Door-to-balloon time in primary percutaneous coronary intervention for patients with ST-Segment Elevation Myocardial Infarction

Introduction: Over the past years Primary Percutaneous Coronary Intervention (PCI) has emerged as an effective treatment strategy for acute ST-Elevation Myocardial Infarction (STEMI).1 The survival rate with Primary PCI however is dependent on the time to treatment,2 thus, given the time dependency of survival in patient with STEMI undergoing Primary PCI, the American College of Cardiology and American Heart Association (ACC/AHA) in their management guidelines of acute myocardial infarction also endorsed by European Society of Cardiology (ESC) have established a door- to-balloon time of 90 minutes as a gold standard for Primary PCI.4 The aim of this audit is to measure and compare this key performance measurement for quality of care of patients with STEMI in the Maltese Islands. Methods: This audit was conducted at the only PCI-capable hospital in Malta – Mater Dei Hospital. All the patients coming in through the Accident and Emergency Department with an ST-elevation Myocardial Infarction or a new onset Left Bundle Branch Block (LBBB), thus eligible for a Primary PCI, were included in this audit. This was a prospective audit between January 2012 and December 2012 and using a proforma, data was collected primarily to map out the Door-to-Ballon times for Primary PCI during that period. This data was also used to pinpoint areas were time delays occur when dealing with STEMI cases. Door-to-Balloon times from pre-hospital diagnosis of STEMI using the MRX was also audited and compared to times of in-hospital STEMI diagnosis. Results: During the 12 months duration of the audit, 157 patients were recorded in the CathLab Database as having had an Emergency Primary PCI. Recorded in the audit were 135 patients of which 123 were STEMI patients eligible for a Primary PCI and 12 STEMI patients not eligible for Primary PCI and thus not included in the audit. The Mean Door-to- Balloon times of all 123 patients was found to be 101.45 minutes. Data analysis showed that the times during 'Office Hours' (8am to 5pm) were statistically significantly less than those of 'After hours' (5pm to 8am) (N=123, p<0.001) and those with a Door-to- Balloon time of more than 90 minutes, data analysis showed the number of such cases were statistically significantly less during 'Office Hours' (N=36, p=0.02). With pre-hospital ECG diagnosis of STEMI, data analysis showed that with MRX, Door-to-Ballon times are significantly less when compared to those during 'Office Hours' and 'After Hours' (N=57, p=0.003 and N=66, p<0.001 respectively). Conclusion: From the results obtained, local achievement to remain well within the standards suggested by the ACC/AHA and ESC of Primary PCI ? 90 minutes for STEMI was not reached, however several factors contributing to delays and strategies to minimize delay were pointed out in order to further improve the local practice and thus lowering mortality rates associated with STEMI.peer-reviewe

New Approaches in Coalition Stability

In this paper we propose the state of art in the theory of coalitional games in effectiveness form without bargaining between coalitions. We study some solution concepts: The largest consistent set (Chwe, 1994); the largest cautious consistent set (Mauleon et al., 2004); the credible consistent set (Bhattacharya, 2002); standard stable behaviors (Xue, 1998). A series of examples, showing main features and differences between these solutions, are presented in order to outline some drawbacks and positive aspects in the philosophical framework of stability concepts.coalitonal games; stable sets; farsightedness.

International Environmental Agreement: a Dynamic Model of Emissions Reduction

We model an International Environmental Agreement as a two stages game: during the first stage each country decides whether or not to join the agreement while, in the second stage, the quantity of emissions reduction is choosen. Players determine their abatement levels in a dynamic setting, given the dynamics of pollution stock and the strategies of other countries. Players may act cooperatively, building coalitions and acting according to the interest of the coalition, or they make their choices taking care of their individual interest only. Countries can behave myopically or in a farsighted way. As a consequence, the size of stable coalition can completely change. A continuous time framework is choosen in the present paper and consequently the problem is studied by a differential game.IEA, Differential games, Coalition stability.

Progetto di una cupola reticolare per la copertura di un planetario con annesso museo astronomico

Sommario: La presente tesi affronta lo studio, la progettazione ed il montaggio di una cupola reticolare sferica metallica a strato semplice, per la copertura di un Planetario con annesso Museo astronomico. Il complesso si trova nel Comune di Massa (Toscana), occupa una superficie di 2000 mq, ed è sviluppato su due piani. Dopo alcuni cenni sulla storia ed il funzionamento dei planetari, segue una breve descrizione dell’intero progetto architettonico e l’analisi dettagliata delle caratteristiche geometriche e meccaniche della cupola in esame. Infine, si espongono i criteri utilizzati per la sua progettazione ed il montaggio. La cupola è di tipo geodetica a strato semplice, con tassellazione parallela. Ha un diametro di 23 m, ed è realizzata con nodi in acciaio inossidabile, aste in lega di alluminio ed infine pannelli in parte opachi, se realizzati in lamiera di alluminio, o, trasparenti, se in vetro strutturale stratificato. Al suo interno, è prevista una cupola sferica più piccola, con diametro di 21,40 m, e realizzata con pannelli in lamiera di alluminio, che costituisce lo schermo di proiezione. La capienza del Planetario è di 250 posti a sedere. Al progetto si è voluto dare una forma piena di significati. Infatti, l’elemento circolare più grande, dove è collocato il Museo, rappresenta il pianeta; i settori delle corone circolari dove trovano posto le attività complementari e di servizio e la vasca d’acqua, sono gli anelli del pianeta; l’altro elemento circolare, che contiene il Planetario, rappresenta il satellite. Abstract: The present thesis faces the study, the design and the assembling of a metallic spherical dome, for covering a Planetarium associated to an astronomical Museum. The construction is located in Massa (Tuscany), has a surface of 2000 mq, and develops on two plans. After a brief recall about the history and the functions of the planetariums, a short description is given about the architectonic design. After, a detailed description is given about the geometric and mechanical properties of the shell under investigation. Finally, the criteria used for designing and assembling are illustrated. The shell is a simple layer spherical geodesic dome, with parallel tessellation. Its diameter is 23 m. Joints are made of stainless steel, members are in aluminium alloy and, at last, panels are partly opaque, if they are made of aluminium sheet, or, transparent, if they are of stratified structural glass. An inner dome, with diameter of 21,40 m and composed of spherical aluminium panels, constitutes the screen of projection. The Planetarium contains a maximum of 250 people. The architectural complex has a meaningful shape: the larger circular element, where the Museum is placed, represents the planet; the sectors, where complementary activities and the pool are placed, are the rings of the planet; finally, the remaining circular element containing the Planetarium, represents the satellite

