Case report of subacute presentation of tricuspid valve thrombus complicated by widespread bilateral pulmonary emboli: a multifactorial aetiology.

BackgroundRight heart thrombus (RHTh) complicated by pulmonary embolism (PE) usually presents as a medical emergency with significant haemodynamic instability. However, less is known about subacute presentations.Case summaryWe present a 74-year-old haemodynamically stable gentleman with a 3-week history of mild pleuritic chest pain and exertional dyspnoea preceded by lower respiratory tract infection. Early trans-thoracic echocardiogram (TTE) revealed a 3 cm elongated tricuspid valve thrombus with right ventricular dysfunction, new-onset atrial fibrillation, and new-onset severe left ventricular impairment. Subsequent computed tomography pulmonary angiogram showed widespread bilateral pulmonary emboli with retrograde opacification of the hepatic veins. The RHTh successfully resolved with warfarin therapy with no further complications, and the patient was discharged on Day 8 of hospitalization.DiscussionAn early TTE is crucial in detecting the RHTh in patients suspected of PE and can significantly change the management compared with uncomplicated PE. The index of suspicion for PE and RHTh should remain high even in subacute cases

Συσχέτιση Σεισμικών Παραμέτρων και Ολικών Δεικτών Βλάβης σε Κατασκευές Οπλισμένου Σκυροδέματος

In the present work, a correlation is made between seismic intensity parameters and total damage indicators of reinforced concrete structures. For this purpose, natural ground motions recordings were used, from which intensity measures were calculated and alternatives were proposed. Then, through dynamic inelastic time history analyzes, damage indices were evaluated for 1st and 2nd order theory (P-Delta effects). The correlation between each seismic parameter and the corresponding damage index was made through polynomial regressions. Seismic parameters that do not take into account the characteristics of the building, showed a minimal or moderate correlation, while spectral parameters of velocities and energies explain the change of damage indices in percentages above 80 or even 90 per cent.Στην παρούσα εργασία πραγματοποιείται συσχέτιση μεταξύ σεισμικών παραμέτρων έντα-σης και ολικών δεικτών βλάβης σε κατασκευές οπλισμένου σκυροδέματος. Για αυτόν τον σκοπό, χρησιμοποιήθηκαν καταγραφές πραγματικών σεισμών, από τις οποίες υπολογίστηκαν παράμετροι, που χαρακτηρίζουν ένα επιταχυνσιογράφημα και προτάθηκαν εναλλακτικές τους. Στη συνέχεια μέσω δυναμικών ανελαστικών αναλύσεων χρονοϊστορίας αποτιμήθηκαν δείκτες βλάβης για θεωρία 1ης και 2ης τάξης. Η συσχέτιση μεταξύ του εκάστοτε ζεύγους σεισμικής παραμέτρου και δείκτη βλάβης έγινε μέσω πολυωνυμικών παλινδρομήσεων. Σεισμικές παρά-μετροι που δεν λαμβάνουν υπόψη τους τα χαρακτηριστικά του ταλαντωτή, παρουσίασαν ελάχιστη ή μέτρια συσχέτιση, ενώ φασματικές παράμετροι ταχυτήτων και ενεργειών ερμη-νεύουν τη μεταβολή των δεικτών βλάβης σε ποσοστά άνω του 80 ή και 90 τοις εκατό

Severe dysphagia due to a huge epiphrenic diverticulum: long-term treatment with balloon dilation and botulinum toxin injection: a case report

We herein describe the first case of a high elderly patient with severe dysphagia in solids and liquids, caused by a huge epiphrenic diverticulum, who was treated with combined therapy of balloon dilation and botulinum toxin injection. Due to comorbid associated diseases the patient was unsuitable to withstand surgical or laparoscopic intervention. Treatment with botulinum toxin injection at the region of lower esophageal sphincter was unsuccessful. Combined therapy with balloon dilatation and botulinum toxin injection at the compressed part of esophageal lumen by the diverticulum resulted in improvement in dysphagia and malnutrition. During the long-term follow-up the patient developed symptomatic relapses, successfully treated by subsequent combined therapy resulting in longer-lasting symptom relief

Structural Damage Prediction of a Reinforced Concrete Frame under Single and Multiple Seismic Events Using Machine Learning Algorithms

