1,696 research outputs found
CARDIAC REMODELING IN PATIENTS WITH HFrEF TREATED WITH SACUBITRIL/VALSARTAN: ECHOCARDIOGRAPHIC ANALYSIS
No full textAim of the study: The aim of the present study was to assess reverse remodelling in patients with HFrEF after six months of treatment with sacubitril/valsartan through 3D echocardiography and two-dimensional Speckle Tracking echocardiography, which are known to allow automatic and reproducible assessment of ventricular volumes, ejection fraction, left atrium volume and global longitudinal strain of the left ventricle and left atrium, and other additional echocardiographic parameters. Regarding right heart, size and function were assessed, with PAPS, TAPSE and S'TDI estimated.
A further aim of the study was to analyse the clinical and echocardiographic baseline characteristics of the patients in order to identify the presence of factors predictive of significant reverse remodelling, and, thus, of response to sacubitril/valsartan therapy.
Finally, the variation in atrial natriuretic peptides plasmatic levels after sacubitril/valsartan therapy was also evaluated.
Material and Methods: In this prospective longitudinal study, patients with HFrEF treated with sacubitril/valsartan were enrolled. The following were inclusion criteria: age over 18, EF ≤ 35%, NYHA class ≥ II, treatment with the maximum tolerated dosage of ACEi or ARB or patients naïve to ACEi or ARB, undergoing pre-treatment with one of theese drugs. Exclusion criteria were: symptomatic hypotension, systolic blood pressure 5.2 mmol/L, history of angioedema, adverse reactions during ACEi/ARB therapy, concomitant initiation of therapy that may induce reverse remodelling (for example, CRT implantation or coronary revascularization during follow-up or in the six months prior to enrolment), non-sinus rhythm, suboptimal acoustic window. Patients have been undergoing a clinical examination, 12-lead electrocardiogram, transthoracic echocardiogram (2D/3D parameters and 2D-Speckle Tracking), and dosage of natriuretic peptides before the start of therapy with sacubitril/valsartan and in follow-up at 6 months. Functional assessment was performed using the NYHA classification.
Results: The final study population consisted of 32 patients. At the time of the follow up several echocardiographic parameters improved significantly in the entire study population. 13 (41%) of the patients in the study population were classified 'responders' and 19 (59%) were 'super responders'. In the 'responders' group more severe left ventricular remodelling before treatment was documented, in particular greater VTDi values and higher indexed atrial volumes.
An improvement in global ventricular and atrial strain was also observed in 'responders', although less marked than the other group.
Conclusions: Sacubitril/valsartan significantly improves reverse remodeling in patients with HFrEF. This result tends to occur in patients with a ventricular dilation of lesser severity. In accordance with these considerations, the drug should be used early and independently of the apparent clinical "stability" to avoid further progression of ventricular remodelling. Further studies may lead to an indication of sacubitril/valsartan since an earlier stage of the disease
Direct oral anticoagulants use in elderly patients with non valvular atrial fibrillation. state of evidence
No full textNon-valvular atrial fibrillation (NVAF) increases the risk of stroke by three-to five-fold, especially in elderly patients, creating a huge burden on medical system as well as a negative impact on patients' lives. Balancing efficacy and bleeding risk is a challenge when considering anticoagulation therapy in elderly patients, because of their frequent high risk of both stroke and bleeding. Real world data reveal the underuse of anticoagulation in the elderly, especially due to physicians' fear of bleeding, often neglecting the thromboembolic risk. Care of elderly patients with NVAF is often complicated by factors including adherence, cognitive impairment, health literacy, risk of falling, adverse effects, involvement of caregivers, and patient-physician relationship. Therefore, shared decision making and conversations between clinicians and patients are crucial. In addition, elderly patients often suffer from multiple comorbidities, requiring multiple concomitant medications, with an increased risk of drug interactions. Four non-Vitamin K antagonist oral anticoagulants, the so-called direct oral anticoagulants (DOACs) - dabigatran, rivaroxaban, apixaban and edoxaban - have been approved for reducing the risk of stroke and systemic embolism in patients with NVAF. Clinical trials and real-world data show the advantages of this class of drugs compared to conventional anticoagulation in the treatment of elderly patients with NVAF and identify subgroups of older patients who may be more suitable candidates for particular agents. However, there are conflicting opinions on the absolute benefit of DOACs use in elderly patients. A key factor to consider is that elderly patients frequently suffer from renal impairment and therefore dose adjustments according to creatinine clearance are mandatory for DOACs. As each DOAC comes with its own unique advantages and safety profile, a personalized case by case approach should be adopted to decide on the appropriate anticoagulation regimen for elderly patients after weighing the overall risks and benefits of therapy
TUTELA DEL LAVORO E LIBERTA' D'IMPRESA NEI PROCESSI DI ESTERNALIZZAZIONE
No full textL’elaborato analizza le conseguenze lavoristiche della successione fra imprenditori, muovendo da una ricognizione delle varie tipologie di esternalizzazione con le relative esigenze e principali criticità.