L-ortografija tal-Għaqda

Naħsbu li llum ftit fadal nies li mhumiex jaddottaw l-ortografija li swiet tant ħidma u għaraq lill-membri tal-Għaqda tal-Kittieba tal-Malti.N/

Cooperazione e competizione nello sfruttamento di una risorsa rinnovabile

In this paper we propose a static model describing the commercial exploitation of a common property renewable resource by a population of agents. Players can cooperate or compete; cooperators maximize the utility of their group while defectors maximize their own profit. Agents aren't assumed to be divided into the two groups from the beginning; by solving the static game we obtained the best response function of i-th player without making other agents positions. Then, the Nash equilibria we calculated point out how different strategies - all the players cooperate, all the players compete or players can be divided into cooperators and defectors - can coexist.Resource Exploitation, Game theory

Modelling environment effects on spectroscopic molecular responses with hybrid QM/classical methods

The objective of this work is the accurate modelling of environment effects, i.e. the modifications in the properties and the processes of molecular systems when interacting with an environment, using hybrid Quantum Mechanical/classical methods. In particular, the focus is on the changes induced by the environment on electronic transitions (both in absorption and in the emission processes), vibrational transitions and vibrational couplings. The hybrid QM/classical methods used introduce either an atomistic or a continuum description for the classical part of the system but in both cases mutual polarization effects between the QM and the classical subsystems are included. These methods have been applied to environments of increasing complexity going from isotropic solvents to lipid bilayers and DNA fragments

Monitoraggio e adeguamento sismico di padiglioni nell'ospedale di Fivizzano (MS)

Nella tesi viene condotta un’analisi di rischio sismico di alcuni padiglioni dell’ospedale di Fivizzano, sito in provincia di Massa-Carrara, e viene avanzata una proposta di adeguamento sismico di uno dei suddetti padiglioni, alla luce dell’attuale D.M. 14/01/2008. Inizialmente si procede con un’indagine storica e delle tecniche costruttive degli edifici, affiancata da un rilievo geometrico-strutturale, al fine di individuare la geometria, i dettagli costruttivi ed i materiali utilizzati. In particolare risulta che i due padiglioni in esame, realizzati in anni diversi e con tecniche e materiali differenti (padiglione E-F in struttura mista muratura-cemento armato e padiglione G in c.a.), costituiscono un’unica unità strutturale. I dati raccolti vengono utilizzati per la successiva modellazione della struttura, su cui vengono eseguite le verifiche per valutare il comportamento dell’organismo edilizio soggetto all’azione sismica e giungere, pertanto, alla determinazione dell’indice di rischio sismico. Infine il padiglione G viene riportato al livello di sicurezza richiesto dalla normativa vigente, tramite due interventi: prima viene eseguito un consolidamento statico con trave rompitratta, per dimezzare i carichi statici sulle travi che non soddisfano le verifiche; poi viene effettuato un adeguamento sismico mediante la realizzazione di un giunto sismico di separazione del padiglione G dalla iniziale unità strutturale, e la costruzione di un sistema di controventamento con controventi metallici a croce di S. Andrea, disposti lungo le due direzioni principali dell’edificio

Competition and Cooperation in a dynamical model of natural resources

In this paper we propose a model describing the commercial exploitation of a common property renewable resource by a population of agents. Players can cooperate or compete; cooperators maximize the utility of their group while defectors maximize their own profit. The model provides for one utility function which can be used for every kind of player. Agents aren't assumed to be divided into the two groups from the beginning; by solving the static game we obtained the best response function of i-th player without making other agents positions. Then, the Nash equilibria we calculated point out how different strategies - all players cooperate, all players compete or players can be divided into cooperators and defectors - can coexist. In any case the total harvest depend on renewable resource stock, and it influences agents' positions. According to the Nash equilibria, harvested is arranged to fishing population dynamics and a complete analysis for the equilibria obtained and for their stability is proposed. The effects of the different Nash equilibria on the fish stock are compared showing the more stability in the cooperative case.Nash Equilibria, Resource Exploitation, Population Dynamics.

New disagreement metrics incorporating spatial detail – applications to lung imaging

Evaluation of medical image segmentation is increasingly important. While set-based agreement metrics are widespread, they assess the absolute overlap, but fail to account for any spatial information related to the differences or to the shapes being analyzed. In this paper, we propose a family of new metrics that can be tailored to deal with a broad class of assessment needs