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The Mediterranean basin is particularly prone to climate change and vulnerable to its impacts. One of the most relevant consequences of climate change, especially for the southern Mediterranean regions, is certainly water scarcity as result of a reduction of surface runoff and groundwater levels. Despite the progress achieved in recent years in the field of climate change and its impact on water resources, results and outcomes should be treated with due caution since any future climate projection and derived implications are inevitably affected by a certain degree of uncertainty arising from each different stage of the entire modeling chain. This work offers a comprehensive overview of recent works on climate change in the Mediterranean basin, mainly focusing on the last ten years of research. Past and future trends on different components of the hydrological balance are discussed in a companion paper (Noto et al. 2022), while the present paper focuses on the problem of water availability and water scarcity. In addition, the work aims to discuss the most relevant sources of uncertainty related to climate change with the aim to gain awareness of climate change impact studies interpretation and reliability.

Common complications of coronavirus disease 2019 (COVID-19) related ARDS and ventilation are barotrauma-induced pneumothorax, pneumatocele and/or empyema. We analysed indications and results of video-assisted thoracoscopic surgery (VATS) in complicated COVID-19 patients. This is a retrospective single-institution study analysing a case series of patients treated by VATS for secondary spontaneous pneumothorax (SSP), pneumatocele and empyema complicating COVID-19, not responding to drainage in Lodi Maggiore Hospital between February 2020 and May 2021. Out of 2076 patients hospitalized in Lodi Maggiore Hospital with COVID-19, nine Males (0,43%; mean age 58,1-33-81) were treated by VATS for complications of pneumonia (6 SSP and 3 empyema; 1 case complicated by haemothorax). 7 patients (77%) had CPAP before surgery for 21.3 days mean (4-38). Mean Operative time was 80.9 min (38-154). Conversion rate was 0%. 3 (33%) patients were admitted to ICU before VATS. Treatments were: bullectomy in six patients (66%), drainage of the pleural space in all patients, pleural decortication and fluid aspiration in five cases (55%). two patients (22%) needed surgery interruption and bilateral ventilation to restore adequate oxygenation. Mortality was 1/9 (11%) due to respiratory failure for persistent pneumonia. In one patient (11%) redo surgery was performed for bleeding. Mean postop Length of Stay (LOS) was 37.9 days (10-77). Our report shows that VATS can be considered an extreme, but effective treatment for COVID-19 patients with SSP, pneumatocele or empyema, for patients who can tolerate general anaesthesia. Attention must be paid to the aerosol-generation of infected droplets.

Supplemental Figure. Consort diagram highlighting the flow of patients throughout the study

The paper presents a methodology for the pre-processing of the combustion time intervals, that is the basic signal used in misfire detection strategies, with the aim of increasing the signal-to-noise ratio to enable a more efficient misfire diagnosis, especially when the engine is running at high speeds and low loads. The performance of the basic misfire detection algorithm shows that in those engine operating conditions the background noise amplitude has approximately the same value of the information related to the misfire presence, thus hiding the misfire event that may not be detected. The proposed methodology is based on the correction of the combustion time signal cycle-by-cycle, using a vector of data that take into account the specific behavior of every cylinder combustion. For each engine running condition, the vector of data for the combustion time correction is stored in a map inside the control unit and could be continuously updated with an auto-adaptive learning technique. Some results of the methodology are reported in the paper, and compared with the basic misfire detection algorithm performance.

The CERN Axion Solar Telescope (CAST), a 10 meter long LHC, 9 Tesla, test magnet is mounted on a moving platform that tracks the sun about 1.5 hours during sunrise, again during sunset. It moves ±8 0 vertically and ±40 0 horizontally. It has been taking data continuously since July 10, 2003. Data analyzed thus far yield an upper bound on the photon-axion coupling constant, g aγγ ⩽ 3 × 10 −10 GeV −1 for axion masses less than 5 × 10 −2 eV.

