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En el presente trabajo se analiza la sentencia del Tribunal de Justicia, de 16 de diciembre de 2020, recaída en el asunto Chrysostomides (asunto C-603/18 P). Se destacan sus principales consecuencias, en particular, la ausencia de responsabilidad jurídica del Eurogrupo y la insuficiencia de los mecanismos de rendición de cuentas. Por último, se propone una conceptualización del órgano que permitiría superar su presunta invisibilidad jurídica.

Background: At the beginning of COVID-19 pandemic, specific COVID/PSY wards were created in France to provide care for inpatients with COVID-19 and psychiatric disorders. In this multi-center prospective study, we set out to assess the clinical features and risk factors of somatic aggravation in patients hospitalized in COVID/PSY wards. Methods: Data were collected between 28 February and 30 May, 2020. We collected demographic data, psychiatric diagnoses, medical data and COVID-19-related clinical data. Somatic aggravation was estimated by the number of patients transferred to intensive care or medicine units, the number of deaths and the number of patients presenting a confusional state. A multivariate logistic model was used to assess the risk factors of confusional state and transfer to intensive care or medicine units. The risk of death was analysed by the univariate predictors of this outcome. Outcomes: 350 patients were included in the study. The number of inclusions peaked one week after that of the general population and declined more slowly. Overall, 24 (7%) were transferred to medicine units, 7 (2%) died and 51 (15%) patients presented a confusional state. Severe respiratory symptoms predicted the transfer to a medicine unit (OR 17.1; CI 4.9-59.3). Older age, an organic mental disorder, a confusional state, and severe respiratory symptoms predicted mortality in univariate analysis. Age > 55 (OR 4.9; CI 2.1-11.4), an affective disorder (OR 4.1; CI 1.6-10.9), and severe respiratory symptoms (OR 4.6; CI 2.2-9.7) predicted a higher risk, while smoking (OR 0.3; CI 0.1-0.9) predicted a lower risk of a confusional state. Interpretation: COVID-19 patients with severe psychiatric disorders have multiple somatic comorbidities and a high risk of confusion. COVID/PSY wards may play a role in reducing the mortality of COVID-19 in patients with psychiatric disorders. Funding Statement: There was no funding source for this study. Declaration of Interests: There are no conflicts of interest to be declared. Ethics Approval Statement: This observational study was conducted according to the principles of the Declaration of Helsinki. In accordance with French bioethics laws, it was classified as a non- interventional study, since it concerned anonymized clinical data that are routinely compiled in medical records. Compliance with French regulations on personal data collection was supervised by the personal data referent of the Centre Psychotherapique de Nancy. Patients, and their legal guardian when appropriate, were informed in writing, in agreement with national regulations for observational studies.

Background: Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome for which clear evidence of effective therapies is lacking. Understanding which factors determine this heterogeneity may be helped by better phenotyping. An unsupervised statistical approach applied to a large set of biomarkers may identify distinct HFpEF phenotypes. Methods: Relevant proteomic biomarkers were analyzed in 392 HFpEF patients included in Metabolic Road to Diastolic HF (MEDIA-DHF). We performed an unsupervised cluster analysis to define distinct phenotypes. Cluster characteristics were explored with logistic regression. The association between clusters and 1-year cardiovascular (CV) death and/or CV hospitalization was studied using Cox regression. Results: Based on 415 biomarkers, we identified 2 distinct clusters. Clinical variables associated with cluster 2 were diabetes, impaired renal function, loop diuretics and/or betablockers. In addition, 17 biomarkers were higher expressed in cluster 2 vs. 1. Patients in cluster 2 vs. those in 1 experienced higher rates of CV death/CV hospitalization (adj. HR 1.93, 95% CI 1.12–3.32, p = 0.017). Complex-network analyses linked these biomarkers to immune system activation, signal transduction cascades, cell interactions and metabolism. Conclusion: Unsupervised machine-learning algorithms applied to a wide range of biomarkers identified 2 HFpEF clusters with different CV phenotypes and outcomes. The identified pathways may provide a basis for future research.Clinical significance More insight is obtained in the mechanisms related to poor outcome in HFpEF patients since it was demonstrated that biomarkers associated with the high-risk cluster were related to the immune system, signal transduction cascades, cell interactions and metabolism Biomarkers (and pathways) identified in this study may help select high-risk HFpEF patients which could be helpful for the inclusion/exclusion of patients in future trials. Our findings may be the basis of investigating therapies specifically targeting these pathways and the potential use of corresponding markers potentially identifying patients with distinct mechanistic bioprofiles most likely to respond to the selected mechanistically targeted therapies.

