Optimized Duration of Clopidogrel Therapy Following Treatment with the Endeavor Zotarolimus-Eluting Stent in Real-World Clinical Practice (OPTIMIZE) Trial: Rationale and design of a large-scale, randomized, multicenter study

Background Current recommendations for antithrombotic therapy after drug-eluting stent (DES) implantation include prolonged dual antiplatelet therapy (DAPT) with aspirin and clopidogrel >= 12 months. However, the impact of such a regimen for all patients receiving any DES system remains unclear based on scientific evidence available to date. Also, several other shortcomings have been identified with prolonged DAPT, including bleeding complications, compliance, and cost. The second-generation Endeavor zotarolimus-eluting stent (E-ZES) has demonstrated efficacy and safety, despite short duration DAPT (3 months) in the majority of studies. Still, the safety and clinical impact of short-term DAPT with E-ZES in the real world is yet to be determined. Methods The OPTIMIZE trial is a large, prospective, multicenter, randomized (1: 1) non-inferiority clinical evaluation of short-term (3 months) vs long-term (12-months) DAPT in patients undergoing E-ZES implantation in daily clinical practice. Overall, 3,120 patients were enrolled at 33 clinical sites in Brazil. The primary composite endpoint is death (any cause), myocardial infarction, cerebral vascular accident, and major bleeding at 12-month clinical follow-up post-index procedure. Conclusions The OPTIMIZE clinical trial will determine the clinical implications of DAPT duration with the second generation E-ZES in real-world patients undergoing percutaneous coronary intervention. (Am Heart J 2012;164:810-816.e3.)

Sleep duration in elderly obese patients correlated negatively with intake fatty

Study objectives: The purpose of the present study was to evaluate the relationship between sleep duration and dietary habits in elderly obese patients treated at an institute of cardiology. Methods: The fifty-eight volunteers were elderly patients with obesity (classified as obese according to BMI) of both genders, between 60 and 80 years of age. All participants were subjected to assessments of food intake, anthropometry, level of physical activity, and duration of sleep. Results: The men had significantly greater weight, height, and waist circumference than women. Sleep durations were correlated with dietary nutrient compositions only in men. We found a negative association between short sleep and protein intake (r = -0.43; p = 0.02), short sleep and monounsaturated fatty acids intake (r = -0.40; p = 0.03), and short sleep and cholesterol dietary intake (r = -0.50; p = 0.01). Conclusions: We conclude that mainly in men, volunteers that had short sleep duration showed a preference for high energy-density as fatty food, at least in part, may explain the relationship between short sleep duration and the development of metabolic abnormalities.

Effect of the rest interval duration between contractions on muscle fatigue

Background: We aimed to investigate the effect of rest interval, between successive contractions, on muscular fatigue. Methods: Eighteen subjects performed elbow flexion and extension (30 repetitions) on an isokinetic dynamometer with 80 degrees of range of motion. The flexion velocity was 120 degrees/s, while for elbow extension we used 5 different velocities (30, 75, 120, 240, 360 degrees/s), producing 5 different rest intervals (2.89, 1.28, 0.85, 0.57 and 0.54 s). Results: We observed that when the rest interval was 2.89 s there was a reduction in fatigue. On the other hand, when the rest interval was 0.54 s the fatigue was increased. Conclusions: When the resting time was lower (0.54 s) the decline of work in the flexor muscle group was higher compared with different rest interval duration.

Involvement of the basolateral complex and central nucleus of amygdala in the omission effects of different magnitudes of reinforcement

