1,721,002 research outputs found
Gli strumenti finanziari nazionali di supporto alla riduzione dei consumi energetici negli edifici delle pubbliche amministrazioni
Full text linkPublic Administrations are currently constrained, in their aims of carrying out actions and projects for the limitation of
the energy consumption of buildings, by the scarcity of adequate budgets and by the need of observing the Growth
and Stability Pact. On the contrary, the availability of (and the access to) suitable financial sources would represent
significant opportunities for an economic development characterized by energy and environmental sustainability.
This paper, after a short review of the domestic financial tools actually available for the reduction of their energy
consumption of municipalities, analyses the technical and economic barriers that limit their effective utilization
and that should be properly removed
ANALISI DELLE RISORSE FINANZIARIE NAZIONALI PER LA RIDUZIONE DEI CONSUMI ENERGETICI NELLE PUBBLICHE AMMINISTRAZIONI
No full textThe compliance with the Italian Internal Stability Pact represents a relevant
constraint for Public Administrations in their aims of improving the
efficiency with which they use energy, despite several interesting financial
tools have been released for helping these institutions in the imple
mentation of effective actions.
The available domestic financial tools are here shortly revised, particularly
about their compatibility with the Stability Pact. The role of the socalled
rotative founds is moreover described as a tool for supporting Public
Administrations in improving their energy efficiency, even in the observance
of the limits established by the Stability Pact
Molecular and clinical aspects of factor VII deficiency
No full textFactor VII (FVII) plays an important role in the initiation of blood coagulation, forming a complex with tissue factor (TF) which activates FIX and FX and FVII zymogen. FVII deficiency displays considerable phenotypic and molecular heterogeneity and there are inconsistencies between the clinical picture observed and the underlying clotting and molecular defects. We have reviewed the data available in the literature on FVII-deficient patients. Clinically, cases range from asymptomatic to patients with severe haemorrhagic tendencies. Asymptomatic patients typically have FVII activity levels of >20% and are heterozygotes, double heterozygotes or homozygotes. Mild FVII-deficient patients, with FVII activity levels >2%, may be double heterozygotes or homozygotes for FVII gene missense mutations. Undetectable FVII levels in severely affected patients are often due to severe gene defects such as frameshifts or mutations affecting the splice sites. The analysis of structure-function relationships in FVII deficiency is difficult due to the complexity of the interactions involving FVII. Also, assays using different reagents may give different results with a given plasma sample, and are not very accurate at low levels of FVII which, although relatively low, may be clinically significant, adding complexity to the analysis of FVII deficiency. The sensitivity of our methods for phenotypic evaluation of FVII deficiency remains inadequate
An empirical approach for ranking environmental and energy saving measures in the hotel sector
No full textThe energy demand of the hotel sector of an Italian region is here utilized for hierchizing, by means of an empirical method, efficient measures devoted to energy saving and reduction of CO2 emissions.
Due to the large number of consumers present in the selected territorial area and the lack in detailed data, the energy demand assessment is here carried out by the analysis of a sample of representative consumers.
A short set of indexes, referring to energy and environmental performances, are defined and calculated for different clusters of hotels, grouped on the basis of site characteristics, opening periods, number of beds, and building age. Such indexes are utilised to establish lists of actions with assigned priorities stemming from energy, environmental and economics issues.
Energy planners and decision makers can easily use this approach for defining, implementing and monitoring energy efficiency as well as sustainability policies in the tourist sector of a given geographical area, starting from a limited set of data. The method has been proposed by authors within the assessment of the Sicilian Energy Master Plan
The Persistance of Residual Vein Thrombosis, after an Episode of Deep Vein Thrombosis, and the Risk of New Overt Cancer and Cardiovascular Disease
No full textCANCER AS A PREDICTOR FOR INCREASED PERIPROCEDURAL BLEEDING DURING SURGERY OR PLATELET-INDUCED CHEMOTHERAPY IN CHRONICALLY ANTICOAGULATED PATIENTS
No full textResidual Vein Thrombosis Improves Screening for Occult Cancer: Results On 537 Patients with Idiopathic Deep Vein Thrombosis
No full textBackground: Clinical advantage of extensive screening for occult cancer in patients with idiopathic Deep Vein Thrombosis (DVT) is unknown. We have demonstrated that the Residual Vein Thrombosis (RVT)-based screening for occult cancer improves early detection as well as cancer-related mortality (Siragusa S et al. Blood 2007;110(699):OC). Here we report on final analysis of 537 patients over a period of 8 years.
Objective of the study: We conducted a prospective study evaluating whether a RVT-based screening for cancer is sensitive and influences cancer-related mortality.
Study design: Prospective with two cohorts of DVT patients: the first cohort was monitored for clinical overt cancer only (Group A), while the second (Group B) received complete screening for occult neoplasm and subsequent surveillance.
