Chemical characterisation of construction and demolitionwaste in Skopje city and its surroundings (Republic of Macedonia)

In the Republic of Macedonia, construction and demolition waste is often dumped, underestimating the potential recycling and re-use as raw materials for civil engineering works and/or cement/ceramic industries. SAMCODE (Sustainable Approach to Managing Construction and Demolition Waste) is a know-how exchange program, the focus of which is chemical characterisation in terms of major and trace elements in order to evaluate the possible Macedonian construction and demolition waste recycling. Thirty-nine waste samples were collected from different dumps in Skopje and surroundings. X-ray fluorescence analyses, carried out on powdered samples, show i) highly variable concentrations, indicative of the heterogenous nature of construction and demolition waste, and ii) high concentration in Cr, Ni, and Zn with respect to Italian, Chinese, and Dutch tolerance limits, probably due to the presence of these elements in ophiolitic rocks and sulphide-bearing deposits, used as raw material in building activity. Inductively coupled plasma mass spectrometry analyses of leachates, performed to assess the mobility of heavy metals, show significant concentrations of Cr, and to a lesser extent, Ni. Results suggest that homogenisation processes of the recycled materials should be implemented and preliminary screening of construction and demolition waste should be performed to eliminate heavy metals-bearing components

Deroofing - a method of choice in the treatment of suppurative perineal hidradenitis

Purpose: Suppurative hidradenitis is a chronic relapsing inflammatory disease that affects the apocrine sweat glands. Therefore, it is most often located in the axilla, groin and perianal area. Usually, people of working age affected. Perineal and perianal locations cover about 37% of the total morbidity rate and are more common in males. The objective of this study was to share our experience with the application of deroofing for the treatment of purulent perineal hidradenitis.Material and methods: This prospective interventional study covered 13 patients with suppurative fistulasing hidradenitis of perineum treated in Division of Coloproctology and Septic Surgery, Georgi Stranski University Hospital of Pleven for the period from 2008 till 2013.Results: The interval between the occurrence of disease and its surgical treatment was very long - from two to 36 years (average of 9,2 years). It resulted from the progression of the disease with enlarged soft tissue involvement. Sometimes, the disease was complicated by chroniosepsis. The average hospital stay was 13,5-day long. Operative wounds healed secondarily at an average of about 30 days. The patients were followedup for six months, one year and two years. Two patients with relapses on the sixth postoperative month were hospitalized again. The surgical intervention warranted good results.Conclusion: Treatment of suppurative hidradenitis of the perineum is complex, both in terms of local status and systematic violations resulting in chronic infection. There are numerous surgical techniques for treating this pathology. The advantages of deroofing are the following: minimal trauma to the patient, application by using local anesthesia at the early stage in order to minimize hospital stay, no need of special equipment, a lower recurrence rate than the other methods and formation of aesthetically acceptable scar

Intercomparison Study of Six HTDMAs: Results and Recommendations

We report on an intercomparison of six different hygroscopicity tandem differential mobility analysers (HTDMAs). These HTDMAs are used worldwide in laboratory experiments and field campaigns to measure the water uptake of aerosol particles and have never been intercompared. After an investigation of the different design of the instruments with their advantages and inconveniencies, the methods for calibration, validation and data analysis are presented. Measurements of nebulised ammonium sulphate as well as of secondary organic aerosol generated from a smog chamber were performed. Agreement and discrepancies between the instruments and to the theory are discussed, and final recommendations for a standard instrument are given, as a benchmark for laboratory or field experiments to ensure a high quality of HTDMA data.JRC.H.2-Climate chang

Impact of renal impairment on atrial fibrillation: ESC-EHRA EORP-AF Long-Term General Registry

