Validation request

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Introduction 2. Definitions 3. Purpose 4. Transport regulations 5. Operating methods 5. Procedure for transporting biological material inside a health facility 7. Transport Card 8. Spillage of biological fluids 9. Traceability Levels of responsibility Clinical Chemistry and Hematology exam table with storage times and methods for each test Conclusion: The transport of biological samples is now a strategic issue.

The movement of them is no longer a rare event but a frequent practice, both due to the tendency of public structures to centralization and of private ones to consortium. Even the hub and spoke model and the flourishing of sampling centers see the handling of samples as the fulcrum of the activities aimed at improving the service to citizens. At the Italian level there is a lack of univocal regulations for which various regions have regulated the matter and today we can also include Campania among these.

Nowadays, telemedicine has different clinical applications since it is used in almost all medical specialties. The COVID pandemic has created not only major economic and social upheavals but also has an important impact on public health. In this emergency situation, the use of telemedicine has been rise aiming to mitigate the effects of COVID on human health 1.

Telemedicine has been implemented in the routine clinical practice at HTC many years ago 2 and actually, during the COVID pandemic, this system is of significant aid in the management of this therapy allowing patients to perform the test at home or to self-manage their own therapy. The system is organised as a centralised net-supported program with a server and PC stations in the HTC and workstations in the peripheral districts.

Points-of-Care INR allow patients to easy perform the test on capillary blood and to quickly gain the INR result thus reducing the number of controls that patients would perform at the HCT 3.

In accordance with other economic models, the metanalysis also showed that self-monitoring is cost-effective. Telemedicine is usefull in managing patients on VKAs and, as suggested by the FCSA 6 , it is a safe and efficacy system to guarantee an adequate medical assistance not only routinely but especially during pandemic. Finally, telemedicine could be used also for DOACs patients putting in place a system that may allow patients to attach the PDF file of their laboratory tests and to video-call the doctors at HTC.

J Med Internet Res ;e Telemedicine can improve the quality of oral anticoagulation using portable devices and self-testing at home. J Telemed Telecare ;— Is self-monitoring an effective option for people receiving long-term vitamin K antagonist therapy? A systematic review and economic evaluation. BMJ Open ;5:e Point-of-care testing INR: an overview. Clin Chem Lab Med ;— Patient Prefer Adherence ;— Intern Emerg Med ;— In Tuscany since management of people with diabetes mellitus is proactive, in order to do early diagnosis and slow down the onset of the complications.

At the beginning of this experience general practitioners took care of patients with low level of assistance and diabetologists of patients with high level of assistance Expanded Chronic Care Model. In , with the creation of Individual Assistance Plan PAI , general practitioners shared the management of high level assistance patients with the specialists. In PAI was extended at all the chronic patients of each level of assistance and shared with the specialist.

In this way all the patients since diagnosis could be evaluated by the specialist and benefit from the most appropriate therapy and management. In the same period in Tuscany was created the diagnostic-therapeutic pathway for adult people with diabetes mellitus, which outlines the criteria and the modalities of the interactions between general practitioners and specialists for the first access and in case of modification of glicometabolic control and acute or chronic complications appearance.

After that Covid pandemic contributed to telemedicine diffusion and emergency needing to share patients data in order to promptly review the PAI.

Therefore in May Tuscan region hypothesize also a software house for data sharing and the use of rapid modalities like Point of Care POCT and teleconsultation. In our center we have carried on a pilot project with teleconsultation aimed to implement the diagnostic-therapeutic pathway for adult people with diabetes mellitus and to improve the visits and therapy appropriateness. Teleconsultation with the general practitioner was carried out to discuss clinical features, glicometabolic control and cardiovascular risk class.

Modification of therapy was shared and the side effects appearance 7. The Tuscany regional law n. The clinical laboratory is part of the team as a determining factor both to clarify the clinical question but also to establish the terms and times of 2nd level specialist intervention.