Therapies - In Press.Proof corrected by the author Available online since dimanche 4 novembre 2018

A methodology for I/O cells area optimization starting from latch-up protection rules will be presented. To define compact layout rules, the starting points will be the design rule formally given by the foundry. The proposed methodology uses Design of Experiment (DOE) statistical approach based on the mentioned rules. The result will be a consistent flow that can be re-iterated for each silicon-implemented latchup test-chip, regardless of the technological node. The methodology will also help in finding the sensitivity of all input parameters in relationship to the tested output.

Previous studies have established a correlation between empathy and burnout among healthcare providers. The aim of this study is to explore whether empathy – the ability to understand what another person is experiencing, was related to mental healthcare staffs’ burnout. We performed a descriptive, cross-sectional, observational study among medical and nursing mental healthcare staff working in the district of Moselle, France. Participants completed a survey including The French versions of the Jefferson Scale of Empathy (JSPE) and The Maslach Burnout Inventory-Human Services Survey (MBI-HSS). The sample included 241 (n=241) participants (N=420, response rate=51.7%). 187 (77.6%) respondents had low burnout, 43 (17.8%) had intermediate burnout and 11 (4.6%) had high burnout. 41 (17%) had low empathy, 156 (64.7) had moderate empathy and 44 (18.3%) scored high. Empathy scores were positively correlated with scores of personal accomplishment of the MBI-HSS (r=0.2; p Participation in the Omega educational program was associated with lower scores of EE on the MBI-HSS survey (mean score 14.7 versus a mean score of 19.7 for nonparticipants). Empathic mental healthcare providers have lower levels of burnout. Forensic psychiatric staff showed low means of compassionate care and high depersonalization. Interventions designed to foster attributes and skills such as empathy, resilience, and perception of security may be an essential step in reducing and preventing burnout.

The present paper describes the current technical achievements in seismic instrumentation and monitoring within a national network and the role of this developed concept in disaster prevention and mitigation, in particular case of Romanian seismicity. Many studies are being conducted in the field of structural health monitoring, for seismically instrumented/monitored buildings, based on existed sensor technology, seismic data acquisition systems, data communication and information flow, computer hardware/software engineering, new solutions for seismic data transfer etc. Seismic records in free-field and on buildings are capitalised in anti-seismic design, development of technical and technological solutions in construction, seismic evaluation and rehabilitation of buildings, as well as in the process of education and earthquake preparedness. It aimed also to create a virtual seismic network (through Internet, WAN property networks, public analogue telephone network). It is a national priority creating a preventive culture in order to mitigate the seismic risk, starting with the strengthening of buildings, upgrading of the code for seismic design, seismic instrumentation as a usual practice and continuing with public communication and information actions, empowering communities and decision-makers related to the risks, prevention measures, what behaviour to be adopted. The efforts of last years show that Romania has taken important steps in preparing a response according to the challenges induced by the existing seismic sources from the entire territory of the country.

Seismic resilience of urban community is ensured also through organization and preparation of technical activities in order to build a post-seismic investigation capacity. Thus, some elements are necessary: responsible structures, competencies and specific legislative references for the management of post-earthquake response measures, at central and local level; information resources; collection and storage of information related on the existing built fund; computerized databases - creation, maintenance and management of information; organizing the keeping of the primary documents of the investigations; training of inspectors and technical staff; material resources; stocks of materials strictly necessary in the event of an earthquake for the implementation of emergency response measures; buffer spaces for sheltering persons evacuated from unsafe damaged area etc. The paper presents in this context the role of the building instrumentation before and after the incidence of severe earthquakes. An interdisciplinary investigation system in-situ and with advanced techniques of the effects on buildings with different functions, in emergencies produced by powerful earthquakes is also defined. The level reached by the research studies within NIRD URBAN-INCERC and the future premises for development in this direction will be reviewed, as a safety necessity and as a European requirement.

Aims To examine the impact of diabetes mellitus on long-term clinical outcomes in patients with myocardial infarction (MI) complicated by clinical signs of heart failure (HF) or left ventricular dysfunction (LVD). Methods and results The High-Risk MI Database consists of individual data from 28 771 patients and was created by merging four large recent randomized clinical trials (VALIANT, EPHESUS, OPTIMAAL, and CAPRICORN) that each examined the impact of pharmacological interventions following MI in patients with evidence of HF or LVD. The mean age of patients was 65 years, 70% were male, and almost 94% Caucasian. Overall, 7368 (26%) had a history of diabetes. All the major outcomes were adjudicated by independent end-point committees. Strong and highly significant associations were found with all major clinical outcomes. Diabetes was associated with an increased risk for all-cause death [adjusted hazard ratio (HR) 1.37; confidence interval (CI) 1.28–1.46; P < 0.001]. The higher risk for all-cause death was largely mediated by higher risk for cardiovascular death (adjusted HR 1.38; CI 1.27–1.48; P < 0.001) predominantly due to a substantially increased risk for fatal re-infarction (adjusted HR 1.78; CI 1.42–2.23; P < 0.001). Additionally, diabetes was associated with an increased risk for hospitalizations, particularly HF hospitalization (adjusted HR 1.50; CI 1.39–1.63; P < 0.001). There were also elevated risks for composite outcomes, particularly death or hospitalization due to HF (adjusted HR 1.48; CI 1.38–1.59; P < 0.001). Conclusion The risk for adverse outcomes associated with diabetes remains elevated even after debut of coronary artery disease in patients with MI complicated by clinical signs of HF or LVD. This association is particularly strong for HF-related outcomes.

