Problem of the Integration of the Tools of Environmental Politics, VAS (Ex Directive 2001/42/CE), EMAS (Rule 761/2001/CE), and New Model of Industrial Sustainable Area

The study deepens the problem list in the application of the VAS and the new procedures relative EMAS II° to industrial areas e/o territorial organizations, and it analyzes some cases of study. The cases of study analyzed are those of the district of Solofra and the area ASI in Trapani in south Italy, and Prato in centre Italy, The objective principals of the project are integral part of the project LIFE-SIAM 2005: to define to analyze the degree of vertical integration (from the directive UEs to the local actions) and horizontal (from the partenariato for the governance to the forums of AG21L) of the principles of the sustainability and the governance in the territory beginning from the location and management of the industrial areas; the analysis of the methods experimented of shared territorial planning of the development, based on an approach multidisciplinary, comprendente partenariato, planning, evaluation and monitoring; the analysis of the levels of know managerial how and necessary planning development of a collaborative climate and of effective relationships among the Local Authorities, the citizens, the productive system, the experts and the scientific world; the analysis of the necessary professional dimensions and applications with the purpose to form new subject responsible and figures professional able to plan and to manage the governance and the sustainable development beginning from the industrial areas. The project as defined a new Model of Industrial Sustainable Area. These objectives of analysis will be pursued through the verification on the field of the state of application, the adaptation and the integration of different community tools of environmental politics, what the Evaluation Environmental Strategy (VAS), ex Directive 2001/42/CE and the EMAS, ex Rule 761/2001/CE, in the procedures of governance effected on the territory. The study intends to give a contribution to show the difficulties attuative in to integrate different voluntary community tools inside models as the governance, or of policy as the sustainable development, and to allow one innovative approach of theirs, how much more possible inserted in the planning and territorial management. The study as experimented the application of the Model in the case study.

Problem of the Integration of the Tools of Environmental Politics, VAS (Ex Directive 2001/42/CE), EMAS (Rule 761/2001/CE), and New Model of Industrial Sustainable Area

The study deepens the problem list in the application of the VAS and the new procedures relative EMAS II° to industrial areas e/o territorial organizations, and it analyzes some cases of study. The cases of study analyzed are those of the district of Solofra and the area ASI in Trapani in south Italy, and Prato in centre Italy, The objective principals of the project are integral part of the project LIFE-SIAM 2005: to define to analyze the degree of vertical integration (from the directive UEs to the local actions) and horizontal (from the partenariato for the governance to the forums of AG21L) of the principles of the sustainability and the governance in the territory beginning from the location and management of the industrial areas; the analysis of the methods experimented of shared territorial planning of the development, based on an approach multidisciplinary, comprendente partenariato, planning, evaluation and monitoring; the analysis of the levels of know managerial how and necessary planning development of a collaborative climate and of effective relationships among the Local Authorities, the citizens, the productive system, the experts and the scientific world; the analysis of the necessary professional dimensions and applications with the purpose to form new subject responsible and figures professional able to plan and to manage the governance and the sustainable development beginning from the industrial areas. The project as defined a new Model of Industrial Sustainable Area. These objectives of analysis will be pursued through the verification on the field of the state of application, the adaptation and the integration of different community tools of environmental politics, what the Evaluation Environmental Strategy (VAS), ex Directive 2001/42/CE and the EMAS, ex Rule 761/2001/CE, in the procedures of governance effected on the territory. The study intends to give a contribution to show the difficulties attuative in to integrate different voluntary community tools inside models as the governance, or of policy as the sustainable development, and to allow one innovative approach of theirs, how much more possible inserted in the planning and territorial management. The study as experimented the application of the Model in the case study

Italian consensus conference on guidelines for conservative treatment on lower limb muscle injuries in athlete

Provide the state of the art concerning (1) biology and aetiology, (2) classification, (3) clinical assessment and (4) conservative treatment of lower limb muscle injuries (MI) in athletes. Seventy international experts with different medical backgrounds participated in the consensus conference. They discussed and approved a consensus composed of four sections which are presented in these documents. This paper represents a synthesis of the consensus conference, the following four sections are discussed: (i) The biology and aetiology of MIs. A definition of MI was formulated and some key points concerning physiology and pathogenesis of MIs were discussed. (ii) The MI classification. A classification of MIs was proposed. (iii) The MI clinical assessment, in which were discussed anamnesis, inspection and clinical examination and are provided the relative guidelines. (iv) The MI conservative treatment, in which are provided the guidelines for conservative treatment based on the severity of the lesion. Furthermore, instrumental therapy and pharmacological treatment were discussed. Knowledge of the aetiology and biology of MIs is an essential prerequisite in order to plan and conduct a rehabilitation plan. Another important aspect is the use of a rational MI classification on prognostic values. We propose a classification based on radiological investigations performed by ultrasonography and MRI strongly linked to prognostic factors. Furthermore, the consensus conference results will able to provide fundamental guidelines for diagnostic and rehabilitation practice, also considering instrumental therapy and pharmacological treatment of MI. Expert opinion, level IV

