Arcing fault in sub-distribution branch-circuits

In earlier experimental investigations into the functional simulation of insulation loss in branch circuit conductors, the authors normalized the arcing-fault simulation to be used in laboratory tests. This conventional simulation allows one to characterize this intrinsically random phenomenon by means of a probabilistic approach, in order to define in statistical terms the expected short circuit value. The authors examine more closely the arcing fault in the design of sub-distribution branch circuits as weak points of the installation. Straightforward criteria are proposed, whether in the structure of the system or in the coordination of protection, which afford a more rational control on arcing faul

A multicriteria decision making approach for defining strategies in logistics

The homogeneous nature of logistics providers’ services, characterized by low margins and price-sensitive customers, has pushed the market towards a commoditization of logistics services in the last decades. For this reason, the efforts towards the definition of innovative success factor for this industrial setting is significant to increase the logistics service marginality. However, current scientific studies related to Logistics Service Providers (LSPs) overlook the identification of operational success factors to increase business competitiveness and profitability, leaving logistics organizations with ambiguity when defining their operational strategies. Hence, this paper aims to identify crucial elements in the logistics sector, specifically in chemical transport and distribution. The approach involves first qualitative research of the main factors that increase the competitiveness of the LSPs’ service. The factors are evaluated and ranked by adopting the Analytic Hierarchy Process (AHP) methodology to identify the main elements that could influence the LSPs’ competitiveness. Once the ranking has been provided, the paper proposes a framework to properly choose a set of operational strategies for logistics organizations and an industrial application for chemical transport and distribution. The presented case study shows how to apply the methodology to a real-world instance of the logistics sector

Clinical and angiographical features of first episode of acute coronary syndrome in patients with human immunodeficiency virus infection

BackgroundPatients affected by the human immunodeficiency virus (HIV) show an increased risk of myocardial infarction. Clinical and angiographic features of HIV positive (HIV+) patients presenting with the first episode of an acute coronary syndrome (ACS) are not well defined in previous studies.ObjectiveTo demonstrate that HIV + patients with acute coronary syndrome had different features than non-HIV patients.MethodsWe identified 48 HIV + patients without previous cardiovascular events admitted to our Emergency Department with ACS diagnosis between 2012 and 2020. Clinical and angiographic characteristics were compared with a control group of 48 non-HIV consecutive patients affected by ACS as first episode.ResultsHIV + patients were most frequently men (87.5% vs 62.5%, p = 0.009) and younger about a decade (mean age 53.8 +/- 8.2 vs 63.7 +/- 11.9 years old, p < 0.0001); statistically significant hypertriglyceridemia has been found in the HIV group (178,6 +/- 59,8 mg/dl vs 142,7 +/- 63,7 mg/dl, p = 0.005). HIV(+) patients had a higher rate of anterior ST-elevation myocardial infarction (STEMI) (65% vs 33%, p = 0.03) and significant lesions on left anterior descending (LAD) coronary artery (83% vs 58% p = 0.01).ConclusionsHIV + patients with the first episode of ACS are generally young men with higher triglycerides and most frequently presenting with anterior STEMI and LAD involvement. The strict control of risk factors and a program for the early identification of coronary artery disease are strongly recommended in this subset of patients

Phenotypic classification and biochemical profile of obesity for cardiovascular prevention

Obesity is one of the major cardiovascular risk factors. The combination of obesity with other cardiovascular risk factors causes a systemic inflammation that increases the progression of cardiovascular disease. Ectopic fat plays a key role in inflammation and in the production of cytokines. There are various types of obesity and each phenotype has a different cardiometabolic risk. The clinical biochemistry laboratory is extremely relevant in the correct characterization of obesity phenotypes thanks to cardiometabolic markers. In fact, these markers quantify the metabolically active adipose tissue, which is responsible for atherosclerosis and cardiovascular diseases. On the other hand, monitoring obesity patients through the activity of those markers can be of fundamental help in the follow-up of diet therapies and in the pharmacological approach. Patients with same weight and body mass index (BMI) may have different levels of biochemical markers and body composition, and therefore different profiles of cardiovascular risk. The aim of this paper is to characterize the biochemical markers of ectopic fat and any obesity phenotype for a correct cardiovascular prevention

Target-controlled infusion during MitraClip procedures in deep-sedation with spontaneous breathing

- OBJECTIVE: Percutaneous mi-tral valve repair with the MitraClip system is an alternative procedure for high-risk patients not suitable for conventional surgery. The Mi-traClip can be safely performed under gener-al anesthesia (GA) or deep sedation (DS) with spontaneous breathing using a combination of propofol and remifentanil. This study aimed to evaluate the benefits of target-controlled infu-sion (TCI) of remifentanil and administration of propofol during DS compared with manual ad-ministration of total intravenous anesthesia (TI -VA) medication during GA in patients undergo-ing MitraClip. We assessed the impact of these procedures in terms of remifentanil dose, he-modynamic profile, adverse events, and days of hospital stay after the process.PATIENTS AND METHODS: From March 2013 to June 2015 (mean age 73.5 +/- 9,54), pa-tients underwent transcatheter MitraClip repair, 27 received DS via TCI and 27 GA with TIVA.RESULTS: Acute procedural success was 100%. DS-TCI group, in addition to a significant reduction of remifentanil dose administrated (249 mu g vs. 2865, p < 0.01), resulted in a decrease in vasopressor drugs requirement for hemodynam-ic adjustments (29.6% vs. 63%, p = 0.03) during the procedure and a reduction of hypotension (p = 0.08). The duration of postoperative hospital-ization did not differ between the two groups (5.4 days vs. 5.8 days, p = 0.4).CONCLUSIONS: Administration of remifen-tanil by TCI for DS in spontaneously breathing patients offers stable anesthesia conditions, with a lower amount of drugs, higher hemody-namic stability, and decreased side effects

Every minute counts: in-hospital changes of left ventricular regional and global function in patients with ST-segment elevation myocardial infarction

Aims The aim of our study was to assess the effects of an early percutaneous coronary intervention on changes of in-hospital left ventricular ejection fraction (LVEF) and wall motion score index (WMSI) in patients with ST-segment elevation myocardial infarction. Methods The study population consisted of 324 consecutive patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention, divided into two groups, according to the first medical contact (FMC)-to-reperfusion time, respectively, 90 min or less (n = 173) and more than 90 min (n = 151). Moreover, we performed a sub-analysis in the group of patients who showed at discharge an improvement in the LVEF of at least 10%. Results In both groups at baseline, patients suffered from a moderately reduced LVEF (40.88 +/- 8.38% in <= 90 min group vs. 40.70 +/- 8.98% in >90 min group; P = 0.858). A WMSI of more than 1 was recorded uniformly: 1.71 +/- 0.37 in patients with FMC-to-reperfusion 90 min or less and 1.72 +/- 0.38 in patients more than 90 min (P = 0.810). At the time of discharge, a significant improvement in LVEF (43.82 +/- 8.38%, P = 0.001) and WMSI (1.60 +/- 0.41, P = 0.009) exclusively emerged in the 90 min or less group. Furthermore, we identified 105 patients who experienced an improvement in the LVEF of at least 10% compared with baseline values. In these patients FMC-to-reperfusion and total ischemic time resulted as significantly shorter, when compared with patients with LVEF improvement of less than 10%. Conclusion Our study confirms and reinforces the concept that reducing the duration of the time between FMC and reperfusion, as well as the total ischemic time influences a positive recovery of left ventricular global and regional function during in-hospital stay