Applicazione delle metodologie Lean alla progettazione e industrializzazione: il caso ThyssenKrupp Encasa

L'oggetto del testo è il frutto di un progetto di revisione dei costi associati alla produzione di piattaforme elevatrici di tipo inclinato. L'analisi ha come obiettivo un saving annuo del 15% e si sono utilizzate diverse strategie, dalla riprogettazione dei pezzi all'implementazione dei processi, fino alla gestione della Supply Chain. Si riportano in dettaglio i metodi utilizzati ed alcuni esempi pratici dei miglioramenti apportati. Particolare attenzione è stata dedicata al progetto d'insourcing per la produzione di binari del modello RPSP, con l'analisi degli sfridi generati e la creazione di una linea apposita

A Novel Approach to Fuzzy Clustering based on a Dissimilarity Relation extracted from Data using a TS System

Clustering refers to the process of unsupervised partitioning of a data set based on a dissimilarity measure, which determines the cluster shape. Considering that cluster shapes may change from one cluster to another, it would be of the utmost importance to extract the dissimilarity measure directly from the data by means of a data model. On the other hand, a model construction requires some kind of supervision of the data structure, which is exactly what we look for during clustering. So, the lower the supervision degree used to build the data model, the more it makes sense to resort to a data model for clustering purposes. Conscious of this, we propose to exploit very few pairs of patterns with known dissimilarity to build a TS system which models the dissimilarity relation. Among other things, the rules of the TS system provide an intuitive description of the dissimilarity relation itself. Then we use the TS system to build a dissimilarity matrix which is fed as input to an unsupervised fuzzy relational clustering algorithm, denoted any relation clustering algorithm (ARCA), which partitions the data set based on the proximity of the vectors containing the dissimilarity values between each pattern and all the other patterns in the data set. We show that combining the TS system and the ARCA algorithm allows us to achieve high classification performance on a synthetic data set and on two real data sets. Further, we discuss how the rules of the TS system represent a sort of linguistic description of the dissimilarity relation

Newborn hearing screening protocol in tuscany region

Background: Newborn hearing screening has to be considered the first step of a program for the identification, diagnosis, treatment and habilitation/rehabilitation of children with hearing impairment. Main Part: In Tuscany Region of Italy, the universal newborn hearing screening is mandatory since november 2007. The first guidelines for the execution of the screening have been released in June 2008; then many other Italian regions partially or totally adopted these guidelines. On the basis of the experience from 2008 and according to the recent evidences in the scientific literature, a new screening protocol was released in Tuscany region. The new protocol is an evolution of the previous one. Some issues reported in the previous protocol and in the Joint Committee on Infant Hearing statement published in 2007 were revised, such as the risk factors for auditory neuropathy and for late onset, progressive or acquired hearing loss. The new updated guidelines were submitted to the Sanitary Regional Council and then they have been approved in August 2016. The updated screening protocol is mainly aimed to identify newborns with a congenital moderate-to-profound hearing loss, but it also provides indications for the audiological follow-up of children with risk's factor for progressive or late onset hearing loss; further it provides indications for the audiological surveillance of children at risk for acquired hearing impairment. Then, in the new guidelines the role of the family paediatrician in the newborn hearing screening and audiological follow-up and surveillance is underscored. Finally the new guidelines provide indications for the treatment with hearing aids and cochlear implant, in accordance with the recent Italian Health Technology Assessment (HTA) guidelines. Conclusions: In the paper we report the modality of execution of the universal newborn hearing screening in the Tuscany Region, according to the recently updated protocol. The main features of the protocol and the critical issues are discussed

Assessment of management of a golf course by means of sustainability indicators

Golf courses are supposed to produce remarkable negative effects on the environment, due to some techniques involved in their management. To provide data useful for the proper assessment of the agro-environmental sustainability of a golf course, the framework agro-environmental sustainability information system (AESIS) was used, utilizing a set of indicators suitable to evaluate different dimensions of sustainability (physical, ecological, productive and social). The management of areal golf course located in Tuscany (central Italy) was compared to an alternative land use of the same area represented by an ordinary farm based on a sunflower-wheat rotation. Assessment indicators were selected by applying a conceptual model based on ecology theory and were calculated considering site-specific production and pedo-climatic features of the area. Different weighting scenarios were hypothesized in order to have different management options assessed and to carry out a targeted sensitivity analysis. Main results confirmed the significant impact of golf management on some ecological characteristics but the holistic assessment of AESIS approach permitted an overall evaluation that comprised a wide range of different issues. AESIS demonstrated to be a practical and adaptive tool able to perform an efficient comparison of possible land destinations

Genetic stress echocardiography: role of A2a receptors polymorphism in modulating coronary flow reserve response in non-ischemic dilated cardiomyopathy

