a telaio. Lo stesso si può affermare per le costruzioni costituite da pareti miste a telai. In particolare, l’argomento della progettazione sismica di tali tipologie di edifici ha sempre riguardato soprattutto gli edifici alti nei quali, evidentemente, l’impiego delle pareti avveniva allo scopo di limitarne la elevata deformabilità. Il comportamento sismico di strutture realizzate interamente a pareti portanti in c.a. è stato meno studiato negli anni, nonostante si sia osservato che edifici realizzati mediante tali sistemi strutturali abbiano mostrato, in generale, pregevoli risorse di resistenza nei confronti di terremoti anche di elevata intensità. Negli ultimi 10 anni, l’ingegneria sismica si sta incentrando sull’approfondimento delle risorse di tipologie costruttive di cui si è sempre fatto largo uso in passato (tipicamente nei paesi dell’Europa continentale, in America latina, negli USA e anche in Italia), ma delle quali mancavano adeguate conoscenze scientifiche relativamente al loro comportamento in zona sismica. Tali tipologie riguardano sostanzialmente sistemi strutturali interamente costituiti da pareti portanti in c.a. per edifici di modesta altezza, usualmente utilizzati in un’edilizia caratterizzata da ridotti costi di realizzazione (fabbricati per abitazioni civili e/o uffici). Obiettivo “generale” del lavoro di ricerca qui presentato è lo studio del comportamento sismico di strutture realizzate interamente a setti portanti in c.a. e di modesta altezza (edilizia caratterizzata da ridotti costi di realizzazione). In particolare, le pareti che si intendono qui studiare sono caratterizzate da basse percentuali geometriche di armatura e sono realizzate secondo la tecnologia del cassero a perdere. A conoscenza dello scrivente, non sono mai stati realizzati, fino ad oggi, studi sperimentali ed analitici allo scopo di determinare il comportamento sismico di tali sistemi strutturali, mentre è ben noto il loro comportamento statico. In dettaglio, questo lavoro di ricerca ha il duplice scopo di: • ottenere un sistema strutturale caratterizzato da elevate prestazioni sismiche; • mettere a punto strumenti applicativi (congruenti e compatibili con le vigenti normative e dunque immediatamente utilizzabili dai progettisti) per la progettazione sismica dei pannelli portanti in c.a. oggetto del presente studio. Al fine di studiare il comportamento sismico e di individuare gli strumenti pratici per la progettazione, la ricerca è stata organizzata come segue: • identificazione delle caratteristiche delle strutture studiate, mediante lo sviluppo/specializzazione di opportune formulazioni analitiche; • progettazione, supervisione, ed interpretazione di una estesa campagna di prove sperimentali eseguita su pareti portanti in c.a. in vera grandezza, al fine di verificarne l’efficace comportamento sotto carico ciclico; • sviluppo di semplici indicazioni (regole) progettuali relativamente alle strutture a pareti in c.a. studiate, al fine di ottenere le caratteristiche prestazionali desiderate. I risultati delle prove sperimentali hanno mostrato di essere in accordo con le previsioni analitiche, a conferma della validità degli strumenti di predizione del comportamento di tali pannelli. Le elevatissime prestazioni riscontrate sia in termini di resistenza che in termini di duttilità hanno evidenziato come le strutture studiate, così messe a punto, abbiano manifestato un comportamento sismico più che soddisfacente.

Knowledge Flows and Networks: the Interplay between Local and Global Linkages within Bangalore IT Cluster

