Association of Accelerometry-Measured Physical Activity and Cardiovascular Events in Mobility-Limited Older Adults: The LIFE (Lifestyle Interventions and Independence for Elders) Study.

BACKGROUND:Data are sparse regarding the value of physical activity (PA) surveillance among older adults-particularly among those with mobility limitations. The objective of this study was to examine longitudinal associations between objectively measured daily PA and the incidence of cardiovascular events among older adults in the LIFE (Lifestyle Interventions and Independence for Elders) study. METHODS AND RESULTS:Cardiovascular events were adjudicated based on medical records review, and cardiovascular risk factors were controlled for in the analysis. Home-based activity data were collected by hip-worn accelerometers at baseline and at 6, 12, and 24 months postrandomization to either a physical activity or health education intervention. LIFE study participants (n=1590; age 78.9±5.2 [SD] years; 67.2% women) at baseline had an 11% lower incidence of experiencing a subsequent cardiovascular event per 500 steps taken per day based on activity data (hazard ratio, 0.89; 95% confidence interval, 0.84-0.96; P=0.001). At baseline, every 30 minutes spent performing activities ≥500 counts per minute (hazard ratio, 0.75; confidence interval, 0.65-0.89 [P=0.001]) were also associated with a lower incidence of cardiovascular events. Throughout follow-up (6, 12, and 24 months), both the number of steps per day (per 500 steps; hazard ratio, 0.90, confidence interval, 0.85-0.96 [P=0.001]) and duration of activity ≥500 counts per minute (per 30 minutes; hazard ratio, 0.76; confidence interval, 0.63-0.90 [P=0.002]) were significantly associated with lower cardiovascular event rates. CONCLUSIONS:Objective measurements of physical activity via accelerometry were associated with cardiovascular events among older adults with limited mobility (summary score >10 on the Short Physical Performance Battery) both using baseline and longitudinal data. CLINICAL TRIAL REGISTRATION:URL: http://www.clinicaltrials.gov. Unique identifier: NCT01072500

Sutureless valves and the quality of perfusion: towards a goal directed aortic valve replacement

BACKGROUND: Aim of this study was to assess the potential differences in respecting the principles of goal-directed perfusion between aortic valve replacement with sutureless vs. conventional stented bioprostheses.METHODS: Data from 94 consecutive patients undergoing aortic valve replacement with Perceval sutureless valve, with or without concomitant coronary artery bypass grafting, were compared to a contemporary cohort of 116 patients receiving conventional stented bioprostheses. Propensity score matching was used to reduce selection bias. Flow-dependent estimate of oxygen delivery and carbon dioxide production were compared in accordance to the principles of goal directed perfusion. Hospital outcomes were assessed as well.RESULTS: Propensity score matching resulted in 39 pairs with similar characteristics and operative risk. Cross-clamping time (41.6 +/- 20.6 vs. 89.6 +/- 48.2; P<0.001) and cardiopulmonary bypass time (66.9 +/- 29.4 vs. 121.2 +/- 56.6, P<0.001) were shorter in Perceval patients. Flow-dependent parameters were significantly better in Perceval patients (peak VCO(2)i P=0.010; nadir VO(2)i P=0.035; nadir DO(2)i/VCO(2)i P=0.015; peak RQ P=0.020) and therefore goal-directed perfusion principles were met more frequently (all P<0.001). Peak lactates were higher in controls (P=0.001), as well as number of patients receiving transfusions during CPB (P=0.044). QualyP Score was also higher in controls (P<0.001). Perceval patients experienced reduced postoperative bleeding, had a lower incidence of surgical revisions and transfusions. Duration of ventilation was longer in controls.CONCLUSIONS: The use of sutureless valves significantly reduces cardiopulmonary bypass and cross-clamping times and contributes to achieve a goal-directed perfusion. This results in better perfusion quality, with a positive clinical impact

Are public state libraries efficient? An empirical assessment using network Data Envelopment Analysis.

In Italy, public state libraries are multi-product organizations preserving ancient books of great historical relevance for future generations, and providing divisible services to the public. Hence, they may undertake different activities for conservation and use, which together constitute a network. This paper shows the importance of considering multi-process interactions in evaluating the overall performance of public state libraries and focuses on library operations and their sub-processes. It uses a network two-stage Data Envelopment Analysis (DEA) approach to examine the relationship between the libraries' basic inputs, intermediate outputs and final outputs. The main result is that Italian public state libraries generally perform better in the first stage of conservation, but score poorly in the second stage of use. Some policy advice to improve the decision-making process follo

Presence of olivine in asbestos-containing materials widely used in the petrochemical industry

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Fully-2D and quasi-2D modeling of flooding scenarios due to embankment failure

The occurrence of river levee breaks due to high return period floods can have catastrophic effects on the environment and human lives. The study of these kinds of problems is of great importance for hydraulic hazard assessment, for the development of civil protection plans and for the organization of corrective and preventative measures to reduce flood damage. In this context, the paper presents the main results of two case studies concerning two floodable regions located in the middle reach of the Po river (Northern Italy). For the first case, numerical simulations were performed by means of a 2D finite volume MUSCL-Hancock scheme (belonging to the Surface Gradient Methods class) and also by a quasi-2D numerical model based on the subdivision of the domain in storage cells linked through weirs. Even if the flooding dynamics was not correctly described in the first hours after the breaching, the results obtained through the quasi-2D approach showed a fairly good agreement with fully-2D ones: flooded areas, maximum water depths and, above all, the discharge flowing through the breach are comparable. The satisfactory results obtained led to the adoption of a hybrid methodology that was applied to the second case study: the discharge flowing through the breach was computed by the quasi-2D approach and then adopted as the inflow boundary condition for the fully-2D modeling of the sole area prone to flooding. In this way the flooding dynamics was predicted avoiding the burdensome 2D description of the riverbed; in addition the downstream boundary condition was moved far away from the breach and the computational time significantly reduced