The patient with known diabetes accesses the II level of care, exclusively by being sent by the GP using the priority classes as already indicated for the first visit or through a scheduled visit. Different laboratory parameters represent indicators that, introduced in the priority decision algorithm, can, if communicated in a timely manner, define the path and strategies of specialist therapy in the most appropriate way.

In the reality of the USL TSE, a project has been developed that allows to communicate via SMS the results of the laboratory parameters, related to diabetes monitoring, to the patient and the GP when these vary significantly compared to previous controls or represent a clinical state that justifies an intervention by the Team. Bellini 1 , M. Fantacci 2. In recent years, the management of territory-based diagnostic networks has taken on a major role, in order to guarantee an effective and efficient service covering the entire territory.

Most recently the need for a territorial response to Covid has further highlighted its centrality. In this context the use of point-of-care testing POCT represents a valuable diagnostic opportunity that responds to the need for timeliness and proximity for the management of territorial emergencies and urgencies and to support the health activities of zonal hospitals, first-aid points and remote areas.

For several years now an ISO certified territorial POCT Network has been organised to support and integrate laboratory analysis activities, coordinated by the Laboratories, which guarantees a timely and quality diagnostic service close to the places of care and also at domiciliary. Technological and analytical advances in POCT equipment, together with careful monitoring of Quality Control QC , have improved the analytical quality of results.

However in order to produce an overall quality result and minimise errors that may jeopardise patient safety, the whole process must be addressed for POCT, as we are used to doing for laboratory results. In detail several pre-analytical issues that can cause many potentially harmful errors, also considering the rapid availability of results, are worth focusing. 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. There were victims, injured, about homeless, and the historical center of the town suffered a great number of partial and total collapses. The strong motion records obtained for the first event were analyzed and plotted in a shakemap, comparing them with the macroseismic damage surveys made in localities.

On the basis of an inspection survey made in September , a map of the damage patterns of the buildings in the historical center was elaborated according to the EMS 98 classification. The elevated level of destruction was mainly caused by the high vulnerability of the masonry buildings, mostly due to specific vulnerability factors such as the poor quality of masonry, the lack of connections between walls and the poor connection between external walls and floors.

The seismic events which hit Central Italy on August 24, October 26 and October 30 have caused casualties and major damage mostly to buildings and architectural heritage of the Italian regions of Abruzzo, Lazio, Marche and Umbria. These events caused a total of fatalities, injured and about homeless Italian Department of Civil Protection Most of the victims were in the areas of Amatrice, Accumoli, and Arquata del Tronto.

In these municipalities heavy damage and collapse of residential buildings were reported. On October 26, there were two strong aftershocks, the first at with Mw 5.

The earthquake of October 30, which happened at am, had a M W 6. It has also to be considered that the October epicenters are located close to Norcia municipality Fig. Nevertheless, while the earthquake of August 24 had a very destructive impact on a restricted area included in the above listed municipalities, the impact of the following seismic events was distributed on a larger portion of territory extending northwards in the Marche Region.

Many small towns and villages, which have survived to the first earthquake, were heavily damaged during the October 30 earthquake. This work has two main purposes: firstly it provides some new elaborations and comparisons regarding the seismic input and the damages in the area affected by the earthquake. The strong motion records of the Italian accelerometric network were analyzed and plotted in a shakemap making use of a G. Furthermore the response spectra of the Amatrice recording station have been compared with the Italian Building Code for different return periods and with the more recent GMPEs.

The second scope of this work is to provide quantitative results about the damage in the historical center of Amatrice on the basis of a field survey. The damage to strategic structures such as hospitals and lifelines is not considered in this work, as it has to be studied by means of specific methods Nuti et al.

In the aftermath of the earthquake, several research groups performed field surveys, limited however to the southern part of Amatrice municipality Santarsiero et al. The peculiarity of this work is that the authors had the possibility of visiting the historical center red zone of Amatrice in order to accurately evaluate the damage due to the August 24 earthquake.

In fact, other works made on the basis of surveys done after the October 30 earthquake, had the problem of quantifying the cumulative damage due to multiple events.

