bluuebunny/crossref_metadata_2025 huggingface dataset:
Smart Resilience
Authors: Pan Jing
Published: June 2016

Resilient cities are characterized by enough capacity to respond to internal and external changes and uncertainties. Crisis arises from unprepared residents and inadequate capacity of a community to adapt to hazards. It leads to pollution and wastes due to the recovery and reconstruction activities. Empirical data show that unavailability of accurate building information and poorly informed public contribute to most of the crisis. Building resilience is a fundamental component of community resilience. It determines the resilient capacity of a community. The chapter presents a theoretical framework of Building Resilience Information Modeling (BRIM), including a dynamic real-time hazard mapping module and a scaled building vulnerability indicator module, and how it supports multiple stakeholders to collaborate in decision making. It presents not only a solution to community resilience as a use case of smart cities, but also an innovative way of integrating social and environmental aspects in built environments in terms of collective intelligence oriented to anticipating hazards so as to resolve them proactively and effectively.
Decentralization and Sub-National Government in Poland
Authors: Gałuszka Jolanta
Published: June 2016

During the past two decades, decentralization as a silent revolution in public sector governance has generated a keen interest in a large number of countries including Poland. However, this notion is very difficult to define as it refers to a wide range of institutional arrangements on the political, economic and social levels. There are many good reasons why allocating fiscal resources and budget transfers among levels of government must come after a strict assignment of spending powers. The aim of this chapter is to point out the basic characteristics of financing system of local government in Poland. The chapter examines the structure of local revenues and the problem of financial autonomy. The research shows that the Polish public sector is already considerably decentralised, however the level of financial autonomy of local governments is low and the local revenues are unable to cover expenditures. Thus, the amounts of local public debt keep expanding. Though a system of equalizing grants was introduced to diminish horizontal fiscal imbalances, its' efficacy is still limited.
Local Public Service Delivery Arrangements in the Czech Republic and Slovakia
Authors: Nemec Juraj , Soukopova Jana , Merickova Beata Mikusova
Published: June 2016

This chapter discusses the issue of efficiency of the different modes of the provision of local public services in two selected new EU member states – the Czech Republic and Slovakia. The Czech Republic and Slovakia have a long common history and it is feasible to include both of them in the analysis. The first main part of the chapter analyses the history, transformation and the current local public delivery arrangements in the Czech Republic and Slovakia with the focus on the efficiency of the different modes of production. The final part tries to explain the main purposes behind the fact that externalisation does not deliver visible improvements.
Evolutionary Computing Approaches to System Identification
Authors: Subudhi Bidyadhar , Jena Debashisha
Published: June 2016

In this chapter, we describe an important class of engineering problem called system identification which is an essential requirement for obtaining models of system of concern that would be necessary for controlling, analyzing the systems. The system identification problem is essentially to pick up the best model out of the several candidate models. Thus, the problem of system identification or modeling building turns out to be an optimization problem. The chapter explain what are different evolutionary computing techniques used in the past and the state- of the art technologies on evolutionary computation. Then, some case studies have been included how the system identification of a number of complex systems effectively achieved by employing these evolutionary computing techniques.
A New Approach of Dynamic Load Balancing Scheduling Algorithm for Homogeneous Multiprocessor System
Authors: Alam Mahfooz , Varshney Ankur Kumar
Published: June 2016

Load balancing of parallel tasks in homogeneous as well as heterogeneous systems are major trouble for researches of both industry and academia. Load balancing were broadly classified into two categories namely static load balancing and dynamic load balancing. Nowadays, numerous of researches focus towards dynamic load balancing schemes for multiprocessor system. In this paper, the authors propose a dynamic load balancing strategy for homogeneous multiprocessor system and apply on cube based interconnection network named as Folded Crossed Cube network. The performance of folded crossed cube network gives better result in terms of diameter. Experimental results show that lesser load imbalance factor has been achieved along with execution time. By this algorithm, parallel jobs are solved with largest number of tasks. The merit of this algorithm is that when the number of tasks increases, the execution time decreases with lesser load imbalance factor.
Hybrid Solar and Wind Electric System for Romanian Nearly Zero Energy Buildings (nZEB) - Case Study
Authors: Badea Gheorge , Felseghi Raluca Andreea , Răboaca Simona , Aşchilean Ioan , Bolboacă Andrei , Mureşan Dan , Moldovan Emil , Şoimoşan Teodora
Published: June 2016

For a good approach to new challenges recommended by EU Energy Performance of Buildings Directive, nearly Zero Energy Buildings (nZEB) concept for new residential buildings is conceived in order to drastically improving the overall performance of classical buildings, especially in terms of energy use, production and CO2 equivalent (CO2e) emissions. This paper shows the results of the case study where was investigated energy, economic and environmental performances of hybrid solar and wind system for neutral in terms of climate parameters nZEB. The aim of this study was to demonstrate the capability and feasibility of RES hybrid technology for the energy supply of Romanian nZEB, and also, was to establish new general criteria with the goal to determinate the optimal design solution and providing general principles for green energy production. The main results reveal that Romania has a potential for green energy to implement the new concept nZEB and the global technical optimum of a hybrid system for nZEB is determined by the optimal interaction between the design parameters. The hybrid solar and wind electric systems are functioned in operational stand alone mode, its are supplied 100% by energy from RES and embedded CO2 emissions are decreased by over 50% compared to the classics systems.
Reduced-Order Multiple Observer for Aircraft State Estimation during Landing
Authors: Lungu Mihai , Lungu Romulus
Published: June 2016

