Information barriers in shipping: Assessing effects on stakeholder decision-making with respect to the energy efficiency of vessels in the time charter market

Given the increasing pressure for emission reduction through the Paris Agreement and the International Maritime Organisation’s emission reduction ambition set in 2018, energy performance in shipping is more important than ever. Several studies have identified information barriers lead to uncertainty around energy efficiency and vessel performance. This prevents more efficient vessels from being rewarded and discourages the uptake of energy efficiency technologies and operational measures. Poor in-service data quality, suboptimal performance modelling and information asymmetry between stakeholders regarding vessel performance result in challenging decision-making when choosing energy efficiency technologies, operational measures or when fixing a vessel for a charter. There is very little literature focused on investigating decision-making practices in relation to vessel and technology performance to expose specific problems related to information use. This work explores these problems and evaluates the effect of information related shortcomings in vessel efficiency on decision-making in deep sea cargo shipping. A mixed-methods approach is proposed, starting with an exploratory case study. The aim is to understand the use of information and identify information asymmetries encountered by all parties involved when making decisions on fixtures or energy efficiency technology selection. The insights from the case study are used to develop a probabilistic techno-economic model which quantifies uncertainties arising from identified information asymmetries and the impact they have on different stakeholders. A game theoretic framework is used as a basis for the model. As a third step, solutions to reduce uncertainty are tested. These solutions are focused on increasing transparency between stakeholders and are shown to provide a mutually beneficial scenario for both charterers and owners. The novel model developed can be used as a tool to evaluate risk stemming from stakeholder behaviour and the impact this has on operating profit for owners and charterers based on assumptions related to information flow and use. The work is aimed towards creating an evidence base for targeted commercial tools and policy designed to promote and reward vessel efficiency by bridging the information gap between technical and commercial sides of the shipping industry

Seismic vulnerability of masonry heritage buildings in Malta

The structural behaviour of masonry heritage buildings in Malta subjected to seismic action is a major risk in conserving such buildings. This is because Malta lies on a seismic zone which was subjected to high intensity earthquakes in the past (Galea, 2007). Many of the existing masonry heritage buildings were subjected to major earthquakes of 1693, 1743 and 1856, with repairs ranging from minor repairs to partial rebuilding (Abela, 1969; Galea, 2007). The survival of such buildings does not determine the degree of seismic resistance to any future strong tremor. The study will explore the possibility to determine the seismic vulnerability of masonry heritage buildings using Applied Element Method (AEM), a numerical structural modelling. Since AEM was never used to determine seismic vulnerability of masonry heritage buildings in Malta, simple masonry heritage building typology is being analysed in this study.peer-reviewe

Georisks in the Mediterranean and their mitigation

An international scientific conference organised by the Seismic Monitoring and Research Unit, Department of Geoscience, Faculty of Science, Department of Civil and Structural Engineering and Department of Construction and Property Management, Faculty of the Built Environment, University of Malta.Part of the SIMIT project: Integrated civil protection system for the Italo-Maltese cross-border area. Italia-Malta Programme – Cohesion Policy 2007-2013This conference is one of the activities organised within the SIMIT strategic project (Integrated Cross-Border Italo-Maltese System of Civil Protection), Italia-Malta Operational Programme 2007 – 2013. SIMIT aims to establish a system of collaboration in Civil Protection procedures and data management between Sicilian and Maltese partners, so as to guarantee the safety and protection of the citizens and infrastructure of the cross-border area. It is led by the Department of Civil Protection of the Sicilian region, and has as other partners the Department of Civil Protection of Malta and the Universities of Palermo, Catania and Malta. SIMIT was launched in March 2013, and will come to a close in October 2015. Ever since the initial formulation of the project, it has been recognised that a state of national preparedness and correct strategies in the face of natural hazards cannot be truly effective without a sound scientific knowledge of the hazards and related risks. The University of Malta, together with colleagues from other Universities in the project, has been contributing mostly to the gathering and application of scientific knowledge, both in earthquake hazard as well as in building vulnerability. The issue of seismic hazard in the cross-border region has been identified as deserving foremost importance. South-East Sicily in particular has suffered on more than one occasion the effects of large devastating earthquakes. Malta, although fortunately more removed from the sources of such large earthquakes, has not been completely spared of their damaging effects. The drastic increase in the building density over recent decades has raised the level of awareness and concern of citizens and authorities about our vulnerability. These considerations have spurred scientists from the cross-border region to work together towards a deeper understanding of the underlying causes and nature of seismic and associated hazards, such as landslide and tsunami. The SIMIT project has provided us with the means of improving earthquake surveillance and analysis in the Sicily Channel and further afield in the Mediterranean, as well as with facilities to study the behaviour of our rocks and buildings during earthquake shaking. The role of the civil engineering community in this endeavour cannot be overstated, and this is reflected in the incorporation, from the beginning, of the civil engineering component in the SIMIT project. Constructing safer buildings is now accepted to be the major option towards human loss mitigation during strong earthquakes, and this project has provided us with a welcome opportunity for interaction between the two disciplines. Finally the role of the Civil Protection authorities must occupy a central position, as we recognize the importance of their prevention, coordination and intervention efforts, aided by the input of the scientific community. This conference brings together a diversity of geoscientists and engineers whose collaboration is the only way forward to tackling issues and strategies for risk mitigation. Moreover we welcome the contribution of participants from farther afield than the Central Mediterranean, so that their varied experience may enhance our efforts. We are proud to host the conference in the historic city of Valletta, in the heart of the Mediterranean, which also serves as a constant reminder of the responsibility of all regions to protect and conserve our collective heritage.peer-reviewe

