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Purpose Italian expenditure for vitamin D greatly increased in the last few years, reaching €314 million ($376.8 million) in 2019. In Italy, the main cause of the increase in public spending for vitamin D is the marketing of high-cost medicines. At national and regional levels, some interventions have been performed to reduce expenditure, but spending has continued to increase. The aim of this work is to propose a new saving strategy determined by an analysis of a significant sample of the market. Methods Data on the use of vitamin D formulations, including data for the different active substances that represent its pharmaceutical analogue and composition of groups of equivalence, were extrapolated from the Italian Medicines Agency transparency lists and from the Farmadati database. Data on pharmaceutical expenditure were obtained from the Data Warehouse of Liguria Region; the composition of this expenditure was analyzed in detail, focusing on the characteristics of the pharmaceutical preparations and their cost (price per defined daily dose). Findings Vitamin D expenditure paralleled that of cholecalciferol, the most used active ingredient, which in Liguria increased from €643,352 ($772,022.4) in 2010 to €8,006,574 ($9,607,888.8) in 2019 (increase of 1144%). Spending focused on high-cost formulations, exceeding 90% of total cholecalciferol cost in 2019. We simulated a possible optimization of the expense for cholecalciferol by applying a revised price to all the cholecalciferol consumptions in high-cost products because these formulations do not have an added therapeutic value, finding that the saving would be at least 60%. National data on the detailed expenditure composition for vitamin D are not available, but we found a strong resemblance between total cholecalciferol expenditure time series in Italy and the Liguria Region. Implications The expense of cholecalciferol and consequently the expense of vitamin D could be optimized by modifying the reimbursement of high-cost formulations. At a national level, savings should be proportional to that estimated for the Liguria Region. On the basis of the 2019 data, Italian savings with respect to total cholecalciferol expenditure should be €170.65 million ($204.78 million); per capita cholecalciferol expenditure would shift from €4.66 ($5.59) to €1.84 ($2.21).

We present a solution for layer inspection based on digital imaging and machine learning (ML) suitable for application to in-process monitoring of fused filament fabrication. Top-down images of the layer are captured in-process via a digital camera, decomposed into patches representing specific types of topographic patterns, and processed through a binary classifier, trained to recognize acceptable and out-of-control states in relation to the presence/absence of topographic defects. Classifiers implementing different types of ML technologies (support vector machines on dense image features, convolutional neural networks of different depths, and convolutional autoencoder) are investigated and compared in terms of performance at detecting layer defects. The generalizability of the approach to different part geometries is also discussed. A prototype implementation is illustrated through application to selected test parts. Research achievements as well as open challenges are highlighted.

Environmental effects and natural resources depletion associated with agriculture production affect the agriculture response to climate change. Traditional cross-sectional climate response models ignore this requirement. This research estimates the impact of climate on European agriculture using a continental scale Ricardian analysis. We correct farm income by accounting for resources (energy, fertilisers, pesticides, and water) use intensity and calculate the sustainable value for a sample of 9497 specialized field crop farms. Compared with the traditional Ricardian method, the marginal effects of temperature remain positive (but less positive) in Northern countries, while it leads to less damages in Southern countries when net revenue and farms' sustainable values are used as dependent variables. Accounting for the environmental effects and depletion of natural capital improves the ability of the Ricardian method to estimate agriculture climate response functions in the long run.

In the past decade, to improve crop production and productivity, Ethiopia has embarked on an ambitious irrigation farming expansion program and has introduced new large- and small-scale irrigation initiatives. However, in Ethiopia, poverty remains a challenge, and crop productivity per unit area of land is very low. Literature on the technical efficiency (TE) of large-scale and small-scale irrigation user farmers as compared to the non-user farmers in Ethiopia is also limited. Investigating smallholder farmers’ technical efficiency (TE) level and its principal determinants is very important to increase crop production and productivity and to improve smallholder farmers’ livelihood and food security. Using 1026 household-level cross-section data, this study adopts a technology flexible stochastic frontier approach to examine agricultural TE of large-scale irrigation users, small-scale irrigation users and non-user farmers in Ethiopia. The results indicate that, due to poor extension services and old-style agronomic practices, the mean TE of farmers is very low (44.33%), implying that there is a wider room for increasing crop production in the study areas through increasing the TE of smallholder farmers without additional investment in novel agricultural technologies. Results also show that large-scale irrigation user farmers (21.05%) are less technically efficient than small-scale irrigation user farmers (60.29%). However, improving irrigation infrastructure shifts the frontier up and has a positive impact on smallholder farmers’ output.

Photomodelling is an innovative, economical and fast technique based on the same principles of photogrammetry, which leads to the creation of 3-dimensional models starting from the simple acquisition of photographs. The aim of this paper is to define performances and metrological characteristics of this new technique and to understand the full potential offered by point cloud processing software. The analytical comparison considers a structured light 3D scanning system Creaform Go Scan 50 with metrological certification as a reference, in order to verify the accuracy and precision of photomodelling, using a modified function of the ICP algorithm and spatial, volumetric and superficial comparison criteria.