This doctoral work gains deeper insight into the dynamics of knowledge flows within and across clusters, unfolding their features, directions and strategic implications. Alliances, networks and personnel mobility are acknowledged as the three main channels of inter-firm knowledge flows, thus offering three heterogeneous measures to analyze the phenomenon. The interplay between the three channels and the richness of available research methods, has allowed for the elaboration of three different papers and perspectives. The common empirical setting is the IT cluster in Bangalore, for its distinguished features as a high-tech cluster and for its steady yearly two-digit growth around the service-based business model. The first paper deploys both a firm-level and a tie-level analysis, exploring the cases of 4 domestic companies and of 2 MNCs active the cluster, according to a cluster-based perspective. The distinction between business-domain knowledge and technical knowledge emerges from the qualitative evidence, further confirmed by quantitative analyses at tie-level. At firm-level, the specialization degree seems to be influencing the kind of knowledge shared, while at tie-level both the frequency of interaction and the governance mode prove to determine differences in the distribution of knowledge flows. The second paper zooms out and considers the inter-firm networks; particularly focusing on the role of cluster boundary, internal and external networks are analyzed, in their size, long-term orientation and exploration degree. The research method is purely qualitative and allows for the observation of the evolving strategic role of internal network: from exploitation-based to exploration-based. Moreover, a causal pattern is emphasized, linking the evolution and features of the external network to the evolution and features of internal network. The final paper addresses the softer and more micro-level side of knowledge flows: personnel mobility. A social capital perspective is here developed, which considers both employees’ acquisition and employees’ loss as building inter-firm ties, thus enhancing company’s overall social capital. Negative binomial regression analyses at dyad-level test the significant impact of cluster affiliation (cluster firms vs non-cluster firms), industry affiliation (IT firms vs non-IT fims) and foreign affiliation (MNCs vs domestic firms) in shaping the uneven distribution of personnel mobility, and thus of knowledge flows, among companies.

Identificazione di un QTL principale per resistenza a ruggine bruna sul cromosoma 7B di frumento duro

Leaf rust caused by Puccinia triticina is a serious disease of durum wheat (Triticum durum) worldwide. However, genetic and molecular mapping studies aimed at characterizing leaf rust resistance genes in durum wheat have been only recently undertaken. The Italian durum wheat cv. Creso shows a high level of resistance to P. triticina that has been considered durable and that appears to be due to a combination of a single dominant gene and one or more additional factors conferring partial resistance. In this study, the genetic basis of leaf rust resistance carried by Creso was investigated using 176 recombinant inbred lines (RILs) from the cross between the cv. Colosseo (C, leaf rust resistance donor) and Lloyd (L, susceptible parent). Colosseo is a cv. directly related to Creso with the leaf rust resistance phenotype inherited from Creso, and was considered as resistance donor because of its better adaptation to local (Emilia Romagna, Italy) cultivation environment. RILs have been artificially inoculated with a mixture of 16 Italian P. triticina isolates that were characterized for virulence to seedlings of 22 common wheat cv. Thatcher isolines each carrying a different leaf rust resistance gene, and for molecular genotypes at 15 simple sequence repeat (SSR) loci, in order to determine their specialization with regard to the host species. The characterization of the leaf rust isolates was conducted at the Cereal Disease Laboratory of the University of Minnesota (St. Paul, USA) (Chapter 2). A genetic linkage map was constructed using segregation data from the population of 176 RILs from the cross CL. A total of 662 loci, including 162 simple sequence repeats (SSRs) and 500 Diversity Arrays Technology markers (DArTs), were analyzed by means of the package EasyMap 0.1. The integrated SSR-DArT linkage map consisted of 554 loci (162 SSR and 392 DArT markers) grouped into 19 linkage blocks with an average marker density of 5.7 cM/marker. The final map spanned a total of 2022 cM, which correspond to a tetraploid genome (AABB) coverage of ca. 77% (Chapter 3). The RIL population was phenotyped for their resistance to leaf rust under artificial inoculation in 2006; the percentage of infected leaf area (LRS, leaf rust susceptibility) was evaluated at three stages through the disease developmental cycle and the area under disease progress curve (AUDPC) was then calculated. The response at the seedling stage (infection type, IT) was also investigated. QTL analysis was carried out by means of the Composite Interval Mapping method based on a selection of markers from the CL map. A major QTL (QLr.ubo-7B.2) for leaf rust resistance controlling both the seedling and the adult plant response, was mapped on the distal region of chromosome arm 7BL (deletion bin 7BL10-0.78-1.00), in a gene-dense region known to carry several genes/QTLs for resistance to rusts and other major cereal fungal diseases in wheat and barley. QLr.ubo-7B.2 was identified within a supporting interval of ca. 5 cM tightly associated with three SSR markers (Xbarc340.2, Xgwm146 e Xgwm344.2), and showed an R2 and an LOD peak value for the AUDPC equal to 72.9% an 44.5, respectively. Three additional minor QTLs were also detected (QLr.ubo-7B.1 on chr. 7BS; QLr.ubo-2A on chr. 2AL and QLr.ubo-3A on chr. 3AS) (Chapter 4). The presence of the major QTL (QLr.ubo-7B.2) was validated by a linkage disequilibrium (LD)-based test using field data from two different plant materials: i) a set of 62 advanced lines from multiple crosses involving Creso and his directly related resistance derivates Colosseo and Plinio, and ii) a panel of 164 elite durum wheat accessions representative of the major durum breeding program of the Mediterranean basin. Lines and accessions were phenotyped for leaf rust resistance under artificial inoculation in two different field trials carried out at Argelato (BO, Italy) in 2006 and 2007; the durum elite accessions were also evaluated in two additional field experiments in Obregon (Messico; 2007 and 2008) and in a green-house experiment (seedling resistance) at the Cereal Disease Laboratory (St. Paul, USA, 2008). The molecular characterization involved 14 SSR markers mapping on the 7BL chromosome region found to harbour the major QTL. Association analysis was then performed with a mixed-linear-model approach. Results confirmed the presence of a major QTL for leaf rust resistance, both at adult plant and at seedling stage, located between markers Xbarc340.2, Xgwm146 and Xgwm344.2, in an interval that coincides with the supporting interval (LOD-2) of QLr.ubo-7B.2 as resulted from the RIL QTL analysis. (Chapter 5). The identification and mapping of the major QTL associated to the durable leaf rust resistance carried by Creso, together with the identification of the associated SSR markers, will enhance the selection efficiency in durum wheat breeding programs (MAS, Marker Assisted Selection) and will accelerate the release of cvs. with durable resistance through marker-assisted pyramiding of the tagged resistance genes/QTLs most effective against wheat fungal pathogens.