The paper presents a new reduced-order multiple observer which can achieve the finite-time reconstruction of the system’s state associated to a multiple-model. This observer is a combination of a reduced-order observer and a full-order multiple observer. The design of the new observer involves the usage of the Lyapunov theory, the solving of a linear matriceal inequality, and a variables’ change. The steps of the design procedure have been software implemented in order to validate the new reduced-order multiple observer for the case of an aircraft motion during landing.
Small Orbital Launcher, Performance Evaluation
Authors: Chelaru Teodor Viorel , Chelaru Adrian
Published: June 2016

The purpose of this paper is to present some aspects regarding the computational model and performance evaluation for three stages launch vehicle (LV) used to inject into circular orbit a small size payload. The computational model consists in numerical simulation of LV evolution for imposed start conditions and optimisation of flight parameter in order to obtain injection into circular orbit. The launcher model presented will be with three degrees of freedom (3DOF) and variable mass. The results analysed will be the flight parameters and the ballistic performances. The discussions area will focus around the technical possibility to evaluate the performance of a small multi-stage launcher using the developed model. From a technical point of view, the paper is focused on ESA project “Study – concept, to achieve a Small Orbital Launcher through zonal cooperation – SOL” finalised in 2015
Effect of Welding Current and Welding Time for Micro Resistance Spot Welding on Dissimilar Thin Thickness Materials of Al 1100 and KS 5 Spring Steel
Authors: Baskoro Ario Sunar , Muzakki Hakam , Winarto
Published: June 2016

In the dissimilar materials and dissimilar thin thickness sheets joining, welding current and welding time parameters of resistance spot welding (RSW) effect weld ability. RSW used for joining thin plate less than 1000 μm is called micro-resistance spot welding (μRSW). The objective of this article is to study the effect of welding current and welding time to the joining dissimilar thin thickness materials and the microstructure of a weld joint. The thickness of Al 1100 is 400 μm, and KS 5 Spring Steel is 200 μm. Welding parameters are Cycle Time 0.5, 1, 1.5, Welding Current 1kA and 2 kA, and holding time 10 second. Welding current 1kA, Cycle time of 0.5 produce maximum shear load of 227.4 N and fracture area of 6.644 mm2. Welding current 2 kA, cycle time of 1.5 affect maximum load of 222.7 N and fracture area of 10.559 mm2. Welding parameters lead to the majority fracture on aluminum material. The welding current and cycle time do not significantly affect maximum shear load and fracture area.
Dynamics of Multiple-Drive Belt Conveyors during Starting
Authors: Kusumaningtyas Indraswari , Nuttall Ashley J.G. , Lodewijks Gabriel
Published: June 2016

In this paper, the dynamics of multiple-drive belt conveyors during starting is discussed. The aim of the research is to determine whether the belt sections in a multiple-drive belt conveyor can be viewed as a single-drive belt conveyor, and whether the DIN 22101 standard for the starting of a single-drive belt conveyor can still be used for the starting of a multiple-drive belt conveyor. A finite element model of a belt conveyor system was built in Matlab, consisting of a model of the belt and its support structure, and a model of the drive system. In this work, the simulations were carried out for the starting procedures of empty belt conveyors with varying number of drives. For each simulation case, the linear start-up procedure was tested. The simulations focused on the study of the axial elastic response of the belt. The simulations revealed that, by using more drives, the maximum belt stress during non-stationary as well as stationary conditions decreased. However, when using reduced starting times, negative stresses occur in the system. Overall, it was observed that the behaviour of each section between two drive stations in the multiple-drive belt conveyor differed from those of the single-drive belt conveyor. Therefore, the DIN 22101 guidelines for the start-up of a single-drive belt conveyor cannot be applied directly for the start-up of a multiple-drive belt conveyor.
Application of Genetic Algorithm for the Design Optimization of Geodesic Beam Structure
Authors: Sudira I Gusti Ngurah , Hadi Bambang K. , Moelyadi Mochammad Agoes , Widagdo Djarot
Published: June 2016

Application of optimization method for structure design and analysis is a technology trend to provide optimum products. This paper describe optimization process using genetic algorithm that was applied on non traditional structure, geodesic beam element. Finite element method program was developed as a main computer code for supporting optimization process. Pre-and post processor program was created to support GA. Based on minimum structure weight as the target of design optimization, the number of beam, beam element angle, and its size are to be the output of optimization process. The geodesic structure weight of plane model have been compared with traditional structure, and the results show that geodesic structure provide better performance of responding load direction than traditional structure. The influence of swept angle to the weight structure show that the higher the swept angle of geodesic beam structure, the higher values of weight structure are resulted.
Spectral Error Analysis of Windowed Discrete Sinusoidal Signals
Authors: Heryadi Budi , Nurprasetio Ignatius Pulung , Abidin Zainal
Published: June 2016

This paper presents an analysis of spectral error analysis of windowed discrete sinusoidal signals. The objective of the work is to understand how window functions affect the discrete frequency spectrum and how to minimize spectrum errors. The spectral error analysis, in which the mathematical expression of the spectral error is derived, is conducted to a discrete sinusoidal signal with single frequency. The analysis reveals the fact that the applied window functions will produce peak spectral error regardless of the sampling rate and recording time. This result has been confirmed through numerical simulations. In addition, an experiment is conducted to investigate another type of spectral error, which is frequency error. The frequency error can be minimized by collecting more samples in signal measurement process, which means the recording time is increased, even though this effort does not improve the amplitude accuracy.
Study and Fabrication of Virtual TIG Welding Equipment
Authors: Nguyen Tien Duong
Published: June 2016

