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Simultaneous occurrence of EDTA-dependent lymphoagglutination and agglutination of myeloid cells in a patient with chronic myelomonocytic leukemia. Statistical analyses were applied to correlate MDW values with common inflammatory markers, disease severity, clinical trajectories and final outcome. GEER, November 22, Artificial Intelligence will be non-optional. Accepted : 26 October The maximum intensity assigned to the epicentral area after the August 24 earthquake Galli et al. Figure 25 shows the damage occurred to the fourteenth century church of S. For damage level D4 there were mainly out-of-plane mechanisms. Except for one case, bell towers suffered minor damage with respect to ordinary masonry buildings, probably due to the fact that they have larger vibration periods, thus suffering smaller spectral accelerations. The impairment of this pathway is a common characteristic of many tumors and it is frequently observed in breast and ovarian cancer.


Windows 10 1703 download iso italys population density.Damage patterns in the town of Amatrice after August 24th 2016 Central Italy earthquakes

Furthermore, evaluating MDW dynamics in cases with longer follow-up, we frequently observed progressive MDW increments in patients with worsening inflammatory conditions, while clinical recoveries were consistently associated with MDW decreases. D because, for the area of Amatrice and for intensities as high as 9, the historical catalogue can be considered complete only since year Stucchi et al. Padoan 1 , C. Miller JA. Pirotti 1 , T. It can be noted that many buildings which had tie rods suffered heavy damage and collapse, probably because in many cases the retrofitting had been made by means of inappropriate interventions, as depicted in Fig. Pellegrini , L.❿

. Windows 10 1703 download iso italys population density


A risk-based approach to POCT management allows to analyse all steps, to set up monitoring indicators to verify their correctness and to implement corrective and preventive measures to decrease the incidence of errors [1].

Traceability from request to report and registration of all operators and devices involved doctor, nurse, patient, request, sample, batch, instrument facilitate the workflow management and enable verification of data consistency.

Besides the selection of tests often already preset for the emergency , the timing of their execution useful for the clinical need and the correct preparation of the patient e. Also the collection of the sample in terms of type, volume, device and sampling method, and the eventual treatment or storage before analysis are carefully controlled with shared checklists and operating procedures, as well as other QC on the sample, such as for example the presence of bubbles, clots or haemolysis.

It is therefore essential to act on training and to manage the skills of all the operators involved both in the use of the equipment and in its control in presence and remotely.

The multidisciplinary committee is crucial in all aspects of the POCT network from the choice of tests, sites and patients, to the supervision of training and competency, as well as in monitoring performances [2]. Identifying sources of error and selecting quality indicators for point of care testing. Pract Lab Med. J Appl Lab Med. PMID: Point-of-care testing POCT can be used in clinical setting such as hospitals and in areas where decentralized testing is requested i.

Decentralized diagnostics are affected by several organizational, environmental, operational and technical challenges. The personel responsibilities in nonhospital-based POCT are the same as hospital-based ones. Laboratory errors may have serious consequences for patient health and outcome. The most common preanalytical errors in decentralized diagnostics are related to patient preparation such as incorrect sampling time, to blood collection as patient identification, to sample handing such as inadequate sample mixing and tube filling, transport and to interferences such as hemolysis.

Many constituents have a daily variation and the blood composition undergoes significant changes after food consumption. Sampling should preferably be done after an overnight fast from 7am and 9am and should always be done prior to the potentially interfering diagnostic and therapeutic treatments.

If decentralized tests have to be performed at different times it is necessary to record sampling time and time of administration of any therapeutic treatments. For a proper patient identification it is recommended to use barcoding systems. The recommended order for microcollection is different from venous blood sampling: blood gases they may be altered if sampling is delayed , EDTA tubes, tubes with other additives and serum tubes 4.

Any anticoagulated sample must be rejected if any detected clot are present. Hemolysis is the most frequent preanalytical error and can affect many assays. Spurious iperkaliemia in whole blood may be found using POCT such as blood gas devices if occult hemolysis is present and no HIL detection system is available. Essential Tool for Implementation and management of a Point-of-Care testing program. Carta 1 , G.

Bonetti 2. The self-monitoring of blood glucose is of utmost importance for diabetic patients: it allows patients to evaluate their individual response to the therapy and verify whether the glycemic objectives have been met. All of this must of course be based on the use of one data which accurately reflects the glycemia.

