Nuovi e vecchi anticoagulanti: impiego, profilo emorragico e dati di outcome nell'Ospedale di Lucca.

Introduzione: Tra i farmaci ad utilizzo extraospedaliero, gli anticoagulanti orali sono tra quelli a maggior rischio di reazioni avverse. I risultati incoraggianti sulla prevenzione dell’ictus hanno favorito lo sviluppo di nuove molecole ad azione inibitrice diretta della trombina, dabigatran, rivaroxaban ed apixaban. Dagli studi clinici alla base della approvazione di questi farmaci risulta che tutti e tre i NAO hanno comportato una riduzione statisticamente significativa dell’ictus cerebrale emorragico, la complicanza più temuta della terapia con anticoagulanti orali. Inoltre, tutti e tre i farmaci hanno ridotto il rischio di sanguinamento, come dimostrato dalla minor incidenza di sanguinamenti maggiori per apixaban e dabigatran 110 mg e dalla riduzione dei sanguinamenti fatali per rivaroxaban. I primi dati ufficiali post-marketing europei rilevano che la frequenza con cui avvengono sanguinamenti fatali con dabigatran è significativamente inferiore rispetto a quella osservata negli studi clinici che hanno supportato l’autorizzazione dei NAO suggerendo, comunque, di tenere questo aspetto sotto stretto controllo. Ugualmente tranquillizzanti sono i dati di sorveglianza post-marketing rilasciati dalla FDA ad inizio novembre 2012 (Mini Sentinel pilot of the Sentinel Initiative) che dimostrano un’incidenza di emorragie equivalenti per dabigatran e warfarin in un ampio numero di pazienti con FA dopo l’inizio della TAO nel mondo reale. Da circa un anno è stata approvata dall'AIFA la commercializzazione in Italia dei nuovi anticoagulanti orali (NAO). Pochi sono per ora i dati sulla sicurezza di utilizzo di tali farmaci nella pratica clinica italiana. Scopo dello studio è analizzare retrospettivamente l'esposizione a farmaci anticoagulanti di casi non selezionati di emorragia giunti al Pronto Soccorso e la correlazione dell'esposizione farmacologica con l'outcome dell'evento. Scopo secondario è inoltre analizzare il profilo clinico dei pazienti sottoposti ad anticoagulazione con NAO in un setting ospedaliero. Risultati: Sono stati estratti 47 casi di emorragia, di età compresa tra i 44 ed i 103 anni. Il 64% circa dei pazienti risultava esposto ad anticoagulanti, mentre più di un terzo delle emorragie si sono verificate in pazienti non anticoagulati. Tra i pazienti sottoposti a terapia anticoagulante, il 47% era in trattamento con warfarin ed il 33% con NAO. Tra i pazienti anticoagulati con NAO, il 50% aveva una prescrizione che risultava inappropriata al momento dell'osservazione rispetto alle linee guida e raccomandazioni internazionali. Tra i pazienti in NAO, di almeno 12 anni in media più anziani rispetto alla popolazione dei trial, il 62% degli esposti a dabigatran e il 100% degli esposti a rivaroxaban aveva una compromissione moderata o severa della funzione renale. Nel sottogruppo dabigatran sono state più frequenti le emorragie gastrointestinali che le emorragie intracraniche, mentre nel gruppo warfarin l'andamento è stato opposto. Il ricorso ad emotrasfusione ed il calo di emoglobina correlato ai sanguinamenti gastrointestinali è stato però percentualmente più rappresentato nel sottogruppo warfarin, così come il ricorso al ricovero e l'outcome infausto. Conclusioni: nelle popolazioni di pazienti in NAO che sono andate incontro ad eventi emorragici, sono rappresentati in maniera consistente errori prescrittivi in base alle caratteristiche di base del paziente. E' verosimile pertanto che l'educazione prescrittiva e la maggiore esperienza nell'uso di questi nuovi farmaci portino ad una riduzione degli effetti avversi. Maggior attenzione dovrebbe essere posta all'utilizzo dei NAO nei pazienti di età avanzata e con fattori di rischio di instabilizzazione della funzione renale

