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Background The intake of Sugar-Sweetened Beverages (SSBs) has increased around the world, leading to a growing burden of disease due to these beverages, such as obesity, diabetes, and heart disease. Taxation is a major action for comprehensive programmes aimed at reducing consumption of sugars. For these reasons, the aims of our study were to systematically summarize national tax legislation on SSBs and to assess the impact of these laws on the prevalence of overweight, obesity, and diabetes. Methods We conducted a scoping review to summarize the landscape of national tax laws on SSBs implemented worldwide. We included any document reporting both currently into force and past national tax laws addressing SSBs. As to the time series analysis, data regarding the national prevalence of obesity, overweight, and diabetes were retrieved from WHO Global Health Observatory data repository. Results As of July 2020, 34 countries worldwide implemented SSB taxation (amount-specific and ad valorem tax design), of which 17 (50.0%) in high-income countries, 12 (35.3%) in upper-middle income countries, and 5 (14.7%) in low-income countries. As for overweight, Hungary was the only country showing a slower rate of change after the taxation. Regarding obesity, France, Guatemala, Hungary and Panama showed a deceleration of the rates of change after the intervention. Eventually, Hungary and Tonga exhibited a one-time decrease of diabetes prevalence at the intervention point. Decelerating rates of change in the post-intervention period was also found for Guatemala and Fiji. Conclusions Laws targeting SSBs showed, at least in part, to be an effective measure to reduce the prevalence of overweight, obesity, and diabetes. Less than one fifth of worldwide countries have implemented national taxation policies. Finally, while taxation might be effective to reduce SSB consumption, other types of Public Health interventions, such as educational initiatives, should not be neglected. Key messages • Sugar-Sweetened Beverages (SSBs) are associated with obesity, diabetes, and heart disease. Taxation can be an important tool to reduce the consumption of SSBs. • Prevalence of obesity, overweight and diabetes decreased in countries that adopted taxation. However, other strategies such as educational programs should be implemented to reduce the intake of SSBs.

Background Previous findings suggest a positive association between body mass index (BMI) and survival from head and neck cancer (HNC). The aim of this study is to investigate the prognostic role of BMI at the time of diagnosis in a large international cohort of HNC patients. Methods We performed a pooled analysis of studies included in the INHANCE consortium. Cases were adults with HNCs of the oral cavity, oropharynx, hypopharynx, and larynx. We used Cox proportional hazards models to estimate the adjusted hazard ratios (HR) for overall survival and HNC-specific survival, by cancer site. Subgroups analyses were performed according to smoking status and duration of follow-up. Results The study included 10,177 patients from 10 studies worldwide with a median follow-up of 48 months; 3654 patients (35.9%) died from all causes, including 1202 (11.8%) from HNC. Underweight patients had lower overall survival (HR = 1.69, 95% CI: 1.31-2.19) respect to normal BMI patients (BMI=18.5-24.9 kg/m2) with consistent results across the HNC sites. In HNC-specific mortality analyses, the survival for underweight patients was not significant, except for underweight patients with oropharyngeal cancer (HR = 1.43, 95% CI: 1.11-1.83). Overweight and obese patients for oropharyngeal cancers had a favourable HNC-specific survival (HR = 0.50 (95% CI: 0.33-0.75) and HR = 0.51 (95% CI: 0.36-0.72), respectively). Among never smokers, overall BMI status was not associated with HNC-specific survival. Among ever smokers overweight and obese categories showed a favourable HNC-specific survival (HR = 0.69 (95% CI: 0.56-0.86) and HR = 0.70 (95% CI: 0.61-0.80)). Conclusions Our findings show that high BMI values increase the survival rates in smoking patients with HNC, suggesting that a nutritional reserve may help patients survive HNC cancer. This effect, however, may be partly explained by residual confounding, reverse causation, and collider stratification bias. Key messages • Our analysis reports the results of the largest available pooled analysis on the prognostic significance of BMI in the survival of 10,177 HNC patients from 10 studies worldwide. • Lower overall survival was observed in underweight patients for all HNC sites and a lower HNC-specific survival was observed with oropharyngeal cancer. Adiposity could serve as a nutrient reserve.