Background: Vasodilator stress imaging is based on coronary A2a receptor stimulation via endogenous adenosine (with dipyridamole administration), exogenous adenosine, or selective A2a receptor stimulation (with binodenoson).The recognized inter-individual variability in response to adenosine might be in part determined by genetic polymorphism in A2a adenosine receptors. Aim: to assess whether A2a receptor (263 C>T and 1976 C>T) polymorphism affects the coronary flow reserve (CFR) response in patients with non-ischemic dilated cardiomyopathy (DCM). Methods: we evaluated 44 DCM patients 34 males; age 62?9 years) by transthoracic dipyridamole (0.84 mg/kg) stress echocardiography. All patients had an ejection fraction <40% (mean 21.1?16.3%) and angiographically normal coronary arteries with NYHA class <3. CFR was assessed on left anterior descending coronary artery using Doppler as the ration of maximal peak vasodilation (dipyridamole) to rest diastolic flow velocity. All patients underwent peripheral blood sampling and A2a receptor genotyping with PCR and enzyme restriction analysis. Results: CFR was 2.1?0.6 (range=1.5-4). There was no correlation between CFR and 263 C>T variant of A2a gene. However, patients with 1976 TT genotype had significantly lower values from 1976 CC patients (p<0.05). The 7 patients omozygous for 1976 TT had an OR=8.8 (95% CI, 1-81, p=0.04) for abnormal CFR. Conclusion: In DCM patients 1976 C>T polymorphism of the adenosine A2A receptor gene may affect CFR response. In particular, the 1976-TT variant of A2a gene blunts the coronary vasodilatory response

Elevated Interleukin-6 Levels Are Associated With an Increased Risk of QTc Interval Prolongation in a Large Cohort of US Veterans

Background: Although accumulating data indicate that IL-6 (interleukin-6) can promote heart rate-corrected QT interval (QTc) prolongation via direct and indirect effects on cardiac electrophysiology, current evidence comes from basic investigations and small clinical studies only. Therefore, IL-6 is still largely ignored in the clinical management of long-QT syndrome and related arrhythmias. The aim of this study was to estimate the risk of QTc prolongation associated with elevated IL-6 levels in a large population of unselected subjects. Methods and results: An observational study using the Veterans Affairs Informatics and Computing Infrastructure was performed. Participants were US veterans who had an ECG and were tested for IL-6. Descriptive statistics and univariate and multivariate regression analyses were performed to study the relationship between IL-6 and QTc prolongation risk. Study population comprised 1085 individuals, 306 showing normal (&lt;5 pg/mL), 376 moderately high (5-25 pg/mL), and 403 high (&gt;25 pg/mL) IL-6 levels. Subjects with elevated IL-6 showed a concentration-dependent increase in the prevalence of QTc prolongation, and those presenting with QTc prolongation exhibited higher circulating IL-6 levels. Stepwise multivariate regression analyses demonstrated that increased IL-6 level was significantly associated with a risk of QTc prolongation up to 2 times the odds of the reference category of QTc (e.g. QTc &gt;470 ms men/480 ms women ms: odds ratio, 2.28 [95% CI, 1.12-4.50] for IL-6 &gt;25 pg/mL) regardless of the underlying cause. Specifically, the mean QTc increase observed in the presence of elevated IL-6 was quantitatively comparable (IL-6 &gt;25 pg/mL:+6.7 ms) to that of major recognized QT-prolonging risk factors, such as hypokalemia and history of myocardial infarction. Conclusions: Our data provide evidence that a high circulating IL-6 level is a robust risk factor for QTc prolongation in a large cohort of US veterans, supporting a potentially important arrhythmogenic role for this cytokine in the general population

Multicentre Italian study of SARS-CoV-2 infection in children and adolescents, preliminary data as at 10 April 2020

Data on features of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children and adolescents are scarce. We report preliminary results of an Italian multicentre study comprising 168 laboratory-confirmed paediatric cases (median: 2.3 years, range: 1 day-17.7 years, 55.9% males), of which 67.9% were hospitalised and 19.6% had comorbidities. Fever was the most common symptom, gastrointestinal manifestations were frequent; two children required intensive care, five had seizures, 49 received experimental treatments and all recovered

Trials

BACKGROUND: The aim of this open-label, randomized controlled trial conducted in four African countries (Madagascar, Niger, Central African Republic, and Senegal) is to compare three strategies of renutrition for moderate acute malnutrition (MAM) in children based on modulation of the gut microbiota with enriched flours alone, enriched flours with prebiotics or enriched flours coupled with antibiotic treatment. METHODS: To be included, children aged between 6 months and 2 years are preselected based on mid-upper-arm circumference (MUAC) and are included based on a weight-for-height Z-score (WHZ) between - 3 and - 2 standard deviations (SD). As per current protocols, children receive renutrition treatment for 12 weeks and are assessed weekly to determine improvement. The primary endpoint is recovery, defined by a WHZ >/= - 1.5 SD after 12 weeks of treatment. Data collected include clinical and socioeconomic characteristics, side effects, compliance and tolerance to interventions. Metagenomic analysis of gut microbiota is conducted at inclusion, 3 months, and 6 months. The cognitive development of children is evaluated in Senegal using only the Developmental Milestones Checklist II (DMC II) questionnaire at inclusion and at 3, 6, and 9 months. The data will be correlated with renutrition efficacy and metagenomic data. DISCUSSION: This study will provide new insights for the treatment of MAM, as well as original data on the modulation of gut microbiota during the renutrition process to support (or not) the microbiota hypothesis of malnutrition. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03474276 Last update 28 May 2018