Materials and methods: Consecutive patients with a first episode of DVT who presented RVT after 3 month of anticoagulation and without signs and/or symptoms for overt cancer. Screening for occult cancer was based on: ultrasound and/or CT scan of the abdomen and pelvis, gastroscopy, colonoscopy or sigmoidoscopy, hemoccult, sputum cytology and tumor markers. These tests were extended with mammography and Pap smear for women and ultrasound of the prostate and total specific prostatic antigen (PSA) for men. All investigations had to be completed within four-weeks from the assessment of RVT. All patients were followed-up for at least 2 years. Incidence and cancer-related mortality was compared between the two groups by survival curves (Kaplan-Mayer) and related Breslow test for statistics.
Results: Over a period of 8 years, 537 patients were included in the analysis: first cohort included 346 patients (Group A), second cohort 191 (Group B). Clinical characteristics between groups were homogenous. During the follow-up, 8.3% of patients developed overt cancer in group A; in group B, 7.8% of patients had diagnosed cancer at the moment of extensive screening while 2 new cases (0.7%) occurred during the follow-up (Table). The sensitivity of this approach was 92.1% (95% confidence intervals 75.2-104.2). Cancer-related mortality was 7.5% in group A and 3.6% in group B (p< 0.001).
Conclusions: The RVT-based screening for occult cancer is highly effective for improving early detection as well as cancer-related mortality in a cohort of 537 patient with DVT of the lower limbs
Patients requiring interruption of long-term oral anticoagulant therapy: the use of fixed sub-therapeutic doses of low-molecular-weight heparin
No full textIntroduction: We tested the efficacy and safety of fixed doses of
Low-Molecular Weight Heparin (LMWH) in patients requiring interruption of
Vitamin-k Antagonist (VKA) because of invasive procedures Methodology:
Pre-operatively, patients discontinued VKA 5 +/- 1days; in those at low-risk for
thrombosis, LMWH was given at a prophylactic dosage of 3.800 U.I. (nadroparin) or
4.000 U.I. (enoxaparin) anti-FXa once daily the night before the procedure. In
patients at high-risk for thrombosis, LMWH was started early after VKA cessation
and given at fixed sub-therapeutic doses (3.800 or 4.000 UI anti-FXa twice daily)
until surgery. Post-operatively, LMWH was reinitiated 12 hours after procedure
while VKA the day after. Heparin was continued until a therapeutic INR value was
reached. The primary efficacy endpoints were the incidence of thromboembolism and
major bleeding from VKA suspension (because of surgery) to 30 +/- 2 days
post-procedure. Results: A total of 328 patients (55.4% at low-risk and 44.6% at
high-risk for thrombosis) were enrolled; 103 (31.4%) underwent major surgery and
225 (68.6%) non major invasive procedures. Overall, thromboembolic events
occurred in 6 patients (1.8%, 95% confidence intervals 0.4 to 3.2), 5 belonging
to high-risk and 1 to low-risk group. Overall, major bleeding occurred in 7
patients (2.1%, 95 CI 0.6 to 3.6), 6 patients belonged to high-risk and 1 to
low-risk group; most of events occurred in high-risk group during major surgery.
Conclusion: LMWH given at fixed sub-therapeutic doses appears to be a feasible
and safe approach for bridging therapy in chronic anticoagulated patients.Summary. Introduction: We tested the efficacy and safety of fixed doses of low-molecular-weight heparin (LMWH) in patients requiring interruption of vitamin-K antagonist (VKA) because of invasive procedures. Methodology: Preoperatively, patients discontinued VKA for 5 +/- 1 days; in those at low risk for thrombosis, LMWH was given at a prophylactic dosage of 3800 UI (nadroparin) or 4000 UI (enoxaparin) anti-factor (F) Xa once daily the night before the procedure. In patients at high risk for thrombosis, LMWH was started early after VKA cessation and given at fixed sub-therapeutic doses (3800 or 4000 UI anti-FXa twice daily) until surgery. Postoperatively, LMWH was reinitiated 12 h after procedure while VKA was reinitiated the day after. Heparin was continued until a therapeutic INR value was reached. The primary efficacy endpoints were the incidence of thromboembolism and major bleeding from VKA suspension (because of surgery) up to 30 +/- 2 days postprocedure. Results: A total of 328 patients (55.4% at low risk and 44.6% at high risk for thrombosis) were enrolled; 103 (31.4%) underwent major surgery and 225 (68.6%) non-major invasive procedures. Overall, thromboembolic events occurred in six patients (1.8%, 95% confidence interval 0.4-3.2), five belonging to the high-risk group and one belonging to the low-risk group. Overall, major bleeding occurred in seven patients (2.1%, 95 confidence interval 0.6-3.6), six patients belonged to the high-risk group and one belonged to the low-risk group; most of the events occurred in the high-risk group during major surgery. Conclusion: LMWH given at fixed sub-therapeutic doses appears to be a feasible and safe approach for bridging therapy in chronic anticoagulated patient
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