Vaccinations are successful, cost-effective public health interventions; nevertheless, vaccine hesitancy represents a concern and several EU countries have implemented mandatory vaccinations to counteract it. The assessment of vaccination coverage data is helpful to clarify the reason behind this choice better and assess its impact. Data were extracted from the WUENIC database as of July 2021. All the 27 EU countries were included, considering the period from 1980 to 2020 (depending on data availability). Coverage indicators on seven vaccinations scheduled during the first year of life to prevent nine vaccine-preventable diseases were considered. Joinpoint regression was run using Joinpoint Trend Analysis Software 4.9.0.0. For each coverage indicator, the last two trends in time identified by the joinpoint regression were considered to identify countries with a positive vaccination coverage trend (having either the last trend significantly positive or the second last significantly negative but followed by a trend reversal) or a negative coverage trend (having either the last trend significantly negative or the second last significantly positive but followed by a trend reversal). To assess each country, we collated together information on each coverage indicator. A total of 180 jointpoint regressions were run. At least one joinpoint was observed in 144 cases: 39 (27.1%) showed a significant positive trend, and 49 (34%) had a significantly negative one. In 36 cases, there was a single trend lacking a joinpoint, either positive (21, 58.3%), negative (8, 22.2%), or not showing a change (7, 19.4%). Overall, 14 countries had mostly negative vaccination coverage trends, whereas 13 had mostly positive vaccination coverage trends. Systematised data collection and analysis of vaccination coverage trends are needed to support public health systems. EU countries differ broadly, but the overall situation shows that coverage trends are a key issue to be addressed. Key messages • Vaccination coverage in the EU shows a general negative trend. The assessment and comparison of coverage trends across EU countries could make policymakers able to respond to critical issues timely. • Mandatory vaccinations have been issued in different countries to prevent vaccination coverages from decreasing. Some countries have not issued any mandate but show high vaccination coverages.

Background Primary care physicians have a crucial role in determining the appropriate healthcare setting for their confirmed or suspect COVID-19 patients. Machine learning provides science-based tools that can be used for clinical decision-making which have already been applied to the fight against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) both in the therapeutic and the prevention area. The aim of this study was to develop a machine learning-based tool to support primary care physicians to decide between home monitoring and hospitalization for their patients before diagnostic test results are available. Methods A retrospective cohort study with data from a hospital setting was performed. Patients' medical history and clinical, laboratory and radiological findings were collected and the dataset was used to train a predictive model for COVID-19 severity. The patients were divided between confirmed and suspect cases on the basis of the positivity of the nasopharyngeal RT-PCR test results. A splitting algorithm was recursively used to choose the predictor. A decision tree was built. Results A total of 198 subjects were enrolled for the study. Out of them, 28 cases were classified as mild disease, 62 as moderate disease, 64 as severe disease, and 44 as critical disease, according to WHO guidelines. The G2 value was used to determine the contribution of each obtained value to build the decision tree. The tree was, therefore, built choosing values that maximized G2 and LogWorth. SpO2 (cut point = 92%) was chosen for the optimal first split. The correspondence between inputs and outcomes was validated. Conclusions Our tool provides accurate clinical severity prediction for both confirmed and suspect COVID-19 patients. We, therefore, propose its implementation in the everyday life challenges of primary care physicians to support their clinical decision-making in providing appropriate and timely care for their patients. Key messages Primary care physicians have a crucial role in determining the appropriate healthcare setting for their confirmed or suspect COVID-19 patients. We propose a tool that provides an accurate clinical severity prediction for both confirmed and suspect COVID-19 patients to help choosing the appropriate healthcare setting for them.

To develop a deep learning-based decision tree for the primary care setting, to stratify adult patients with confirmed and unconfirmed coronavirus disease 2019 (COVID-19), and to predict the need for hospitalization or home monitoring.We performed a retrospective cohort study on data from patients admitted to a COVID hospital in Rome, Italy, between 5 March 2020 and 5 June 2020. A confirmed case was defined as a patient with a positive nasopharyngeal RT-PCR test result, while an unconfirmed case had negative results on repeated swabs. Patients' medical history and clinical, laboratory and radiological findings were collected, and the dataset was used to train a predictive model for COVID-19 severity.Data of 198 patients were included in the study. Twenty-eight (14.14%) had mild disease, 62 (31.31%) had moderate disease, 64 (32.32%) had severe disease, and 44 (22.22%) had critical disease. The G2 value assessed the contribution of each collected value to decision tree building. On this basis, SpO2 (%) with a cut point at 92 was chosen for the optimal first split. Therefore, the decision tree was built using values maximizing G2 and LogWorth. After the tree was built, the correspondence between inputs and outcomes was validated.We developed a machine learning-based tool that is easy to understand and apply. It provides good discrimination in stratifying confirmed and unconfirmed COVID-19 patients with different prognoses in every context. Our tool might allow general practitioners visiting patients at home to decide whether the patient needs to be hospitalized.