The results of the survey performed by the authors in September , allowed to assess the damage level, collapse mechanisms and vulnerability factors of buildings out of about in the historical center. The elevated level of destruction was mainly due to the high vulnerability of the buildings, mostly made by cobblestone masonry.

In the masonry structures, the presence of some vulnerability factors such as the lack of strong connections between walls, the poor connection between external masonry walls and floors and especially the inadequate quality of masonry, were the main causes of the activation of mostly out-of-plane collapse mechanisms. Blue circles represent historical earthquakes, size-scaled with the magnitude according to the data contained in the Parametric Catalogue of Italian Earthquakes Rovida et al.

The earthquakes that affected Central Italy in August and October are among the strongest events happened in that area. The maximum intensity assigned to the epicentral area after the August 24 earthquake Galli et al. An earthquake very similar to the one occurred in at only 4 km from Amatrice with the same magnitude 6. Other strong earthquakes happened in Aquilano M W 6.

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. All the seismic events were recorded by a large number of strong-motion stations of the Italian accelerometric network RAN , managed by the Department of Civil Protection.

CF08 and Ak14 were adjusted multiplied by a factor of 1. The recorded values of PGA are generally higher than those predicted by the considered relations at short distances, and smaller at distances greater than km. In particular the Effective Peak Acceleration EPA has been calculated as the mean of the acceleration spectral ordinates in the period range 0. Figure 4 shows the comparison between the shakemap of EPA and the isoseismals calculated as interpolation of the MCS intensities evaluated in localities in the macroseismic surveys performed after August 24 Galli et al.

It is worth noting that the majority of these localities are very small villages with few tens of inhabitants; among the surveyed only 27 have an intensity above VIII MCS and 90 above VI, confirming that the damage is concentrated in a rather small area around the epicenter. The figure shows also the strong motion stations blue triangles together with the value of EPA, calculated for each station as said above geometrical. Comparison between the isolines of the macroseismic intensity evaluated after the 24 August earthquake Galli et al.

The largest values of I MCS are concentrated in a rather restricted area around the epicenter. The differences in building stock vulnerability also explain the discrepancy between the isoseismal pattern, mainly oriented in N-S direction, and the ground motion pattern oriented in the NW—SE direction, according to the directivity effect of the causative fault Fig.

The AMT accelerometric station is located in the municipality of Amatrice, 8. It is placed at approximately meters from the town center choosing the civic Tower of Amatrice as reference and it lies at the base of the hill. Therefore there could be some differences with the ground motion on the hilltop. The response spectra of the AMT station have been compared in Fig. The values at short periods are comparable to those derived from the Ak14 GMPE with the addition of 1 standard deviation.

It is worth noting that the NS component shows much lower values with respect to EW component at short periods and higher values at periods larger than 0. It is possible to observe that, in the range of periods corresponding to the majority of buildings in Amatrice 0. The vertical component of AMT station exceeds the Italian code spectra for all the periods, reaching values up to 1 g, again more than double of the years spectrum.

It is important to highlight that the Italian code vertical spectrum does not take into account the different soil conditions, neither is thought for near field events. 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.

❿
 
 

❿

 

Windows 10 1703 download iso italys population density

 
Frog 70, Download eartha kitt santa baby, Rate me out of 10 sms, Din en iso , Vioolsdrift accommodation south africa, Courtyard carnegie way. 10, North America 27, Italy, , , , , , , 38, Norway, , , , , , , , , , , population. % of total population average annual. % growth million metric tons. Per capita kilograms of oil equivalent billion kilowatt hours. – Kyle adams nfl draft, Windows 7 dlna client software, Windows pe iso, Icnnd, Mente argentina study abroad, Cisco vpn windows 10 download. Spillage of biological fluids 9. Traceability Levels of responsibility Clinical Chemistry and Hematology exam table with storage times.❿
 
 

Windows 10 1703 download iso italys population density

 
 
With health-related knowledge doubling in months, AI http://replace.me/16376.txt become a mandatory survival kit. Three of these earthquakes occurred in October and two in August. Definitions 3. 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.

❿