L’indagine si concentra in primo luogo sul trasferimento d’azienda, esaminando la normativa e la giurisprudenza europee per passare poi alla disciplina di diritto interno, alle procedure sindacali e a uno specifico focus sul trasferimento delle aziende in crisi.
Successivamente l’autore si sofferma sull’appalto, prendendone in particolare considerazione gli indici di genuinità, i criteri di distinzione dalla somministrazione illecita di manodopera e la tutela delle maestranze in caso di avvicendamento fra imprese.
Da ultimo, la ricerca approfondisce le c.d. “clausole sociali”, sia di prima che di seconda generazione, valutandone la compatibilità con il diritto eurounitario e con la costituzione nonché riflettendo sui possibili rimedi in caso di loro violazione.The author analyzes the labour consequences of the succession between entrepreneurs, starting from a recognition of the various types of outsourcing with the related needs and main critical issues.
The survey focuses primarily on the transfer of businesses, examining European legislation and case-law and then moving on to internal legislation, trade union procedures and a specific focus on the transfer of companies in crisis.
The author then dwells on the contract, taking into account in particular the indications of authenticity, the criteria of distinction from the illicit administration of labour and the protection of workers in the event of turnover between companies.
Finally, the research deepens the "social clauses", both first and second generation, assessing their compatibility with European law and with the constitution and reflecting on possible remedies in case of their violation
Ultra Low Carbon Vehicles: New Parameters for Automotive Design
No full textAs the influence of vehicle emissions on our environment has become better understood, the UK government has recently placed urgent emphasis on the implementation of low carbon
technologies in the automotive industry through: the UK Low Carbon Industrial Strategy. The overall objective is to offer big incentives to consumers and support for the development of infrastructure and engineering solutions. This scheme however does not consider how the development of functional and experiential user value might drive consumer demand, contributing to the adoption of low carbon vehicles (LCVs) in the mass market.
With the emergence of the North East of England as the UK’s first specialised region for the development of ultra-low carbon vehicles (ULCVs), ONE North East, as a development agency for the region's economic and business development, and Northumbria University Ideas-lab have supported a project to facilitate innovation through the collaboration of technology, research and development (R&D) and business. The High Value Low Carbon (HVLC) project aims to envisage
new user value made possible by the integration of low carbon vehicle platforms with new process and network technologies. The HVLC consortium represents vehicle manufacturers and their suppliers as well as technology based companies and through an ongoing process of design concept generation the project offers a hub for innovation led enterprise.
Whilst new technological developments in areas such as power generation, nano materials, hydrogen fuel cells, printed electronics and networked communications will all impact on future automotive design, the mass adoption of low carbon technologies represents a paradigm shift for the motorist. This paper aims to describe how the mapping of new parameters will lead to new transport scenarios that will create the space for new collaborative research on user experiences supported by innovative technologies and related services
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Matteo Maria Boiardo (1441-1494)
No full textMatteo Maria Boiardo – contemporary of Sir Thomas Malory and forerunner of Shakespeare, Spenser, Milton, Cervantes, Tolkien, and C.S. Lewis – is best known as the author of the Orlando Innamorato [Orlando in Love], a poem in ottava rima organically merging Carolingian epic and Arthurian romance. He was also a lyric and pastoral poet, playwright, and translator of classical texts into the Italian vernacular. Matteo was active in Italy during the years of 1463 throughout 1494, the year of his death
Uno sguardo all'Est. Lavoro e diritti fondamentali in Russia e negli altri Paesi della Comunità di Stati indipendenti
