a b s t r a c tShock focusing in water is a phenomenon that can occur during the impact of a shock wave generated by an underwater explosion onto any type of convergent marine structures. To predict the dynamic material response of the marine structure, it is important to understand the shock wave dynamics during the focusing event. In this paper, both experimental investigations and numerical studies of twodimensional shock focusing in water are presented. Here, a convergent geometry given by a logarithmic spiral curve is used to focus the shock waves. In the experiments, the interaction between three types of materials and the shock wave in water is explored by using high-speed photography. Distinct features of such flows are unveiled. Three scenarios have been considered in simulations: a rigid structure where only the water-filled region is taken into account, a fluid-structure interaction problem in which the surrounding material responses are included, and an axisymmetric simulation to determine the threedimensional effects.

Objective:Assessment of the knowledge and application as well as perceived utility by doctors of clinical governance tools in order to explore their impact on clinical units’ performance measured through mortality rates and efficiency indicators.Methods:This research is a cross-sectional study with a deterministic record-linkage procedure. The sample includes n = 1250 doctors (n = 249 chiefs of clinical units; n = 1001 physicians) working in six public hospitals located in the Emilia-Romagna Region in Italy. Survey instruments include a checklist and a research-made questionnaire which were used for data collection about doctors’ knowledge and application as well as perceived utility of clinical governance tools. The analysis was based on clinical units’ performance indicators which include patients’ mortality, extra-region active mobility rate, average hospital stay, bed occupancy, rotation and turnover rates, and the comparative performance index as efficiency indicators.Results:The clinical governance tools are known and applied differently in all the considered clinical units. Significant differences emerged between roles and organizational levels at which the medical leadership is carried out. The levels of knowledge and application of clinical governance practices are correlated with the clinical units’ efficiency indicators (bed occupancy rate, bed turnover interval, and extra-region mobility). These multiple linear regression analyses highlighted that the clinical governance knowledge and application is correlated with clinical units’ mortality rates (odds ratio, −8.677; 95% confidence interval, −16.654, −0.700).Conclusion:The knowledge and application, as well as perceived utility by medical professionals of clinical governance tools, are associated with the mortality rates of their units and with some efficiency indicators. However, the medical frontline staff seems to not consider homogeneously useful the clinical governance tools application on its own clinical practice.

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Aims of this study were to evaluate the incidence of falls in subjects aged ≥65 years in Parma Province (Northern Italy), and the burden of fall-related hospitalizations. All the Emergency Department (ED) visits for domestic or trivial falls were retrieved from the database of the two EDs of Parma Province during 2013. All cases were classified according to age and gender. Out of 129,898 total ED visits, 3720 (2.9%) were related to trivial falls in patients aged ≥65 years. Females accounted for 2648 visits and males for 1072. The absolute number of visits due to falls increased with age in both genders, with a peak between 80 and 84 yrs. When related with the actual number of residents by age groups, females showed a continuous increase, peaking at age >100 yrs, and males a continuous increase, peaking at age 95-99 yrs. Of these patients, 963 (25.9%) needed hospitalization, 605 in the orthopedic ward, 342 in medical wards, and 16 in specialist surgical units. In conclusion, falls represent a major cause of morbidity in the elderly in Northern Italy, representing 13.3% of the ED visits for people aged ≥65, with a high impact on hospital workload.