Evidence from appetitive Pavlovian and instrumental conditioning studies suggest that the amygdala is involved in modulation of responses correlated with motivational states, and therefore, to the modulation of processes probably underlying reinforcement omission effects. The present study aimed to clarify whether or not the mechanisms related to reinforcement omission effects of different magnitudes depend on basolateral complex and central nucleus of amygdala. Rats were trained on a fixed-interval 12 s with limited hold 6 s signaled schedule in which correct responses were always followed by one of two reinforcement magnitudes. Bilateral lesions of the basolateral complex and central nucleus were made after acquisition of stable performance. After postoperative recovery, the training was changed from 100% to 50% reinforcement schedules. The results showed that lesions of the basolateral complex and central nucleus did not eliminate or reduce, but interfere with reinforcement omission effects. The response from rats of both the basolateral complex and central nucleus lesioned group was higher relative to that of the rats of their respective sham-lesioned groups after reinforcement omission. Thus, the lesioned rats were more sensitive to the omission effect. Moreover, the basolateral complex lesions prevented the magnitude effect on reinforcement omission effects. Basolateral complex lesioned rats showed no differential performance following omission of larger and smaller reinforcement magnitude. Thus, the basolateral complex is involved in incentive processes relative to omission of different reinforcement magnitudes. Therefore, it is possible that reinforcement omission effects are modulated by brain circuitry which involves amygdala. (C) 2012 Elsevier B.V. All rights reserved.

The impact of psychiatric diagnosis on treatment adherence and duration among victimized children and adolescents in Sao Paulo, Brazil

OBJECTIVE: Despite the high prevalence of substance abuse and mood disorders among victimized children and adolescents, few studies have investigated the association of these disorders with treatment adherence, represented by numbers of visits per month and treatment duration. We aimed to investigate the effects of substance abuse and mood disorders on treatment adherence and duration in a special programfor victimized children in Sao Paulo, Brazil. METHODS: A total of 351 participants were evaluated for psychiatric disorders and classified into one of five groups: mood disorders alone; substance abuse disorders alone; mood and substance abuse disorders; other psychiatric disorders; no psychiatric disorders. The associations between diagnostic classification and adherence to treatment and the duration of program participation were tested with logistic regression and survival analysis, respectively. RESULTS: Children with mood disorders alone had the highest rate of adherence (79.5%); those with substance abuse disorders alone had the lowest (40%); and those with both disorders had an intermediate rate of adherence (50%). Those with other psychiatric disorders and no psychiatric disorders also had high rates of adherence (75.6% and 72.9%, respectively). Living with family significantly increased adherence for children with substance abuse disorders but decreased adherence for those with no psychiatric disorders. The diagnostic correlates of duration of participation were similar to those for adherence. CONCLUSIONS: Mood and substance abuse disorders were strong predictive factors for treatment adherence and duration, albeit in opposite directions. Living with family seems to have a positive effect on treatment adherence for patients with substance abuse disorders. More effective treatment is needed for victimized substance-abusing youth.

The impact of psychiatric diagnosis on treatment adherence and duration among victimized children and adolescents in São Paulo, Brazil

OBJECTIVE: Despite the high prevalence of substance abuse and mood disorders among victimized children and adolescents, few studies have investigated the association of these disorders with treatment adherence, represented by numbers of visits per month and treatment duration. We aimed to investigate the effects of substance abuse and mood disorders on treatment adherence and duration in a special program for victimized children in São Paulo, Brazil. METHODS: A total of 351 participants were evaluated for psychiatric disorders and classified into one of five groups: mood disorders alone; substance abuse disorders alone; mood and substance abuse disorders; other psychiatric disorders; no psychiatric disorders. The associations between diagnostic classification and adherence to treatment and the duration of program participation were tested with logistic regression and survival analysis, respectively. RESULTS: Children with mood disorders alone had the highest rate of adherence (79.5%); those with substance abuse disorders alone had the lowest (40%); and those with both disorders had an intermediate rate of adherence (50%). Those with other psychiatric disorders and no psychiatric disorders also had high rates of adherence (75.6% and 72.9%, respectively). Living with family significantly increased adherence for children with substance abuse disorders but decreased adherence for those with no psychiatric disorders. The diagnostic correlates of duration of participation were similar to those for adherence. CONCLUSIONS: Mood and substance abuse disorders were strong predictive factors for treatment adherence and duration, albeit in opposite directions. Living with family seems to have a positive effect on treatment adherence for patients with substance abuse disorders. More effective treatment is needed for victimized substance-abusing youth

Analisi di performance di un terminal aeroportuale e sistemi a coda: studio teorico e applicazione numerica per la mobilità land-side dell'aeroporto `G.Marconi' di Bologna

Questa tesi si propone di indagare l'impatto di alcuni scenari di sviluppo aeroportuale legati alla prevista implementazione di un sistema di trasporto APM - People Mover, in termini di performance del terminal passeggeri dell'Aeroporto `G.Marconi' di Bologna, per fornire soluzioni efficaci alla mobilità. Il background teorico è rappresentato dai risultati ottenuti dalla ricerca sperimentale e ormai acquisiti dalla trattazione classica per code markoviane avanzate (bulk queus), mentre il metodo messo a punto, del tutto generale,parte dagli arrivi schedulati e attraverso una serie di considerazioni econometriche costruisce una serie di scenari differenti,implementati poi attraverso la simulazione dinamica con l'utilizzo del software ARENA. Le principali grandezze di stato descrittive dei processi modellizzati ottenute in output vengono confrontate e valutate nel complesso, fornendo in prima approssimazione previsioni sull'efficacia del sistema previsto. Da ultimo, vengono proposti e confrontati i due approcci forniti tanto dalla manualistica di settore quanto da contributi di ricerca per arrivare a definire un dimensionamento di massima di strutture per la mobilità (una passerella di collegamento del terminal alla stazione APM) e una verifica della piattaforma per l'attesa ad essa contigua.

Analisi delle funzionalità e delle prestazioni di un casello autostradale mediante un modello di coda multiclasse

Riguarda la realizzazione di un modello per l'analisi prestazionale di un casello autostradale, in grado di valutare performance e livello di qualità erogato all'utenza in relazione al rapporto esistente tra domanda e offerta di servizio. Trattandosi di un varco autostradale si tratterà di analizzare un problema relativo ad un certo numero di veicoli in attesa di ricevere un servizio caratterizzato da tempi e modalità diverse a seconda della tipologia veicolare e della tipologia di esazione utilizzata. Il problema viene affrontato tramite la teoria delle code che permette la valutazione dei relativi parametri prestazionali. Partendo dallo studio dei casi più semplici di coda M/M/1 vengono fatte valutazioni sui tempi di servizio arrivando a identificare il modello M/G/1 come più appropriato per un tale problema. Viene poi illustrata l'impostazione del modello con input e output relativi. Il modello viene infine applicato a una stazione reale della rete per evidenziare le valutazioni che è possibile ottenere da un modello così realizzato.

Proposta di traduzione parziale dal cinese di "Le avventure del topolino senza coda: Le uova decorate venute dal cielo". Un racconto di Liu Haiqi.

Il presente elaborato ha l'obiettivo di mostrare una proposta di traduzione dal cinese dei primi due capitoli di "Le avventure del topolino senza coda: le uova decorate venute dal cielo", terzo e ultimo episodio della serie scritta da Liu Haiqi, pubblicata nel 2012 dalla Jieli editrice. La prima parte è dedicata alle informazioni sull'autore, sulla serie, sul libro e sul contesto letterario in cui si inserisce, nonché alla presentazione della proposta di traduzione, il cui testo originale si trova in appendice. La seconda parte contiene l'analisi, il commento e i temi emersi dalla lettura del testo.

Riparazione del trave di coda di un Cessna Super Skymaster 337A danneggiato

Il presente elaborato ha lo scopo di descrivere le fasi di riparazione del trave di coda di un Cessna Super Skymaster 337A danneggiatosi durante le fasi di rimessaggio in hangar. Per prima cosa andremo ad analizzare le normative in materia di manutenzione degli aeromobili, in particolare la circolare 13 del RAI (Metodi accettabili per la manutenzione degli aeromobili) e la circolare 43.13-1A delle FAA (Acceptable methods, techniques, and practices-Aircraft ispection and repair). Verificheremo poi la tipologia del danno subito dal velivolo e, rifacendoci anche al Service Manual del costruttore, andremo a progettare la riparazione. Riparazioni estese a rivestimenti resistenti su strutture a guscio, infatti, devono preferibilmente essere fatte seguendo le specifiche raccomandazioni del costruttore dell’aeromobile. In molti casi, soprattutto se il danno non è esteso, le parti della riparazione possono essere progettate, e ne può essere dimostrata l’adeguata resistenza, senza calcolare i carichi e le sollecitazioni di progetto, considerando nel modo dovuto il materiale e le dimensioni delle parti originali e dei giunti chiodati. La cosa importante è che la parte riparata dovrà risultare pari all’originale per quanto riguarda la robustezza in relazione a tutti i tipi di carichi e alla rigidezza generale. Nel nostro caso andremo comunque a effettuare un’analisi strutturale per verificare l’effettiva correttezza dei principi contenuti nel manuale di manutenzione. Una volta verificato questo, procederemo con la realizzazione della riparazione soffermandoci sulle caratteristiche dei materiali utilizzati e sulle metodologie utilizzate durante la lavorazione. A lavoro ultimato trarremo poi le dovute conclusioni.

Inconsistencies in the planning of the duration of anticoagulation among outpatients with acute deep-vein thrombosis. Results from the OTIS-DVT Registry

Three-month anticoagulation is recommended to treat provoked or first distal deep-vein thrombosis (DVT), and indefinite-duration anticoagulation should be considered for patients with unprovoked proximal, unprovoked recurrent, or cancer-associated DVT. In the prospective Outpatient Treatment of Deep Vein Thrombosis in Switzerland (OTIS-DVT) Registry of 502 patients with acute objectively confirmed lower extremity DVT (59% provoked or first distal DVT; 41% unprovoked proximal, unprovoked recurrent, or cancer-associated DVT) from 53 private practices and 11 hospitals, we investigated the planned duration of anticoagulation at the time of treatment initiation. The decision to administer limited-duration anticoagulation therapy was made in 343 (68%) patients with a median duration of 107 (interquartile range 91-182) days for provoked or first distal DVT, and 182 (interquartile range 111-184) days for unprovoked proximal, unprovoked recurrent, or cancer-associated DVT. Among patients with provoked or first distal DVT, anticoagulation was recommended for < 3 months in 11%, 3 months in 63%, and for an indefinite period in 26%. Among patients with unprovoked proximal, unprovoked recurrent, or cancer-associated DVT, anticoagulation was recommended for < 6 months in 22%, 6-12 months in 38%, and for an indefinite period in 40%. Overall, there was more frequent planning of indefinite-duration therapy from hospital physicians as compared with private practice physicians (39% vs. 28%; p=0.019). Considerable inconsistency in planning the duration of anticoagulation therapy mandates an improvement in risk stratification of outpatients with acute DVT.

Factors predicting protracted improvement after pallidal DBS for primary dystonia: the role of age and disease duration

In many patients, optimal results after pallidal deep brain stimulation (DBS) for primary dystonia may appear over several months, possibly beyond 1 year after implant. In order to elucidate the factors predicting such protracted clinical effect, we retrospectively reviewed the clinical records of 44 patients with primary dystonia and bilateral pallidal DBS implants. Patients with fixed skeletal deformities, as well as those with a history of prior ablative procedures, were excluded. The Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) scores at baseline, 1 and 3 years after DBS were used to evaluate clinical outcome. All subjects showed a significant improvement after DBS implants (mean BFMDRS improvement of 74.9% at 1 year and 82.6% at 3 years). Disease duration (DD, median 15 years, range 2-42) and age at surgery (AS, median 31 years, range 10-59) showed a significant negative correlation with DBS outcome at 1 and 3 years. A partition analysis, using DD and AS, clustered subjects into three groups: (1) younger subjects with shorter DD (n = 19, AS < 27, DD ? 17); (2) older subjects with shorter DD (n = 8, DD ? 17, AS ? 27); (3) older subjects with longer DD (n = 17, DD > 17, AS ? 27). Younger patients with short DD benefitted more and faster than older patients, who however continued to improve 10% on average 1 year after DBS implants. Our data suggest that subjects with short DD may expect to achieve a better general outcome than those with longer DD and that AS may influence the time necessary to achieve maximal clinical response.