Current activities of Cardiovascular Rehabilitation in the ambulatory setting of the Lombardy Region

In the present work, the current activities of Cardiovascular Rehabilitation and Prevention (CRP) in the ambulatory setting of the Lombardy Region (Italy) are described. Based on the 2012 Legislation, ambulatory CRP is delivered by means of three programme categories (MAC 6, 7, and 8) with different degrees of intensity. The patient evaluation of global cardiovascular/clinical risk, comorbidity, and disability is the cornerstone for MAC prescription. Following the organization of MAC activities, a survey on 327 patients was carried out by the regional network of the Italian Society of Cardiovascular Rehabilitation (GICR-IACPR). Globally, acute coronary syndromes (with or without coronary revascularization) constituted the main access group to CRP. More than 60% of patients displayed a condition of high risk, comorbidity, and disability. The outcome of ambulatory CRP by means of MAC 6 and 7 was satisfactory, while in the 'less intensive' MAC 8 patients with complete drug up-titration and achievement of secondary prevention targets were no more than 70%.  Riassunto La Cardiologia Riabilitativa e Preventiva (CRP) storicamente riconosce nei percorsi ambulatoriali un importante setting per l’erogazione dell’intervento. In Regione Lombardia negli ultimi anni le attività di CRP sono state oggetto di una profonda riorganizzazione, con il contributo di esperti GICR-IACPR attivi presso lo specifico tavolo tecnico attivato presso la Direzione Generale Sanità. Dal 2012 sono attive le Macroattività Ambulatoriali Complesse e ad alta integrazione di risorse (MAC), che riguardano anche la sfera della CRP. Le MAC si sono poste come integrazione e alternativa al percorso degenziale e sono state classificate in tre livelli a complessità decrescente (MAC 6, MAC 7 e MAC 8 nel nuovo nomenclatore delle attività ambulatoriali). Il network GICR-IACPR ha quindi successivamente condotto una survey su 327 pazienti in tre Centri di CRP, di cui vengono esposti i risultati. Complessivamente, le condizioni di accesso alle MAC più utilizzate sono stati gli esiti di sindrome coronarica (con o senza rivascolarizzazione) e vi è stata una robusta rappresentazione (oltre 60%) di situazioni cliniche a medio/alto rischio clinico, complessità e disabilità. L’outcome dell’intervento in regime di MAC (in termini di recupero funzionale, titolazione della terapia di cardioprotezione e raggiungimento dei target terapeutici) è stato globalmente soddisfacente, seppure minore (non superiore al 70%) nel MAC 8 meno "intensivo"

Molecular understanding of sulphuric acid-amine particle nucleation in the atmosphere

4 pages 359-363 in the print version, additional 7 pages online.Peer reviewe

The effect of acid-base clustering and ions on the growth of atmospheric nano-particles

The growth of freshly formed aerosol particles can be the bottleneck in their survival to cloud condensation nuclei. It is therefore crucial to understand how particles grow in the atmosphere. Insufficient experimental data has impeded a profound understanding of nano-particle growth under atmospheric conditions. Here we study nano-particle growth in the CLOUD (Cosmics Leaving OUtdoors Droplets) chamber, starting from the formation of molecular clusters. We present measured growth rates at sub-3 nm sizes with different atmospherically relevant concentrations of sulphuric acid, water, ammonia and dimethylamine. We find that atmospheric ions and small acid-base clusters, which are not generally accounted for in the measurement of sulphuric acid vapour, can participate in the growth process, leading to enhanced growth rates. The availability of compounds capable of stabilizing sulphuric acid clusters governs the magnitude of these effects and thus the exact growth mechanism. We bring these observations into a coherent framework and discuss their significance in the atmosphere.Peer reviewe

ANN Model to predict the bake hardenability of Transformation-Induced Plasticity steels

Neural networks are useful tools for optimizing material properties, considering the material's microstructure and therefore the thermal treatments it has undergone. In this research an artificial neural network (ANN) with a Bayesian framework able to predict the bake hardening and the mechanical properties of the Transformation-Induced-Plasticity (TRIP) steels was designed. The forecast ability of the ANN model is achieved taking into account the operating parameters involved in the Intercritical Annealing (IA), in the Isothermal Bainite Treatment (IBT) and also considering the different prestrain values and the volume fraction of the retained austenite before the Bake Hardening (BH) treatment. This approach allowed one to overcome the need to know the metallurgical rules that describe all the active phenomena in multiphase steels. The neural network approach allowed one to overcome the lack of prediction capability in the existing numerical model

Improving Of The Productivity And The Quality Of A Manufacturing Robotized Cell For Mig/Mag Welding