The green technology is applied in training welders by using simulation equipment. The virtual tungsten inert gas welding (TIG welding) equipment permits of reducing the cost of welding practice training by saving on materials, electricity. It does not cause the environmental pollution. It is not harmful to welding learners. This paper studies on the permissible range of technological and technical parameters of TIG welding process. This is basis to develop the software in order to evaluate learners on virtual TIG welding equipment. These are foundations to manufacture the virtual TIG welding equipment. This equipment allows welding learners to practice the basic operations and skills as on real TIG welding machine, including the techniques of striking the arc, restarting the arc, maintenance of arc length, controlling of torch angle, filler rod angle, the operations of torch move, filler rod move,... with different welds and different positions
Assembly Programmable Logic Control (PLC) in the Rotary Dryer Machine for Processing Waste Liquid System
Authors: Hendra  , Indriani Anizar , Hernadewita  , Rizal Y.
Published: June 2016

Programmable Logic Controller (PLC) is widely used to control systems on the manufacturing industry, automotive industry and etc. PLC is used to regulate the production process and machine systems to work simultaneously and continue. PLC has system to regulate the movement of machine components, displacement system of product, system settings motion or displacement of other components. PLC is a control system with some advantages such as simple in design, easy to use and circuit modification, low cost, easy maintenance, high reliability and safe. In this paper, we will focus on the PLC that used in the control of equipment movement on the rotary dryer system for waste liquid processing. PLC will be control the movement of the motor for drum of dryer, heating system, water circulation in the wet scrubber system, vacuum cleaner and smoke systems. All these systems are connected by PLC and working by arranged the setting time of system. The first process, PLC will activate the motion system of motor to drive the dryer drum rotating to left or right side. Then the burner is active for heating the drum of dryer. Effect in this process made smoke and dust happen in the rotary dryer system. The pump automatically will be activating to spray water on a wet scrubber system to catch the dust and smoke. Dust and smoke will be inhaled by the blower and flow back into the rotary dryer machine. Therefore there is no smoke and dust flowing into the environment. The results show that the PLC can be control the motion system and processes machine rotary dryer to drying the waste liquid in short time. Such as 20 minutes to 5 liters of liquid waste volume and 30 minutes to 15 liters and made the waste liquid be friendly environment.
Development of Air Combat Effectiveness Simulation and Analysis Scheme for beyond Visual Range (BVR) Case
Authors: Suseno Prasetyo A.P. , Sasongko Rianto A.
Published: June 2016

This paper focuses on the simulation of Beyond Visual Range (BVR) Air Combat using calculation of Probability of Kill (PK) and Supremacy to analyze the effectivity of the tactics and strategies. The developed simulation program is expected to be used as a means of developing tactics, weapons systems evaluation and to support other air combat system applications. The simulation system can be utilized so that strategy for using weapons and better tactics for maneuver can be determined and formulated in the face of an aerial battle. The simulation illustrates how an aerial battle in a 2D plane took place. The battle occurs between two sides and can also cover case of many against many air battle. Fighters maneuver will be generated based on logic and defined tactic by providing input in the form of initial conditions. Formulation / functions, parameters and variables influencing the fighter effectiveness will be taken into account. These elements are modelled using a dynamic and open scenario approach. The simulation used a method called 'Missile Launch Envelope Model' for computing PK of missile along its way to the target. Simulation results for one versus one and many versus many cases show that the developed system can produce good and relatively realistic prediction of the outcome. Further modification of simulation program include fly out modeling to the missile.
Electropolishing of Orthodontic Bracket Produced by Investment Casting Process
Authors: Supriadi Sugeng , Sitanggang Tito W. , Irawan Bambang , Suharno Bambang , Prasetyadi Tjokro , Faturrahman Zulfickry Fauzan
Published: June 2016

Malocclusion or improper teeth arrangement is the most common problem in the field of orthodontics. If the malocclusion is not corrected, it will promote more serious problems, such as bleeding gums, tooth decay, cavities, difficulty breathing and other problems. Currently, the most common technique used to cure the malocclusion is using treatment of orthodontic brackets. Normally, orthodontic brackets can be produced by machining, metal injection molding and investment casting processes. In the previous research, orthodontic brackets have been successfully produced using investment casting process. The investment casting is selected, since the technology was developed well in Indonesia which is shown by existing number of investment casting industries. However, surface roughness of the bracket produced by investment casting is still high, valued at 0.91 μm. On the other hand, surface roughness of the commercial orthodontic bracket is 0.53 μm. In this current work is focused on surface modification of investment casting brackets by using electropolishing. The best result shows that the surface roughness of cast brackets achieve up to 0.44 μm. It shows that opportunity to fabricate orthodontic brackets domestically is applicable.
Numerical Study on Weld Joints of Steel Longitudinal Welded Piles during Pile Driving Process
Authors: Wisnugroho Joko , Wicaksono Satrio , Suharto Djoko , Siswosuwarno Mardjono
Published: June 2016