The relationship between irrigation water availability and crop revenue is multifaceted. However, most of the previous studies focused only on the direct effect of irrigation water on crop revenue or considered that the indirect effect passes only through the farmers’ improved farm inputs usage. Nevertheless, unlike previous studies, this study argues that a one-sided argument that irrigation water directly causes high crop revenue or indirectly affects crop revenue only via the farmers’ improved farm inputs usage is incomplete, as irrigation water not only directly contributes to crop revenue but also indirectly conduces to crop revenue via both the type of crops produced and the farmers’ improved farm inputs usage. Considering the previous studies’ limitations, this study investigates pathways how small-scale irrigation water affects crop revenue and identifies challenges of small-scale irrigation farming in Fogera district, Ethiopia. Results endorsed that irrigation water has both direct and indirect effects on crop revenue. The indirect effect is 67 percent of the total effect and it is mediated by both the type of crops produced and farmers’ improved farm inputs usage. The result also indicated that irrigation user farmers have a higher income, more livestock assets and resources and better food, housing, and cloths than the non-users. Moreover, challenges related to agricultural output and input market were identified as the most severe problem followed by crop disease. The findings of our study suggest that to utilize the benefits of irrigation water properly, it is crucial to encourage farmers to use more improved farm inputs and to shift from staple to cash crop production. Moreover, farmers are frequently exposed to cheating by illegal brokers in the output market, therefore it is also important to increase farmers’ accessibility to output and input markets, the quality of improved farm inputs, and the bargaining power of farmers with market information.

The quality of dental arch impression has a substantial role in the precision of the intervention. It is traditionally acquired with resins that solidify when in contact with the air. Compared to that method, digital impression gives great advantages and, together with three-dimensional (3D) digitization devices, allows a simplification of the digital impression process. The growing adoption of such systems by a large number of dental clinics determines the need for an in-depth evaluation of the accuracy and the precision of the different systems. The aim of this work is to define a methodology for the evaluation of the accuracy and precision of 3D intraoral and desktop scanning systems, by using volumetric and linear methods. The replica of a tooth was realized with zirconium, afterward, high-accuracy point clouds of the master model were acquired by a coordinate measurement machine (CMM). In this way, the dimensions of the replica were accurately known. An intraoral scanner (I) and three desktops (D1, D2, D3) were then used to scan the replica. The geometry resulting from the CMM was compared with the ones derived from the scanners, using two different commercial programs (Geomagic and 3-Matic) and a custom-developed algorithm (MATLAB). Geomagic showed the mean values to be in a range from 0.0286 mm (D1) to 0.1654 mm (I), while 3-Matic showed mean values from &minus, 0.0396 mm (D1) to 0.1303 mm (I). MATLAB results ranged from 0.00014 mm (D1) to 0.00049 mm (D2). The probability distributions of the volumetric error of the measurements obtained with the different scanners allow a direct comparison of their performances. For the results given by our study, the volumetric approach that we adopted appears to be an excellent system of analysis.

Several indicators and methods are already applied for sustainability assessment in agriculture. The links between sustainability indicators, agricultural management and policies are not well explained. The aim of this study is to combine biophysical and monetary sustainability assessment tools to support agriculture policy decision-making. Three methodological steps are considered: i) the environmental impacts of farms are assessed using terrestrial acidification, freshwater eutrophication, soil and freshwater ecotoxicity as well as natural land transformation; ii) the most relevant indicators of agriculture damages on ecosystems quality are aggregated into an index; iii) the farms' index scores are integrated with farm assets, land and labor, into the Sustainable Value approach (SVA), as indicator of natural resources used by farms. As a case study, the methodology was applied to arable farms with and without animal husbandry of the "Alta Murgia" National Park. The crop farms, in our sample, have a higher sustainable value using their economic and environmental resources. Mixed farms need to improve their resources use efficiency. Although crop farms have lower land-use efficiency compared to mixed farms, our results suggest supporting, by means of policy options, the specialized crop farms that, on average, perform better in terms of ecosystems quality preservation. Finally, we find that Life Cycle Assessment (LCA) to soundly measure the environmental impacts clearly enriches the SVA. (C) 2016 Elsevier Ltd. All rights reserved.

On-machine, optical imaging of the layer is bound to play an important role in the development of future in-process monitoring solutions for fused filament fabrication. In addition to detecting layer internal defects, layer imaging offers the possibility to retrieve the outer contours of a layer and thus three-dimensionally reconstruct the side walls of a part by vertically stacking contours belonging to sequential layers. The current open challenges for layer imaging relate to the compromise between imaging resolution and extension of covered area, and to the complexity of image interpretation, exacerbated by optically difficult materials, complex filament patterns and non-uniform environmental conditions. In this work we propose an original optical imaging solution for layer contour identification and stacking. Our solution overcomes the current challenges related to range/resolution and image interpretation by making use of digital twins, i.e. geometric simulations of the layer, based on the current manufacturing process parameters. Thanks to the use of digital twins, our vision system is able to: use high-resolution imaging only where it is needed, by following the predicted positions of the layer contours while acquiring a sequence of images; algorithmically interpret each image by concentrating only on interesting regions as suggested by the simulated prediction, thus reducing the risk for false positives; and finally monitor contour quality by performing a more accurate comparison between the measurement and a reference contour obtained by a simulation which replicates the actual fingerprint of the process, as opposed to simply relying on the edge obtained by slicing the CAD model. The in-process monitoring capability of the computer vision system is demonstrated through the fabrication of acceptable and defected instances of a test geometry. Fabrication issues are effectively and efficiently detected by the system and alarms are triggered that can be used to command early termination of the build process or to initiate corrective actions.

