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AbstractBackground and aimBariatric surgery (BS) is a pillar for the treatment of morbid obesity and its related comorbidities. However, it might be associated with long-term deficiencies and absorption issues. Adherence to micronutrient supplementation is a crucial aspect in the management of these patients.AimThe aim of the present survey was to evaluate the adherence to micronutrient supplementation in a cohort of Italian patients submitted to BS (BS patients) and to identify predictors of adherence using a self-administered, anonymous, internet-based instrument.MethodsPatients who underwent BS over the last decade in a single center were invited to participate to a self-administered, anonymous, internet-based survey consisting of a 23 items structured questionnaire evaluating: a. demographic information b. Bariatric procedures performed; c. Indication to BS; d. Lapse of time since last BS, e. Frequency of follow up visits post-surgery, f. Perception of well-being post BS; g. Adherence to micronutrient supplementation; h. Changes in their quality of life and self-esteem.ResultsWe received an automatic notification of delivery from 1100 out of 1600 BS patients and 290 (81.4% female, mean age 39.5 ± 10.1 years) completed the questionnaire. The main reported bariatric procedures were: Sleeve Gastrectomy (59%), Roux-en-Y Gastric Bypass (31%) and Adjustable Gastric Banding (7.2%). Only 33.1% of the sample acknowledged to have taken all recommended medication regularly. BS patients who underwent malabsorptive procedures and had their last follow up visit more than 5 years earlier, had a higher risk of being nonadherent to micronutrient supplementation. Conversely, BS patients in their forties seemed more likely to adhere to treatment recommendations. Losing more weight was the only independent risk factors for nonadherence to micronutrient supplementation, independently from patient’s perception of wellbeing.ConclusionAfter BS, several clinical and psychosocial factors might predict nonadherence to micronutrient supplementation.

The 16.9km long Gotthard Road Tunnel in Switzerland, is the key element of one of the most important road connections through the Alps. The single-bore tunnel with bi-directional traffic on [...]

AbstractNuclear fusion power plants require electron cyclotron (EC) heating and current drive (H&CD) systems for plasma heating and stabilization. High-power microwave beams between 1 and 2 MW generated by gyrotrons propagate in a dedicated waveguide transmission system to reach the plasma at specific locations. Key components in this transmission system are the chemical vapor deposition diamond windows on both the torus and gyrotron sides of the reactor as they allow transmission of high-power beams while acting as confinement and/or vacuum boundaries. Diamond windows consist of a polycrystalline diamond disk integrated in a metallic housing. In the conventional configuration, there is one disk perpendicular to the beam propagation direction. A steering mechanism is then used to deploy the fixed frequency beam at different locations in the plasma. This is, for instance, the configuration used in the ITER EC H&CD system. Movable parts close to the plasma will be problematic for the lifetime of launchers in future fusion reactors like the DEMOnstration nuclear fusion reactor (DEMO) because of the higher heat loads and neutron fluxes. Therefore, one of the alternative concepts is to deploy the beams directly at the desired resonant magnetic flux surface by frequency tuning gyrotrons. In this case, diamond windows able to work in a given frequency range, like the diamond Brewster-angle window, are required. It is an elegant and compact broadband window solution with the disk inclined at the Brewster angle with respect to the beam direction. This paper shows the development and the current state of different diamond window concepts including the design, the numerical analyses, and application of standard construction nuclear codes and of a specific qualification program.

AbstractWhile digital space is explained in itself by computer science, important questions for the humanities - such as how the Digital affects human behaviour, or how it impacts society and economy – are outside its scope. Different disciplines have provided answers, but there has been no integrated concept bridging these insights. This paper proposes a concept to explain the Digital by integrating insights from computer science, media studies, sociology and philosophy. The resulting framework suggests that the Digital consists of characteristic dynamics, spaces and mechanisms. After explaining the concept of Digital Machine,an ontological framework consisting of four main fields of analysis - Transformation, Territory, Frameand Use- is proposed. With Transformations and Territories, the processes of the Digital and its wider socio-political and economic dimensions are analysed. Within Frames, human action and interpretation happen. In the Uses of the Digital, consumption has become a form of production, and User’s uses can be analysed in the differential between the intents of a Digital Machine and the interpretations of its users.To conclude, Anders’ concept of Promethean slopeis taken to explain the increasing problems of humans to distinguish the actions of algorithms from human action, and future implications of the evolution of the Digital are discussed. Finally, routes for digital innovation and recommendations for design practice are proposed.

Objectives:We analyzed the behavior of preoperative and postoperative vestibular evoked myogenic potentials (VEMPs) and vestibular evoked periocular potentials (VEPPs) in 3 patients who had vestibular schwannoma and underwent modified translabyrinthine surgery.Methods:We compared VEMPs and VEPPs, measured with both air-conducted (AC) and bone-conducted (BC) stimulations. Vestibular evoked potentials were measured both in the immediate postoperative period and some months later.Results:At the immediate postoperative examination, VEPPs were preserved in all 3 patients with both AC and BC stimulations. The VEMPs showed stable or improved parameters in 2 of our patients and were absent in the third patient. At the follow-up examination, VEMPs did not show any significant change with respect to the previous evaluation. In contrast, VEPPs were absent in 2 of our patients with AC stimulation and in 1 patient with BC stimulation.Conclusions:Our results seem to indicate a greater stability and reproducibility of VEMPs compared with VEPPs. In 1 patient, who had a schwannoma of the inferior vestibular nerve, the preservation of VEPPs and the absence of VEMPs in the immediate postoperative period confirm that the saccule represents the origin of VEMPs. Furthermore, these results suggest that not only the saccule, but also the utriculus, could be implicated in the origin of VEPPs.

The present investigation was specifically designed to evaluate the ability of the glycerol test combined with pure tone audiometry, distortion-product otoacoustic emissions (DPOAEs), and vestibular evoked myogenic potentials (VEMPs) to diagnose endolymphatic hydrops early and to identify cases that may evolve toward Meniere's disease. This investigation consisted of 29 consecutive patients with mild dizziness or vertigo who received no treatment. Each patient underwent glycerol testing measured with conventional pure tone audiometry and with both DPOAEs and VEMPs. It is interesting to note that in 7 and 8 of the 29 cases, the VEMPs and DPOAEs, respectively, showed an improvement after glycerol administration that had not been shown on traditional audiometry. A further element worthy of consideration emerges from an analysis of the VEMP results compared to the DPOAE results that divided the patients into 4 groups. The first group had a postglycerol improvement with both methods, which would seem to suggest hydrops in both the anterior and posterior parts of the labyrinth. In the second and third groups, there was an improvement only either with VEMPs or DPOAEs, and this finding seems to indicate that only one endolymphatic compartment might be involved. In the last group, all patients had a positive glycerol test with positive DPOAEs on one side and with positive VEMPs on the other. Although endolymphatic hydrops can only be proven after death, a combination of VEMPs and DPOAEs with the glycerol test may permit early diagnosis of endolymphatic hydrops. These results clearly imply that these methods should be permanently included in the diagnostic protocol of patients with vestibular and audiological symptoms.

Objectives/Hypothesis:The objective was to evaluate dizziness as the first symptom of endolymphatic hydrops, which could provide valuable information on the initial stages of endolymphatic hydrops development.

The aim of the study was to present a case report demonstrating that vestibular evoked myogenic potentials originate from the saccular nerve.

The purpose of this study was to determine the effectiveness of a new liberatory maneuver in the management of the geotropic variant of horizontal canal paroxysmal positional vertigo (HC-PPV).