177,879 research outputs found

    Trasferimento di attività della Pubblica amministrazione e passaggi di personale

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    SOMMARIO: 1. L’evoluzione normativa. – 2. Profili oggettivi della fattispecie. – 2.1. L’atto di trasferimento. – 2.2. L’oggetto del trasferimento. – 3. Profili soggettivi: p.a. e dipendenti interessati. – 4. Disposizioni speciali. – 5. Effetti sul rapporto di lavoro. – 6. Informazione e consultazione sindacale. - Davide Casale è autore dei §§ 3, 4, 5 e 6; S. Mainardi è autore dei primi due §§

    T-Wave Alternans: lessons learned from a biophysical ECG model

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    T-wave alternans (TWA) is an alteration of the ECG T-wave which repeats every other beat. An alternating pattern has been also observed at myocytes level, involving both action potential duration and morphology (mainly in phases 2 and 3). While this might happen in a specific region (i.e., myocardial ischemia), it can also involve the entire myocardium. It is still unclear how alternations at the myocytes level are reflected on surface ECG modification of T-waves, especially when in vivo human hearts are considered. We have recently proposed a simple stochastic model of ventricular repolarization (IEEE Trans. Biomed. Eng., 2011), which takes into account both repolarization heterogeneity across the myocardium as well as random beat-to-beat variations in cells' activity. In this work, we generalized that model incorporating a term which describes myocytes alternans related to T-wave variability. Starting from the model and using the electrophysiological formulation developed by van Oosterom, we derived an analytical formula relating surface ECG to variations at the myocytes' level. Several theoretical results were then obtained. First, temporal small random variations in repolafization heterogeneity affect the precision of TWA estimates in a significant way. Second, TWA theoretically differs across leads, but multilead configuration can be used to reduce the effect of noise. Finally, the dependency between TWA and T-wave amplitude was analyzed

    Quantification of Spatial Repolarization Heterogeneity: Testing the Robustness of a New Technique

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    The V-index is a recently-proposed metric related to repolarization heterogeneity (RH) across the myocardium, a key quantity for the development of arrhythmias. The metric is derived from multi-leads ECG recordings and this paper investigates two of its properties: i) the dependency on the lead system (Frank's orthogonal vs. 12 standard leads); ii) the influence of errors in the location of the T-end position. The first investigation was performed by simulations, using a forward ECG model (ECGSIM). In the lead system of interest, the V-index was computed varying the standard deviation of RH (sv). The results showed that the average bias in the estimate of RH (at σφ = 1 ms) ranged from -20.4±4.0% (sv = 20.6 ms) to -26.3±4.0% (sv = 70.9 ms) for the standard system and from -7.0 ± 4.2% to - 19.0 ± 4.2% for the Frank's one. While the bias diminished, the vulnerability to noise slightly increased. Secondarily, 68 ECGs from the E-OTH-12-0068-010 THEW database were analyzed. To simulate mislocation, the T-end point was consistently moved (±20 ms) around its correct position and the V-index computed. The average differences in the V-index estimates across the population were always smaller than 1%. This is a desirable property, given the discrepancies across methods in locating T-end positions
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