Metodologia para planejamento de capacidade de Call Center

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro Tecnológico.Este trabalho apresenta uma metodologia para planejamento de capacidade de um call center, considerando os índices de desempenho definidos pela Agência Nacional de TELecomunicações (ANATEL) para a prestação de serviços de telecomunicações. Apresenta-se um estudo das tecnologias e equipamentos envolvidos na composição de uma central de atendimento e uma análise das variáveis relevantes para o dimensionamento e projeções de volumes de chamadas. Um estudo de caso, considerando um call center de uma empresa de telefonia celular, ilustra a metodologia proposta

EU Regional Competitiveness Index RCI 2013

To measure the different dimensions of competitiveness at the regional level, the European Commission has developed the Regional Competitiveness Index – RCI. The RCI was published in 2010 and this is the 2013 edition, which includes most recent data and implements improvements and refinements. RCI 2013 reveals a strong regional dimension of competitiveness, which national level indicators cannot capture, and a polycentric pattern with strong capital and metropolitan regions in many parts of Europe. Some capital regions are surrounded by similarly competitive regions, but in many countries, particularly in the less developed Member States in Central and Eastern Europe, regions neighboring the capital are less competitive.JRC.G.3-Econometrics and applied statistic

Airborne acoustic emission of an abrasive waterjet cutting system as means for monitoring the jet cutting capability

Abrasive waterjet cutting is a manufacturing technology making use of a high-speed waterjet with abrasive particles in suspension, for cutting materials with different mechanical properties. Product quality requirements are pushing towards an improvement of tracking and stabilization methods of the relevant process variables. Amongst those, the jet kinetic power defines the cutting capability and has a significant impact on the final cut features. This variable is subject to relevant fluctuations versus time. Besides, the current state of the art does not provide means for its in-line monitoring. The aim of this contribution is to monitor the airborne acoustic emission of an abrasive waterjet cutting head and investigate its correlation with the jet kinetic power. The investigation is carried out by means of factorial studies, in which the jet is fired at various water pressures and abrasive feed rates, providing different kinetic powers. The acoustic emission is synchronously monitored by means of a condenser microphone, installed on the cutting head. Data at frequencies above 40 kHz is found to constitute a robust and selective acoustic signature of the airborne jet. The acoustic signature is proven to be an effective in-line indicator of the jet kinetic power and its pressure-induced variations, whilst abrasive-induced variations remain undetected. A calibration procedure is presented, for translating the acoustic data into a jet kinetic power. The method is validated by means of further experiments that envisage its deployment in a real scenario. Overall, the presented method constitutes a robust tool for monitoring pressure-induced variations of the jet cutting capability

RCI 2010: Some in-depth analysis

The European Commission has recently published the first edition of the Regional Competitiveness Index (RCI) (Annoni and Kozovska, 2010). The index provides a tool to improve the understanding of competitiveness at the regional level by showing the strengths and weaknesses of each of the European regions at the NUTS2 level in a number of dimensions related to competitiveness. The analysis offered by the first edition of the RCI is a snapshot of regional competitiveness as it is in 2010 and is based upon data mostly spanning between 2007 and 2009. The present document takes a step further and offers a two-fold analysis based on the RCI indices: an exploratory spatial data analysis and an analysis of possible relationships between exogenous indicators and the RCI index and sub-indices.JRC.DG.G.3-Econometrics and applied statistic