Technical innovations for the diagnosis and the rehabilitation of motor and perceptive impairments of the child with Cerebral Palsy

The treatment of the Cerebral Palsy (CP) is considered as the “core problem” for the whole field of the pediatric rehabilitation. The reason why this pathology has such a primary role, can be ascribed to two main aspects. First of all CP is the form of disability most frequent in childhood (one new case per 500 birth alive, (1)), secondarily the functional recovery of the “spastic” child is, historically, the clinical field in which the majority of the therapeutic methods and techniques (physiotherapy, orthotic, pharmacologic, orthopedic-surgical, neurosurgical) were first applied and tested. The currently accepted definition of CP – Group of disorders of the development of movement and posture causing activity limitation (2) – is the result of a recent update by the World Health Organization to the language of the International Classification of Functioning Disability and Health, from the original proposal of Ingram – A persistent but not unchangeable disorder of posture and movement – dated 1955 (3). This definition considers CP as a permanent ailment, i.e. a “fixed” condition, that however can be modified both functionally and structurally by means of child spontaneous evolution and treatments carried out during childhood. The lesion that causes the palsy, happens in a structurally immature brain in the pre-, peri- or post-birth period (but only during the firsts months of life). The most frequent causes of CP are: prematurity, insufficient cerebral perfusion, arterial haemorrhage, venous infarction, hypoxia caused by various origin (for example from the ingestion of amniotic liquid), malnutrition, infection and maternal or fetal poisoning. In addition to these causes, traumas and malformations have to be included. The lesion, whether focused or spread over the nervous system, impairs the whole functioning of the Central Nervous System (CNS). As a consequence, they affect the construction of the adaptive functions (4), first of all posture control, locomotion and manipulation. The palsy itself does not vary over time, however it assumes an unavoidable “evolutionary” feature when during growth the child is requested to meet new and different needs through the construction of new and different functions. It is essential to consider that clinically CP is not only a direct expression of structural impairment, that is of etiology, pathogenesis and lesion timing, but it is mainly the manifestation of the path followed by the CNS to “re”-construct the adaptive functions “despite” the presence of the damage. “Palsy” is “the form of the function that is implemented by an individual whose CNS has been damaged in order to satisfy the demands coming from the environment” (4). Therefore it is only possible to establish general relations between lesion site, nature and size, and palsy and recovery processes. It is quite common to observe that children with very similar neuroimaging can have very different clinical manifestations of CP and, on the other hand, children with very similar motor behaviors can have completely different lesion histories. A very clear example of this is represented by hemiplegic forms, which show bilateral hemispheric lesions in a high percentage of cases. The first section of this thesis is aimed at guiding the interpretation of CP. First of all the issue of the detection of the palsy is treated from historical viewpoint. Consequently, an extended analysis of the current definition of CP, as internationally accepted, is provided. The definition is then outlined in terms of a space dimension and then of a time dimension, hence it is highlighted where this definition is unacceptably lacking. The last part of the first section further stresses the importance of shifting from the traditional concept of CP as a palsy of development (defect analysis) towards the notion of development of palsy, i.e., as the product of the relationship that the individual however tries to dynamically build with the surrounding environment (resource semeiotics) starting and growing from a different availability of resources, needs, dreams, rights and duties (4). In the scientific and clinic community no common classification system of CP has so far been universally accepted. Besides, no standard operative method or technique have been acknowledged to effectively assess the different disabilities and impairments exhibited by children with CP. CP is still “an artificial concept, comprising several causes and clinical syndromes that have been grouped together for a convenience of management” (5). The lack of standard and common protocols able to effectively diagnose the palsy, and as a consequence to establish specific treatments and prognosis, is mainly because of the difficulty to elevate this field to a level based on scientific evidence. A solution aimed at overcoming the current incomplete treatment of CP children is represented by the clinical systematic adoption of objective tools able to measure motor defects and movement impairments. A widespread application of reliable instruments and techniques able to objectively evaluate both the form of the palsy (diagnosis) and the efficacy of the treatments provided (prognosis), constitutes a valuable method able to validate care protocols, establish the efficacy of classification systems and assess the validity of definitions. Since the ‘80s, instruments specifically oriented to the analysis of the human movement have been advantageously designed and applied in the context of CP with the aim of measuring motor deficits and, especially, gait deviations. The gait analysis (GA) technique has been increasingly used over the years to assess, analyze, classify, and support the process of clinical decisions making, allowing for a complete investigation of gait with an increased temporal and spatial resolution. GA has provided a basis for improving the outcome of surgical and nonsurgical treatments and for introducing a new modus operandi in the identification of defects and functional adaptations to the musculoskeletal disorders. Historically, the first laboratories set up for gait analysis developed their own protocol (set of procedures for data collection and for data reduction) independently, according to performances of the technologies available at that time. In particular, the stereophotogrammetric systems mainly based on optoelectronic technology, soon became a gold-standard for motion analysis. They have