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Sabrina Lai - One of the best experts on this subject based on the ideXlab platform.
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differentials in the Regional operational program expenditure for public services and infrastructure in the coastal cities of sardinia italy analyzed in the ruling context of the Regional landscape plan
Land Use Policy, 2013Co-Authors: Corrado Zoppi, Sabrina LaiAbstract:Abstract The planning activity of the Regional Administration of Sardinia (Italy) has undergone a deep change after the approval of the Regional Landscape Plan (RLP), which establishes the directions for nearly any future planning activity in Sardinia, and requires that actual sectoral and local plans, as well as plans for protected areas, be changed to comply with its directions. This mandatory adjustment process can be conflictual, if the Administrations responsible for these plans disagree with the rules established by the RLP. With regards to Sardinian coastal cities, this paper analyzes the investment policies for public services and infrastructure implemented by the Sardinian Region through the 2000–2006 Regional Operational Program (2000–2006 ROP-ERDF), in order to assess whether the RLP exerts a negative impact.
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differentials in the Regional operational program expenditure for public services and infrastructure in the coastal cities of sardinia italy analyzed in the ruling context of the Regional landscape plan
ERSA conference papers, 2011Co-Authors: Corrado Zoppi, Sabrina LaiAbstract:The planning activity of the Regional Administration of Sardinia (Italy) is characterized by a deep change after the approval of the Regional Landscape Plan (RLP). The RLP, ruled by the National Code of Cultural Heritage and Landscape, establishes the directions for future Sardinian Regional planning and requires that sectoral, province and city plans, and plans for protected areas, be changed to comply with its directions. The adjustment process could be conflictual, since cities, provinces, and bodies responsible for protected areas might disagree with the Regional Administration about the rules established by the RLP. These are particularly restrictive for coastal areas, where cities could suffer a sharp decline in building expansion rights and risk losing financial resources that would come from the impact fees paid by the developers. Moreover, payments of communal tax for real estate might decrease, since the value of land would plummet without development rights. The investment attraction capacity of Sardinian coastal cities could therefore drop as a consequence of the ruling framework of the RLP. The Sardinian Regional operational program 2007-2013 concerning the European Regional Development Fund (ERDF) respects the rules of the ERDF on the investments for territorial cohesion (as defined by Regulation no. 1080/2006/EC), since it promotes their Regional geographic concentration. With regards to Sardinian coastal cities, this paper analyzes the investment policies for public services and infrastructure implemented by the Sardinian Region through the Regional Operational Program, in order to assess the impact of the RLP. The first section develops a geographic information system (GIS) to define a territorial taxonomy of Sardinian coastal cities, by analyzing the spatial distribution of investment in public services and infrastructure and of other attributes concerning demography, urbanization, RLP ruling framework. The second section analyzes, through linear regression and logit methodologies, the investment policies concerning public services and infrastructure, and identifies correlations between the variables represented by the GIS. The methodological approach adopted in this paper can be used in Regional planning processes to address the important issue of the often-conflictual relationship between the implementation of conservative planning policies and local economic development programs.
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assessment of the Regional landscape plan of sardinia italy a participatory action research case study type
Land Use Policy, 2010Co-Authors: Corrado Zoppi, Sabrina LaiAbstract:Abstract The planning activity of the Regional Administration of Sardinia (Italy) has undergone a deep change after the approval of the Regional Landscape Plan (RLP), which establishes the directions for nearly any future planning activity in Sardinia, and requires that actual sectoral and local plans, as well as plans for protected areas, be changed to comply with its directions. This mandatory adjustment process can be conflictual, if the Administrations responsible for these plans disagree with the rules established by the RLP. On these bases, this essay develops a discussion around two issues concerning public participation in the Sardinian RLP. The first part focuses on the extent to which integration of different stakeholders was looked for in the plan preparation and what the likely consequences of this degree of participation are. The second part discusses how local communities may participate in the implementation process of the RLP. This assessment builds on empirical studies on conflictual issues concerning the Sardinian RLP analyzed through Multicriteria analysis and Contingent Valuation. The contribution of this essay to define an on-going strategic assessment of the RLP identifies two main normative points. First, the right concept of subsidiarity has to be restored in the RLP planning implementation code. Second, the Regional planning activity has to be based on a true cooperative-planning approach so that the relations between the Regional Administration and the cities may lose their conflict-derived inefficiency.
Corrado Zoppi - One of the best experts on this subject based on the ideXlab platform.
