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Despite the encouraging results obtained with the endovascular treatment of ruptured intracranial aneurysms, few data are available on the effects of the timing of this approach on clinical outcome. The aim of our study was to evaluate the effects of the hyper-early timing of treatment and of pre-treatment and treatment-related variables on the clinical outcome of patients with ruptured intracranial aneurysms. Five hundred and ten patients (167 M, 343 F; mean age 56.45 years) with 557 ruptured intracranial aneurysms were treated at our institution from 2000 to 2011 immediately after their admission. The total population was divided into three groups: patients treated within 12 hours (hyper-early, group A), between 12-48 hours (early, group B) and after 48 hours (delayed, group C). A statistical analysis was carried out for global population and subgroups. Two hundred and thirty-four patients (46%) were included in group A, 172 (34%) in group B and 104 (20%) in group C. Pre-treatment variables (Hunt&Hess, Fisher grades, older age) and procedure-related variable (ischaemic/haemorrhagic complications) showed a significant correlation with worse clinical outcomes. The hyper- early treatment showed no correlation with good clinical outcomes. The incidence of intraprocedural complications was not significantly different between the three groups; 1.2% of pretreatment rebleedings were observed. The hyper-early endovascular treatment of ruptured intracranial aneurysm does not seem to be statistically correlated with good clinical outcomes although it may reduce the incidence of pre-treatment spontaneous rebleedings without being associated with a higher risk of intraprocedural complications. However, since no significant differences in terms of clinical outcome and pre-treatment rebleeding rate were observed, a hyper-early treatment is not be supported by our data. [ABSTRACT FROM AUTHOR]

Abstract: A design procedure, based on a one-dimensional simulation, is presented for an ejection refrigeration system. Heat exchangers are included in the calculation, accounting for temperature differences between the fluids and for pressure losses. The ideal gas assumption, which is quite common in the literature concerning ejector systems, is avoided. Furthermore, the supersonic diffuser is designed with a continuous profile, without cylindrical piece, controlling the variation of momentum along the flow path and accounting for friction. At design conditions, this should reduce the irreversibility due to the normal shock. A comparison between different operating fluids is presented and R245fa is selected. The results of the design procedure and the expected performance, in terms of first and second law efficiency, are presented. [Copyright &y& Elsevier]

Immunochemical faecal occult blood tests have shown a greater sensitivity than guaiac test in colorectal cancer screening, but optimal number of samples and cutoff have still to be defined. The aim of this multicentric study was to evaluate the performance of immunochemical-based screening strategies according to different positivity thresholds (80, 100, 120 ng ml(-1)) and single vs double sampling (one, at least one, or both positive samples) using 1-day sample with cutoff at 100 ng ml(-1) as the reference strategy. A total of 20 596 subjects aged 50-69 years were enrolled from Italian population-based screening programmes. Positivity rate was 4.5% for reference strategy and 8.0 and 2.0% for the most sensitive and the most specific strategy, respectively. Cancer detection rate of reference strategy was 2.8 per thousand, and ranged between 2.1 and 3.4 per thousand in other strategies; reference strategy detected 15.6 per thousand advanced adenomas (range=10.0-22.5 per thousand). The number needed to scope to find a cancer or an advanced adenoma was lower than 2 (1.5-1.7) for the most specific strategies, whereas it was 2.4-2.7, according to different thresholds, for the most sensitive ones. Different strategies seem to have a greater impact on adenomas rather than on cancer detection rate. The study provides information when deciding screening protocols and to adapt them to local resources. [ABSTRACT FROM AUTHOR]

Abstract: Energy performances and building quality can be achieved by high performance envelopes. In this paper the thermal and mechanical performances of external cladding, applied to a traditional wall, largely used in existing buildings, were investigated by a transient simulation. Result comparison with the thermal performances obtained by simulating the wall without the insulation system showed that external insulation is particularly effective in reducing cooling and heating loads and can also guarantee indoor thermal comfort. Fatigue stresses of the external cladding, investigated by ANSYS simulation, showed that continuous change of the loads over time with limited cyclic stress can cause deterioration of materials. [Copyright &y& Elsevier]