The technologies that allow for a deeper understanding of the human 'omic infrastructure are creating unprecedented opportunities for disease prevention, diagnosis, and treatment and for disease monitoring on a personalised basis, both within the health system and beyond. As all the new technologies and their applications advance, they are likely to play an integral role in shaping healthcare and the ways in which citizens manage and optimise their health. The 'omic profiling have the potential to be considered a useful component of health management since birth, but the extent to which it really represents an added value in terms of improved outcomes and quality of life needs additional evidences. The use of PRS in health subjects is an important area of development for public health and warrants close attention, but there is still a good deal to learn about how to maximise benefits for population health. When it comes to digitalization, we can anticipate that its impact on health, health care delivery and health systems will be profound. It will likely (further) affect the different phases of health care delivery, including health promotion, prevention, primary care, specialised care, long term care, social care, and self-care. In this context, a key challenge is to ensure that all people enjoy the benefits of digital technologies for everyone. Establishing the critical digital infrastructure, training the workforce, improve citizens awareness, and secure safeguarded systems to protect data as a central issue to fostering patients and citizens trust in data sharing, are key aspects that we need to address now. Additionally, we must make sure that all the innovation and technologies helps to reduce the inequities in our world, instead of becoming another reason people are left behind.

BACKGROUND: Hip Osteoarthitis (OA) risk is sport-specific and depends on frequency, intensity, and type of mechanic stress the hip is subjected to. This retrospective observational study aims to investigate the safety and performance of Hymovis (HYADD-4) injection, a hexadecyl (C-16) HA-derivative, when used to manage symptomatic hip OA in active middle-aged sportsmen over a 24-month observation period. METHODS: The retrospective analysis included clinical records of active sportsmen, aged between 40 and 65 years, and suffering from symptomatic Kellgren-Lawrence grade II to III hip OA, treated with two (24 mg/3 ml) Hymovis injections, two weeks apart, every 3–4 months, for two years. When available, data on MRI examination were included in the analysis as well as Heidelberg Sports Activity Score (HAS) and Copenhagen Hip and Groin Outcome Score (HAGOS) questionnaires. RESULTS: Thirty patients (56.4 ± 7.3 years) were included in the study, sixteen cyclists and 14 tennis players. For all patients, HAS and most HAGOS scores improved significantly (p

Prevalence of the

Summary Prevalence of the Anisakis Simplex's (AS) sensitization in children sensitized to Dermatophagoides pteronissynus (DP) is not known, neither it is to which percentage it might be due to cross-reactivity. The primary objective of the present retrospective cross-sectional study is to evaluate the prevalence of sensitization to AS in children sensitized or allergic to DP. Secondary outcomes were the prevalence of cross-reactivity and clinical relevance of the condition. The prevalence of sensitization to AS differs significantly among patients sensitized and not to DP (13.43% vs. 3.80%; p=0.019). The higher prevalence is mainly due to cross-reactivity with Der p10 (OR=8.86; 95% CI=4.33-40.74; p=0.0001). Currently, the sensitization to AS seems to have no clinical relevance in the pediatric population.