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differentials in the Regional operational program expenditure for public services and infrastructure in the coastal cities of sardinia italy analyzed in the ruling context of the Regional landscape plan
Land Use Policy, 2013Co-Authors: Corrado Zoppi, Sabrina LaiAbstract:Abstract The planning activity of the Regional Administration of Sardinia (Italy) has undergone a deep change after the approval of the Regional Landscape Plan (RLP), which establishes the directions for nearly any future planning activity in Sardinia, and requires that actual sectoral and local plans, as well as plans for protected areas, be changed to comply with its directions. This mandatory adjustment process can be conflictual, if the Administrations responsible for these plans disagree with the rules established by the RLP. With regards to Sardinian coastal cities, this paper analyzes the investment policies for public services and infrastructure implemented by the Sardinian Region through the 2000–2006 Regional Operational Program (2000–2006 ROP-ERDF), in order to assess whether the RLP exerts a negative impact.
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differentials in the Regional operational program expenditure for public services and infrastructure in the coastal cities of sardinia italy analyzed in the ruling context of the Regional landscape plan
ERSA conference papers, 2011Co-Authors: Corrado Zoppi, Sabrina LaiAbstract:The planning activity of the Regional Administration of Sardinia (Italy) is characterized by a deep change after the approval of the Regional Landscape Plan (RLP). The RLP, ruled by the National Code of Cultural Heritage and Landscape, establishes the directions for future Sardinian Regional planning and requires that sectoral, province and city plans, and plans for protected areas, be changed to comply with its directions. The adjustment process could be conflictual, since cities, provinces, and bodies responsible for protected areas might disagree with the Regional Administration about the rules established by the RLP. These are particularly restrictive for coastal areas, where cities could suffer a sharp decline in building expansion rights and risk losing financial resources that would come from the impact fees paid by the developers. Moreover, payments of communal tax for real estate might decrease, since the value of land would plummet without development rights. The investment attraction capacity of Sardinian coastal cities could therefore drop as a consequence of the ruling framework of the RLP. The Sardinian Regional operational program 2007-2013 concerning the European Regional Development Fund (ERDF) respects the rules of the ERDF on the investments for territorial cohesion (as defined by Regulation no. 1080/2006/EC), since it promotes their Regional geographic concentration. With regards to Sardinian coastal cities, this paper analyzes the investment policies for public services and infrastructure implemented by the Sardinian Region through the Regional Operational Program, in order to assess the impact of the RLP. The first section develops a geographic information system (GIS) to define a territorial taxonomy of Sardinian coastal cities, by analyzing the spatial distribution of investment in public services and infrastructure and of other attributes concerning demography, urbanization, RLP ruling framework. The second section analyzes, through linear regression and logit methodologies, the investment policies concerning public services and infrastructure, and identifies correlations between the variables represented by the GIS. The methodological approach adopted in this paper can be used in Regional planning processes to address the important issue of the often-conflictual relationship between the implementation of conservative planning policies and local economic development programs.
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assessment of the Regional landscape plan of sardinia italy a participatory action research case study type
Land Use Policy, 2010Co-Authors: Corrado Zoppi, Sabrina LaiAbstract:Abstract The planning activity of the Regional Administration of Sardinia (Italy) has undergone a deep change after the approval of the Regional Landscape Plan (RLP), which establishes the directions for nearly any future planning activity in Sardinia, and requires that actual sectoral and local plans, as well as plans for protected areas, be changed to comply with its directions. This mandatory adjustment process can be conflictual, if the Administrations responsible for these plans disagree with the rules established by the RLP. On these bases, this essay develops a discussion around two issues concerning public participation in the Sardinian RLP. The first part focuses on the extent to which integration of different stakeholders was looked for in the plan preparation and what the likely consequences of this degree of participation are. The second part discusses how local communities may participate in the implementation process of the RLP. This assessment builds on empirical studies on conflictual issues concerning the Sardinian RLP analyzed through Multicriteria analysis and Contingent Valuation. The contribution of this essay to define an on-going strategic assessment of the RLP identifies two main normative points. First, the right concept of subsidiarity has to be restored in the RLP planning implementation code. Second, the Regional planning activity has to be based on a true cooperative-planning approach so that the relations between the Regional Administration and the cities may lose their conflict-derived inefficiency.
Simon W Young - One of the best experts on this subject based on the ideXlab platform.
