n management practice, performance indicators are considered as a prerequisite to make informed decisions in line with the organization’s goals. On the other hand, indicators summarizes compound phenomena in a few digits, which can induce to inadequate decisions, biased by information loss and conflicting values. Model driven approaches in enterprise engineering can be very effective to avoid these pitfalls, or to take it under control. For that reason, “performance modeling” has the numbers to play a primary role in the “model driven enterprise” scenario, together with process, information and other enterprise-related aspects. In this perspective, we propose a systematic review of the literature on performance modeling in order to retrieve, classify, and summarize existing research, identify the core authors and define areas and opportunities for future research.

TSF is an Italian IT service company, focused on logistics and transportation IT market segments.. It is able to support customer’s business operations through a complex IT service chain, appraised by a Service Level Management (SLM) system. Due to the long term contractual relationship (10 years) with Italian Railways, TSF developed a symbiotic relationship with its main customer, becoming co-accountable for its business performance. This aspect has highlighted the necessity of the definition of an extended SLM model able to correlate the customer business performances with the delivered ICT service levels, in the perspective of an end-to-end service delivery chain. The paper illustrates the conceptual approach and the method adopted to overcome this problem in a pilot project.

The present work analyzes the results of an Italian care management project, called Leonardo Project, promoted by Apulia Region, in the south of Italy, in partnership with Pfizer. The work starts from the consideration that care management represents an innovation in the management of the chronic diseases because it introduces a new model in the organization of healthcare services. Such a model needs gradual refinements in a continuous improvement cycle, in order to be totally effective. The research activity has regarded the test of Business Process Modelling Notation (BPMN) as the tool able to support the modelling of care management process as developed in Leonardo project and the analysis of results in order to retrieve guidelines to improve the following cycle. In this paper we discuss the results of Leonardo project and we highlight how the software support represents a critical element for the success of a care management initiative. BPMN helps to highlight indications about system requirements. The paper aims to illustrate how analyzing a care management project with tools borrowed from other domains can help to show weaknesses to be overcome in the design of the second generation’s tools.

In university education, classroom activities are more and more combined with on-line teaching materials, webinars, electronic forums, wikis, web calendar and so on. This “blended approach” is often based on the adoption of Learning Management Systems (LMS), which are customized in many aspects to match both the teaching style of the university and the needs of teachers and students. More recently, also laboratory experiments, that are integral parts of science and technology classes, have come online. The first generation of Remote Web Laboratories (RWL) has demonstrated the feasibility and the effectiveness of on line experiments, with two major drawbacks: the lack of integration between LMS and RWL and the lack of synchronous interaction among the participants (teacher and students) to the experiment. In this scenario, the paper discusses the principal aspects and the main results about an integration project between the Moodle LMS and the MicroNet RWL at University of Salento, in Italy.

Abstract. – Purpose: To investigate if early epidural analgesia can influence fetal head engage- ment into the pelvis and if it can increase the rate of transverse and asynclitic position during labour. Materials and Methods: 195 women with combined spinal-epidural analgesia (CSE) or with- out neuraxial analgesia were studied. CSE was performed using a mixture of ropivacaine 0.02% with 0.3 μg/ml of sufentanil administered in the spinal space. Maintenance of analgesia was man- aged with intermittent epidural administration of 10-15 ml of ropivacaine (0.07%-0.10%) mixed with 0.5 μg/ml of sufentanil, based on the stage of labour and the degree of pain. 2D transabdominal ultrasound (US) was used. Serial transabdominal US examinations were performed at 45-90 min in- tervals to detect transverse and asynclitic posi- tions, using the following signs: squint sign, sun- set thalamus and cerebellum signs that best de- tails the fetal head station. After delivery, the com- plete set of clinical and US data obtained by each examination were recorded and compared in women with and without labour analgesia. Data were examined by independent reviewers. Results: There was no difference in obstetric outcome between women in whom CSE had been used and those who did not request anal- gesia during labour (p>0.05). Conclusions: Epidural analgesia initiated early during labour and using low doses does not in- crease the rate of dystocic labors. Transverse fetal head positioning with anterior or posterior asyn- clitism does not seem to be promoted by drug or technique-related mechanisms, but rather should be the consequence of cephalopelvic disproportion.

Robotic Surgery is a current procedure in endosurgery, but literature has not addressed the learning curve for the use of the robotic assisted surgery. The learning curve for robot surgical procedures varies widely. Apart from innate skill, learning curves are composed of at least two fundamentals related to the volume of cases and the incidence rate. Commonly cited reasons include lack of adequate training in residency programs because of the time devoted to abdominal, vaginal, and obstetric procedures, lack of available and adequate training opportunities outside of dedicated fellowships, lack of proctors and mentor surgeons in communities to help to further advance the skills of younger surgeons, and lack of desire to leave established surgical practices to try to develop skills requiring long learning curves to master. Currently, the training involves practice with the surgical robot in either pig or human fresh tissue in a laboratory environment in order to become familiar with the functions of the robot, the attachment of the robotic arms to the robotic trocars, and the overall functions of the robotic console. In this chapter authors reviewed current literature on learning curve in robotic assisted surgery and screened problems linked to robotic surgical skills.

