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Background & aims: The literature regarding enteral nutrition and mortality in older frail people is limited and still conflicting. Moreover, the potential role of comprehensive geriatric assessment is poorly explored. We therefore aimed to investigate whether the Multidimensional Prognostic Index (MPI), an established tool that assesses measures of frailty and predicts mortality, may help physicians in identifying patients in whom ETF (enteral tube feeding) is effective in terms of reduced mortality. Methods: Observational, longitudinal, multicenter study with one year of follow-up. Data regarding ETF were recorded through medical records. A standardized comprehensive geriatric assessment was used to calculate the MPI. Participants were divided in low (MPI-1), moderate (MPI-2) or severe (MPI-3) risk of mortality. Data regarding mortality were recorded through administrative information. Results: 1064 patients were included, with 79 (13 in MPI 1–2 and 66 in MPI-3 class) receiving ETF. In multivariable analysis, patients receiving ETF experienced a higher risk of death (odds ratio, OR = 2.00; 95% confidence intervals, CI: 1.19–3.38). However, after stratifying for their MPI at admission, mortality was higher in MPI-3 class patients (OR = 2.03; 95%CI: 1.09–3.76), but not in MPI 1–2 class patients (OR = 1.51; 95%CI: 0.44–5.25). The use of propensity score confirmed these findings. Conclusions: ETF is associated with a higher risk of death. However, this is limited to more frail patients, suggesting the importance of the MPI in the prognostic evaluation of ETF. © 2019 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism

Adverse Drug Reaction (ADR) is a major problem faced by medical practitioners with respect to drug safety. A number of Pre-marketing trials have fail to detect adverse drug reactions, instead, they are only observed after long term post-marketing surveillance of drug usage. The detection of Adverse Drug Reactions should be done as early as possible for the progress and safety of pharmaceutical industry. The increase in the number of adverse events and development of mining technology have motivated development of statistical and data mining methods for ADRs detection. These methods are inconvenient and tedious for users and exploration processes are time consuming. There are particular health units which provide access to electronic records of patients Aggregating and integrating electronic health records from multiple sources is rather challenging. The manual addition of data about drugs, adverse drug reactions, disease reported in scientific literature has been used to create tables as data collection technique In this work, Proportional Reporting Ratio (PRR) have been used, in combination with an estimator of the precision of point estimate such as the Chi-square test, to mine the different associations between drugs and adverse reactions. This work proposes a system for the detection of ADRs allowing an interactive discovery of associations between drugs and symptoms, called a drug-ADR association which has been further developed using other factors of interest to the user, such as demographic information, the current analysis has been done on 5000 records.

Thermo mechanical fatigue problem is treated to define an analysis methodology permitting the strength evaluation by reliability viewpoint. The main difficulty is the lack of both theoretical and experimental information; consequently the problem is treated verifying continually the validity and the limits of the developing solution method. The main task of the activity described in this paper was the development of a numerical methodology, based on FE analyses, for the evaluation of the structural behavior of engine components subjected to thermo mechanical fatigue phenomena. The chosen application was the exhaust manifold of an IC engine; FE analyses were executed following the standard methodology consolidated by this time in CRF. In particular a time transient thermal analysis was performed taking into account the exhaust gas fluid dynamics inside the manifold; the thermo structural analysis took into account both geometrical and material non linearities; the contact between the manifold and the cylinder head was simulated and the bolts pre load was applied. The methodology can be reassumed in the following fundamental points: 1. FE modeling of the component 2. Material modeling The evaluation of the thermal fatigue damage is executed 3. Thermal, thermo structural analyses (stress, strain) adapting methods developed to face isothermal fatigue, analysing also energetic criteria. A preliminary reliability evaluation was executed, on the base of numerical results and of experimental information. The results permitted the individuation of critical areas of the manifold and a preliminary evaluation of the number of cycles allowable before the rupture. Since the several criteria furnished different durations, a more accurate evaluation may be deferred to the execution of experimental tests.

ABAQUS gasket elements are an efficient and flexible tool to study gasket applications. Nevertheless the usage of the ABAQUS gasket elements is not limited to gasket analysis, but it provides an effective improvement in structural analysis. The results point out that both the predicted contact pressure and the predicted stress distribution depend on the mesh topology. Several combinations of mesh dimension and topology are investigated. The purpose is the definition of a calculation methodology and the demonstration of the application potentiality. Complex models analysis highlights that the set methodology constitutes a very effective tool for the design and optimization of gasket, cylinder head and cylinder block. At last a particular case is studied and a structural improvement to resolve the problem of the low seal was obtained by FEM; the modifications were introduced in the layout and the test on the modified component confirmed the calculation previsions. The qualitative and quantitative indications provided by the calculation are confirmed by the experimental results, whether in condition of cold assembly (color film paper approach) or in condition of hot working (test to motor bench).