A simple microwave sensor for the detection of the dynamic characteristics of large structure vibration is proposed. It consists of a continuous-wave radar capable of detecting the structure movement by measuring the phase of the back-reflected wave. The system performances have been demonstrated in a case study monitoring a pedestrian bridge. [ABSTRACT FROM AUTHOR]

universe of the evaluation obtained from a probability stratified simple random sampling design with the optimum allocation of sample buildings to the strata. The strata considered refers to age of buildings. We checked two correlations over the real surveyed sample buildings and the numeric map sample buildings. The correlations are utilizedto evaluate the energy needs of the urban universe of building. The proposed method can be useful for the territorial energy programming using energy needs maps of the urban settlements, as a tool for rational use and save of energy. [ABSTRACT FROM AUTHOR]

The extended exergy analysis method, taking into account the mean life time cycle of building, has been applied to evaluate the sustainability of an urban area. The impact of the emissions due to the life cycle of the buildings has been evaluated. Two thermodynamic indexes, ηI and ηII showing, respectively, the first and second law efficiency of buildings, have been proposed as thermodynamic indexes. The applied methodology provides a single thermodynamics environmental criterion for the selection of technological alternatives, strategies and designs that produce lower environmental impacts connected to higher exergy indexes ηII. [Copyright &y& Elsevier]

Background and Objectives Despite the procedures adopted for the selection of blood donors, in Italy the HIV prevalence per 100 000 repeat tested donors ( RTD) and first-time tested donors (FTD) is high compared to most other Council of Europe member states. To evaluate the effectiveness of predonation procedures, we studied both the characteristics and the undisclosed risk behaviours of HIV-positive donors. Materials and Methods We analysed the data from the Italian blood donor surveillance system in 2009, 2010 and 2011. Based on the postdonation interview, HIV-positive donors were classified by risk behaviour (heterosexual, MSM, 'non-sexual' and 'not determined') and by time elapsed from risk behaviour to donation. In Italy, the temporary deferral for exposure to behaviour at risk is 4 months. Results In the postdonation interview, 113 HIV-positive donors (32·4%), who denied at-risk behaviours in the predonation selection, reported sexual risk behaviours <4 months prior to donation; they were predominantly males (84·1%) and RTD (63·7%). The main reason for not having reported the risk behaviour in the predonation selection was 'not realizing having engaged in at-risk behaviour' (66·4%). Conclusion These findings underline the need for more comprehensible educational material, a clearer predonation questionnaire, and effective information campaigns to improve the awareness of HIV sexual risk behaviours among blood donors. [ABSTRACT FROM AUTHOR]

Background In the countries with high G6 PD deficiency prevalence, blood donors are not routinely screened for this genetic defect. G6 PD deficiency is often asymptomatic, blood donors may be carriers of the deficiency without being aware of it. The aim of the study was to evaluate the prevalence of G6 PD deficiency among the Italian blood donors. Design and Methods From October 2009 to April 2011, 3004 blood donors from a large hospital transfusion centre were screened for G6 PD deficiency using differential pH-metry and the characterization of G6 PD mutations was performed on G6 PD-deficient subjects. The haematological features of G6 PD-deficient and normal donors were also compared. Results Thirty-three subjects (25 men and 8 women) with low G6 PD activity were identified, corresponding to 1·1% of the examined blood donor population. The frequencies of class II severe alleles ( Mediterranean, Valladolid, Chatham and Cassano) and class III mild alleles (Seattle, A- and Neapolis) were 48% and 43%, respectively. The haematological parameters of G6 PD- donors were within normal range; however, the comparison between normal and G6 PD- class II donors showed significant differences. Conclusion In Italy, the presence of blood donors with G6 PD deficiency is not a rare event and the class II severe variants are frequent. The identification of G6 PD-deficient donors and the characterization of the molecular variants would prevent the use of G6 PD-deficient RBC units when the haemolytic complications could be relevant especially for high risk patients as premature infants and neonates and patients with sickle cell disease submitted to multiple transfusions. [ABSTRACT FROM AUTHOR]

