Boundary elements in potential and elasticity theory

A general theory that describes the B.I.E. linear approximation in potential and elasticity problems, is developed. A method to tread the Dirichlet condition in sharp vertex is presented. Though the study is developed for linear elements, its extension to higher order interpolation is straightforward. A new direct assembling procedure of the global of equations to be solved, is finally showed.

Diagnosis and Management of Grain-Induced Asthma

Grain-induced asthma is a frequent occupational allergic disease mainly caused by inhalation of cereal flour or powder. The main professions affected are bakers, confectioners, pastry factory workers, millers, farmers, and cereal handlers. This disorder is usually due to an IgE-mediated allergic response to inhalation of cereal flour proteins. The major causative allergens of grain-related asthma are proteins derived from wheat, rye and barley flour, although baking additives, such as fungal α-amylase are also important. This review deals with the current diagnosis and treatment of grain-induced asthma, emphasizing the role of cereal allergens as molecular tools to enhance diagnosis and management of this disorder. Asthma-like symptoms caused by endotoxin exposure among grain workers are beyond the scope of this review. Progress is being made in the characterization of grain and bakery allergens, particularly cereal-derived allergens, as well as in the standardization of allergy tests. Salt-soluble proteins (albumins plus globulins), particularly members of the α-amylase/trypsin inhibitor family, thioredoxins, peroxidase, lipid transfer protein and other soluble enzymes show the strongest IgE reactivities in wheat flour. In addition, prolamins (not extractable by salt solutions) have also been claimed as potential allergens. However, the large variability of IgE-binding patterns of cereal proteins among patients with grain-induced asthma, together with the great differences in the concentrations of potential allergens observed in commercial cereal extracts used for diagnosis, highlight the necessity to standardize and improve the diagnostic tools. Removal from exposure to the offending agents is the cornerstone of the management of grain-induced asthma. The availability of purified allergens should be very helpful for a more refined diagnosis, and new immunomodulatory treatments, including allergen immunotherapy and biological drugs, should aid in the management of patients with this disorder.

Design and analysis of ripple-based controls based on the discrete modeling and Floquet theory

Ripple-based controls can strongly reduce the required output capacitance in PowerSoC converter thanks to a very fast dynamic response. Unfortunately, these controls are prone to sub-harmonic oscillations and several parameters affect the stability of these systems. This paper derives and validates a simulation-based modeling and stability analysis of a closed-loop V 2Ic control applied to a 5 MHz Buck converter using discrete modeling and Floquet theory to predict stability. This allows the derivation of sensitivity analysis to design robust systems. The work is extended to different V 2 architectures using the same methodology.

Lessons learned on home energy monitoring and management: Smartcity Málaga

The Smartcity Málaga project is one of Europe?s largest ecoefficient city initiatives. The project has implemented a field trial in 50 households to study the effects of energy monitoring and management technologies on the residential electricity consumption. This poster presents some lessons learned on energy consumption trends, smart clamps reliability and the suitability of power contracted by users, obtained after six months of data analysis.

Planning and Management of Mobility in Natural Protected Areas

The paper describes some relevant results of an on-going research aiming to elaborate a methodology to help the mobility management in natural parks, compatible with their protection missions: it has been developed a procedure to reproduce the mobility-environment relationships in various operational conditions. The final purpose is the identification of: a) the effects of various choices in transport planning, both at long term and strategic level; b) the most effective policies of mobility management. The work is articulated in the following steps: 1) definition of protected area on the basis of ecological and socio-economic criteria and legislative constraints; 2) analysis of mobility needs in the protected areas; 3) reconstruction of the state of the art of mobility management in natural parks at European level; 4) analysis of used traffic flows measurement methods; 5) analysis of environmental impacts due to transport systems modelling (air pollution and noise only); 6) identification of mitigation measures to be potentially applied. The whole methodology has been tested and validated on Italian case studies: i) the concerned area has been zoned according to the land-use peculiarities; ii) the local situations of transport infrastructure (roads and parking), services (public transport systems) and rules (traffic regulations) have been mapped with references to physical and functional attributes; iii) the mobility, both systematic and touristic, has been represented in an origin-destination matrix. By means of an assignment model the flows have been distributed and the corresponding average speeds to quantify gaseous and noise emissions was calculated, the criticalities in the reference scenario have been highlighted, as well as some alternative scenarios, including both operational and infrastructural measures have been identified. The comparison between projects and reference scenario allowed the quantification of effects (variation of emissions) for each scenario and a selection of the most effective management actions to be taken.