The guidelines recommend the use of a device for the self-measurement of glycemia POCT which passed the necessary tests of accuracy and precision and thus presents the CE mark. Some studies, however, have emphasized how a non-negligible number of devices bears the CE mark without actually meeting the minimum criteria of accuracy requested 1. Even the Italian guidelines 2 highlight the necessity that producing firms clearly declare the analytical features of their devices, particularly in terms of accuracy and precision.

The hierarchy of the sources of information has the scientific studies of literature in the first place, with the declarations of producers only ranked second.

Lacking explicit and comparable references or in the presence of diverging situations around the analytical performances, diabetic facilities may activate a local evaluation of themselves, with a periodic comparison of the accuracy of the devices being recommended anyway.

The evaluation of the accuracy of POCT systems is very discussed. In any case, the accuracy of glucometers is based on the comparison with a reference method, and it is thus necessary to utilize a correct reference method in laboratories.

Much has been discussed around possible variables that may alter the quality of a comparative study of this type method used, type of capillary or venous sample, use of first or second drop for POCT measurement etc. Traditionally, sodium fluoride NaF is used to stop the glycolysis; this, however, is unable to contrast the glycolysis during the first hour of conservation of the sample.

The use of inhibitors that associate the NaF with the citrate buffer thus provoking an early inhibition of the glycolysis has proved more effective in that sense. The use of early glycolysis inhibitors NaF plus citrate has proved effective to stabilize samples even up to 15 days and this may allow their use even as control material to evaluate the analytical performances of the glucometers alternatively to the materials currently employed which are based on serum or plasma with an addition of glucose and which may present commutability problems.

Carta, M. Riv Ital Med Lab 10, — International Organization for Standardization. In vitro diagnostic test systems-requirements for blood glucose monitoring systems for self testing in managing diabetes mellitus.

ISO US Food and Drug Administration. How should glucose meters be evaluated for critical care. As with tests in central laboratories, decentralized analyzes show risks of error in the post-analytical phase. Trying to outline some elements of this problem, it is possible to identify at least three critical elements with different peculiarities, with respect to “centralized” analyzes validation, reporting and, last but not least, clinical interpretation of the result.

We can discuss these items with respect to at least three macro areas: the skills of the personnel dedicated to POCT analysis, the available technologies and methodologies, the standardization of procedures.

The validation of the result is the decision to consider an analytical result “valid”, reliable, to make decisions. Results from central laboratory are generally considered valid a priori. In the POCT setting, validation is responsibility of personnel performing the test, usually “non-laboratory” people who do not have the training that laboratory professionals do. Validation of a result must also take into account at least the correctness of the pre-analytical and analytical phases, the devices functionality, as well as the verification of quality through the control systems.

Controlling panic and delta check ranges adds further complexity. We can combat these risks of error with continuous training, such as in the pre-analytical and analytical phases; using updated technologies, which allow self-checks, warning systems, blocking of results in case of non-compliance with quality specifications, etc. We are near the start of Artificial Intelligence and utilizing big data to prove competency of operators, to prove that meters were giving reliable results, close to the other meters in the hospital and to maintain quality control in devices used outside of the hospital and operated by nurses, emergency medical technicians, and others not laboratorians [1].

Numerous studies have shown that reporting can be a critical element, when the execution of the tests is very far from the control of the central laboratory. The incorrect laboratory report is the most relevant issue for the post-analytical POCT phase, and specific quality indicators specific quality indicators could be very useful or even mandatory soon [3].

Specific competence counts in the interpretation of the results. For some tests, such as blood gas tests or thromboelastometry, the skills of specialists who have POCT systems at their points of care are likely to be high, often the highest in the health care system.

However, there is evidence for others tests and other clinical contexts monitoring tests [4] or management of critical results [5] the situation is very variable and sometimes worrying. The training of operators and the assessment of skills must therefore also concern, and with particular attention, the clinical significance of the results and the actions to be taken in the event of critical or unusual results. Miller JA. Quality performance of laboratory testing in pharmacies: a collaborative evaluation.

Clin Chem Lab Med ; Pract Lab Med ;e Medicina Kaunas. J Appl Lab Med 1; ISO and ISO enforce the implementation of dashboards, indicators, and patient risk management to continuously improve diagnostic outcome quality and TAT reduction. Our laboratory studied a year-old patients who underwent synthetic treatment or prosthetic surgery for femoral fractures within 48 h of admission and had symptoms attributable to ischemic heart disease dyspnea, chest pain, arrhythmia, and hypotension.

Troponin dosage was measured in all these patients with third-party POCT quality controls; these controls were validated by dedicated software to reduce analytical variability and allow monitoring of high-risk patients directly in TIPO by cardiologists with protocol 0—1 h; this also allowed the laboratory to measure, assess and reduce the risk of harm to the patient by IQCP system Individualized Quality Control Plan and monitoring integrated software as guidelines means to guarantee and protect above all the physician and the patient.

