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Reduced muscle mass represents one of the top ranked phenotypic criteria for malnutrition proposed by the Global Leadership Initiative on Malnutrition. Although height-indexed fat-free mass (FFMI) thresholds have been proposed as useful surrogate measures of reduced muscle mass, the independent prognostic value of BIA-derived FFMI by bioelectric impedance analysis (BIA) in patients with cancer still needs to be fully explored.Data on body mass index (BMI), 6-month percentage of weight loss (%WL), FFMI by BIA and quality of life (QoL by EORTC Quality of Life Questionnaire [EORTC QLQ-C30]) of Italian and German patients observed prospectively until death or censoring were used (N = 1217). Patients were stratified in 5 risk categories according to a robustly validated scoring system based on BMI and %WL. Low FFMI was defined as follows: men,17 kg/mReduced FFMI was found in 234 patients (19.2%). After a median follow-up of 57 months [25th-75th, 31-60], 620 patients (50.9%) had died. The study detected differences in survival between patients presenting with and without reduced FFMI (14.0 months vs. 45.1 months; P 0.001). The fully-adjusted hazard ratio of mortality for low FFMI was 1.46 [95%CI, 1.18-1.81] (P 0.001). Low FFMI was also independently associated with reduced QoL: fully-adjusted odds ratio, 1.50 [95%CI, 1.00-2.25] (P = 0.050).Reduced FFMI by BIA independently predicted survival and was associated with impaired QoL. Altered body composition should always be considered in all patients with cancer as additional phenotypic criterion of poor prognosis and BIA offers the possibility of multiple, noninvasive bedside assessments.

Risk Management (RM) is awell recognised approach to addressprojects uncertainties, to provideaccurate CAPEX estimates and tohave proactive responses tounplanned events.However, RM is often presented asa standard and repetitive process,disregard to projects diversechallenges. This acceptance is amain obstacle to its successfulimplementation, because this canlead to over complex risk studies forsimple matter or, on the contrary,scarce results for intricate issues.Drilling & Completion projectspresent a high versatility ofsituations (from a standard onshoreworkover to a very challenging deepoffshore exploratory campaign).Project challenges can be verydifferent: technical (HP/HT, newtechnologies, etc), environmental(sensitive areas, deep offshoreconditions, etc), economic (marketconditions, etc), or strategic(partnership, etc).The natural consequence is thateach project requires an adequateresponse in terms of RM. Actually,RM toolbox encompasses a numberof different studies, such as riskregisters, risk mapping, probabilisticCAPEX/schedule, fault trees, etc.Not all studies should besystematically performed. Thus, theRM approach must be tailored toeach project challenges, in order tobring the highest added value to thedecision makers. eni Drilling, Completion &Production optimization departmenthas built an integrated RM systemthat provides a properly designedworkflow for treating each projectwith a suitable approach accordingto its maturity and other technical,environmental, economic or strategiccriteria.This paper takes advantage of aneni experience on a well campaignand describes how RM approachsupported strategic decisions on theimplementation of technologies(RSS, continuous circulating system,aluminium drill pipe, ceramicprotectors and centralisers) to reducewell operations uncertainties. Thiscase study encompasses thecomplete decision loop, from thecost/benefit analysis of eachtechnology to the measured benefitsfrom the rig operations in terms ofperformance enhancement.Finally, it substantiates the values ofRM in investment decision byaddressing RM in a practical way.This case study will definitely helpto spread a RM culture withinproject management organizations.

BACKGROUND & AIMS: The aim of this study was to evaluate the nutritional support management in mechanically ventilated coronavirus disease 2019 (COVID-19) patients and explore the association between early caloric deficit and mortality, taking possible confounders (i.e. obesity) into consideration. METHODS: This was a prospective study carried out during the first pandemic wave in the intensive care units (ICUs) of two referral University Hospitals in Lombardy, Italy. Two hundred twenty-two consecutive mechanically ventilated COVID-19 patients were evaluated during the ICU stay. In addition to major demographic and clinical data, we recorded information on the route and amount of nutritional support provided on a daily basis. RESULTS: Among patients still in the ICUs and alive on day 4 (N = 198), 129 (65.2%) and 72 (36.4%) reached a satisfactory caloric and protein intake, respectively, mainly by enteral route. In multivariable analysis, a satisfactory caloric intake on day 4 was associated with lower mortality (HR = 0.46 [95%CI, 0.42-0.50], P

Purpose: This cross-sectional study aimed at comparing the quality of life (Qol), the prevalence of psychiatric diagnosis and pharmacological treatment in 104 candidates to bariatric surgery according to the degree of obesity (class 2 vs. class ≥ 3 obesity). Methods: All surgical candidates underwent a detailed psychiatric interview based on DSM-5 criteria, including sociodemographic, clinical, psychological and psychiatric data. Participants completed the Binge Eating Scale (BES) and the 12-Item Short Form Health Survey (SF-12). Results: Overall, bariatric candidates reported a significant impairment in the physical (PCS 38.8 [95% CI 36.2–41.5]) and mental (MCS 42.2 [95% CI 40.4–43.9]) components of Qol compared to population norms (p < 0.001 for both). Subjects with class 2 obesity scored significantly lower in the MCS compared to those with class 3 (38.7 (8.1) vs. 43.6 (8.4), p = 0.008). No other statistically significant differences were found between the two groups in terms of sociodemographic and clinical variables. Conclusion: These data support the usefulness of Qol assessment in bariatric candidates as a sensible screening parameter, especially in patients with lower BMI, in whom MCS could identify the need for early psychosocial intervention. Level of evidence: Level III,case-control analyticstudy.

