This paper describes an advanced care and alert portable telemedical monitor (AMON), a wearable medical monitoring and alert system targeting high-risk cardiac/respiratory patients. The system includes continuous collection and evaluation of multiple vital signs, intelligent multiparameter medical emergency detection, and a cellular connection to a medical center. By integrating the whole system in an unobtrusive, wrist-worn enclosure and applying aggressive low-power design techniques, continuous long-term monitoring can be performed without interfering with the patients' everyday activities and without restricting their mobility. In the first two and a half years of this EU IST sponsored project, the AMON consortium has designed, implemented, and tested the described wrist-worn device, a communication link, and a comprehensive medical center software package. The performance of the system has been validated by a medical study with a set of 33 subjects. The paper describes the main concepts behind the AMON system and presents details of the individual subsystems and solutions as well as the results of the medical validation.

Background and ObjectivesThe haemoglobin level of prospective blood donors is usually performed on blood obtained by from the finger pulp by fingerstick with a lancet and filling a capillary tube with a sample. New noninvasive methods are now available for rapid, noninvasive predonation haemoglobin screening. Materials and MethodsProspective blood donors at our blood centre were tested, in two different trials, as follows: by the NBM 200 (OrSense) test (n = 445 donors) and by the Pronto-7 (Masimo) test (n = 463 donors). The haemoglobin values of each trial and the haemoglobin of finger pulp blood obtained by fingerstick with a lancet (HemoCue) were compared with the haemoglobin values obtained from a venous sample on a Cell Counter (Beckman Coulter).Results Comparison of Beckman Coulter Cell Counter and OrSense and results showed a bias of 0Á29 g/dl, the standard deviation of the differences (SDD) of 0Á98 and 95% limits of agreement from -1Á64 to 2Á21, using Bland and Altman statistical methodology. Comparison of Masimo and Beckman Coulter Cell Counter results showed a bias of -0Á53 g/dl, SDD of 1Á04 and 95% limits of agreement from -2Á57 to 1Á51. Cumulative analysis of all 908 donors, as tested by the usual fingerstick test showed a bias of 0Á83 g/dl, SDD of 0Á70 and 95% limits of agreement from -0Á54 to 2Á20 compared with the Coulter Cell Counter. Compared with the Coulter Counter, the specificity of the methods was 99Á5% for fingerstick, 97% for OrSense and 83% for Massimo, and the sensitivity was 99, 98 and 93%, respectively.Conclusions Analysis of finger pulp blood by either direct sampling by fingerstick and Hemocue, or by noninvasive haemoglobin tests does not replicate the results of cell counter analysis of venous samples. Compared with fingerstick, noninvasive haemoglobin tests eliminate pain and reduce stress, but have a lower level of specificity and sensitivity.

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SUMMARY:Analytical stock assessment of sardine (Sardina pilchardus, Walb.) in the Adriatic Sea from 1975 to 1999 was performed taking into account the occurrence of discarding at sea of sardine caught by the Italian fleet. We have attempted to model the fishermen's behaviour using data collected by an observer on board fishing vessels. This enabled us to estimate the amounts of discards, which were added to the catches landed, collected by ISMAR-CNR Ancona. Discards were calculated for the period 1987-1999, as their values were negligible before 1987. Stock assessment on the entire data series from 1975-1999 was carried out by means of Virtual Population Analysis (VPA). Discarding behaviour differs among ports due to different local customs and market conditions. The quantity added to the annual total catch ranged from 900 tonnes to 4000 tonnes, corresponding to between 2% and 15% of the total corrected catch. VPAs indicated that mid-year sardine stock biomass rose steadily from 400,000 tonnes in 1975 to a peak of 950,000 tonnes in 1984. Subsequently, biomass declined steadily to the more recent values, around 300,000 tonnes. Although discarded quantities were relatively high, their influence on stock assessment was not strong because of the high level of both catch and, in particular, estimated biomass at sea.Keywords: sardine, Adriatic Sea, discards, observer data, regression tree models, stock assessment, population dynamics methods, Virtual Population Analysis (VPA).RESUMEN: EVALUACIÓN DEL ESTOC DE SARDINA DEL MAR ADRIÁTICO (SARDINA PILCHARDUS WALB.), ESTIMANDO LOS DES-CARTES. -Se realizó una evaluación analítica del estock de sardina (Sardina pilchardus, Walb.) del mar Adriático, desde 1975 a 1990, considerando los descartes de sardina realizados por la flota italiana. Se ha intentado modelar el comportamiento de los pescadores utilizando los datos recogidos por un observador a bordo de los barcos de pesca. Ello nos ha permitido estimar las cantidades descartadas y añadirlas posteriormente a los datos de desembarcos recogidos por ISMAR-CNR Ancona. Se calcularon los descartes para el período 1987-1999, ya que los valores eran insignificantes antes de 1987. Se realizó la evaluación del estock de sardina por medio del Análisis de Poblaciones Virtuales (VPA), aplicándolo a toda la serie de datos desde 1975 a 1999. El comportamiento en el descarte varía entre puertos debido a las diferentes costumbres locales y a las condiciones de mercado. La cantidad añadida a la captura total anual varía entre 900 y 4.000 toneladas, que corresponden al 2% y 15% respectivamente, del total de la captura corregida. Los VPAs indican que la biomasa del estock de sardina aumentó de manera constante de 400.000 toneladas en 1975 a un máximo de 950.000 toneladas en 1984. Posteriormente, la biomasa disminuyó de forma continuada hasta alcanzar valores aproximados de 300.000 toneladas en la actualidad. Aunque las cantidades descartadas fueron relativamente altas, su influencia en la evaluación del estock de sardina no parece ser importan...

