Quantitative ultrasound for the detection and management of osteoporosis.

Quantitative ultrasound (QUS) appears to be developing into an acceptable, low-cost and readily-accessible alternative to dual X-ray absorptiometry (DXA) measurements of bone mineral density (BMD) in the detection and management of osteoporosis. Perhaps the major difficulty with their widespread use is that many different QUS devices exist that differ substantially from each other, in terms of the parameters they measure and the strength of empirical evidence supporting their use. But another problem is that virtually no data exist outside of Caucasian or Asian populations. In general, heel QUS appears to be most tested and most effective. Some, but not all heel QUS devices are effective assessing fracture risk in some, but not all populations, the evidence being strongest for Caucasian females > 55 years old, though some evidence exists for Asian females > 55 and for Caucasian and Asian males > 70. Certain devices may allow to estimate the likelihood of osteoporosis, but very limited evidence exists supporting QUS use during the initiation or monitoring of osteoporosis treatment. Likely, QUS is most effective when combined with an assessment of clinical risk factors (CRF); with DXA reserved for individuals who are not identified as either high or low risk using QUS and CRF. However, monitoring and maintenance of test and instrument accuracy, precision and reproducibility are essential if QUS devices are to be used in clinical practice; and further scientific research in non-Caucasian, non-Asian populations clearly is compulsory to validate this tool for more widespread use.

Estratégias de implementação de plataformas de e-maintenance na indústria: desenvolvimento de uma aplicação para um sistema logístico de viaturas

Mestrado em Engenharia Electrotécnica – Sistemas Eléctricos de Energia

Quantitative ultrasound in the management of osteoporosis: the 2007 ISCD Official Positions

Dual-energy X-ray absorptiometry (DXA) is commonly used in the care of patients for diagnostic classification of osteoporosis, low bone mass (osteopenia), or normal bone density; assessment of fracture risk; and monitoring changes in bone density over time. The development of other technologies for the evaluation of skeletal health has been associated with uncertainties regarding their applications in clinical practice. Quantitative ultrasound (QUS), a technology for measuring properties of bone at peripheral skeletal sites, is more portable and less expensive than DXA, without the use of ionizing radiation. The proliferation of QUS devices that are technologically diverse, measuring and reporting variable bone parameters in different ways, examining different skeletal sites, and having differing levels of validating data for association with DXA-measured bone density and fracture risk, has created many challenges in applying QUS for use in clinical practice. The International Society for Clinical Densitometry (ISCD) 2007 Position Development Conference (PDC) addressed clinical applications of QUS for fracture risk assessment, diagnosis of osteoporosis, treatment initiation, monitoring of treatment, and quality assurance/quality control. The ISCD Official Positions on QUS resulting from this PDC, the rationale for their establishment, and recommendations for further study are presented here.

The clinical use of quantitative ultrasound (QUS) in the detection and management of osteoporosis

For the detection and management of osteoporosis and osteoporosis-related fractures, quantitative ultrasound (QUS) is emerging as a relatively low-cost and readily accessible alternative to dual-energy X-ray absorptiometry (DXA) measurement of bone mineral density (BMD) in certain circumstances. The following is a brief, but thorough review of the existing literature with respect to the use of QUS in 6 settings: 1) assessing fragility fracture risk; 2) diagnosing osteoporosis; 3) initiating osteoporosis treatment; 4) monitoring osteoporosis treatment; 5) osteoporosis case finding; and 6) quality assurance and control. Many QUS devices exist that are quite different with respect to the parameters they measure and the strength of empirical evidence supporting their use. In general, heel QUS appears to be most tested and most effective. Overall, some, but not all, heel QUS devices are effective assessing fracture risk in some, but not all, populations, the evidence being strongest for Caucasian females over 55 years old. Otherwise, the evidence is fair with respect to certain devices allowing for the accurate diagnosis of likelihood of osteoporosis, and generally fair to poor in terms of QUS use when initiating or monitoring osteoporosis treatment. A reasonable protocol is proposed herein for case-finding purposes, which relies on a combined assessment of clinical risk factors (CR.F) and heel QUS. Finally, several recommendations are made for quality assurance and control.