Advanced machine learning algorithms have the potential to be successfully applied to many areas of system modelling. In the present study, the capability of ten machine learning algorithms to predict the structural damage of an 8-storey reinforced concrete frame building subjected to single and successive ground motions is examined. From this point of view, the initial damage state of the structural system, as well as 16 well-known ground motion intensity measures, are adopted as the features of the machine-learning algorithms that aim to predict the structural damage after each seismic event. The structural analyses are performed considering both real and artificial ground motion sequences, while the structural damage is expressed in terms of two overall damage indices. The comparative study results in the most efficient damage index, as well as the most promising machine learning algorithm in predicting the structural response of a reinforced concrete building under single or multiple seismic events. Finally, the configured methodology is deployed in a user-friendly web application.Keywords: seismic sequence; machine learning algorithms; repeated earthquakes; structural damage prediction; intensity measures; damage accumulation; machine learning; artificial neural networ

Structural Damage Prediction Under Seismic Sequence Using Neural Networks

Advanced machine learning algorithms, such as neural networks, have the potential to be successfully applied to many areas of system modelling. Several studies have been already conducted on forecasting structural damage due to individual earthquakes, ignoring the influence of seismic sequences, using neural networks. In the present study, an ensemble neural network approach is applied to predict the final structural damage of an 8-storey reinforced concrete frame under real and artificial ground motion sequences. Successive earthquakes consisted of two seismic events are utilised. We considered 16 well-known ground motion intensity measures and the structural damage that occurred by the first earthquake as the features of the machine-learning problem, while the final structural damage was the target. After the first seismic events and after the seismic sequences, both actual values of damage indices are calculated through nonlinear time history analysis. The machine-learning model is trained using the dataset generated from artificial sequences. Finally, the predictive capacity of the fitted neural network is accessed using the natural seismic sequences as a test set

Towards specification of a software architecture for cross-sectoral big data applications

The proliferation of Big Data applications puts pressure on improving and optimizing the handling of diverse datasets across different domains. Among several challenges, major difficulties arise in data-sensitive domains like banking, telecommunications, etc., where strict regulations make very difficult to upload and experiment with real data on external cloud resources. In addition, most Big Data research and development efforts aim to address the needs of IT experts, while Big Data analytics tools remain unavailable to non-expert users to a large extent. In this paper, we report on the work-in-progress carried out in the context of the H2020 project I-BiDaaS (Industrial-Driven Big Data as a Self-service Solution) which aims to address the above challenges. The project will design and develop a novel architecture stack that can be easily configured and adjusted to address cross-sectoral needs, helping to resolve data privacy barriers in sensitive domains, and at the same time being usable by non-experts. This paper discusses and motivates the need for Big Data as a self-service, reviews the relevant literature, and identifies gaps with respect to the challenges described above. We then present the I-BiDaaS paradigm for Big Data as a self-service, position it in the context of existing references, and report on initial work towards the conceptual specification of the I-BiDaaS software architecture.This work is supported by the IBiDaaS project, funded by the European Commission under Grant Agreement No. 780787.Peer ReviewedPostprint (author's final draft

The role of thyroid hormones adiponectin and gene polumorphisms (nuclear factor kappa B and angiotensin converting enzyme) in chronic heart failure

