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Dans le cadre d’une amélioration des procédés de fabrication du verre, Arc International a engagé un programme de recherche sur l’optimisation de la fabrication de moules de verrerie bimétalliques. Le sujet de la thèse constitue une contribution à ce projet et apporte réponses et compréhension de plusieurs questions. Tout d’abord, la sollicitation subie par les moules de verrerie en terme de variations de température a été étudiée, ce qui a permis de localiser les zones sensibles à l’endommagement dont l’origine est la fatigue thermique. Des analyses métallographiques combinées à des essais de fatigue ont prouvé que l’endommagement provient de l’interface entre le substrat en acier doux et le revêtement en alliage de nickel, à cause de la faible résistance à la fatigue oligocyclique du substrat. Une alternative au substrat initial a été proposée et l’impact du procédé de recouvrement sur les matériaux en présence a été étudié. Le procédé utilisé pour revêtir le moule provoque des transformations de la microstructure : l’acier devient ferritique-perlitique, tandis que le revêtement se transforme en une matrice métallique base nickel dans laquelle des borures Ni3B sont dispersés. Une zone intermédiaire se forme entre l’acier et l’alliage de nickel et comprend deux bandes de solution solide résultant de l’interdiffusion fer-nickel. La résistance des matériaux candidats a été étudiée sous sollicitation cyclique en traction-compression à déformation totale imposée à 450°C; l’endommagement par fatigue de l’acier 4130 est essentiellement du à l’accommodation cyclique des grains de ferrite. L’alliage de nickel présente une très mauvaise tenue à la fatigue oligocyclique. L’étude du comportement en fatigue de l’assemblage substrat + revêtement a permis d’établir le rôle de la zone intermédiaire dans le mécanisme de fissuration par fatigue en identifiant les étapes d’amorçage et de propagation de la fissure. Enfin, un modèle en éléments finis de l’endommagement mécanique cyclique a ensuite été mis en place, afin d’ébaucher une description de l’endommagement du matériau substrat. Le modèle utilisé est un modèle élastoplastique cyclique non linéaire. Une étude a pu être menée jusqu’à la prédiction de la durée de vie d’un moule monolithique en matériau substrat dans les conditions du modèle. / Arc International, worldwide leader of tableware, has developed a research program concerning optimization of bimetallic glass mould making. This PhD thesis contributes to this project by answering and explaining some questions upon this project.First of all the thermal solicitation imposed to the moulds has been studied, which permitted localize the critical zones when it comes to thermal fatigue damaging. Metallographic analyses and fatigue tests led to prove that fatigue damaging initiates at the interface between the substrate composed of a soft steel and the coating composed of a nickel alloy, due to low cycle fatigue resistance of the substrate. An alternative material for the substrate part has been proposed, and the coating process impact on both materials has been studied. Coating process leads to changes in the microstructure of the component: the steels become ferritic-pearlitic, and the nickel alloy becomes a nickel-based solid solution matrix in which nickel borides are dispersed. An intermediate zone is formed, which is composed of two bands of solid solution resulting from nickel-iron interdiffusion.Fatigue resistance of the materials has been studied under strain control in a fully push-pull mode at 450°C; fatigue damage of 4130 steel is essentially due to cyclic accommodation of ferrite grains. Fatigue resistance of is very weak. Fatigue behaviour study of the assembly “substrate + coating” permitted to demonstrate the role of the intermediate zone in fatigue cracking mechanisms by identifying the crack initiation and propagation steps. At last, a finite elements model of cyclic mechanical damage has been put on, using a non linear cyclic elastoplastic model, in order to describe the damaging of the substrate material. A study has been carried on fatigue life prediction of a monolithic steel mould in certain conditions.

