Search

1. Il Progetto TEVV: Teacher Education via Video2. Qualità partecipata e servizi 0-6 anni: una ricerca formazione3. La cittadinanza tra globalità, sostenibilità ed educazione. Un'indagine sulle convinzioni degli insegnanti

The final value value problem for the Brinkman–Forchheimer–Kelvin–Voigt equations is analysed for quadratic and cubic types of Forchheimer nonlinearity. The main term in the Forchheimer equations is allowed to be fully anisotropic. It is shown that the solution depends continuously on the final data provided the solution satisfies an a priori bound in $$L^3.$$ L 3 . The technique employed avoids the use of a specialist method for an improperly posed problem such as logarithmic convexity.

Malgrado il paradigma dell'inclusione sia ormai ampiamente diffuso, a livello internazionale e nel nostro Paese, sul terreno concreto della pratica le persone disabili (e le loro famiglie) continuano a scontrarsi con difficoltà e ostacoli che ne impediscono una sana costruzione identitaria. Attraverso una rilettura dell'avventura della soggettivazione nelle situazioni di disabilità, l'autore individua una serie di ostacoli comunicativi ed operativi derivanti dal difficile confronto con la "diversità". Viene proposto un approccio globale, psicodinamico e gruppale come maggiormente coerente con la prospettiva inclusiva da intendere come un processo che tiene conto della diversità di ciascuno per favorire partecipazione e apprendimento, ma anche per ridurre l'esclusione e l'emarginazione.

This article reports the study protocol of a nationwide multicentric study in seven Italian regions aimed at assessing the effectiveness of a digitally supported approach for the early screening of frailty risk factors in community-dwelling older adults. SUNFRAIL+ is a prospective observational cohort study aimed at carrying out a multidimensional assessment of community-dwelling older adults through an IT platform, which allows to connect the items of the SUNFRAIL frailty assessment tool with a cascading multidimensional in-depth assessment of the bio–psycho–social domains of frailty. Seven centers in seven Italian regions will administer the SUNFRAIL questionnaire to 100 older adults. According to the answers provided by older adults, they will be subjected to one or more validated in-depth scale tests in order to perform further diagnostic or dimensional evaluations. The study aims to contribute to the implementation and validation of a multiprofessional and multistakeholder service model for the screening of frailty in community-dwelling older adult population.

Abstract The onset of thermal convection in an anisotropic horizontal porous layer heated from below and rotating about vertical axis, under local thermal non-equilibrium hypothesis is studied. Linear and nonlinear stability analysis of the conduction solution is performed. Coincidence between the linear instability and the global nonlinear stability thresholds with respect to the L2—norm is proved. Article Highlights A necessary and sufficient condition for the onset of convection in a rotating anisotropic porous layer has been obtained. It has been proved that convection can occur only through a steady motion. A detailed proof is reported thoroughly. Numerical analysis shows that permeability promotes convection, while thermal conductivities and rotation stabilize conduction.

La pandemia in atto sta profondamente incidendo sulla vita di noi tutti e dei minori in particolare. La chiusura della scuola e l'utilizzazione costante e pervasiva della Dad, infatti, hanno creato notevoli problemi soprattutto a coloro che si trovano in una condizione di "fragilità psicosociale" amplificando diseguaglianze già esistenti e favorendo l'emergenza di ulteriori problematiche affettivo-relazionali. L'articolo affronta alcuni nodi critici del funzionamento della Scuola al tempo del Covid e delinea una prospettiva per una "nuova scuola" (più resiliente) da rimettere in moto alla ripresa post-pandemica.