The Health Commission of the Conference between the Italian State and Regions recognized the need to establish an institutional accreditation model for Haemophilia Centres (HCs) to be implemented by 21 Regions in order to provide patients with haemophilia and allied inherited coagulations disorders with high and uniform standards of care. The Italian National Blood Centre, on behalf of the Commission, convened a panel of clinicians, patients, experts, representatives from Regions and Ministry of Health. The agreed methodology included: systematic literature review and best practice collection, analysis of provisions and regulations of currently avalable services, priority setting, definition of principles and criteria for the development of recommendations on the optimal requirements for HCs. The result was the formulation of two recommendations sets. Two sets of recommendations were produced. The first concerns regional policy planning, in which the following aspects of comprehensive haemophilia care should be considered for implementation: monitoring and auditing, multidisciplinary approach to clinical care, protocols for emergency management, home treatment and its monitoring, patient registries, drug availability and procurement, recruitment and training of health care professionals. The second set concerns the accreditation process and lists 23 organizational requirements for level 1 HCs and 4 additional requirements for level 2 HCs. These recommendations help to provide Italian Regional Health Authorities with an organizational framework for the provision of comprehensive care to patients with inherited coagulation disorders based on current scientific evidence. [ABSTRACT FROM AUTHOR]

EuBIS, the European blood inspection system, is a collaborative effort of 27 representatives from 19 Member States (MS), including governmental institutions, blood establishments and competent authorities. EuBIS has been initiated by co-funding through the Public Health Programme (Directorate General Sanco) of the European Commission bringing together regulators (competent authorities) and manufacturers (blood establishments) to jointly develop criteria and standards aimed to assist: blood establishments in need to optimize their quality system and self-inspection process and to prepare for regulatory inspections by competent authorities and, competent authorities, who wish to use the manual and training guide as a reference for the implementation process of legislative requirements related to regulatory inspections., These standards and criteria have been published in a EuBIS Manual and a EuBIS Training Guide. The structure of the EuBIS training guide follows critical aspects of quality management to be addressed to achieve good/best practice. For each of the quality related critical points, a criterion description, examples evidence and references to relevant international standards (GMP, PIC/S and CoE/EDQM CD-P-TS) and legislative requirements based on the European blood directives are given. Using 'fishbone' diagrams, quality indicators for risk assessment can be easily developed in a systematic fashion covering all relevant activities of a blood establishment. Chapter 3·5 refers to Blood collection, testing and processing with detailed subchapters on blood collection, processing and validation, labelling and release of blood and blood components. Additional quality requirements are described in Chapter 3·3 for Premises (Collection, Processing, Storage and Distribution), Chapter 3·4 Equipment and Chapter 3·8 non-conformance. Based on these standards and criteria, quality management systems have been nationally adapted to include reporting systems for risk analysis, prevention and acceptance based on deviations of processes, non conforming products and/or adverse events as well as non-compliances from audits and regulatory inspections. [ABSTRACT FROM AUTHOR]

Background: In Italy, cervical cancer screening programmes actively invite women aged 25-64 years. Programmes are hindered by low participation.Methods: A sample of non-responder women aged 35-64 years, belonging to three different programmes (in Rome, Florence and Teramo), was randomly split into four arms: two control groups received standard recall letters to perform either Pap-test (first group) or human papillomavirus (HPV) test (second group) at the clinic. A third arm was sent letters offering a self-sampler for HPV testing, to be requested by phone, whereas a fourth group was directly sent the self-samplers home.Results: Compliance with standard recall was 13.9% (N619). Offering HPV test at the clinic had a nonsignificant effect on compliance (N616, relative risk (RR)=1.08; 95% CI=0.82-1.41). Self-sampler at request had the poorest performance, 8.7% (N622, RR=0.62; 95% CI=0.45-0.86), whereas direct mailing of the self-sampler registered the highest compliance: 19.6% (N616, RR=1.41; 95% CI=1.10-1.82). This effect on compliance was observed only in urban areas, Florence and Rome (N438, RR=1.69; 95% CI=1.24-2.30), but not in Abruzzo (N178, RR=0.95; 95% CI=0.61-1.50), a prevalently rural area.Conclusions: Mailing self-samplers to non-responders may increase compliance as compared with delivering standard recall letters. Nevertheless, effectiveness is context specific and the strategy costs should be carefully considered. [ABSTRACT FROM AUTHOR]