BACKGROUND Patient adherence to follow-up after a first episode of psychosis (FEP) is currently a major challenge. Patient's early adherence reduces the risk of relapse and improves their prognosis in the short and long term. The primary goal of our study was to determine the incidence of treatment disengagement at 1-year follow-up in patients with first-episode schizophrenia, schizophreniform or schizoaffective disorder. The secondary goal was to assess the factors associated with treatment disengagement in this patient population. METHODS We conducted a monocentric retrospective study of 136 patients in France. Relevant information was collected on sociodemographic, pre-morbidities and co-morbidities data, as well as the management and treatment characteristics at 1.3 and 12 months. Survival analysis was used to assess the association between clinical variables, management and treatment disengagement. RESULTS Eighty-four patients (62%) have interrupted their medical follow-up at 1 year, 16% at 1 month and 34% at 3 months. A higher number of out-patient appointments after a FEP was associated with better adherence (HR:0.85 p

Spanish Abstract: A pesar de ser un termino comunmente empleado en la doctrina juridica actual, el concepto de “Constitucion economica” permite interpretaciones muy variadas, incluso contrapuestas. La presente contribucion pretende esbozar las caracteristicas esenciales de este concepto. Tras recorrer teoricamente la evolucion de la Constitucion economica (en especial, su origen ordoliberal y las definiciones alternativas mas significativas en el nivel europeo), se proponen tres rasgos fundamentales que otorgarian a esta norma una estabilidad vital. Se trata de un concepto juridico, autonomo, que se intersecta constantemente con la Constitucion politica en dos ambitos basicos (ambito social y ambito axiologico). La interconexion vital de las dos normas justificaria la existencia de un criterio de legitimidad comun en las dos Constituciones (el principio de la dignidad humana). Por ultimo, se proponen dos posibles funciones de la Constitucion economica, definidas como efectos de la regulacion juridica: la funcion constitutiva (reconocimiento del mercado como herramienta de proteccion de la libertad economica en sentido estricto) y la funcion potenciadora (garantia de la libertad economica sustantiva y su armonizacion con el resto de vertientes de la libertad humana). English Abstract: Although it is a commonly used term in contemporary legal doctrine, the concept of “Economic Constitution” allows for widely varying, even conflicting, interpretations. The present contribution aims to outline the essential characteristics of this concept. Following a theoretical overview of the evolution of the Economic Constitution (especially its ordoliberal origins and the most significant alternative definitions at the European level), three basic features are proposed in order to ensure the vital stability of this norm. It is a legal and autonomous concept that consistently overlaps with the Political Constitution on two core areas (social and axiological). The vital interconnection of the two norms could justify the existence of a common criterion of legitimacy within the two Constitutions (the principle of human dignity). Lastly, two possible functions of the Economic Constitution are suggested: foundational (recognition of the market as a tool for the protection of economic freedom in a narrow sense) and enforcement (protection of substantive economic freedom and its harmonization with the other dimensions of human freedom).

Background Many patients with heart failure with preserved ejection fraction (HFpEF) are women. Exploring mechanisms underlying the sex differences may improve our understanding of the pathophysiology of HFpEF. Studies focusing on sex differences in circulating proteins in HFpEF patients are scarce. Methods A total of 415 proteins were analyzed in 392 HFpEF patients included in The Metabolic Road to Diastolic Heart Failure: Diastolic Heart Failure study (MEDIA-DHF). Sex differences in these proteins were assessed using adjusted logistic regression analyses. The associations between candidate proteins and cardiovascular (CV) death or CV hospitalization (with sex interaction) were assessed using Cox regression models. Results We found 9 proteins to be differentially expressed between female and male patients. Women expressed more LPL and PLIN1, which are markers of lipid metabolism; more LHB, IGFBP3, and IL1RL2 as markers of transcriptional regulation; and more Ep-CAM as marker of hemostasis. Women expressed less MMP-3, which is a marker associated with extracellular matrix organization; less NRP1, which is associated with developmental processes; and less ACE2, which is related to metabolism. Sex was not associated with the study outcomes (adj. HR 1.48, 95% CI 0.83–2.63), p = 0.18. Conclusion In chronic HFpEF, assessing sex differences in a wide range of circulating proteins led to the identification of 9 proteins that were differentially expressed between female and male patients. These findings may help further investigations into potential pathophysiological processes contributing to HFpEF.