Background & Aims Great interest has been raised by the possible protective role of vitamin D in coronavirus disease 2019 (COVID-19), but objective data on 25(OH)vitamin D deficiency in hospitalized COVID-19 patients are not conclusive. The aim of this study was to determine the prevalence of 25(OH)vitamin D deficiency in COVID-19 patients admitted to an Italian referral hospital and explore its association with clinical outcomes and the markers of disease severity. Methods In this single-center cohort study, 129 consecutive adult COVID-19 patients hospitalized in an Italian referral center were enrolled from March to April 2020. 25(OH)Vitamin D serum levels were assessed 48 hours since hospital admission and categorized into: normal (≥30 ng/mL), insufficient (

The COVID-19 outbreak has drastically changed practices inside hospitals, which include oncology routines. In oncology, malnutrition was and certainly still is a frequent problem associated with an increase in treatment-related toxicity, a reduced response to cancer treatment, an impaired quality of life, and a worse overall prognosis. Even in this situation of healthcare crisis, nutritional support in cancer care is an essential element. During the current COVID-19 pandemic, there is a concrete high risk to see a dramatic worsening of cancer patients' nutritional status, who are left without adequate clinical and nutritional support. The consequences are already reasonably foreseeable and will have a severe negative impact after the emergency. Therefore, we believe that it is essential to try to continue, as far as possible, the activity of clinical nutrition in oncology, by revolutionizing the setting and the approach to patients. For this purpose, the Clinical Nutrition and Dietetics Unit and the Medical Oncology Unit of our hospital, one of the largest community hospital in Lombardy that has been involved in the COVID-19 outbreak management since its inception, have reorganized the clinical routine activity in strict collaboration since the very beginning of the emergency, to better face up to the challenge, while preserving cancer patients' needs.

Background: The aim of the present prospective study (ClinicalTrials.gov Identifier: NCT02111538) was to assess the prognostic value of phase angle (PhA), derived from bioimpedance vectorial analys...

Background Serum uric acid (SUA) is increasingly recognised as an important predictor of cardiovascular disease (CVD) and total mortality. However, the levels of SUA that discriminate across the different strata of risk for CVD and total mortality remain unknown, complicating the identification of subjects at high or low mortality risk for SUA in clinical practice. Purpose In this study we used a large Italian population comprising >3ehz748.0326 subjects to assess the threshold of SUA that increases the risk of total and CVD mortality. Methods The URic Acid Right for heArt Health (URRAH) study is a regional-basis multicentre cohort study which collected data from prospective studies and databases from different hypertension centres, including subjects with at least one measure of SUA and a follow-up of about 20 years. Total mortality was defined as mortality for any causes, cardiovascular mortality as death due to fatal myocardial infraction, stroke or heart failure. Multivariate dichotomic logistic and Cox regression models were used to confirm the relationship between SUA and mortality status both from cardiovascular and any causes, while ROC curves were used to identify the threshold of SUA that better discriminated people at higher or lower mortality risk. Results A total of 22.275 subjects had SUA and mortality information. Logistic regression identified a direct and strong association between SUA and an increased risk of total (OR 1.176, 95% CI 1.127–1.227) and CVD (OR 1.147, 95% CI 1.093–1.203) mortality, independently of other CVD risk factors (age, BMI, LDL cholesterol, diagnosis of diabetes, hypertension, chronic kidney disease, alcohol consumption and smoking). Cox models confirmed the presence of an independent association between SUA and any causes (HR 1.123, 95% CI 1.090–1.567) and CVD (HR 1.124, 95% CI 1.081–1.169) mortality. ROC curve analysis identified a cut-off value od SUA [(4.79 mg/dL (95% CI 4.7–5.4 mg/dl)] able to discriminate total mortality status, and a different one [(5.60 mg/dL (95% CI 5.09–5.89 mg/dl)] able to identify CVD mortality status. Multivariate Cox analysis adjusted for confounders confirmed that subjects with SUA >4.79 mg/dl had a significantly higher total mortality (HR 1.293, 95% CI 1.181–1.416) compared to those with SUA 5.60 mg/dl had a significantly higher CVD mortality (HR 1.428, 95% CI 1.273–1.600) than those with SUA Conclusion Levels of SUA that increase the risk of total and CVD mortality are significantly lower than those commonly used for the definition of hyperuricemia in clinical practice. Our data provide the first large evidence of a level of “cardiovascular” SUA that might be used in clinical practice to identify subjects at greater risk of total and CVD mortality.

Background: Nutritional support, including nutritional counseling and oral nutritional supplements (ONSs), has been recommended at the earliest opportunity in head and neck (H&N) cancer patients. The limited available evidence on the efficacy of immunonutrition during chemoradiotherapy (CT-RT) in H&N cancer patients is positive with regard to some secondary endpoints, but is still scanty, particularly with regard to toxicity and treatment tolerance. We hypothesize that early systematic provision of ONSs with a high-protein–high-calorie mixture containing immunonutrients (Impact) compared to standard high-calorie–high-protein nutritional blends, in addition to nutritional counseling, may be beneficial to patients with H&N cancer during CT-RT. Hence, we designed the present study to evaluate the efficacy, in terms of treatment tolerance, toxicity and response, body weight, body composition, protein-calorie intake, quality of life (QoL), fatigue, muscle strength and immunological profile of the early systematic provision of ONSs enriched in immunonutrients compared to isonitrogenous standard blends, in H&N cancer patients undergoing CT-RT. Methods: This is a pragmatic, bicentric, randomized (1:1), parallel-group, open label, controlled, pilot clinical trial. Discussion: Many efforts are still to be taken to improve the efficacy of nutritional support in oncology. Immunonutrition represents a promising approach also in H&N cancer patients, but the evidence on its efficacy in improving clinical outcomes during CT-RT is still inconclusive. The present pilot study, which guarantees the early provision of nutritional assessment and support to all the enrolled patients in accordance with the recent guidelines and recommendations, could represent one of the first proofs of the clinical effectiveness of early oral immunonutrition in cancer patients undergoing CT-RT and could stimulate further large randomized trials, potentially resulting in the improvement of supportive care quality. Trial registration: This study is registered on ClinicalTrials.gov Identifier: NCT04611113.