021: Clopidogrel low response and correlation between the different tests: light transmission aggregometry, VerifyNow-P2Y12 and V ASP

BackgroundClopidogrel low response correlates with poor prognosis after percutaneous coronary intervention (PCI). Many biological tests are currently available to test the clopidogrel response. However, the presence of any correlation between the different tests is today poorly reported.MethodsIn this prospective study, clopidogrel response was assessed in 100 consecutive patients. All patients were tested between 18h and 24h after a600mg clopidogrel loading dose using 3 different tests: light transmission aggregometry with 10μmol ADP (LTA, results expressed as platelet inhibition percentage), VerifyNow-P2Y12 (VN, results expressed as PRU) and vasodilatator stimulated phosphoprotein (VASP, results expressed as IRP). Patients under chronic clopidogrel therapy were excluded.ResultsThe mean platelet inhibition percentage, PRU value and IRP value were 38.5±13% by LTA, 178±89 PRU by VN and 52±21% by VASP. When results were analyzed as continuous variables, there was a good correlation between the different tests: LTA/VN (R2=0,642, p<0,001), LTA/VASP (R2=0,409, p<0,001) and VN/VASP (R2=0,616, p<0,001). However, when results were analyzed as pre-specified cut-off points to define patients as “low or good responders” (according to the literature: 50% for LTA, 235 PRU for VN and 50% IRP for VASP), only 47% of the patients were defined as “good” or “low responders” by the 3 tests. Altogether, 33% of the patients were defined as “low responders” by only 1 test, 20% by 2 tests and only 16% by the 3 tests.ConclusionIf the correlation between the different tests is good when results are analyzed as continuous variables, each individual is rarely (less than 50%) defined as “low or good responder” by all the 3 tests when recognized cut-off values are used. In that way, a sole test might not be sufficient to manage antiplatelet therapy in an individual patient

056: Biological efficacy of a 600mg loading dose of clopidogrel in ST-elevation myocardial infarction

BackgroundOptimal platelet reactivity (PR) inhibition is critical to prevent thrombotic events in primary percutaneous coronary intervention (PCI). We aimed to determine the relationship between high on-treatment platelet reactivity (HTPR) and ST-elevation myocardial infarction (STEMI) following a 600mg loading dose (LD) of clopidogrel.Methods and resultsWe performed a prospective monocentre study enrolling patients on clopidogrel undergoing PCI. The VASP index was used to assess PR inhibition after clopidogrel LD. HTPR was defined according to the consensus as a VASP index ≥50%. The present study included 833 patients undergoing PCI. Most patients had PCI for an acute coronary syndrome (58.7%). The mean VASP index was 50±23% with a large inter-individual variability (range: 1–94%). Patients with a VASP index ≥50% were significantly older (p=0.03), with a higher BMI (p<0.001), more often diabetic (p=0.03), taking omeprazole (p=0.03), admitted for an ACS and with a high fibrinogen level compared to good responders (VASP<50%). In multivariate analysis BMI, omeprazole use, acute coronary syndrome and high fibrinogen level (p<0.001) remained significantly associated with HTPR. Of importance, in this analysis STEMI was independently associated with HTPR when compared with the other forms of ACS (NSTEMI and unstable angina) with an odd ratio of 2.14 (95% CI: 1.3 –3.5; p=0.003).ConclusionSTEMI is associated with high on-treatment platelet reactivity following 600mg of clopidogrel. The present results suggest that 600mg of clopidogrel may not be able to achieve an optimal PR inhibition in STEMI patients undergoing PCI and more potent drugs may be preferred