The National Network for the Seismic Monitoring and Protection of Building Stock is a key infrastructure of the National Institute for Research and Development in Construction, Urban Planning and Sustainable Spatial Development "URBAN-INCERC" in Romania. This infrastructure includes at present, among other research facilities, a strong-motion network of 64 permanent seismic stations, to which other temporary stations are added for various short-term vibration monitoring projects. Since its establishment in 1967, the seismic network has played an essential role in recording the earthquakes that affect Romania. Today, the seismic stations are distributed all over the country, according to its characteristic seismicity patterns. Most of them use state-of-the-art recording and communication equipment, being permanently connected online to the Data Center in Bucharest. The management of the network implies conducting a complex set of activities, centered on the recording, processing, analysis and interpretation of natural- and human-induced vibrations. All of these are seconded, in parallel, by various maintenance, reporting, logging, communication and dissemination tasks. The logistic and financial management also plays an important role. A rational and efficient administration of the seismic network cannot be acquired without a rigorous organization of data flows pertaining to the various activities performed. The paper provides insights from the organization of the network, highlighting the intercorrelation between the hierarchical levels of its functionality and the logical course of operation. A brief review of the challenges and solutions gradually developed and implemented by the members of the network team, in order to provide the required functionality, is presented.

Introduction L’usage du baclofene, un agoniste selectif des recepteurs GABAB, dans les troubles lies a l’usage d’alcool (TUAL) a augmente de facon exponentielle. En mars 2014, l’ANSM a mis en place une recommandation temporaire d’utilisation du baclofene dans les TUAL. En octobre 2018, l’ANSM a octroye une AMM pour l’utilisation du baclofene dans les TUAL (apres echec des autres traitements disponibles, dose maximale de 80 mg/j). Cette etude a evalue les pratiques de prescription du baclofene en situation reelle dans l’hopital psychiatrique de Nancy (France). A notre connaissance, c’est la premiere fois que ce type d’etude est realisee dans un hopital psychiatrique. Methode Une etude de cohorte retrospective a ete menee en utilisant la base de donnees hospitaliere du Centre Psychotherapique de Nancy. La periode de l’etude etait comprise entre le 01/03/2014 et al., 01/03/2019 avec : une periode d’inclusion de 4 ans (entre le 01/03/2014 et le 01/03/2018) et une periode de suivi glissante de 12 mois a partir de la date d’inclusion qui a necessite de cloturer la periode de suivi au 01/03/2019. Seuls les patients avec au moins une initiation de prescription de baclofene entre le 01/03/2014 et le 01/03/2018 ont ete inclus. Resultats 184 patients ont ete inclus. La majorite etait des hommes (60 %). L’âge median de mise sous baclofene etait 44,0 [20-75] ans, 89 % presentaient une autre comorbidite psychiatrique. La dose quotidienne mediane journaliere etait de 80 [10 ; 240] mg. Un total de 43 EI a ete identifie, notamment : effets neurologiques et neuromusculaires (n = 26), troubles vasculaires (n = 3), troubles psychiatriques (n = 2) et troubles renaux (n = 2). Dix cas de mesusage ont ete identifies : intoxications medicamenteuses volontaire a vissee suicidaire (n = 7) et 3 patients ont augmente la dose sans avis medical. Trois patients sont decedes (cause inconnue). Conclusion Le baclofene etait bien tolere par notre cohorte de patients, y compris ceux souffrant d’autres comorbidites psychiatriques. Cependant, une attention particuliere doit etre portee lors de la prescription de baclofene avec d’autres medicaments sedatifs et chez les patients ayant des antecedents de tentatives de suicide.

The purpose of research. The paper presents a complex approach performed to identify the vibration natural periods of a building of general interest, in the form of H, with basement, ground floor and 7 levels, built in 1968. Thus, qualitative and quantitative analyzes, topometric measurements, non-destructive tests, vibration recordings from microseisms, in order to establish the general technical condition, the degree of geometric conformation, the determination of dynamic characteristics, as well as static, modal modeling etc. for the validation of those obtained results were made. Finally, proposing several consolidation solutions, because the building is located in Bucharest where the peak ground acceleration (PGA) is 0.3g according to the Seismic design code and a further increase to a mean return period of 475 years for PGAis taken into consideration. At this moment, this building is in the process of consolidation and rehabilitation and will be included in the national permanent vibrations monitoring program. Principal results: eccentricities and irregularities from non-structural components, relative horizontal displacements, sclerometric and ultrasonic recordings, spatial structure displacements in the three main directions NS, EV and vertical Z, velocities, accelerations, frequencies and periods, structural damping factors, basic shear force etc. Major conclusions. It is important to obtain correct information regarding the behaviour of a structural system, the contribution of each presented technical approaches is consistent, using the advantages of non-destructive methods, ambient vibration monitoring and modal analysis. Reducing the seismic risk of buildings in Romania is a complex action nowadays, of national interest, and in 2020, a national strategy on seismic risk reduction will be finalized (with legislative, normative, investment reforms etc.).

