Global performance index for integrated management system: GPI-IMS

Background: The present work starts from a literature review of the evolution of Integrated Management Systems (IMSs), considering different points of view and standards: quality, environmental, occupational health and safety, sustainability and social issues. Even if the benefits are possible, there is not a common approach and a clear link between the integration of management systems and business performance, in particular considering safety performance. Methods: The present study analyzes the application of Risk Assessment in order to realize the integration of management systems. The main objective is to provide a tool for an integrated evaluation of all company performances, starting from the definition of some Key Performance Indicators—KPIs— proposed for a particular case study, even if their choice is not the core of the paper. The assessment team members on the basis of their knowledge, experience and useful literature, could choose the right KPIs for the specific application, able to take a picture of the current state and to suggest a possible recommended action of improving. The proposed Risk Assessment approach is an integration of modern management techniques: Integrated Management System and Improving Cycle DMAIC. Results: The new method, called the Global Performance Index for Integrated Management System—GPI-IMS, has been applied to a real case study in the logistic field in order to evaluate its goodness and possible generalization. Conclusions: The proposed method allows to define the requirements that any company must have to perform the best. The role of the assessment team is very important to evaluate the global performance of the company and to suggest the corrective actions to be adopted

Association between interleukin-10 polymorphisms and Alzheimer's disease: a systematic review and meta-analysis

It has been hypothesized that polymorphisms of interleukin (IL)-10 genes affect the risk of developing late onset Alzheimer's disease (AD). However, results of different studies are often inconsistent. Our aim was to investigate by meta-analysis the association of the common polymorphisms comprehensively defining the genetic variability of the IL-10 gene with AD risk. Fifteen studies investigating the association between IL-10 polymorphisms (-1082,-819,-592) and AD were found and analyzed. The model-free approach was applied to meta-analyze these case-control genetic association studies. Available data suggested an association between-1082 polymorphism and AD risk with a marginal statistical significance (GG versus AG/AA: pooled odds ratio [OR]: 0.82, 95% confidence interval CI: 0.65-1.02) and evidence of a moderate degree of between-study heterogeneity (χ 2 = 27.13, d.f. = 13, p = 0.01, I 2 = 52%). For the-819 and-592 polymorphisms, we did not find an association with AD, but significant between-study heterogeneity made genotype data pooling unacceptable. Analysis by IL-10 haplotype showed that the-1082G/-819C/-592C haplotype is associated with a lower risk of AD, although with a marginal statistical significance, probably due to the low number of studies included (GCC versus other genotypes: OR: 0.61, 95% CI: 0.32-1.15; I 2: 85%). Current findings suggest a possible association between-1082 A > G polymorphism and the risk of developing AD; this effect is more evident in the oldest patients. The high degree of between-study heterogeneity, due to several underpowered studies and to other methodological problems of individual studies underlies the need for further methodologically adequate studies. © 2012-IOS Press and the authors. All rights reserved

A hybrid model to evaluate human error probability (HEP) in a pharmaceutical plant

The aim of the present research is to propose a hybrid model to evaluate Human Error Probability (HEP) called Logit Human Reliability (LHR). The new approach is based on logit normal distribution, Nuclear Action Reliability Assessment (NARA), and Performance Shaping Factors (PSFs) relationship. The present paper analyzed some shortcomings related to literature approaches, especially the limitations of the working time. We estimated PSFs after 8 hours (work standard) during emergency conditions. Therefore, the correlation between the advantages of these three methodologies allows proposing a HEP analysis during accident scenario and emergencies. The proposed approach considers internal and external factors that affect the operator's ability. LHR has been applied in a pharmaceutical accident scenario, considering 24 hours of working time (more than 8 working hours)

When and how to treat acute hepatitis C?

Background: Appropriate treatment of acute hepatitis C is still a matter of controversy due to the lack of large controlled trials. Aim: To assess the effectiveness of interferon as treatment for acute hepatitis C by meta-analysis. Methods: MEDLINE search (1985-2002) was supplemented with manual searches of reference lists. Studies were included if they were controlled trials comparing interferon to no treatment and if they included patients with either post-transfusion or sporadic acute hepatitis C. Twelve trials were analyzed (414 patients). The outcome assessed was the sustained virological response (SVR) rate (undetectable hepatitis C virus RNA in serum at least 6 months after cessation of therapy). Results: Interferon significantly increased the SVR (risk difference 49%; 95% confidence interval 32.9-65%) in comparison to no treatment. The risk difference of SVR increased from 5 to 90% when trials were ordered by increasing interferon weekly dose. Delaying therapy by 8-12 weeks after the onset of disease does not compromise the SVR rate. Conclusions: Current evidence is sufficient to recommend interferon treatment of patients with acute hepatitis C. A later initiation of therapy yields the same likelihood of response as early treatment. A daily induction dose during the 1st month is the best option of treatment. © 2003 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved

Assessing the potential of molten carbonate fuel cell-based schemes for carbon capture in natural gas-fired combined cycle power plants

Abstract This work explores two configurations of natural gas-fired combined cycles (NGCC) with molten carbonate fuel cells (MCFC) for CO2 capture. Special attention is devoted to the selection of MCFC operating conditions (trade-off between CO2 capture and voltage losses), heat integration scheme, fuel use and CO2 purification. Two schemes are considered: (i) in the first "integrated" scheme, MCFC modules are installed between the gas turbine and the heat recovery steam generator (HRSG) to maximize the efficiency of the integrated power plant; (ii) in the second "non-integrated" layout, the MCFC is located downstream of the HRSG and a regenerative heat exchanger is designed to preheat cathode reactants up to the MCFC working temperature. This study includes a full techno-economic analysis of the two layouts based on a preliminary sizing of the key-components, and a sensitivity analysis on the CO2 utilization factor. Compared to a benchmark amine scrubbing process, the "integrated" configuration shows considerably better performance (Specific Primary Energy Consumption for CO2 Avoided - SPECCA = 0.31 MJ kgCO2-1; Cost of CO2 avoided - CCA = 50 $tCO2−1), whereas the "non-integrated" solution shows higher energy penalties but similar CO2 avoidance cost (SPECCA = 2.4  MJ  kgCO2−1; CCA = 76$ tCO2−1)

Recruiting hard to reach populations to studies: breaking the silence: an example from a study that recruited people with dementia

Objective To share the challenges of recruiting people with dementia to studies, using experiences from one recently completed trial as an exemplar. Background Research publications always cite participant numbers but the effort expended to achieve the sample size is rarely reported, even when the study involved recruiting a hard to reach population. A multisite study of a psychosocial intervention for people with dementia illustrates the challenges. This study recruited 468 ‘dyads’ (a person with dementia and a family carer together) from 15 sites but the time taken to achieve this was longer than originally estimated. This led to a study extension and the need for additional sites. Recruitment data revealed that certain sites were more successful than others, but why? Can the knowledge gained be used to inform other studies? Methods Secondary analysis of routinely collected recruitment data from three purposefully selected sites was examined to understand the strategies used and identify successful approaches. Findings At all three sites, the pool of potential recruits funnelled to a few participants. It took two sites 18 months longer than the third to achieve recruitment numbers despite additional efforts. Explanations given by potential participants for declining to take part included ill health, reporting they were ‘managing’, time constraints, adjusting to a diagnosis of dementia and burden of study procedures. Conclusions Successful recruitment of people with dementia to studies, as one example of a hard to reach group, requires multiple strategies and close working between researchers and clinical services. It requires a detailed understanding of the needs and perspectives of the specific population and knowledge about how individuals can be supported to participate in research. Experiences of recruitment should be disseminated so that knowledge generated can be used to inform the planning and implementation of future research studies

Arterial stiffness, endothelial and cognitive function in subjects with type 2 diabetes in accordance with absence or presence of diabetic foot syndrome.

BACKGROUND: Endothelial dysfunction is an early marker of cardiovascular disease so endothelial and arterial stiffness indexes are good indicators of vascular health. We aimed to assess whether the presence of diabetic foot is associated with arterial stiffness and endothelial function impairment. METHODS: We studied 50 subjects with type 2 diabetes mellitus and diabetic foot syndrome (DFS) compared to 50 diabetic subjects without diabetic foot, and 53 patients without diabetes mellitus, by means of the mini mental state examination (MMSE) administered to evaluate cognitive performance. Carotid-femoral pulse wave velocity (PWV) and augmentation index (Aix) were also evaluated by Applanation tonometry (SphygmoCor version 7.1), and the RH-PAT data were digitally analyzed online by Endo-PAT2000 using reactive hyperemia index (RHI) values. RESULTS: In comparison to diabetic subjects without diabetic foot the subjects with diabetic foot had higher mean values of PWV, lower mean values of RHI, and lower mean MMSE. At multinomial logistic regression PWV and RHI were significantly associated with diabetic foot presence, whereas ROC curve analysis had good sensitivity and specificity in arterial PWV and RHI for diabetic foot presence. CONCLUSIONS: Pulse wave velocity and augmentation index, mean RHI values, and mean MMSE were effective indicators of diabetic foot. Future research could address these issues by means of longitudinal studies to evaluate cardiovascular event incidence in relation to arterial stiffness, endothelial and cognitive markers