Σχέδιο πρόληψης Δασικών Πυρκαγιών με την Χρήση Γεωγραφικών Συστημάτων Πληροφοριών (GIS). Περίπτωση Μελέτης: Δήμος Καλαβρύτων

Η παρούσα διπλωματική Διατριβή Ειδίκευσης έχει ως στόχο την παρουσίαση ενός Σχεδίου Πρόληψης Δασικών Πυρκαγιών στον Δήμο Καλαβρύτων με την χρήση Γεωγραφικών Συστημάτων Πληροφοριών και συγκεκριμένα του λογισμικού qGIS. Αρχικά γίνεται η παράθεση των χαρακτηριστικών της πυρκαγιάς και στη συνέχεια ακολουθεί η παρουσίαση των φυσικών και ανθρωπογενών στοιχείων του Δήμου με την παράθεση στοιχείων για την διοικητική υπαγωγή, το κλίμα, την χλωρίδα και τα δασικά οικοσυστήματα, την πανίδα, τα γεωμορφολογικά στοιχεία, τα στοιχεία των οικισμών και του οικονομικού περιβάλλοντος στον Δήμο Καλαβρύτων. Ακολουθεί η εκτίμηση της χωρικής Απειλής των Δασικών Πυρκαγιών, όπως ορίζει η Ελληνική Νομοθεσία, με την σύνθεση θεματικών χαρτών με βαθμούς αρίθμησης 1 (ελάχιστο) έως 10 (μέγιστο), με τη χρήση ΓΣΠ, των: Χάρτη Εκτίμησης Αιτιών Πυρκαγιάς, Χάρτη Εκτίμησης Πιθανότητας Πυρκαγιάς, Χάρτη Εκτίμησης Έντασης Πυρκαγιάς, Χάρτη Εκτίμησης Απειλούμενων Αξιών και με την σύνθεση των παραπάνω Χαρτών να δίνει τον τελικό Χάρτη Εκτίμησης Απειλής Πυρκαγιάς. Παρουσιάζονται επίσης και τα υφιστάμενα μέτρα πυροπροστασίας στην περιοχή του Δήμου Καλαβρύτων, όπως δόθηκαν από την Πυροσβεστική Υπηρεσία. Με βάση τα παραπάνω, παρατηρείται ότι στον Δήμο Καλαβρύτων υπάρχουν περιοχές που παρουσιάζουν μεγάλη πιθανότητα πυρκαγιάς καθώς συνδυάζουν ανθρώπινη δραστηριότητα και βλάστηση με μεγάλη ευφλεκτότητα και τελικά εμφανίζονται περιοχές με αυξημένη απειλή πυρκαγιάς και ιδιαίτερα ευάλωτες, καθώς εμφανίζονται οικισμοί σε μικρή απόσταση από βλάστηση με υψηλή ευφλεκτότητα και καυσιμότητα. Ως αποτέλεσμα της σύνθεση των χαρτών είναι το πόσο σημαντική η ανάπτυξη μιας ολοκληρωμένης στρατηγικής για την αντιμετώπισης των δασικών πυρκαγιών με τον υπολογισμό των ιδιαίτερων στοιχείων του Δήμου Καλαβρύτων. Παρουσιάζονται επίσης ενδεικτικά προτεινόμενα μέτρα πρόληψης πυρκαγιών, με έμφαση στην ευαισθητοποίηση του κοινού και ιδιαίτερα των μαθητών, καθώς και η ενίσχυση του δικτύου ανίχνευσης πυρκαγιάς για την καλύτερη αντιπυρική διαχείριση του Δήμου Καλαβρύτων.This dissertation was submitted in the context of the “Environmental, Disaster & Crises Management Strategies” Post Graduate Program of the Department of Geology & Geoenvironment of the National & Kapodistrian University of Athens and aims to present a Forest Fire Prevention Plan in the Municipality of Kalavryta, using Geographic Information Systems, specifically the qGIS Software, which is an open source software provided a considerable amount of features. First of all, Greece has witnessed in the last years, how a forest fire can quickly become a fatal danger for settlements, roads and communities and thus forests, as an ecosystem and locations and fire, as a phenomenon, are explained and details are provided regarding how a fire is created, how a fire is spread and generally the characteristics and stages of a forest fire as well as the role that vegetation plays in a forest fire. Following that, the characteristics of the natural and man-made elements of the environment are provided with the presentation of data about the administrative affiliation, the climate of the area, the flora and forest ecosystems, the fauna, the geomorphological elements, the settlements of the area and their population as well as the economic environment of the Kalavryta Municipality. The data above are also presented from qGIS generated images. The Kalavryta Municipality is characterized by the high altitude, the majority of it being above 600m. The climate of the area can be described as “harsh” and “cold” (relatively to the rest of Greece) with average temperature ranging from 2.5 oC in January (coldest) to 23 oC in August (hottest). Precipitation is also relatively high with rainfall ranging from 4.6 – 109.8 mm while wind is predominantly South-South Eastern with the notable exception of summer (the most important months for fires) when the winds change to North-Eastern direction. The flora of the area is Mediterranean and typical for this altitude with large areas of coniferous vegetation as well as broad-leaved forests, mixed forests and sclerophyllous vegetation, while there are some important