Vibration analysis for Bearing outer race condition diagnostics

This paper investigates defect detection methodologies for rolling element bearings through vibration analysis. Specifically, the utility of a new signal processing scheme combining the High Frequency Resonance Technique (HFRT) and Adaptive Line Enhancer (ALE) is investigated. The accelerometer is used to acquire data for this analysis, and experimental results have been obtained for outer race defects. Results show the potential effectiveness of the signal processing technique to determine both the severity and location of a defect. The HFRT utilizes the fact that much of the energy resulting from a defect impact manifests itself in the higher resonant frequencies of a system. Demodulation of these frequency bands through use of the envelope technique is then employed to gain further insight into the nature of the defect while further increasing the signal to noise ratio. If periodic, the defect frequency is then present in the spectra of the enveloped signal. The ALE is used to enhance the envelope spectrum by reducing the broadband noise. It provides an enhanced envelope spectrum with clear peaks at the harmonics of a characteristic defect frequency. It is implemented by using a delayed version of the signal and the signal itself to decorrelate the wideband noise. This noise is then rejected by the adaptive filter that is based upon the periodic information in the signal. Results have been obtained for outer race defects. They show the effectiveness of the methodology to determine both the severity and location of a defect. In two instances, a linear relationship between signal characteristics and defect size is indicated.

Corrosion Health Monitoring System for Steel Ship Structures

Corrosion represents one of the largest through life cost component of ships. Ship owners and operators recognize that combating corrosion significantly impacts the vessels’ reliability, availability and through life costs. Primary objective of this paper is to review various inspections, monitoring systems and life cycle management with respect to corrosion control of ships and to develop the concept of “Corrosion Health” (CH) which would quantify the extent of corrosion at any point of ships’ operational life. A system approach in which the ship structure is considered as a corrosion system and divided into several corrosion zones, with distinct characteristics, is presented. Various corrosion assessment criteria for assessment of corrosion condition are listed. A CH rating system for representation of complex corrosion condition with a numeric number along with recommendations for repair/maintenance action is also discussed

The untethered facilities manager

Facilities managers have a host of skills to sustain the functionality of complex buildings, often not provided by them directly, but by the team of specialists they draw upon to effectively plan for the future, whether the resource be money, space or technology. Building intelligence presents a challenge in terms of understanding a wholly new approach to the building management. This paper asks if the intelligent building of today meets the needs of the facilities management team. Does it enable them to manage their asset more effectively? New technologies are converging that will enable a radically new approach to maintenance, enabling remote smart sensing or remote condition based monitoring (CBM). Some of the design and economic issues that arise from this radically new approach to managing built assets are highlighted and the possibilities for a maintenance environment, where wires, power cables and data loggers become a thing of the past, is described.

Case study on the maintenance of a construction monitoring using USN-based data acquisition

In recent years, there has been an increasing interest in the adoption of emerging ubiquitous sensor network (USN) technologies for instrumentation within a variety of sustainability systems. USN is emerging as a sensing paradigm that is being newly considered by the sustainability management field as an alternative to traditional tethered monitoring systems. Researchers have been discovering that USN is an exciting technology that should not be viewed simply as a substitute for traditional tethered monitoring systems. In this study, we investigate how a movement monitoring measurement system of a complex building is developed as a research environment for USN and related decision-supportive technologies. To address the apparent danger of building movement, agent-mediated communication concepts have been designed to autonomously manage large volumes of exchanged information. In this study, we additionally detail the design of the proposed system, including its principles, data processing algorithms, system architecture, and user interface specifics. Results of the test and case study demonstrate the effectiveness of the USN-based data acquisition system for real-time monitoring of movement operations.

Road maintenance, funds and fund management

This edition of the Bulletin deals with road maintenance, funds and fund management. Among other things, it emphasizes, the need to manage road funds in accordance with clear performance rules which seek to minimize maintenance costs and ensure that the road network is maintained in an appropriate condition.

Contributi della Geomatica nella salvaguardia e gestione dei Beni Culturali

Il territorio italiano presenta una grandissima ricchezza nel campo dei Beni Culturali, sia mobili che immobili; si tratta di un patrimonio di grande importanza che va gestito e tutelato nel migliore dei modi e con strumenti adeguati, anche in relazione ai problemi ad esso legati in termini di manutenzione e di salvaguardia dai fattori di rischio a cui può essere esposto. Per una buona conoscenza del Patrimonio Culturale, è fondamentale un’acquisizione preliminare di informazioni condotte in modo sistematico e unitario, che siano diffuse ed organiche, ma anche utili ad una valutazione preventiva e ad una successiva programmazione degli interventi di restauro di tipo conservativo. In questo ambito, l'impiego delle tecniche e tecnologie geomatiche nel campo dei Beni Culturali, può fornire un valido contributo, che va dalla catalogazione e documentazione del bene culturale al suo controllo e monitoraggio. Oggigiorno il crescente sviluppo di nuove tecnologie digitali, accompagnato dai notevoli passi avanti compiuti dalle discipline della geomatica (in primo luogo topografiche e fotogrammetriche), rende possibile una efficace integrazione tra varie tecniche, favorita anche dalla diffusione di soluzioni per l’interscambio dati e per la comunicazione tra differenti dispositivi. Lo studio oggetto della presente tesi si propone, di approfondire gli aspetti legati all’uso delle tecniche e tecnologie della Geomatica, per mettere in risalto le condizioni di un bene ed il suo stato di degrado. Per la gestione e la salvaguardia di un bene culturale , si presenta il SIT Carta del Rischio che evidenzia le pericolosità legate al patrimonio, e come esse sommate alla vulnerabilità di un singolo bene, contribuiscano all’individuazione del grado di rischio. di approfondire gli aspetti legati all’uso delle tecniche e tecnologie delle Geomatica, per mettere in risalto le condizioni di un bene ed il suo stato di degrado.

The medical management after surgery for advanced heart failure

The aim of the Research of this Ph D Project is to improve the medical management after surgery for advanced heart failure, both after left ventricular assist devices (LVAD) implantation, and after heart transplantation in the long-term. Regarding heart transplantation (HTx), the Research Project is focused on diagnostics, classification, prevention and treatment of cardiac allograft vasculopathy (CAV), and on treatment of post-HTx cancers; the results are presented in the first part of this Thesis. In particular, the main aspect investigated are the prognostic role of information derived from coronary angiography, coronary tomography and intravascular ultrasound, and the different sensitivity of these techniques in predicting outcomes and in diagnosing CAV. Moreover, the role of mTOR inhibitors on CAV prevention or treatment is investigated, both alone and in combination with different anti-CMV prevention strategies, as well as the impact of mTOR inhibitors on clinical outcomes in the long term. Regarding LVAD, the main focus is on the role of transthoracic echocardiography in the management of patients with a continuous-flow, centrifugal, intrapericardial pump (HVAD, Heartware); this section is reported in the second part of this Thesis. The main aspects investigated are the use of echocardiography in patients with HVAD device and its interaction with the information derived from pump curves' analysis in predicting aortic valve opening status, a surrogate of the condition of support provided by the LVAD.

Multimodal imaging in macular diagnostics: combined OCT-SLO improves therapeutical monitoring

BACKGROUND: Digital imaging methods are a centrepiece for diagnosis and management of macular disease. A recently developed imaging device is composed of simultaneous confocal scanning laser ophthalmoscopy (SLO) and optical coherence tomography (OCT). By means of clinical samples the benefit of this technique concerning diagnostic and therapeutic follow-up will be assessed. METHODS: The combined OCT-SLO-System (Ophthalmic Technologies Inc., Toronto, Canada) allows for confocal en-face fundus imaging and high resolution OCT scanning at the same time. OCT images are obtained from transversal line scans. One light source and the identical scanning rate yield a pixel-to-pixel correspondence of images. Three-dimensional thickness maps are derived from C-scan stacking. RESULTS: We followed-up patients with cystoid macular edema, pigment epithelium detachment, macular hole, venous branch occlusion, and vitreoretinal tractions during their course of therapy. The new imaging method illustrates the reduction of cystoid volume, e.g. after intravitreal injections of either angiostatic drugs or steroids. C-scans are used for appreciation of lesion diameters, visualisation of pathologies involving the vitreoretinal interface, and quantification of retinal thickness change. CONCLUSION: The combined OCT-SLO system creates both topographic and tomographic images of the retina. New therapeutic options can be followed-up closely by observing changes in lesion thickness and cyst volumes. For clinical use further studies are needed.

Impacts of out-migration on land management in mountain areas

INTRODUCTION Out-migration from mountain areas is leaving behind half families and elderly to deal with managing the land alongside daily life challenges. A potential reduction of labour force as well as expertise on cropping practices, maintenance of terraces and irrigation canals, slope stabilization, grazing, forest and other land management practices are further challenged by changing climate conditions and increased environmental threats. An understanding of the resilience of managed land resources in order to enhance adaptation to environmental and socio-economic variability, and evidence of the impact of Sustainable Land Management (SLM) on the mitigation of environmental threats have so far not sufficiently been tackled. The study presented here aims to find out how land management in mountains is being affected by migration in the context of natural hazards and climate change in two study sites, namely Quillacollo District of Bolivia and Panchase area of Western Nepal, and which measures are needed to increase resilience of livelihoods and land management practices. The presentation includes draft results from first field work periods in both sites. A context of high vulnerability According to UNISDR, vulnerability is defined as “the characteristics and circumstances of a community, system or asset that make it susceptible to the damaging effects of a hazard”.Hazards are another threat affecting people’s livelihood in mountainous area. They can be either natural or human induced. Landslides, debris flow and flood are affecting peopleGood land management can significantly reduce occurrence of hazards. In the opposite bad land management or land abandonment can lead to negative consequences on the land, and thus again increase vulnerability of people’s livelihoods. METHODS The study integrates bio-physical and socio-economic data through a case study as well as a mapping approach. From the social sciences, well-tested participatory qualitative methodologies, typically used in Vulnerability and Capacity Analyses, such as semi-structured interviews with so-called ‘key informants’, transect walks, participatory risk and social resource mapping are applied. The bio-physical analysis of the current environmental conditions determining hazards and structural vulnerability are obtained from remote sensing analysis, field work studies, and GIS analysis The assessment of the consequences of migration in the area of origin is linked with a mapping and appraisal of land management practices (www.wocat.net, Schwilch et al., 2011). The WOCAT mapping tool (WOCAT/LADA/DESIRE 2008) allows capturing the major land management practices / technologies, their spread, effectiveness and impact within a selected area. Data drawn from a variety of sources are compiled and harmonised by a team of experts, consisting of land degradation and conservation specialists working in consultation with land users from various backgrounds. The specialists’ and land users’ knowledge is combined with existing datasets and documents (maps, GIS layers, high-resolution satellite images, etc.) in workshops that are designed to build consensus regarding the variables used to assess land degradation and SLM. This process is also referred to as participatory expert assessment or consensus mapping. The WOCAT mapping and SLM documentation methodologies are used together with participatory mapping and other socio-economic data collection (interviews, questionnaires, focus group discussions, expert consultation) to combine information about migration types and land management issues. GIS and other spatial visualization tools (e.g. Google maps) will help to represent and understand these links. FIRST RESULTS Nepal In Nepal, migration is a common strategy to improve the livelihoods. Migrants are mostly men and they migrate to other Asian countries, first to India and then to the Gulf countries. Only a few women are migrating abroad. Women migrate essentially to main Nepali cities when they can afford it. Remittances are used primarily for food and education; however they are hardly used for agricultural purposes. Besides traditional agriculture being maintained, only few new practices are emerging, such as vegetable farming or agroforestry. The land abandonment is a growing consequence of outmigration, resulting in the spreading of invasive species. However, most impacts of migration on land management are not yet clear. Moreover, education is a major concern for the respondents; they want their children having a better education and get better opportunities. Linked to this, unemployment is another major concern of the respondents, which in turn is “solved” through outmigration. Bolivia Migration is a common livelihood strategy in Bolivia. In the area of study, whole families are migrating downward to the cities of the valleys or to other departments of Bolivia, especially to Chapare (tropics) for the coca production and to Santa Cruz. Some young people are migrating abroad, mostly to Argentina. There are few remittances and if those are sent to the families in the mountain areas, then they are mainly used for agriculture purpose. The impacts of migration on land management practices are not clear although there are some important aspects to be underlined. The people who move downward are still using their land and coming back during part of the week to work on it. As a consequence of this multi-residency, there is a tendency to reduce land management work or to change the way the land is used. As in Nepal, education is a very important issue in this area. There is no secondary school, and only one community has a primary school. After the 6th grade students have therefore to go down into the valley towns to study. The lack of basic education is pushing more and more people to move down and to leave the mountains. CONCLUSIONS This study is on-going, more data have to be collected to clearly assess the impacts of out-migration on land management in mountain areas. The first results of the study allow us to present a few interesting findings. The two case studies are very different, however in both areas, young people are not staying anymore in the mountains and leave behind half families and elderly to manage the land. Additionally in both cases education is a major reason for moving out, even though the causes are not always the same. More specifically, in the case of Nepal, the use of remittances underlines the fact that investment in agriculture is not the first choice of a family. In the case of Bolivia, some interesting findings showed that people continue to work on their lands even if they move downward. The further steps of the study will help to explore these interesting issues in more detail. REFERENCES Schwilch G., Bestelmeyer B., Bunning S., Critchley W., Herrick J., Kellner K., Liniger H.P., Nachtergaele F., Ritsema C.J., Schuster B., Tabo R., van Lynden G., Winslow M. 2011. Experiences in Monitoring and Assessment of Sustainable Land Management. Land Degradation & Development 22 (2), 214-225. Doi 10.1002/ldr.1040 WOCAT/LADA/DESIRE 2008. A Questionnaire for Mapping Land Degradation and Sustainable Land Management. Liniger H.P., van Lynden G., Nachtergaele F., Schwilch G. (eds), Centre for Development and Environment, Institute of Geography, University of Berne, Berne

People and Facility Management. The team: the main asset of any management

From the moment we enter a large office building until we leave it, we receive a lot of attentions served by the management of services to the user. However, it is usually quite inappreciable the work that is being developed to keep things running smoothly.The services provided in a building are carried out by people. However, we often tend to forget these people when we talk about the tasks that make that a building operates properly 24 hours a day, 365 days a year.But, for example, what would happen if one day the service provided by the reception in a large building did not function as it should? What would it be like if one day the person performing the service of maintenance of the building's cleaning were not at his post? How would the working day develop if there were not a correct air handling system?People are the foundation of the proper functioning of a building. The work of the Facilities Manager and the Facility Management is the management of their functions: the responsible management of the team.

People and Facility Management. The team: The main asset of any management

From the moment we enter a large office building until we leave it, we receive a lot of attentions served by the management of services to the user. However, it is usually quite inappreciable the work that is being developed to keep things running smoothly. The services provided in a building are carried out by people. However, we often tend to forget these people when we talk about the tasks that make that a building operates properly 24 hours a day, 365 days a year. But, for example, what would happen if one day the service provided by the reception in a large building did not function as it should? What would it be like if one day the person performing the service of maintenance of the building's cleaning were not at his post? How would the working day develop if there were not a correct air handling system? People are the foundation of the proper functioning of a building. The work of the Facilities Manager and the Facility Management is the management of their functions: the responsible management of the team.