been successfully applied especially for scientific purposes. Nowadays the optoelectronic systems have significantly improved their performances in term of spatial and temporal resolution, however many laboratories continue to use the protocols designed on the technology available in the ‘70s and now out-of-date. Furthermore, these protocols are not coherent both for the biomechanical models and for the adopted collection procedures. In spite of these differences, GA data are shared, exchanged and interpreted irrespectively to the adopted protocol without a full awareness to what extent these protocols are compatible and comparable with each other. Following the extraordinary advances in computer science and electronics, new systems for GA no longer based on optoelectronic technology, are now becoming available. They are the Inertial and Magnetic Measurement Systems (IMMSs), based on miniature MEMS (Microelectromechanical systems) inertial sensor technology. These systems are cost effective, wearable and fully portable motion analysis systems, these features gives IMMSs the potential to be used both outside specialized laboratories and to consecutive collect series of tens of gait cycles. The recognition and selection of the most representative gait cycle is then easier and more reliable especially in CP children, considering their relevant gait cycle variability. The second section of this thesis is focused on GA. In particular, it is firstly aimed at examining the differences among five most representative GA protocols in order to assess the state of the art with respect to the inter-protocol variability. The design of a new protocol is then proposed and presented with the aim of achieving gait analysis on CP children by means of IMMS. The protocol, named ‘Outwalk’, contains original and innovative solutions oriented at obtaining joint kinematic with calibration procedures extremely comfortable for the patients. The results of a first in-vivo validation of Outwalk on healthy subjects are then provided. In particular, this study was carried out by comparing Outwalk used in combination with an IMMS with respect to a reference protocol and an optoelectronic system. In order to set a more accurate and precise comparison of the systems and the protocols, ad hoc methods were designed and an original formulation of the statistical parameter coefficient of multiple correlation was developed and effectively applied. On the basis of the experimental design proposed for the validation on healthy subjects, a first assessment of Outwalk, together with an IMMS, was also carried out on CP children. The third section of this thesis is dedicated to the treatment of walking in CP children. Commonly prescribed treatments in addressing gait abnormalities in CP children include physical therapy, surgery (orthopedic and rhizotomy), and orthoses. The orthotic approach is conservative, being reversible, and widespread in many therapeutic regimes. Orthoses are used to improve the gait of children with CP, by preventing deformities, controlling joint position, and offering an effective lever for the ankle joint. Orthoses are prescribed for the additional aims of increasing walking speed, improving stability, preventing stumbling, and decreasing muscular fatigue. The ankle-foot orthosis (AFO), with a rigid ankle, are primarily designed to prevent equinus and other foot deformities with a positive effect also on more proximal joints. However, AFOs prevent the natural excursion of the tibio-tarsic joint during the second rocker, hence hampering the natural leaning progression of the whole body under the effect of the inertia (6). A new modular (submalleolar) astragalus-calcanear orthosis, named OMAC, has recently been proposed with the intention of substituting the prescription of AFOs in those CP children exhibiting a flat and valgus-pronated foot. The aim of this section is thus to present the mechanical and technical features of the OMAC by means of an accurate description of the device. In particular, the integral document of the deposited Italian patent, is provided. A preliminary validation of OMAC with respect to AFO is also reported as resulted from an experimental campaign on diplegic CP children, during a three month period, aimed at quantitatively assessing the benefit provided by the two orthoses on walking and at qualitatively evaluating the changes in the quality of life and motor abilities. As already stated, CP is universally considered as a persistent but not unchangeable disorder of posture and movement. Conversely to this definition, some clinicians (4) have recently pointed out that movement disorders may be primarily caused by the presence of perceptive disorders, where perception is not merely the acquisition of sensory information, but an active process aimed at guiding the execution of movements through the integration of sensory information properly representing the state of one’s body and of the environment. Children with perceptive impairments show an overall fear of moving and the onset of strongly unnatural walking schemes directly caused by the presence of perceptive system disorders. The fourth section of the thesis thus deals with accurately defining the perceptive impairment exhibited by diplegic CP children. A detailed description of the clinical signs revealing the presence of the perceptive impairment, and a classification scheme of the clinical aspects of perceptual disorders is provided. In the end, a functional reaching test is proposed as an instrumental test able to disclosure the perceptive impairment. References 1. Prevalence and characteristics of children with cerebral palsy in Europe. Dev Med Child Neurol. 2002 Set;44(9):633-640. 2. Bax M, Goldstein M, Rosenbaum P, Leviton A, Paneth N, Dan B, et al. Proposed definition and classification of cerebral palsy, April 2005. Dev Med Child Neurol. 2005 Ago;47(8):571-576. 3. Ingram TT. A study of cerebral palsy in the childhood population of Edinburgh. Arch. Dis. Child. 1955 Apr;30(150):85-98. 4. Ferrari A, Cioni G. The spastic forms of cerebral palsy : a guide to the assessment of adaptive functions. Milan: Springer; 2009. 5. Olney SJ, Wright MJ. Cerebral Palsy. Campbell S et al. Physical Therapy for Children. 2nd Ed. Philadelphia: Saunders. 2000;:533-570. 6. Desloovere K, Molenaers G, Van Gestel L, Huenaerts C, Van Campenhout A, Callewaert B, et al. How can push-off be preserved during use of an ankle foot orthosis in children with hemiplegia? A prospective controlled study. Gait Posture. 2006 Ott;24(2):142-151.