flora species that are being threatened. As far as fauna is concerned there is a significant amount of biodiversity, but there are a lot of threated species that are being protected by various organizations and treaties. There are also areas with significant ecological value and those areas are protected by the NATURA 2000 program. The seismicity of the area is also relatively high, being in the II zone for seismicity in Greece. According to the 2011 census, the Kalavryta Municipality has 679,769 permanent residents with the town of Kalavryta having 1,674 permanent residents. There is also a high number of smaller settlements around the area, some in difficult to approach locations. The economy of the Area has a strong tourism sector, especially winter tourism with the Kalavryta Skiing Center being one of the major skiing points in Greece and in close proximity to Athens. Kalavryta also has a rich history and archaeological interest, being a significant location for both ancient and modern Greek history. A spatial Forest Fire Threat Assessment is then presented in the form of thematical maps with grading from 1(lowest) to 10(highest), according to the theory provided by the Greek Legislation, namely ΥΠΕΝ/ΔΠΔ/61247/2789, compiling the following maps using qGIS and based on the vegetation polygons as provided by the CORINE program and assuming a standard vegetation density of approximately 40%-70%: 1) Fire Causes Assessment Map, in which the possible causes of fire are presented, with settlements and human activities such as tourism, agricultural practices, energy grids being the main causes of fire in the area, the road network of the area is also taken into account on both sides of the road, while the roads are considered part of the provincial network 2) Fire Probability Assessment Map, taking into account the possible causes of fire as presented in Map 1 and the flammability of the vegetation as considered empirically and presented in the Greek Legislation providing a map with the areas that have the highest probability of fire due to their vegetation and the human activity in the area 3) Fire Intensity Map, where the combustibility of the vegetation and the elevation of terrain are taken into account to estimate the intensity of v the fire 4) Threatened Values Map where settlements, archaeological sites, sites of great ecological values are presented and marked for their significance with settlements and children summer camps are noted as the most important while sites of significant ecological value and sites of archaeological value are also rated as important 5) Forest Fire Threat Assessment Map which is the final composition of the above maps presenting the threat level that various areas are facing, taking into account the probability of a fire, the combustibility of the vegetation-fire front intensity and the values that are being threatened. A map detailing the fire prevention measures is also presented, with data provided by the local Fire-Fighting service. Based on the above, it is observed that there are many areas that face a high probability of fire as they combine a high level of human activity with rich vegetation with high levels of flammability and combustibility, thus these areas are rated as High Threat zones as many settlements can be found in those zones. The data presented above reveal the need for a comprehensive forest fire prevention strategy for effectively dealing, and ultimately living with, forest fires. Indicative forest fire prevention measures are also presented with a heavy emphasis being placed on raising public awareness, especially students as a good education on forest ecosystems and the knowledge of the threat that forest fires present of humans and the natural environment alike, can be a very effective and relatively low cost measure of raising awareness and thus mitigating the threat of forest fires. Fire detection measures and measures to help the fire-fighting services are also presented, such as strengthening the fire detection network, the usage of new technologies such as the use of Unmanned Aerial Vehicles to provide a clear aerial picture of large areas and various other measures to enhance the fire management of the Kalavryta Municipality