Wastewater reuse provides valuable solutions to solve the societal challenges of decreasing availability and limiting access to secure water resources. The present study quantifies the environmental performance of nectarine orchards irrigation using treated municipal wastewater (TMW) and surface water using a unique dataset based on field experimental data. Climate change, toxicity (for human and freshwater), eutrophication (marine and freshwater) and acidification impacts were analysed using the impact assessment method suggested by the International Reference Life Cycle Data System (ILCD). The water footprint associated to the life cycles of each system has been estimated using the Available WAter REmaining (AWARE) method. Monte Carlo simulation was used to assess data uncertainty. The irrigation of nectarine orchards using TMW performs better than the irrigation using surface water for eutrophication impact categories. Compared with surface water resources, the potential impacts of TMW reuse in agriculture on climate change and toxicity are affected by the wastewater treatment phase (WWT). Only eutrophication and acidification burdens are generated by in-field substitution of surface water with TMW. Considering human and ecosystem water demand, the irrigation with TMW increases water consumption of 19.12 m3 per kg of nectarine produced. Whereas, it shows a positive contribution to water stress (−0.19 m3) if only human water demand is considered. This study provides important results that allow for a better understanding of the potential environmental consequences of TMW reuse in agriculture. It suggests that embracing the type of WWTs, the replacement of fertilizers, the effects on water scarcity and ecosystem quality might be useful to redefine water reuse regulations and increase public acceptance for the reuse of TMW in agriculture. Moreover, this study reveals the need for developing consensus and standardized guidance for life cycle analysis of water reuse applications.

Surface topography modifications due to wear or other factors are usually investigated by visual and microscopic inspection, and – when quantitative assessment is required – through the computation of surface texture parameters. However, the current state-of-the-art areal topography measuring instruments produce detailed, areal reconstructions of surface topography which, in principle, may allow accurate comparison of the individual topographic formations before and after the modification event. The main obstacle to such an approach is registration, i.e. being able to accurately relocate the two topography datasets (measured before and after modification) in the same coordinate system. The challenge is related to the measurements being performed in independent coordinate systems, and on a surface which, having undergone modifications, may not feature easily-identifiable landmarks suitable for alignment. In this work, an algorithmic registration solution is proposed, based on the automated identification and alignment of matching topographic features. A shape descriptor (adapted from the scale invariant feature transform) is used to identify landmarks. Pairs of matching landmarks are identified by similarity of shape descriptor values. Registration is implemented by resolving the absolute orientation problem to align matched landmarks. The registration method is validated and discussed through application to simulated and real topographies selected as test cases.

Organic municipal solid waste (OMSW) as a feedstock for energy recovery and material recycling offers the potential to reduce environmental impacts from energy production while displacing emission intensive waste management strategies such as landfills. This paper quantifies the environmental impact of anaerobic digestion of local, residual biomass. A life-cycle assessment was jointly performed for two scenarios for the biological treatment of local organic municipal solid waste and pig manure in the Netherlands. Scenario 1 was a separate treatment using anaerobic digestion, and Scenario 2 was a bio-refinery system that integrates anaerobic digestion of organic, municipal solid waste, and co digestion of pig manure and other organic co-substrates \. For both scenarios, electricity and heat are generated using a combined heat and power engine. The bio-refinery system (Scenario 2) contribution to climate change resulted in 0.16 Mt CO2 eq./yr, which is lower than the 0.17 Mt CO2 eq./yr of Scenario 1. Both scenarios are found to be beneficial with regard to resource depletion and human toxicity. The integration of organic waste and manure anaerobic digestion has no effect on acidification and terrestrial eutrophication impact categories, resulting in 43.59 AE eq. and 86.33 AE eq. for Scenario 1 and 43.58 AE eq. and 86.30 AE eq. for Scenario 2. Moreover, Scenario 2 yields 18% lower emissions than those from natural gas derived electricity in the Netherlands. The biorefinery system represents an opportunity to improve organic waste-management strategies, at the same time as reducing the environmental impact from energy production and the costs for surplus manure disposal by producing high-quality commodities that can be traded on the market. (C) 2017 Elsevier Ltd. All rights reserved.

Agricultural adaptation to climate change is indispensable. Unfortunately, most climate response modeling methods accounting for adaptation are based on economic modelling that assumes simple farm profit-maximization and autonomous farm adaptation. This makes adaptation look like something unconditional , explaining why agricultural policy down-sized the attention for adaptation. This is incorrect as adaptation is facing numerous barriers such as low levels of adaptive capacity. This paper therefore captures and quantifies the impact of adaptive capacity explicitly in economic cross-sectional models, showing that those methods can be more policy-oriented. It shows that higher levels of adaptive capacity lead to more positive climate responses. Acknowledgement : This paper was supported by the Horizon 2020 project SUFISA (Grant Agreement No. 635577).

Photomodelling is a new and fast solution for 3D modelling, based on the same principles of photogrammetry. The comparison between photomodelling and the metrological technique of structured light 3D scanning, provided by the Creaform Go Scan 50 with metrological certification, is the aim of this paper, defining performances and verifying the potential of this innovative, simple and economical technique.

The aims achieved in this work have been the development of a software for the processing of thermal imaging films in frequency domain which makes the use of the thermovision useful to the assessment of the fatigue damageability of components loaded by random loads conditions. To this aim an experimental test rig and the relative measuring chain was built. The measuring system allows to analyze a system or a mechanical component providing the user, in addition to the usual thermographic output, a whole series of results of both local and global type.

