Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

Bifurcations and Subharmonics in Stochastic Nonlinear Rolling

In this paper, the rolling motion of a ship is investigated to highlight the possibilities of falling in a bifurcation-and-jump scenario in a stochastic sea. It results that this possibility, while being remote in the typical standard sea spectrum, has a non negligible probability passing to narrow band excitation. This can be connected with local fluctuations or wave grouping in the wave record in beam sea and can give rise to bifurcations both in synchronism and in the first subharmonic due to the high degree of nonlinearity presented by the rolling motion. In following or quartering seas, the bifurcations reveal in terms of parametric resonance and are connected with the double effect of the advancing speed having as a result a reduction of centerpeak frequency and a hardening of the spectrum

A Critical Review of the Symbols and Terminology Relevant to Ship Stability

The ITTC Symbols and Terminology relevant to Ship Stability has been reviewed to check completeness and to try to solve some ambiguity in the international use of symbols

La modellizzazione stocastica dei moti non lineari di sistemi galleggianti in presenza di eccitazione stocastica a banda stretta

I moti di navi e strutture galleggianti vengono di solito di solito studiati in due situazioni tipiche corrispondenti ad eccitazione strettamente deterministica (sinusoidale), nel qual caso si usano approcci non lineari che si spingono fino alla previsione di biforcazioni e della loro degenerazione a moti caotici, o, all\u2019estremo opposto, ad eccitazione stocastica a banda larga, nel qual caso si usano approcci lineari o debolmente non lineari. Entrambi gli approcci non sono completamente realistici in quanto il primo trascura la inevitabile presenza di fluttuazioni casuali nella forzante, mentre il secondo sopravvaluta questo elemento, trascurando al tempo stesso l\u2019effetto delle non linearit\ue0. In questa memoria, si studia la risposta di un tipico sistema non lineare, atto alla descrizione dei sistemi reali di cui sopra, in presenza di forzante a banda sufficientemente stretta, cio\ue8 autocorrelazione sufficientemente alta, da poter dare origine a biforcazioni. I risultati sono di grande interesse per valutare la sicurezza in quanto influenzano in maniera significativa le code delle distribuzioni statistiche delle escursioni e dei carichi sulle strutture

Towards a Reliability Based Approach to the Hydrodynamic Aspects of Seagoing Vessels Safety

The hydrodynamic part of ship safety is actually managed by means of prescriptive stability criteria based on static stability characteristics of the ship. The analysis reveals that this approach leads to many contradictions whose final effect is to delay the formulation and adoption of higher safety standards. Only the development of a fully physical approach could allow a realistic evaluation of the probabilities of ship loss through the different mechanisms. The final goal will be an effectively unified approach to ship safety

The Rules Making Process and the Effect of Regional Differences on Maritime Transportation Safety

In this paper the maritime safety and the protection of marine environment are discussed from a general point of view with particular reference to the effect of ship typology and of the regional differences. Some contradictions and existing gaps are discussed with reference to explanations on hystorical basis. Foreseeable developments are presented with reference to examples of particular interest

Stochastic Response of Nonlinear Compliant Platforms in Narrow band Sea

The dynamics of the nonlinear motions of compliant offshore structures is analysed with regard to the bandwidth of the stochastic excitation. It appears that there is the possibility of large amplitude and sudden oscillations that can take place through jumps at bifurcations. Since these phenomena, in the interest to the design stage and for the Classification Societies are not properly accounted by current approaches, a deeper stochastic analysis in the narrow band excitation case is proposed