We evaluated the prognostic value of a new body composition parameter (creatinine height index [CHI]) obtained from bioimpedance vectorial analysis-derived body cell mass and its association with nutritional and functional status. Data of Italian and German cancer patients observed prospectively until death were used (N=1084). Multivariable models (adjusted for age, gender, hydration status, performance status, disease's stage) were built in both cohorts to assess the association between body composition outcome parameters (low fat-free mass, 70 years] kg/m2), clinically significant weight loss (>10% in 6 months) and low handgrip strength ( Low CHI was independently associated with mortality in both Italian (HR=1.84 [95%CI, 1.18-2.86]; P=0.007) and German cohorts (HR=1.52 [95%CI, 1.17-2.07]; P=0.008). Low FFMI and low SPA did not predict survival in the German cohort. In patients with low CHI, worse nutritional and functional status were observed in both study populations. Performance of models addressing the study endpoints showed substantial consistency with both cohorts, particularly of those including low CHI. We validated a new prognostic body composition parameter, which is easier to interpret than standard nutritional parameters and may be useful for identifying cancer patients at nutritional risk, requiring early nutritional support. Its prognostic value should be confirmed in other patient populations and its sensitivity in detecting changes in protein-calorie intake is still to be investigated.

Background and aims: Recently, the albuminocentric view of diabetic kidney disease (DKD) in type 2 diabetes (T2DM) has been changing. Therefore, the relationship between diabetic retinopathy (DR) and chronic kidney disease (CKD) has to be addressed according to this new clinical presentation of DKD. The aim of this study was to evaluate, in a real-world setting, the correlation DR–DKD in T2DM. Methods and results: A total of 2068 type 2 diabetic patients enrolled in a multicenter cross-sectional study were investigated. Albuminuric subjects were largely prevalent among subjects with DR (p = 0.019). In the whole study population, no difference in albumin excretion rate (AER) was observed between presence/absence of DR; instead, AER was significantly higher among patients with glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 (CKD) (p = 0.009), above all in those with CKD and AER ≥0.03 g/24 h (p = 0.005). Multivariate analysis confirmed that eGFR (O.R. 0.976; 95% C.I.: 0.960–1.028; p < 0.001) and AER (O.R. 1.249; 95% C.I. 1.001–1.619; p = 0.004) were independently associated with DR and HDL–cholesterol (O.R.: 1.042; 95% C.I.: 1.011–1.120; p = 0.014). Additionally, among patients with eGFR

We have realized an ultimate photon-noise-limited array of cold-electron bolometers (CEBs) for OLIMPO Balloon Telescope. The CEB array demonstrates very effective electron self-cooling of the absorber from 310 mK to 100 mK without optical power load, P0, and from 310 mK to 160 mK with P0= 20 pW at 345 GHz. Due to this effective electron cooling acting as strong electrothermal feedback, the ultimate photon-noise-limited mode of operation is realized in the range of P0 starting from 8 pW and up to P0=20 pW at Tph=330 mK. To our knowledge, there is no analog in the world for bolometers working at electron temperature less than phonon temperature.

Patients with peripheral arterial disease (PAD) suffer from increased cardiovascular morbidity and mortality. The ankle brachial index has been widely used as an easy tool to identify and stratify patients with PAD, however its predictive value remains limited. Higher levels of inflammatory and prothrombotic biomarkers have been associated with the development and progression of PAD and recent data suggest that may provide additional information for cardiovascular risk stratification of these patients. The current review will present available information on functional, genetic and biochemical biomarkers which have been associated with PAD in cross sectional and large prospective studies and highlight their additive value for risk stratification of these patients.

Summary Conventional drilling techniques used in harsh drilling environments are sometimes impractical or uneconomical. This was experienced while drilling through the reservoir section being investigated. This section is characterized by high pressure and formation fluids estimated to contain 18–20% H2S and 4–6% CO2. The presence of extensive karst/fractures along with severe circulation losses prevents successful drilling using the conventional circulation technique. For this scenario, the pressurized-mud-cap closed-hole circulation-drilling (CHCD) technique was applied, and it proved to be the most effective method to drill through the Lower Carboniferous carbonate. In conventional drilling through such lost circulation zones, the typical method is to isolate the thief formation [lost circulation-materials (LCMs) pills, gunks, and cement plugs] to maintain an overbalanced condition. These methods have their disadvantages: uncertain results, time and cost increase, and damages on well productivity. Furthermore, it may be a long, ineffective process because of multiple leakoff zones or massively fractured zones. Where unsustainable losses occur and conventional circulation is no longer possible, the CHCD technique may be used to allow the continuation of drilling. This technique is not underbalanced drilling. The annulus is closed, and no returns are circulated to the surface. The CHCD is not a simple or an inexpensive system. It is used only when other systems for controlling losses have proved to be ineffective. Large quantities of water and mud are required as well as additional equipment and specialized personnel. An accurate evaluation of several factors has to be performed. Drilling hazards are the major issue because the primary barrier to well influx is jeopardized, but also rig time, material availability, and consumption have to be considered. The aforementioned uncertainties can be addressed through risk evaluations by comparing two drilling scenarios of a typical development well where one uses CHCD technology and the other uses conventional drilling techniques. This paper will discuss the operational details of conducting CHCD as well as the risk-management approach, which involves the identification, evaluation, and mapping of all risks involved in each scenario (qualitative risk assessment). A probabilistic model is, therefore, developed to combine all the risks identified and to address their consequences within operational time (quantitative risk assessment).