Irritable bowel syndrome (IBS) is a common multifactorial condition that affects the large intestine and is characterized by chronic and relapsing abdominal pain and altered bowel habit. IBS is due to a combination of genetic, environmental and dietary factors. It's usually a lifelong problem very frustrating to live with and can have a big impact on quality of life, as single-agent therapy rarely relieves bothersome symptoms for all patients. The objective of this study was to analyze the approaches and solutions that address the social and health unmet needs of patients with IBS. A qualitative approach was adopted in the current study to identify and specify key digital solution and high impact user scenarios applied to IBS patients, through an adaptation of the "Blueprint on Digital Transformation in Health and Care in an Ageing Society" persona methodology. A Survey was administered to a group of patients in anonymous form. The theoretical elaboration IBS personas was developed through an interdisciplinary Focus Group, which also mapped the pathway for the patient's management. Three main needs were identified to be met to improve IBS patient's lifestyle: access to psychological support, mHealth solutions supporting diet and adapted physical activity, and homebased digital health support. mHealth intervention has been identified for diet adherence, physical exercise and psychological well-being. The process has been mapped and adapted to integrate the new solutions into the care pathway. Further research is needed to evaluate how mHealth services enable IBS patients to manage their conditions and improve their quality of life. KEY WORDS: Digital Health, Irritable bowel syndrome, mHealth, Nutrition, Physical activity, Psychological support.La sindrome dell’intestino irritabile (IBS) è una condizione multifattoriale comune che colpisce l’intestino crasso ed è caratterizzata da dolore addominale cronico e recidivante e alterazione delle abitudini intestinali. L’IBS è dovuta a una combinazione di fattori genetici, ambientali e dietetici. Di solito è un problema che permane per tutta la vita, molto frustrante per conviverci e può avere un grande impatto negativo sulla qualità della vita, poiché la terapia con un solo farmaco raramente allevia i sintomi fastidiosi per tutti i pazienti. L’obiettivo di questo studio era di analizzare gli approcci e le soluzioni che affrontano i bisogni sociali e sanitari insoddisfatti dei pazienti con IBS. Nel presente studio è stato adottato un approccio qualitativo per identificare e specificare la soluzione digitale chiave e gli scenari utente ad alto impatto applicati ai pazienti con IBS, attraverso un adattamento al singolo della metodologia “Blueprint on Digital Transformation in Health and Care in an Aging Society”. Un sondaggio è stato somministrato a un gruppo di pazienti in forma anonima. L’elaborazione teorica IBS personale è stata sviluppata attraverso un Focus Group interdisciplinare, che ha anche tracciato il percorso per la gestione del paziente. Sono state identificate tre esigenze principali da soddisfare per migliorare lo stile di vita dei pazienti affetti da IBS: accesso al supporto psicologico, soluzioni di mHealth a supporto della dieta e dell’attività fisica adattata e supporto sanitario digitale domiciliare. L’intervento mHealth è stato identificato per l’aderenza alla dieta, l’esercizio fisico e il benessere psicologico. Il processo è stato mappato e adattato per integrare le nuove soluzioni nel percorso assistenziale. Sono necessarie ulteriori ricerche per valutare in che modo i servizi di mHealth consentano ai pazienti con IBS di gestire le loro condizioni e migliorare la loro qualità di vita.

Background Bullying is recognized as one of the most significant social and health problems in the school environment for children and adolescents. In Italy, bullying involved 2 in 10 kids between 11–17 years that referred to have been bullied two or more times in a month. In Sicily, the estimated prevalence of children aged 11 to 15 that suffered at least one act of bullying in the last two months was 14% in 2011. Methods A questionnaire consisting of 30 items investigating physical, verbal and indirect bullying, observers of bullying, resiliency, and prosociality was administered to preadolescents of ten first-grade secondary schools within the Palermo Province in order to analyze prevalence and factors associated with bullying phenomenon. Also, a systematic literature review (SLR) analyzing manuscripts that reported prevalence of the bullying phenomenon worldwide was conducted. Results Survey: a total of 867 students, belonging to 35 s and 31 third classes of ten different schools in Palermo, Italy, were recruited in the survey. The values of physical bullying are included between the 4% of the single question method and the almost forty percent detected by the score of 7 method. Verbal bullying oscillates between 15.9% and 66.3%. Observers average values varies from 15.8% to 47.5%. SLR: the estimated prevalence showed a considerable fluctuation. The occurrence of the bullying phenomenon was low in some Northern European countries, while in Anglo-Saxon countries it affected over a quarter of the middle school student population (28% in Maryland, USA and 21% in the UK). Conclusions The prevalence of the bullying phenomenon recorded by this survey with the three different methods used is similar to observations in international literature. In the Sicilian context, a higher prevalence of bullying phenomena was observed in pre-adolescents attending major classes and in schools with lower socio-economic index. Though it remains difficult to obtain univocal data that clarifies the prevalence of different type of bullying, the continuous investigation of prevalence and factors associated with the phenomenon is a necessary starting point to introduce interventions and preventive measures in Public Health programs.