Diskriminationsleistungen des Schmerzsinnes und deren Korrelate in Laser-evozierten Potenzialen

In der vorliegenden Arbeit sollte die Fähigkeit untersucht werden, Schmerzreize auf der Haut zu lokalisieren und deren Intensität zu differenzieren. Während dieser Diskriminationsaufgaben wurde die elektrische Aktivität des Gehirns gemessen.Traditionell werden dem nozizeptiven System nur geringe Diskriminationsleistungen zugeschrieben. In einer ersten Versuchsreihe sollten daher die räumlichen Diskriminationsleistungen für nozizeptive und taktile Reize verglichen werden. Auf dem Handrücken konnten schmerzhaft Laserhitzereize genauso gut lokalisiert werden wie taktile Reize (von-Frey-Haar). Nur ein mechanischer Nadelreiz, der taktiles und nozizeptives System koaktivierte, konnte noch besser lokalisiert werden. In der zweiten Versuchsreihe wurden während verschiedener Diskriminationsaufgaben (räumliche Diskrimination, Intensitätsdiskrimination) und einer Ablenkungsaufgabe (mentale Arithmetik) Laser-evozierte Potenziale von der Kopfhaut abgeleitet. Eine Dipolquellenanalyse zeigte als erstes eine Aktivierung des frontalen Operculums, entsprechend einem zur Zeit noch umstrittenen Projektionsgebiet eines nozizeptiven Thalamuskerns (VMpo), gefolgt vom primären somatosensorische Kortex (SI) und dem Gyrus cinguli. Im Gegensatz zum taktilen System wurde SI signifikant später aktiviert als SII (bzw. das Operculum). Die Diskriminationsaufgaben erhöhten die Aktivität aller Quellen im Vergleich zu der Ablenkungsbedingung. Dies konnte sogar für die früheste Quelle im Operculum gezeigt werden.Die frühe sensorisch-diskriminative Komponente der Schmerzverarbeitung im Operculum zeigte eine Hemisphärenasymmetrie, mit stärkerer Aktivierung der linken Hemisphäre unabhängig von der Stimulationsseite.