Healthcare is the one of the largest success stories of our times. Technology is another of the largest success stories of our times.

We are in the middle of a health-tech secular change. This is for good. This is unstoppable. This is the best part of the story.

Yet, healthcare spending is unsustainable in an aging world. Technology, as every tool, brings its risks. Global levels of assistance are outrageously unequal. Mental disorders are exponentially growing. How will the lab of the future adapt to the entire story? Internet of Things will be the main key to acquire all the right data.

Artificial Intelligence will be non-optional. With health-related knowledge doubling in months, AI will become a mandatory survival kit.

Yet, it still will see things that human eye might miss. Or making correlations that are simply too difficult anyway else. Yes, it will be both defensive for professionals and offensive to diseases, if used in the right way, as every tool. Digital will influence behaviors, create communities, and redefine the patient-professional interaction.

Patients are individuals, parents, children, workers, citizens, consumers, with ever-growing expectations on what and how can be done through a smartphone. Space and satellite technology will provide the communication background for all above, from remote surgery to distributed expert network, etc. But Space will also bring additional data coming from macroscopic data gathering, earth observation, context-related data and gravity-less phenomenon analysis.

Can the lab of the future stay immune from all above? Hard to believe. While exact predictions are useless, some trends are clearly visible and point to the raise of a next-generation ubiquitous lab. The complete blood count CBC is one of the most requested tests, routinely performed in the central laboratory LAB by large haematological analysers, useful to diagnose many diseases and manage urgent clinical decisions such as transfusion or administration of chemotherapy and antibiotics.

Hb remains the most common POCT in haematology, essential to exclude anaemia. There are two types of technology: small benchtop analysers and portable devices. The latter, some of which use disposable cartridges, do not require start-up procedures, maintenance and calibrations. The latest generation of portable devices combines advanced digital technology with innovative technologies of viscoelastic focusing and microfluidics and techniques, such as digital microscopy and computer vision, using near infrared spectroscopy and the absorption of light at multiple wavelengths, obtaining CBC results unthinkable until a few years ago.

Poor finger prick technique can provide misleading results, it was proved that capillary samples significantly underestimate PLTs overestimating Hb and WBCs, but differences have not clinical relevance when the samples are collected according to standardized procedures.

POCT devices can not differentiate normal cells from pathological ones e. As recommended by the guidelines, due to the inherent risk of preanalytical errors and the standard risk of error during analytical and postanalytical phases, threshold values must be established to repeat CBC in a LAB.

Literature suggests that POCTs are not yet the ideal tools to perform CBC for diagnostic purposes, but they are useful in urgent situations such as rapid monitoring of some parameters e. Further studies are needed to confirm the promising results of POCTs and evaluate their performance even at low ranges and in pathological conditions. Rampoldi E. Carraro P. Biochim Clin ; Briggs C. Where are we at with point-of-care testing in haematology?. BJH ; — Mooney C. Point of care testing in general haematology.

Machine learning algorithms have proven to be very effective in predicting the behavior of phenomena represented in biomedical data. The most commonly used machine learning algorithms, such as artificial neural networks, produce so-called “black box” results, namely: a complex set of mathematical equations that cannot be interpreted by people who do not have in-depth mathematical skills;. When applying machine learning to data such as images, black box algorithms are not a problem, since the value of the model lies in its accuracy in detecting the presence of certain patterns, attributable, for example, to the presence of a tumor.

A specific ML technique, the Rulex “rule generation method”, builds models described by a set of intelligible rules, thus allowing the extraction of important knowledge regarding the variables included in the analysis and their relationships with the outcomes of the phenomenon analyzed. Introduction: Point-of-care testing POCT is laboratory testing conducted close to the site of patient care.

POCT is growing in popularity with manufacturers offering a wide menu of tests and devices where the operator can obtain a rapid test result with the potential to initiate faster patient care decisions. But POCT is not fool-proof, and any test can and will fail if operated under the wrong conditions.

Methods: Risk management is a process where laboratories can assess their weaknesses, implement a control plan to detect and prevent erroneous results, and monitor the effectiveness of their plans. Results: The Clinical and Laboratory Standards Institute CLSI EPA: Quality Control Based on Risk Management provides guidance based on risk management for laboratories to develop quality control plans tailored to the particular combination of measuring system, laboratory setting, and clinical application of the test.