This paper shows a field application of the risked-based approach to an innovative tool based on a biogenetic algorithm for the integrated production optimization of surface facilities. The tool was applied to analyzed different solutions available in the PLEM configuration for a new well tie-in. Uncertainties related to a planned acid job on a well of the system has been taken into account in order to compare the probabilistic results of the analyzed configurations. The described tool has the ability to integrate in a unique environment the whole production system, handling a high number of optimization variables simultaneously. In the first phase, the integrated optimization process with genetic algorithm takes place. The result is an optimized field configuration characterized by a deterministic production increase. In the second phase, after having identified the uncertain input variables in the optimization process, a Monte Carlo simulation for the optimized field configuration is performed. The result is a probabilistic distribution of the production increase. Different PLEM configurations have been compared on the basis of the probabilistic results obtained. The integrated production model was developed for a FPSO treating the production from different subsea oil wells. An additional well was planned to be connected through an existing PLEM to the FPSO. Different configurations were analyzed to connect the well and the deterministic results from the optimization have been compared. Additionally, an acid job was planned for one of the wells in the system. The risked-based approach has been used to compare the different possible configuration to be applied, taking into consideration also the statistical distribution of the productivity index expected after the work-over. The probabilistic results obtained for the different configuration studied were characterized by a defined level of confidence and were used as a support in the decision making process for the tie-in of the new well. The tool is able to take into account uncertainties related to work-over on wells and to evaluate different scenarios with a desired level of confidence. Results from the study show the strength of the presented innovative risked-based approach to the integrated asset modeling, as a tool to support the decision making process.

The full potential of simulation has, to date, not been fully exploited for numerous reasons, including but not limited to lack of awareness of this computational approach. Nowadays, steady state simulators that model operating plant are used as the custom-made tools to predict global performances, even though they are not able to mimic ‘real’ process behaviour. The work described herein introduces dynamic process plant models as an efficient way to simulate time-dependent variables, handling changeable ‘real-time’ operating conditions. A stabilization unit was the object of an engineering study with the intent to sustain production, enhance energy efficiency and safety of operations through low-cost computational technology. The entire process plant was modelled and tuned with commercial simulator equipped with a dynamic suite. The latter requires equipment data and real geometry to simulate operating conditions upsets, feed or composition change in a transient way. Once the steady state model is matched, the switch to dynamic environment allows the user to model upset of input variables and to study system response. It guarantees to adapt the entire process in a new and more efficient configuration by optimization of the control system. Steady state simulations are very fast and use continuous, time-interval based, steady-state approximations, requiring the least effort to set up and calibrate. Contrariwise, they are not able to simulate transient phenomena and control system responses, thus limiting simulation capabilities to provide representative conditions of the real plant behavior. Considering that cost to benefit ratio is rapidly moving in favor of computerization, the implementation of dynamic simulations in process industries represents the best way to achieve complex targets. The presented case study demonstrates the strength of this approach and its influence on optimal monitoring and control of process plant performance. Other benefits have been shown on real time optimization, including operational troubleshooting and field operating cost reductions. ‘Fine-tuning’ is the resume word of this work and represents the way to efficiently achieve complex targets, moving Oil & Gas toward applications that have otherwise been characterized only for petrochemical or complex plants. Currently, the global energy world is facing even more complex scenarios, which technical engineers must address in order to confront the new challenges ahead.

Batchwise fluidized bed combustion of chars from two bituminous coals, characterized by large difference in vitrinitc to inertinite ratio, has been carried out to investigate the influence of maceral composition on carbon fines generation under combustion-assisted attrition conditions. Samples of unreacled char, of attrited carbon fines collected at different times during the fluidized bed combustion experiments and of char retrieved from the bed in the same experiments have been characterized from the standpoints of petrographic composition and of intrinsic reactivity to oxygen Char produced by devolatilizalion of vitrinite tends to be attrited preferentially in respect to residue of inertinite. In spite of this, attrited fines are characterized by intrinsic reactivity averagely lower than that of unreacled char.

Abstract Production optimization is one of the most complex and multi-disciplinary task in the Oil & Gas industry. It involves the surface asset during all its production life and requires a continuous improvement process. Integrated optimization of surface asset, including both gathering facilities and process plant, is a difficult goal to be achieved due to the complexity of such systems and the presence of several variables, uncertainties and operational constraints. Technology improvements have enabled a widespread use of integrated simulation models for a better asset management according with actual field data. Production department team of ENI E&P has developed a tool which maximizes production integrating gathering system simulation with process plant simulation. The global optimum is reached through a powerful genetic algorithm that, according to system constraints, allows to control different variables in a simultaneous way. In fact, steady state simulation environments could bring to unstable field configuration. As a consequence, an updated operative workflow for fluid-dynamic module is needed. This workflow supports the process to select optimized solutions that do not have any criticalities during operation and asset variables upset. This implies that unstable solution are discarded among the investigated ones. Therefore, the obtained maximized production configuration is the global optimum solution (robustness of algorithm) as well as the most stable (fluid-dynamically). Finally, multiphase transient code analysis allows to understand actual flow regime and, if necessary, to identify mitigative actions for management's improvement of investigated asset. The integrated workflow has been applied to a real case study. This presents technical contributions of this work for definition of field potential, production optimization, de-bottlenecking activities, asset management. Introduction Oil and gas continue to be widely used worldwide as energy resources, because new sources of safe energy have not yet been well developed. These conditions have motivated researchers and workers in the area of oil and gas production to investigate new approaches in the application of optimization methods to maximize gas & oil production rates and to minimize production costs. The term "Production Optimization" is used to describe different processes in the oil and gas industries. No rigorous definition has been found in the literature, but it means determination and implementation of optimum values of parameters in the production system to maximize hydrocarbon production rate and minimize operating costs under various technical and economical constraints.