SUMMARY: Anchovy (Engraulis encrasicolus, L.) is one of the most important commercial species of the northern and central Adriatic Sea. The mean annual catch of anchovy estimated by IRPEM for these areas, in the time interval , is equal to 25,000 tonnes. Estimates of anchovy stock biomass at sea in the time interval 1975-1996 were obtained using two population dynamics methods based on different data inputs: Virtual Population Analysis (VPA) and the DeLury model with recruitment index. VPA was carried out tuning the estimated fishing mortality rate at age by fitting on corresponding Catch Per Unit of fishing Effort (CPUE). Both VPA and the DeLury model yielded sensible results. The effect on the assessments due to the use of a different birth date and thus of split-year data was investigated. Biomass values as well as patterns over time so estimated were similar on the basis of both assessment methods and calendar year versus split-year data. In particular, the biomass in more recent years (around 100,000 tonnes) was lower than in the second half of the 1970s and first half of the 1980s (over 200,000 tonnes). The minimum value (lower than 50,000 tonnes) was always estimated in 1987, when a strong drop in the catch and crisis of the anchovy fishery took place. Though high values of both fishing effort and fishing mortality/exploitation rate were obtained for some years before 1987, very low levels of recruitment in 1986 and 1987 seem to be mainly responsible for the collapse of the stock.

Summary:The present clinical trial was undertaken to investigate the toxicity and antimyeloma activity of busulfan (BU) and cyclophosphamide (CY) at the maximum tolerated doses of, respectively, 16 mg/kg and 200 mg/kg (BU-CY 4) as conditioning therapy for allogeneic bone marrow transplantation (BMT) in 19 consecutive patients with multiple myeloma (MM). Twelve (63%) had failed to respond to prior chemotherapy, while the remaining 37% had chemosensitive disease. No life-threatening or fatal regimen-related complications were observed. The incidence of veno-occlusive disease of the liver was zero according to Jones' criteria and 21% according to McDonald's system. Transplant-related mortality was 37%. Using stringent criteria, the frequency of complete remission (CR) was 42% among all patients and 53% among those who could be evaluated. With a median follow-up of 21 months for all patients and 66 months for survivors, the actuarial probability of survival and event-free survival at 4 years from BMT was 26% (95% CI: 7-46) and 21% (95% CI: 3-39), respectively. A more favorable outcome of transplantation was observed in the subgroup of patients with chemosensitive disease who had a transplant-related mortality of 14%, an overall CR rate of 86% (95% CI: 49-97) and a 4-year projected probability of event-free survival of 57% (95% CI: 20-93). Four of these patients are currently alive in continuous CR after 54, 66, 80 and 94 months, respectively. It is concluded that BU-CY 4 as conditioning for allogeneic transplantation for MM is associated with acceptable morbidity and relatively low mortality. This regimen exerts substantial antimyeloma activity, resulting in a high CR rate and durable responses, especially in patients with chemosensitive disease. Long-lasting remission and probable cure is possible following allogeneic stem cell transplantation for MM.

The Adriatic stock of European sardine ( Sardina pilchardus ) has experienced large interannual demographic fluctuations over the last 30 years, with a severe decline beginning in 1991 and continuing until 1997. In the present study, six microsatellite loci were used on a time series collection of otoliths and scales from sampling locations of northern (Chioggia) and southern (Vieste) Adriatic Sea, with the aim to investigate the genetic effects of these stock biomass fluctuations. The northern samples showed significant reduction in observed heterozygosity (HO) and mean number of alleles (Na) that explain the genetic diversity variation, while the same parameters turned out to be more stable in the southern samples. In addition, we detected the presence of a genetic bottleneck and low effective population size (Ne) values in several northern samples. Even if the northern and southern Adriatic sardine samples belong to the same genetic stock, the more pronounced decrease in genetic variability recorded in the northern sample led us to speculate that a more intensive fishing pressure and a more pronounced oceanographic isolation of this area could have accentuated the effects of the genetic bottleneck.

ObjectivesMedical comorbidities affect outcome in elderly patients with hip fracture. This study was designed to preliminarily evaluate the usefulness of a hip-fracture unit led by an internal medicine specialist.MethodsIn-hospital and 3-month outcomes in patients with hip fracture were prospectively evaluated in 121 consecutive patients assessed before and followed after surgery by a multidisciplinary team led by internal medicine specialist; 337 consecutive patients were recalled from ICD-9 discharge records and considered for comparison regarding in-hospital mortality.ResultsIn the intervention period, patients treated within 48 hours were 54% vs. 26% in the historical cohort (P<0.0001). In-hospital mortality remained stable at about 2.3 per 1000 person-days. At 3 months, 10.3% of discharged patients had died, though less than 8% of patients developed postoperative complications (mainly pneumonia and respiratory failure). The presence of more than 2 major comorbidities and the loss of 3 or more BADL were independent predictors of death. 50/105 patients recovered previous functional capacity, but no independent predictor of functional recovery could be identified. Mean length of hospital stay significantly decreased in comparison to the historical cohort (13.6± 4.7 vs 17 ± 5 days, p = 0.0001). Combined end-point of mortality and length of hospitalization < 12 days was significantly lower in study period (27 vs 34%, p <0.0132).ConclusionsIdentification and stabilization of concomitant clinical problems by internal medicine specialists may safely decrease time to surgery in frail subjects with hip fracture. Moreover, integrated perioperative clinical management may shorten hospital stay with no apparent increase in in-hospital mortality and ultimately improve the outcome. These results are to be confirmed by a larger study presently ongoing at our institution.