Cancer therapy and cardiotoxicity: The need of serial Doppler echocardiography

Cancer therapy has shown terrific progress leading to important reduction of morbidity and mortality of several kinds of cancer. The therapeutic management of oncologic patients includes combinations of drugs, radiation therapy and surgery. Many of these therapies produce adverse cardiovascular complications which may negatively affect both the quality of life and the prognosis. For several years the most common noninvasive method of monitoring cardiotoxicity has been represented by radionuclide ventriculography while other tests as effort EKG and stress myocardial perfusion imaging may detect ischemic complications, and 24-hour Holter monitoring unmask suspected arrhythmias. Also biomarkers such as troponine I and T and B-type natriuretic peptide may be useful for early detection of cardiotoxicity. Today, the widely used non-invasive method of monitoring cardiotoxicity of cancer therapy is, however, represented by Doppler-echocardiography which allows to identify the main forms of cardiac complications of cancer therapy: left ventricular (systolic and diastolic) dysfunction, valve heart disease, pericarditis and pericardial effusion, carotid artery lesions. Advanced ultrasound tools, as Integrated Backscatter and Tissue Doppler, but also simple ultrasound detection of "lung comet" on the anterior and lateral chest can be helpful for early, subclinical diagnosis of cardiac involvement. Serial Doppler echocardiographic evaluation has to be encouraged in the oncologic patients, before, during and even late after therapy completion. This is crucial when using anthracyclines, which have early but, most importantly, late, cumulative cardiac toxicity. The echocardiographic monitoring appears even indispensable after radiation therapy, whose detrimental effects may appear several years after the end of irradiation

How important are perceived barriers and drivers versus other contextual factors for the adoption of energy efficiency measures: An empirical investigation in manufacturing SMEs

This study examines determinants of adoption of energy-efficiency measures (EEMs) in small and medium-sized enterprises (SMEs) in the manufacturing sector, where the energy-efficiency gap is more likely to persist according to findings in previous literature. By simultaneously examining the relevance of multiple groups of perceived barriers and drivers and several other objectively measurable contextual factors, this research aims to fill the noted gap in econometric evidence. Discrete choice models are applied to a representative sample of 220 Slovenian manufacturing SMEs, comprising 10% of all manufacturing SMEs in the country to validate the relevance of barriers and drivers for both past adoptions of EEMs and firms’ plans for adoption in the future. In line with previous empirical findings, results show that economic incentives, namely cost reductions for past investments and the potential for energy savings for future investments, are among the key drivers, while limited financial resources in more indebted firms blocked decisions to implement EEMs. Interestingly, energy-efficiency-related determinants play a more significant role than other self-perceived barriers and drivers. The importance firms place on energy efficiency, running energy-efficiency awareness programs for employees in the firms and obtaining information through external advice or energy audits triggered past company investments. Energy-intensive and innovative firms that are more aware of the importance of energy efficiency and those that have carried out investments in the past are more prone to adopt EEMs in the future, also confirming the path-dependency of energy efficiency activities. Lessons for policy-makers and managerial implications lie in spreading awareness about energy efficiency among managers and employees, building competence, and providing information on the potentials for energy efficiency improvements and on the availability of public and private funds

Implementing energy efficiency measures: do other production resources matter? A broad study in Slovenian manufacturing small and medium-sized enterprises

© 2020 Elsevier Ltd Literature has largely investigated barriers to energy efficiency in industrial firms. Recently, research is looking at the non-energy benefits accompanying the adoption of energy efficiency measures that may contribute to overcoming these barriers. In our study we take an innovative perspective by specifically exploring the relationships between energy efficiency measures and other production resources, being assessed by their importance and capability of firms to manage them efficiently. By analysing 10% of Slovenian small and medium-sized manufacturing firms, our exploratory findings show that decision-makers carefully look at the multiple effects (either positive or negative) energy efficiency measures may have on a number of other production resources, particularly on those closer to the production (shop floor). Additionally, companies seem to struggle in efficiently managing the most important production resources, thus suggesting that energy efficiency measures should be looked in close consideration to other resources, which represents a new barrier to energy efficiency not accounted by previous research. Further, we could not detect significant differences between clusters of small versus medium-sized firms and energy intensive versus non-energy intensive ones, differently from previous research that was emphasizing the larger perception of barriers in smaller and less energy intensive firms. Our findings may challenge the discussion over incentive schemes for energy efficiency measures by promoting those with the largest (positive) implications for other production resources