Impact of initial clinical presentation on clopidogrel low response

SummaryBackgroundLarge interindividual variability exists in clopidogrel response. Clopidogrel low response correlates with poor prognosis after percutaneous coronary intervention. Some authors also suggest intraindividual variability over time.AimTo assess the impact of initial clinical presentation on clopidogrel low response.MethodsIn this prospective study, clopidogrel response was assessed in 100 patients. Fifty patients presenting with acute coronary syndromes (ACS group) were compared with 50 patients with stable coronary artery disease matched 1:1 for age, sex, body mass index and diabetes (stable group). All patients were tested 18–24h after a 600mg loading dose of clopidogrel using the VerifyNow-P2Y12 test (results expressed as platelet reaction units [PRUs]). Patients under chronic clopidogrel therapy or treated with glycoprotein IIb/IIIa inhibitors, bivalirudin or thrombolytics were excluded.ResultsMean age was 61±12 years in each group; 28% of patients in each group were diabetic; mean body mass index was 27.6±5.6kg/m2 in the ACS group and 27.9±5.9kg/m2 in the stable group (p=0.80). Mean PRU values were 197±81 in the ACS group and 159±94 in the stable group (p=0.03). By multivariable analysis, the ACS group was significantly associated with a higher PRU value (p=0.02). There were significantly more clopidogrel low responders (PRU value>230) in the ACS group (38% vs. 18%; p=0.04).ConclusionOur study confirms that initial clinical presentation, especially ACS, is a strong predictor of clopidogrel low response; this suggests that the evolution of coronary artery disease for one patient influences the clopidogrel response over time. These results are in accordance with recent trials showing a benefit for more aggressive antiplatelet therapy in ACS patients

Platelet inhibition with ticagrelor 60 mg versus 90 mg twice daily in the PEGASUS-TIMI 54 trial

Background The PEGASUS-TIMI 54 (Prevention of Cardiovascular Events in Patients with Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin–Thrombolysis In Myocardial Infarction 54) trial studied 2 doses of ticagrelor, 90 mg twice a day (bid) and 60 mg bid, for long-term prevention of ischemic events in patients with prior myocardial infarction. Both doses similarly reduced the rate of ischemic events versus placebo. The pharmacokinetics and pharmacodynamics of ticagrelor 60 mg bid have not been studied. Objectives In this study, the authors sought to study the pharmacokinetics and pharmacodynamics for ticagrelor 60 mg compared with 90 mg bid. Methods A total of 180 patients who received >4 weeks of study medication had blood sampling in the morning pre-maintenance dose and again 2 h post-dose. All patients received aspirin. Plasma levels of ticagrelor and its active metabolite AR-C124910XX were determined. P2Y12 inhibition was assessed by the VerifyNow P2Y12 assay (Accumetrics, Inc., San Diego, California) (P2Y12 reaction units [PRU]), light transmittance aggregometry (adenosine diphosphate 5 and 20 μmol/l and arachidonic acid), and vasodilator-stimulated phosphoprotein phosphorylation assays. VerifyNow Aspirin assays and serum thromboxane B2 measurements were performed. Results Mean pre- and post-dose plasma levels of ticagrelor were 35% and 38% lower, respectively, with 60 mg versus 90 mg. Both doses achieved high levels of platelet inhibition pre- and post-dose, with numerically slightly more variability with 60 mg: mean (SD) pre-dose PRU values were 59 ± 63 and 47 ± 43 for ticagrelor 60 and 90 mg, respectively (p = 0.34). High platelet reactivity, determined as PRU >208, was rare with the 60-mg pre-dose and was absent post-dose. Platelet reactivity pre- and post-dose, as measured by light transmittance aggregometry or vasodilator-stimulated phosphoprotein assays, was numerically but not significantly lower with 90 mg than with 60 mg. Aspirin response was not affected by either dose. Conclusions Ticagrelor 60 mg bid achieved high levels of peak and trough platelet inhibition in nearly all patients, similar to that with 90 mg bid, helping to explain the efficacy of the lower ticagrelor dose in PEGASUS-TIMI 54