PURPOSE Malignant pericardial effusion, although highly variable, is an uncommon complication of cancer. It is often associated with symptoms like dyspnea, chest pain, and cough, which may be severe and disabling. We analyzed the results of our current treatment policy to evaluate the effectiveness and tolerance of a new approach for this disorder. PATIENTS AND METHODS Patients with malignant pericardial effusions were treated with intracavitary thiotepa (15 mg on days 1, 3, and 5) through an indwelling pericardial cannula after extraction of as much pericardial fluid as possible on day 0. Responses were assessed by clinical examination, computed tomographic (CT) scan, and echocardiography before treatment, 1 month after treatment, and every 2 months thereafter. Twenty-three patients with malignant symptomatic pericardial effusion were treated and all were assessable for effectiveness and tolerance of the procedure. RESULTS Nine patients with breast cancer, 11 with lung cancer, two with an unknown primary tumor, and one with metastatic melanoma were treated. In all but three patients, systemic medical treatment was started after completion of intracavitary therapy. Nineteen patients responded to treatment (83%; 95% confidence interval, 61% to 95%) with a rapid improvement of symptoms. The median time to pericardial effusion progression was 8.9 months (range, 1 to 26). No significant side effects were registered, except one patient who had transient grade III thrombocytopenia and leukopenia and one patient who had grade I leukopenia. CONCLUSION A short course of intracavitary treatment with thiotepa is highly effective and well tolerated in the treatment of malignant pericardial effusion.

Objective: To determine the potential influence of prulifloxacin (AF3012, NM441), a new antibacterial fluoroquinolone, on the pharmacokinetics of theophylline.

Editor Ronald K. Jurgen offers an informative introduction, clearly explaining the overall format and layout of the book. Content closely examines the many areas surrounding electronic engine control technologies. Chapters cover: Neural Networks on the Rise Fuel Injection Controls Electronic Throttle Controls Idle Speed Controls Air Fuel Ratio Controls Torque-Based Engine Controls Ignition Controls Combustion Controls Pressure-Based Controls Miscellaneous Controls Diagnostics Engine Modeling Innovative Solid-State Hardware and Software Systems Communications Techniques for Engine Control Neural Network Applications A Look to the Future

Summary: Purpose: To assess whether phenytoin affects the pharmacokinetics of the dihydropyridine calcium antagonist nisoldipine. Methods: Twelve patients with epilepsy receiving chronic phenytoin therapy and 12 healthy control subjects matched for age and gender received a single oral dose of nisoldipine (40 and 20 mg, respectively). Blood samples were collected for up to 48 h for estimation of plasma nisoldipine levels by capillary gas chromatography. Results: Mean plasma nisoldipine concentrations were much lower in the patients. Geometric means for areas under the concentration-time curve (AUC0-tn) normalized to a 20-mg dose were 1.6 μg/L/h (95% confidence intervals, 0.6–3.8 μg/L/h) in the patients compared with 15.2 (10.7–21.6) μg/L/h in control subjects (p < 0.002). Conclusions: These results suggest that phenytoin increases the first-pass metabolism of nisoldipine to a clinically important extent. In view of the magnitude and variability of interaction, use of nisoldipine in patients receiving chronic phenytoin therapy is contraindicated. Key Words: Epilepsy- Nisoldipine-Phenytoin-Pharmacokinetics-Drug interaction.

BACKGROUND Androgen deprivation is currently the standard treatment for patients with metastatic prostate carcinoma. Few reliable prognostic markers are able to select, at diagnosis, patients who will respond favorably and durably to hormone ablation. Circulating polyamines, markers of cell proliferation that are elevated in prostate carcinoma, have been evaluated as a prognostic tool. METHODS Eighty-eight patients with untreated, M1 classified prostate carcinoma who received endocrine therapy between 1988 and 1993 were included in this study. Performance status, hemoglobin, alkaline phosphatases, prostate specific antigen, Gleason tumor grade, extent of disease by bone scan, and circulating erythrocyte spermidine and spermine were correlated with observed progression free and cause-specific survivals. Multiple correspondence analysis and ascending hierarchical classification were performed to determine significant pretreatment prognostic factors. RESULTS Pretreatment performance status, alkaline phosphatase, hemoglobin, and erythrocyte spermine levels were correlated with progression, with hemoglobin and erythrocyte spermine level being the most significant independent variables (P < 0.00001 and P < 0.0001, respectively). With regard to cause specific survival, only hemoglobin and spermine erythrocyte levels were significant independent variables (P < 0.0001 and P < 0.0005, respectively). Patients with spermine levels of less than 9 nmol/8·109 had a statistically better outcome than patients with 9 nmol/8·109 or more erythrocytes. Erythrocyte spermine was the best sole determinant of progression. A test combining spermine with performance status or hemoglobin improved each variable's predictive values. CONCLUSIONS Circulating erythrocyte spermine levels, extracted from a blood sample, can discriminate, at diagnosis, patients with hormone-refractory from those with hormone-responsive metastatic prostate carcinoma. Cancer 1996;78:1055-65.

