Historical cohort study examining comparative effectiveness of albuterol inhalers with and without integrated dose counter for patients with asthma or chronic obstructive pulmonary disease

This study was supported financially by an unrestricted grant from Teva Pharmaceuticals, Frazer, PA, USA. The authors thank Jenny Fanstone of Fanstone Medical Communications Ltd., UK, and Elizabeth V Hillyer for medical writing support, funded by Research in Real-Life. We acknowledge with gratitude Dr Ruchir Parikh for his review of and contributions to the manuscript.Peer reviewedPublisher PD

Seasonal undernutrition in rural Ethiopia:

Marked seasonal variability of both production- and consumption is characteristic of virtually all farming systems in the developing world. This study examines the magnitude and significance of seasonal undernutrition in south central Ethiopia, southern Shewa and Zigwa Boto, a peasant association in the Gurage Zone. The study seeks to answer five questions: (1)Does seasonal energy stress affect individuals of various age groups and sexes differently? (2)Do members of the same household show divergent responses to seasonal energy stress? (3)What are the functional consequences of different levels of adult undernutrition? (4)Are the current anthropometric cut-off points for adults appropriate for rural Ethiopia? (5)What household characteristics are associated with vulnerability to seasonal undernutrition? A number of important findings emerge from this research.....The study clarifies some points of contention in the field of adult undernutrition and shows how seasonal undernutrition operates as an intermittent warning signal, reminding us not to miss opportunities to promote good nutrition throughout the life cycle.Nutrition, Ethiopia, Malnutrition., Food crops., Climate.,

feasibility and effectiveness of exoskeleton structures for seismic protection

Abstract In this study, a self-supporting structure, namely an exoskeleton, is considered as set outside a main structure and suitably connected to it. From the structural point of view, the exoskeleton is conceived as a "sacrificial" appendage, called to absorb seismic loads in order to increase the performance of the main structure. From the architectural and technological point of view, additional functions may be associated through an integrated design approach, combining seismic with urban and energy retrofitting. Particular and attractive applications can therefore be envisaged for existing buildings. A reduced-order dynamic model is introduced, in which two coupled linear viscoelastic oscillators represent the main structure and the exoskeleton structure, respectively, while either a rigid link or a dissipative viscoelastic connection is considered for the coupling. The equations of motion are set in non-dimensional form and a parametric study is carried out in the frequency domain to confirm that exoskeleton structures can be feasible and effective in reducing earthquake-induced dynamic responses

Malpractice and patient safety descriptors: an innovative grid to evaluate the quality of clinical records

Introduction: The medical record contains all the health information related to the patient’s clinical condition and its evolution during hospitalization. It was defined by the Italian Ministry of Health in 1992 as "The information tool designed to record all relevant demographic and clinical information about a patient during a single episode of hospitalization". The documents and information in a Medical Record must meet the following criteria: traceability, clarity, accuracy, authenticity, pertinence and completeness. The objectives of our study was to develop a tool capable of assessing the quality of the clinical record and pointed the critical point at the Organizational, Technical - Professional, Managerial level. Methods: To evaluate the quality of the medical documentation, we created an assessment grid composed of 4 sections with a total of 92 criteria. This grid was tested on 200 medical records that were randomly selected from 25 (18 medical and 7 surgical) wards of a teaching hospital in Rome. Results: The grid contains 4 sections. The first part regards administrative and clinical data; the second assesses the quality of hospital stay and surgical/invasive procedures; the third part is concerned with the discharge of the patient and the fourth aims to identify the presence of advisory reports given to the patient. This grid has been validated to verify internal consistency with Cronbach's Alpha = 0,743. Conclusions: Medical records were analyzed using a validated tool with grids to identify critical issues in care activities. Weaknesses in the system were identified in order to improve planning. The sample testing also in terms of ‘self-assessment' represents a tool to introduce activities to improve safety and quality of care, greatly reducing the costs of litigation

Quality assessment of medical record as a tool for clinical risk management: a three year experience of a teaching hospital Policlinico Umberto I, Rome