Dans un contexte international de réduction des émissions de CO2, le groupe VALEO, soutenu par l’ADEME, développe de nouveaux alterno-démarreur permettant d’assurer des fonctions telles que le « Start-Stop ». La géométrie complexe et les nouveaux profils de mission entrainent une sollicitation par fatigue des ventilateurs de l’alterno-démarreur, dont la durée de vie est, en l’état actuel des connaissances, difficile à prévoir. L’amélioration de la fiabilité des composants passe donc par une analyse des mécanismes d’endommagement cyclique du matériau qui constitue l’objectif de la thèse. Les travaux ont été dirigés selon trois axes. Tout d’abord le comportement de l’acier ferritique a été étudié sur éprouvette de laboratoire en fatigue oligocyclique sous différents chargements (influence de la déformation moyenne, de la vitesse de déformation, de l’introduction d’un temps de maintien). Puis, une étude microstructurale basée sur l’imagerie MET et l’EBSD a permis de comprendre et d’évaluer l’endommagement plastique cyclique du matériau sur éprouvette de laboratoire comme sur composants réels, avant et après utilisation. Cette analyse a conduit à la construction d’indicateurs d’endommagement basés sur les évolutions de la microstructure des éprouvettes après chargement cyclique et le lien avec la durée de vie a été fait. Au final, les informations récoltées ont été utilisées afin d’améliorer la modélisation du comportement du matériau utilisée dans le logiciel de calcul par éléments finis ANSYS®. Ainsi, une loi matériau mieux adaptée a été choisie, à savoir le modèle d’écrouissage mixte de Chaboche, et les paramètres associés ont été identifiés. / In the international context of CO2 emissions reduction, VALEO, supported by the French Environment and Energy Agency, develops new car alternators allowing the “Start-Stop” function. Due to their specific geometry and the complex loading conditions, alternator cooling fans are subjected to fatigue damage. Their life time, based on current knowledge, is difficult to assess. A better reliability of the component depends on the understanding of the cyclic damage mechanisms of the material and this is the aim of the PhD thesis.The work followed three axes. At first, fatigue behaviour of the ferritic steel was studied on lab specimens and by means of Low Cycle Fatigue tests. They were carried out under different loading signals, studying the influence of mean strain, of strain rate or of a holding time. Then, a TEM study on one hand, and EBSD investigations on the other hand, focused on the microstructure, allowed to understand and to estimate cyclic plastic damage of the lab specimens, as well as of the fans (before and after cycling in real using conditions). Through this study, damage criteria based on the evolutions of the microstructure have been built and a relationship with the life time has been established. At the end, fatigue information was used in order to improve the material database of the commercial Finite Elements Method (FEM) software called ANSYS®. A better representation of the fatigue behaviour of the material was proposed through the Chaboche model.

Le travail de thèse porte sur l’étude du comportement mécanique d’un tissu soumis à un impact balistique en utilisant une modélisation multi-échelle prenant en compte les fibres et les fils. Cette approche micro-méso permet de mettre en évidence les phénomènes physiques pouvant se produire lors d’un impact balistique sur un tissu. A l’échelle du fil, une étude paramétrique a permis de cerner l’influence des propriétés physiques et mécaniques sur les réponses balistiques d’un tissu 2D. En plus, les effets de la localisation de l’impact sont étudiés pour tenir compte de la position du projectile sur un tissu 3D. A l’échelle de la fibre, une analyse fine des déformations en compression transversale d’un fil est développée. Ces phénomènes sont pris en considération pour prédire la tenue balistique d’un fil soumis à un impact transversal en utilisant une modélisation à l'échelle microscopique (échelle d'une fibre). Aussi, un tissu est modélisé en utilisant une approche multi-échelle. En effet, la zone affectée par l’impact est modélisée à une échelle microscopique tandis que les autres zones sont modélisées à une échelle mésoscopique. Une analyse des résultats est effectuée en termes d'évolutions des vitesses d'impact avec et sans perforation, des énergies cinétique et déformation et des forces d'impact. Les résultats numériques sont validés par confrontation aux données expérimentales. / The thesis focuses on the study of mechanical behavior of a fabric subjected to ballistic impact by using a multi-scale modeling that takes into account fibers and yarns. This micro-meso approach allows highlighting the physical phenomena that may occur during the ballistic impact on fabric. At the yarn level, a parametric study enables investigation into the influences of physical and mechanical yarn properties on the ballistic behavior of a plan-woven-fabric. Also, the effects of the impact localization are investigated to take into account the strike position of the projectile on a 3D fabric. At the fibers level, a detailed analysis of transverse compressive deformation of yarn is developed. These phenomena are considered to predict the ballistic response of a yarn subjected to a transverse impact using modeling at the microscopic scale (the scale of fiber). A modeling of fabric using a multi-scale approach is also performed. In this model, the area affected by the impact is modeled on the microscopic scale, while other areas are modeled on the mesoscopic scale. An analysis of the results is carried out regarding projectile velocity history, the kinetic energies and deformation, and impact forces in the cases of impact with and without perforation. The numerical results are validated by comparison with experimental data.

