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INTRODUZIONE:Stante come il numero degli accessi dei pazienti in un dipartimento di emergenza (ED) non possa essere pianificato con precisione, le risorse disponibili possono essere talvolta sovraccariche ("affollamento"), con conseguenti rischi per la sicurezza dei pazienti. OBIETTIVO:L’obiettivo del presente studio è stato quello di valutare l’efficacia di nuovo sistema di valutazione di triage presso il Pronto Soccorso di un’azienda ospedaliera italiana. MATERIALI E METODI: Studio pilota a due bracci; assegnazione ai due gruppi (valutazione standard –codice a 4 vs valutazione sperimentale – codice 5 colori) attraverso randomizzazione semplice. Sono state confrontate le valutazioni infermieristiche al momento del triage di ammissione con quelle al momento della dimissione.RISULTATI:Sono stati arruolati 1060 soggetti con “dolore toracico non traumatico” e 960 inquadrati come “disturbi neurologici acuti”; l’adozione del nuovo codice colore ha permesso una valutazione corretta del grado di gravità in oltre l’86% dei casi “cardiologici” e il 93% dei casi “neurologici”; il metodo standard ha permesso una valutazione corretta inferiore all’83% nei casi cardiologici e al 77% in quelli neurologici.CONCLUSIONI:I risultati emersi depongono a favore del nuovo sistema valutazione in triage infermieristico a cinque livelli; approfondimenti su campioni più ampi sono auspicabili., BACKGROUND:Since the volume of patient admissions in an emergency department (ED) cannot be planned precisely, the available resources can sometimes be overloaded ('crowding'), resulting in risks to patient safety. AIM:The study aimed to evaluate the effectiveness of a new triage evaluation system in the emergency room of an Italian hospital. METHODS:Two-arm pilot study; assignment to the two groups (standard assessment - 4-colour code vs. experimental assessment - 5-colour code) by simple randomisation. Nursing assessments at admission triage were compared with those at discharge RESULTS:1060 subjects with 'non-traumatic chest pain' and 960 classified as 'acute neurological disorders' were enrolled; the implementation of the new color code allowed a correct assessment of the level of severity in more than 86% of 'cardiological' and 93% of 'neurological' cases; the standard method allowed a correct assessment of less than 83% in cardiological and 77% in neurological cases. CONCLUSIONS:The five-level triage system is a valid method for assessing the severity of incoming patients' conditions by nursing staff in the emergency department. In-depth studies on broader samples are recommended.

This paper analyzes Bruce Chatwin's The Songlines, a late 20th-century masterpiece of travel literature, from a thematic perspective. We will explore the fact that his prose does not fit a defined literary genre (novel, diary, essay, collection of aphorisms) and that it can thus be examined only from a philosophical perspective. His literary production, in fact, stems from the need to understand his own life, thus creating a mise en abyme of journeys within his own story. The key question he asks himself is: why do people ‘move’ instead of standing still? Hence, his experience in Australia to find an answer along the Dream Ways of the Aborigines. These are tribes that for generations have handed down their endless repertoire of oral songs to orient themselves in the desert, to embark on ritual journeys rooted in the melodies of their ancestors, and to experience ‘the land’ in a way which has been long forgotten in today’s society. Therefore, as we explore the episodes of colonial and epistemic violence recounted by Chatwin, we will try to trace, together with one of his main philosophical points of reference, Martin Heidegger, a path towards the heart of the journey as a peculiar way of inhabiting the world by reversing it. Indeed, among the dozens of philosophical and literary references cited by Chatwin, behind which we can find the apparently negative shadow of cultural syncretism, there is a strong need to question the relationship that binds the essence of humankind to their wandering, to their religiosity, to their willingness to meet ‘the other’. Heidegger, especially in his second production, offers us useful tools to move away from our technocentric paradigm in favor of a more original poiesis than that of modernity and of a language (the mélos of the poets) that is deeper and more communicative than that of the industrial era. Today, humankind is ’capitalized’ and sedentary: their symbolic