Discussion: This presentation will describe how laboratories can partner with manufacturers to conduct risk assessments and implement quality control plans in their laboratory and at the point-of-care. The advantages of utilizing a risk management approach to controlling laboratory errors will be emphasized along with the efficiencies gained from conducting a risk assessment and implementing a quality control plan.

A revision of CLSI EPA is currently being drafted, and this presentation will preview a few of the updates that can be expected in the next version of the guidance document. Evidence based laboratory medicine EBLM focuses on the use of diagnostic tests to improve patient outcomes. POC are tests conducted near the site of patient care, outside of the laboratory, usually performed by patients or clinical personnel not trained in laboratory medicine. POCT require small sample volumes, minimize pre-analytical errors, and reduce alterations of labile analytes.

However, when used appropriately, could improve the patients outcomes by providing faster results and earlier therapeutic strategies 2. Instead, its over or incorrected use could leads a patient risk and potential increase of healthcare costs. We assessed, through a systematic review of the recent scientific literature, the accuracy of the POCT on troponin, procalcitonin, C-reactive protein, parathyroid hormone, INR and d-dimer, and evaluate the impact of faster results on patient management.

Instead, studies on CRP claimed a significant reduction of antibiotic prescription. Several authors evaluated troponin and INR reporting faster decision-making without any improvement in clinical outcome. Faster results are often translated in better outcomes, without evidence to support this conclusion.

So, it is important that the POCT practice is evidence-based looking for evidence of whether POCT confers any advantage in clinical decision making in different scenarios. In some settings, such as rural environment, a rapid availability of cardiac troponins or other analytes can help clinicians to rule out or rule in disease, without transfer patient in other center, avoiding unnecessary costs 3.

Likewise, in Emergency Department, availability of more rapid results with POCT help clinicians to refer patients, but does not always translate into shorter stays 4. The satisfactory analytical performance, together with an excellent practicability, suggest that the POCT represents an important technological advance in patient care, but, the lack of evidence about the patients outcome invite healthcare workers to use it with judgement.

Price CP. Point of care testing. BMJ ; — Ann Clin Biochem. Arch Pathol Lab Med. Alter DN. Arterial and venous blood gas analysis reveals oxygenation and acid-base status of the body.

Hemoximetry is recommended to determine the impact of dyshemoglobins on oxygenation. Some calculated values may be in error, e. Moreover, the presence of high concentration of fetal hemoglobin may also be a problem if blood gas analyzer does not detect it, as instrument assumes hemoglobin to be of the adult type, and therefore the calculated blood gas oxygen saturation values are underestimated.

In critically ill patients many other analytes have been used to estimate the severity of disease and try to prognosticate morbidity and mortality. No measurements can encompass the complexity of a disorder, but lactic acid can approach that goal 3 Indeed lactic acidosis is the most frequent metabolic acidosis and many causes are reported for lactate increase, not only hypoxia: the higher the lactate concentration, the worse the outcome. The initial values have a prognostic significance, but serial measurements are more valuable for prognosis.

Conductivity-based Hematocrit Ht estimations have limitations. Abnormal protein concentration will change plasma conductivity. Low protein concentration, resulting from dilution of blood with protein-free electrolyte solution during surgery, will result in erroneously low Ht value. In any situation, to correctly interpret BGA results history should be always considered: reasons for presentation, information concerning events, environment, trauma, medications, poisons, toxins and an accurate physical examination should be carefully collected.

Acute respiratory distress syndrone: the berlin definition, Ranieri MV et al. Conductivity-based Hematocrit measurement during cardiopulmonary bypass. Steinfelder-Visccher J et al. The knowledge that has been garnered so far on severe acute respiratory syndrome coronavirus 2 SARS-CoV-2 infection is that humoral immunity encompasses the generation of immunoglobulins of most classes against surface viral antigens, which mostly involve the spike protein, the nucleocapsid protein, but also envelope and membrane proteins.

Since the spike protein is the anchor that the virus uses for penetrating the host cells through biding with its natural host cells receptors, it can be assumed that antibodies binding to spike protein of SARS-CoV-2, and especially to its receptor binding domain, would retain stronger neutralizing potency against the virus.

Serological testing has been conventionally defined as a diagnostic procedure used for detecting an immune response against an infectious agent. The diagnostic sensitivity stratified according to the assay methodology is highly variable. Additionally important drawbacks of rapid serological tests include the facts that the information provided by the companies is concerning because often lacks details, its quality is considerably variegated among different devices, several claims are vague, there is a lack of transparency along with the fact that human aspects are not been adequately addressed for purpose of alleviating the risk of inappropriately using the device.

The risk of misinterpreting tests results by patients when rapid kits are used for self-diagnosis is another aspect that must be considered. This was mostly due to objective difficulties encountered by the patients in reading and interpreting the results of the strips. Important considerations for implementing point-of-care serology testing thus include i usage of well-validated tests, evaluated against a gold standard; ii performance characteristics – thus encompassing sensitivity, specificity, positive and negative predictive values or cross-reaction with other coronaviruses – shall be tested using serum samples collected from patients infected with SARS-CoV-2, with other respiratory viruses including seasonal coronaviruses and also from healthy controls; iii adequate training of healthcare workers is needed iv and, finally, IV provisions must be in place, encompassing the capture of testing data for individual patient records and surveillance purposes, and the participation to external quality assessment schemes, to systematically monitor the quality of this type of testing.

At the heart of society 4. It is in these sectors that, lately, the greatest investments have been made in digital transformation aimed at exploiting -through data-all the new present and emerging technologies, from the Internet of Things IoT to Artificial Intelligence AI. The exploitation of Big Data, in fact, constitutes the starting point and the indispensable resource for the development of innovative and precision medicine, providing scientific, organizational and infrastructural support to promote research and accelerate preclinical and clinical studies.

However, this development, having increased the number of subjects holding health-related data, the speed of transmission of such data and the quantity of information electronically stored often not on national territory , has determined an exponential increase in the danger of data processing from the point of view of confidentiality and an increased possibility of damaging the dignity and fundamental freedoms of the individual.

This has led to an increased sensitivity of the European legislator and, subsequently, of the national legislator, towards the protection of such data and related protections. In addition to the General Data Protection Regulation, which has revolutionized the way of conceiving the data economy, it is, in fact, being evaluated by European institutions the first draft of the Artificial Intelligence Act, which will be the real springboard for the massive and regulated use of algorithms, especially in healthcare.

To be precise, this last mentioned regulation will only define the limits to the use of algorithmic systems already widely in use. AIFA, through this guide, has described some case studies, showing some workflows that represent the regulations impacted depending on the type of system used and paying particular attention to the compliance related to the treatment of data and the related profiles of cybersecurity.

Ad oggi sono operativi circa 72 Drive-Through-Difesa. I contributi, forniti da ciascuna Forza Armata, sono diretti e coordinati fin dalla prima ora dal Comando Operativo di vertice Interforze COI per mezzo di una Sala Operativa dedicata, composta da personale interforze. In the last couple of decades, Laboratory Medicine has made giant steps forward in terms of innovative technology and has made major scientific breakthroughs in the medical field as a whole. Indeed, a plethora of both in vitro and in vivo assays and tests in biological fluids of the human hydrodynamic system are now available.

The importance, for clinical purposes, of novel metabolic processes and protein cross-talk mechanisms is being increasingly recognized. The increased survival period of sick, elderly people, plus the therapeutic aspects of precision medicine, in which the drugs selected resulted in a series of direct approaches to altered target molecules, have made it difficult to identify the most effective molecules to use as biomarkers in most of this population scenario.

Therefore, it seems that Laboratory Medicine does not need to increase further value in the contribution to the care of fragile individuals, and in people affected by chronic degenerative diseases.

Notwithstanding all these premises, and the increase in Clinical Laboratory testing, which is, and will continue in the future to be an indispensable ally of medical care, the correct diagnosis of a single or of multiple diseases occurring in a single individual will benefit enormously from this Discipline, if some steps forward will be made.

I believe that the enormous amount of knowledge now accumulating in the field of Laboratory Medicine will revolutionize, not only the medical care of people, but, in the various areas of the medical scenario, also the field of Laboratory Medicine Science itself and the practice deriving from it. In other words, we should all begin to be mindful of our state of health as early as about 20—25 years of age, when most auxological aspects have been reached, and sexual maturity completed.

Therefore, also healthy people should be monitored as well as patients, which should be one of the tenets of preventive medicine. Having said that, I must now say that chronological age is practically meaningless in calculating health status. This, of course, applies much more to multimorbidity; in fact, once identified them, measures can be made to eradicate or to delay the start or the progression of each illness, therefore determining a better state of health during the progression of chronological age.

The revolution I am talking about is to look at each individual when they are enjoying still normal health, as mentioned above.

This approach may be considered too costly, but in effect it is much less costly than waiting for the appearance of an overt disease, which must then be treated for decades, frequently with very expensive drugs and tests laboratory and imaging. This will also support the joining of Preventive Medicine to effective Individualized Medicine. Salvatore F. The shift of the paradigm between ageing and diseases.