Planning and management of mobility in natural protected areas

The final purpose is the identification of: a) the effects of various choices in transport planning, both at long term and strategic level; b) the most effective policies of mobility management. The preliminary work was articulated in the following steps: 1) definition of protected area on the basis of ecological and socio-economic criteria and legislative constraints; 2) analysis of mobility needs in the protected areas; 3) reconstruction of the state of the art of mobility management in natural parks at European level; 4) analysis of used traffic flows measurement methods; 5) analysis of environmental impacts due to transport systems modelling (limited to air pollution and noise); 6) identification of mitigation measures to the potentially applied. The whole methodology has been firstly tested on the case study of the National Park of ?Gran Sasso and Monti della Laga? and further validated on the National Park of ?Gargano?, both located Italy: i) the concerned area has been zoned according to the land-use peculiarities; ii) the local situations of transport infrastructure (roads and parking), services (public transport systems) and rules (traffic regulations) have been mapped with references to physical and functional attributes; iii) the mobility, both systematic and touristic, has been synthetically represented in an origin-destination matrix. By means of an assignment model it has been determined the distribution of flows and the corresponding average speeds to quantify gaseous and noise emissions. On this basis the environmental criticalities in the reference scenario have been highlighted, as well as some alternative scenarios including both operational and infrastructural measures have been identified. The comparison between the projects and the reference scenario allowed the quantification of the effects (variation of emissions) for each scenario and a selection of the most effective management actions to be taken.

Clinical presentation, allergens, and management of wheat allergy

IgE-mediated allergy to wheat proteins can be caused by exposure through ingestion, inhalation, or skin/mucosal contact, and can affect various populations and age groups. Respiratory allergy to wheat proteins is commonly observed in adult patients occupationally exposed to flour, whereas wheat food allergy is more common in children. Wheat allergy is of growing importance for patients with recurrent anaphylaxis, especially when exercise related. The diagnosis of wheat allergy relies on a consistent clinical history, skin prick testing with well-characterized extracts and specific IgE tests. The accuracy of wheat allergy diagnosis may be improved by measuring IgE responses to several wheat components. However, a high degree of heterogeneity has been found in the recognition pattern of allergens among patient groups with different clinical profiles, as well as within each group. Thus, oral provocation with wheat or the implicated cereal is the reference test for the definitive diagnosis of ingested wheat/cereal allergy.

Implications of applying widely accepted cholesterol screening and management guidelines to a British adult population: cross sectional study of cardiovascular disease and risk factors

Objective: To compare the implications of four widely used cholesterol screening and treatment guidelines by applying them to a population in the United Kingdom.

Optic neuritis in pediatric population: A review in current tendencies of diagnosis and management

Optic neuritis is an inflammation of the optic nerve and may be related to different systemic conditions. The clinical presentation of this pathology usually includes sudden loss of visual acuity (VA) which may be unilateral or bilateral, visual field restriction, pain with eye movements, dyschromatopsia, a relative afferent pupillary defect and optic disk swelling. Optic neuritis in children has specific clinical features and a better prognosis than in adulthood. Although usually appears an underlying viral disease, the main concern for practitioners is the relationship of optic neuritis with multiple sclerosis. In addition to the classical techniques as magnetic resonance imaging (MRI), current tendencies of diagnosis for eye practitioners include new imaging devices as optical coherence tomography (OCT), useful to show a thinning of the retinal fibers layer (RFL) after the inflammatory episode. Regarding the management of these patients, short-term intravenous steroid dosages seem to be the best option to treat acute attacks characterized by a very poor bilateral VA.