Production Optimization is one of the most complex and multi-disciplinary task in the oil & gas industry from an operational point of view. Optimization involves surface asset all along its production life and requires a continuous improvement process. Improvements, modifications, and temporary upsets in surface facilities during operation phase create the necessity to manage and optimize production scenarios with a more tight time-frame. Technology improvements have enabled a widespread use of integrated simulation models for a better asset management to be fully combined with measured field data. This paper shows a dedicated workflow for surface facilities – gathering system and process plant - production enhancement and management using an advanced optimization technique based on a biogenetic algorithm. The main feature of the proposed workflow is the ability to control many variables simultaneously according to the system constraints even with complex, conflicting, and non-direct interconnections and objectives to be reached. The workflow and the optimization approach are included in a wider integrated tool for production management, called rabbit™ - Risked Algorithm for Biogenetical Balance Integration Tool. Other features of this tool, such as transient phenomena and risk analysis evaluations, complete the ability of the tool to support the production and operation management. This paper will provide a useful description of how the tool can contribute in definition of field potential, production optimization and planning, minimizing production losses during planned/unplanned upsets as well as supporting debottlenecking activities. It will provide some case studies of rabbit™ implementations on different oil and gas fields, both on-shore and off-shore, showing benefits on using the integrated workflow.

Eni Near Balance Drilling (e-nbd™) is an innovative drilling process to maintain constant bottom hole annular pressure at all times while circulating, and to manage annular dynamic hydraulic pressure profile accordingly. The operational benefits of this process are measured on field operations through the enhancement of borehole quality, the reduction of NPT and the ability to reach targets otherwise inaccessible. e-nbd™ can improve drilling operations safety, especially by reducing the probability of the most significant threats, which is a blowout event. These benefits are not measurable on operations, unless having a huge number of statistical records. Nonetheless the probability of a complex event like a blowout can be effectively calculated through dedicated fault tree models. Eni drilling department has developed a replicable blowout probability model that is suitable for most of the current drilling and completion situations. This model is offering a high number of possible operating scenarios and detailed settings, in order to guarantee the accuracy of each analysis. This model has been used to address the benefits of e-nbd™, in order to compare analogous wells to be drill with or without e-nbd™. In both situations results were analysed to measure the overall impact on blowout probability and to further address the sensitivity to technical / non technical factors. By comparing two situations using a probabilistic fault tree, this paper shows that the key factors affecting a blowout probability are notably impacted by the use of e-nbd™. These key factors are not only technical, but also organizational and human.

Drilling exploration wells may be challenging due to uncertainties related to several factors like well downhole pressure, pore and fracture pressures, etc. As a result, a well may fail to reach its target depth. Managed Pressure Drilling (MPD) is a useful technique in challenging conditions. It allows pore and fracture pressures to be accurately calculated while drilling, and the mud weight adjusted accordingly. Besides, it reduces the chance of human errors as it is an automatic device managed by specific software. Eni's distinctive MPD system is the e-nbd™ (Eni Near Balance Drilling). This system consists of an innovative drilling process that maintains constant bottom hole annular pressure at all times. The system does not require that mud circulation be stopped and compensated with a back up pressure. The e-nbd™ is assisted by a proprietary system for continuous circulation that is called e-cd™ (Eni Circulating Device). The e-cd™ system is composed of special subs that are positioned on top of each drilling stand. The number of required subs is defined by the length of the open hole section that is to be drilled with continuous circulation. The system is completed by a dedicated manifold that is positioned on the rig floor that automatically diverts mud flow from the Stand Pipe Manifold to the subs. e-nbd™ through the e-cd™ System ensures a continuous MPD process, without any "transient" time. This paper presents this innovative system and the achieved results. It reports a summary of the applications performed to date, including some offshore applications from floaters, as well as the major benefits of the system.

A new Magneto-Optic Surface Plasmon Resonance (MOSPR) gas sensor is presented. This sensor is based on the combination of the magneto-optic effects of magnetic materials and the Surface Plasmon Resonance in metallic layers. Preliminary results proofed the enhancement in sensitivity of the MOSPR sensor with respect to traditional SPR sensor.

The combustion reactivity of char obtained by devolatilization of South African bituminous coal has been investigated by thermogravimetric analysis in the temperature range of 653 to 733 K at oxygen partial pressures from 0.21 to 1 bar. Samples of the same char, either unreacted or preburned in a fixed bed reactor to given levels of carbon burn-off, have been characterized from the standpoints of their surface area and of their volume and size distribution of pores. Different experimental techniques, namely mercury porosimetry and adsorption of either carbon dioxide or nitrogen, and models for the interpretation of porosimetric data have been used. Analysis of meso- and macropore size distributions, and of adsorption isotherms in the low relative pressure region, has been directed to check whether the topological structure of the porous matrix of the char might be described as a fractal.