During the last years, globalization and the necessity to reduce production costs have pushed industry to employ more and more manufacturing robotized cells. This trend has been assimilated by arc welding too. The use of robotic systems allows to increase the performance of productive systems by means of reduction in lead-time, reproducibility of processes and increase in quality. However, process automation needs pre-scheduling of manufacturing cell movements and also a setup of different welding parameters, such as power provided by the welding generator, arc length and robot speed, all of which allows to get a joint without defects. An online scheduling of robotic systems brings certainly a delay in production times, whereas offline scheduling allows to maintain the desired production without any production stop. An interface that allows to easily translate the coordinate points established by a simulation software (such as Robcad) in some complete programs that can be sent to the controller of the manufacturing cell, has been developed. Besides, in order to improve the joint’s quality, an analysis of the joint quality has been carried out by macrographic analysis. The employment of image analysis techniques on the obtained macrographs allowed to translate the morphology of each joint in terms of a matrix. After different morphologies have been distinguished in numerical terms and correlated to the joint’s quality, these data have been introduced as input to the interface. The output, constituted by the program for the controller of the cell and the best welding parameters, under such conditions, has allowed to increase both the cell’s productivity and the quality of the joints. Therefore, during offline scheduling, the initial phase of loop control of the joint morphology allows to evaluate the best welding parameters both in terms of productivity and joint quality. The same interface allows also to plan the best parameters for different welded joints with varying thickness and typology, which makes the system more eflexible and maintains a high level of productivity. The whole system has been implemented on a robotized cell GMAW Gas Metal Arc Welding Comau, that foresees a welding robot with six degrees of freedom and a position system with other six freedom degrees. Different T fillet joints have been realized at using of weathering steel sheets 5 and 6 mm thick

Vinificazione in bianco in presenza di chips di quercia di origine e livello di tostatura diversi

Some musts from Grillo grapes, a cultivar autochthonous of western Sicily, fermented with medium toasted American oak chips or with non toasted French oak chips (Classic Line \u2013 HTS enology) have been vinified. the wines were significantly different as regards the contents in volatile and non volatile compounds extracted from American and French oak chips. a slight increase in alcoholic fermentation rate and in some cases a higher content of ethyl esters and medium chain fatty acids, were observed in musts charged with chips, independently of their origin. In wines obtained from musts charged with french medium toasted oak chips, the content in furans was higher (5-methylfurfural, trans-methyl\uf02d\uf062\uf020\uf067-octalattone), phenolic aldehydes (syringic aldehyde, vanillin), eugenol, tyrosol, dihydro methoxycinnamyl alcohol. the wines, subjected to the sensory analysis, appeared more complex, fine and their aromatic intensity was higher than the control. Significant differences in visual and olfactory descriptors were found as well

IL-17A-associated IKK-alpha signaling induced TSLP production in epithelial cells of COPD patients

Thymic stromal lymphopoietin (TSLP) is a cytokine expressed in the epithelium, involved in the pathogenesis of chronic disease. IL-17A regulates airway inflammation, oxidative stress, and reduction of steroid sensitivity in chronic obstructive pulmonary disease (COPD). TSLP and IL-17A were measured in induced sputum supernatants (ISs) from healthy controls (HC), healthy smokers (HS), and COPD patients by enzyme-linked immunosorbent assay. Human bronchial epithelial cell line (16HBE) and normal bronchial epithelial cells were stimulated with rhIL-17A or ISs from COPD patients to evaluate TSLP protein and mRNA expression. The effects of the depletion of IL-17A in ISs, an anticholinergic drug, and the silencing of inhibitor kappa kinase alpha (IKK alpha) on TSLP production were evaluated in 16HBE cells. Coimmunoprecipitation of acetyl-histone H3(Lys14)/IKK alpha was evaluated in 16HBE cells treated with rhIL-17A and in the presence of the drug. TSLP and IL-17A levels were higher in ISs from COPD patients and HS compared with HC. TSLP protein and mRNA increased in 16HBE cells and in normal bronchial epithelial cells stimulated with ISs from COPD patients compared with ISs from HC and untreated cells. IKK alpha silencing reduced TSLP production in 16HBE cells stimulated with rhIL-17A and ISs from COPD patients. RhIL-17A increased the IKK alpha/acetyl-histone H3 immunoprecipitation in 16HBE cells. The anticholinergic drug affects TSLP protein and mRNA levels in bronchial epithelial cells treated with rhIL-17A or with ISs from COPD patients, and IKK alpha mediated acetyl-histone H3(Lys14). IL-17A/IKK alpha signaling induced the mechanism of chromatin remodeling associated with acetyl-histone H3(Lys14) and TSLP production in bronchial epithelial cells. Anticholinergic drugs might target TSLP derived from epithelial cells during the treatment of COPD