BACKGROUND: An anal fissure is a small laceration in the tissue (mucosa) that lines the anus. Anal fissures can cause pain and bleeding with bowel movements. Anal fissures can be attributed to constipation or repeated straining: a hard-fecal bolus cut the mucosa of anal canal that is relatively soft at sphincter level. Management and treatment of the disease are controversial. Many studies recommend conservative and medical treatment modalities as the initial options, since they are noninvasive and do not have risks of sphincter injury. Lateral internal sphincterotomy (LIS) is considered the gold standard for treatment of chronic anal fissure. Nonetheless, anal incontinence is one of the worrisome complications of LIS. LigaSure™ (Medtronic, Dublin, Ireland) is a bipolar electrosurgical device designed to deliver high current and very low voltage to tissue. It monitors tissue impedance between the jaws of the instrument and continuously adjusts the delivery of energy. We have applied the use of this device to a group of patients complaining about chronic anal fissure in order to verify if there is any advantage in performing it, compared to traditional technique (blade, scissors, electrocautery). METHODS: A group of 436 patients were treated in our institution as proctological day-surgery patients from January 2016 to January 2021. Three hundred fifty-one underwent lateral internal sphincterotomy. As comparative group (CG), we considered the results of the systematic review of Boland et al. whose sphincterotomy group consisted of 349 patients (45% of 775patients) from 9 studies included. RESULTS: Of 351 patients who underwent to LIS pile excision, 322 healed within 9 weeks from treatment (91.73%) compared to 332 (95.1%) of the CG. Sixty-three out 85 (74.1%) of patients with AF + other treatments. In the LIS group the overall recurrence over a period of 6 months for all patients was 17 patients (4.84%) compared with 6.9% (24/349) over a period of 2-6 months follow-up. CONCLUSIONS: The use of LigaSure™ Small Jaw (SJ) (Medtronic) was never reported for anal fissures in literature. LigaSure™ SJ (Medtronic) is a bipolar device which allows to perform the procedure in a reduced time and in a safer way even if differences with traditional techniques are not significant. The costs of the operation are higher in LigaSure group. Literature up today does not report any article about the use of LigaSure™ (Medtronic) for treatment of anal fissures. It could be controversial for the cost of the device but is safer and quicker compared to traditional knife or scissors.

Background : Irritable bowel syndrome (IBS) is a common multifactorial condition that affects the large intestine and is characterized by chronic and relapsing abdominal pain and altered bowel habit. IBS is due to a combination of genetic, environmental and dietary factors. It's usually a lifelong problem very frustrating to live with and can have a big impact on quality of life, as single-agent therapy ra: Objective to analyze the approaches and solutions that address the social and health unmet needs of patients with IBS. Design: A quantitative-qualitative approach was adopted in the current study to identify and specify key digital solution and high impact user scenarios applied to IBS patients, through an adaptation of the “Blueprint on Digital Transformation in Health and Care in an Ageing Society” persona methodology. Settings: Digital health solutions bring the potential of supporting health interventions through mobile apps, wearable devices, telemedicine. Patients: A Survey was administered to a group of patients in an anonymous form, and no need for Medical Ethical Committee approval was identified. Interventions. The theoretical elaboration IBS personas was developed through an interdisciplinary Focus Group, which also mapped the pathway for the patient's management. Main Outcome : Three main needs were identified to be met to improve IBS patient’s lifestyle: access to psychological support, mHealth solutions supporting diet and adapted physical activity, and home-based digital health support. mHealth intervention has been identified for diet adherence, physical exercise and psychological well-being. The process has been mapped and adapted to integrate the new solutions into the care pathway. Limitation: Further research is needed to evaluate how mHealth services enable IBS patients to manage their conditions and improve their quality of life. Conclusion The person-centered approach was implemented through a multidisciplinary Focus group that enabled the identification of the need for a mHealth intervention

