a b s t r a c tShock focusing in water is a phenomenon that can occur during the impact of a shock wave generated by an underwater explosion onto any type of convergent marine structures. To predict the dynamic material response of the marine structure, it is important to understand the shock wave dynamics during the focusing event. In this paper, both experimental investigations and numerical studies of twodimensional shock focusing in water are presented. Here, a convergent geometry given by a logarithmic spiral curve is used to focus the shock waves. In the experiments, the interaction between three types of materials and the shock wave in water is explored by using high-speed photography. Distinct features of such flows are unveiled. Three scenarios have been considered in simulations: a rigid structure where only the water-filled region is taken into account, a fluid-structure interaction problem in which the surrounding material responses are included, and an axisymmetric simulation to determine the threedimensional effects.

The presence in the serum of specific autoantibodies, such as antinuclear antibodies (ANA), anti-double-stranded DNA (anti-dsDNA), and antiextractable nuclear antigens (anti-ENA), is one of the diagnostic criteria for autoimmune rheumatic disease, and the requests for these tests in the last few years have grown remarkably. A guideline for reducing clinically inappropriate requests in autoantibody testing (ANA, anti-dsDNA, anti-ENA) has been applied in the Parma Hospital since 2007. The results for the period January-December 2007 were compared to those of the previous period January-December 2006, and a significant reduction in the number of anti-dsDNA (23.9%) and anti-ENA (20.7%) was found. The aim of this study was to assess the applicability of a similar guideline in a wide area (Parma, Modena, Piacenza, Reggio-Emilia) with reference to the diagnosis of autoimmune rheumatic disease. This project, supported by a regional grant for innovative research projects, was started in January 2008 and consists of three different steps: (1) a study group of clinicians and laboratory physicians to evaluate the diagnostic criteria, the analytical procedures, and the number of tests performed in different hospitals; (2) developing common guidelines for autoantibody testing that takes into account the different clinical needs with the aim of improving efficiency and clinical effectiveness of diagnosis and monitoring; and (3) assessing compliance with the guidelines in the different hospitals that are evaluating the second-level test (anti-dsDNA, anti-ENA) decrease. We think that the validation of guidelines for the laboratory diagnosis of autoimmune rheumatic disease can represent a tool for improving patients' outcomes and economic efficiency.

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Aims of this study were to evaluate the incidence of falls in subjects aged ≥65 years in Parma Province (Northern Italy), and the burden of fall-related hospitalizations. All the Emergency Department (ED) visits for domestic or trivial falls were retrieved from the database of the two EDs of Parma Province during 2013. All cases were classified according to age and gender. Out of 129,898 total ED visits, 3720 (2.9%) were related to trivial falls in patients aged ≥65 years. Females accounted for 2648 visits and males for 1072. The absolute number of visits due to falls increased with age in both genders, with a peak between 80 and 84 yrs. When related with the actual number of residents by age groups, females showed a continuous increase, peaking at age >100 yrs, and males a continuous increase, peaking at age 95-99 yrs. Of these patients, 963 (25.9%) needed hospitalization, 605 in the orthopedic ward, 342 in medical wards, and 16 in specialist surgical units. In conclusion, falls represent a major cause of morbidity in the elderly in Northern Italy, representing 13.3% of the ED visits for people aged ≥65, with a high impact on hospital workload.

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