GM Powertrain Europe and Istituto Motori CNR have undergone a research project aimed at studying the effects on engine performance, emissions and fuel consumption of alternative diesel fuels, from both first (FAME) and second (GTL) generation. The present paper reports some of the results achieved studying the impact on injection and spray behavior of rapeseed and soybean methyl-esters, as well as of GTL diesel blends. The test were performed on a Bosch second generation common rail solenoid-driven fuel injection system capable of 1600bar maximum injection pressure, fitted on GM 1.9L Euro4 diesel engine for passenger cars. The characterization of the injection process has been carried out in terms both of fuel injection rate, as well as of spatial and temporal fuel distribution in a quiescent non-evaporative optically accessible chamber. The injection schedules that have been analyzed, as well as the gas density in the spray bomb, have been chosen as representative of different engine working conditions for data correlation, both at partial and full load. Digital processing of the spray images, captured at different instant from the start of injection and for the diverse operating conditions, enabled the spatial and temporal characterization of the fuel in terms of tip penetration and spray-cone angle. Experimental results support the consideration that, at ambient temperature, alternative fuels induce small variations in the injection pattern, in particular the pilot event which is mostly impacted by variations in fuel viscosity and density that affect the needle dynamics. Also spray pattern exhibit very similar behaviour among the different fuels, with deviations over the standard dispersion that are noticeable at low injected quantities. As a consequence, the variations in performance and emissions that were measured on the multi-cylinder engine with the same fuels can be primarily traced back to the chemical composition of the fuel itself and to the drift in engine working point it triggers in torque-based diesel engine controllers.

The aim of the paper was to perform a 64-slice CT evaluation of the main anatomic variants of paranasal sinuses.From April 2005 to January 2006, 100 patients were chosen among all those that had undergone a paranasal sinuses CT examination. They were 45 women and 55 men, all aged between 18 and 70 years, mean age 46 years; they were all caucasian. This research has been conducted using a 64-slice Siemens Somatom Volume-Zoom multidetector Spiral CT. Para-nasal sinuses CT examination has been performed through a thin axial acquisition; the patient was lying on his back and the images were processed with multiplanar reconstruction (MPR). The anatomic variants considered in this study are: concha bullosa, Haller cells, uncinate process abnormalities, agger nasi cells, ethmoidal bulla, Onodi cell, middle turbinate curvature abnormalities.In this research it has been noticed that 29% of patients are affected by concha bullosa, 5% by Haller cells and again 5% by uncinate process abnormalities; 52% are affected by agger nasi cells, 15% by ethmoidal bulla, 9% by Onodi cell and 11% by middle turbinate curvature abnormalities.By using a 64-slice CT you can get a better quality of images in terms of spatial and temporal resolution. Osteomeatal complex structures are often featured by many anatomic variants. The most of the time, percentages are the same as recent researches have shown.