Temporary work, supplied by temporary-help agencies and sometimes referred to as "job in leasing", was only recently introduced in Italy, and has since spread considerably thanks to its flexibility and cost effectiveness. In this study, trends in the rates of occupational injuries in different sectors of Italian industries in the period 2000-2004 are explored, contrasting direct employment and temporary work. Data on occupational injuries from the National Organization for Labour Injury Insurance as well as data directly obtained through a field survey in three large manufacturing firms were analysed to highlight the interaction between injury frequency index (FI) and the characteristics of the labour force. FI for temporary workers ranged between 89.23 and 94.10, i.e., between 136.4% and 175.2% more than the value found for direct employees in the most hazardous industrial sector. Also accident severity (assessed on the basis of time lost due to injuries) is twice the overall value of the severity index. The results from the field survey confirmed the trend: FI for direct employees ranges from 25.7 to 45.0 in respect of total hours of work in the range 1.99 x 10^6-2.40 x 10^6; whereas FI in temporary workers ranges from 86.2 to 163.5 in respect of total hours of work ranging from 1.25 x 10^5 to 1.28 x 10^5. Given this evidence, an empirical statistical analysis, based on responses from injured temporary workers was carried out. The questionnaire was intended to collect data on a variety of control variables relating to personal characteristics of respondents. The analysis of the questionnaire data using ANOVA and response surface methodology highlighted the interaction between short duration of work assignments, inadequate training period and FI increase. Reasons can be traced to lack of experience in the activity, insufficient specific knowledge (formal and informal knowledge) about a particular installation and to inadequate training period. Means of promoting safety include diffusion of information on regulatory provisions, management training in safety, enhancement of specific training and formation. Language: en

The occurrence of a rapid phase transition, or so-called explosive boiling, when a cold volatile liquid comes into contact with a hot liquid or hot surface is a potential hazard in industry. This study was focused on the explosive boiling potential of thermally stratified liquid-liquid systems that result from a runaway reaction. The experimental runs were performed on both a non-reacting and a reacting system. The experimental results showed that under the analysed conditions, the cold phase was superheated but did not evaporate explosively, as the limits of superheat of the phase were not achieved. The response of the cold phase appeared to be completely controlled by the interface temperature between the hot and the cold phase. In general, based on the order of magnitude of temperature differences that result from a runaway reaction in a multi-phasic system and the fact that the system is pressurised by its own vapour pressure, the occurrence of explosive boiling under runaway conditions appears unlikely for these type of systems. © 2002 Elsevier Science B.V. All rights reserved.

Summary This study was intended to extend, by optimizing modified atmosphere packaging (MAP), the shelf-life of the Italian vegetable sauce used for spaghetti and known as ‘pesto’. A mathematical model was developed in order to predict gas composition inside the polymeric package (CO2 concentration). Predictions of equilibration time and equilibrium gas composition showed moderately good agreement with experimental data. A useful extension of pesto shelf-life, up to 120 days, was achieved by adopting a target atmosphere containing, at steady-state, 10% CO2 and 90% N2 at 5 °C. Microbial growth was inhibited by the CO2 levels, but was not accompanied by significant changes in odour and colour.

The nuclear industry has considerably contributed to the development of methods and procedures to cope with and solve the problems of safety and management of hazards. One of the problems of spent nuclear fuel reprocessing management is the treatment of organic radioactive wastes. This paper is intended to present a new process for radioactive waste treatment, based on two combined steps, i.e. preliminary distillation and wet oxidation. The results of distillation tests, carried out in a laboratory scale apparatus, on both simulated and radioactive liquid solutions, are reported. The tests carried out with simulated solution prove to be of significant value for a more thorough and fundamental understanding of distillation equipment. High decontamination factors were obtained by distillation of radioactive waste, showing no need for further particular treatment of the distillate, A noteworthy result from the point of view of safety and management of hazards connected to radioactive wastes in nuclear plants is the remarkable reduction in the volume of contaminated liquid wastes, which should encourage further investigations with a view to utilizing industrial distillation plant.

This paper deals with the problem of defining the operational tasks, modelling and optimizing of antifire crew and their attempts. Unwanted events are generally modest and easily controlled in their starting phase. This obviously leads to considering that quickness and coordination enhance the possibility of successful fire control. Hence the importance that the first intervention of the factory antifire crew is supported by strong organization and efficiency. Immediate and appropriate response to emergency is essential to minimize severity of accidents, life losses, as well as the potential reduction in the plant future productivity. In approaching internal antifire crew optimization, it is convenient to distinguish a traditional inventory phase, a subsequent optimization and a graphic modelling phase. Optimization criterion is developed according to graph theory, with regard to intervention pathways and to consistency of antifire crew. The proposed graphic model provides, in an immediately readable way, the sequence of operator actions to be followed in order to cope with emergency situations.