Blowout is one of the most significant threats associated with exploration and exploitation of petroleum resources, with the potential to cause injury as well as environmental and economic damage. This paper will present the approach for complex probability evaluation and discuss a sensitivity analysis of blowout occurrence factors for two challenging situations: High Pressure wells drilled using the Closed Hole Circulation Drilling (CHCD) technique and High Pressure / High Temperature (HP/HT) wells drilled using a conventional technique. As such, a risk assessment approach is recommended to properly face blowout probability. In the first scenario (where the primary barrier to well influx is jeopardised), the analysis will predict the level of safety risk and identify any additional procedures and/or additional equipment that may be required. In the second scenario, the analysis will identify the proper safety procedures and equipment required for challenging drilling conditions. The complex probability evaluation uses fault tree analysis. This allows the consideration of the real condition of the operations including equipment, operating resources and environmental conditions, all broken down to their smallest subsystem (basic event). Each basic event failure rate is then determined using statistical databases. However, anywhere new technologies, equipment and procedures are implemented, and thus are not yet represented in historical statistics, the reliability of a standard fault tree analysis could be degraded. Therefore, where historical statistics is limited, it is possible to add variability in the fault tree, ultimately combined through a stochastic simulation, to reduce the uncertainty in the fault tree analysis. By comparing the two challenging conditions using a probabilistic fault tree, this paper shows that the key factors affecting the considered drilling scenario can be different, such that further investigation in the form of a blowout causes/events analysis may be necessary. These key factors are not only technical, but also organizational and human. Recommendations for preparatory works to minimise the likelihood of a blowout will also be presented.

Acute respiratory failure can be the product of any of a great number of muscular, neuromuscular, and neurologic causes. The family history may be extremely helpful in narrowing the differential diagnosis. We report the case of a girl who, during the course of a slight upper respiratory infection, presented with acute respiratory failure requiring mechanical ventilation. The family history was significant for a brother who had arthrogryposis and died at 15 h of life, also from respiratory failure. The patient herself had a history of palpebral ptosis in the evening. The absence of electromyographic and muscle biopsy abnormalities and the patient's positive response to anticholinesterase therapy supported the diagnosis of familial infantile myasthenia. We emphasize the importance of considering the myasthenic syndromes in the differential diagnosis of acute respiratory failure, since appropriate therapy can rapidly resolve the symptoms. Furthermore, an accurate diagnosis allows appropriate genetic counseling for the hereditary forms.

Objectives: Iloprost, an analogue of prostacy- clin, is often utilised in subjects with diabetes mellitus complicated by macroangiopathy. Methods: The eects of iloprost infusion on plasminogen activator inhibitor type-1 (PAI-1), glucometabolic con- trol and cardiovascular equilibrium in patients with type-2 diabetes mellitus and peripheral arterial occlusive disease were investigated. Thirteen (7 men/6 women) normal-weight, normotensive and non-smoker type-2 diabetic patients (63.8 3.4 years, mean SD) with peripheral arterial occlusive disease, stage-II according to Fontaine classi®cation, were enrolled. Eight (four men/four women) patients underwent three study de- signs, each separated by a 1-week interval: study I, in- fusion of iloprost (3 ng kgA1 minA1 for 5 h) for 1 day alone (short-term treatment); study II, infusion of saline (for 5 h) for 1 day (control treatment); study III, infu- sion of iloprost (3 ng kgA1 minA1 for 5 h) over a period of 28 days (long-term treatment). The remaining ®ve (three men/two women) patients underwent study IV only, infusion of saline over a period of 28 days (placebo treatment). Plasma levels of glucose, plasminogen, PAI-1 activity and ®brinogen, blood pressure and heart rate were determined in all studies, while plasma insulin levels, blood HbA1c, walking distance and Winsor index only in studies III and IV. Results: Both short- and long-term treatments with ilo- prost signi®cantly reduced PAI-1 activity (baseline vs end: 17.4 1.9 AU/ml vs 15.0 1.6 AU/ml, P < 0.02; 20.5 7.6 AU/ml vs 7.9 2.1 AU/ml, P < 0.002,respectively). Long-term treatment with iloprost signi®- cantly increased walking distance (baseline vs end: 32541m vs 49652m, P

Background There are marked ethnic differences in cardiovascular risk in UK adults; South Asians have high coronary heart disease (CHD) and stroke risks while black African-Caribbeans have high stroke risks and low CHD risks when compared with white Europeans. Ethnic differences in cardiovascular risk factors are apparent in childhood, but ethnic differences in vascular structure and function during childhood have been little studied. We measured common carotid intima-media thickness (cIMT) and carotid-femoral pulse wave velocity (PWV) in UK children from different ethnic groups. Methods School-based study examining the cardiovascular risk profiles of 9–10 year-old UK children, including similar numbers of South Asian, black African-Caribbean and white European participants. Following a baseline cardiovascular risk survey with measurements of body build, blood pressure, fasting blood lipids, insulin and glycated haemoglobin (HbA1c), 1400 children were invited to have ultrasound measurements of cIMT. A subgroup of these children (n = 900) was invited for PWV measurements. All analyses were adjusted for age, gender and allowed for clustering at school level. Results In all, 939 children (67% response) had cIMT measurements and 631 children (70% response) had PWV measurements. Mean cIMT was 0.475 mm (SD 0.035 mm); mean PWV was 5.2 m/s (SD 0.7 m/s). Compared with white European children, black African-Caribbeans had higher cIMT (mean difference 0.014 mm, 95% CI 0.008 to 0.021 mm) and PWV (% difference 3.3, 95% CI 0.4 to 6.2); South Asian children had similar cIMT to white Europeans but slightly higher PWV (% difference 2.7, 95% CI −0.1 to 5.5%). cIMT was positively associated with systolic and diastolic blood pressure but not with other cardiovascular risk markers. In contrast, PWV was positively associated with adiposity, diastolic blood pressure and insulin resistance. Black African-Caribbean children had lower LDL-cholesterol levels and higher insulin and HbA1c levels than white Europeans; South Asian children had higher insulin, HbA1c and triglyceride levels. However, adjustment for these risk factors had little effect on the observed ethnic differences in cIMT and PWV. Conclusions Ethnic differences in cIMT and PWV, adult predictors of cardiovascular risk, are apparent in childhood. These differences are not fully explained by the ethnic differences in established cardiovascular risk markers observed. There may be important opportunities for prevention of cardiovascular disease before adult life in ethnic minority groups at high risk of adult cardiovascular disease.