The CERN Axion Solar Telescope (CAST) searches for axions coming from photon to axion conversion in the sun's core, as stated by the Primakoff effect. Axions arise in particle physics as a consequence of the breaking of Peccei-Quinn symmetry which has been introduced as a solution to the strong CP problem. As cosmological axions they are candidates for at least some part of cold Dark Matter.They are also expected to be produced copiously in stellar interiors with energies as high as the thermal photons undergoing photon to axion conversion. In our sun the axion energy spectrum peaks at about 4.4 keV, extending up to 10 keV. CAST collected preliminary data in 2002 and data taking with its full capability will start in the beginning of 2003., NEB-X Conference on "New Developments in Gravity", May 30-June 2, 2002, Chalkidiki, GREECE. 5 pages, 2 figures

Summary: Purpose: To evaluate the effect of oxcarbazepine (OCBZ) on the pharmacokinetic profile of steroid oral contraceptives. Methods: Twenty-two healthy women aged 18–44 years were recruited, and 16 of them completed the study. By using a randomized double-blind crossover design, each woman was studied in two different menstrual cycles, during which placebo or OCBZ (maintenance dosage, 1,200 mg/day) was given in randomized sequence for 26 consecutive days with a washout of at least one cycle in between. A steroid oral contraceptive containing 50 μg ethinylestradiol (EE) and 250 μg levonorgestrel (LN) was taken for the first 21 days of each cycle. Plasma concentrations of EE and LN were measured by gas chromatography-mass spectrometry in samples collected at regular intervals on days 21–23 of each cycle. Results: Compared with placebo, areas under the plasma concentration curves (AUC0–24h, geometric means) decreased by 47% for both EE (from 1,677 to 886 pg.h/ml; p < 0.01) and LN (from 137 to 73 ng.h/ml; p < 0.01), during OCBZ treatment. Peak plasma EE concentrations decreased from 180 pg/ml during the placebo cycle to 117 pg/ml during the OCBZ cycle (p < 0.01), whereas peak plasma LN concentrations decreased from 10.2 to 7.7 ng/ml (p < 0.01). The half-lives of EE and LN also decreased from 13.6 to 7.9 h (p < 0.01) and from 28.8 to 15.8 h, respectively (p < 0.01). Conclusions: OCBZ reduces plasma concentrations of the estrogen and progestagen components of steroid oral contraceptives, presumably by stimulating their CYP3A-mediated metabolism in the liver or gastrointestinal tract or both. Because this may lead to a decreased efficacy of the contraceptive pill, women treated with OCBZ should receive preferentially a high-dosage contraceptive and should be monitored for signs of reduced hormonal cover.

PURPOSE This study was conducted to determine whether vigabatrin affects in vivo indices of hepatic microsomal enzyme activity and the pharmacokinetics of steroid oral contraceptives in healthy subjects. METHODS Under double-blind conditions, 13 female healthy volunteers received, in random order and with a washout interval of > or = 4 weeks, two oral 4-week treatments with vigabatrin (VGB) (maintenance dosage, 3,000 mg daily) and placebo, respectively. The clearance and half-life of antipyrine (a broad marker of drug oxidation capacity), the urinary excretion of 6-beta-hydroxycortisol (a selective marker of cytochrome CYP3A-mediated oxidation), and the activity of serum gamma-glutamyltransferase (a nonspecific index of microsomal enzyme activity) were determined after 3 weeks of each treatment. The single-dose kinetics of a combined oral contraceptive containing 30 micrograms ethinyl estradiol and 150 micrograms levonorgestrel were also determined after 3 weeks of treatment by specific radioimmunologic assays. RESULTS VGB treatment had no influence on antipyrine clearance (28 +/- 5.6 vs. 30 +/- 4.5 ml/h/kg on placebo), antipyrine half-life (15.5 +/- 3.5 vs. 14.1 +/- 2.1 h), urinary 6-beta-hydroxycortisol excretion (488 +/- 164 vs. 470 +/- 228 nmol/ day), 6-beta-hydroxycortisol-to-cortisol concentration ratio (6.8 +/- 3.1 vs. 6.1 +/- 3.1) and serum gamma-glutamyltransferase activity (12 +/- 3 vs. 11 +/- 3 IU/L). No difference in pharmacokinetic parameters between VGB and placebo sessions were found for ethinyl estradiol (half-life, 12.5 +/- 3.2 vs. 13.9 +/- 3.2 h; AUC, 874 +/- 301 vs. 939 +/- 272 ng/ L/h) and levonorgestrel (half-life, 17.7 +/- 5.2 vs. 23.1 +/- 9.8 h; AUC, 27.5 +/- 9.6 vs. 30.0 +/- 12.0 micrograms/L/h). Two subjects, however, showed a 50 and a 39% reduction in ethinyl estradiol AUC during VGB treatment. CONCLUSIONS At therapeutic dosages, VGB did not modify in vivo indices of hepatic microsomal enzyme activity and did not interfere significantly with the CYP3A-mediated metabolism of ethinyl estradiol and levonorgestrel. Based on these data, VGB is unlikely to affect consistently the efficacy of steroid oral contraceptives or interact pharmacokinetically with drugs that are eliminated mainly by oxidative pathways, particularly those involving cytochrome CYP3A.