The subject matter of this dissertation is the ways of representing the everydayness of life in poetic texts authored by members of Group 42. Of special interest is the category of time, as the transformation of understanding of this category is one of the cornerstone aspects of modern literature in the first half of the 20th century. Time as a category is reflected in Group 42 poetry through three principles used by the Group 42 authors to grasp and work with the time-space continuum and the place of humans in it. The fundamental principle of Group 42 poetry, which will be discussed in this thesis, is the fragmentarization principle. Using a fragment, the poet grasps the present, multi-layered moment and represents temporal discontinuity. Another principle of representation of everydayness the thesis will concentrate on is the principle of variations, which represents heading towards a unifying grasp of discontinuous everydayness. As opposed to the previous ways, notation in the form of diary entries then allows for the ability to better formulate the dynamics of successive temporal flow of everyday reality. The possibility of formulating the temporal mode on the field of a lyrical work is yet another topic discussed here. The temporal mode is then reflected in relation to the "myth of the modern humus", the proclamation of which was on the agenda of Group 42 in its time.

Numerose ricerche indicano i modelli di cure integrate come la migliore soluzione per costruire un sistema più efficace ed efficiente nella risposta ai bisogni del paziente con tumore, spesso, però, l’integrazione è considerata da una prospettiva principalmente clinica, come l’adozione di linee guida nei percorsi della diagnosi e del trattamento assistenziale o la promozione di gruppi di lavoro per specifiche patologie, trascurando la prospettiva del paziente e la valutazione della sua esperienza nei servizi. Il presente lavoro si propone di esaminare la relazione tra l’integrazione delle cure oncologiche e l’esperienza del paziente; com'è rappresentato il suo coinvolgimento e quali siano i campi di partecipazione nel percorso oncologico, infine se sia possibile misurare l’esperienza vissuta. L’indagine è stata svolta sia attraverso la revisione e l’analisi della letteratura sia attraverso un caso di studio, condotto all'interno della Rete Oncologica di Area Vasta Romagna, tramite la somministrazione di un questionario a 310 pazienti con neoplasia al colon retto o alla mammella. Dai risultati, emerge un quadro generale positivo della relazione tra l’organizzazione a rete dei servizi oncologici e l’esperienza del paziente. In particolare, è stato possibile evidenziare quattro principali nodi organizzativi che introducono la prospettiva del paziente: “individual care provider”,“team care provider”,“mixed approach”,“continuity and quality of care”. Inoltre, è stato possibile delineare un campo semantico coerente del concetto di coinvolgimento del paziente in oncologia e individuare quattro campi di applicazione, lungo tutte le fasi del percorso: “prevenzione”, “trattamento”,“cura”,“ricerca”. Infine, è stato possibile identificare nel concetto di continuità di cura il modo in cui i singoli pazienti sperimentano l’integrazione o il coordinamento delle cure e analizzare differenti aspetti del vissuto della persona e dell’organizzazione. / Several studies from around the world have focused on integrated care models as key solutions to build more effective and efficient healthcare systems that can better meet the needs of patients and the populations served. Often, the coordination is mostly clinical, and consists of the promotion of workgroup activities centered on specific oncological pathologies and in the adoption of common guidelines. However, the process needs to be developed and assessed also with respect to the patient perspective and patient experience. The purposes of this research are to explore the relationship between the integration of cancer services and the patient experience; to describe the representation of “patient engagement” and to examine what kind of application exists in the cancer services; finally to examine if patient experience can be measured. The research’s method consisted of a literature review and analysis, and also it consisted of a case study in the Area Vasta Romagna Cancer Network, via the use of a survey distributed to 310 patients with breast or colo-rectal cancer. From the findings, it appears a positive relationship between integration and patient experience. Also,we identified four main themes of patient experience related to integration: “individual care provider”, “team/system care providers”, “mixed approach”, “continuity and quality of care”. Furthermore, it was possible to describe a consistent representation of patient engagement models and to identify four main fields of application: “screening”, “treatment”, “care”, “research”. Finally, the continuity of care framework results an appropriate measure to analyse the integrated cancer care from patient perspective and to evaluate the patient experience over the entire cancer pathway.

