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Introduction Every year more than 300,000 proximal femur fractures are diagnosed. Their number will double within 30 years. In femoral neck fractures treated with hip hemiarthroplasty 90-days mortality is 29.5-51.6%. Haemorrhage is one amongst other complications that is associated with increasing postoperative mortality. Transfusion rate in these patients ranges from 25.7% to 39%. Blood transfusions expose to complications. Fibrin sealants are useful in reducing perioperative need for transfusions, total blood loss, blood loss from drainage. The aim of this study is to assess whether the use of a fibrin sealant during hip hemiarthroplasty implant reduces the need for transfusion. Patient and methods All patients admitted with a proximal femur fracture from September 2018 to May 2019 were reviewed. Inclusion criteria were: femoral neck fracture AO 31B2-3, hip hemiarthroplasty. Exclusion criteria were: previous surgery on the affected hip, coagulation disorders, hematopoietic disorders. Patients were divided in fibrin sealant group and control group. All patients underwent partial hip replacement through a posterolateral approach. 4 ml of fibrin sealant (EVICEL, Omrix Biopharmaceuticals, Diegem, Belgium) were sprayed on the soft tissues of patients included in the fibrin sealant group. Primary outcome of our study was need for perioperative transfusion. Secondary outcomes were: mean red blood cell transfused volume, variations in haematocrit and haemoglobin and total blood volume loss. Results Eighty-one consecutive patients were enrolled. EVICEL was used on 19 patients, standard haemostatic care on 62 patients. Two patients were transfused in the fibrin sealant group, 22 in the control group (p 0,0371). Mean transfused volume was 21,05 ml in the fibrin sealant group and 116,16 ml in the control group (p 0,0017). No significant difference could be found in haematocrit and haemoglobin variation and total blood loss. Discussion A reduction in transfusional need with the use of fibrin sealants was reported in studies on total hip arthroplasty and was confirmed by our study. Conclusion EVICEL reduces need for transfusion in patients undergoing hip hemiarthroplasty for a femoral neck fracture. It must be held among the options when a stricter control on transfusional requirement is needed.

Introduction Incidence of hip fractures is increasing with upward estimates representing one of the most current health problems. According to some authors this condition is associated with an early mortality rate ranging between 20% and 35% and low outcomes. One of the predictive factors of poor outcome after hip fracture is anaemia. In fragile patients, hormonal changes due to fracture and surgical trauma, may occur in the hypophyseal hypothalamus axis which may lead to the Euthyroid Sick Syndrome (ESS). This pathological condition is characterized by a reduction in the concentration of triiodothyronine (T3) with normal or slightly reduced thyrotropin (TSH) values and with or without a reduction (cancellata) ​​of thyroxine (T4). ESS has been associated to an increased mortality in elderly patients. Materials and methods Inclusion criteria were: age > 65y, X-ray diagnosis of proximal femoral fracture classified as AO 31A or 31B requiring surgical treatment, admittance to the emergency room within 72 hours from trauma. Exclusion criteria were: any thyroid-related pathology, concomitant acute coronary syndrome, active pneumonia, concomitant neoplastic disease, assumption of medications able to affect thyroid function, refusal to undergo surgical treatment. All patients underwent routine blood testing and a complete thyroid-hormone profile dosage before surgical operation. The same blood tests performed before surgical operation were repeated on the first and third post-operative days. Results Thirtytwo patients met the inclusion criteria and were enrolled after they accepted to participate to the study. Sixteen patients presented with ESS on admission and 16 patients did not. The mean age was 82,5 yo. There was no statistically significant difference in bleeding risk factors among the two groups. In the ESS group there was a number of blood transfusions of 1.06 units higher than the control group (p=0.01). Conclusions We have demonstrated that patients with ESS have a higher need of red blood cells transfusion compared to patients without ESS and, thus they have a higher risk to develop anemia in the peri-operative period. We believe it would be useful to diagnose ESS in fragile patients at their arrival to the emergency room and apply a peri-operative therapeutic protocol to prevent anemia.

One of the main challenges in teaching and learning activities is the assessment: it allows teachers and learners to improve the future activities on the basis of the previous ones. It allows a deep analysis and understanding of the whole learning process. This is particularly difficult in virtual learning environments where a general overview is not always available. In the latest years, Learning Analytics are becoming the most popular methods to analyze the data collected in the learning environments in order to support teachers and learners in the complex process of learning. If they are properly integrated in learning activities, indeed, they can supply useful information to adapt the activities on the basis of student's needs. In this context, the paper presents a solution for the digitally enhanced assessment. Two different Learning Dashboards have been designed in order to represent the most interesting Learning Analytics aiming at providing teachers and learners with easy understandable view of learning data in virtual learning environments.

In this paper an analytical method for the electrothermal solution to the non-linear 3-D heat flow equation for multilayer structure electronic devices is proposed. Compared with previous models presented in literature, it is general and can be easily applied to a large variety of integrated devices, provided that their structure can be represented as an arbitrary number of superimposed layers with a 2-D embedded thermal source, so as to include the effect of the package. The proposed method is independent of the specific physical properties of the layers, hence GaAs MESFETs and HEMTs as well as silicon and silicon-on-insulator MOSFETs and heterostructure LASERs can be analysed. Moreover, it takes into account the dependence of the thermal conductivity of all the layers on the temperature; the heat equation is solved coupled with the device current–voltage relation in order to give physical consistence to the experimental evidence that a temperature increase causes a degradation of the electrical performances and that the electrical power is not uniformly distributed.

In the region of Puglia in 2010 the rate of childhood overweight was 26% and that of obesity 14%. Prevention of childhood obesity, through its risk factors modification, is a public health aim of the regional government. During the last years several initiatives have been taken to promote healthy nutrition and increasing of physical activity. However, the huge number of activities promoted by health, political institutions, NGOs, etc. highlighted the limits of the lack of coordination among the main stakeholders, as well limited the impact and the comparison of the outcomes of the different programmes. To create a unique preventive programme 5 regional departments (Health, Sport, Agriculture, Education, and Urbanization) unified their financial, human, and strategic resources to promote healthy lifestyle. In addition, a memorandum of understanding was established between the regional health department and the Regional Education Office to develop shared high quality initiatives to promote health education in schools. From this alliance was developed the programme “SBAM!”, composed by different actions financed by the different departments, but all together pieces of only one programme. The programme involved 19,000 children 8 years old attending the 3rd class of the primary school. Sport dept. financed 1 more hour of physical education per week; agriculture dept. financed 1 laboratory of horticulture and 1 explanatory meeting with parents; health dept. financed 1 meeting with parents and 1 with teachers, as well as meetings with children during the school hours; education dept. paid all the booklets; urbanization dept. financed children’s ideas to improve the city’s urban design.