The purpose of this paper is to examine the fluctuations of accident frequency in the Italian industry during a period of time covering almost a hundred years (from 1890 to 1989) and to examine possible connections with industrial production fluctuations. Notwithstanding the considerable variations of economic and social conditions and the increasing technological and scientific improvement, the number of accidents never drops below 110 cases per 1000 workers/year. We focused our attention on economic factors, which, especially over the long run, seem to be the most important, so as to set the basic trends in occupational accidents. A nice parallelism between the economic cycle and the trend of accidents has been pointed out, differences not exceeding 20% over the whole period of observations. This relationship affords the oppurtinity to verify that the factors influencing human safety conditions in industrial activities do not depend on technological development.

In this paper, attention is focussed on the plume rise of smoke arising from free burning fires. Free burning fires have both geometric and emission ch

Several factors can affect occupational accident frequency, namely economical factors, technologies used (low automation, discontinuous operating) job design, organization of work/environmental conditions and human factors. In particular, technological advances in industrial activities can give rise to improvement in productivity and in occupational health and safety, but not necessarily simultaneously. The beginning of the container transport dates back to 50 years ago, but while containerization changed everything, from ships and ports to patterns of global trade, its impact on work injuries was not explored at all. The aim of this paper is to investigate the relationship between work organization, job experience, productivity and occupational accidents, from the starting of the container expansion to nowadays, considering Genoa port (Italy), one of the largest of the Mediterranean Sea. In order to minimize possible reporting biases, such as underreporting or reclassification to a lower level of severity, injury statistics are elaborated starting from data collected directly on-site, from internal accident or medical-aid reports. An in-depth statistical analysis on occupational injuries in the years 1980–2006 is carried out, with reference to frequency indexes, mechanism of injury and material causes. The increase of container-ships traffic and, consequently, the sharp change in port infrastructure involved a rapid modification also in the work organization, with particular reference to the number and characteristics of workforce (decrease from 5783 to nearly 1000 employees and increase of low experience workers from 28% to 74%). The striking high percentage increase of young or low experienced workers in handling container (and performing correlated new tasks) caused a remarkable increase of the risk for occupational injuries. In the studied port, we recorded an increase of the frequency index (injuries per hundred thousand hours worked) from 13.0 to 29.7. It results that the increased expansion of shipping container utilization is not connected to a correspondent human factor safety implementation. Main risk factors are pointed out, revealing an increase of accidents due to transport vehicle (+8.3%) and a reduction of accidents caused by substance or materials (−4.5%). These factors show a statistical significant correlation with the new job tasks. Consideration of these findings may enable managerial solutions and workplace organization interventions for the prevention of injuries and safety performance improvement in port activities.

The authors have compared the results of gonadotropin stimulation with a gonadotropin releasing hormone (GnRH) intravenous bolus of 100 µg and of 10 µg in a group of eumenorrheic women. They conclude that there are no differences between the responses of the two dosages in normal women. Therefore the authors clarify that the dosage of 10 µg of GnRH as a bolus test may be used currently in clinical practice in order to assess gonadotropic function.

This paper offers a perspective on the relationship between accident frequency and number of employees in the Italian industry, during the period from 1995 to 2000. The number of firms examined is 2,983,753 with a total number of non-fatal and fatal injuries corresponding to 3,321,960. A statistical significant reverse relationship (p

Despite the relative recent move towards inherent safe materials, the relentless drive of consumerism requires increased quantities of dangerous goods to be manufactured, transported, stored and used year on year. The safety and effectiveness of road transport systems is to be considered a strategic goal in particular in those countries, like Italy, in which 80% of goods are transported by this means. In this paper, we face the risk from dangerous good transport by presenting a site-oriented framework for risk assessment and developing a theoretical approach for emergency planning and optimisation. In the first step, we collected field data on a pilot highway and developed a database useful to allow a realistic evaluation of the accident frequency on a given route, by means of multivariate statistical analysis. To this end, we considered both inherent factors (such as tunnels, bend radii, height gradient, slope etc), meteorological factors, and traffic factors (traffic frequency of tank truck, dangerous good truck etc.) suitable to modify the standard national accident frequency. By applying the results to a pilot area, referring to flammable and explosive scenarios, we performed a risk assessment sensitive to route features and population exposed. The results show that the risk associated to the transport of hazardous materials, in some highway stretches, can be at the boundary of the acceptability level of risk set down by the well known F/N curves established in the Netherlands. On this basis, in the subsequent step, we developed a theoretical approach, based on the graph theory, to plan optimal emergency actions. The effectiveness of an emergency planning can normally be evaluated in term of system quickness and reliability. As a case study, we applied the developed approach to identify optimal consistency and localisation in the pilot area of ‘prompt action vehicles’, properly equipped, quick to move and ready for every eventuality. Applying this method results in an unambiguous and consistent selection criterion that allows reduction of intervention time, in connection with technical and economic optimisation of emergency equipment.

The risk from dangerous goods transport by road and strategies for selecting road load/routes are faced in this paper, by developing an original site-oriented framework of general applicability at local level. A realistic evaluation of the frequency must take into account on one side inherent factors (e.g. tunnels, rail bridges, bend radii, slope, characteristics of neighborhood, etc.) on the other side factors correlated to the traffic conditions (e.g. dangerous goods trucks, etc.). Field data were collected on the selected highway, by systematic investigation, providing input data for a database reporting tendencies and intrinsic parameter/site-oriented statistics. The developed technique was applied to a pilot area, considering both the individual risk and societal risk and making reference to flammable and explosive scenarios. In this way, a risk assessment, sensitive to route features and population exposed, is proposed, so that the overall uncertainties in risk analysis can be lowered.

OBJECTIVES—Trends in the rates of total injuries and fatal accidents in the different sectors of Italian industries were explored during the period 1951-98. Causes and dynamics of injury were also studied for setting priorities for improving safety standards. METHODS—Data on occupational injuries from the National Organisation for Labour Injury Insurance were combined with data from the State Statistics Institute to highlight the interaction between the injury frequency index trend and the production cycle—that is, the evolution of industrial production throughout the years. Multiple regression with log transformed rates was adopted to model the trends of occupational fatalities for each industrial group. RESULTS—The ratios between the linked indices of injury frequency and industrial production showed a good correlation over the whole period. A general decline in injuries was found across all sectors, with values ranging from 79.86% in the energy group to 23.32% in the textile group. In analysing fatalities, the trend seemed to be more clearly decreasing than the trend of total injuries, including temporary and permanent disabilities; the fatalities showed an exponential decrease according to multiple regression, with an annual decline equal to 4.42%. CONCLUSIONS—The overall probability of industrial fatal accidents in Italy tended to decrease exponentially by year. The most effective actions in preventing injuries were directed towards fatal accidents. By analysing the rates of fatal accident in the different sectors, appropriate targets and priorities for increased strategies to prevent injuries can be suggested. The analysis of the dynamics and the material causes of injuries showed that still more consideration should be given to human and organisational factors. Keywords: labour injuries; severity; regression model

Publisher Summary In the chemical industry, there are a number of reactions performed in mixed multi-phasic systems. In these systems, accidental loss of agitation might lead to a segregation of the phases and the occurrence of a runaway reaction in one of the phases. The reaction is performed under well-stirred conditions to obtain the desired product specifications. A malfunctioning of the stirrer will lead to a segregation between the aqueous phase and the organic phase in which the exothermic polymerization reaction proceeds. The occurrence of a rapid phase transition, or so-called “explosive boiling,” when a cold volatile liquid comes into the contact with a hot liquid or hot surface is a potential hazard in industry. The study described in the chapter focuses on the explosive boiling potential of thermally stratified liquid-liquid systems that result from a runaway reaction. The experimental results showed that under the given conditions, the cold phase superheates but cannot evaporate explosively as the limits of superheat of the phase are not achieved. The response of the cold phase appeared to be completely controlled by the interface temperature between the hot and the cold phase. Based on the order of magnitude of temperature differences that result from a runaway reaction in a multi-phasic system and the fact that the system is pressurized by its own vapor pressure, the occurrence of explosive boiling under runaway conditions appears unlikely for these types of systems.