Could the U.S. Energy Sector Become New Engine For Growth?

The intent of this paper is to discuss the U.S. energy sector in the context of economic growth, employment conditions, manufacturing competitiveness, and trade deficits. The paper carefully examines how utilization of domestic energy resources can strengthen the United States economic position in both domestic and foreign markets. Consideration is given to expanding the use of domestic energy resources to improve competitiveness in the global goods market and reduce dependency on foreign oil. In particular, the sections of the paper discuss: the current U.S. macroeconomic situation with an emphasis on economic growth and labor market; domestic oil and gas production; energy security; institutional arrangements necessary to deliver reliable U.S. energy resources to domestic and foreign markets; and policy considerations deemed necessary to boost energy growth. Keywords: Economic growth, Energy consumption, Energy production, development policy JEL Classifications: O;

Detection of herpes simplex virus Type-1 in patients with fibrotic lung diseases

The current study intends to investigate i) the incidence of herpes viruses including Herpes Simplex Virus type-1 (HSV-1), Cytomegalovirus (CMV) and Human Herpes Virus -6, -7, -8 (HHV6, HHV7, HHV8) in two biological samples, bronchoalveolar lavage fluid (BALF) and lung tissue biopsy, in different forms of pulmonary fibrosis, and ii) the induction of molecular pathways involved in fibrosis by herpesvirus infection in primary cell cultures. PCR was employed for the detection of CMV, HHV6-8 and HSV-1 DNA in lung specimens (4 controls and 11 IPF specimens) and BALF pellet [6 controls and 20 fibrotic Idiopathic Intestitial Pneumonias (f-IIPs) samples: 13 idiopathic pulmonary fibrosis (IPF) and 7 nonspecific idiopathic interstitial pneumonia (NSIP)] samples. Among all herpesviruses tested, HSV-1 was detected in 1/11 (9%) specimens from IPF lung tissue and in 2/20 (10%) samples of f-IIPs BALF whereas the control group was negative. Primary cell cultures from BALF of patients with IPF and healthy controls were infected in vitro with wild-type HSV-1 virus and Real Time PCR was employed for the detection of gene transcription of specific axes implicated in lung fibrosis. Primary cell cultures were permissive to HSV-1, resulting in an upregulation of the fibrotic growth factors TGFβ1 and FGF, the angiogenetic markers SDF1a, SDF1b, VEGF, FGF and the regulators of tissue wound healing MMP9 and CCR7. Downregulation was noted for the CXCR4 and MMP2 genes, while a different response has been detected in healthy donors regarding the expression of the aforementioned markers. These results implicate for the first time the HSV-1 with Fibrotic Idiopathic Interstitial Pneumonias since the virus presented similar incidence in two different biological samples

Preoperative tumor marking with indocyanine green prior of robotic colorectal resections

This prospective case-series study aimed to assess the usefulness of preoperative colonoscopic marking of colorectal tumors using Indocyanine Green (ICG) fluorescence in patients that underwent robotic surgical colorectal resections. Consecutive patients that were eligible for colorectal resection with intent to cure in a single hospital (Athens Medical Center), from February 2022 to June 2022, were included. ICG solution was injected into the submucosal layer at 2 opposite sites (180 degrees apart) distal to the tumor, without submucosal elevation. Identification of the tumor marking was then performed after switching to near-infrared (NIR) fluorescence mode. During the robotic procedure, qualitative evaluation of fluorescence was performed by the surgical team (primary surgeon, first assistant, second assistant, research fellow). All 10 patients underwent robotic surgical approach and operations included right-sided colectomy (n = 1), left-sided colectomy (n = 6) and low anterior resection (n = 3). Visualisation of this dye with near-infrared light was very clear with bright intensity in all patients when the marking was performed one day prior of surgery. Preoperative tumor marking with ICG was identified intraoperatively in all cases and the techinque was easily reproducible

Subcutaneously administered tirzepatide vs semaglutide for adults with type 2 diabetes: a systematic review and network meta-analysis of randomised controlled trials