To assess potential ethnic and gender-related differences in the expression of cytochrome CYP1A2-mediated activity, the pharmacokinetics of phenacetin (a CYP1A2 substrate) and its metabolite paracetamol were compared in 20 Caucasian and 20 Chinese subjects after administration of a single oral 900 mg phenacetin dose. Peak plasma concentrations and apparent oral clearance values for phenacetin did not differ between the two groups (geometric means: 3.4 micrograms/ml and 1.56 ml h-1 kg-1, respectively, for Caucasians vs. 4.7 micrograms/ml and 1.25 ml h-1 kg-1, respectively, for Chinese, after excluding one Caucasian with aberrantly low plasma phenacetin values). Pharmacokinetic parameters for metabolically derived paracetamol were also similar in the two groups. When subjects were divided into subgroups according to gender, phenacetin apparent oral clearance values were found to be lower in Chinese women compared with both Chinese men and Caucasian subjects of either sex. It is concluded that there are no major interethnic differences in the expression of CYP1A2-related activity between Caucasians and Chinese, although Chinese women as a subgroup may exhibit comparatively lower enzyme activity.

Androgen deprivation is currently the standard treatment for patients with metastatic prostate carcinoma. Few reliable prognostic markers are able to select, at diagnosis, patients who will respond favorably and durably to hormone ablation. Circulating polyamines, markers of cell proliferation that are elevated in prostate carcinoma, have been evaluated as a prognostic tool.Eighty-eight patients with untreated, M1 classified prostate carcinoma who received endocrine therapy between 1988 and 1993 were included in this study. Performance status, hemoglobin, alkaline phosphatases, prostate specific antigen, Gleason tumor grade, extent of disease by bone scan, and circulating erythrocyte spermidine and spermine were correlated with observed progression free and cause-specific survivals. Multiple correspondence analysis and ascending hierarchical classification were performed to determine significant pretreatment prognostic factors.Pretreatment performance status, alkaline phosphatase, hemoglobin, and erythrocyte spermine levels were correlated with progression, with hemoglobin and erythrocyte spermine level being the most significant independent variables (P0.00001 and P0.0001, respectively). With regard to cause specific survival, only hemoglobin and spermine erythrocyte levels were significant independent variables (P0.0001 and P0.0005, respectively). Patients with spermine levels of less than 9 nmol/8.10(9) had a statistically better outcome than patients with 9 nmol/8.10(9) or more erythrocytes. Erythrocyte spermine was the best sole determinant of progression. A test combining spermine with performance status or hemoglobin improved each variable's predictive values.Circulating erythrocyte spermine levels, extracted from a blood sample, can discriminate, at diagnosis, patients with hormone-refractory from those with hormone-responsive metastatic prostate carcinoma.

The forensic interest in the use of food colours is related to health rights and safeguard of the consumer, as established in national legislations. The regulations related to food dyes consider the health of human beings and the adulteration of foodstuffs and economic needs connected with quantitative restrictions on imports. Efficient analytical methods are required for evaluating toxicity and authenticity or adulteration, in order (a) to determine whether there are synthetic dyes present in foods and whether they are permitted, (b) to determine the levels, (c) to confirm the absence of added dyes in foods where they are not declared and (d) to check on the stability of dyes during processing and storage. Recent HPLC methods for the identification and determination of natural and synthetic dyes and of carcinogenic amines contained as impurities in synthetic dyes are reviewed.