Tree-based approaches for understanding growth patterns in the European regions

The paper describes an empirical analysis to understand the main drivers of economic growth in the European Union (EU) regions in the past decade. The analysis maintains the traditional factors of growth used in the literature on regional growth - stage of development, population agglomeration, transport infrastructure, human capital, labour market and research and innovation - and incorporates the institutional quality and two variables which aim to reflect the macroeconomic conditions in which the regions operate. Given the scarcity of reliable and comparable regional data at the EU level, large part of the analysis has been devoted to build reliable and consistent panel data on potential factors of growth. Two non-parametric, decision-tree techniques, randomized Classication and Regression Tree and Multivariate Adaptive Regression Splines, are employed for their ability to address data complexities such as non-linearities and interaction eects, which are generally a challenge for more traditional statistical procedures such as linear regression. Results show that the dependence of growth rates on the factors included in the analysis is clearly non-linear with important factor interactions. This means that growth is determined by the simultaneous presence of multiple stimulus factors rather than the presence of a single area of excellence. Results also conrm the critical importance of the macroeconomic framework together with human capital as major drivers of economic growth of countries and regions. This is overall in line with most of the economic literature, which has persistently underlined the major role of these factors on economic growth but with the novelty that the macroeconomic conditions are here incorporated. Human capital also has an important role, with low-skilled workforce having a higher detrimental eect on growth than high-skilled. Not surprisingly, other important factors are the quality of governance and, in line with the neoclassical growth theory, the stage of development, with less developed economies growing at a faster pace than the others. The evidence given by the model about the impact of other factors on economic growth such as those on the quality of infrastructure or the level of innovation seems to be more limited and inconclusive. The analysis conclusions support the reinforcement of the EU economic governance and the conditionality mechanisms set in the new architecture of the EU regional funds 2014-2020 whose rationale is that the eectiveness of the expenditure is conditional to good institutional quality and sound economic policies

Protection for Victims of Human Trafficking in Brazil

La trata de personas es una acción ilegal presente en todomundo, incluso en Brasil. El Protocolo de las Naciones Unidascontra la Trata de Personas fue ratificado por Brasil en 2004. Apesar de esto, aún la evolución normativa del país no ha sidosignificativa. Este artículo busca analizar la protección normativaexistente y futura a las víctimas, especialmente extranjeras, detrata de personas en Brasil. Así, inicialmente se presenta lo que secomprende como trata de personas, con base en el Protocolo delas Naciones Unidas para prevenir, reprimir y sancionar la trata depersonas, especialmente mujeres y niños, y son apuntadas algunasconsideraciones sobre la realidad de la trata de personas en elmundo y en Brasil. En la secuencia son presentadas las medidasde protección a las víctimas, y previstas en el Protocolo de lasNaciones Unidas. Por último, son enumeradas y analizadas lasacciones normativas existentes y los proyectos de ley que puedencambiar esta realidad. La conclusión del estudio indica que Brasilaún tiene una débil protección para las víctimas extranjeras detrata de personas, pero hay una perspectiva optimista de mejoríacon los proyectos de ley que tramitan en el Congreso Nacional.Human trafficking is an illegal action observed in the whole world,even in Brazil. The Protocol of the United Nations against humantrafficking was ratified by Brazil in 2004. However, the countryhas not shown a significant regulatory evolution. This article isintended to analyze present and future norms to protect victims(foreign victims, especially) of human trafficking in Brazil. First, thearticle presents what is understood as human trafficking, basedon the protocol of the United Nations to prevent, repress, andpenalize human trafficking (women and children, specifically); thearticle also describes some considerations about the reality ofhuman trafficking in Brazil and worldwide. The sequence showsthe measures taken to protect victims, contemplated in the UnitedNations protocol. Finally, the article provides a list of the existingregulatory actions and the bills than can change this reality. Theconclusion of the study indicates that Brazil still offers a weakprotection for foreign victims of human trafficking, but an optimisticimprovement perspective is shown in relation to the bills currentlyanalyzed by the National Congress

An innovative machine for Fused Deposition Modeling of metals and advanced ceramics

The design of a new additive manufacturing (AM) system based on extrusion and 3D deposition of a mixture of metal (or advanced ceramic) powder and polymeric binder is described in this paper. The proposed system is totally innovative in terms of combination of deposited work material, extrusion system (head and nozzle), and deposition work table, which is based on a 5-axes parallel kinematics machine (PKM). The extrusion head and nozzle have been designed in order to be able to extrude high viscosity mixtures with low polymeric content. The 5-axes PKM is aimed at obtaining a good surface quality of the deposited work and reducing the need for supports during deposition. After the deposition, the material is de-binded and sintered to nearly the density of the solid material as-cast. The design and kinematics of the machine and especially the PKM table is described in this paper, the main design issues are discussed and some preliminary extrusion and sintering results are presented