Introduction: The medical record was defined by the Italian Ministry of Health in 1992 as "the information tool designed to record all relevant demographic and clinical information on a patient during a single hospitalization episode". Retrospective analysis of medical records is a tool for selecting direct and indirect indicators of critical issues (organizational, management and technical). The project’s aim being the promotion of an evaluation and self-evaluation process of medical records as a Clinical Risk Management tool to improve the quality of care within hospitals. Methods: The Authors have retrospectively analysed, using a validated grid, 1,184 medical records of patients admitted to the Teaching Hospital “Umberto I” in Rome during a three-year period (2013-2015). Statistical analysis was performed using SPSS for Windows © 19:00. All duly filled out criteria (92) were examined. “Strengths” and "Weaknesses" were identified through data analysis and Best and Bad Practice were identified based on established criteria. Conclusion: The data analysis showed marked improvements (statistically significant) in the quality of evaluated clinical documentation and indirectly upon behaviour. However, when examining some sub-criteria, critical issues emerge; these could be subject to future further corrective action

Mapping and profiling of Albanian diaspora: an economic and social survey in five Italian regions: an overview of the situation in France and Belgium

The aim of the book is to better understand the characteristics of the Albanian diaspora in the three countries, investigating plans and expectations of migrating Albanian citizens with particular interest to a possible direct or indirect contribution and investment. Diaspora and diaspora networks are indeed considered key possible actors to economic and financial contribution to the country of origin, besides the help they grant through family remittances. More particularly, they are recognized for their more trusted and lasting relationships with domestic actors, being able to merge self-economic and solidarity motivation to invest in the country of origin and also be able to mobilize larger networks and forms for capitals and resources. Based on these assumptions, the research had been designed to verify and analyse the extent and the conditions in which could the Albania diaspora abroad be a relevant economic player benefiting the development and investment policies in Albania. The goal is not to make a comparison between Albanian Diaspora communities in Italy, France, and Belgium, but rather to provide an analysis on the driving factor, which has stimulated the migration in these countries. Meanwhile considering that the Albanian Diaspora in Italy is amongst the largest Diaspora abroad, the research is mainly focused on the different patterns of communities in the main five regions of Italy. Moreover, it provides a profiling of Albanian citizens residing in Italy, who have declared an interest in investing in Albania, in order to offer an instrument aimed at strengthening the role of the diaspora for the development of Albania

new self healing techniques for cement based materials

Abstract: In recent years, researches concerning cement-based materials has been focused not only on the strength and the toughness but also on the durability. In fact, the interest on concrete's self-healing process is increasing, due to the rapidly deterioration of that material which tends to crack and thus quickly deteriorate. In this paper, a new self-healing technology for cement-based materials is proposed. This technology is based on the encapsulation method of repairing agent inserted in randomly distributed shell inside the material during its preparation. Two different kind of shells were used: glass spheres and pharmaceutical capsules. The material the shells are made of has to be endowed with a series of fundamental characteristics. That material has to be inert with respect to the repair agent so that it doesn't react with it, resisting to the severe stress condition that the shells undergo during the mixing, and at the same time being capable of breaking down when the crack intercept them, having a good compatibility with the cement mixture. The results demonstrate that it is possible to use this kind of shell to encapsulate the repairing agent: the crack breaks them and they release the healing agent, which allows patching up the crack

Stochastic Multi-objective Optimisation of Exoskeleton Structures

In this study, a structural optimisation problem, addressed through a stochastic multi-objective approach, is formulated and solved. The problem deals with the optimal design of exoskeleton structures, conceived as vibration control systems under seismic loading. The exoskeleton structure is assumed to be coupled to an existing primary inner structure for seismic retrofit: the aim is to limit the dynamic response of the primary structure to prevent structural damage. A non-stationary filtered Gaussian white noise stochastic process is taken as the seismic input. Design variables pertain to the mechanical properties (stiffness, damping) of the exoskeleton structure. Two concurrent and competing objective functions are introduced, in order to take into account not only safety performance but also economic cost considerations. The resulting trade-off is solved searching the Pareto front by way of a controlled elitist genetic algorithm, derived from the Non-dominated Sorting Genetic Algorithm-II. Sensitivities of Pareto fronts and Pareto optimal sets to different system parameters are finally investigated by way of a numerical application