Le strategie di internazionalizzazione delle imprese distrettuali: un'analisi comparata di tre diversi sistemi locali di produzione in Emilia Romagna

Since the Nineties, the process of globalization has caused a sharp increase in the real and financial integration of the worldwide economy, reducing the obstacles to international trade and minimizing the cost of transaction. The entrance of foreign firms in the domestic market has deeply modified the competitive situation of Italian enterprises, which have been forced to change their strategies in order to cope with those of the new competitors. In this scenario, internationalization is no longer one of the different strategic options available for the firm, but it becomes a forced choice to maintain or acquire a competitive advantage sustainable over time. Internationalization strategies of SMEs, however, are hindered by the shortage of financial resources and entrepreneurial skills, therefore this kind of firms tends toward light forms of foreign expansion, like export and subcontracting. Despite this, many studies have demonstrated that the district localisation increases the firms’ productivity and innovative capacity, so their competiveness both at a domestic and international level. The majority of these empirical contributions has focused mainly on the analysis of commercial flows, confirming that district enterprises reach a superior international performance compared to their external competitors. On the contrary, only few works have tried to evaluate the existence of a district effect on the firms’ ability to invest abroad, but the obtained results are not straightforward. One of the reason of these conclusions is that the phenomena has been analysed without taking into account the differences existing between districts in terms of enterprises’ dimension, diffusion of industrial groups and, above all, the sector of productive specialization, because the technological content of production could improve the innovativeness of district firms, allowing them to adopt advanced forms of internationalisation as foreign direct investments (FDI). The aim of the thesis is to further investigate the district effect on internationalisation, trough an econometric analysis of the international strategies carried out by firms localised in three different local system of production characterised by different technological specialization.

Supporting semantic web technologies in the pervasive service ecosystems middleware

Semantic Web technologies are strategic in order to fulfill the openness requirement of Self-Aware Pervasive Service Ecosystems. In fact they provide agents with the ability to cope with distributed data, using RDF to represent information, ontologies to describe relations between concepts from any domain (e.g. equivalence, specialization/extension, and so on) and reasoners to extract implicit knowledge. The aim of this thesis is to study these technologies and design an extension of a pervasive service ecosystems middleware capable of exploiting semantic power, and deepening performance implications.

Quantifying the Economics of Medical Malpractice - A View from a Civil Law Perspective