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intraosseous Regional Administration of antibiotic prophylaxis in total knee arthroplasty
Jbjs Essential Surgical Techniques, 2020Co-Authors: Jaymeson R Arthur, Joshua S Bingham, Henry D Clarke, Mark J Spangehl, Simon W YoungAbstract:Background Periprosthetic joint infection (PJI) is a devastating complication following total knee arthroplasty (TKA), and perioperative antibiotics are commonly administered to try to mitigate the chance of infection. Intraosseous Regional Administration (IORA) of prophylactic antibiotics during TKA is a method of antibiotic delivery that has been shown to achieve markedly higher tissue concentrations at much lower doses. Other advantages include ease of Administration, ability to time the antibiotic delivery with the surgical start time for maximal effectiveness, and less systemic side effects. The concept is similar to a Bier block, except that IORA involves the use of antibiotics instead of local anesthetic to perfuse the limb and is given via intraosseous rather than intravenous access. Description After standard patient preparation and draping, the tourniquet is inflated and an intraosseous needle is inserted into the proximal medial face of the tibia, just medial and slightly above the level of the tubercle. A large syringe containing the desired antibiotic (typically 500 mg vancomycin suspended in normal saline solution) is connected to the needle and the solution is administered over 1 to 2 minutes. The intraosseous needle can then be removed and the surgical procedure proceeds as it normally would per surgeon preference and technique. Alternatives Systemic Administration of intravenous antibiotics, vancomycin powder, and antibiotic-impregnated cement are alternative options that can be utilized during TKA. Rationale IORA has several distinct advantages over other methods of antibiotic delivery, including the ability to (1) deliver antibiotic directly to the surgical bed and avoid systemic delivery, (2) precisely time and quickly administer antibiotics to achieve highest concentrations at the start of and throughout the surgical procedure, and (3) avoid several common and potentially serious side effects, especially those associated with antibiotics such as vancomycin. Expected outcomes This technique for antibiotic delivery achieves markedly higher tissue concentrations compared with systemic Administration, without prolonged preoperative infusion times. Intraosseous delivery optimizes timing and reduces the risk of systemic side effects while simultaneously providing equal or enhanced antibiotic prophylaxis in TKA. This delivery mechanism is especially useful in patients who are at high risk for infection and in the revision TKA setting. Further, there is little to no additional risk and the use of this method does not substantially prolong operative time. Important tips The proximal aspect of the tibia is the optimal injection site because the cortex is thinner in this region, making needle insertion easier. Additionally, the metaphyseal bone allows faster flow rates for the infusion. We have found that insertions made slightly more proximally are easier and have faster flow rates. Of note, although the antibiotic is infused into the tibia, as seen in the attached technique video, intraosseous Administration achieves rapid uptake into the vascular tree. Therefore, all tissues distal to the tourniquet, including the femur and patella, will receive this optimal dose as well.We prefer the use of a power driver (EZ-IO; Teleflex); however, manual needles (Cook Medical) can also be utilized. Longer needles are available if needed for obese patients.Flow rates are variable and the infusion typically takes 1 to 2 minutes to complete. If the flow rate is slow, twisting and withdrawing the needle slightly (2 to 4 mm) may increase the rate. This contrasts with the 1 to 2-hour intravenous infusion time required when vancomycin is administered systemically.In our experience, intraosseous injection is still successful in the case of a previous high tibial osteotomy, although the flow rate may be slower.In complex revision cases with compromised proximal tibial bone, the medial malleolus is an alternative site for intraosseous Administration.Choice of antibiotic: as vancomycin is difficult to adequately administer intravenously, it is ideally suited for IORA. We have studied and utilized a 500-mg dose of vancomycin suspended in a solution of 140 mL of normal saline solution (prepared by our pharmacy). Of note, we have not found rapid infusion of intraosseous vancomycin to cause red-man syndrome as it would with rapid systemic infusion. This is because of the lower dose of 500 mg and the use of the tourniquet, which keeps the antibiotic in the local tissues about the knee without allowing systemic exposure. All patients, regardless of weight or the size of their limb, receive the dose of 500 mg of vancomycin.As cefazolin does not have the same difficulties with intravenous Administration, we continue to use standard intravenous prophylaxis with an appropriate weight-based dose of cefazolin prior to incision.Indications for IORA of vancomycin include clinical scenarios in which vancomycin would be administered intravenously. These indications include revision TKA, obesity (body mass index >40 kg/m2), diabetes, beta-lactam allergy, known colonization with methicillin-resistant Staphylococcus aureus (MRSA), patients coming from institutions with a high prevalence of MRSA, previous ligamentous surgical procedure or osteotomies, and current or recent smokers. IORA can be utilized even in the primary TKA setting if the patient is considered high-risk as defined by the criteria above. We also use IORA during reimplantation following 2-stage exchange for PJI and in patients undergoing irrigation and debridement for acute PJI when the organism has been identified preoperatively.
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Regional intraosseous Administration of prophylactic antibiotics is more effective than systemic Administration in a mouse model of tka
Clinical Orthopaedics and Related Research, 2015Co-Authors: Simon W Young, Tim Roberts, Sarah Johnson, James P Dalton, Brendan Coleman, Siouxsie WilesAbstract:Background In human TKA studies, intraosseous Regional Administration (IORA) of prophylactic antibiotics achieves local tissue antibiotic concentrations 10 times greater than systemic Administration. However, it is unclear if such high concentrations provide more effective prophylaxis.