The article presents a hybrid monitoring technique for the measurement of the deformation field. The goal is to obtain information about crack propagation in existing structures, for the purpose of monitoring their state of health. The measurement technique is based on the capture and analysis of a digital image set. Special markers were used on the surface of the structures that can be removed without damaging existing structures as the historical masonry. The digital image analysis was done using software specifically designed in Matlab to follow the tracking of the markers and determine the evolution of the deformation state. The method can be used in any type of structure but is particularly suitable when it is necessary not to damage the surface of structures. A series of experiments carried out on masonry walls of the Oliverian Museum (Pesaro, Italy) and Palazzo Silvi (Perugia, Italy) have allowed the validation of the procedure elaborated by comparing the results with those derived from traditional measuring techniques.

Olive growing is an important cultural and traditional system in the Mediterranean region that has considerable environmental impacts. Italy is ranked second in the world in terms of olive production and olive-cultivated area. Apulia is Italy's largest olive growing region and accounts for 33% of the total Italian surface area planted to olive trees. Organic farming is assumed to have beneficial effects by reducing the environmental impacts of agricultural practices. However, literature shows that this system is not always less harmful to the environment than the conventional one. This study investigates this hypothesis through the comparison of environmental impacts and economic performances between organic and conventional olive systems in Apulia region. It also provides options to optimize the agricultural practices that could contribute to the reduction of the environmental impacts. Life Cycle Assessment (LCA) was applied to evaluate the environmental impacts, and Life Cycle Costing (LCC) was utilized to assess the economic performance of the studied systems referring to one hectare as functional unit and to a system boundary limited to olive production (cradle-to-farm gate). Results showed a lower environmental impact of agricultural practices in the organic system, mainly due to the higher efficiency in reducing the impact on fossil fuel depletion. Moreover, the organic system resulted to have higher Net Present Value and Internal Rate of Return values that indicate its higher profitability as compared to the conventional system. Optimization of fertilization is the first priority to optimize olive growing, particularly in the organic system, since manure fertilization results in higher costs and higher environmental impact on almost all impact categories compared to synthetic foliar fertilization. Good agricultural practices with electrically-driven irrigation system, mechanical weeding and biological pest control, no-tillage or reduced tillage can be considered as further optimization options to mitigate environmental burdens and reduce their costs. (C) 2014 Elsevier Ltd. All rights reserved.

Smart grids (SGs) have a central role in the development of the global power sector. Cost-benefit analyses and environmental impact assessments are used to support policy on the deployment of SG systems and technologies. However, the conflicting and widely varying estimates of costs, benefits, greenhouse gas (GHG) emission reduction, and energy savings in literature leave policy makers struggling with how to advise regarding SG deployment. Identifying the causes for the wide variation of individual estimates in the literature is crucial if evaluations are to be used in decision-making. This paper (i) summarizes and compares the methodologies used for economic and environmental evaluation of SGs (ii) identifies the sources of variation in estimates across studies, and (iii) point to gap in research on economic and environmental analyses of SG systems. Seventeen studies (nine articles and eight reports published between 2000 and 2015) addressing the economic costs versus benefits, energy efficiency, and GHG emissions of SGs were systematically searched, located, selected, and reviewed. Their methods and data were subsequently extracted and analysed. The results show that no standardized method currently exists for assessing the economic and environmental impacts of SG systems. The costs varied between 0.03 and 1143 M€/yr, while the benefits ranged from 0.04 to 804 M€/yr, suggesting that SG systems do not result in cost savings The primary energy savings ranged from 0.03 to 0.95 MJ/kWh, whereas the GHG emission reduction ranged from 10 to 180 gCO2/kWh, depending on the country grid mix and the system boundary of the SG system considered. The findings demonstrate that although SG systems are energy efficient and reduce GHG emissions, investments in SG systems may not yield any benefits. Standardizing some methodologies and assumptions such as discount rates, time horizon and scrutinizing some key input data will result in more consistent estimates of costs and benefits, GHG emission reduction, and energy savings.

In light of the European Union’s objectives on sustainable energy production and supply, several member states have been advocating for the integration of renewable generation, distributed generation, and smart grid (SG) technologies. SGs are recognized by scientists, nongovernmental organizations, and policy makers as a pivotal tool for driving Europe toward an energy-efficient and low-carbon economy. To accelerate the development of SG benefits in Northwest Europe (NWE) and to encourage communities and small-medium enterprises (SMEs), there is a need for a deeper understanding of (1) the level of SG development, (2) the economic and environmental benefits society can receive from SG implementation, and (3) the policies put in place to support SG integration. Three main critical points were recognized in the European SG integration proposition: (1) the lack of overall applicable economic and environmental data, (2) the large amount of components required to fully integrate SG into the existing grids infrastructure, and (3) the existence of several regulatory barriers that limit SG development in NWE. This chapter provides a summary of the potential benefits arising from the development of SG technologies in NWE. More specifically, it consists of three parts: a review of existing economic and environmental impact assessments of SGs, a life cycle assessment (LCA) of the deployment of smarter grid technologies in Belgium, and an analysis of the regulatory status quo and the existing barriers for the deployment of SGs in Northwestern European countries.

Verification of conformance to design specifications in production, and identification of defects related to wear or other damage during maintenance, are key metrological aspects that must be addressed for micro-scale tessellated surfaces. A new algorithmic approach is presented that operates on topography datasets as obtained by areal topography instruments. The approach combines segmentation algorithms with a novel implementation of the angular radial transform, originally adopted by the MPEG-7 standard, to implement shape descriptors and associated similarity metrics. Applications to the inspection and verification of laser-manufactured micro-embossing topographies are illustrated. The topographies are first segmented to extract the individual tiles; the tiles are then encoded through shape descriptors. Principal component analysis and cluster analysis are used to investigate the behaviour of the angular radial transform coefficients. Finally, an algorithmic classifier based on supervised learning (k-nearest neighbours) is implemented and shown to be effective at identifying defects and at discriminating between defect types.

