FACTORS AFFECTING THE DIAGNOSTIC DELAY IN AMYOTROPHIC LATERAL SCLEROSIS

Background: Although amyotrophic lateral sclerosis (ALS) is a relentlessly progressive disorder, early diagnosis allows a prompt start with the specific drug riluzole and an accurate palliative care planning. ALS at onset may however mimic several disorders, some of them treatable (e.g., multifocal motor neuropathy) or epidemiologically more frequent (e.g., cervical myelopathy). Objective: To study the delay from onset to diagnosis in a cohort of ALS patients and to the variables that may affect it. Methods: We performed a retrospective analysis of the diagnostic delays in a cohort of 260 patients affected by ALS (M/F = 1.32) followed at our tertiary referral ALS Center between 2000 and 2007. Results: The median time from onset to diagnosis was 11 months (range: 6–21) for the whole ALS cohort, 10 months (range: 6–15) in bulbar-onset (n = 65) and 12 months (range: 7–23) in spinal-onset (n = 195) patients (p = 0.3). 31.1% of patients received other diagnoses before ALS and this led to a significant delay of the correct diagnosis in this group (other diagnoses before ALS, n = 81: median delay, 15 months [9.75–24.25] vs ALS, n = 179, median delay, 9 months [6–15.25], p < 0.001). Conclusions: The diagnostic delay in ALS is about one year, besides the growing number of tertiary centres and the spread of information about the disease through media and internet. Cognitive errors based on an incorrect use of heuristics might represent an important contributing factor. Furthermore, the length of the differential diagnosis from other disorders and delays in referral to the neurologist seems to be positively associated with the delay in diagnosis

A Conceptual Review on Using Consequential Life Cycle Assessment Methodology for the Energy Sector

Energy is engaged in the supply chain of many economic sectors; therefore, the environmental impacts of the energy sector are indirectly linked to those of other sectors. Consequential life cycle assessment (CLCA) is an appropriate methodology to examine the direct and indirect environmental impacts of a product due to technological, economic or social changes. To date, different methodological approaches are proposed, combining economic and environmental models. This paper reviews the basic concept of CLCA and the coupling of economic and environmental models for performing CLCA in the energy sector during the period 2006\u20132020, with the aim to provide a description of the different tools, highlighting their strengths and limitations. From the review, it emerges that economic modelling tools are frequently used in combination with environmental data for CLCA in the energy sector, including equilibrium, input-output, and dynamic models. Out of these, the equilibrium model is the most widely used, showing some strengths in availability of data and energy system modelling tools. The input-output model allows for describing both direct and indirect effects due to changes in the energy sector, by using publicly available data. The dynamic model is less frequently applied due to its limitation in availability of data and modelling tools, but has recently attracted more attention due to the ability in modelling quantitative and qualitative indicators of sustainability

Life-Cycle Land-Use Requirement for PV in Vietnam

Over the last 15 years, photovoltaics (PV) in Vietnam has experienced development. The increased installed capacity of PV requires more land for installation sites as well as for manufacturing the plants’ component and waste treatment during the plants’ decommissioning. As a developing country, in which more than 80% of the population’s livelihood depends on agriculture, there are concerns about the competition of land for agriculture and solar development. This paper estimates the life-cycle land-use requirement for PV development in Vietnam, to provide the scientific-based evidence for policy makers on the quantity of land required, so that the land budget can be suitably allocated. The direct land-use requirement for PV ranges from 3.7 to 6.7 m2 MWh−1 year, and the total fenced area is 7.18 to 8.16 m2 MWh−1 year. Regarding the life-cycle land use, the land occupation is 241.85 m2a and land transformation is 16.17 m2 per MWh. Most of the required land area is for the installation of the PV infrastructure, while the indirect land use of the background process is inconsiderable

CLCA for Assessing Environmental Impacts of Power Sector in the GHG Policy Context