Background: Atrial fibrillation (AF) and renal impairment share a bidirectional relationship with important pathophysiological interactions. We evaluated the impact of renal impairment in a contemporary cohort of patients with AF. Methods: We utilised the ESC-EHRA EORP-AF Long-Term General Registry. Outcomes were analysed according to renal function by CKD-EPI equation. The primary endpoint was a composite of thromboembolism, major bleeding, acute coronary syndrome and all-cause death. Secondary endpoints were each of these separately including ischaemic stroke, haemorrhagic event, intracranial haemorrhage, cardiovascular death and hospital admission. Results: A total of 9306 patients were included. The distribution of patients with no, mild, moderate and severe renal impairment at baseline were 16.9%, 49.3%, 30% and 3.8%, respectively. AF patients with impaired renal function were older, more likely to be females, had worse cardiac imaging parameters and multiple comorbidities. Among patients with an indication for anticoagulation, prescription of these agents was reduced in those with severe renal impairment, p <.001. Over 24 months, impaired renal function was associated with significantly greater incidence of the primary composite outcome and all secondary outcomes. Multivariable Cox regression analysis demonstrated an inverse relationship between eGFR and the primary outcome (HR 1.07 [95% CI, 1.01–1.14] per 10 ml/min/1.73 m2 decrease), that was most notable in patients with eGFR <30 ml/min/1.73 m2 (HR 2.21 [95% CI, 1.23–3.99] compared to eGFR ≥90 ml/min/1.73 m2). Conclusion: A significant proportion of patients with AF suffer from concomitant renal impairment which impacts their overall management. Furthermore, renal impairment is an independent predictor of major adverse events including thromboembolism, major bleeding, acute coronary syndrome and all-cause death in patients with AF

Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry

Background: Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients. Methods: From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses. Results: Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58–0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52–0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58–0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56–0.98) and composite outcome (aHR: 0.76, 95%CI 0.60–0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome. Conclusions: An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients

Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

Background: Epidemiological studies in atrial fibrillation (AF) illustrate that clinical complexity increase the risk of major adverse outcomes. We aimed to describe European AF patients\u2019 clinical phenotypes and analyse the differential clinical course. Methods: We performed a hierarchical cluster analysis based on Ward\u2019s Method and Squared Euclidean Distance using 22 clinical binary variables, identifying the optimal number of clusters. We investigated differences in clinical management, use of healthcare resources and outcomes in a cohort of European AF patients from a Europe-wide observational registry. Results: A total of 9363 were available for this analysis. We identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients and prevalent non-cardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients with low prevalence of comorbidities; Cluster 3 (n = 2955;31.6%) characterized by patients\u2019 prevalent cardiovascular risk factors/comorbidities. Over a mean follow-up of 22.5 months, Cluster 3 had the highest rate of cardiovascular events, all-cause death, and the composite outcome (combining the previous two) compared to Cluster 1 and Cluster 2 (all P <.001). An adjusted Cox regression showed that compared to Cluster 2, Cluster 3 (hazard ratio (HR) 2.87, 95% confidence interval (CI) 2.27\u20133.62; HR 3.42, 95%CI 2.72\u20134.31; HR 2.79, 95%CI 2.32\u20133.35), and Cluster 1 (HR 1.88, 95%CI 1.48\u20132.38; HR 2.50, 95%CI 1.98\u20133.15; HR 2.09, 95%CI 1.74\u20132.51) reported a higher risk for the three outcomes respectively. Conclusions: In European AF patients, three main clusters were identified, differentiated by differential presence of comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of major adverse outcomes

Conduction of Heat in Inhomgeneous Solids

In this letter we present a method for calculation of linear heat flow in inhomogeneous solids. The method is based on the evaluation of transfer matrices for each layer in a multilayered structure from the Laplace transformation of the partial differential equation of heat conduction. The multilayered structure is then described by a matrix obtained as a chain of products of individual layer transfer matrices and corresponding boundary thermal resistivity matrices. The analytic expression for the nth power of the multilayered transfer matrix is found, describing a periodic multilayered structure composed of n equal multilayered structures. The application of the presented method for calculation of photothermal signals is also shown. Dispersion relation for the thermal waves in inhomogeneous solids is obtained from the matrix elements of the transfer matrix. Finally, from the dispersion relation explicit expressions for the effective values of thermal diffusivity and conductivity of both the discontinuously and continuously inhomogeneous solids are evaluated