In light of the European Union objectives concerning energy efficiency and sustainability, several Member States are advocating for, and even subsidizing the integration of renewable generation, distributed generation and smart grid technologies. This paper aims to evaluate the existing environmental and electricity market regulation applied in the five regions across Europe involved within the GREAT project, i.e. Flanders, England, The Netherlands, Scotland, Ireland. This analysis focuses particularly on communities and SMEs.

Introduction Cardiomyopathies are diseases of the heart muscle, with frequent genetic component, characterized by a strong heterogeneity concerning clinical presentation and echocardiographic profile. Diastolic dysfunction can affect all forms of cardiomyopathy, often being an expression of a more advanced state of the disease. Objectives To analyze the role of diastolic dysfunction in cardiomyopathies. Conclusions Echo-Doppler analysis is therefore very helpful, as it may give important information concerning the clinical stage of disease progression and could provide a prognostic stratification tool in order to orient the clinician toward early specific treatment.

INTRODUCTION: High prevalence of coeliac disease (CD) has been reported among patients with idiopathic dilated cardiomyopathy (DCM). We evaluated the feasibility and diagnostic accuracy of screening for CD by rapid test of anti-transglutaminase antibodies in the cardiology outpatients' clinic. MATERIAL AND METHODS: We screened the blood samples of 104 patients with DCM, 44 of their first-degree relatives, 63 diseased controls and 101 healthy controls for the presence of anti-transglutaminase antibodies in a drop of whole blood using a rapid assay. This test was compared to the enzyme-linked immunosorbent assay and the anti-endomysium antibody test. RESULTS: Our rapid test was positive in three (2.9%) DCM patients, in one (2%) relative and in one (1%) healthy control. These subjects were positive at both control assays. Two DCM patients had iron-deficient anaemia. The healthy relative was asymptomatic, while the healthy control experienced extreme asthenia. The relative refused intestinal biopsy, while the others showed histological evidence of CD. During the gluten-free diet, the patient with the worst left ventricular ejection fraction (LVEF) underwent heart transplant, and LVEF values improved in the other two. Anaemia and tiredness resolved in all patients. CONCLUSION: Early detection of CD in a cardiological setting allows prompt treatment with a gluten-free diet of gluten-dependent complaints with potential benefits for the course of DCM.

Aims Familial screening of patients with dilated cardiomyopathy (DCM) allows an early diagnosis of the disease in family members. It is unclear if familial forms (FDC) have a different long-term outcome compared with sporadic DCM. Our aim was to compare the long-term prognosis of FDC and sporadic forms in order to assess the role of familial screening. Methods and results Between 1988 and 2007, 637 DCM patients were consecutively enrolled. Of these, 130 patients (20.4%) had FDC, including 82 (12.9%) probands and 48 (7.5%) non-proband FDC patients (NP-FDC), identified by family screening. We compared the 48 NP-FDC patients with a sample of 96 patients with sporadic DCM, who were randomly matched by year of enrolment in a 2:1 ratio. At enrolment the NP-FDC patients were younger (40 ± 16 vs. 48 ± 13 years, P = 0.002), less symptomatic [New York Heart Association, (NYHA) III–IV: 8 vs. 28%, P = 0.006], had higher left ventricular ejection fraction (35 ± 10 vs. 30 ± 9%, P = 0.005) and were less intensively treated with evidence-based drugs than the sporadic DCM patients. Survival free from heart transplant at 2, 5 and 10 years was 93, 91 and 82%, respectively, in NP-FDC patients compared with 86, 76 and 62% in sporadic forms (P = 0.04). After stratification for NYHA classes, no difference in survival was observed between sporadic and NP-FDC patients. Conclusion Our study demonstrates that family screening can effectively identify DCM patients at an earlier stage of disease and can improve survival. The possibility of changing the prognosis of DCM needs to be verified in patients intensively treated with tailored medical treatment. Family screening should be recommended for all DCM patients.

In the last decade, the durum wheat-pasta production chain was been, with the other food chains, vulnerable to prices volatility, that became stronger in the last five years due to the unfavourable economic condition. The supply chains internal competition and the unwillingness to cooperation, directly linked to lack of trust between actors on different levels, represent barriers for the efficiency this economic structure (the chain), that have to deal with the actual economic condition and the global market competition. The Italian durum wheat-pasta production chain is characterized by a high level of vertical integration for the downstream stages (mills and pasta industries) and by a farms-pasta industries contracts increase; whereas very high is the upstream stage firms' fragmentation. The study aims to examine the Apulian durum wheat-pasta production chain, by means of the netchain analysis methodology, to point out its organisational set-up and its degree of integration and evaluate the horizontal and vertical existent relationships. The geographical location of the study is due to the importance that durum wheat has for the Region; that is in the first place of the national production ranking (almost the 20, 65% in 2011), and have a great territory specialisation (almost the 87, 68% of cereals regional uaa). The study started from the analysis of a quality product chain that can be considered as a best practice into the area because both the final product (dry pasta) is made from local durum wheat flour only, and the whole chain are certified ("Prodotti di qualità di Puglia" and dnv Business Assurance). The results obtained, show an high horizontal integration for farms. However, they are able to create ties only with selling cooperatives. The latter on the other hand, show the capability to promote cohesion between farms and mills for the supply of high quality raw materials. This chain, observed for its peculiarity of being a best practice, show the relevance of pasta industries in promoting strong horizontal and vertical relationships, and theirs importance in improving chain market competitiveness. Further studies are still necessary, since a more comprehensive analysis of the entire Apulian chain, considering also those one located into areas with an higher number of pasta industries (eg. Emilia-Romagna), can provide essential information that can be used to drive innovation in chain governance at the regional or national level.