David F. Stroncek - One of the best experts on this subject based on the ideXlab platform.
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a phase 1 trial of autologous monocytes stimulated ex vivo with sylatron peginterferon alfa 2b and actimmune interferon gamma 1b for intra peritoneal Administration in recurrent ovarian cancer
Journal of Translational Medicine, 2018Co-Authors: Daniel S. Green, Ana T. Nunes, Irene B. Ekwede, Nicole D. Houston, Steven L. Highfill, Hanh Khuu, Virginia Davidocampo, David F. StroncekAbstract:Ovarian cancer has no definitive second line therapeutic options, and largely recurs in the peritoneal cavity. LocoRegional immune therapy using both interferons and monocytes can be used as a novel approach. Interferons have both cytostatic and cytotoxic properties, while monocytes stimulated with interferons have potent cytotoxic properties. Due to the highly immune suppressive properties of ovarian cancer, ex vivo stimulation of autologous patient monocytes with interferons and infusion of all three agents intraperitoneally (IP) can provide a strong pro-inflammatory environment at the site of disease to kill malignant cells. Patient monocytes are isolated through counterflow elutriation and stimulated ex vivo with interferons and infused IP through a semi-permanent catheter. We have designed a standard 3 + 3 dose escalation study to explore the highest tolerated dose of interferons and monocytes infused IP in patients with chemotherapy resistant ovarian cancer. Secondary outcome measurements of changes in the peripheral blood immune compartment and plasma cytokines will be studied for correlations of response. We have developed a novel immunotherapy focused on the innate immune system for the treatment of ovarian cancer. We have combined the use of autologous monocytes and interferons alpha and gamma for local–Regional Administration directly into the peritoneal cavity. This therapy is highly unique in that it is the first study of its type using only components of the innate immune system for the locoRegional delivery consisting of autologous monocytes and dual interferons alpha and gamma. Trial Registration ClinicalTrials.gov Identifier: NCT02948426, registered on October 28, 2016. https://clinicaltrials.gov/ct2/show/NCT02948426
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A Phase 1 trial of autologous monocytes stimulated ex vivo with Sylatron® (Peginterferon alfa-2b) and Actimmune® (Interferon gamma-1b) for intra-peritoneal Administration in recurrent ovarian cancer
BMC, 2018Co-Authors: Daniel S. Green, Ana T. Nunes, Virginia David-ocampo, Irene B. Ekwede, Nicole D. Houston, Steven L. Highfill, Hanh Khuu, David F. Stroncek, Seth M. Steinberg, Kathryn C. ZoonAbstract:Abstract Background Ovarian cancer has no definitive second line therapeutic options, and largely recurs in the peritoneal cavity. LocoRegional immune therapy using both interferons and monocytes can be used as a novel approach. Interferons have both cytostatic and cytotoxic properties, while monocytes stimulated with interferons have potent cytotoxic properties. Due to the highly immune suppressive properties of ovarian cancer, ex vivo stimulation of autologous patient monocytes with interferons and infusion of all three agents intraperitoneally (IP) can provide a strong pro-inflammatory environment at the site of disease to kill malignant cells. Methods Patient monocytes are isolated through counterflow elutriation and stimulated ex vivo with interferons and infused IP through a semi-permanent catheter. We have designed a standard 3 + 3 dose escalation study to explore the highest tolerated dose of interferons and monocytes infused IP in patients with chemotherapy resistant ovarian cancer. Secondary outcome measurements of changes in the peripheral blood immune compartment and plasma cytokines will be studied for correlations of response. Discussion We have developed a novel immunotherapy focused on the innate immune system for the treatment of ovarian cancer. We have combined the use of autologous monocytes and interferons alpha and gamma for local–Regional Administration directly into the peritoneal cavity. This therapy is highly unique in that it is the first study of its type using only components of the innate immune system for the locoRegional delivery consisting of autologous monocytes and dual interferons alpha and gamma. Trial Registration ClinicalTrials.gov Identifier: NCT02948426, registered on October 28, 2016. https://clinicaltrials.gov/ct2/show/NCT0294842
Siouxsie Wiles - One of the best experts on this subject based on the ideXlab platform.
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Regional intraosseous Administration of prophylactic antibiotics is more effective than systemic Administration in a mouse model of tka
Clinical Orthopaedics and Related Research, 2015Co-Authors: Simon W Young, Tim Roberts, Sarah Johnson, James P Dalton, Brendan Coleman, Siouxsie WilesAbstract:Background In human TKA studies, intraosseous Regional Administration (IORA) of prophylactic antibiotics achieves local tissue antibiotic concentrations 10 times greater than systemic Administration. However, it is unclear if such high concentrations provide more effective prophylaxis.