Novel low-voltage and high-speed level shifter topologies will be presented. The level shifters circuits were designed in 40 nm technology using 1.2V devices and zero-VT transistors. These techniques will provide functionality near the threshold region. The simulated results were compared with a reference architecture. The resulted level shifters will be integrated in an already tested I/O structure. The results were analyzed in terms of electrical performance and silicon area.

France is the only European country with a dedicated addictovigilance network (French addictovigilance network [FAN]). However, the reporting of cases of abuse/dependence is insufficient. In an attempt to overcome this under-reporting, data from the medical information systems program (PMSI) is regularly used to identify cases. Since addictions are frequently associated with psychiatric comorbidities, a pilot study was conducted for the first time in a psychiatric hospital. It aims, through a PMSI request, to identify the sociodemographic characteristics and psychiatric diagnoses of patients consuming psychoactive substances (PAS) and the PAS types consumed.This is a retrospective observational study conducted over a nine-month period at the psychotherapeutic center of Nancy (CPN). The codes used for the PMSI request are those of the international classification of diseases, tenth revision (ICD-10), codes F10 to F19 that characterize mental and behavioral disorders associated with the use of PAS. Cases presenting the four criteria necessary for an addictovigilance notification: (1) identified notifier, (2) identified patient, (3) known consumed product (s) and (4) presence of an effect related to the abuse/dependence of PAS; were retained and analyzed.On an initial number of 252 cases, 82 cases of abuse/dependence were retained. The selected sample is predominantly male (67%). Cannabis (29%) and heroin (15%) are the most common illicit PAS. Regarding drugs, the consumption of benzodiazepines, a predominantly female phenomenon, is observed in 34% of subjects. Sixty-four per cent of the subjects were diagnosed "disorders related to the use of PAS", 14% as neurotic disorders, 9% as schizophrenia and 5% as of the mood disorders.This study identified a significant number of potentially reportable cases to the French Addictovigilance Network and demonstrated the interest of investigating cases of abuse/dependence in a psychiatric hospital.

International audience; OBJECTIVE:To assess the relationship between heart rate (HR), pulse pressure (PP), and their association with mortality in a population of high-risk patients following acute myocardial infarction (MI).METHODS:We performed an analysis in 22,398 patients included in "The High-Risk Myocardial Infarction Database Initiative", a database of clinical trials evaluating pharmacologic interventions in patients with MI complicated by signs of heart failure (HF) or left ventricular dysfunction. We found an interaction between HR and PP. Based on median HR and median PP, patients were divided in four categories: (1) HR

The main objective of the National Seismic Network for Constructions, operated by the National Institute for Research and Development in Constructions, Urban Planning and Spatial Territorial Development “URBAN-INCERC”, is the monitoring of situations generated by earthquakes or other dangerous sources of vibrations induced in constructions on the entire Romanian territory. The NIRD URBAN-INCERC seismic records obtained in-situ and on buildings were and are extremely important for designers, especially in 1977, 1986 and 1990. It is the largest network in Romania, consisting of some 60 digital acceleration recorders distributed in Bucharest and in the country. This network is strategic from the population safety point of view. Due to the specific seismic hazard and vulnerability, our country shall be in preparation for the impact of a possible earthquake, which cannot be predicted in time domain, but it is possible to occur anytime. To prevent and mitigate negative consequences of such an event, urgent actions are required to ensure structural safety. Given the facts, Romania is in a critical time on strategic options regarding the seismic risks. Presently, a urgent necessity is the seismic network function in order to get as much as possible strong-motion data for advanced research and to understand why damages in buildings occurred. The next goal is to have more parametric and spectral data for engineering design, as well as to improve the zoning maps, having more stations at reduced distances. If possible, strong-motion micro-zonation data would explain some specific shaking differences, as a future option for local arrays. The paper presents the necessity, means and requirements of achieving a holistic and integrative concept for the national seismic network of constructions, taking into account geological settings, environmental and local soil conditions on regional profiles, attenuation patterns, architectural and structural patterns, and number of seismic stations in specific seismic zones. Also, a case study of building seismic instrumentation in Bucharest according to the Romanian Seismic Design code, indicative P100-1:2013.

A good methodology flow can improve significantly the time needed to develop an I/O library. It is mandatory that the fastest methodology also gives accurate results. Given the new technology nodes, it is important to re-evaluate all the software characterization formats (NLDM, CCS and ECSM) and see if there is room for improvement. The analysis will be conducted by comparing liberty file data with HSPICE simulation results.