The combustion of fine char particles obtained by devolatilization of a bituminous coal has been investigated by means of a TGA apparatus. The coal tested belongs to a class of coals showing a notably high content of macerals of inertinite group compared to those of vitrinite group. Carbon conversion rate vs burn off profiles have been obtained at temperatures ranging from 380 to 460°C and oxygen partial pressures in the interval 0.21 to 1 bar. Under conditions tested combustion took place in the chemical kinetic controlled regime. Kinetic parameters have been obtained by regression analysis of experimental data. Experimental results are compared with predictions of literature models which assume homogeneity of the reacting solid and with results of calculations in which the existence in the char of two distinct phases of different reactivity, which are the residues after devolatilization of vitrinite and of inertinite macerals respectively, is assumed. Comparison of experimental data with result...

Recently large voids in galaxy distribution have been found by means of red shift surveys. We consider the possible effect of the presence of one of these voids (the one found by Kirshner et al. (1982) in Bootis) on the cosmic microwave background photons.

PdB acknowledges support from University of Rome La Sapienza (project “Cosmologia di Precisione 2015”) and from the Italian Space Agency (Agreement 2016-019-H.0 “Kinetic Inductance Detectors for Space”). CJM is supported by an FCT Research Professorship, contract reference IF/00064/2012, funded by FCT/MCTES (Portugal) and POPH/FSE (EC). C.H.-M. acknowledges the financial support of the Spanish Ministry of Economy and Competitiveness via I+D project AYA-2015-66211-C2-2-P. GDZ acknowledges the financial support of ASI/INAF agreement n. 2014-024-R.1. J.G.N. acknowledges financial support from the Spanish MINECO for a “Ramon y Cajal” fellowship (RYC-2013-13256) and the I+D 2015 project AYA2015-65887-P (MINECO/FEDER). F.J.C., E.M.-G. and P.V. acknowledge support from the Spanish Ministerio de Econom´ıa y Competitividad project ESP2015-70646- C2-1-R co-financed with EU FEDER funds., De Bernardis, P., Ade, P.A.R., Baselmans, J.J.A., Battistelli, E.S., Benoit, A., Bersanelli, M., Bideaud, A., Calvo, M., Casas, F.J., Castellano, M.G., Catalano, A., Charles, I., Colantoni, I., Columbro, F., Coppolecchia, A., Crook, M., D'Alessandro, G., Petris, M.D., Delabrouille, J., Doyle, S., Franceschet, C., Gomez, A., Goupy, J., Hanany, S., Hills, M., Lamagna, L., Macias-Perez, J., Maffei, B., Martin, S., Martinez-Gonzalez, E., Masi, S., McCarthy, D., Mennella, A., Monfardini, A., Noviello, F., Paiella, A., Piacentini, F., Piat, M., Pisano, G., Signorelli, G., Tan, C.Y., Tartari, A., Trappe, N., Triqueneaux, S., Tucker, C., Vermeulen, G., Young, K., Zannoni, M., Achúcarro, A., Allison, R., Artall, E., Ashdown, M., Ballardini, M., Banday, A.J., Banerji, R., Bartlett, J., Bartolo, N., Basak, S., Bonaldi, A., Bonato, M., Borrill, J., Bouchet, F., Boulanger, F., Brinckmann, T., Bucher, M., Burigana, C., Buzzelli, A., Cai, Z.Y., Carvalho, C.S., Challinor, A., Chluba, J., Clesse, S., Gasperis, G.D., Zotti, G.D., Valentino, E.D., Diego, J.M., Errard, J., Feeney, S., Fernandez-Cobos, R., Finelli, F., Forastieri, F., Galli, S., Génova-Santos, R., Gerbino, M., González-Nuevo, J., Hagstotz, S., Greenslade, J., Handley, W., Hernández-Monteagudo, C., Hervias-Caimapo, C., Hivon, E., Kiiveri, K., Kisner, T., Kitching, T., Kunz, M., Kurki-Suonio, H., Lasenby, A., Lattanzi, M., Lesgourgues, J., Lewis, A., Liguori, M., Lindholm, V., Luzzi, G., Martins, C.J.A.P., Matarrese, S., Melchiorri, A., Melin, J.B., Molinari, D., Natoli, P., Negrello, M., Notari, A., Paoletti, D., Patanchon, G., Polastri, L., Polenta, G., Pollo, A., Poulin, V., Quartin, M., Remazeilles, M., Roman, M., Rubiño-Martín, J.A., Salvati, L., Tomasi, M., Tramonte, D., Trombetti, T., Väliviita, J., De Weyjgaert, R.V., Tent, B.V., Vennin, V., Vielva, P., Vittorio, N.