Clin Chem. Lab Med. During the second wave, the validation of SARS-CoV-2 antigen rapid diagnostic tests RDT has substantially changed testing strategies globally, since results were available within 30 min, reducing turnaround time and therefore exposure risk. Recently, validated self-tests for SARS-CoV-2 based on the nasopharyngeal swab NPS or saliva have prompted for the empowerment of the general population in the fight against the spread of infectious.

Swabbing is a complex task requiring training and competency assessment, and thus they are performed by trained nurses or physicians. Recently, Tsang et al. The Authors concluded that saliva and nasal swabs are clinically acceptable alternatives to commonly used nasopharyngeal swabs. Saliva is a matrix elective for self-collection, and molecular testing is reliable but require laboratory instrumentation to be performed.

Indeed, antigen determination on salivary samples is still under debate [2]. Most of the errors occur in the preanalytical phase, with relatively few analytical and post-analytical errors. Some issues arising during the pre-analytical phase of SARS-CoV-2 diagnostics regards: the time of swab, swabbing practice, sample handling and conservation and RNA extraction.

NPS should be taken at the time of symptom onset when the highest viral load occurs in COVID, thus not the day immediately before and not too far from possible close contact with positive subjects. Differently, sample preparation is a crucial factor for antigen testing, and centrifuged vs.

In conclusion, self-testing could be of aid in the screening programs for reducing viral spread, but other alternatives are possible, such as self-collection of samples with analytical tests performed in clinical laboratories.

These required the optimization of pre-analytical steps to reduce the impact on results. Woloshin, S. Basso, D. In a broad and complex territory such as that of ULSS 6 Euganea, composed of five local health districts with a population of about Information is sent in real time to central laboratory using IT middleware, where data are validated and historicized. Historicized data can be consulted and downloaded like other laboratory exams. Results: the project involved patients.

From January 1st to June 30th the average frequency of determinations per patient was about 30 days, while the average number of determinations per patient was about 7,5. This model simplifies management of both patients in IHC and followed by RMC, allowing easier access to the determination of PT-INR, with more constant therapy control and significant improvement of life quality.

Ovarian cancer is the seventh most frequent malignancy in the female population worldwide and the leading cause of death among gynecological cancers. In Italy, about new cases were registered in Amatrice suffered the most extensive damages caused by the August 24 earthquake, both in terms of human losses and damage to constructions.

The town is located m above sea level. The urban composition of the historical center derives from the medieval structure of the city, within the former city walls. The city develops along the East—West direction with parallel streets and it is crossed by the main street Corso Umberto I, where many public and religious buildings are located. The majority of the structures in the historical center of Amatrice are constituted by masonry building aggregates mainly made with cobblestones.

This type of housing has typically wooden floors with span of about 4—5 m, while the vertical structure is formed by rubble stone masonry with poor connection between the external leaf and the core absence of bondstones. Most used stones are limestones and sandstones, which were also used as aggregates in lime mortar, which has a poor binding capacity worsened by the presence of irregular smooth stones.

Isolated houses built in recent times have better construction quality, few RC frame buildings exist while there is no presence of steel buildings except one. To the authors knowledge, only two studies have been performed about the damage distribution in the Amatrice historical center after the earthquake of August The map shown in Fig.

The map constitutes a first evaluation of the damage in Amatrice made essentially for emergency management purposes. The main drawbacks are that the damage level is assigned to building blocks which include more than one building, and that the satellite photo neglects possible damage when the roof is not collapsed.

The shortcomings, in this case are that the survey has been performed along Corso Umberto Fig. The survey, done in Amatrice by the authors accompanied by a crew of the Italian Fire Brigades on September 12 , allowed to assess the damage and collapse mechanisms of buildings out of about in the historical center of the town. Due to the high risk related to the presence of debris on many streets and to falling material from damaged buildings it was not possible to map all the buildings.

Moreover, the damage assessment was made by observing the buildings from the street only. The proposed methodology aims at defining the damage in the historical center of Amatrice caused by the earthquake of August 24, , and relating this damage to damage mechanisms and to vulnerability factors of the observed buildings.

The method was applied using QGIS software. Definition of single buildings: based on the cartographical data provided by project Copernicus, the geometries of blocks were subdivided into single units. Definition of damage mechanisms: the mechanisms were assigned both to reinforced concrete and masonry buildings as reported in the work of Zuccaro and Papa and are illustrated in Table 3 and Fig. Schemes of damage mechanisms for masonry buildings Pagano Vulnerability factors: the factors selected for masonry and reinforced concrete buildings are shown in Table 4.