AIMS. To assess integrated healthcare pathways for children with special health care needs after hospital discharge from St. Orsola Malpighi University Hospital of Bologna and Local Health Authorities of Bologna and Imola. MATERIALS AND METHODS. Existing procedures were assessed through interviews with key informants and collection of written procedures. During 24 months, children meeting inclusion criteria as incident cases were recruited at discharge with their families. During 9 months of follow-up parents’ perspective was assessed with qualitative methods (SpeNK-I) and the administration of a 20-item questionnaire (SpeNK-Q), after its validation in a sample of parents of 101 preterm newborns. During follow-up, Family Pediatricians (FPs) recorded care coordination activities for subjects with an 8-item data collection tool (SpeNK-FP). Utilization of healthcare resources was examined through data-linkage with administrative databases. RESULTS AND DISCUSSION. Different practices and procedures exist, with different level of standardization and formalization within Bologna province. A sample of 82 children was recruited, with a majority of extremely low birth weight newborns (42.6%). To 16 parents involved in SpeNK-I, continuity of care and empowerment were important, with different issues from hospitalization to home care. The SpeNK-Q administered to parents of 67 children reported high levels of continuity of care, with items referring to the informational continuity endorsed with the lowest frequency. Forty FPs recorded 382 encounters for 49 children, showing some difficulty to record these activities and a potential for care coordination. Administrative data analyses showed a higher level of utilization of healthcare services for hospitalizations, some differences in specialty outpatient care use with almost none in emergency room contacts. CONCLUSIONS. In Bologna province, children with special health care needs run a continuous and coordinated integrated healthcare pathway although with some weaknesses. Connecting users’, professionals’ and system’s viewpoints may facilitate the identification of improvement areas to reduce risk of fragmentation.

