Full Load Testing Of A 12.5 MW Vertical High Speed Subsea Motorcompressor

Lecturepg. 79-92In late 2006 Authors’ company was awarded a contract for the motorcompressor for the Ormen Lange Subsea Compression Pilot. This Pilot represents the first subsea motorcompressor unit ever built in a fully marinized version and tested in a water pit, which was developed specifically for the project at the customer’s site (Nhyamna, Norway). The prototype unit is a 12.5MW (16763HP) integrated motorcompressor, which runs up to 10.5krpm in a vertical configuration with the following features: Single casing; High-speed motor rigidly coupled to a multistage centrifugal compressor (3 journal bearings shaft line); Canned Active Magnetic Bearings (AMBs); Process gas used as cooling fluid for the Electric Motor; Internal separation system (to protect the bearings and the electric motor from the intrusion of solid and liquid materials); Fully marinized AMBs control system; The design and validation plan for this complex equipment were developed through a four years program where many challenging milestones were achieved. The Ormen Lange Subsea Compression Pilot motorcompressor has successfully completed an intensive full load testing campaign in the Authors’ Company plant including the following: Static-dynamic tuning of the AMBs; Mechanical Running Test; Compressor Performance Test (ASME PTC-10 Type 2 + Full Load test); Electric Motor Performance Test; Overall cooling system check; Landing test (partial landing and full speed delevitation test). The test campaign has fully demonstrated the functionality of this prototype unit capable of operation in the service conditions. The Next step will be the shipment to the costumer site where the submerged testing will be conducted. This paper will provide a detailed description of the main test results of the subsea motorcompressor covering all aspects of the test program including rotordynamic behaviour, compressor thermodynamic performance, axial load variation versus operating conditions (monitored thanks to the thrust AMB), electric motor cooling system behaviour, electric motor performance, AMBs and control system operability. Of special interest is the rotor delevitation test from full speed consisting in the two ton rotor running at 10.5krpm dropping onto the mechanical emergency bearings until the machine reached a complete stop condition. This test, which was repeated 5 times, provided a full-scale verification of the landing numerical simulation developed by the authors (Ransom et al., 2009)

Nationwide consensus on the clinical management of treatment-resistant depression in Italy: a Delphi panel

Background: Treatment-resistant depression (TRD) is defined by the European Medicines Agency as a lack of clinically meaningful improvement after treatment, with at least two different antidepressants. Individual, familiar, and socio-economic burden of TRD is huge. Given the lack of clear guidelines, the large variability of TRD approaches across different countries and the availability of new medications to meet the need of effective and rapid acting therapeutic strategies, it is important to understand the consensus regarding the clinical characteristics and treatment pathways of patients with TRD in Italian routine clinical practice, particularly in view of the recent availability of esketamine nasal spray. Methods: A Delphi questionnaire with 17 statements (with a 7 points Likert scale for agreement) was administered via a customized web-based platform to Italian psychiatrists with at least 5 years of experience and specific expertise in the field of depression. In the second-round physicians were asked to answer the same statements considering the interquartile range of each question as an index of their colleagues' responses. Stata 16.1 software was used for the analyses. Results: Sixty panellists, representative of the Italian territory, answered the questionnaire at the first round. For 8/17 statements more than 75% of panellists reached agreement and a high consensus as they assigned similar scores; for 4 statements the panellists assigned similar scores but in the middle of the Likert scale showing a moderate agreement with the statement, while for 5 statements there was indecision in the agreement and low consensus with the statement. Conclusions: This Delphi Panel showed that there is a wide heterogeneity in Italy in the management of TRD patients, and a compelling need of standardised strategies and treatments specifically approved for TRD. A high level of consensus and agreement was obtained about the importance of adding lithium and/or antipsychotics as augmentation therapies and in the meantime about the need for long-term maintenance therapy. A high level of consensus and agreement was equally reached for the identification of esketamine nasal spray as the best option for TRD patients and for the possibility to administrate without difficulties esketamine in a community outpatient setting, highlighting the benefit of an appropriate educational support for patients

Evaluation of E-Health Applications for Paediatric Patients with Refractory Epilepsy and Maintained on Ketogenic Diet

E-health technologies improve healthcare quality and disease management. The aim of this study was to develop a ketogenic diet management app as well as a website about this dietary treatment and to evaluate the benefits of giving caregivers access to various web materials designed for paediatric patients with refractory epilepsy. Forty families participated in the questionnaire survey, from January 2016 to March 2016. All caregivers were exposed to paper-based materials about the ketogenic diet, whereas only 22 received the app, called KetApp, and videos produced by dieticians. Caregivers with free access to web materials were more satisfied than the others with the informative material provided by the centre (p 64 0.001, Mann\u2013Whitney test). Indeed, they showed a better attitude towards treatment, and they became more aware of dietary management in comparison to the control group (p 64 0.001). Moreover, caregivers provided with web materials were stimulated to pursue the treatment (p = 0.002) and to introduce it to their children and other people (p = 0.001). Additionally, caregivers supplied with web materials were more willing to help other families in choosing the ketogenic diet (p = 0.004). Overall, these findings indicate that web materials are beneficial for caregivers of paediatric patients with refractory epilepsy in our centres. Thus, the use of e-health applications could be a promising tool in the daily aspects of ketogenic diet management, and it is especially of value in the attempt to start or maintain the diet during the ongoing COVID-19 pandemic crisis

Preoperative charcoal suspension tattoo for the detection of differentiated thyroid cancer recurrence