The livestock production sector represents more than 40 % of the economic value of EU primary productions. This sector consists of a huge diversity of processes and techniques depending on the animal species and the final products. Because of these differences, livestock productions are associated with several adverse effects on the environment, especially in the breeding phases and feeding composition and management; moreover, in terms of raising awareness of the environmental implications of livestock productions, LCA applications are of increasing importance for systematic assessment of the environmental burdens connected with this sector. After an overview of the structural and economic characteristics of the most significant livestock supply chain and its main environmental problems, we provide a description of the international state of the art of LCA implementations for livestock. Methodological problems connected with the application of LCA are investigated, starting with the critical analysis of international papers and the few Italian papers in the scientific literature. Finally, the best practices regarding LCA methodology implementation are proposed, in order to improve results and manage the methodological problems identified.

Many measurements techniques have been proposed for the "digitalization of objects": structured light 3D scanner, laser scanner, high resolution camera, depth cam, thermal-cam, ... Since the adoption of the European Agenda for Culture in 2007, heritage has been a priority for the Council's work plans for culture, and cooperation at European level has advanced through the Open Method of Coordination. Political interest at EU level has steadily grown cultural and heritage stakeholders recently highlighted in the Declaration on a New Narrative for Europe: "Europe as a political body needs to recognize the value of Cultural Heritage". Photomodelling is an innovative and extremely economical technique related to the conservation of Cultural Heritage, which leads to the creation of three-dimensional models starting from simple photographs. The aim of the research is to understand the full potential offered by this new technique and dedicated software, analysing the reliability of each instrument, with particular attention to freeware ones. An analytical comparison between photomodelling and structured light 3D scanner guarantees a first measure of the reliability of instruments, tested in the survey of several Umbrian heritage artefacts. The comparison between tests and reference models is explained using different algorithms and criteria, spatial, volumetric and superficial.

Starting from areal surface topography data as provided by current commercial three-dimensional (3D) profilometers and 3D digital microscopes, this work investigates the problem of automatically identifying and extracting functionally relevant, individual features within the acquisition area. Feature identification is achieved by adopting an original template-matching algorithmic procedure, based on applying the ring projection transform in combination with a parametric template. The proposed algorithmic procedure addresses in particular template-matching scenarios where significant variability may be associated with the features to be compared to the reference template. The algorithm is applied to a test case involving the characterization of the surface texture of a superabrasive polishing tool used in hard-disk manufacturing.

The aims of this study were to investigate the clinical outcomes of patients with low-gradient aortic stenosis despite preserved left ventricular ejection fraction and to assess reliable prognostic clinical-instrumental features in patients experiencing or not experiencing aortic valve replacement (AVR). Clinical-laboratory and echocardiographic data from 167 patients (median age 78 years, interquartile range 69 to 83) with aortic valve areas 70 years showed a trend toward being a prognostic predictor (p = 0.082). In conclusion, in patients with low-gradient aortic stenosis despite a preserved left ventricular ejection fraction, AVR was strongly correlated with a better prognosis. Patients with atrial fibrillation associated with advanced New York Heart Association class had the worst prognosis if treated medically but at the same time a relative better benefit from surgical intervention.

Cardiomyopathies (CMP) are defined as disorders of the heart muscle unexplained by coronary artery disease, hypertension, valvular disease, or congenital heart disease. All forms of CMP can be caused by genetic and nongenetic mechanisms. Whereas differences exist in the classification schema, CMP have historically been broken down into several major phenotypic categories: hypertrophic, dilated, arrhythmogenic, and restrictive. Phenotype overlap is common and increases the challenge in diagnostic accuracy. Some genetic and nongenetic subtypes can be identified using a step-by-step strategy, including history, physical examination, electrocardiography, echocardiography, laboratory, and a CMP-focused approach to interpreting cardiac and noncardiac investigations, not only in the patient but also in the familial history. Genetic testing is most informative if directed to a specific diagnosis suspected on the basis of the clinical assessment, and it is becoming an important tool for a personalized medical approach to CMP.

Infiltrative/storage cardiomyopathies (CMP) are diseases characterized by the deposition of pathological substances in the heart muscle. In particular, the term infiltrative refers to intercellular infiltration, whereas storage refers to intracellular deposition within the myocardium. As the infiltration/storage usually involves multiple organs, these CMP should be considered part of a systemic disorder. Despite variable etiology and pathological mechanisms, this group of CMP shares some common features, such as myocardial hypertrophy and progressive myocardial stiffness, with diastolic and systolic dysfunction. Heart failure is the main clinical manifestation, but arrhythmias and conduction defects are common. Accurate clinical evaluation is therefore crucial for correctly targeting further examinations. Moreover, cardiac imaging plays a major role not only in differential diagnosis but also in prognostic stratification. The impact of identifying cardiac involvement and the underlying pathology reflects upon treatment and prognosis.