Life is full of uncertainties. Legal rules should have a clear intention, motivation and purpose in order to diminish daily uncertainties. However, practice shows that their consequences are complex and hard to predict. For instance, tort law has the general objectives of deterring future negligent behavior and compensating the victims of someone else's negligence. Achieving these goals are particularly difficult in medical malpractice cases. To start with, when patients search for medical care they are typically sick in the first place. In case harm materializes during the treatment, it might be very hard to assess if it was due to substandard medical care or to the patient's poor health conditions. Moreover, the practice of medicine has a positive externality on the society, meaning that the design of legal rules is crucial: for instance, it should not result in physicians avoiding practicing their activity just because they are afraid of being sued even when they acted according to the standard level of care. The empirical literature on medical malpractice has been developing substantially in the past two decades, with the American case being the most studied one. Evidence from civil law tradition countries is more difficult to find. The aim of this thesis is to contribute to the empirical literature on medical malpractice, using two civil law countries as a case-study: Spain and Italy. The goal of this thesis is to investigate, in the first place, some of the consequences of having two separate sub-systems (administrative and civil) coexisting within the same legal system, which is common in civil law tradition countries with a public national health system (such as Spain, France and Portugal). When this holds, different procedures might apply depending on the type of hospital where the injury took place (essentially whether it is a public hospital or a private hospital). Therefore, a patient injured in a public hospital should file a claim in administrative courts while a patient suffering an identical medical accident should file a claim in civil courts. A natural question that the reader might pose is why should both administrative and civil courts decide medical malpractice cases? Moreover, can this specialization of courts influence how judges decide medical malpractice cases? In the past few years, there was a general concern with patient safety, which is currently on the agenda of several national governments. Some initiatives have been taken at the international level, with the aim of preventing harm to patients during treatment and care. A negligently injured patient might present a claim against the health care provider with the aim of being compensated for the economic loss and for pain and suffering. In several European countries, health care is mainly provided by a public national health system, which means that if a patient harmed in a public hospital succeeds in a claim against the hospital, public expenditures increase because the State takes part in the litigation process. This poses a problem in a context of increasing national health expenditures and public debt. In Italy, with the aim of increasing patient safety, some regions implemented a monitoring system on medical malpractice claims. However, if properly implemented, this reform shall also allow for a reduction in medical malpractice insurance costs. This thesis is organized as follows. Chapter 1 provides a review of the empirical literature on medical malpractice, where studies on outcomes and merit of claims, costs and defensive medicine are presented. Chapter 2 presents an empirical analysis of medical malpractice claims arriving to the Spanish Supreme Court. The focus is on reversal rates for civil and administrative decisions. Administrative decisions appealed by the plaintiff have the highest reversal rates. The results show a bias in lower administrative courts, which tend to focus on the State side. We provide a detailed explanation for these results, which can rely on the organization of administrative judges career. Chapter 3 assesses predictors of compensation in medical malpractice cases appealed to the Spanish Supreme Court and investigates the amount of damages attributed to patients. The results show horizontal equity between administrative and civil decisions (controlling for observable case characteristics) and vertical inequity (patients suffering more severe injuries tend to receive higher payouts). In order to execute these analyses, a database of medical malpractice decisions appealed to the Administrative and Civil Chambers of the Spanish Supreme Court from 2006 until 2009 (designated by the Spanish Supreme Court Medical Malpractice Dataset (SSCMMD)) has been created. A description of how the SSCMMD was built and of the Spanish legal system is presented as well. Chapter 4 includes an empirical investigation of the effect of a monitoring system for medical malpractice claims on insurance premiums. In Italy, some regions adopted this policy in different years, while others did not. The study uses data on insurance premiums from Italian public hospitals for the years 2001-2008. This is a significant difference as most of the studies use the insurance company as unit of analysis. Although insurance premiums have risen from 2001 to 2008, the increase was lower for regions adopting a monitoring system for medical claims. Possible implications of this system are also provided. Finally, Chapter 5 discusses the main findings, describes possible future research and concludes.

Quantifying the OH radical by global scale NMHC measurements from the NOAA - ESRL cooperative flask sampling network

Summary PhD Thesis Jan Pollmann: This thesis focuses on global scale measurements of light reactive non-methane hydrocarbon (NMHC), in the volatility range from ethane to toluene with a special focus on ethane, propane, isobutane, butane, isopentane and pentane. Even though they only occur at the ppt level (nmol mol-1) in the remote troposphere these species can yield insight into key atmospheric processes. An analytical method was developed and subsequently evaluated to analyze NMHC from the NOAA – ERSL cooperative air sampling network. Potential analytical interferences through other atmospheric trace gases (water vapor and ozone) were carefully examined. The analytical parameters accuracy and precision were analyzed in detail. It was proven that more than 90% of the data points meet the Global Atmospheric Watch (GAW) data quality objective. Trace gas measurements from 28 measurement stations were used to derive the global atmospheric distribution profile for 4 NMHC (ethane, propane, isobutane, butane). A close comparison of the derived ethane data with previously published reports showed that northern hemispheric ethane background mixing ratio declined by approximately 30% since 1990. No such change was observed for southern hemispheric ethane. The NMHC data and trace gas data supplied by NOAA ESRL were used to estimate local diurnal averaged hydroxyl radical (OH) mixing ratios by variability analysis. Comparison of the variability derived OH with directly measured OH and modeled OH mixing ratios were found in good agreement outside the tropics. Tropical OH was on average two times higher than predicted by the model. Variability analysis was used to assess the effect of chlorine radicals on atmospheric oxidation chemistry. It was found that Cl is probably not of significant relevance on a global scale.