Publisher Summary Seveso II Directive (96/82/EC), dealing with the control of major accidents and acknowledged by Italian law D.L. 334/99, implies the need of developing adequate tools for the evaluation and mitigation of industrial risk. Retrospective Hazop is considered suitable for safety assurance, but it is rejected because it suffers from limitations and involves considerable time. The technique has been developed ad hoc starting from Hazop and Process Hazard Review and applied to a process of acrylic polymerization along the whole production cycle. The process of Hazop is well known as an effective and highly respected method of hazard identification. The Hazop is applied only to those sections of a plant where it has been determined that a deviation from the design intent could lead to serious accidents; it suggests the action required to reduce the risk of accidents. The evaluation of a risk by the Index Method allows a univocal interpretation of the hazards of an existing plant, related to the intrinsic characteristics, the chemistry, and the environmental conditions, allowing to characterize every unit by a global risk index. On the other side, the technique attempts to overcome Hazop limitations for existing plants, taking into account all the interventions and modifications to plant design, by the use of experience, current best practice, and actual tendency towards inherent safety plants.

Publisher Summary The evaluation of the rate of air mixing with a sudden release of flammable or toxic material is an essential tool for properly designing flares, vents, and other safety devices, as well as to quantify the potential risk connected to the existing ones or arising from the various kinds of accidents that can happen in process industries. An iterative procedure was developed for the evaluation of the boundaries of the cloud flammable region, making use of the experimental data obtained in wind tunnel. It was showed that a significant subset of this data can be correlated to describe the boundaries of the flammable cloud by means of a simple formula. In addition, it was also demonstrated that a similar approach can be applied to the whole set of the data, resulting in a more general mathematical description of the jet dispersion, applicable to face easily the different kinds of design problems concerning upward directed releases with much more ease. The model, validated by means of replicated tunnel experiments, substantially agrees with the existing ones for the limiting cases of horizontal and upward directed jets. The model directly gives the boundaries of flammable clouds and the ground level concentrations of toxic releases; in addition, with some modifications, it can be applied to evaluate the heat transfer on vessels and buildings due to flame radiation and impingement.

Publisher Summary This paper discusses the risk associated with the transportation of dangerous goods by road and strategies for selecting road load/routes by developing a site-oriented framework of general applicability. A methodological approach for the assessment of standard vehicle and dangerous good truck flows was applied to a pilot area, allowing a statistical reinforced evaluation of intrinsic enhancing/mitigating parameters. In this way a risk assessment sensitive to route specifics and population exposed is proposed and the overall uncertainties by the risk analysis can be lowered. The developed model, of general applicability, can represent a useful tool not only to estimate transport risk but also to define strategies for the reduction of risk and emergency management. Poor appreciation of factors related to road conditions such as road class, designated speed limits, traffic density, as well as of the population characteristics, is likely to result in a risk assessment insensitive to route specifics and over- or under-estimating the overall level of risk. The results show that the risk associated with the transport of hazardous materials on the highway considered in the chapter is at the limit of the personally acceptable level of risk.

The LH/FSH ratio values between gonadotropins dosed with a monoclonal antibody assay (IRMA) in the micropolycystic ovary syndrome (PCOS), are discussed and compared to those obtained with the classic assays using polyclonal antibodies. Because of the higher selectivity of this IRMA assay it is noteworthy that the cut-off value between normal and PCOS patients is now equal to or above one. The evaluation of the LH/FSH ratio between the peak values of the two gonadotropins after a GnRH 100 micrograms iv bolus, may be useful in the diagnosis of PCOS in those patients who present an LH/FSH less than 1 in basal conditions even in the presence of clinical and ecographic aspects of PCOS.

A 68 year-old hypertensive woman carried out, linked with the featuring complaints of temporal arteritis-polymyalgia rheumatica complex, an orthostatic hypotension caused, probably, by a spread immunocomplex damage. The presence of depression in Horton's Arteritis and its improvement with the complete recovery would show, perhaps, a central catecholaminergic failure.

The most important clinical studies using spironolactone as an antiandrogen drug either per os or topically are referred. Menstrual disturbances very often occur during SP treatments thus limiting its systemic use. As far as the topical use is concerned SP seems to be highly effective with absence of systemic effects. Local mild side effects were present in a small number of patients.