Single-Center Experience with Simultaneous Mural Aortic Thrombosis and Peripheral Obstructive Disease in Pre-COVID-19 and COVID-19 Era

Background: Mural aortic thrombosis associated with chronic peripheral obstruction of the lower limbs is an unusual event. Repeated embolism of instability aortic mural thrombosis caused acute limb ischemia (Rutherford 2 classification) in patients with peripheral arterial disease (PAD). We report a single-center experience for patients with transmural aortic thrombosis and peripheral artery disease. Methods: We retrospectively analyzed data of 54 patients with aortic mural thrombus disease with PAD presentation, treated at our center between 2013 and 2022. Results: Thirty patients (six with proven SARS-CoV-2 infection) underwent hybrid or staged treatment for an aortic lesion and for lower limb ischemia, by the placement of an endovascular aortic stent graft and a femoro-distal or a popliteal-distal bypass graft. The remaining 24 cases were only subjected to an intravascular treatment of the thoracic or abdominal aorta. Transient renal failure occurred in three patients. No embolic events were detected during the procedures. Aortic-related mortality was reported in just one patient who died from multiple organ failure. There was an embolic stroke in one patient with proven SARS-CoV-2 infection, three major amputations in patients with proven SARS-CoV-2 infection and no aortic-related mortality. Conclusions: Stent coverage of complex aortic lesions, alone or in association with a distal bypass graft, supports this approach in a variety of settings. The COVID-19 pandemic caused an increased mortality and amputation rate

Comparison of two disaster drills' management performed by trained and not-trained students: key times evaluation

Introduction The aim of this report is to compare two disaster exercises' management of students with different backgrounds. To our knowledge nobody has ever compared two exercises, probably because of the difficulty in their evaluation. We implemented a tool for an objective evaluation [1] and we used it for this purpose. Methods Both drills represented a ceiling collapse over a crowded room with a similar amount of casualties and similar severity index. The START triage system was used. The trained students (T) were attending the European Master in Disaster Medicine (EMDM), while the not-trained students (NT) were at the beginning of an introductory course in disaster medicine. During the exercises we recorded key victim-provider interaction times [2] using victim-based data collection. Each victim had their own data card to record triage and time information. Results In this preliminary report we present data regarding the scene length of stay (LOS) and triage to collecting area/advanced medical post time (T-AMP). The LOS was 67.5 (50.0 to 111.0) minutes (25 to 75 IQR) for T as compared with 145.0 (110.0 to 150.0) minutes (25 to 75 IQR) for NT (P < 0.001). Stratification according to assigned triage code showed no difference for high-priority codes (reds and yellows) as opposed to the green code (55.0 (47.0 to 75.0) minutes for T vs 145.0 (141.0 to 155.0) minutes for NT with P < 0.01). T-AMP was 10.0 (3.0 to 34.5) minutes for T as compared with 63.5 (19.5 to 104.3) minutes for NT (P < 0.001). Stratification according to triage code showed no difference for red codes between T and NT but showed a difference for yellow codes (36.5 (15.0 to 82.0) vs 71.0 (30.0 to 99.0) minutes) and green codes (7.0 (3.0 to 12.0) vs 85.0 (17.3 to 115.0) minutes) with P < 0.01. Conclusions Both teams evacuated red codes before the yellow ones in similar time. T-AMP was shorter considering global, yellow and green codes for T as opposed to NT. Global and green LOS was also shorter in the T group as opposed to NT. Training seems to influence global exercise management, less affecting red codes but with an impact on yellow and green evacuation strategies

Combination Forecasts of Bond and Stock Returns: An Asset Allocation Perspective

We investigate the out-of-sample forecasting ability of the HML, SMB, momentum, short-term and long-term reversal factors along with their size and value decompositions on U.S. bond and stock returns for a variety of horizons ranging from the short run (1 month) to the long run (2 years). Our findings suggest that these factors contain significantly more information for future bond and stock market returns than the typically employed financial variables. Combination of forecasts of the empirical factors turns out to be particularly successful, especially from an an asset allocation perspective. Similar findings pertain to the European and Japanese markets

A novel ionic exchange membrane crystallizer to recover magnesium hydroxide from seawater and industrial brines

A novel technology, the ion exchange membrane crystallizer (CrIEM), that combines reactive and membrane crystallization, was investigated in order to recover high purity magnesium hydroxide from multi-component artificial and natural solutions. In particular, in a CrIEM reactor, the presence of an anion exchange membrane (AEM), which separates two-compartment containing a saline solution and an alkaline solution, allows the passage of hydroxyl ions from the alkaline to the saline solution compartment, where crystallization of magnesium hydroxide occurs, yet avoiding a direct mixing between the solutions feeding the reactor. This enables the use of low-cost reactants (e.g., Ca(OH)2) without the risk of co-precipitation of by-products and contamination of the final crystals. An experimental campaign was carried out treating two types of feed solution, namely: (1) a waste industrial brine from the Boles\u142aw \u15amia\u142y coal mine in \u141aziska G\uf3rne (Poland) and (2) Mediterranean seawater, collected from the North Sicilian coast (Italy). The CrIEM was tested in a feed and bleed modality in order to operate in a continuous mode. The Mg2+ concentration in the feed solutions ranges from 0.7 to 3.2 g/L. Magnesium recovery efficiencies from 89 up to 100% were reached, while magnesium hydroxide purity between 94% and 98.8% was obtained

Avaliação da adoção de cultivares de soja com base na opinião de produtores do DF e entorno.

bitstream/item/83409/1/Bolpd-309.pdf; bitstream/item/83601/1/bolpd-309.pd

A pilot-plant for the selective recovery of magnesium and calcium from waste brines