L’attuale frammentazione dei percorsi assistenziali rivolti ai pazienti anziani con multimorbosità e fragili, non garantisce cure efficaci, efficienti né soddisfazione dei pazienti e delle loro famiglie. Si stanno sviluppando a livello internazionale modelli di organizzazione dei servizi di “cure intermedie”, per rispondere ai bisogni emergenti rappresentati da invecchiamento, aumento di patologie croniche, multimorbosità e fragilità, per evitare ospedalizzazioni inappropriate e ritardare l’istituzionalizzazione di lungo periodo. Coerentemente con le indicazioni normative nazionali, la Regione Emilia-Romagna (RER) ha intrapreso un percorso di ridefinizione dei servizi territoriali e della rete ospedaliera con l’obiettivo di garantire la continuità delle cure e l’integrazione ospedale-territorio, in particolare per le persone con patologia cronica, potenziando i servizi assistenziali di cure intermedie e attivando strutture residenziali intermedie territoriali (Ospedali di Comunità). Il progetto di ricerca aveva l’obiettivo di definire, attraverso l’individuazione di specifici indicatori, una modalità strutturata per il monitoraggio dell’assistenza fornita ai pazienti che vengono presi in carico negli Ospedali di Comunità dal punto di vista clinico, organizzativo e del paziente. Il modello organizzativo è stato studiato confrontando tre Ospedali di Comunità della Regione Emilia-Romagna. Gli indicatori individuati sono quindi stati analizzati per descrivere la coorte di pazienti dimessa dall’Ospedale di Comunità di Castel San Pietro Terme (Ausl Imola). L’analisi condotta, con l’identificazione di sottotipi caratteristici di pazienti che accedono all’Ospedale di Comunità può costituire un valido supporto conoscitivo nel processo di miglioramento dei percorsi clinico-assistenziali. La descrizione dei percorsi di cura seguiti dai pazienti presi in carico negli Ospedali di Comunità, di cui l’analisi presentata rappresenta un primo step, può infatti contribuire a meglio definire le strategie organizzative dell’assistenza ospedaliera e territoriale, sanitaria e socio-assistenziale per potenziare quindi la capacità di risposta ai bisogni dei pazienti. / The fragmentation of services for elderly with multimorbidity and frailty does guarantee neither effective and efficient care, nor the satisfaction of patients and their families. At international level, for decades, organizational models for “intermediate care” have been developing, as solution to emerging problems (aging, chronic disease, multiborbidity and frailty), to avoide inappropriate hospital admission and to delay long-term care. Consistent with national documents, Emilia-Romagna Region has been redefining community services and the acute hospital network with the aim of ensuring continuity of care and integration between hospital and community services, especially for people with chronic diseases, developing intermediate care and activating bed-based intermediate care services (Community Hospitals). The research project aimed to define – through the identification and analysis of specific indicators – a structured method for monitoring health care provided to patients in Community Hospitals in terms of clinical, organizational and patient perspective. The organizational model has been examined comparing three Community Hospital of Emilia-Romagna Region. Indicators have been analyzed to describe patients discharged from the Community Hospital of Castel San Pietro Terme (Imola Local Health Authority). The structured analysis and the identification of emerging clusters of patients admitted in Community Hospital, could provide important input for the best planning of integrated care pathways for patients. The description of clinical pathway of patients admitted in Community Hospitals may help to better define organizational strategies for both acute and community care, both health and social assistance, to enhance responses to patients' needs.

Introduzione I Tumori Naso-Sinusali (TuNS) sono neoplasie a bassa incidenza ma, per gli istotipi epiteliali, ad elevata frazione eziologica professionale. Il Registro Tumori Naso-Sinusale (ReNaTuNS) è stato istituito in Italia nel 2008, mentre in Emilia Romagna, il relativo Centro Operativo Regionale (COR) nel 2012. Obiettivo dello studio: • effettuare una revisione della letteratura scientifica sui cancerogeni associati all'insorgenza di TuNS; • descrivere l' attività di costruzione del COR in Emilia Romagna; • stimare l'incidenza di TuNS in Emilia Romagna; • analizzare i questionari somministrati ai casi incidenti al fine di individuare l'eventuale esposizione professionale a cancerogeni. Metodi • La revisione della letteratura è stata svolta utilizzando i database Cochrane Library e Medline. • la descrizione delle attività di costruzione del COR è avvenuta attraverso l’analisi delle attività svolte, dei documenti prodotti e dei dati raccolti; • il calcolo dei tassi di incidenza (anni 2007-2011) è avvenuto utilizzando la popolazione standard italiana di riferimento censita nel 2011; • l'analisi dei questionari è avvenuta tramite un panel di esperti Risultati • La revisione della letteratura ha