Aims/hypothesis: We conducted a systematic review and network meta-analysis to compare the efficacy and safety of s.c. administered tirzepatide vs s.c. administered semaglutide for adults of both sexes with type 2 diabetes mellitus. Methods: We searched PubMed and Cochrane up to 11 November 2023 for RCTs with an intervention duration of at least 12 weeks assessing s.c. tirzepatide at maintenance doses of 5 mg, 10 mg or 15 mg once weekly, or s.c. semaglutide at maintenance doses of 0.5 mg, 1.0 mg or 2.0 mg once weekly, in adults with type 2 diabetes, regardless of background glucose-lowering treatment. Eligible trials compared any of the specified doses of tirzepatide and semaglutide against each other, placebo or other glucose-lowering drugs. Primary outcomes were changes in HbA1c and body weight from baseline. Secondary outcomes were achievement of HbA1c target of ≤48 mmol/mol (≤6.5%) or <53 mmol/mol (<7.0%), body weight loss of at least 10%, and safety outcomes including gastrointestinal adverse events and severe hypoglycaemia. We used version 2 of the Cochrane risk-of-bias tool (ROB 2) to assess the risk of bias, conducted frequentist random-effects network meta-analyses and evaluated confidence in effect estimates utilising the Confidence In Network Meta-Analysis (CINeMA) framework. Results: A total of 28 trials with 23,622 participants (44.2% female) were included. Compared with placebo, tirzepatide 15 mg was the most efficacious treatment in reducing HbA1c (mean difference −21.61 mmol/mol [−1.96%]) followed by tirzepatide 10 mg (−20.19 mmol/mol [−1.84%]), semaglutide 2.0 mg (−17.74 mmol/mol [−1.59%]), tirzepatide 5 mg (−17.60 mmol/mol [−1.60%]), semaglutide 1.0 mg (−15.25 mmol/mol [−1.39%]) and semaglutide 0.5 mg (−12.00 mmol/mol [−1.09%]). In between-drug comparisons, all tirzepatide doses were comparable with semaglutide 2.0 mg and superior to semaglutide 1.0 mg and 0.5 mg. Compared with placebo, tirzepatide was more efficacious than semaglutide for reducing body weight, with reductions ranging from 9.57 kg (tirzepatide 15 mg) to 5.27 kg (tirzepatide 5 mg). Semaglutide had a less pronounced effect, with reductions ranging from 4.97 kg (semaglutide 2.0 mg) to 2.52 kg (semaglutide 0.5 mg). In between-drug comparisons, tirzepatide 15 mg, 10 mg and 5 mg demonstrated greater efficacy than semaglutide 2.0 mg, 1.0 mg and 0.5 mg, respectively. Both drugs increased incidence of gastrointestinal adverse events compared with placebo, while neither tirzepatide nor semaglutide increased the risk of serious adverse events or severe hypoglycaemia. Conclusions/interpretation: Our data show that s.c. tirzepatide had a more pronounced effect on HbA1c and weight reduction compared with s.c. semaglutide in people with type 2 diabetes. Both drugs, particularly higher doses of tirzepatide, increased gastrointestinal adverse events. Registration: PROSPERO registration no. CRD42022382594 Graphical Abstract

Assessing health status in COPD. A head-to-head comparison between the COPD assessment test (CAT) and the clinical COPD questionnaire (CCQ)

BACKGROUND: Health status provides valuable information, complementary to spirometry and improvement of health status has become an important treatment goal in COPD management. We compared the usefulness and validity of the COPD Assessment Test (CAT) and the Clinical COPD Questionnaire (CCQ), two simple questionnaires, in comparison with the St. George Respiratory Questionnaire (SGRQ). METHODS: We administered the CAT, CCQ and SGRQ in patients with COPD stage I-IV during three visits. Spirometry, 6 MWT, MRC scale, BODE index, and patients perspectives on questionnaires were recorded in all visits. Standard Error of Measurement (SEM) was used to calculate the Minimal Clinical Important Difference (MCID) of all questionnaires. RESULTS: We enrolled 90 COPD patients. Cronbach's alpha for both CAT and CCQ was high (0.86 and 0.89, respectively). Patients with severe COPD reported worse health status compared to milder subgroups. CAT and CCQ correlated significantly (rho =0.64, p < 0.01) and both with the SGRQ (rho = 0.65; CAT and rho = 0.77; CCQ, p < 0.01). Both questionnaires exhibited a weak correlation with lung function (rho = −0.35;CAT and rho = −0.41; CCQ, p < 0.01). Their reproducibility was high; CAT: ICC = 0.94 (CI 0.92-0.96), total CCQ ICC = 0.95 (0.92-0.96) and SGRQ = 0.97 (CI 0.95-0.98). The MCID calculated using the SEM method showed results similar to previous studies of 3.76 for the CAT, 0.41 for the CCQ and 4.84 for SGRQ. Patients suggested both CAT and CCQ as easier tools than SGRQ in terms of complexity and time considerations. More than half of patients preferred CCQ instead of CAT. CONCLUSIONS: The CAT and CCQ have similar psychometric properties with a slight advantage for CCQ based mainly on patients’ preference and are both valid and reliable questionnaires to assess health status in COPD patients

A case of bilateral self-induced keratoconus in a patient with tourette syndrome associated with compulsive eye rubbing: case report

