Investigation of Dark Counts in Innovative Materials for Superconducting Nanowire Single-photon Detector Applications

The phenomenon of dark counts in nanostripes of different superconductor systems such as high-temperature superconducting YBa2Cu3O7-x and superconductor/ferromagnet hybrids consisting of either NbN/NiCu or YBa2Cu3O7- x/L0.7Sr0.3MnO3 bilayers have been investigated. For NbN/NiCu the rate of dark-count transients have been reduced with respect to pure NbN nanostripes and the events were dominated by a single vortex entry from the edge of the stripe. In the case of nanostripes based on YBa2Cu3O7-x, we have found that thermal activation of vortices was also, apparently, responsible for triggering dark-count signals

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): study protocol for a randomized controlled trial

BACKGROUND: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). METHODS/DESIGN: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH2O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure 6430 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. DISCUSSION: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration metho

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

The fitness to work certificate in a worker exposed to ionizing radiation with an oncological disease: criteria and assessment process

To assess the fitness to work certificate in employees both affected by neoplasia and exposed to ionizing radiation always represents a clinical and professional issue, as well as human and social. The aim of our study is to analyze the case of a 40-year-old clinician (woman, endoscopist, gastroenterologist) who underwent left mastectomy and breast reconstruction with a tissue expander, professionally exposed to ionizing radiation. Due to the presence of the BRCA1 gene mutation and the presence of breast and ovarian cancer familiarity, the patient also underwent a prophylactic right mastectomy and bilateral oophorectomy. According to Italian legislation and international guidelines, several elements and criteria have been taken into account to release the fitness to work certificate in this peculiar case of a female worker exposed to ionizing radiation, resulting in a final positive indication

The fitness to work certificate in a worker exposed to ionizing radiation with an oncological disease: criteria and assessment process

To assess the fitness to work certificate in employees both affected by neoplasia and exposed to ionizing radiation always represents a clinical and professional issue, as well as human and social. The aim of our study is to analyze the case of a 40-year-old clinician (woman, endoscopist, gastroenterologist) who underwent left mastectomy and breast reconstruction with a tissue expander, professionally exposed to ionizing radiation. Due to the presence of the BRCA1 gene mutation and the presence of breast and ovarian cancer familiarity, the patient also underwent a prophylactic right mastectomy and bilateral oophorectomy. According to Italian legislation and international guidelines, several elements and criteria have been taken into account to release the fitness to work certificate in this peculiar case of a female worker exposed to ionizing radiation, resulting in a final positive indication

[Vocational integration of the worker suffering from ischemic heart disease: prognostic factors, occupational evaluation, and criteria for the assessment of their suitability for the specific task].

Ischemic heart disease, even if it has an incidence rate that increases with increasing age, can affect young people of working age. Remarkable progress in the treatment of acute coronary syndrome (ACS) and its complications, while it reduced the mortality due to myocardial infarction in both acute and later stages, on the other hand have contributed to increase prevalence, in people of working age, of ischemic heart disease and chronic conditions of post-ischemic left ventricular dysfunction in the outcomes of previous acute ischemic event. The first stage of the process of job placement is the study of worker health after acute coronary syndrome. After making all clinical and instrumental examinations, the first objective is risk stratification aimed to assess the prognosis of ischemic heart disease. The pathophysiological factors that allow risk stratification and thus constitute the determinants of prognosis after acute coronary event are: the presence of residual ischemia and inducibility of the same threshold; the left ventricular function; the presence of electrical instability and age. Only when the prognostic assessment has defined a low risk profile, an accurate study of work suitability, based both on hearth functional assessment and on work activity evaluation, becomes possible. Occupational assessment must consider, as a central factor (although not exclusive), measurement of energy expenditure required by work activity carried out through ergometric studies, but usually it occurs only in exceptional cases. However, although with some degree of approximation, energy expenditure of most occupational activities may be deducted from appropriate tables and should be regarded as a value "estimates". When the occupational physician has acquired, on the one hand all informations relating to the prognostic evaluation, risk stratification and clinical and instrumental analysis of residual work capacity, on the other hand all data pertaining to the evaluation (with models to "estimate") of energy expenditure of the specific task and data relating to occupational risk factors, he can compare the two groups of data. In the matching process, alongside the essential elements of judgment collected, criteria based on work physiology and on cardiac rehabilitation are necessary. It is assessed that a person is able to play for 6-8 hours continuous employment with consumption of oxygen equal to 35-40% (critical power - PCRIT) of maximum aerobic capacity (VO2 max) achieved in the ergospirometric test with peak values which must not exceed 2/3 of the maximal achieved. Return to work may be permitted and recommended if the patient's functional capacity is at least twice the energy demands of specific work activity

Work on a building site at high altitude: physiopathological features and entailments for the occupational medicine

SUMMARY: Introduction. From a physiological perspective the high altitude is defined by altitudes higher than 3000 meters above sea level: at this altitude the atmospheric pressure is reduced to 525 mmHg and the partial pressure of Oxygen drops to 110 mmHg in the ambient air follows and 60 mmHg in the alveolar air. To stay at altitudes above 3000 m s.l.m. therefore places the human organism in front of a notable reduction of the functional respiratory reserve already in conditions of rest, leading to inevitable repercussions on the ability to sustain physical effort. Materials and methods. A population of 39 workers employed in the construction sector at a high altitude construction site (2200-3480 m) was examined. Data relating to sex, age, body mass index, smoking, residence altitude, mountaineering history (maximum altitude reached over a lifetime, frequency of ascents, time spent at high altitude, both for pleasure and for work) and sport practice were collected. Among them, for 25 workers the data of the ergometric tests in normobaric hypoxia (pO2, desaturation and peak values of heart rate, respiratory frequency, ventilation) conducted with simplified mode were collected. Purpose. The study aims to analyze the health of a group of workers exposed to the risk related to staying at high altitude in light of the indications of the scientific literature on health surveillance. Results. The data relating to the group of workers studied with regard to anamnestic data and to the results of ergospirometric examinations in hypoxic conditions are described. Conclusions. In working conditions at high altitude it is necessary to consider both the effect of high altitude in itself, similar to a sort of substantially unchangeable "background risk", and the ways in which high altitude interacts with other risk factors characteristic of the work site activity (which are the same as for any construction site activity that takes place at sea level), considering also the pathophysiological or frankly pathological conditions of which the worker is a carrier. This evaluation can be articulated on two levels: a first level concerning the suitability of the individual for access and the simple prolonged stay in altitude where the work activity will be performed; a second level regarding the suitability of the worker to carry out the work tasks required by the specific task in the particular environmental conditions