Omeprazole has been reported to increase cytochrome P450IA2 (CYP1A2) activity in vitro, but whether this effect also occurs in vivo is controversial. To clarify this issue, the effect of omeprazole (20 mg/day for 8 days) on the kinetics and metabolism of phenacetin, an in vivo marker of CYP1A2 activity, was examined in 10 healthy volunteers. The pharmacokinetic parameters of phenacetin and metabolically derived paracetamol on the 8th day of omeprazole administration were very similar to those observed in a control session in the absence of omeprazole administration, the only significant difference being a higher peak plasma phenacetin concentration during omeprazole treatment. It is concluded that at the dosage used omeprazole does not increase the rate of oxidative and conjugative reactions involved in the metabolism of phenacetin and paracetamol respectively. These data are consistent with the hypothesis that omeprazole is generally devoid of inducing effects on CYP1A2 activity in vivo, at least in a Caucasian population with a low prevalence of the omeprazole-mephenytoin poor metabolizer phenotype.

Eighteen myasthenic patients have been operated on under general anaesthesia; 14 subjected to thymectomy and 2 to emergency procedures (caesarean section and laparotomy because of intestinal obstruction). Atracurium (0.3 mg/kg) and vecuronium (0.06 mg/kg) exhibited a long duration of action only in the two cases affected by the more severe signs and symptoms of the disease.

THE RELATIONSHIP between contemporary science and Christian dogmatic statements is one of the most neglected areas of contemporary theological thinking. One can only be amazed at the nearly complete silence of the theologian when confronted with the revolution in physics of the past fifty years. One looks nearly in vain, in contemporary discussions about Christology, creation, the Incarnation, and other basic Christian doctrines, for references to current conceptions within modern physics of what constitutes the "real world," what is at the heart of things-in-themselves. Much of the sterility of contemporary theology can be attributed to the fact that theologians have either completely ignored advances in the physical sciences as somehow having nothing to do with them, or have been content to pick up a smattering of relativity theory from a popular magazine, allude to it in a most superficial manner in discussing a particular Christian doctrine, and let it go at that. A few, however, have attempted in their own way to come to grips with the rather confusing and awesome picture of reality that is being spun out progressively in modern physics. One of these is Filippo Selvaggi, S.J., who was one of the leading protagonists in a debate on transubstantiation which began in the late forties and went on to the sixties. The debate itself and Selvaggia name are not well known, as the debate appeared in papers in less than widely-read journals. But excellent summaries of the debates appeared in this periodical, the first in 1951 by J. T. Clark, who reported the first part of the debate, and the second by Cyril Vollert, who extended coverage of the debate to 1960. It is not merely in nostalgia that I wish to re-examine this somewhat obscure debate on transubstantiation, nor to engage in esoteric theological showmanship. The issues at stake were important, and they are still important. I think it urgent that these issues be again raised in the context of the current debate over transubstantiation, since the issues at stake in the Selvaggi debate are not being fully represented in post-Vatican II Eucharistie theology, which is associated especially with Schillebeeckx in Holland and Powers in the United States.

The behavior of an injection system with a rotative pump for reciprocating engines has been investigated. Experimental investigations were carried out using a specially designed apparatus to monitor several parameters, such as pressure inside the different chambers of the apparatus, moving part lift, and injected fuel quantity. In addition, a predictive mathematical model, based on mass momentum conservation laws, was developed to simulate such behavior and to predict all the most important parameters of the injection system. The comparison between numerical and experimental results has been satisfactory, allowing a generalization of the model and extensive theoretical predictions of the system behavior.

This report describes the development of, and the results obtained from, an organic Rankine cycle (ORC) engine aimed at the utilization of low temperature heat sources. The activities carried out in order to assess the feasibility of the engine have been: engine and test rig design and set up working fluid and thermodynamic cycle choice engine performance and mechanical behaviour evaluation laboratory investigation on chemical compatibility and thermal stability of the candidate working fluids.