<p>Abstract</p> <p>Background</p> <p>Tourette syndrome is a neurologic disorder that is characterized by repetitive muscle contractions that produce stereotyped movements or sounds. Approximately 50% of individuals with TS also exhibit obsessive-compulsive behaviors including eye rubbing. We report a case of bilateral self-induced keratoconus in a patient with TS, associated with compulsive eye rubbing.</p> <p>Case presentation</p> <p>A 35-year-old man was first seen in our clinic as an outpatient due to rapid deterioration of vision in his right eye associated with pain and tearing, over a period of one month. Slit lamp biomicroscopy of the right eye showed a central stromal scar due to corneal hydrops. Clinical examination and corneal topography of the left eye were normal. Six months later the patient developed corneal hydrops of his left eye. During the following examinations his vision continued to deteriorate in both eyes, while a central stromal scar was forming in his left cornea. Four years after the initial examination the patient's visual acuity was no light perception in the right eye and counting fingers at 33 cm in the left eye. His right eye was phthisic.</p> <p>Conclusions</p> <p>Our patient developed a rapidly progressing bilateral corneal ectasia and phthisis of his right eye during a time period of 4 years. This unusual pattern suggests that the patient's compulsive behavior compromised both of his corneas and led to bilateral keratoconus.</p

Unusual cardiovascular complications of brucellosis presenting in two men: two case reports and a review of the literature

Introduction: Brucellosis is a zoonosis with worldwide distribution, which is particularly endemic in many countries of the Mediterranean basin. Cardiovascular complications of this disease, such as endocarditis, myocarditis and pericarditis, are very rare, with even fewer cases of myocarditis or asymptomatic pericardial effusion in the absence of concomitant endocarditis being reported. Case presentation: We report two cases of brucellosis in two Caucasian men, aged 17 and 34 years old, with myocarditis and asymptomatic pericardial effusion, respectively. Of note, neither patient had concomitant endocarditis. The disease was confirmed serologically and by blood cultures. Both patients recovered completely after receiving appropriate antibiotic treatment without any sign of relapse during a follow-up of 12 months. Conclusion: These two cases emphasize that in endemic areas Brucella can be considered as a potentially causative agent of idiopathic pericardial effusion or myocarditis, even in the absence of concomitant endocarditis. This possibility could be taken into account particularly in cases where contraction of brucellosis is possible, such as occupational exposure or consumption of unpasteurized dairy products. © 2011 Gatselis et al; licensee BioMed Central Ltd

Impact of safety-related dose reductions or discontinuations on sustained virologic response in HCV-infected patients: Results from the GUARD-C Cohort

BACKGROUND: Despite the introduction of direct-acting antiviral agents for chronic hepatitis C virus (HCV) infection, peginterferon alfa/ribavirin remains relevant in many resource-constrained settings. The non-randomized GUARD-C cohort investigated baseline predictors of safety-related dose reductions or discontinuations (sr-RD) and their impact on sustained virologic response (SVR) in patients receiving peginterferon alfa/ribavirin in routine practice. METHODS: A total of 3181 HCV-mono-infected treatment-naive patients were assigned to 24 or 48 weeks of peginterferon alfa/ribavirin by their physician. Patients were categorized by time-to-first sr-RD (Week 4/12). Detailed analyses of the impact of sr-RD on SVR24 (HCV RNA <50 IU/mL) were conducted in 951 Caucasian, noncirrhotic genotype (G)1 patients assigned to peginterferon alfa-2a/ribavirin for 48 weeks. The probability of SVR24 was identified by a baseline scoring system (range: 0-9 points) on which scores of 5 to 9 and <5 represent high and low probability of SVR24, respectively. RESULTS: SVR24 rates were 46.1% (754/1634), 77.1% (279/362), 68.0% (514/756), and 51.3% (203/396), respectively, in G1, 2, 3, and 4 patients. Overall, 16.9% and 21.8% patients experienced 651 sr-RD for peginterferon alfa and ribavirin, respectively. Among Caucasian noncirrhotic G1 patients: female sex, lower body mass index, pre-existing cardiovascular/pulmonary disease, and low hematological indices were prognostic factors of sr-RD; SVR24 was lower in patients with 651 vs. no sr-RD by Week 4 (37.9% vs. 54.4%; P = 0.0046) and Week 12 (41.7% vs. 55.3%; P = 0.0016); sr-RD by Week 4/12 significantly reduced SVR24 in patients with scores <5 but not 655. CONCLUSIONS: In conclusion, sr-RD to peginterferon alfa-2a/ribavirin significantly impacts on SVR24 rates in treatment-naive G1 noncirrhotic Caucasian patients. Baseline characteristics can help select patients with a high probability of SVR24 and a low probability of sr-RD with peginterferon alfa-2a/ribavirin