Gene Polymorphisms and Thyroid Function in Patients with Heart FailureOBJECTIVE: We evaluated nuclear factor kappa B {NFkB, rs28362491 [-94ins/delATTG (W/D)]} and angiotensin converting enzyme {ACE; rs1799752 [Ins(I)/Del(D)]} gene polymorphisms and their correlation with thyroid function in patients with heart failure (HF). DESIGN: Peak oxygen uptake (VO2) was evaluated (by Weber classification) during a symptom-limited cardiopulmonary exercise test in 194 patients. Thyroid-stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4) and free (F) T3 and FT4 were also measured. According to their cardiovascular (CV) capacity, patients were subdivided into four groups: group A included patients with peak VO2 >20 ml/kg/min, group B 16-20 ml/kg/min, group C 10-16 ml/kg/min and group D 6-10 ml/kg/min. Patients were also genotyped for NFkB and ACE genetic variants.RESULTS: T3 was increased and FT3 was decreased for every i in Weber’s classification (p=0.007 and p=0.012, respectively). Del carriers had elevated FT3 levels compared with Ins carriers (p=0.021). Patients with II genotype had elevated T4 levels compared with ID genotype (p=0.044). Both T4 and FT4 were decreased in D allele carriers (p=0.007 and p=0.045, respectively). CONCLUSIONS: Thyroid hormones correlated with CV capacity. Associations between the NFkB and ACE gene polymorphisms and thyroid hormones levels were also observed. Further larger studies are required to clarify genes contribution in HF.Γονιδιακοί πολυμορφισμοί και θυρεοειδική λειτουργία σε ασθενείς με καρδιακή ανεπάρκεια Σκοπός:Στην παρούσα μελέτη εκτιμήσαμε τις πιθανές συσχετίσεις των γονιδιακών πολυμορφισμών του πυρηνικού παράγοντα κάπα Β{NFkB, rs28362491 [-94ins/delATTG (W/D)]} και του μετατρεπτικού ενζύμου της αγγειοτασίνη {ACE; rs1799752 [Ins(I)/Del(D)]} με την λειτουργία του θυρεοειδούς αδένα σε ασθενείς με καρδιακή ανεπάρκεια.Σχεδιασμός της μελέτης:Η μέγιστη κατανάλωση οξυγόνου (VO2) όπως αυτή εκτιμάτε από την μέγιστη καρδιοαναπνευστική δοκιμασία και την σταδιοποίηση κατά Weber προσδιοριστικέ σε 194 ασθενείς με καρδιακή ανεπάρκεια. Η λειτουργία του θυρεοειδούς αδένα έγινε με τον προσδιορισμό των : Thyroid-stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4) and free (F) T3 and FT4. Οι ασθενείς ανάλογα με την ικανότητα τους για άσκηση κατατάχτηκαν σε 4 ομάδες : Στην ομάδα Α με peak VO2 >20 ml/kg/min, στην ομάδα Β με peak VO2 =16-20 ml/kg/min, στην ομάδα Γ με peak VO2 =10-16 ml/kg/min, και στην ομάδα Δ με peak VO2 =6-10 ml/kg/min. Στους παραπάνω ασθενείς επιπρόσθετα έγινε γονιδιακή ανάλυση για NFkB and ACE.Αποτελέσματα:Οι τιμές της Τ3 και της ελεύθερης Τ3 μειώνονται με κάθε αύξηση της ομάδας κατά Weber. (p=0.007 and p=0.012 αντίστοιχα). Οι ασθενείς με Del γονότυπο έχουν υψηλότερη FT3 σε σχέση με τους ασθενείς με Ins γονότυπο (p=0.021).Οι ασθενείς με γονότυπο ΙΙ είχαν αυξημένα επίπεδα Τ4 σε σχέση με τους ασθενείς με ID γονότυπο (p=0.044). Τόσο οι τιμές της Τ4 όσο και οι τιμές στης ελεύθερης Τ4 ήταν μειωμένες στην ομάδα των ασθενών με αλλήλιο D (p=0.007 and p=0.045, αντίστοιχα).Συμπεράσματα:Οι ορμόνες του θυρεοειδούς αδένα συσχετίζονται με την ικανότητα για άσκηση. Επιπρόσθετα παρατηρήθηκαν συσχετίσεις ανάμεσα στους πολυμορφισμούς του γονιδίου του NFkB και του ACE και των επιπέδων των θυρεοειδικών ορμονών. Περισσότερες και μεγαλύτερου μεγέθους μελέτες είναι απαραίτητες για να διαλευκάνουν την συνεισφορά των γονιδιακών πολυμορφισμών στην καρδιακή ανεπάρκεια

Strategic Hotel Management in the “Hostile” International Environment

This paper examines the perspectives of using effective strategic management in the hotel industry in order to overcome the extended difficulties of the hostile international environment. Hotels are facing increasing challenges. Globalization, high competition of different tourism markets, technological developments, political and social circumstances (such as coronavirus), various needs and demands of multinational customers and many other factors are leading hotel industry to activate a more strategic perspective in order to deal successfully with the elements affecting them. The international developments gradually lead even small hotel enterprises to adopt extensive tools of strategic management in order to increase their competiveness. The article is aimed at exploring the increasing necessity of using extending strategic management approaches to anticipate threats and possible opportunities by exploiting the advantages and dealing with the weak features of hotel enterprises, providing a framework of interrelated issues based on the existing literature in this research field. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG

Strategic Human Resource Management in the International Hospitality Industry. An Extensive Literature Review

This review takes an evolutionary perspective on the development of strategic human resource management literature. Managing human resources strategically, provides to a hotel business the opportunity to develop its plans for recruitment, training, and compensation based on the goals of the organization, ensuring a greater chance of organizational success. The paper focuses on how the field has evolved to its current state, articulates many of the major findings and contributions, and discusses how its potential future evolution. This approach contributes to the field of strategic human resource management by analyzing cases and good practices from the international environment. The article is aimed at exploring human resource management from a strategic perspective, tracing and exploiting effective managerial approaches of hospitality industry in the global environment. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG