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In un contesto in cui il coinvolgimento e la partecipazione dei consumatori/clienti di prestazioni sanitarie è oggi più che mai all’ordine del giorno, il concetto di “patient engagement” si è sempre più imposto nella letteratura scientifica e manageriale come call to action in risposta alle sfide epidemiologiche – legate all’aumento della cronicità – ed economiche – connesse all’aumento dei costi sanitari e alla riduzione delle risorse disponibili - a cui i sistemi sanitari contemporanei devono necessariamente rispondere per evitare il collasso. Per ciò, a fronte di una letteratura sul tema ancora parziale e frammentata, definire il concetto di “patient engagement” e le sue implicazioni a vari livelli diviene cruciale per passare da una dichiarazione di intenti ad una concreta strategia di azioni volte a promuoverlo. Alla luce di queste premesse, il progetto di ricerca ambisce a rispondere ad una necessità fondativa sia da un punto di vista teroico che empirico di questo concetto e ad evidenziare possibili linee di sviluppo e ricadute applicative per una rinnovata professionalizzazione dei clinici che devono oggi riadattare le proprie pratiche professionali e ripensare alla propria identità in funzione di un paziente sempre più attivo e partecipe rispetto alle scelte legate alla gestione della propria salute. / The expectancy of patient living with chronic disease has improved significantly in the recent years due to advances in medical sciences. To address the burden of this growing demand of care, patient engagement is considered crucial as it contributes to improve health outcomes and control healthcare costs. However, many gaps still exist for its implementation starting from the lack of a shared definition and shared guidelines for medical practice based on the direct patients' care experience. In the light of this premises this dissertation will propose a sequential research design generally aimed at improving the knowledge and understanding of patient engagement and its implications for the medical practice and professionalism. To answer the overall aim of this thesis both literature reviews and qualitative methodology were used. Chapter 1 was aimed to set scene and give the readers an overview of the global cultural and societal scenario that justifies the need to deal with the topic of patient engagement. Chapter 2 and 3 consist in in-depth literature reviews aimed at shading light on the concepts featuring the participatory medicine movement and, more specifically, the one of patient engagement. An in-depth qualitative study according to the grounded theory principles was conducted and reported in chapter 4 and was aimed at deepening the heart failure patient’s perspective towards engagement in their care in order to build and experience-based model of this phenomenon. The last two chapters, based on the insights emerged from both the literature analysis and the grounded theory study, were aimed at discussing the implications of patient engagement for the clinical decision making process (chapter 5), and for training health professionals in patient engagement strategies and improving the effectiveness of their communication and relational habits with this aim (chapter 6).

Improvements have been made to the fuel cell power module (FCPM) within the SOFC cogeneration simulation code developed under the umbrella of the International Energy Agencies Annex 42 project. The main objective of the improved model developed here is to increase generality and applicability, and to decrease reliance on empirical data. A semi-mechanistic model has been developed to represent a nominal 5 kW tubular SOFC stack power module. This model has been implemented into the building simulation software ESP-r. Results illustrating the FCPM system performance as it relates to the output power required by the building as well as results from a number of different operating scenarios are presented in this study. Actual tests performed on a 5 kW SOFC unit were used to validate the model. The simulation results are found to correlate well with experimental observations. The improved model also allows for manipulation of operational parameters such as fuel utilization, excess air ratio and temperature as well as physical parameters such as cell dimensions and materials. Results from sensitivity and parametric simulations are also presented to demonstrate the enhanced capabilities of the model.

Le silicium se présente comme un bon candidat d’électrode négative pour améliorer la densité d’énergie des accumulateurs Li-ion ou rendre les microaccumulateurs compatibles avec le procédé de brasure à refusion qui nécessite un recuit à 260 °C. En effet, il présente une forte capacité spécifique (3759 mAh.g-1) et sa température de fusion est élevée (1410°C). Néanmoins, de fortes variations volumiques se produisent lors du processus de lithiation/délithiation pouvant atteindre 280 %, ce qui constitue un frein majeur à son développement. Ces travaux de thèse se focalisent sur l’étude approfondie du comportement électrochimique du silicium préparé sous forme de couche mince par pulvérisation cathodique. Cette nanostructuration limite la décrépitation de la matière active, et évite l’utilisation de charges et de liants. Ainsi, elle permet d’étudier plus finement le comportement intrinsèque du matériau et révèle des phénomènes en général non détectables avec les électrodes composites. / Silicon which has a theoretical capacity of 3579 mAh.g-1 and low insertion/deinsertion potentials is one of the most promising candidates to replace graphite as a negative electrode in lithium-ion batteries. Moreover, silicon could replace lithium in microbatteries to make them compatible with the solder-reflow. However, this high capacity associated with a dense material leads to high volumetric variations which are a starting point to various issues resulting in poor cycle performances. During this thesis, electrochemical behavior of silicon is evaluated on thin films electrodes. This allows avoiding the use of binder and charges, and it leads to better cycle performances which emphasizes slow phenomenon, not yet measurable on conventional composite electrode.