No full textNel contributo l'autore, dopo aver esaminato i diritti fondamentali del lavoro presenti nelle Costituzioni dei Paesi della Comunità di Stati indipendenti, si sofferma sul diritto del lavoro russo. La trattazione, a carattere diacronico, abbraccia i rami principali del diritto del lavoro: il rapporto individuale, le relazioni collettive, il mercato del lavoro. L'autore rileva una sorprendente continuità nelle linee essenziali del diritto del lavoro russo, pur nel susseguirsi di sistemi socioeconomici completamente diversi. Egli conclude che il diritto del lavoro russo appartiene saldamente alla matrice europea della materia.The contribution of the author starts by examining fundamental labour rights recognised by the Constitutions of the Countries of the Community of Independent States. Then the author focuses upon Russian Labour Law, going through the history of the main branches of the discipline: the individual relationship, industrial relations, the labour market. The article finds a surprising continuity in the essential lines of Russian Labour Law, in spite of the completely different socio-economic systems that were experimented in Russia during the twentieth century. The author concludes that Russian Labour Law clearly belongs to the European matrix of the discipline
Corpo, spazio, architettura. Fenomenologia dell’esperienza spaziale Matteo Vegetti, Fabrizia Bandi (eds.), Editrice Morcelliana, Brescia 2024
No full textThe author reviews "Corpo, spazio, architettura: Fenomenologia dell’esperienza spaziale," edited by Matteo Vegetti and Fabrizia Bandi. The book examines the philosophical underpinnings of spatial experience through a phenomenological lens, engaging with both traditional and contemporary notions of how space, body, and architecture interconnect. The author highlights the text\u27s exploration of how architects and designers might integrate phenomenological insights into their work, transforming space from mere physical dimensions into lived, experienced reality. The review appreciates the book’s thematic organization, which starts with foundational theories from Merleau-Ponty and expands through discussions on virtual spaces and the future of architecture in the digital age. Through this anthology, readers gain a comprehensive view of the architectural implications of phenomenological thought, making it a critical resource for anyone involved in the conceptualization and design of space
A step forward towards increasing the mobility and participation of people with disabilities utilizing Satellite Navigation Technology Applications
No full textLarge groups of the population in Europe encounter significant difficulties in taking part in everyday life due to their functional limitations. The NADIA (NAvigation for DIsability Applications) Project, funded and promoted by the Italian Space Agency (ASI) and implemented by Thales Alenia Space Italia with the collaboration of a mixed team of companies, university and user associations, has made concrete steps forward in demonstrating that satellite navigation applications can have an important role in facilitating the mobility of people with disabilities. This paper describes not only some basic features of the system, but looks at how they are related to the process of defining user needs and requirements, highlighting the role of end users and of professional users of Assistive Technology (AT)
St. George and the Dragon or the town planner as a story-teller. In conversation with Bernardo Secchi about Il racconto urbanistico / Der heilige Georg und der Drache, oder: Der Stadtplaner als Geschichtenerzähler. Ein Gespräch mit Bernardo Secchi über Il racconto urbanistico
No full textAt the end of the second edition of his Storia dell’architettura italiana, Manfredo Tafuri declares that “one book assumes a crucial relevance”1 in finding a way out of the endemic crisis of modern architecture in the 1980s: Il racconto urbanistico. The publication of this work by the Italian urban planner 2 Bernardo Secchi in 1984 constitutes a unique event in recent European architecture—an event that still has not been appropriately described or analyzed. Matteo D’Ambros and Roberto Zancan met with the author to discuss the circumstances of the book’s publication. In a world of short memory, revisiting the possible contribution of literary studies to architecture and urban planning promises to shed light on the contemporary understanding of the disciplines. / Manfredo Tafuri schreibt am Ende der zweiten Auflage seiner Storia dell’architettura italiana, dass bei der Suche nach einem Ausweg aus der endemischen Krise der modernen Architektur in den 1980er Jahren „einem Buch entscheidende Bedeutung zukommt“1: Il racconto urbanistico. Die Ver öffentlichung dieses Werks des italienischen Stadtplaners 2 Bernardo Secchi im Jahr 1984 ist ein außergewöhnliches Ereignis in der neueren euro päischen Architektur – ein Ereignis, das noch nicht angemessen gewürdigt beziehungsweise analysiert worden ist. Matteo D’Ambros und Roberto Zancan trafen sich mit dem Autor, um über Aspekte rund um die Veröf fentlichung des Buches zu sprechen. In einer Welt mit kurzem Gedächtnis verspricht die erneute Betrachtung des Beitrags der Literaturwissenschaf ten zum Verständnis von Architektur und Stadt, neues Licht auf das berufliche Selbstverständnis zu werfen
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