Although there is a strong evidence of prevalence of condylomata in the HIV-positive population, literature on HIV prevalence in HIV-unscreened population diagnosed with condylomata is still unconclusive. Our aim is to review literature about HIV screening and diagnosis of anal condylomata in order to evaluate medical aspects, ethical and legal issues concerning the management of this disease. We undertook an online search on Pubmed for the keywords "HIV", "screening" and "anal condylomata" and 23 papers were analysed, 2 being randomized controlled trial, 11 comparative studies and 10 reviews. A total of 1270 patients were reviewed. All authors strongly recommend HIV testing in patients with clinical evidence of anal condylomata. In undeveloped countries with high prevalence of HIV, a proctological evaluation could be a could represent an unexpected therapeutic option for HIV infected male patients to prevent anal cancer. Clinical trials and prospective studies are necessary to validate this interesting hypothesis. KEY WORDS: Anal condylomatosis, HIV screening, Papilloma virus.L’associazione di condilomi anali in pazienti HIV-positivi è di riscontro molto frequente ma i dati della letteratura in questo senso non sono conclusivi.Abbiamo quindi esaminato la letteratura esistente circa gli screening e la diagnosi di condilomatosi anale per verificare gli aspetti etici, legali e medici presenti nella gestione della malattia. Abbiamo quindi condotto una ricerca su fonte “Pubmed” con le parole chiave “HIV”,”anal condilomata”,” screening”, ed abbiamo esaminato 23 pubblicazioni di cui due trial randomizzati e controllati, 11 studi comparativi e 10 review. In totale sono stati esaminati 1279 pazienti. Tutti gli autori consigliano la somministrazione di test HIV in presenza di pazienti con condilomatosi anale; in paesi non industrializzati con alta incidenza di HIV la valutazione proctologica inoltre potrebbe essere una buona opportunità per uno screening mirato in una popolazione ad alto rischio. Infine due vaccini HPV oggi disponibili potrebbero rappresentare una efficace opzione terapeutica nei pazienti maschi HIV nell’ottica di prevenire l’insorgenza del cancro dell’ano.Ulteriori trial clinici sono necessari comunque per attribuire una validità scientifica a questa interessante ipotesi.

The onset of thermal convection in anisotropic rotating bidisperse porous media is investigated. The optimal result concerning the coincidence between linear instability and nonlinear stability thresholds with respect the $$L^2$$ L 2 -norm is obtained.

Chronic radiation proctitis is a frequent complication after radiotherapy for pelvic malignancies. It is reported that 1 to 5% of patients develop chronic radiation proctitis even with recent advances in external radiotherapy. Hematochezia, mucus discharge, urgency and tenesmus are common symptoms and they can vary in severity but bleeding is often the most debilitating to the patient. Different options are reported for treatment of this condition that always should keep in differential diagnosis in patients with history of pelvic radiotherapy. Treatments range from easy, with topic administration of formalina, to expensive and requiring specialized equipment such as hyperbaric oxygen therapy. Surgery is reserved to patients with failure of conservative treatments due to the high risk of leakage and high morbidity up to 60%. KEY WORDS: Argon beam, Bleeding, Formalin, Radiation, Proctitis, Sucralfate enema.La proctite cronica da radiazioni è una complicanza frequente dopo la radioterapia per le neoplasie pelviche. È stato riferito che l’1-5% dei pazienti sviluppa proctite cronica da radiazioni anche con i recenti progressi nella radioterapia esterna. Ematochezia, secrezione di muco, urgenza e tenesmo sono sintomi comuni e possono variare in gravità, ma il sanguinamento è spesso il più debilitante per il paziente. Diverse opzioni sono riportate per il trattamento di questa condizione che dovrebbe mantenere sempre una diagnosi differenziale nei pazienti con storia di radioterapia pelvica. I trattamenti vanno da soluzioni facili ed economiche come la somministrazione topica di formalina, a costose che richiedono attrezzature speciali come l’ossigenoterapia iperbarica. La chirurgia è riservata ai pazienti con fallimento dei trattamenti conservativi a causa dell’elevato rischio di perdite e dell’elevata morbilità fino al 60%. In questo studio sono riportati due casi di pazienti trattati con radioterapia e con sintomatologia da probabile colite attinica. Entrambi i pazienti sono stati sottoposti a colonscopia ed a trattamento topico e valutazione a distanza. In uno dei casi, visto il perdurare del sanguinamento, è stato necessario eseguire un trattamento con Argon Plasma Coaguletor, per ottenere un risultato definitivo.