horizon seems to have disappeared and their sedentariness impacts on their natural willingness ‘to move’. This has turned into an aberrant form of imposition on nature – while peoples such as the Aborigines, because of this Eurocentric imposition, are uprooted from their land and alienated from their culture. Therefore, we will try to adopt a more globalized and exoticist perspective on travel in order to find a theoretical, ethical, and symbolic way to rethink the role and meaning of travel in the contemporary world. Questo saggio cercherà di analizzare The Songlines di Bruce Chatwin, un capolavoro della letteratura di viaggio del tardo XX secolo, da una prospettiva tematica. Avvicinandoci al testo, analizzeremo l'impossibilità di incasellare la sua prosa in uno specifico genere letterario (romanzo, diario, saggio, raccolta di aforismi) e ci collocheremo invece su uno sfondo molto più complesso che per certi versi non può che essere filosofico. L'intera opera, infatti, parte da un'esigenza di senso legata alle vicende biografiche dello stesso Chatwin, capace di creare una mise en abyme di viaggi all'interno della propria storia. La domanda fondamentale che si pone è: perché gli uomini si muovono invece di stare fermi? Da qui la sua esperienza in Australia alla ricerca di una risposta lungo le Vie del Sogno degli aborigeni, tribù che da tempo si tramandano oralmente un infinito repertorio di canti con cui orientarsi nel deserto, per intraprendere viaggi rituali che affondano le radici nelle melodie degli antenati e in un'esperienza della terra a lungo dimenticata dalla nostra società contemporanea. In seguito, attraversando gli episodi di violenza coloniale ed epistemica raccontati da Chatwin, cercheremo di aprire, insieme a uno dei suoi punti di riferimento filosofici, Martin Heidegger, una finestra di riflessione che punti al cuore del viaggio come modo peculiare di abitare il mondo, rovesciandolo. Infatti, tra le decine di suggestioni filosofiche e letterarie citate da Chatwin, dietro le quali si nasconde l'ombra apparentemente negativa di un sincretismo culturale, c'è una profonda esigenza di interrogarsi sul rapporto che lega l'essenza dell'uomo al suo errare, al suo essere religioso, aperto all'incontro con l'altro; Heidegger, soprattutto nella sua seconda produzione, ci offre strumenti interessanti per uscire dal nostro paradigma tecnocentrico e per risvegliare il fare e il vivere dell'uomo nella forma di una poiesis più originale di quella della modernità e di un linguaggio (il mélos dei poeti) più profondo e comunicativo del chiacchiericcio dell'uomo dell'era industriale, capitalizzato, sedentario, il cui orizzonte simbolico sembra essere diventato impossibile, e la sua apertura costantemente irretita dalla sua sedentarietà, che si è trasformata in un'aberrante imposizione sulla natura a differenza di quella di popoli (come gli aborigeni) che, a causa di questa imposizione eurocentrica, sono sradicati dalle loro case e alienati dalla loro cultura. Infine, quello che cercheremo di fare è delineare una prospettiva diversa da quella della concezione del viaggio che oggi domina la visione eurocentrica, globalizzata ed esotista, per cercare di riscoprire un'alternativa teorica, etica e simbolica che ci permetta di pensare in modo diverso il ruolo e il significato del viaggio nel mondo contemporaneo., ECHO, N. 4 (2022): Metafore del viaggio: testi, identità, generi in movimento

Over the last decades, ovarian tissue cryopreservation has been reported as a promising fertility preservation strategy and the only option available for young women with primarily cancer diseases who need immediate anticancer therapies. To date, a pregnancy rate of about 30% has been reported after auto-transplantation of frozen-thawed tissue, corresponding to more than 130 live births [1]. However, the possible risk of reintroducing malignant cells in ovarian cortical grafts remains the major problem associated with this procedure [2]. To overcome this limitation, the only possibility could be represented by a complete in vitro folliculogenesis, in a well-designed culture system. The possibility of obtaining in vitro mature oocytes in metaphase II starting from the huge reserve of primordial follicles present in the ovary, was born in 1996; when Eppig [3] obtained the birth of mice for the first time after the fertilization of mature oocytes derived from the development of follicles primordial in vitro, and improved in 2003 [4]. Although this promising technology has attracted numerous researchers over the past twenty