Purpose: Current greenhouse gas (GHG) policy aims at reducing emissions from power sector. However, there are some known trade-offs of GHG emission reductions, in terms of other types of environmental impacts and impacts on other economic sectors. Consequential life cycle assessment (CLCA) has been developed to assess the environmental impacts of the power sector in relation with changes in the policy and its indirect impacts on other economic sectors. Methods: A systematic review of CLCA method is conducted in the power sector. CLCA studies since 2005 are reviewed in terms of obtained results and methodology to identify whether CLCA is a more suitable approach for assessing environmental impacts of power sector in the context of GHG policy intervention, compared to attributional life cycle assessment (ALCA). Results and discussion: With CLCA the total environmental impacts/benefits of power system change when indirect impacts are accounted. The variations between the total environmental impacts quantified with CLCA and ALCA range widely from inconsiderable difference (less than 5%) to 200%, depending on the investigated product system. These variations originate from CLCA\u2019s modelling principles of expanding the system boundary and the inclusion of socio-economic interactions. With the expansion of system boundary, CLCA covers affected products and accounts for their relevant environmental impacts, which makes the obtained results comprehensively quantified. At the same time, the inclusion of socio-economic interactions in CLCA improves its capability of identifying the connections between environmental impacts and social-economic changes such as economic growth and consumer behaviours

Multi-Objective Building Envelope Optimization through a Life Cycle Assessment Approach

This work describes a methodology for the identification of the optimal features for the envelope of a residential building. The optimization process allows minimizing operating energy consumption, investment costs and life cycle energy and environmental embodied impacts. A dynamic model for the estimation of building energy consumption during its use phase has been employed, while literature data were adopted for embodied energy and global warming potential impacts. The considered variables refer to the envelope of the building, i.e. external walls and roof insulation and external walls thermal mass. The model was obtained combining EnergyPlus building energy simulator and MOBO, a versatile freeware that allows running the optimization of building features. The optimization was solved using NSGA II, a widespread adopted multi-objective genetic algorithm available in MOBO. The same building was simulated in two different climatic zones, namely Palermo (Italy) and Copenhagen (Denmark), in order to compare differences attained in the optimal solutions. The case study shows that the adoption of glass wool for the roof insulation and small concrete layers for external walls are to be preferred, providing optimal results in both climates. The present work was developed within the framework of IEA EBC Annex 72

Ottimizzazione Multi-Obiettivo delle Prestazioni Energetiche e Ambientali di un Edificio Residenziale

Il presente lavoro, svolto nell’ambito dell’Annex 72 dell’International Energy Agency, descrive un approccio metodologico volto all’identificazione di interventi ottimali di ristrutturazione da effettuare sull’involucro di un edificio residenziale, permettendo di minimizzare contemporaneamente quattro funzioni obiettivo: i consumi energetici in fase d’uso, i costi d’investimento e gli impatti energetici e ambientali di ciclo di vita. L’ottimizzazione, eseguita tramite un algoritmo multi-obiettivo, ha permesso di identificare gli spessori di materiale isolante e di materiali massivi da aggiungere sul tetto e sulle pareti perimetrali dell’involucro edilizio per minimizzare le quattro funzioni obiettivo. La domanda energetica in fase d’uso è stata valutata tramite un simulatore termofisico, mentre per stimare i costi e gli impatti di ciclo di vita sono stati utilizzati dati di letteratura

TELEPHONE FOLLOW-UP FOR PATIENTS WITH AMYOTROPHIC LATERAL SCLEROSIS

The relentless evolution of amyotrophic lateral sclerosis (ALS), a severe neurodegenerative disorder of the upper and lower motoneurons, leads to an increasing level of disability. Most patients, during the course of the disease, become unable to attend the tertiary clinical care center and are thus prevented from enrolling in clinical trials or benefiting from specialized care and management. The main objective of this study was to verify whether the ALS functional rating scale (ALSFRS) could be reliably administered by telephone to patients, when unable to attend the ALS clinic, or to their caregivers. ALSFRS is a validated instrument that assesses the functional status and the disease progression in ALS. We first administered the functional rating scale directly in the clinic to 30 patients, with definite or probable ALS, and to their respective caregivers, and found a very high agreement between the two groups for the total score and the majority of the rating items. Next, we showed, in both patients and caregivers, a high degree of correlation between the total score of the ALSFRS measured by telephone and that reported in the clinic. This indicates that ALSFRS is a reliable instrument for monitoring the disease progression in homebound patients, even when the person contacted by telephone is the caregiver. We also performed a telephone clinic, based on an unstructured interview, with 16 ALS patients at an advanced stage of the disease and unable to attend the ALS clinic. On some occasions, the person interviewed was the caregiver. The symptoms most frequently reported were a worsening of muscle strength, swallowing and breathing problems, constipation, and inability to clear lung secretions. Several patients asked for assistive and adaptive equipment. All patients and caregivers found the telephone clinic very useful and considered it a good complement to the management and care programme