Health promotion and disease prevention in the education of health professionals : a mapping of European educational programmes from 2019

Background Health professionals face barriers in carrying out effective health promotion and disease prevention. To indicate what are the needs for curriculum development in educational programmes, this study aims to provide an overview of how various health professionals are currently trained in health promotion and disease prevention at different educational levels. Methods In 2019, a descriptive mapping exercise was performed focusing on European programmes for different health and healthcare professionals at the three levels of education (undergraduate, postgraduate, and continuous professional development [CPD]). Data were collected by a self-developed online survey that was distributed using a modified snowball method. Results A total of 186 educational programmes of 17 different health professionals were analysed, implemented in 31 countries (60% were undergraduate, 30% postgraduate and 10% CPD programmes). Nearly all programmes indicated that expected outcomes were defined on knowledge (99%), skills (94%) and behaviours/attitudes (89%) regarding health promotion and disease prevention. A multidisciplinary approach was reported to be applied by 81% of the programmes. Traditional teaching methods such as lectures (97%) and assignments (81%) were dominant, while e-learning was less frequently used (46%). Digitalization in health promotion and digital health coaching were the least addressed topics in most programmes. Conclusions Health promotion and disease prevention are reported at all surveyed levels of education for a broad spectrum of health professionals. Educational programmes cover contents on knowledge, skills, and behaviours. There is a need for capacity building and joint development in health promotion education. Specifically, there is a need to include digitalisation and novel teaching in the educational programmes of health promotion and disease prevention.Peer reviewe

039: Platelet reactivity predicts both ischemic and bleeding events at one year follow-up in acute coronary syndome patients receiving prasugrel

There are evidences of a link between platelet reactivity inhibition and thrombotic and bleeding events. We have previously demonstrated that PR after prasugrel loading dose (LD) predicts short-term thrombotic events. We aimed to further investigate the relationship between PR under prasugrel and one-year thrombotic and bleeding events.MethodPatients were prospectively included in this multicentre study if they had a successful PCI for an acute coronary syndrome (ACS) and received prasugrel. Vasodilator-Stimulated Phosphoprotein (VASP index) was measured after prasugrel LD. Endpoint included the rate of thrombotic events (cardiovascular death, myocardial infarction and stent thrombosis) and bleeding events (TIMI) at one year.ResultsThree hundreds and one patients were enrolled. Nine patients (3%) were lost to follow-up at one year. The rates of thrombotic and bleeding events at one year were 7.5 and 6.8% respectively. The mean VASP index after a 60mg LD of prasugrel was 34}23% and 76 patients (25%) were considered as having high on-treatment platelet reactivity (HTPR). Patients with HTPR had a higher rate of thrombotic events compared to good responders (19.7 vs 3.1%;p<0.001). Patients with a minor or major non-CABG related TIMI bleeding had lower PR compared to patients with no bleeding events (21}18 vs 35}23%;p=0.008). In multivariate analysis, the VASP index predicted both thrombotic and bleeding events (OR: 1.44 (95% CI: 1.2–1.72; p<0.001 and 0.75 (95% CI: 0.59–0.96;p=0.024 (respectively, per 10% increase)).ConclusionPlatelet reactivity measurement after prasugrel LD predicts both ischemic and bleedings events at one year follow-up for ACS patients undergoing PCI

Emerging topics in nanophononics and elastic, acoustic, and mechanical metamaterials:An overview

This broad review summarizes recent advances and “hot” research topics in nanophononics and elastic, acoustic, and mechanical metamaterials based on results presented by the authors at the EUROMECH 610 Colloquium held on April 25–27, 2022 in Benicássim, Spain. The key goal of the colloquium was to highlight important developments in these areas, particularly new results that emerged during the last two years. This work thus presents a “snapshot” of the state-of-the-art of different nanophononics- and metamaterial-related topics rather than a historical view on these subjects, in contrast to a conventional review article. The introduction of basic definitions for each topic is followed by an outline of design strategies for the media under consideration, recently developed analysis and implementation techniques, and discussions of current challenges and promising applications. This review, while not comprehensive, will be helpful especially for early-career researchers, among others, as it offers a broad view of the current state-of-the-art and highlights some unique and flourishing research in the mentioned fields, providing insight into multiple exciting research directions