Assignment of damage levels: the observed level of damage was assigned to each inspected building, based on the survey and on the analysis of the photographic documentation. Then, for each assigned mechanism, the vulnerability factor determining the damage or collapse was stated. The main features of the map are the following:.

Map of damage in Amatrice according to EMS damage classification: The main mechanisms identified for each building are reported. The observation of the map allows to make the following considerations: many of the buildings which suffered major damage or collapsed lied along Corso Umberto, where the majority of the historical buildings are located 32 collapses out of a total of ; the majority of the collapses in Corso Umberto happened east of Via Roma, while in the west part of the town the damage seems to be more scattered see Fig.

The building heritage of the historical center of Amatrice Fig. As discussed previously, the prevalent structural period of these buildings ranges between 0. By observing the map, it is clear that the area located eastward of Via Roma has a larger percentage of D5.

Bell Towers are included in the map and counted in the total number of buildings. Except for one case, bell towers suffered minor damage with respect to ordinary masonry buildings, probably due to the fact that they have larger vibration periods, thus suffering smaller spectral accelerations. Figure 13 shows the damage levels of masonry buildings without tie rods grey bars , with any type of retrofitting system yellow bars and those who had only tie rods black bars.

It can be noted that many buildings which had tie rods suffered heavy damage and collapse, probably because in many cases the retrofitting had been made by means of inappropriate interventions, as depicted in Fig. Partial facade collapse mechanism M3 of a building which had tie rods: general view left and detail right.

The most probable damage mechanism arises focusing on the masonry buildings which have a damage level from D1 to D4 from Table 1 : buildings—3 bell towers. In Fig. For damage level D4 there were mainly out-of-plane mechanisms. In-plane mechanisms were identified mostly for damage levels D2 and D3, while local mechanisms are related mostly with levels D1-D2. Figure 16 compares the different damage mechanisms identifying the buildings with retrofitting and tie rods.

Differently to what expected in a retrofitted building, it must be observed that, among the buildings which suffered damage mechanisms M3 and M4 total or partial wall overturning , 9 out of 18 buildings had tie rods, thus allowing to state that the presence of tie rods did not prevent the activation of out-of-plane mechanisms, probably because of the poor masonry quality which did not allow an efficient force transfer system to the masonry. Comparison between damage mechanisms and presence of tie rods for D1—D4 damage levels see Table 3.

Figure 17 reports the vulnerability factors identified for masonry buildings with damage level ranging from D1 to D4. The most relevant factors more than 10 buildings affected are:. Examples of the first two vulnerability factors are reported in Figs. Example of ev4 vulnerability factor poor quality masonry : a absence of bondstones in the wall-section; b cobblestones with poor quality mortar.

Example of ev12 vulnerability factor local discontinuities : closure of previous wall openings a , presence of weak wooden elements b , presence of chimney in the wall c.

The vulnerability factors connected with the out-of-plane overturning of a wall i. The poor quality masonry ev4 and local discontinuities ev12 characterize all the damage scale. Figure 20 shows the type of damage mechanism in-plane, out-of-plane, local for each vulnerability factor.

It is worth noting that in plane mechanisms are only caused by ev5 high percentage of openings , ev4 poor masonry quality and ev11 local reduction of thickness. Out of plane mechanisms are due to ev1 lack of connection between walls , ev2 absence of stringcourses , ev9 heavy roof , and partially to ev3 connection wall-floors , ev4 poor quality of masonry and ev6 contact with other buildings with different stiffness.

Local failure mechanisms are due to ev7 variation of the structural system at upper levels , ev8 presence of staggered levels , ev10 presence of lintel with reduced bending stiffness , ev12 local discontinites , and ev6. RC structures had a better response to the earthquake. The most frequent type of damage for RC structures, as shown in Fig. The Hotel Roma building, which was rated D4, presented a soft-storey mechanism and had been demolished at the date of our survey; therefore the damage level was assigned based on newspaper images.

RC buildings: correlation between damage mechanisms and damage levels for the 16 RC buildings with damage D1—D4. Figure 22 shows the picture of a 3-floors masonry residential building located at the entrance of the town along the provincial road. The assigned damage level was D3 due to the in-plane cracking and partial detachment of the external walls. The visual inspection revealed: poor masonry quality and different types of masonry at various floors irregular pattern stone masonry at the first floor, regular pattern brick masonry at the second floor ; local discontinuities under the windows hollow bricks ; presence of RC roof and RC stringcourses; incipient overturning of the wall corner.