The problem of brines disposal has raised great interest towards new strategies for their valorisation through the recovery of minerals or energy. As an example, the spent brine from ion exchange resins regeneration is often discharged into rivers or lakes, thus impacting on the process sustainability. However, such brines can be effectively reconcentrated, after removal of bivalent cations, and reused for the resins regeneration. This work focuses on developing and testing a pilot plant for selective recovery of magnesium and calcium from spent brines exploiting a novel proprietary crystallization unit. This is part of a larger treatment chain for the complete regeneration of the brine, developed within the EU-funded ZERO BRINE project. The pilot crystallizer was tested with the retentate of the nanofiltration unit processing the spent brine from the industrial water production plant of Evides Industriewater B.V. (Rotterdam, The Netherlands). Magnesium and calcium hydroxide were selectively precipitated by adding alkaline solution in two consecutive steps and controlling reaction pH. Performance was assessed in terms of recovery efficiency and purity of produced crystals, observing in most investigated cases a recovery of about 100% and 97% and a purity above 90% and 96%, for magnesium and calcium hydroxide, respectively

The multiple potentialities of anthozoans: analyses and comparisons between animal models

Anthozoans are the richest class of species of the phylum Cnidaria. They are a candidate group for studying the evolution of mutualisms and immunity and despite their morphological simplicity exhibit a repertoire of immunological components with large genomes and gene families similar to those of the Bilateria. Like other invertebrates, anthozoans immunity is based on self/non-self recognition mechanisms and allorecognition responses, therefore, maintaining their integrity and responding actively to selection pressures. Highlight and investigate the link between innate immunity, homeostasis maintenance, inflammation, tissue remodelling and regeneration in Anthozoa could be useful to elucidate the adaptive capability features to different stress factors. We have carried out studies demonstrating that all these processes are highly conserved among the anthozoans species. We have compared the inflammatory responses and the morpho-functional aspects related to regeneration in different species of Mediterranean anthozoans using histological, cellular and molecular technical approaches on organisms, maintained in aquaria under environmental and pathogenic stressful conditions. This approach appears to be a useful tool from baseline studies in immunology and anthozoans result valid models able to respond to environmental stress conditions. Important results have been obtained with potential biotechnological transferability in pharmacology

Virtual reality and live scenario simulation: options for training medical students in mass casualty incident triage

Introduction Multicasualty triage is the process of establishing the priority of care among casualties in disaster management. Recent mass casualty incidents (MCI) revealed that health personnel are unfamiliar with the triage protocols. The objective of this study is to compare the relative impact of two simulation-based methods for training medical students in mass casualty triage using the Simple Triage and Rapid Treatment (START) algorithm. Methods A prospective randomized controlled longitudinal study. Medical students enrolled in the emergency medicine course were randomized into two groups (A and B). On day 1, group A students were exposed to a virtual reality (VR) scenario and group B students were exposed to a live scenario (LS), both exercises aiming at triaging 10 victims in a limited period of time (30 seconds/victim). On day 2 all students attended a 2-hour lecture about medical disaster management and START. On day 3 group A and B students were exposed to a LS and to a VR scenario respectively. The vital signs and clinical condition of the 10 victims were identical in the two scenarios. Ability of the groups to manage a simulated triage scenario was then compared (times and triage accuracy). Results Groups A and B were composed of 25 and 28 students respectively. During day 1 group A LS triage accuracy was 58%, while the average time to assess all patients was 4 minutes 28 seconds. The group B VR scenario triage accuracy was 52%, while the average time to complete the assessment was 5 minutes 18 seconds. During day 3 the triage accuracy for group A VR simulation was 92%, while the average time was 3 minutes 53 seconds. Group B triage accuracy during the LS was 84%, with an average time of 3 minutes 25 seconds. Triage scores improved significantly during day 3 (P < 0.001) in the two groups. The time to complete each scenario decreased significantly from day 1 to day 3. Conclusions The study demonstrates that the training course generates significant improvement in triage accuracy and speed. It also reveals that VR simulation compared to live exercises has equivalent results in prompting critical decisions in mass casualty drills. In the beginning the average time to complete the VR scenario was higher than the LS. This could be due to the fact that on day 1 very detailed VR victims created a higher challenge for untaught students. However, the higher triage accuracy recorded at the end of day 3 in VR could be explained by a lower stress level compared to the LS, which could be creating a more stressful environment in taught students

Model of Double Asteroid Redirection Test Impact Ejecta Plume Observations

The Double Asteroid Redirection Test (DART) spacecraft will impact the moon Dimorphos of the [65803] Didymos binary in order to demonstrate asteroid deflection by a kinetic impactor. DART will measure the deflection by using ground-based telescopic observations of the orbital period change of Didymos and will carry the Light Italian CubeSat for Imaging of Asteroids (LICIACube) cubesat, which will perform a flyby of Didymos about 167 s after the DART impact, obtaining images of the DART impact ejecta plume. LICIACube images showing the ejecta plume spatial structure and temporal evolution will help determine the vector momentum transfer from the DART impact. A model is developed for the impact ejecta plume optical depth, using a pointsource scaling model of the DART impact. The model is applied to expected LICIACube plume images and shows how plume images enable characterization of the ejecta mass versus velocity distribution. The ejecta plume structure, as it evolves over time, is determined by the amount of ejecta that has reached a given altitude at a given time. The evolution of the plume optical depth profiles determined from LICIACube images can distinguish between strength-controlled and gravity-controlled impacts, by distinguishing the respective mass versus velocity distributions. LICIACube plume images discriminate the differences in plume structure and evolution that result from different target physical properties, mainly the strength and porosity, thereby allowing inference of these properties to improve the determination of DART impact momentum transfer