Longitudinally welded steel pipe piles are not as commonly used as seamless steel pipe piles in offshore platform. Although longitudinally welded steel pipe piles are considerably cheaper than seamless steel pipe piles, yet many feared that longitudinally welded steel pipe piles are prone to fail because of non-uniformity in the heat affected zone (HAZ), especially when receiving impact loads during the installation process. In this paper, a finite element model is developed to study the deformation and failure of the longitudinal welded piles. Two modelling cases are performed: single and double piles, with two different failure parameters: maximum stress and maximum plastic displacement.
Human Memory B Cells in Healthy Gingiva, Gingivitis, and Periodontitis
Authors: Mahanonda Rangsini , Champaiboon Chantrakorn , Subbalekha Keskanya , Sa-Ard-Iam Noppadol , Rattanathammatada Warattaya , Thawanaphong Saranya , Rerkyen Pimprapa , Yoshimura Fuminobu , Nagano Keiji , Lang Niklaus P. , Pichyangkul Sathit
Published: June 2016

The presence of inflammatory infiltrates with B cells, specifically plasma cells, is the hallmark of periodontitis lesions. The composition of these infiltrates in various stages of homeostasis and disease development is not well documented. Human tissue biopsies from sites with gingival health (n = 29), gingivitis (n = 8), and periodontitis (n = 21) as well as gingival tissue after treated periodontitis (n = 6) were obtained and analyzed for their composition of B cell subsets. Ag specificity, Ig secretion, and expression of receptor activator of NF-κB ligand and granzyme B were performed. Although most of the B cell subsets in healthy gingiva and gingivitis tissues were CD19+CD27+CD38− memory B cells, the major B cell component in periodontitis was CD19+CD27+CD38+CD138+HLA-DRlow plasma cells, not plasmablasts. Plasma cell aggregates were observed at the base of the periodontal pocket and scattered throughout the gingiva, especially apically toward the advancing front of the lesion. High expression of CXCL12, a proliferation-inducing ligand, B cell–activating factor, IL-10, IL-6, and IL-21 molecules involved in local B cell responses was detected in both gingivitis and periodontitis tissues. Periodontitis tissue plasma cells mainly secreted IgG specific to periodontal pathogens and also expressed receptor activator of NF-κB ligand, a bone resorption cytokine. Memory B cells resided in the connective tissue subjacent to the junctional epithelium in healthy gingiva. This suggested a role of memory B cells in maintaining periodontal homeostasis.
Atypical presentation of thymolipoma
Authors: Kucuk Canan , Arda Kemal , Ata Naim , Turkkani Mustafa Hamidullah
Published: June 2016

Thymolipoma is an uncommon benign neoplasm and its pathogenesis is unclear. The current study describes the case of an 82-year-old woman who presented with dyspnea and dysphagia and was discovered to have an anterior mediastinal thymolipoma enlarged to cranial part of the neck. We conclude that the only curative treatment of thymolipomas is surgical excision.
An exploratory study on the information needs of prostate cancer patients and their partners
Authors: Kassianos Angelos P. , Raats Monique M. , Gage Heather
Published: June 2016

The aim of this study is to explore the information needs of men with prostate cancer and their partners retrospectively at various points in the treatment process. An online questionnaire was used to collect information from men with prostate cancer and their partners about information needs, and when these developed. Readers of a Prostate Care Cookbook and members of a Prostate Cancer Charity were invited to participate: 73 men with prostate cancer and 25 partners completed the questionnaire. Responses showed that participants develop their information needs close to diagnosis. Less educated men with prostate cancer and partners developed their needs closer to the time after diagnosis than those with higher education. Partners develop an interest on information related to treatment and interaction earlier than patients. Patients prioritised treatment and disease-specific information. Patients and partners differ in how their information needs develop. Medical information is prioritized by patients as opposed to practical information by partners. Health care provision can be tailored to meet the different needs of prostate cancer patients and their partners at different times in the treatment process
Biogeography of the ‘water flea’ Daphnia O. F. Müller (Crustacea: Branchiopoda: Anomopoda) on the Indian subcontinent
Authors: Padhye Sameer M. , Kotov Alexey A. , Dahanukar Neelesh , Dumont Henri
Published: June 2016

Studies on Daphnia distribution in Indian subcontinent have been few and regionally restricted despite Daphnia being by far the most studied cladoceran. We here present a first biogeographical assessment of the genus on the Indian subcontinent (Afghanistan, Pakistan, India, Nepal, Bhutan, Bangladesh and Sri Lanka). We collected all pertinent literature and considered nineteen bioclimatic variables along with latitude, longitude, and altitude for statistical analysis of factors governing distribution in space. Significant variables (determined by Kruskal Wallis test) were tested by nonparametric multivariate analysis of variance (PERMANOVA) to clarify whether Daphnia species had specific environmental requirements. Canonical correspondence analysis was used to understand how environmental variables affected distribution.  Eight Daphnia (Ctenodaphnia) and 4 Daphnia s.str. occurred at 100 different localities. The variables temperature, altitude and latitude differed among species and so did their bio-climatic requirements. Daphnia distribution responded positively to altitude and negatively to a decrease in latitude and temperature.
The success of the cyanobacterium Cylindrospermopsis raciborskii in freshwaters is enhanced by the combined effects of light intensity and temperature
Authors: Bonilla Sylvia , González-Piana Mauricio , Soares Maria C.S. , Huszar Vera L.M. , Becker Vanessa , Somma Andrea , Marinho Marcelo M. , Kokociński Mikołaj , Dokulil Martin , Antoniades Dermot , Aubriot Luis
Published: June 2016