Measurements of three velocity components and of the corresponding turbulent fluctuations are reported obtained by laser Doppler anemometry in the cylinder of a FIAT-IVECO 8140 DI Diesel engine motored at 1000 rpm with a 16:1 compression ratio. The results show that the air swirl velocities at inlet valve closure are axially stratified while the intake-generated axial flow structures persist, although decaying, up to 70/sup 0/ BTDC when the squish effect transforms the in-cylinder flow structure. The presence of a flow towards the piston crevice is detected at 20/sup 0/ BTDC while at TDC of compression the formation of, at least, one toroidal vortex in the axial plane inside the piston bowl is detected. The findings of this investigation are compared with similar measurements in simplified engine configurations and reveal a satisfactory qualitative as well as quantitative agreement.

We calculated the annual noise dose absorbed by machine drivers engaged in wine and cereal growing. In order to do that it has been measured the average daily noise dose in the various mechanized operations and then calculated in respect of its duration in a working year. The days spent in manual works were also taken in account. The annual dose of noise became somewhat higher than 90 dB(A) in wine growing, while in cereal growing it was a bit higher than 95 dB(A). The reliability of these data was confirmed by an epidemiological study of hearing damage. In 106 tractor-drivers, employed in farms where wine and cereal growings are done, it was found that the hearing threshold shift due to noise (average 1000-2000-4000 Hz) in relation to the years of employment, had a similar course to that forecasted by the Normative ISO-DIS 1999 in those exposed to a noise dose of 95 dB(A).

Scopo del saggio consiste nel delineare il ruolo dell’International Council of Nurses rispetto alla professione e alle scienze infermieristiche e il nesso con l’Italia. L’intreccio tra assistenza infermieristica italiana e contributo dell’ICN rappresenta infatti un tassello non trascurabile nell’ambito di un volume interessato alla storia del nursing nel nostro Paese con un saldo orientamento al piano internazionale.