The purpose of the research: The paper is going to present the role of seismic areas as living labs/natural laboratories for studying the behavior of buildings and of people and establishing a relationship between a research, a training-education and a knowledge dissemination. The results materialized by experiential actions to reduce negative impacts of disasters are highlighted. Methodology: Engineering learning from earthquakes, based on a long-term seismic culture, became a continuous activity based on field observation, since more than a century. On the other hand, creating earthquake disaster prevention awareness and disaster preparedness can be achieved nowadays by education and active learning addressed to all levels of population, from elder generations to the younger ones, and from usual people to the representatives of authorities. The link between these two approaches is becoming more and more necessary in the context of high local seismicity: investigating the behavior of people, while using emerging technologies (computer-generated imagery, immersive virtual reality etc.), to obtain an active individual attitude. The general concept of awareness and preparedness trends evolved. To deal with earthquake-related situations, people are taught to take measures to prevent severe earthquakes effects, but we must take a step forward to get closer to the system that includes: research knowledge, innovation, GIS and specialized software, and more importantly, the access to all of these, through public and private involvement. Conclusions: The Vrancea seismic zone of Romania, as a natural laboratory, involves us with knowledge and individual perception and attitudes and we have time for improved engineering codes, exploring and experiencing some new learning modalities, refining new policies and regulations from this field, new scenarios for implementation of disaster measures.

The purpose of this research: The large-scale use of the external cladding systems with polystyrene thermal insulation, for rehabilitation of existing and new buildings, requires the experimental determination of the fire performance of these thermal insulating systems, both as wholes, and from the materials point of view, which they are constituted from. This study aims to present the evaluation of the fire performance of some polystyrene thermosystems and of the elements that make up these systems. Methodology: Experimental tests are carried out related to the fire behavior of polystyrene thermal insulation systems used in building renovation, in order to determine the mechanisms of flames initiation and propagation on the surface of combustible facades under natural ventilation conditions, the behavior of thermosystems in different fires scenarios and determining the fire performance of the constituent elements of these thermosystems. As a result of the performed tests, it was found that the overall performance of the thermal system against the fire action during the testing was mainly influenced by the value of the thermal load density parameter, and by the way the thermosystem is built and put into operation. The contribution of the components of the thermal system to the ignition, burning, development and propagation of flames and smoke differed on a case-by-case basis, depending on the materials used to cover the polystyrene, and the time elapsed, since they were put into operation. In the direct fire area of the fire test, temperatures above 1000 ° C have been recorded that have led, in some cases, to complete damage to the thermosystem. It is intended to establish a concordance between the parameters resulting from the tests on the facades of buildings, and those measured during the fire reaction tests of the elements which the facades were made from. This highlights the need to introduce the requirement of performing fire performance tests for building façade systems, following a harmonized testing methodology across the European Union.

The rapid increase of the number newly-erected high-rise buildings in Romania during the last two decades brought up the importance of the continuous monitoring of their state. For seismic actions, a post-event modification of the dynamic characteristics of a building can provide a rapid indicator about its potential damage. The paper presents the methods, procedures and steps by which a system providing online remote access to data resulting from building vibration monitoring could be implemented and used for buildings in Romania. The system would allow rapid identification of building damage, based on the processing of recorded data. Identified issues, as well as potential bottlenecks are presented, together with the proposed solutions. The system is planned to be implemented by using the infrastructure available at NIRD URBAN-INCERC, Romania. The paper also presents a case study concerning the structural health monitoring of a multi-story reinforced concrete building, carried out by the project team.

The article aims to present a way of processing the data within a real-time transmission system of recorded vibration. At present, Romanian National Strong Motion Network for Constructions of URBAN-INCERC has 56 seismic / digital accelerometer stations, of which 46 are in territory and 10 in Bucharest. The seismic stations of this system are placed in some ground floor-buildings type, assimilated with the free-field, or in buildings with 1-3 levels. First application of the real-time transmission system is related to the accelerometric records from moderate earthquakes, which have shown a spatial distribution of PGA with NE-SW directivity, similar to that observed under certain conditions of seismic severity in previous strong earthquakes. Some charts illustrating the acceleration amplitudes recorded from the 2016 and 2017 earthquakes in the URBAN-INCERC network will be shown. The second application is referred to the structural response (structural behaviour under ambient vibrations or moderate and severe seismic motions). Generally, the spectral analysis of these records leads to getting: the natural frequencies, the influence of the general directivity of waves propagation specific to the Vrancea source (on the spectral content and on structural response), the influence of the local soil conditions etc. In this case, for a study building, the vibration modes, the drift/the relative floor displacement etc. can result from this processing, with a validation based on a structural modelling with finite elements. The seismic wave propagation direction is the first option for determining the direction of propagation of severe effects on buildings. The correlation between them can be validated by the existence of pre-event dynamic characteristics of those buildings (before a major seismic event) and at post-event time.