Nuovo scaffold biomimetico per il trattamento delle lesioni osteocondrali: studio clinico pilota

Nel corso degli anni diverse sono le tecniche proposte per il trattamento delle lesioni osteocondrali, da quelle mini-invasive con stimolazione midollare fino a quelle più aggressive basate sul trapianto di tessuti autologhi o eterologhi. Tutti questi metodi hanno comunque dei difetti ed è questo il motivo per cui il trattamento delle lesioni osteocondrali rappresenta tuttora una sfida per il chirurgo ortopedico, in considerazione dell’alta specializzazione e del basso potere di guarigione del tessuto cartilagineo. Buoni risultati sono stati ottenuti con innesti bioingegnerizzati o matrici polimeriche impiantati nei siti danneggiati. La quantità di scaffolds in uso per la riparazione condrale ed osteocondrale è molto ampia; essi differiscono non solo per il tipo di materiali usati per la loro realizzazione, ma anche per la presenza di promotori di una o più linee cellulari , su base condrogenica o osteogenica. Quando ci si approccia ad una lesione condrale di grandi dimensioni, l’osso sub-condrale è anch’esso coinvolto e necessita di trattamento per ottenere il corretto ripristino degli strati articolari più superficiali. La scelta più giusta sembra essere un innesto osteocondrale bioingegnerizzato, pronto per l’uso ed immediatamente disponibile, che consenta di effettuare il trattamento in un unico tempo chirurgico. Sulla base di questo razionale, dopo uno studio preclinico animale e previa autorizzazione del comitato etico locale, abbiamo condotto uno studio clinico clinico pilota utilizzando un nuovo innesto biomimetico nanostrutturato per il trattamento di lesioni condrali ed osteocondrali del ginocchio; la sua sicurezza e maneggevolezza, così come la facile riproducibilità della tecnica chirurgica ed i risultati clinici ottenuti sono stati valutati nel tempo a 6, 12, 24, 36 e 48 mesi dall’impianto in modo da testare il suo potenziale intrinseco senza l’aggiunta di alcuna linea cellulare.

The spatial representation of time

Numerosi studi mostrano che gli intervalli temporali sono rappresentati attraverso un codice spaziale che si estende da sinistra verso destra, dove gli intervalli brevi sono rappresentati a sinistra rispetto a quelli lunghi. Inoltre tale disposizione spaziale del tempo può essere influenzata dalla manipolazione dell’attenzione-spaziale. La presente tesi si inserisce nel dibattito attuale sulla relazione tra rappresentazione spaziale del tempo e attenzione-spaziale attraverso l’uso di una tecnica che modula l’attenzione-spaziale, ovvero, l’Adattamento Prismatico (AP). La prima parte è dedicata ai meccanismi sottostanti tale relazione. Abbiamo mostrato che spostando l’attenzione-spaziale con AP, verso un lato dello spazio, si ottiene una distorsione della rappresentazione di intervalli temporali, in accordo con il lato dello spostamento attenzionale. Questo avviene sia con stimoli visivi, sia con stimoli uditivi, nonostante la modalità uditiva non sia direttamente coinvolta nella procedura visuo-motoria di AP. Questo risultato ci ha suggerito che il codice spaziale utilizzato per rappresentare il tempo, è un meccanismo centrale che viene influenzato ad alti livelli della cognizione spaziale. La tesi prosegue con l’indagine delle aree corticali che mediano l’interazione spazio-tempo, attraverso metodi neuropsicologici, neurofisiologici e di neuroimmagine. In particolare abbiamo evidenziato che, le aree localizzate nell’emisfero destro, sono cruciali per l’elaborazione del tempo, mentre le aree localizzate nell’emisfero sinistro sono cruciali ai fini della procedura di AP e affinché AP abbia effetto sugli intervalli temporali. Infine, la tesi, è dedicata allo studio dei disturbi della rappresentazione spaziale del tempo. I risultati ci indicano che un deficit di attenzione-spaziale, dopo danno emisferico destro, provoca un deficit di rappresentazione spaziale del tempo, che si riflette negativamente sulla vita quotidiana dei pazienti. Particolarmente interessanti sono i risultati ottenuti mediante AP. Un trattamento con AP, efficace nel ridurre il deficit di attenzione-spaziale, riduce anche il deficit di rappresentazione spaziale del tempo, migliorando la qualità di vita dei pazienti.