Il presente capitolo si concentra sulla situazione dell’assistenza infer-mieristica italiana a cavallo tra il XIX e il XX secolo, fino alle soglie dello scoppio della Prima Guerra Mondiale. È già ampiamente nota la difficoltà di parlare di un vero e proprio “sviluppo” ed ancor meno di una “professione” [si veda Tousijn 2000] in tale arco temporale considerato. Si ricorda brevemente che per tutto l’Ottocento ed ancora all’inizio del nuovo secolo sono numerose le voci che si sollevano per lamentare la totale inadeguatezza del personale infermieristico [cfr. Fiumi 1993, Dimonte 1995]; inoltre, la prima legge nazionale organica sull’istruzione infermieristica in Italia risale solo al 1925, il suo decreto attuativo al 1929, mentre la legge di riconoscimento statale della professione infermieristica solamente al 1954 [Tousijn 2000], in un contesto di ritardo cronico nei confronti di molto altri paesi civili [Ardissone 2013a] . Eppure, in questo periodo qualcosa si muove nella società italiana e tra gli operatori sanitari nella direzione della necessità di una maggior prepa-razione del personale dedito all’assistenza. Le tappe poco sopra enunciate non possono, infatti, essere concepite come figlie auto-generatesi, ma sono indubbiamente l’esito, l’approdo di un percorso e di un vero e proprio movimento intellettuale che getta le proprie radici in questo arco temporale per vederle successivamente fiorire in ambito sociale, politico e normativo. Il capitolo procede secondo un’architettura in quattro fasi fondamenta-li: viene anzitutto presentato lo stato dell’arte della figura assistenziale relativa all’arco temporale analizzato, esponendo le cause sottostanti alla situazione in cui essa si trovava; si esaminano dunque i principali fattori alla base del susseguente cambiamento; in terzo luogo, si studiano le varie tipologie formative battezzate tra la fine dell’Ottocento e l’inizio del secolo successivo; infine, si conclude presentando i diversi modelli assistenziali presenti alle soglie della Prima Guerra Mondiale. La tesi qui riportata è che sebbene certamente non si possa ancora parlare di professione, è precisamente in questo periodo storico a cavallo tra il XIX e il XX secolo che in Italia qualcosa comincia a cambiare e che, con quel movimento culturale e quel fiorire di iniziative e scuole che sono stati ampiamente documentati in queste pagine, vengono gettate tutte le premesse di quei passi, di quel percorso che si concretizzerà a partire dagli anni Venti (con la prima norma sulla formazione infermieristica, legge n° 1832 del 1925) fino ai giorni nostri (con la creazione di percorsi universitari, della dirigenza infermieristica e, soprattutto, l’abolizione del mansionario) [cfr. Cipolla, Artioli 2003]. Si deve anche sottolineare come quel radicale mutamento e miglioramento dell’assistenza infermieristica, ritenuti urgenti fondamentalmente da tutti gli stakeholders dell’epoca, non poteva essere soddisfatta dai vecchi infermieri, ignoranti e sfruttati, i quali difendevano con forza il proprio posto di lavoro contro la volontà di licenziarli, ma non potevano certo elevare le loro capacità professionali [cfr. Calamandrei 1993: 61], né vantare alcuna capacità di incidere a livello di policy-making. In sostanza la riforma infermieristica, per il noto stato di fatto in cui questa versava, non poteva essere guidata dal proprio interno. Un rinnovamento poté provenire pertanto dalla borghesia e dall’aristocrazia, anche considerata la riluttanza da parte dello stato di in-terviene in materia. Oltre a questi, anche medici e direttori sanitari, che guardando con sincero interesse allo sviluppo della figura assistenziale in un contesto ospedaliero in profonda trasformazione, si posero alla guida della riforma, evidentemente però plasmandola a propria immagine ed utilità e contribuendo conseguentemente a formare una classe ad essa subalterna [Calamandrei 1993: 55], tra l’altro sostenuta anche da alcune delle principali anime del movimento riformatore, che andavano pacificamente affermando come «una buona infermiera è il miglior aiuto del medico» [Celli 1908: 483]. Quindi, tutti gli esperimenti di questo periodo, premessa della riforma successiva alla Grande Guerra, fu etero-guidata, cioè fu pilotata da elementi esterni all’occupazione infermieristica. Ed infatti, tutta la formazione che nacque in questo periodo fu diretta e svolta da personale medico (fatta in parte eccezione per le esperienze della Croce Azzurra e del “Regina Elena”), in un’ottica di governo e controllo istituzionale di questi sui contenuti e sulle modalità formative degli infermieri [Tousijn 2000]. È senz’altro ancora doveroso ricordare che la situazione infermieristica italiana non vedeva molte figure di particolare spicco e intelletto capaci di dirigere ed imprimere una certa traiettoria in questo campo. Tra l’altro, i medici ebbero una certa influenza anche nel processo di femminilizzazione della categoria, in quanto essi cercavano persone gentili e disponibili a prendere ordini [Bartoloni 2007: 230]. Lo scoppio della Grande Guerra avrebbe cambiato molte cose e tra que-ste avrebbe contribuito a portare a compimento la riforma sulla formazione, che per troppo tempo rimase solamente allo stato di lettera, e da lì in poi sarebbe nata un’altra storia, con battaglie, rivendicazioni e conquiste che verranno meglio documentate in altri capitoli del presente testo (si rimanda specialmente ai contributi di Baccarini, Tavormina e De Paola, Fiumi, Stievano e Rocco, Fava, Marcadelli e Stievano).

Il capitolo esamina l'organizzazione delle cure primarie basandosi sui modelli di cinque differenti regioni italiane, e precisamente Lombardia, Veneto, Toscana, Emilia-Romagna e Puglia, analizzando i percorsi e i processi istituzionalizzati di presa in carico dei pazienti esperiti da ciascuna realtà. Si esaminano altresì gli attori protagonisti delle cure primarie, i quali variano al variare del modello clinico-organizzativo implementato a livello regionale, pur notando un tendenziale superamento della modalità di esercizio solo-practice a vantaggio di modalità collettive, variamente declinate in ciascuna regione.