confermato un’associazione certa tra polveri di legno e cuoio e TuNS, mentre resta da definire l'associazione con altre sostanze di frequente uso nelle attività produttive. • Il COR ha individuato 253 casi di TuNS, incidenti dal 2007 in poi, e ha definito l' eventuale esposizione professionale per 62 casi. • L'incidenza di TuNS stimata in regione è di 1,0 (per 100.000), mentre per la popolazione maschile e femminile rispettivamente dell' 1,3 e dello 0,8 (per 100.000). • L’analisi dei questionari ha rilevato un'esposizione professionale nel 57,9% degli intervistati. Conclusioni L'incidenza di TuNS in Emilia Romagna è tra le più elevate a livello nazionale, in particolare per il genere femminile. L'analisi dei questionari conferma l'elevata frazione eziologica professionale della patologia. / Introduction Sinonasal cancer (SNC) are cancer with low incidence. The epithelial form has an high occupational ethiological fraction. Sinonasal cancer registry (SCR) in Italy has been established in 2008, while the Regional Operting Center (ROC) of Emilia Romagna in 2012. Objectives: • to perform a review of the scientific literature on the carcinogenic agents associated with SNC; • to describe the main activities of construction of the ROC in Emilia Romagna • to estimate the incidence of SNC in Emilia Romagna; • to analyze the questionnaires administered to cases of epithelial SNC to assess the possible occupational exposure Methods • The literature review was performed using Cochrane Library e Medline databases, • In order to describe the main activities of construction of the ROC in Emilia Romagna has been conducted an analysis of the documents and data collected, • Incidence rate (2007-2011) of SNC in Emilia Romagna was estimated using italian standard reference population census in 2011; • The questionnaires were analyzed by a panel of experts Results • The review confirmed an association with sufficient evidence between wood dust and leather dust and SNC. There is an association for other carcinogenic agents but the evidence is limited; • The ROC identified 253 cases of SNC and defined the occupational exposure for 62 cases. • Incidence rate of SNC in Emilia Romagna was 1,0 (per 100.000), 1,3 among men and 0,8 among women; • The occupational exposure was indentified by 57,9% of respondents. Conclusion Data show an incidence of SNC very hig in Emilia Romagna especially among women. The analysis of questionnaires confirms an high occupational ethiological fraction of SNC.

There are many obstacles to the development of an international CO₂ emissions trading system, but the biggest is a feature that is often assumed: the existence of a single national system. Once a national system is in place, an international system will develop naturally more as a matter of self-interested trade than as international agreement. Meeting the Kyoto targets will create a scarcity; and the scarcity requires that use and the associated rent be allocated somehow. This allocation — deciding who gets what — is a familiar problem and the largest impediment to the creation of a national system, and thus of an international regime of CO₂ emissions trading. The paper reviews the various instruments by which such the Kyoto target might be met from the standpoint of the allocation of the scarce use and the associated rent. In particular, the paper emphasizes that existing users will largely continue to use the scarce resource and that they now actively exercise the incipient right to the proposed scarcity. Creation of the scarcity and the allocation of rights raise fundamental issues of equity that lie pre-eminently in the political realm. The author observes that the creation of the scarcity and the allocation of rights are fused and that agreement on one will occur only as there is agreement on the other. Nevertheless, such problems have been solved before — for land and for SO₂ permits — although in both cases the conditions were easier than what is now proposed for CO₂. An international CO₂ trading system will develop from a national allowance system for the same reasons that trading can be expected to occur domestically. However, the unavoidable requirement of certification and verification will impede access to non-Annex B sources of emission reduction, and at the same time encourage countries with such sources to accept Annex B limits. The negotiation of such limits raises the same problems of allocation as faced at the national level, only on a global scale; and there is even less agreement here. Nevertheless, the discussion on global allocation will not begin in earnest until a national system creates the trade opportunities that will make an Annex B limit worth pursuing. The development of an international system for CO₂ emissions trading should not be expected to be either quick or easy, but to occur only by accretion and mostly as a matter of self-interested trade. / Includes bibliographical references (p. 12). / Abstract in HTML and technical report in HTML and PDF available on the Massachusetts Institute of Technology Joint Program on the Science and Policy of Global Change website (http://mit.edu/globalchange/www/)