Background and Objectives Two External Quality Assessment Programmes (EQAPs) were run in 2008 and 2009 to evaluate the proficiency of blood centres in detecting, by nucleic acid amplification techniques (NAT), the possible contamination of plasma with hepatitis C virus (HCV), human immunodeficiency virus (HIV) and hepatitis B virus (HBV). Materials and Methods In the EQAP-2008, three customized panels were designed; each containing positive samples with a viral nominal concentration for the three viruses of about three times the 95% DL of the respective commercial NAT assay. In the EQAP-2009, the proficiency of the participants was evaluated with a single panel, independently on the NAT method used. Results While 84% (10 2/12 2) of the participants in the EQAP-2008 correctly identified the positive and negative samples of the panels, in the EQAP-2009 the percentage of proficient laboratories increased to 97% (118/122). Most importantly, in this 2-year experience, we observed a decrease in the number of pre-/postanalytical errors, from 14 in 2008 to two in 2009. Conclusions The design of these two EQAPs allowed participants to assess the performance of the NAT methods applied in their routine screening of blood donations, not only with respect to analytical errors but also to human errors that, despite the high level of automation reached by NAT methods, can still occur. [ABSTRACT FROM AUTHOR]

The article focuses on the types of research activities undertaken by respondents for the discovery of transfusion medicine and to have an assurance of future innovations. It mentions the four strategic areas for the accomplishment of research projects including donor and community research, applied and developmental research, and transfusion science research. It states that respondents are given various questions including finance for the programme and formal linkages to granting institutions.

The article presents the answers of NetCord-associated banks and national societies for haematology to several questions related to cord blood banking, including the existence and role of a cord blood bank, the importance of storing of samples of autologous cord blood, and the indications for storing directed cord blood samples.

We evaluated the sensitivity for colorectal cancer (CRC) of the latex agglutination test (LAT), an immunochemical test routinely used in the Florence District screening programme since 2000. Sensitivity was calculated by the proportional interval cancer incidence method in a population of 27 503 consecutive subjects screened in 2000–2002, interval cancers being identified by linkage to the Tuscany Cancer Registry files. Sensitivity was calculated overall and by gender, age, time since last negative LAT, CRC site, and rank of screening. Overall 1- and 2-year sensitivity estimates were 80.7 and 71.5%, respectively, suggesting that faecal occult blood testing screening sensitivity may be suboptimal due to testing or programme quality problems. Increasing screening sensitivity might be achieved if the detection rate of advanced adenomas could be increased without unacceptable loss in specificity.British Journal of Cancer (2007) 96, 1750–1754. doi:10.1038/sj.bjc.6603759 www.bjcancer.com Published online 24 April 2007 [ABSTRACT FROM AUTHOR]

We assessed the correlation between quantitative results of immunological faecal occult blood testing (I-FOBT) and colonic lesions (191 colorectal cancers, 890 adenomas) detected at colonoscopy in 2597 FOBT+ (cutoff 100 ng ml−1 Hb) subjects. At univariate analysis, a higher average faecal Hb content was significantly associated with male gender (P=0.003), age (P=0.02), and colonoscopy findings (P=0.000). Among adenomas, higher faecal Hb content was significantly associated with size (P=0.0000), presence of severe dysplasia (P=0.0001), presence of villous component (P=0.0002), and location in the left colon (P=0.003). At multivariate analysis adjusting for potential confounders, age (P=0.03), size (P=0.0000), and location in the left colon (P=0.0005) were confirmed as having an independent association with higher faecal Hb content. Immunological FOBT is confirmed to be a specific screening test to detect cancer and adenoma, with a low positivity rate (3.7%) and a high positive predictive value (41.5%). Faecal Hb content is significantly higher for those lesions (cancer and high-risk adenomas) screening is aimed at detecting.British Journal of Cancer (2007) 96, 218–221. doi:10.1038/sj.bjc.6603534 www.bjcancer.com Published online 9 January 2007 [ABSTRACT FROM AUTHOR]

There have been great advances over the last decades in haematopoietic stem cell (HSC) transplantation, using either bone marrow, peripheral blood or cord blood-derived stem cells. The coming into force of the European legislation on tissues and cells and the consequent transposition of Directives into national laws have required the health authorities in the Member States (MS) and the scientific societies to review the transplantation activities to ensure the circulation of safe HSC products. Here, the regulatory inspection process performed by the Competent Authorities and the professional voluntary accreditation process of the Transplant Programmes active in Italy is compared. [ABSTRACT FROM AUTHOR]