To examine the impact of diabetes mellitus on long-term clinical outcomes in patients with myocardial infarction (MI) complicated by clinical signs of heart failure (HF) or left ventricular dysfunction (LVD).The High-Risk MI Database consists of individual data from 28 771 patients and was created by merging four large recent randomized clinical trials (VALIANT, EPHESUS, OPTIMAAL, and CAPRICORN) that each examined the impact of pharmacological interventions following MI in patients with evidence of HF or LVD. The mean age of patients was 65 years, 70% were male, and almost 94% Caucasian. Overall, 7368 (26%) had a history of diabetes. All the major outcomes were adjudicated by independent end-point committees. Strong and highly significant associations were found with all major clinical outcomes. Diabetes was associated with an increased risk for all-cause death [adjusted hazard ratio (HR) 1.37; confidence interval (CI) 1.28-1.46; P0.001]. The higher risk for all-cause death was largely mediated by higher risk for cardiovascular death (adjusted HR 1.38; CI 1.27-1.48; P0.001) predominantly due to a substantially increased risk for fatal re-infarction (adjusted HR 1.78; CI 1.42-2.23; P0.001). Additionally, diabetes was associated with an increased risk for hospitalizations, particularly HF hospitalization (adjusted HR 1.50; CI 1.39-1.63; P0.001). There were also elevated risks for composite outcomes, particularly death or hospitalization due to HF (adjusted HR 1.48; CI 1.38-1.59; P0.001).The risk for adverse outcomes associated with diabetes remains elevated even after debut of coronary artery disease in patients with MI complicated by clinical signs of HF or LVD. This association is particularly strong for HF-related outcomes.

Submicron designs have the price of dealing with more unwanted physical effects such as high interconnect impedance, noise propagation or Miller effect. This paper's intent is to analyze PAD cells performance for submicron technologies (from 90nm to 55nm). The methods used are HSPICE simulations and cell characterization (NLDM and CCS). The performance of PAD cells will be analyzed through timing parameters, input capacitance values and internal power.

Hyperglycemia predicts death in cardiovascular disease, but intensive glucose-lowering strategies increase mortality rates in diabetes. The present analysis investigated the prognostic value of postadmission blood glucose (BG) concentration on clinical outcomes in high-risk patients with heart failure after acute myocardial infarction.A total of 6,496 patients from the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS) were categorized into 4 groups by plasma glucose concentration: ≤4.5 mmol/L (hypoglycemia), 4.5-5.5 mmol/L (normoglycemia), 5.5-8.3 mmol/L (elevated glucose level), and8.3 mmol/L (severe hyperglycemia). We evaluated the time to all-cause death (primary end point) and time to cardiovascular death or hospitalization (secondary end point). Hypo- and severe hyperglycemia were prevalent in 509 (8%) and 1,588 (24%) patients, respectively. There was a U-shaped relationship between BG level and incidence of all-cause death (11.8% in patients with normoglycemia vs 15.1% and 19.9% in those with hypo- and severe hyperglycemia; P.001). The incidence of the secondary end point was increased only in hyperglycemic patients (36% vs 23% in normoglycemic patients; P.001). In multivariate Cox regression analysis, hypoglycemia (hazard ratio [HR] 1.38, 95% confidence interval [CI] 1.06-1.81; P = .002) and severe hyperglycemia (HR 1.52, CI 1.27-1.83; P.0001) proved to be strong predictors of all-cause death. There was no significant interaction between eplerenone treatment and blood glucose levels regarding clinical outcomes.In heart failure after acute myocardial infarction, both hypo- and hyperglycemia at the postacute phase identify patients with increased risk of death during long-term follow-up.

Background— We evaluated the effect of the selective mineralocorticoid receptor antagonist eplerenone on renal function and the interaction between changes in renal function and subsequent cardiovascular outcomes in patients with heart failure and left ventricular systolic dysfunction after an acute myocardial infarction in the Eplerenone Post–Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS). Methods and Results— Serial changes in estimated glomerular filtration rate (eGFR) were available in 5792 patients during a 24-month follow-up. Patients assigned to eplerenone had a decline in eGFR with an adjusted mean difference of −1.4±0.3 mL · min −1 · 1.73 m −2 compared with placebo ( P −1 · 1.73 m −2 ) and persisted throughout the study. Overall, 914 patients experienced a decline in eGFR >20% in the first month, 16.9% and 14.7% in the eplerenone and placebo groups, respectively (odds ratio, 1.15; 95% confidence interval, 1.02–1.30; P =0.017). In multivariate analyses, determinants of this early decline in eGFR were female sex, age ≥65 years, smoking, left ventricular ejection fraction 20% was associated with worse cardiovascular outcomes independently of baseline eGFR and of the use of eplerenone, which retained its prognostic benefits even under these circumstances. Conclusions— In patients with heart failure after acute myocardial infarction and receiving standard medical care, an early decline in eGFR is not uncommon and is associated with poor long-term outcome. Eplerenone induced a moderately more frequent early decline in eGFR, which did not affect its clinical benefit on cardiovascular outcomes.