We derive linear instability and nonlinear stability thresholds for a problem of thermal convection in a bidispersive porous medium with a single temperature when Darcy theory is employed in the micropores whereas Brinkman theory is utilized in the macropores. It is important to note that we show that the linear instability threshold is the same as the nonlinear stability one. This means that the linear theory is capturing completely the physics of the onset of thermal convection. The coincidence of the linear and nonlinear stability boundaries is established under general thermal boundary conditions.

BACKGROUND: Anal fistulae represent one of the most challenging conditions to treat by proctologists. Nowadays different treatment options are available. METHODS: We analysed our initial experience with bulking agents: we treated 46 patients from January 2014 to December 2017. For our prospective study, they were operated by the same surgical colo-rectal staff in our Istitution. All the details of the procedure were discussed with patients before surgery and a written consent was obtained. All patients were examined after a week, one month, six months and one year after procedure with clinical study including digital examination, proctoscopy and anal UltraSound Scan. We also did a mini-review regarding the most important bulking agents. RESULTS: None of the patients developed continence impairment after procedure. No mortality was observed. Patients needed analgesics for pain relief, for a period of 3-7 days, were 29 of 46 (63%). A total recurrence rate of 21% and overall success rate of 65.2% at 1 year follow-up. CONCLUSIONS: Anal fistulas treatment is still controversial and recurrence is typically very frequent. Our results underlined the importance of an accurate tailored treatment of fistula patients. A unique treatment useful for all types of fistulas does not exist. Among the most recent techniques, bulking agents' injections can be considered simple and safe therapeutic options, with no continence impairment.

Thermal convection of a fluid filling an anisotropic porous medium, uniformly rotating about a vertical axis, with local thermal non equilibrium, is studied. The linear and nonlinear stability analysis are performed. In particular the coincidence between linear instability and nonlinear (global) stability thresholds is proved.

We obtain the linear instability and nonlinear stability thresholds for a problem of thermal convection in a rotating bidispersive porous medium with a single temperature. We show that the linear instability threshold is the same as the nonlinear stability one. This means that the linear theory is capturing completely the physics of the onset of thermal convection.

Linear and nonlinear stability analyses for thermal convection in a rotating bidispersive porous medium, horizontally isotropic, is performed. Since the coincidence between linear instability and non-linear stability thresholds has been proved, the linear theory captures completely the physics of the problem at stake.