A South African bituminous coal was heat treated at different temperatures in the range 500-1300 degreesC under inert conditions with or without exposure to pulses of air. The effect of the heat treatment conditions on the reactivity of the resulting char towards oxygen under chemical kinetic controlled regime was assessed. The oxygen content of chars subjected to different heat treatment conditions was also measured by elemental analysis. Results indicated that exposure to pulses of air during the early stages of heat treatment at temperatures up to 1200 degreesC mitigates the effects of thermal annealing as far as the loss of combustion reactivity of the resulting char is concerned. Beyond about 1200 degreesC, exposure to air is ineffective to mitigate the effects of thermal annealing on combustion reactivity. Altogether, it appears that mutual interactions exist between modifications of the carbon structure induced by thermal annealing, uptake of oxygen during heat treatment and the oxy-reactivity of the resulting char. The preliminary findings of this work would suggest that the loss of carbon combustion reactivity cannot be assessed on the basis of its time-temperature history only, but modes and extent of carbon interaction with oxygen come into play. A speculative explanation of the phenomenology is presented and discussed. (C) 2004 Elsevier Inc. All rights reserved.

Thermal annealing associated with heat treatment of coal chars affects gasification reactivity and levels of unburned carbon in residual ash from coal-fired furnaces. The present study addresses the effect of char surface oxidation, occurring upon exposure to oxygen, on the course of thermal annealing, and related loss of combustion reactivity. This goal is pursued by comparing the extent of thermal annealing suffered by coal char upon heat treatment in a nitrogen atmosphere with that of chars that underwent oxidation prior to or during heat treatment. Oxidation of char was accomplished by supplying single or multiple pulses of air during the heat treatment, which were sufficient to oxidize the char surface but small enough to limit carbon gasification to less than 5%. The extent of thermal annealing was characterized both in terms of the loss of combustion reactivity and of the development of structural anisotropy of char samples, investigated by HRTEM. Results of the present study confirm that heat treatment reduces oxyreactivity of char samples, the effect being more pronounced at temperatures exceeding 1200 degrees C. Oxidation of samples mitigates the effects of heat treatment, as demonstrated by the smaller loss of gasification reactivity and by the more limited development of structural anisotropy of oxidized samples. Correspondingly, elemental analysis of samples indicates the formation of stable surface oxides upon oxidation, that are subsequently desorbed upon heat treatment. At temperatures exceeding 1200 degrees C, the effect of oxidation vanishes. Results are analysed and discussed in the light of the possible hindrance of thermal annealing due to the formation of stable surface oxides and of the parallel modifications occurring to the ash constituents. (c) 2004 The Combustion Institute. Published by Elsevier Inc. All rights reserved.

The annealing-induced loss of gasification reactivity of a bituminous coal char with respect to carbon dioxide was studied by means of a combination of experimental techniques. Heat treatment of coal samples under inert atmosphere for different time intervals was accomplished at temperatures as high as 2000 degrees C by means of thermogravimetric analyzers and of a specially designed heated-strip reactor. Gasification reactivities of untreated and heat-treated coal samples were determined by isothermal thermogravimetric analysis in carbon dioxide atmospheres. The influence of the time-temperature history of the coal sample on the parameters of the apparent gasification kinetics (preexponential factor, activation energy) has been assessed. Results were further analyzed in the framework of a simple annealing kinetic model suitable for implementation in gasification modeling.

The relationship existing between heat treatment of carbons, changes in their microstructural properties and loss of gasification reactivity is addressed. Experiments have been carried out on carbons of different ash content and composition and of different petrographic constitution. Samples have been heat treated under inert conditions at different temperatures (900-1400 degrees C) and for different times (1-300 min). Thermally induced changes of their microstructural properties have been characterized by the combined use of XRD, porosimetric analysis and SEM. Reactivity of the residual char after heat treatment has been measured by isothermal thermogavimetric analysis in carbon dioxide atmosphere at temperatures of 900 and 1200 degrees C. The analysis of the changes of gasification reactivity and of the microstructural properties upon annealing is directed to achieve a better understanding of processes that dominate char thermodeactivation, with particular emphasis on the relative importance of the organic versus inorganic matter transformations. (C) 1998 Elsevier Science Ltd. All rights reserved.

The present work is focused on the influence of the severity of heat treatment of coals during pyrolysis and/or early stages of carbon oxidation on the reactivity of the resulting char towards further gasification. Thermogravimetric analysis has been directed to characterize the reactivity of heat treated samples of a bituminous coal in atmospheres containing different carbon dioxide partial pressures. Carbonization was carried out at different temperatures and for different times prior to thermogravimetric analysis. Parallel microstructural characterization of the samples was accomplished by XRD analysis of untreated coal and heat treated char. Differences in gasification reactivities of chars prepared at a given temperature for various carbonization times are observed, larger in the early stage of gasification, levelling off at larger burn-off. The apparent reaction order with respect to carbon dioxide partial pressure decreases along burn-off for the gasification of equally heat treated samples. Increasing the heat treatment temperature results in substantial char reactivity reduction, associated with major changes of both the turbostratic carbon structure and the mineralogical constitution of the inorganic matter. Experimental results are analysed in the light of a phenomenological model of combined annealing and char gasification. The model is based on a simple reaction scheme according to which char deactivation due to thermal annealing occurs in series-parallel to gasification. The two processes take place over comparable time scales under the experimental conditions tested. The ability of the model to fairly reproduce the observed phenomenology suggests that annealing can be one key to the explanation of the evolution of char gasification rate with burn-off. The discussion on the relative time scales of annealing versus gasification is further extended by examining a body of literature data on annealing of a variety of carbons at different temperatures. Copyright (C) 1997 Elsevier Science Ltd.