The management of refractory recurrent pericarditis is challenging. Previous clinical reports have noted a beneficial effect of high-dose intravenous human immunoglobulins (IvIgs) in isolated and systemic inflammatory disease-related forms. In this article, we analyzed retrospectively our clinical experience with IvIg therapy in a series of clinical cases of pericarditis refractory to conventional treatment. We retrospectively analyzed 9 patients (1994 to 2010) with refractory recurrent pericarditis, who received high-dose IvIg as a part of their medical treatment. Nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, or colchicine treatment was not discontinued during IvIg treatment. No patients had a history of autoimmune or connective tissue diseases. During an average period of 11 months from the first recurrence, patients had experienced a mean of 5 relapses before the first IvIg treatment. In 4 cases, patients showed complete clinical remission with no further relapse after the first IvIg cycle. Two patients experienced a single minor relapse, responsive to short-term nonsteroidal anti-inflammatory drugs. In 2 patients, we performed a second cycle of IvIg after a recurrence of pericarditis, with subsequent complete remission. One patient did not respond to 3 cycles of IvIg and subsequently underwent pericardial window and long-term immunosuppressive treatment. No major adverse effect was observed in consequence of IvIg administration in all the cases. In conclusion, although IvIg mode of action is still poorly understood in this setting, this treatment can be considered as an option in patients with recurrent pericarditis refractory to conventional medical treatment and, in our small series, has proved to be effective in 8 of 9 cases.

Left ventricular non-compaction (LVNC) is characterized by a pseudohypertrophic “spongy” left ventricle with deep trabeculations. It is considered to be a rare cardiomyopathy (CMP), with a prevalence of approximately 1:2,000 to 1:7,000 individuals. The condition shows excessive and unusually trabeculated myocardium within the mature heart muscle in the apical and midlateral/inferior portions of the left ventricle, which is usually hypokinetic (Fig. 8.1). LVNC represents a developmental failure of the heart to form the fully compact myocardium during the later stages of cardiac development.

In patients with a hypertrophic cardiomyopathy (HCM) phenotype, study of the electrocardiogram (ECG) can sometimes suggest a specific diagnosis (Table 5.1). For example, an ECG pattern of ventricular pre-excitation can be found in storage diseases, such as those characterized by abnormalities of muscle glycogen.

In recent years, outstanding progress has been made in the diagnosis and treatment of cardiomyopathies. Genetics is emerging as a primary point in the diagnosis and management of these diseases. However, molecular genetic analyses are not yet included in routine clinical practice, mainly because of their elevated costs and execution time. A patient-based and patient-oriented clinical approach, coupled with new imaging techniques such as cardiac magnetic resonance, can be of great help in selecting patients for molecular genetic analysis and is crucial for a better characterisation of these diseases. This article will specifically address clinical, magnetic resonance and genetic aspects of the diagnosis and management of cardiomyopathies.

Objective: To assess the association of matrix metalloproteinases (MMP) genetic polymorphism (PM) with plaques vulnerability and clinical outcome of acute vascular events. Methods: MMP-1 (-1607 G in/del), MMP-3 (-1171 A in/del), and MMP-9 microsatellite (13–26 CA repeats around -90) PMs have been determined (i) in 204 patients with cerebrovascular disease to assess the association with features of vulnerability in carotid plaques and prevalence of stroke, (ii) in 208 patients with UA/NSTEMI to assess the association with in-hospital clinical outcome. Results: Plaques from carriers of MMP-1 G insertion showed significantly smaller plaques and thicker fibrous cap. In CVD patients carrying such variant, Odds Ratio for previous stroke was 0.27 (95% C.I. 0.13–0.56, P = 0.0002) and, in UA/NSTEMI patients, the risk of Major Adverse Cardiac Events (MACE, persistent angina, NSTEMI, and vascular death) was 0.22 (95% C.I. 0.11–0.44, P < 0.0001).Novariants inMMP-3 PM were associated to differences in either plaque features or clinical outcome. Carriers of MMP-9≥22 repeats in the microsatellite had larger plaques and lipid core. In CVD patients with such variant, Odds Ratio for stroke was 2.2 (95% C.I. 1.1–4.4) and, in UA/NSTEMI patients, MACE risk was 4.1 (95% C.I. 2.3–7.4, P < 0.0001). Persistent angina and NSTEMI separately provided comparable results. Conclusions: Carriers of MMP-1 G insertion show smaller and more stable plaques, as well as better prognosis in acute vascular events, while patients with ≥22 repeats in MMP-9 have larger necrotic core and worse prognosis in UA/NSTEMI.

To investigate the short term effects of Doxycycline on MMP-2 and MMP-9.Short term effects of Doxycycline (100 mg B.I.D.) on plasma levels of MMP-2 and MMP-9 were investigated in 20 healthy subjects; the effects of Doxy, Acetylsalicylic acid, Nitrates, and Enalapril on MMP-9 release from were assessed in isolated polymorphonuclear cells.In plasma, MMP-9 activity was reduced (-22\%, 95\% CI -32/-11; P = 0.002) starting at 12 h after doxy; in vitro, MMP-9 released from stimulated neutrophils was reduced by Doxy (-28\%, 95\% CI -43/-14; P = 0.001), inhibiting degranulation, and by nitrates (-52\%, 95\% CI -76/-28 P = 0.005), increasing three times both pro- and active-MMP-9 bound to neutrophils (P = 0.007 and 0.040, respectively).Doxy decreases MMP-9 plasma levels by around 20\%, within the first 12 h. The mechanism leading to such reduction seems due to the inhibition of PMN degranulation.