Exosomes, nano-sized membrane vesicles, are released by various cells and are found in many human body fluids. They are active players in intercellular communication and have immune-suppressive, immune-regulatory, and immune-stimulatory functions. EBV is a ubiquitous human herpesvirus that is associated with various lymphoid and epithelial malignancies. EBV infection of B cells in vitro induces the release of exosomes that harbor the viral latent membrane protein 1 (LMP1). LMP1 per se mimics CD40 signaling and induces proliferation of B lymphocytes and T cell–independent class-switch recombination. Constitutive LMP1 signaling within B cells is blunted through the shedding of LMP1 via exosomes. In this study, we investigated the functional effect of exosomes derived from the DG75 Burkitt’s lymphoma cell line and its sublines (LMP1 transfected and EBV infected), with the hypothesis that they might mimic exosomes released during EBV-associated diseases. We show that exosomes released during primary EBV infection of B cells harbored LMP1, and similar levels were detected in exosomes from LMP1-transfected DG75 cells. DG75 exosomes efficiently bound to human B cells within PBMCs and were internalized by isolated B cells. In turn, this led to proliferation, induction of activation-induced cytidine deaminase, and the production of circle and germline transcripts for IgG1 in B cells. Finally, exosomes harboring LMP1 enhanced proliferation and drove B cell differentiation toward a plasmablast-like phenotype. In conclusion, our results suggest that exosomes released from EBV-infected B cells have a stimulatory capacity and interfere with the fate of human B cells.

Foreign bodies in the rectum are a true proctological emergency. The incidence of these cases is increasing in recent years mostly due to auto-erotic acts and behavior disordes and is mainly observed in young patients. Most patients with rectal foreign bodies present to the emergency room usually exhausted after efforts of removingothe object at home. Many endoscopic and surgical techniques to get such removal have been described in the literature and the reported variety of in foreign bodies is as large as the number of techniques used to remove them. Authors report a case of unusual foreign body in the rectum that required multiple attempts to be removed and an original solution. KEY WORDS: Emergency surgery, Rectal foreign body, Transanal Extraction.I corpi estranei del retto costituiscono una vera emergenza chirurgica. L’incidenza è cresciuta negli anni piu’recenti specialmente tra i giovani e principalmente per l’incremento delle pratiche auto-erotiche e dei disturbi comportamentali. La maggior parte dei pazienti si presenta al pronto soccorso dopo inutili ed estenuanti tentativi di estrazione praticati a casa. Le tecniche utilizzate e riportate in letteratura sono varie almeno quanto il numero e la forma degli oggetti. Viene di seguito illustrato il caso di un oggetto “inusuale” inserito nel retto a scopo autoerotico estratto con una soluzione originale dopo numerosi tentativi senza successo.