Use of an Inverse Method for Time Series to Estimate the Dynamics of and Management Strategies for the Box Jellyfish Carybdea marsupialis

Frequently, population ecology of marine organisms uses a descriptive approach in which their sizes and densities are plotted over time. This approach has limited usefulness for design strategies in management or modelling different scenarios. Population projection matrix models are among the most widely used tools in ecology. Unfortunately, for the majority of pelagic marine organisms, it is difficult to mark individuals and follow them over time to determine their vital rates and built a population projection matrix model. Nevertheless, it is possible to get time-series data to calculate size structure and densities of each size, in order to determine the matrix parameters. This approach is known as a “demographic inverse problem” and it is based on quadratic programming methods, but it has rarely been used on aquatic organisms. We used unpublished field data of a population of cubomedusae Carybdea marsupialis to construct a population projection matrix model and compare two different management strategies to lower population to values before year 2008 when there was no significant interaction with bathers. Those strategies were by direct removal of medusae and by reducing prey. Our results showed that removal of jellyfish from all size classes was more effective than removing only juveniles or adults. When reducing prey, the highest efficiency to lower the C. marsupialis population occurred when prey depletion affected prey of all medusae sizes. Our model fit well with the field data and may serve to design an efficient management strategy or build hypothetical scenarios such as removal of individuals or reducing prey. TThis This sdfsdshis method is applicable to other marine or terrestrial species, for which density and population structure over time are available.

Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH). Main Recommendations MR1. ESGE recommends immediate assessment of hemodynamic status in patients who present with acute upper gastrointestinal hemorrhage (UGIH), with prompt intravascular volume replacement initially using crystalloid fluids if hemodynamic instability exists (strong recommendation, moderate quality evidence). MR2. ESGE recommends a restrictive red blood cell transfusion strategy that aims for a target hemoglobin between 7 g/dL and 9 g/dL. A higher target hemoglobin should be considered in patients with significant co-morbidity (e. g., ischemic cardiovascular disease) (strong recommendation, moderate quality evidence). MR3. ESGE recommends the use of the Glasgow-Blatchford Score (GBS) for pre-endoscopy risk stratification. Outpatients determined to be at very low risk, based upon a GBS score of 0 - 1, do not require early endoscopy nor hospital admission. Discharged patients should be informed of the risk of recurrent bleeding and be advised to maintain contact with the discharging hospital (strong recommendation, moderate quality evidence). MR4. ESGE recommends initiating high dose intravenous proton pump inhibitors (PPI), intravenous bolus followed by continuous infusion (80 mg then 8 mg/hour), in patients presenting with acute UGIH awaiting upper endoscopy. However, PPI infusion should not delay the performance of early endoscopy (strong recommendation, high quality evidence). MR5. ESGE does not recommend the routine use of nasogastric or orogastric aspiration/lavage in patients presenting with acute UGIH (strong recommendation, moderate quality evidence). MR6. ESGE recommends intravenous erythromycin (single dose, 250 mg given 30 - 120 minutes prior to upper gastrointestinal [GI] endoscopy) in patients with clinically severe or ongoing active UGIH. In selected patients, pre-endoscopic infusion of erythromycin significantly improves endoscopic visualization, reduces the need for second-look endoscopy, decreases the number of units of blood transfused, and reduces duration of hospital stay (strong recommendation, high quality evidence). MR7. Following hemodynamic resuscitation, ESGE recommends early (≤ 24 hours) upper GI endoscopy. Very early (< 12 hours) upper GI endoscopy may be considered in patients with high risk clinical features, namely: hemodynamic instability (tachycardia, hypotension) that persists despite ongoing attempts at volume resuscitation; in-hospital bloody emesis/nasogastric aspirate; or contraindication to the interruption of anticoagulation (strong recommendation, moderate quality evidence). MR8. ESGE recommends that peptic ulcers with spurting or oozing bleeding (Forrest classification Ia and Ib, respectively) or with a nonbleeding visible vessel (Forrest classification IIa) receive endoscopic hemostasis because these lesions are at high risk for persistent bleeding or rebleeding (strong recommendation, high quality evidence). MR9. ESGE recommends that peptic ulcers with an adherent clot (Forrest classification IIb) be considered for endoscopic clot removal. Once the clot is removed, any identified underlying active bleeding (Forrest classification Ia or Ib) or nonbleeding visible vessel (Forrest classification IIa) should receive endoscopic hemostasis (weak recommendation, moderate quality evidence). MR10. In patients with peptic ulcers having a flat pigmented spot (Forrest classification IIc) or clean base (Forrest classification III), ESGE does not recommend endoscopic hemostasis as these stigmata present a low risk of recurrent bleeding. In selected clinical settings, these patients may be discharged to home on standard PPI therapy, e. g., oral PPI once-daily (strong recommendation, moderate quality evidence). MR11. ESGE recommends that epinephrine injection therapy not be used as endoscopic monotherapy. If used, it should be combined with a second endoscopic hemostasis modality (strong recommendation, high quality evidence). MR12. ESGE recommends PPI therapy for patients who receive endoscopic hemostasis and for patients with adherent clot not receiving endoscopic hemostasis. PPI therapy should be high dose and administered as an intravenous bolus followed by continuous infusion (80 mg then 8 mg/hour) for 72 hours post endoscopy (strong recommendation, high quality evidence). MR13. ESGE does not recommend routine second-look endoscopy as part of the management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH). However, in patients with clinical evidence of rebleeding following successful initial endoscopic hemostasis, ESGE recommends repeat upper endoscopy with hemostasis if indicated. In the case of failure of this second attempt at hemostasis, transcatheter angiographic embolization (TAE) or surgery should be considered (strong recommendation, high quality evidence). MR14. In patients with NVUGIH secondary to peptic ulcer, ESGE recommends investigating for the presence of Helicobacter pylori in the acute setting with initiation of appropriate antibiotic therapy when H. pylori is detected. Re-testing for H. pylori should be performed in those patients with a negative test in the acute setting. Documentation of successful H. pylori eradication is recommended (strong recommendation, high quality evidence). MR15. In patients receiving low dose aspirin for secondary cardiovascular prophylaxis who develop peptic ulcer bleeding, ESGE recommends aspirin be resumed immediately following index endoscopy if the risk of rebleeding is low (e. g., FIIc, FIII). In patients with high risk peptic ulcer (FIa, FIb, FIIa, FIIb), early reintroduction of aspirin by day 3 after index endoscopy is recommended, provided that adequate hemostasis has been established (strong recommendation, moderate quality evidence).

Expertise in Ultra-Endurance Triathletes Early Sport Involvement, Training Structure, and the Theory of Deliberate Practice

The theory of deliberate practice (Ericsson, Krampe, & Tesch-Römer, 1993) is predicated on the concept that the engagement in specific forms of practice is necessary for the attainment of expertise. The purpose of this paper was to examine the quantity and type of training performed by expert UE triathletes. Twenty-eight UE triathletes were stratified into expert, middle of the pack, and back of the pack groups based on previous finishing times. All participants provided detailed information regarding their involvement in sports in general and the three triathlon sports in particular. Results illustrated that experts performed more training than non-experts but that the relationship between training and performance was not monotonic as suggested by Ericsson et al. Further, experts' training was designed so periods of high training stress were followed by periods of low stress. However, early specialization was not a requirement for expertise. This work indicates that the theory of deliberate practice does not fully explain expertise development in UE triathlon.