Residential masonry building: D3 damage level, in-plane cracking shear mechanism M2 , poor masonry vulnerability factor ev4. The damage mechanism was an in-plane shear walls failure. The assigned vulnerability factors are: the poor quality of masonry, the presence of large openings realized in recent times, the presence of local discontinuities recess and cracking in spandrel panels.

Residential masonry building: D4 damage level, shear failure of external walls mechanism M1 , poor masonry vulnerability factor ev4. Figure 24 shows a 3-storeys building which represents an example of a building rated with a damage level D5 total collapse of the floor in which the roof did not collapsed. In particular, it is possible to highlight the poor quality of masonry, the presence of discontinuities chimney inserted in the spine wall , the presence of a collapsed arch at the basement, the overturning of external walls.

Figure 25 shows the damage occurred to the fourteenth century church of S. Agostino, which was assigned to a D4 damage level. On the left, it is possible to notice the total collapse of the tympanum and the partial roof collapse.

This collapse mechanism is probably due to the lack of connections between elements. As in other churches in the area, the ruptures revealed the masonry type, a multileaf masonry with an inner core made of poor quality rounded stones with an external panel made of regular stones.

Church of S. The church of S. Francesco, built at the end of the fifteenth century and depicted in Fig. It suffered the partial collapse of the tympanum and the partial collapse of the roof. It is worth noting that the collapse mechanism is the same of the church of S. This building became a symbol of the city of Amatrice in the days after the earthquake because it was one of the few buildings that did not collapse in the eastern part of Corso Umberto.

The picture shows in particular the failure of a beam-column node. A detail of the node shows also that the longitudinal rebars are external to the stirrups. The pictures show also the partial detachment of the infill brick panels, poorly connected to the RC frame. Residential RC building damage level D3 : global damage left , damage of beam-column node center , particular of the node right.

Damage mechanism MC, vulnerability factor evD. Three of these earthquakes occurred in October and two in August. The second shock of August 24 was however of smaller magnitude with respect to the first one 5. Therefore the field survey analyzed in this work and made in September, refers essentially to the damage caused by the first earthquake. Studies which describe data collected after October 30, inevitably include the cumulative damage due to the following shocks too.

For the August 24 earthquake, the strong motion record of Amatrice shows values which largely exceed the Italian code spectrum, both in terms of horizontal and vertical components, in the range of periods corresponding to 2—3 storeys buildings, which constitute the majority of the constructions in Amatrice.

This fact partially contributes to the huge and extensive damage suffered by Amatrice buildings. The event of August 24 was therefore very destructive for low rise buildings, though in a rather small area around the epicenter, where the highest levels of macroseismic intensity are concentrated.

The comparison between damage, represented by the macroseismic surveys, and the ground motion, represented by the Effective Peak Acceleration has been done interpolating the data points in a G. The spatial trend, extending to northwards for the intensity and to NW for the ground motion, resulted slightly different probably due to the different vulnerability of the building heritage.

On the basis of the field survey performed in Amatrice, a detailed map of the damage distribution due to the August 24 earthquake has been realized. The map shows a very high level of damage along the main street of the town, Corso Umberto. The damage survey allowed to identify the damage mechanisms and vulnerability factors both for masonry and RC buildings, thus obtaining a picture of the destructive effects of the earthquake in the historical center of the town and the explanation of the factors that lead to such a devastating result.

A total of buildings out of about were inspected from outside. Focusing on masonry structures, the majority of the inspected buildings had multileaf masonry walls, formed by two panels of irregular stones connected by poor quality mortar joints, filled with poorly cemented rubble stones and without bondstones connecting the inner and outer panels.

The presence of specific vulnerability factors such as the lack of strong connections between walls, the poor connection between walls and floors and especially the inadequate quality of masonry, were the main causes of the activation of mainly out-of-plane collapse mechanisms. Many of the strongly damaged buildings had been modified using reinforced concrete and many as well presented timber horizontal elements, showing both a detrimental effect in some cases and a useful contribution in others.

Once more is confirmed the importance of good engineering evaluations in the design of interventions on existing buildings, which cannot simply be based on standard techniques, requiring a detailed evaluation of local and global structural behavior as well as of material assessment. Bull Earthq Eng 12 1 — Article Google Scholar. Cauzzi C, Faccioli E Broadband 0. J Seismol 12 4 — Ann Geophys 59, Fast Track 5. Google Scholar. Istituto Nazionale di Geofisica e Vulcanologia.

Engineering strong motion database, version 1. Earthq Spectra 20 S1 :S—S Final report volume 5.

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