Recurrent differentiated thyroid carcinoma can easily be detected by means of ultrasound (US) and thyroglobulin, and often requires further surgical intervention. Revision surgery is often a technical challenge with significant risk of complications, considering the altered anatomy, with a possibility of leaving behind residual neoplasm. Preoperative US-guided tattooing localization has been introduced to reduce and prevent these potential problems during revision surgery. Encouraging results have been reported in the literature. Under US guidance, the lesion is identified and 0.5-2 ml of colloidal charcoal is injected in its proximity using a 23 gauge needle. The extraction is accompanied by injection at constant pressure of charcoal in order to leave a trace of pigment along the path of the needle till the skin. From April 2008 to January 2016 we performed revision surgery in 27 patients for lymph-nodes metastasis in differentiated thyroid cancer, using the technique of preoperative charcoal tattoo localization. Our previous study on the first group of 13 patients published in 2012, reported the preliminary results in terms of success rate and complications. The tolerance of charcoal injection was good for all patients and the procedure was demonstrated to be useful, contributing to the removal of metastatic lesion in 93% of procedures. We have registered minor surgical complications during revision in the central compartment of the neck: Transitory hypoparathyroidism in 2 cases (11%) and transitory vocal cord paresis in 3 cases (16%). Based on these results, preoperative charcoal tattoo localization in revision surgery of the neck for differentiated thyroid cancer recurrence can be considered a safe technique, easy to perform, with low-costs and useful during surgical procedures, providing a significant reduction of iatrogenic damage and risks

Laboratory automation, informatics, and artificial intelligence: current and future perspectives in clinical microbiology

Clinical diagnostic laboratories produce one product—information—and for this to be valuable, the information must be clinically relevant, accurate, and timely. Although diagnostic information can clearly improve patient outcomes and decrease healthcare costs, technological challenges and laboratory workflow practices affect the timeliness and clinical value of diagnostics. This article will examine how prioritizing laboratory practices in a patient-oriented approach can be used to optimize technology advances for improved patient care

Nationwide consensus on the clinical management of treatment-resistant depression in Italy: a Delphi panel

Background: Treatment-resistant depression (TRD) is defined by the European Medicines Agency as a lack of clinically meaningful improvement after treatment, with at least two different antidepressants. Individual, familiar, and socio-economic burden of TRD is huge. Given the lack of clear guidelines, the large variability of TRD approaches across different countries and the availability of new medications to meet the need of effective and rapid acting therapeutic strategies, it is important to understand the consensus regarding the clinical characteristics and treatment pathways of patients with TRD in Italian routine clinical practice, particularly in view of the recent availability of esketamine nasal spray. Methods: A Delphi questionnaire with 17 statements (with a 7 points Likert scale for agreement) was administered via a customized web-based platform to Italian psychiatrists with at least 5 years of experience and specific expertise in the field of depression. In the second-round physicians were asked to answer the same statements considering the interquartile range of each question as an index of their colleagues' responses. Stata 16.1 software was used for the analyses. Results: Sixty panellists, representative of the Italian territory, answered the questionnaire at the first round. For 8/17 statements more than 75% of panellists reached agreement and a high consensus as they assigned similar scores; for 4 statements the panellists assigned similar scores but in the middle of the Likert scale showing a moderate agreement with the statement, while for 5 statements there was indecision in the agreement and low consensus with the statement. Conclusions: This Delphi Panel showed that there is a wide heterogeneity in Italy in the management of TRD patients, and a compelling need of standardised strategies and treatments specifically approved for TRD. A high level of consensus and agreement was obtained about the importance of adding lithium and/or antipsychotics as augmentation therapies and in the meantime about the need for long-term maintenance therapy. A high level of consensus and agreement was equally reached for the identification of esketamine nasal spray as the best option for TRD patients and for the possibility to administrate without difficulties esketamine in a community outpatient setting, highlighting the benefit of an appropriate educational support for patients

Acute Delta Hepatitis in Italy spanning three decades (1991–2019): Evidence for the effectiveness of the hepatitis B vaccination campaign

Updated incidence data of acute Delta virus hepatitis (HDV) are lacking worldwide. Our aim was to evaluate incidence of and risk factors for acute HDV in Italy after the introduction of the compulsory vaccination against hepatitis B virus (HBV) in 1991. Data were obtained from the National Surveillance System of acute viral hepatitis (SEIEVA). Independent predictors of HDV were assessed by logistic-regression analysis. The incidence of acute HDV per 1-million population declined from 3.2 cases in 1987 to 0.04 in 2019, parallel to that of acute HBV per 100,000 from 10.0 to 0.39 cases during the same period. The median age of cases increased from 27 years in the decade 1991-1999 to 44 years in the decade 2010-2019 (p < .001). Over the same period, the male/female ratio decreased from 3.8 to 2.1, the proportion of coinfections increased from 55% to 75% (p = .003) and that of HBsAg positive acute hepatitis tested for by IgM anti-HDV linearly decreased from 50.1% to 34.1% (p < .001). People born abroad accounted for 24.6% of cases in 2004-2010 and 32.1% in 2011-2019. In the period 2010-2019, risky sexual behaviour (O.R. 4.2; 95%CI: 1.4-12.8) was the sole independent predictor of acute HDV; conversely intravenous drug use was no longer associated (O.R. 1.25; 95%CI: 0.15-10.22) with this. In conclusion, HBV vaccination was an effective measure to control acute HDV. Intravenous drug use is no longer an efficient mode of HDV spread. Testing for IgM-anti HDV is a grey area requiring alert. Acute HDV in foreigners should be monitored in the years to come