Il bullismo è uno dei problemi sociali e sanitari più rilevanti in ambito scolastico per i bambini e gli adolescenti di tutto il mondo. Dal 2007, il Ministero Italiano della Pubblica Istruzione (D.M. n°16 del 5 febbraio 2007) promuove attività per il contrasto e la prevenzione del fenomeno in scuole di ogni ordine e grado, ed allo stesso tempo le aziende sanitarie locali o provinciali dovrebbero farsi carico di una risposta socio-sanitaria efficace al problema. Nella città di Palermo, negli ultimi anni, sia alcune scuole che alcuni distretti sanitari hanno messo in atto attività ed interventi per cercare di contrastare il fenomeno in questione. La mancanza di un dato rilevato in maniera uniforme a livello regionale e provinciale e la radicalizzazione del problema rendono necessaria ed urgente una risposta strutturata valutabile in termini di efficacia in linea con l'obiettivo 2.3 del Piano Regionale di Prevenzione 2014/2018 (PRP Regione Siciliana - D.A. n.351 del 08/03/2016) che prevede, anche in tal senso, azioni per promuovere il benessere mentale nei bambini, adolescenti e giovani. Tale impostazione, tra l'altro, è condivisa dal Protocollo d'Intesa interistituzionale "Una nuova alleanza per la Salute dei bambini e dei giovani" siglato tra l'USR-Sicilia e l'Assessorato della Salute-DASOE (Decreto Assessorato della Salute del 17/06/2016). Negli ultimi decenni la problematica del bullismo tra bambini e adolescenti ha guadagnato sempre più interesse in sanità pubblica, catalizzando molti sforzi sia di ricerca che di azione. Per bullismo si intende un abuso sistematico di potere che si manifesta con intimidazione/forme di persecuzione fisica, verbale o psicologica, ripetute nel tempo, concepite ed agite con l'intenzionalità di causare paura, angoscia o danni alla vittima; perpetuata da una persona o da un gruppo di persone più forti e potenti nella relazione con la vittima (Farrington et al. D. P. 1993, Gredler et al., G. R. 2003). Intenzionalità, durata nel tempo e asimmetria nella relazione sono, quindi, le parole chiave nella definizione di bullismo. Le vittime sono selezionate per la loro condizione di diversità, che può essere rappresentata dall'obesità, dalla timidezza, dalle scarse competenze sociali, dall'identità sessuale, dall'etnia, dallo stato socio-economico, da disturbi dello spettro autistico, dislessia e differenze di simile natura. Il bullismo coinvolge un'importante percentuale di bambini in età scolare: secondo i dati ISTAT 2014, 2 ragazzi su 10 tra gli 11-17 anni hanno subito atti di bullismo due o più volte al mese, con una prevalenza maggiore per le ragazze (Istat, 2014). In Sicilia, il fenomeno del bullismo è oggetto di particolare attenzione, tanto che l'Ufficio Scolastico Regionale per la Sicilia (USR) è stato tra i primi in Italia ad aver costituito un Osservatorio regionale,che ha prodotto strumenti operativi quali delle linee guida per la prevenzione del bullismo nelle scuole (Beckman L. et al. 2012). La prevalenza stimata di bambini tra gli 11 e i 15 anni che dichiara di aver subito almeno un atto di bullismo negli ultimi due mesi, in regione Sicilia, risulta essere del 14%, secondo gli ultimi dati disponibili della sorveglianza HBSC (2014) (Regione Sicilia. Osservatorio epidemiologico,2014). La letteratura scientifica dimostra una forte associazione tra l'essere stato vittima di bullismo e l'insorgenza di problematiche di salute mentale e fisica, sia a breve che a lungo termine ((Beckman L. et al. 2012 Gini, G. et al. 2009). Inoltre esiti di salute negativa si riscontrano anche per i bulli. Per questo, diversi programmi di prevenzione specifici, basati sul setting scolastico, sono stati creati ed attuati, a partire dal primo grande programma anti-bullismo su larga scala realizzato in Norvegia nel 1983 e perfezionato poi da Olweus nel 1991 (Olweus, D. 2001), che si dimostrò fin da subito di grande efficacia e che tuttora rappresenta il modello d'intervento di maggior successo. Una revisione sistematica (Ttofi, M. et al. 2011) di 44 programmi ha dimostrato come i programmi di prevenzione a scuola siano in grado di ridurre la prevalenza di bullismo, in media, del 20-23%. Obiettivo del progetto BIAS (Bullying In siciliAn School) vuole essere quello di valutare la prevalenza baseline dei fenomeni di bullismo nelle scuole siciliane, proporre un intervento preventivo evidence-based e adattato al contesto locale e infine di valutarne l'efficacia sul campo nel prevenire o ridurre i fenomeni di bullismo. Nel presente rapporto epidemiologico si riportano i risultati preliminari dello studio di prevalenza "pilota" in un campione di scuole nella città di Palermo, capoluogo di Regione e comune con il maggior numero di abitanti della Regione Siciliana. Obiettivi del lavoro sono per l'appunto la valutazione della prevalenza del bullismo in un campione di scuole nella città di Palermo, lo studio delle caratteristiche dei fenomeni di bullismo che si verificano in relazione alle differenti tipologie di scuola e la possibile applicabilità di metodi alternativi al "gold stardard" per la rilevazione della prevalenza del fenomeni di bullismo nelle scuole.