years, attempts to reproduce these results in superior animals and humans have been largely unsuccessful. Ovarian strip in situ culture has tremendous advantages over isolated primordial follicle culture systems because follicles are maintained within their natural environment. Only recently, mature human oocytes have been developed from primordial follicles through a culture method that involves a multi-stage protocol [5]. Although these results are encouraging, the number and quality of the mature oocytes obtained is still very low. The causes for this can be traced back to several reasons listed below: 1. The inadequate cryopreservation of the tissue is one reason. It is a known fact that cryopreservation represents a crucial step of fertility preservation. The American Society for Reproductive Medicine still considers it experimental, despite several pioneers considering ovarian cryopreservation an established technique for preservation of gametes and embryos [6]. Nonetheless, to date we know that almost all live births in cancer patients have been derived from auto-transplantation of cryopreserved ovarian tissue by slow freezing/rapid thawing [7–12] and only two live births have been reported by Suzuki et al. in 2015 [13] following ovarian tissue vitrification in patients with primary ovarian insufficiency. Ovarian cryopreservation needs to be refined to reduce cryo-damage and the consequent depletion of follicles and stromal cells (SCs) that may impair the full recovery of ovarian function. Some studies suggest that slow freezing may cause extensive DNA fragmentation in primordial follicles and cause injury to stromal cells as well [14–17]. Starting with this knowledge, numerous researchers have tried to improve the efficiency of ovarian tissue cryopreservation. The research group, with which I worked for my doctorate had already shown that ultra-rapid vitrification of human ovarian tissue with slush nitrogen (SN) improves recovery of healthy follicles in 2016. The group had also demonstrated preservation of granulosa cells (GCs) and stromal cells ultrastructure, DNA integrity of SCs and viability of oocytes, GCs, and SCs over conventional vitrification with liquid nitrogen (LN) [18]. During my PhD I attempted to merge optimal protocols for cryopreservation and culture and assess the functional potential of SN vitrified strips during long term culture [19]. 2. The second reason is the insufficient number of secondary follicles that are obtained in the early stages of culture or after the first step of culture, that rarely exceeded 10% [5-20]. This could be due to inadequate culture conditions that limit the number and health of secondary follicles produced during the first step of culture. Despite several studies having investigated the nutritional and endocrine requirements of ovarian tissue to optimize media for cortical strip culture, only a few studies have investigated the role of oxygen supply for follicular growth. Therefore, during my second year of PhD, the aim of my project was to study the effects of oxygen on follicular morphology, progression and viability during the culture of the ovarian cortical strips. We made use of oxygen permeable petri dishes to modulate the local oxygen tension in the vicinity of the tissues. To study the effect of media volumes on the performance of the grown strips, we attempted with change in the conditions of ambient oxygen i.e. 5% and 20% oxygen concentration. This was followed by analysis of the influence of the optimal diffusion of oxygen in the in situ culture of the ovarian strip. 3. The third reason is the culture conditions of the current techniques which are still sub-optimal. We showed that the in vitro culture of human ovarian cortical strips in gas-Permeable Dishes (PD) enhances follicular health and secondary follicle growth over conventional dishes by improving oxygen availability in situ [4,5]. However the static culture systems adopted so far, lack physiological and biomechanical cues which generates stagnant media layers around the tissue with a consequent deprivation of nutrients and accumulation of toxic/waste metabolites. Environmental cues such as oxygen tension and mechanical stimuli may be further enhanced to match the physiological requirements. In my last year of PhD, we investigated dynamic culture systems in continuous perfusion bioreactors (PB) that enabled the disruption of solute concentration gradients and application of physiological fluid mechanic stresses on tissue which improved the ovarian cortical tissue culture.