We report a case of a 57 year-old woman with Starr- Edwards model 6120 mitral valve replacement and Kay- Shiley bioprosthetic tricuspid valve replacement in 1968 at Niguarda Hospital in Milan. The mitral caged-ball has proved its excellent durability and its good hemodynamic performance in many patients, even if subject to high tendency to thrombosis. In literature there is no evidence of durability of this prosthesis longer than 35 years. Our patient after 39 years from mitral valve replacement lives a happy and fulfilling life (NYHA II), with no evidence of hemolysis, ball variance, symptomatic embolization or major bleeding.

The use of low molecular weight heparin sometimes leads to major life threatening complications, such as acute abdominal haemorrhages. We report two cases of major haematoma of rectus abdominis. Computed tomography was very helpful to confirm the diagnosis in these cases.

Alcoholic beverages are known to exert a protective effect on atherosclerotic disease. This study aimed to assess the in vivo and in vitro effects of alcohol on matrix metalloproteinase (MMP) -2 and -9, known to determine atherosclerosis progression. Eighteen healthy volunteers, regular drinkers (two standard alcohol servings/day, on average) at first examination (baseline) were asked to abstain from any alcoholic beverage for one week (abstention), and then to assume two standard alcohol servings of beer daily for 1 week (re-exposure). Activity of MMP-2 and -9, total antioxidant activity (AOA), glutathione (GSH) plasma levels were carried out at baseline, at the end of abstention, and after 1 week of re-exposure. To validate the in vivo results, MMP-2 activity and expression, AOA, and GSH, were determined in human smooth muscle cells treated for 96 h with increasing concentrations (12.5-100 mM) of ethanol. MMP-2, but not MMP-9 plasma activity was higher at abstention than at baseline or re-exposure (P

The last 20 years have seen impressive progress in the study of cardiomyopathies. The improved understanding of these diseases has made clear that cardiomyopathies are extremely complex entities that defy current classification standards. The 1980 and 1995 WHO/ISFC Task Forces, and very recently an American Heart Association (AHA) Scientific Statement expert panel, have systematically approached new advances as well as emerging problems. In spite of this effort and an increasingly growing understanding of myocardial disorders, several issues remain unresolved. Without a doubt, the identification of genetic defects responsible for many forms of cardiomyopathies has changed our perspective of myocardial diseases. In fact, in the last few years, we have seen that (1) clinically defined cardiomyopathies, previously considered single entities, are actually the result of mutations in different genes, (2) different mutations in the same gene may be the cause of different clinical entities and (3) in the group of cardiomyopathies, a large phenotypic and genetic heterogeneity exists that is expected to increase in the future. Genotype knowledge is a fundamental advance in medicine and in particular in the field of cardiomyopathies and is becoming increasingly more important in clinical practice for disease diagnosis and prevention, prognostic stratification and possible future therapies. Knowledge of the phenotype, including clinical, morphological and physiological features, however, continues to provide the clinical basis for diagnosis and classification of cardiomyopathies, prognostic evaluation and symptomatic treatment, and should not be abandoned.

The application of both scanning laser vibrometry and thermoelasticity for measurement of stress and strain fields on mechanical components is proposed. A theoretical approach on both the measurement principles is illustrated and an application to a practical case, as an automotive fan blade, is described. The problem of the fan blade failure is tightly due to the force amplitude and frequency, that are applied in working condition; it is, therefore, important, to know the blade resonance frequencies and the mode shapes. For this reason, the measurement techniques, based on scanning laser Doppler vibrometer, give the chance to quickly perform an experimental modal analysis with high accuracy and spatial resolution and to obtain the structure's mode shapes. In the same time, it is important to assess the stress distribution level on the blade associated to every mode shape. Measurement techniques, that apply thermoelastic principle, allow to quickly determine the blade stress pattern at each load frequency. It is, therefore, possible to establish the stress pattern corresponding to the mode shape and predict the fatigue life of the component.© (2006) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

In this paper a new measurement technique to perform thermoelastic stress analysis on rotating mechanical component is proposed. The idea is to use a particular realization of the Dove prism optical system, optimized to work width infrared radiation, able to give a fixed output image of a rotating surface on where a normal thermoelastic measurement system can be applied. The realization of a first prototype of this optical system is described. First results on a test case are illustrated.

Motorcycle frames are mechanical components that need to be optimised in terms of performance and costs but with a limited amount of resources compared to, for example, car frames. Fatigue testing of the component is required for qualification and this is typically performed by using rotating drums with steps or servo-controlled hydraulic actuator based test benches. Therefore a fast and simple measurement and testing technique that operates during the fatigue tests will be a very useful tool. In this paper the possibility of analysing these components by measuring the stress levels and stress concentration in critical parts by thermoelasticity is investigated. The development of a multibody model, useful to simulate the typical working conditions of the motorcycle frame, is also described.

The long-term beta-blockade strategy with carvedilol, metoprolol succinate or bisoprolol is now strongly recommended to reduce the rates of mortality and morbidity in patients with chronic heart failure (CHF). Although the benefits observed with such drugs are viewed as a class effect, theoretically, carvedilol might be superior to the other two agents, considering its unique pharmacological profile, which includes a more comprehensive antiadrenergic activity and potentially relevant ancillary properties. So far, carvedilol has been proven to be effective and safe in a broader range of CHF patients than metoprolol and bisoprolol. Moreover, a recent large clinical trial has shown a significantly greater survival benefit with carvedilol as directly compared with metoprolol tartrate. Therefore, carvedilol may be the preferred beta-blocking agent to treat patients with CHF.