Toxic cyanobacterial blooms in freshwaters are thought to be a consequence of the combined effects of anthropogenic eutrophication and climate change. It is expected that climate change will affect water mixing regimes that alter the water transparency and ultimately the light environment for phytoplankton. Blooms of the potentially toxic cyanobacterium Cylindrospermopsis raciborskii are expanding from tropical towards temperate regions. Several hypotheses have been proposed to explain this expansion, including an increase in water temperature due to climate change and the high phenotypic plasticity of the species that allows it to exploit different light environments. We performed an analysis based on eight lakes in tropical, subtropical and temperate regions to examine the distribution and abundance of C. raciborskii in relation to water temperature and transparency. We then conducted a series of short-term factorial experiments that combined three temperatures and two light intensity levels using C. raciborskii cultures alone and in interaction with another cyanobacterium to identify its growth capacity. Our results from the field, in contrast to predictions, showed no differences in dominance (>40% to the total biovolume) of C. raciborskii between climate regions. C. raciborskii was able to dominate the phytoplankton in a wide range of light environments (euphotic zone = 1.5 to 5 m, euphotic zone/mixing zone ratio <0.5 to >1.5). Moreover, C. raciborskii was capable of dominating the phytoplankton at low temperatures (<15°C). Our experimental results showed that C. raciborskii growing in interaction was enhanced by the increase of the temperature and light intensity. C. raciborskii growth in high light intensities and at a wide range of temperatures, suggests that any advantage that this species may derive from climate change that favors its dominance in the phytoplankton is likely due to changes in the light environment rather than changes in temperature. Predictive models that consider only temperature as a drive factor can therefore fail in predicting the expansion of this potentially toxic cyanobacterium.
Current activities of Cardiovascular Rehabilitation in the ambulatory setting of the Lombardy Region
Authors: Ambrosetti Marco , Pedretti Roberto F.E. , Facchini Mario , Malfatto Gabriella , Riccobono Salvatore Pio , Febo Oreste , Diaco Tommaso
Published: June 2016

In the present work, the current activities of Cardiovascular Rehabilitation and Prevention (CRP) in the ambulatory setting of the Lombardy Region (Italy) are described. Based on the 2012 Legislation, ambulatory CRP is delivered by means of three programme categories (MAC 6, 7, and 8) with different degrees of intensity. The patient evaluation of global cardiovascular/clinical risk, comorbidity, and disability is the cornerstone for MAC prescription. Following the organization of MAC activities, a survey on 327 patients was carried out by the regional network of the Italian Society of Cardiovascular Rehabilitation (GICR-IACPR). Globally, acute coronary syndromes (with or without coronary revascularization) constituted the main access group to CRP. More than 60% of patients displayed a condition of high risk, comorbidity, and disability. The outcome of ambulatory CRP by means of MAC 6 and 7 was satisfactory, while in the 'less intensive' MAC 8 patients with complete drug up-titration and achievement of secondary prevention targets were no more than 70%.Â RiassuntoLa Cardiologia Riabilitativa e Preventiva (CRP) storicamente riconosce nei percorsi ambulatoriali un importante setting per lâ€™erogazione dellâ€™intervento. In Regione Lombardia negli ultimi anni le attivitÃ  di CRP sono state oggetto di una profonda riorganizzazione, con il contributo di esperti GICR-IACPR attivi presso lo specifico tavolo tecnico attivato presso la Direzione Generale SanitÃ . Dal 2012 sono attive le MacroattivitÃ  Ambulatoriali Complesse e ad alta integrazione di risorse (MAC), che riguardano anche la sfera della CRP. Le MAC si sono poste come integrazione e alternativa al percorso degenziale e sono state classificate in tre livelli a complessitÃ  decrescente (MAC 6, MAC 7 e MAC 8 nel nuovo nomenclatore delle attivitÃ  ambulatoriali). Il network GICR-IACPR ha quindi successivamente condotto una survey su 327 pazienti in tre Centri di CRP, di cui vengono esposti i risultati. Complessivamente, le condizioni di accesso alle MAC piÃ¹ utilizzate sono stati gli esiti di sindrome coronarica (con o senza rivascolarizzazione) e vi Ã¨ stata una robusta rappresentazione (oltre 60%) di situazioni cliniche a medio/alto rischio clinico, complessitÃ  e disabilitÃ . Lâ€™outcome dellâ€™intervento in regime di MAC (in termini di recupero funzionale, titolazione della terapia di cardioprotezione e raggiungimento dei target terapeutici) Ã¨ stato globalmente soddisfacente, seppure minore (non superiore al 70%) nel MAC 8 meno "intensivo".
Arterial hypertension: which targets in over-75-year people?
Authors: Mureddu Gian Francesco
Published: June 2016