Divergence Between Clinical Trial Evidence and Actual Practice in Use of Dual Antiplatelet Therapy After Transient Ischemic Attack and Minor Stroke

Background: Randomized controlled trials (RCTs) proved that short-term (21-90 days) dual antiplatelet therapy (DAPT) reduces the risk of early ischemic recurrences after a noncardioembolic minor stroke or high-risk transient ischemic attack (TIA) without substantially increasing the hemorrhagic risk. We aimed at understanding whether and how real-world use of DAPT differs from RCTs. Methods: READAPT (Real-Life Study on Short-Term Dual Antiplatelet Treatment in Patients With Ischemic Stroke or TIA) is a prospective cohort study including >18-year-old patients treated with DAPT after a noncardioembolic minor ischemic stroke or high-risk TIA from 51 Italian centers. The study comprises a 90-day follow-up from symptom onset. In the present work, we reported descriptive statistics of baseline data of patients recruited up to July 31, 2022, and proportions of patients who would have been excluded from RCTs. We compared categorical data through the χ² test. Results: We evaluated 1070 patients, who had 72 (interquartile range, 62-79) years median age, were mostly Caucasian (1045; 97.7%), and were men (711; 66.4%). Among the 726 (67.9%) patients with ischemic stroke, 226 (31.1%) did not meet the RCT inclusion criteria because of National Institutes of Health Stroke Scale score >3 and 50 (6.9%) because of National Institutes of Health Stroke Scale score >5. Among the 344 (32.1%) patients with TIA, 69 (19.7%) did not meet the RCT criteria because of age, blood pressure, clinical features, duration of TIA, presence of diabetes score <4 and 252 (74.7%) because of age, blood pressure, clinical features, duration of TIA, presence of diabetes score <6 and no symptomatic arterial stenosis. Additionally, 144 (13.5%) patients would have been excluded because of revascularization procedures. Three hundred forty-five patients (32.2%) did not follow the RCT procedures because of late (>24 hours) DAPT initiation; 776 (72.5%) and 676 (63.2%) patients did not take loading doses of aspirin and clopidogrel, respectively. Overall, 84 (7.8%) patients met the RCT inclusion/exclusion criteria. Conclusions: The real-world use of DAPT is broader than RCTs. Most patients did not meet the RCT criteria because of the severity of ischemic stroke, lower risk of TIA, late DAPT start, or lack of antiplatelet loading dose. Registration: URL: https://www. Clinicaltrials: gov; Unique identifier: NCT05476081

Frequency of Left Ventricular Hypertrophy in Non-Valvular Atrial Fibrillation

Left ventricular hypertrophy (LVH) is significantly related to adverse clinical outcomes in patients at high risk of cardiovascular events. In patients with atrial fibrillation (AF), data on LVH, that is, prevalence and determinants, are inconsistent mainly because of different definitions and heterogeneity of study populations. We determined echocardiographic-based LVH prevalence and clinical factors independently associated with its development in a prospective cohort of patients with non-valvular (NV) AF. From the "Atrial Fibrillation Registry for Ankle-brachial Index Prevalence Assessment: Collaborative Italian Study" (ARAPACIS) population, 1,184 patients with NVAF (mean age 72 \ub1 11 years; 56% men) with complete data to define LVH were selected. ARAPACIS is a multicenter, observational, prospective, longitudinal on-going study designed to estimate prevalence of peripheral artery disease in patients with NVAF. We found a high prevalence of LVH (52%) in patients with NVAF. Compared to those without LVH, patients with AF with LVH were older and had a higher prevalence of hypertension, diabetes, and previous myocardial infarction (MI). A higher prevalence of ankle-brachial index 640.90 was seen in patients with LVH (22 vs 17%, p = 0.0392). Patients with LVH were at significantly higher thromboembolic risk, with CHA2DS2-VASc 652 seen in 93% of LVH and in 73% of patients without LVH (p <0.05). Women with LVH had a higher prevalence of concentric hypertrophy than men (46% vs 29%, p = 0.0003). Logistic regression analysis demonstrated that female gender (odds ratio [OR] 2.80, p <0.0001), age (OR 1.03 per year, p <0.001), hypertension (OR 2.30, p <0.001), diabetes (OR 1.62, p = 0.004), and previous MI (OR 1.96, p = 0.001) were independently associated with LVH. In conclusion, patients with NVAF have a high prevalence of LVH, which is related to female gender, older age, hypertension, and previous MI. These patients are at high thromboembolic risk and deserve a holistic approach to cardiovascular prevention