Background: Non-serious symptomatic adverse drug events (ADEs) affect the real benefit-risk ratio of a drug. Currently, such ADEs are quantified in different ways, often using reports from a healthcare provider or patients, resulting in large variations in estimated rates. Several studies showed that patients report bothersome or symptomatic ADEs more frequently than providers, but no comparisons to an external reference or gold standard have been made. Objective: We conducted a literature review to assess the agreement and concurrent validity of healthcare provider- and patient-oriented methods for quantifying symptomatic ADEs of oral blood glucose-lowering drugs in patients with type 2 diabetes mellitus. Methods: We systematically searched MEDLINE and EMBASE databases for observational studies reporting on rates of ADEs in patients treated for type 2 diabetes that were published between 1999 and 2011. We included nine observational studies reporting absolute rates of symptomatic ADEs in patients receiving monotherapy. We calculated 95% confidence intervals and assessed agreement between rates observed with different methods. We assessed concurrent validity using the range noted in the Summary of Product Characteristics (SPC) as the gold standard. Results: A comparison of rates reported by patients and providers was only possible using three studies of metformin that assessed mainly gastrointestinal (GI) ADEs. Provider-oriented methods by means of medical record review gave lower rates for abdominal pain (0.6–3.7%), dyspepsia (1.3–2.8%) and constipation (0.6–1.0%) than a patient questionnaire method (8.5%, 11.9% and 20.7%, respectively). For diarrhoea, the patient-reported rate (5.2%) was in agreement with the provider-based rates (1.6–7.6%). The majority of the rates reported by providers and patients were not corresponding with the ranges in the SPC. For GI ADEs the rates were all lower, whereas for lactic acidosis and hypoglycaemia the rates were higher. Conclusion: Although it has repeatedly been proposed that patients’ reports on safety should be incorporated with providers’ reports, especially for symptomatic ADEs, the number of observational studies using patient-oriented methods for assessing ADEs other than hypoglycaemia are limited. Provider-based measurement tended to underestimate symptomatic ADEs. Patient-oriented methods seemed to give ADE rates that were closer to the rates reported in the SPC.

To assess the implementation of home blood pressure measurement (HBPM) by French general practitioners (GPs) in current practice in 2009 and to assess the evolution of practices between 2004 and 2009; the perceived benefits and limitations of the method; and the adherence to methodological European [European Society of Hypertension (ESH) 2007] or French [La Haute Autorité de Santé (HAS) 2005] recommendations.Two phone surveys on a representative random sample of French GPs in 2004 and then in 2009.Five hundred and forty and 801 GPs were contacted in 2004 and 2009, respectively, in which 511 and 500 participated, including the same 214 in both surveys. The proportion of HBPM users increased between 2004 (70%) and 2009 (92%) (P0.0001). The majority still remained occasional users (71%), whereas a minority (21%) used this method nearly systematically in 2009. In 2009, both users and nonusers highlighted the lack of reliability of devices (19 and 47%) and lack of patient reliability (27 and 24%) and patient anxiety (47 and 29%). The expected benefit was primarily the detection of white-coat effect (70%), therapeutic adaptation (36%), diagnostic aid (25%), and better compliance with treatment (14%). Masked hypertension detection (2%) and prognostic interest (0.7%) were marginal. The GPs declared rarely adopting ESH methodology (3% of users), but more often HAS methodology (33%). Adherence to the complete methodology was rare (absolute adherence1%), but more often 'minimal' (three morning and evening measurements, at least 3 days with an upper arm cuff: 17%). Contraindications of HBPM use were not known.Despite greater use of HBPM after enactment of the recommendations, the methodology is not strictly implemented, making its diagnostic and prognostic value uncertain.

We aimed to summarize the predictors of renal dysfunction and present strategies to prevent and/or treat renal dysfunction in Chronic Heart Failure (CHF). Several factors may predict renal dysfunction in CHF, including older age, comorbidities (anemia, hypertension, diabetes), severity of underlying heart disease (systolic and diastolic dysfunction, central venous pressure) as well as certain therapies in specific circumstances (diuretics, nonsteroid acute inflammatory drugs, and renine-angiotensin-aldosterone (RAAS) inhibitors). Thus, prevention of renal dysfunction is possible in CHF by treating comorbidities and underlying heart disease as well as by monitoring therapies with potential toxic renal effect. At present, there is no specific treatment for renal dysfunction, but several new entities are under investigation. In conclusion, prevention of renal dysfunction is possible in CHF, but treatment is still under investigation. New studies are necessary to establish whether a specific algorithm may be used to prevent renal dysfunction in CHF patients.