Arterial hypertension has always been considered the main risk factor in cardiovascular prevention. However, the goals of anti-hypertensive treatment (targets) in the elderly has long been under discussion. The results of the studies in favor of the hypothesis "the lower the better" than those that argue against the existence of the phenomenon of the J-curve, that is, the hypothesis according to which mortality increases to too low pressure values Â lower than 115/75 mmHg, are still controversial. However, in elderly patients the association between blood pressure lowering and increased cardiovascular events seems to depend on the general health status, that means the presence of comorbidity, frailty and / or disability. Recent data from the SPRINT study show that the benefit of an intensive blood pressure target (SBP <120 mmHg) compared to a usual target (SBP <140 mmHg), appears to be greater in the oldest hypertensive patients (â‰¥75 years). The cardio-geriatric functional assessment can provide useful information to better stratify the elderly and to define more accurately the pressure targets, the choice is individual.RiassuntoLâ€™ipertensione arteriosa Ã¨ da sempreÂ  considerata il fattore di rischio centrale in prevenzione cardiovascolare. Tuttavia gli obbiettivi del trattamento anti-ipertensivo (target pressori) nei soggetti anziani Ã¨Â  da molti anni oggetto di discussione. Il risultati degli studi a favore dellâ€™ipotesi â€œthe lower the betterâ€ rispetto a quelli contrari che sostengono lâ€™esistenza del Â fenomeno della cosiddetta curva J, lâ€™ipotesi cioÃ¨ secondo la quale la mortalitÃ  aumenta per valori di pressione troppo bassi, inferiori a 115/75 mmHg, sono tuttâ€™ora controversi. Tuttavia in pazienti anziani lâ€™associazione tra riduzione dei valori di pressione arteriosa e aumento degli eventi cardiovascolari Â sembra dipendere dallo stato di salute generale, ovvero alla presenza di comorbiditÃ , fragilitÃ  e/o disabilitÃ . I recenti dati dello studio SPRINT. Mostrano che il beneficio di un target pressorio intensivoÂ  (PAS<120 mmHg) rispetto ad un target usuale Â (PAS<140 mmHg), sembra essere maggiore nei soggetti Â ipertesi piÃ¹ anziani (â‰¥75 anni). La valutazione funzionale cardio-geriatrica puÃ² fornire informazioni utili a stratificare meglio Â i soggetti anziani e a definirne in maniera piÃ¹ accurata i target pressori, la cui scelta rimane individuale. Â
Aspirin use for primary prevention in elderly patients
Authors: Terrosu Pierfranco
Published: June 2016

The net clinical benefit of aspirin in primary prevention is uncertain as the reduction in occlusive events needs to be balanced against the increase in gastro-intestinal and cerebral bleedings. The meta-analysis of ATT (Anti Thrombotic Trialists) Collaboration in 2009 showed that aspirin therapy in primary prevention was associated with 12% reduction in cardio-vascular events, due mainly to a reduction in non-fatal myocardial infarction (0.18% vs 0.23% per year, p<0.0001). However, the benefit in term of coronary events was almost balanced by the increase in major bleedings. The balance between potential benefit and harm of aspirin differs in each person and appears to be favorable in subjects at higher cardio-vascular risk. Older people have increased risk of hemorrhage as well as increased risk of heart attack and stroke. As a consequence, it is important consider both likelihoods of benefits as well as harm within the lifespan and functioning of the person. The older people who most likely benefit from aspirin in primary prevention are those at higher cardio-vascular risk, with preserved functional abilities, low comorbidity, low risk of bleeding and a prolonged life expectancy.Â RiassuntoIl beneficio clinico netto dellâ€™aspirina in prevenzione primaria Ã¨ poco chiaro, a causa del bilancio critico tra riduzione delle occlusioni vascolari e aumento dei sanguinamenti gastro-intestinali e cerebrali. La metanalisi del 2009 del ATT (Anti Thrombotic Trialists) Collaboration mostra che lâ€™aspirina in prevenzione primaria determina una riduzione del 12% degli eventi cardiovascolari, principalmente dovuta ad una riduzione dellâ€™infarto miocardico non-fatale (0.18% vs 0.23% per anno, p<0.0001). Tuttavia il beneficio in termini di eventi coronarici Ã¨ controbilanciato dallâ€™incremento dei sanguinamenti maggiori. Ne deriva che il bilancio tra vantaggi ed effetti avversi differisce nel singolo soggetto ed appare potenzialmente favorevole nei casi a piÃ¹ elevato rischio cardiovascolare. Nella popolazione anziana Ã¨ aumentato sia il rischio trombotico che quello emorragico. Di conseguenza, Ã¨ importante considerare il rapporto rischio/beneficio in relazione alla aspettativa di vita e alla capacitÃ  funzionale. In sostanza gli anziani che possono trarre vantaggio dallâ€™aspirina in prevenzione primaria sono quelli a piÃ¹ alto rischio cardiovascolare, con mobilitÃ  conservata, scarsa comorbiditÃ , basso rischio emorragico e lunga aspettativa di vita.
High blood pressure and syncope: orthostatic hypotension as a link
Authors: Rafanelli Martina , Ungar Andrea
Published: June 2016