Il Rapporto 2010 sui Siti Istituzionali delle Regioni nasce dall’esigenza di Inforav e dell’Università del Salento di avviare uno studio congiunto sullo stato di attuazione dell’e-Government a livello nazionale. L’Inforav è infatti un Istituto senza finalità di lucro, che dal 1973 svolge attività di ricerca nel campo dell’ICT, di diffusione della relativa cultura, oltre che di promozione delle correlate componenti innovative e di sviluppo in Italia. L’Università del Salento invece è attiva da tempo nella ricerca sulle metodologie innovative per l’analisi e progettazione di contenuti e servizi per il Web, con specifico riferimento all’e- Government. La ricerca ha preso le mosse dall’analisi dei portali regionali, per il ruolo che le Regioni hanno assunto nella prospettiva del federalismo, e per questo ha ricevuto il patrocinio del Ministero per i Rapporti con le Regioni e la Coesione Territoriale.

Purpose: To evaluate the safety and feasibility of supra-pubic percutaneous sclero-embolization (SE) in the treatment of symptomatic female pelvic varicocele (FPV), performed under local anesthesia. Materials and Methods: The authors selected 28 patients screened by transabdominal and transvaginal ultrasound, with venous Doppler signal. Clinicians performed SE by transfemoral catheterization, under local anesthesia, using of a mix of 2 ml of lauromacrogol 400 (Atossisclerol 3%, Chemische F. Kreussler, Wiesbaden, Germany) and 2 ml of air, in a mixed foam fashion. Results: The total operative time for SE was 7.6±2.1 min. Intra-surgical blood loss was 40±14 ml. No migration of sclerosant material occurred and postoperative analgesic request during a 48 hr period occurred in 6 patients. Technical success was 100%. The authors embolized 8 women bilaterally (28.5%), 18 on the left ovarian vein (OV) (64.2%) and 2 only in the right OV (7.1%): 7 women complained of transitory flank pain (25%), which disappeared in few minutes. The major complications in 10 days after SE were: fever (>38°C for two days) in 2 patients (7.1%) and pelvic pain for 3 days in eight patients (28.5%). After 30 days only 6 women suffered of FPV lower symptoms which disappeared in 180 days. A substantial reduction in size of pelvic varicosities was noted in all patients. Conclusions: SE is a safe and feasible procedure. It reduces significantly the mean time of scopies, the intensity of radiation emission, and it is performed under local anaesthesia. This minimally invasive procedure could be proposed to all women with supra-pubic FPV for its reproducibility and feasibility.

The determination of fetal head position can be useful in labor to predict the success of labor management, especially in case of malpositions. Malpositions are abnormal positions of the vertex of the fetal head and account for the large part of indication for cesarean sections for dystocic labor. The occiput posterior position occurs in 15-25% of patients before labor at term and, however, most occiput posterior presentations rotate during labor, so that the incidence of occiput posterior at vaginal birth is approximately 5-7%. Persistence of the occiput posterior position is associated with higher rate of interventions and with maternal and neonatal complications and the knowledge of the exact position of the fetal head is of paramount importance prior to any operative vaginal delivery, for both the safe positioning of the instrument that may be used (i.e. forceps versus vacuum) and for its successful outcome. Ultrasound (US) diagnosed occiput posterior position during labor can predict occiput posterior position at birth. By these evidences, the time requested for fetal head descent and the position in the birth canal, had an impact on the diagnosis of labor progression or arrested labor. To try to reduce this pitfalls, authors developed a new algorithm, applied to intrapartum US and based on suitable US pictures, that sets out, in detail, the quantitative evaluation, in degrees, of the occiput posterior position of the fetal head in the pelvis and the birth canal, respectively, in the first and second stage of labor. Authors tested this computer system in a settle of patients in labor.

Laparoscopy is the standard of treatment for many gynecological diseases, it is a very common procedure in gynaecology and it is widely accepted as the method of first choice for many gynaecological problems. A meta-analysis of 27 randomized controlled trials comparing laparoscopy and laparotomy for benign gynaecological procedures concluded that the risk of minor complications after gynaecological surgery is 40% lower with laparoscopy than with laparotomy, although the risk of major complications is similar. Laparoscopy has been considered a real alternative to laparotomy with numerous advantages: short hospital stay, less need of analgesia, low intraoperative blood loss and faster recovery time. Many researchers are in pursuit of new technologies and new tools of minimally invasive technologies for reducing laparoscopic complications. The industry responded to these demands with many innovations, such as new optical instruments and digital images, virtual and augmented reality, robotic assisted surgery, etc. In this chapter, authors discussed the possible utilization of novel technologies to reduce the risk of laparoscopic gynecological complications.