Ethical and medico-legal issues reviews of Percutaneous Endoscopic Gastrostomy (PEG) placement in elderly patients is an important topic of international medical literature. PEG is often inappropriately placed in patients with not spontaneous oral feeding intake, cause of unrealistic expectations. We performed a critical review of the literature for placement of PEG in geriatric patients.A literature review was performed about the positioning of the PEG in geriatric patients with dementia and severe anorexia. This assessment has served to develop an algorithm that would be able to provide adequate indications for PEG placement in this patient population.We obtained appropriate indications about PEG placement, below: 1) Esophageal obstructions (like esophageal or neck cancer) 2) neurological deficits correlated dysphagia (like ictus sequelae) 3) refusal to swallow without concomitant terminal illness (like protracted pseudo dementia caused by severe depression) 4) chronic gastric decompression in patients with benign/malignant obstruction who do not wish or can't have a nasogastric tube placed.When compared with controls matched for age, elderly patients with cognitive impairment who have feeding gastrostomy do not demonstrate improved survival.Anorexia, Dementia, Elderly, Percutaneous Endoscopic Gastrostomy.I problemi etici e medico-legali del posizionamento della gastrostomia endoscopica percutanea (PEG) nei pazienti anziani sono un argomento importante della letteratura medica internazionale. PEG è spesso posizionato in modo inappropriato in pazienti con assunzione di cibo orale non spontanea, causa di aspettative non realistiche. Abbiamo pertanto eseguito una revisione critica della letteratura sul tela dell’adozione della PEG nei pazienti geriatrici. La revisione della letteratura è stata eseguita concentrandoci sul posizionamento del PEG in pazienti geriatrici con demenza e grave anoressia. Questa analisi è servita a sviluppare un algoritmo che sarebbe in grado di fornire indicazioni adeguate per il posizionamento di PEG in questa popolazione di pazienti. Le indicazioni derivate da questo studio circa l’appropriatezza del posizionamento di PEG, riguardano: 1) ostruzioni esofagee (come il cancro esofageo o al collo); 2) deficit neurologico correlato disfagia (come sequele ictus); 3) rifiuto di deglutire senza malattia terminale concomitante (come pseudo demenza protratto causato da depressione grave); 4) decompressione gastrica cronica in pazienti con ostruzione benigna / maligna che non desiderano o non possono avere una sonda nasogastrica posizionata. In conclusione, se confrontati con i controlli corrispondenti all’età, i pazienti anziani con disabilità cognitiva alimentati con la gastrostomia non hanno dimostrato una migliore sopravvivenza.

In this paper we use an approach based on a Buffon-Laplace type problem for an irregular hexagonal lattice and obstacles to study some problems about analysis of the railway network operations safety in the presence of different obstacles on the route.

We derive the linear instability and nonlinear stability thresholds for a problem of thermal convection in a tridispersive porous medium with a single temperature. Importantly we demonstrate that the nonlinear stability threshold is the same as the linear instability one. The significance of this is that the linear theory is capturing completely the physics of the onset of thermal convection. This result is different to the general theory of thermal convection in a tridispersive porous material where the temperatures in the macropores, mesopores and micropores are allowed to be different. In that case the coincidence of the nonlinear stability and linear instability boundaries has not been proved.

Faecal incontinence is a very debilitating problem. Many techniques have been proposed to treat this condition, with controversial results. Autologous transplant of fat tissue is an established procedure used for the repair of tissue damage, and recent studies revealed the potentiality of tissue regeneration by human adipose-derived stem cells. We treated this condition with the injection, in the intersphincteric anal groove, of lipoaspirate processed by an innovative technology (Lipogems). The aim of the study was to evaluate the efficacy of Lipogems injection for the treatment of faecal incontinence. In February 2014 we treated 3 patients with faecal incontinence. The surgical procedure required three phases: lipoaspiration, processing of lipoaspirate with the Lipogems system, and injection of the obtained product in the intersphincteric anal groove. An accurate proctological examination followed at 1 week, 1 month and 6 months after treatment. Each patient reported an improved Wexner incontinence score at 1 month after the procedure. We observed an increase of resting pressure (by at least 10 mm Hg) and thickness of the internal anal sphincter respectively at ano-rectal manometry and by ultrasound (US) evaluation at the sixth month of follow-up. Our preliminary results are encouraging, but multicentric studies with longer follow-up are needed to validate this novel technique for treatment of faecal incontinence.