The prevalence of hypertension increases with the age. Diagnostic criteria are the same as for the young, but in older adults isolated systolic hypertension is more frequent, due to loss of vascular compliance. Blood pressure should be measured on both sides in the seated position, moreover in the supine and upright position to detect orthostatic hypotension. Ambulatory blood pressure monitoring is useful to detect white coat hypertension and masked hypertension, to tailor the treatment and search for diurnal and nocturnal blood pressure pattern abnormalities. Given that frailty can affect the relationship between blood pressure and mortality, the clinician should properly evaluate and monitor physical performance and cognitive status, throughout specific tools, as the Fried Frailty Phenotype, aiming at a systolic blood pressure target between 130 and 150 mmHg. Before starting hypotensive drugs, a careful risk and benefitsâ€™ evaluation should be performed given the high risk of hypertension and hypotension consequences and the frequent coexistence of orthostatic hypotension, which predisposes to syncope and falls.Â Â RiassuntoLa prevalenza dellâ€™ipertensione arteriosa aumenta con lâ€™etÃ . I criteri diagnostici sono gli stessi previsti nel giovane, nellâ€™anziano tuttavia si osserva piÃ¹ frequentemente ipertensione sistolica isolata, dovuta a perdita dellâ€™elasticitÃ  vascolare. Ai fini diagnostici, la misurazione della pressione arteriosa bilateralmente in posizione seduta, deve essere integrata con la ricerca di ipotensione ortostatica. Il monitoraggio della pressione arteriosa nelle 24h Ã¨ indicato per la conferma diagnostica, per la ricerca di â€œwhite coat hypertensionâ€ e â€œmasked hypertensionâ€, per monitorare la risposta terapeutica e ricercare alterazioni del ritmo circadiano. I benefici della terapia antiipertensiva sono noti, tuttavia un trattamento troppo aggressivo si Ã¨ dimostrato dannoso, rendendo la gestione dellâ€™ipertensione arteriosa nellâ€™anziano ancora piÃ¹ complessa. Data lâ€™influenza della fragilitÃ  sulla relazione tra pressione arteriosa e mortalitÃ , il clinico dovrebbe avvalersi di adeguati strumenti per la definizione di performance fisica e cognitiva ed il monitoraggio nel tempo, mirando ad un target di pressione arteriosa sistolica compreso tra 130 e 150 mmHg. Rischi e benefici della terapia antiipertensiva dovrebbero essere attentamente valutati prima di intraprendere un trattamento, data la possibilitÃ  di eventi correlati sia allâ€™ipertensione che allâ€™ipotensione e la frequente coesistenza di ipotensione ortostatica, che incrementa il rischio di eventi sincopali e cadute. Nellâ€™anziano iperteso con storia di sincope e cadute il trattamento dovrebbe quindi essere intrapreso una volta confermata la diagnosi, mirando ad un target pressorio piÃ¹ contenuto e con una scelta ponderata dei principi attivi.
Are clinical trial results transferable in the real life?
Authors: Natale Enrico , Marsocci Alfiera
Published: June 2016

Generally in the clinical practice patients are more complex in comparison with those included in the clinical trials. In this article, we discuss three relevant items, which may implement the transferability of the clinical trial results in the real world. The observational studies have fewer restrictions on the number of patients included, due to more relaxed inclusion and exlusion criteria than in randomized clinical trials. The absence of randomization however may lead to potential for bias. The recurrent event analysis may extend the positive results of clinical trials regarding the reductions of the first primary endpoint event to total events, including those beyond the first event. This analysis is of great interest in the clinical practice, where recurrent events are common. Finally the reliability of subgroup analysis is discussed. Pre-specified subgroup analyses are more credible and valuable than post-hoc analyses.RiassuntoNella pratica clinica i pazienti sono generalmente piÃ¹ complessi rispetto alle popolazioni studiate nei trial clinici. Si rendono necessari pertanto strumenti di analisi che integrino i trial clinici. In questo articolo vengono esaminati alcuni punti di rilevante importanza nella definizione di una corretta applicabilitÃ  dei risultati dei trial clinici al mondo reale. Il primo punto riguarda il ruolo e i limiti degli studi osservazionali. Il secondo tratta delle analisi degli eventi ricorrenti, una modalitÃ  di analisi dei trial clinici che rende i risultati piÃ¹ aderenti alla vita reale, nella consapevolezza che limitare i dati di outcome al primo evento sia riduttivo rispetto alla necessitÃ  di stabilire che lâ€™intervento studiato nel trial confermi la sua efficacia anche sugli eventi successivi al primo. Il terzo punto riguarda la controversa questione delle analisi per sottogruppi, uno strumento utile per generare ipotesi, ma discutibile quando impiegato per rimediare a trial con risultati negativi o estendere i risultati di trial positivi a sottopopolazioni particolari di pazienti.Â
Bilateral empyema treated by sequential pleuroscopy
Authors: Archontogeorgis Kostas , Lanfranco Anthony , Koulelidis Andreas , Froudarakis Marios E.
Published: June 2016

Bilateral empyema associated to infectious pericarditis is an extremely rare, yet life-threatening condition. Pleuroscopy-medical thoracoscopy has proved its efficacy in series of patients with empyema. Yet, all reported cases treated by this technique, concerned patients with pleural infection located to a single hemithorax. We present the case of a 71-year-old man with bilateral empyema treated successfully by sequential pleuroscopy, associated to infectious pericarditis.
Critical review of the equations predicting 6-minute walking distance in obese subjects
Authors: Donini Lorenzo Maria , Poggiogalle Eleonora , Mosca Veronica , Pinto Alessandro , Migliaccio Silvia , Brunani Amelia , Capodaglio Paolo
Published: June 2016