Cyclic uniaxial testing and constitutive modelling of cementitious composite materials

Innovative cementitious composite materials are drawing considerable interest due to their substantially improved mechanical properties, as compared to ordinary cement-based materials: among the others, higher tensile strength, tensile strain hardening, flexural strength, fracture toughness [1] and resistance to fatigue. Their enhanced ductility appears to be promising and particularly suited to structural applications under severe dynamic loading conditions (earthquake, impact, blast) [2]. Accurate constitutive models to simulate the dynamic behaviour of cementitious composites are hence needed, as well as corresponding appropriate testing protocols for their experimental characterisation [3]. In this study, the response of cementitious composites to cyclic uniaxial loadings has been investigated. Cyclic response is essential to understand the effects of unloading and reloading on the material, to examine how it behaves in the transition from tension to compression and to characterise its properties in terms of energy dissipation and strain-rate sensitivity. Different loading schemes have been considered, including reversed cyclic tension/compression loadings, in order to identify the complete stress-strain curve and the transition behaviour, which can occur, for instance, under seismic, fatigue and wind loads. Monotonic quasi-static tension and compression tests have been also performed, to provide a benchmark for the evaluation of the envelope curve of cyclic response. The experimental campaign was carried out on cylindrical specimens, a standard geometry in compression testing of cement-based materials. Several series of homothetic specimens (height to diameter ratio fixed as 2) with different dimensions were tested, to evaluate the influence of scale effects. Variability and reproducibility of the testing results have been taking into account by employing a minimum number of three specimens per loading condition. All the tests were performed, under deformation-controlled regime, on an MTS servo-hydraulic testing machine with 250 kN load cell. The testing machine was customised with accessories designed to meet specific test requirements, avoiding instability and bending moments during the alternating phases of uniaxial compression and tension. Linear variable displacement transducers (LVDT) and strain gauges were used to measure vertical displacements and lateral deformations, respectively. The results obtained experimentally represent a reliable basis for the development of constitutive models suited to numerical simulation. References [1] Restuccia, L., Reggio, A., Ferro, G.A., Kamranirad, R., “Fractal analysis of crack paths into innovative carbon-based cementitious composites”, Theoretical and Applied Fracture Mechanics, 90, 133-141, 2017. [2] Yoo, D. Y., Banthia N. “Mechanical properties of ultra-high-performance fiber-reinforced concrete: A review”, Cement and Concrete Composites, 73, 267-280, 2016. [3] Kesner, K.E., Billington, S.L., Douglas K.S. “Cyclic response of highly ductile fiber-reinforced cement-based composites”, ACI Materials Journal, 100(5), 381-390, 2003

Internal radiation dose assessment of radiopharmaceuticals prepared with cyclotron-produced 99m Tc

Technetium-99m (99m Tc) is the radioisotope most widely used in diagnostic nuclear medicine. It is readily available from 99 Mo/99m Tc generators as the \u3b2- decay product of the 99 Mo (T\ubd =66 h) parent nuclide. This latter is obtained as a fission product in nuclear reactors by neutron-induced reactions on highly enriched uranium. Alternative production routes, such as direct reactions using proton beams on specific target materials [100 Mo(p,2n)99m Tc], have the potential to be both reliable and relatively cost-effective. However, results showed that the 99m Tc extracted from proton-bombarded 100 Mo-enriched targets contains small quantities of several Tc radioisotopes (93m Tc, 93 Tc, 94 Tc, 94m Tc, 95 Tc, 95m Tc 96 Tc and 97m Tc). The aim of this work was to estimate the dose increase (DI) due to the contribution of Tc radioisotopes generated as impurities, after the intravenous injection of four radiopharmaceuticals prepared with cyclotron-produced 99m Tc (CP-99m Tc) using 99.05% 100 Mo-enriched metallic targets