The correlation between the 6-minute walking distance and obesity has been only partially explored. Results obtained from the existing predictive equations are influenced by a variety of factors (health status, severity of obesity, reduced muscle strength and mobility, decreased aerobic capacity, presence of comorbidities). The aim of our study was to verify, compare and discuss the 6MWD predictive capacity of the equations currently available in the literature in a sample of obese subjects. Despite similar study design, the considered articles varied with regard to the number of individuals included and to age range. None of the equations available in the literature was able to accurately predict the six-minute walked distance performed by the obese subjects involved in our study. The six-minute walked distance performed by obese subjects seems to be influenced by other factors than the variables included in the equations from the literature, suggesting that they may not thoroughly capture the complexity of disability in obese people. Future research should be designed in order to validate population-specific equations, by including variables related to clinical, functional, and psychological areas, which are usually impaired in obese individuals.Â
Guidelines for the diagnosis, prevention and management of osteoporosis
Authors: Rossini M. , Adami S. , Bertoldo F. , Diacinti D. , Gatti D. , Giannini S. , Giusti A. , Malavolta N. , Minisola S. , Osella G. , Pedrazzoni M. , Sinigaglia L. , Viapiana O. , Isaia G. C.
Published: June 2016

Osteoporosis poses a significant public health issue. National Societies have developed Guidelines for the diagnosis and treatment of this disorder with an effort of adapting specific tools for risk assessment on the peculiar characteristics of a given population. The Italian Society for Osteoporosis, Mineral Metabolism and Bone Diseases (SIOMMMS) has recently revised the previously published Guidelines on the diagnosis, riskassessment, prevention and management of primary and secondary osteoporosis. The guidelines were first drafted by a working group and then approved by the board of SIOMMMS. Subsequently they received also the endorsement of other major Scientific Societies that deal with bone metabolic disease. These recommendations are based on systematic reviews of the best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on leading experts’ experience and opinion, and on good clinical practice. The osteoporosis prevention should be based on the elimination of specific risk factors. The use of drugs registered for the treatment of osteoporosis are recommended when the benefits overcome the risk, and this is the case only when the risk of fracture is rather high as measured with variables susceptible to pharmacological effect. DeFRA (FRAX® derived fracture risk assessment) is recognized as a useful tool for easily estimate the long-term fracture risk. Several secondary forms of osteoporosis require a specific diagnostic and therapeutic management.
Comparative performance of traps in catching tsetse flies (Diptera: Glossinidae) in Tanzania
Authors: Malele Imna I. , Ouma Johnson O. , Nyingilili Hamisi S. , Kitwika Winston A. , Malulu Deusdedit J. , Magwisha Henry B. , Kweka Eliningeya J.
Published: June 2016

This study was conducted to determine the efficiency of different tsetse traps in 28 sites across Tanzania. The traps used were biconical, H, NGU, NZI, pyramidal, S3, mobile, and sticky panels. Stationary traps were deployed at a distance of 200 m apart and examined 72 h after deployment. The results showed that 117 (52.2%) out of the 224 traps deployed captured at least one Glossina species. A total of five Glossina species were captured, namely Glossina brevipalpis, Glossina pallidipes, Glossina swynnertoni, Glossina morsitans, and Glossina fuscipes martinii. Biconical traps caught tsetse flies in 27 sites, pyramidal in 26, sticky panel in 20, mobile in 19, S3 in 15, NGU in 7, H in 2 and NZI in 1. A total of 21 107 tsetse flies were trapped, with the most abundant species being G. swynnertoni (55.9%), followed by G. pallidipes (31.1%), G. fuscipes martinii (6.9%) and G. morsitans (6.0%). The least caught was G. brevipalpis (0.2%). The highest number of flies were caught by NGU traps (32.5%), followed by sticky panel (16%), mobile (15.4%), pyramidal (13.0%), biconical (11.3%) and S3 (10.2%). NZI traps managed to catch 0.9% of the total flies and H traps 0.7%. From this study, it can be concluded that the most efficient trap was NGU, followed by sticky panel and mobile, in that order. Therefore, for tsetse fly control programmes, NGU traps could be the better choice. Conversely, of the stationary traps, pyramidal and biconical traps captured tsetse flies in the majority of sites, covering all three ecosystems better than any other traps; therefore, they would be suitable for scouting for tsetse infestation in any given area, thus sparing the costs of making traps for each specific Glossina species.Keywords: tseste; traps; densties; Glossina; mobile; stationary; Tanzania
Early menopause
Authors: Hernández-Angeles Claudio , Castelo-Branco Camil
Published: June 2016

Early menopause or premature ovarian insufficiency (POI) is a common cause of infertility in women and affects about one per cent of young women. This disorder has significant psychological sequelae and major health implications. Its relevance has increased in recent years due to the fact that age of motherhood is being delayed in developed countries, with the risk of having either primary ovarian insufficiency or less possibilities of pregnancy. The main characteristics are absence of ovulation, amenorrhoea and high levels of serum gonadothropins (hypergonadotropic hypogonadism). Although the aetiology remains uncertain in most cases, several rare specific causes have been elucidated. Potential causes for POI are iatrogenic (ovarian surgery, radiotherapy or chemotherapy), environmental factors, viral infections, metabolic and autoinmune diseases, and genetic alterations. Because of the association with other autoimmune diseases, close follow up is recommended in patients with POI. The traditional indicators to evaluate ovarian ageing are age, serum hormonal levels, anti-Mullerian hormone, antral follicle count, and ultrasonography of ovaries. Hormone replacement therapy remains the mainstay of treatment, and the best chance of achieving a pregnancy is through oocyte donation. This article aims to present an overview of potential causes, clinical manifestations, and treatment options of POI.