Definition of a new multi-level early warning procedure for landslide risk management

The identification of potentially critical events involving unstable slopes is a major aspect in the field of natural hazards risk mitigation and management. In this framework, Early Warning Systems (EWS) exploiting advanced technologies represent an efficient approach to decrease the risk generated by landslide phenomena, allowing to reduce the possibility of damages and losses of human lives. EWS effectiveness has increased significantly in recent years, thanks to relevant advances in sensing technologies and data processing. In particular, the introduction of innovative monitoring instrumentation featuring automatic procedures and increased performances in terms of sampling rate and accuracy has permitted to develop EWS characterised by a near-real time approach. Among the several aspects involved in the development of a reliable Early Warning System, one of the most important is the ability to minimize the dissemination of false alarms, which should be avoided or identified in advance. The approach proposed in this study represents a new procedure aimed to assess the hazard level posed by a potentially critical event, previously identified by analysing displacement monitoring data. The process is implemented in a near-real time EWS and defines a total of five different hazard levels, on the basis of the results provided by two different models, namely an accelerating trend identification criterion and a failure forecasting model based on the Inverse Velocity Method (IVM). In particular, the forecasting analysis is performed only if the dataset elaborated by the onset-of-acceleration model highlights a potentially critical behaviour, which represents a first alert level. Following levels are determined by different conditions imposed on three parameters featured by the failure forecasting model, i.e. dataset dimension, coefficient of determination R-squared, and number of sensors displaying an accelerating trend. As these criteria get fulfilled, it is assumed that the monitored phenomenon is gradually evolving towards a more critical condition, thus reaching an increasing alert level depending on the analysis results. According to this classification, it is possible to set up for each single threshold a dedicated warning message, which could be automatically issued to authorities responsible of monitoring activities, in order to provide an adequate dissemination of information concerning the ongoing event. Moreover, the proposed procedure allows to customize the alert approach, giving the possibility to issue warning messages only if a certain Level is reached during the analysis

Outcomes and indications for Emergency Thoracotomy after adoption of a more liberal policy in a western European level 1 Trauma Center: 8-years experience.

Background: The role of Emergency Thoracotomy (ET) in blunt trauma is still a matter of debate and in Europe only small studies have been published. We report our experience about ET both in penetrating and blunt trauma, discussing indications, outcomes and proposing an algorithm for patient selection. Materials and methods: We retrospectively analysed patients who underwent ET at Maggiore Hospital Trauma Center over two periods: from January 1st, 2010 to December 31st, 2012, and from January 1st, 2013 to May 31st, 2017. Demographic and clinical data, mechanism of injury, Injury Severity Score, site of injury, time of witnessed cardiac arrest, presence/absence of signs of life, length of stay, were considered, as well as survival rate and neurological outcome. Results: 27 ETs were performed; 21 after blunt trauma and six after penetrating trauma. Motor vehicle accident was the main mechanism of injury, followed by fall from height. The mean age was 40,5 years and the median Injury Severity Score was of 40. The most frequent injury was cardiac tamponade. The overall survival rate was 10% during the first period and 23.5% during the second period, after the adoption of a more liberal policy. No long term neurological sequelae were reported. Conclusions: The outcomes of ET in trauma patient, either after penetrating or blunt trauma, are poor but not negligible. To date, only small series of ET from European trauma centers have been published, although larger series are available from USA and South Africa. However, in selected patients, all efforts must be made for the patient's survival; the possibility of organ donation should be taken into consideration as well

The challenge of extraabdominal desmoid tumour management in patients with Gardner’s syndrome: radiofrequency ablation, a promising option

Desmoid tumours are benign, myofibroblastic stromal neoplasms common in Gardner's syndrome, which is a subtype of familial adenomatous polyposis characterized by colonic polyps, osteomas, thyroid cancer, epidermoid cysts, fibromas and sebaceous cysts. The primary treatment is surgery, followed by adjuvant radiotherapy, but the local recurrence rate is high, and wide resection can result in debilitating loss of function. We report the case of a 39-year-old man with Gardner's syndrome who had already undergone a total prophylactic colectomy. He developed desmoid tumours localized in the mesenteric root, abdominal wall and dorsal region, which were treated from 2003 through 2013 with several surgical procedures and percutaneous radiofrequency ablation. In 2008 and 2013, RFA was applied under ultrasonographic guidance to two desmoid tumours localized in the dorsal thoracic wall. The outcomes were low-grade pain and one case of superficial skin necrosis, but so far there has been no recurrence of desmoid tumours in these locations. Surgical resection remains the first-line therapy for patients with desmoid tumours, but wide resection may lead to a poor quality of life. Radiofrequency ablation is less invasive and expensive and is a possible therapeutic option for desmoid tumours in patients with Gardner's syndrome

Técnicas avanzadas de control de obras: preconvergencia en túneles y barreras dinámicas

Los diseños geotécnicos se basan en hipótesis y aproximaciones no siempre fiables, por lo que las incertidumbres del comportamiento de estructuras geotécnicas suelen ser mayores que las que se dan en otras estructuras de ingeniería. Así, las observaciones in situ y, en particular, la medición de magnitudes físicas específicas son el mejor antídoto para superar las limita-ciones propias de estas obras. En este contexto, el control o monitorización geotécnica se revela como una herramienta básica para el diseño y ejecución de obras en condiciones de seguridad y economía aceptables. En este estudio se presenta la aplicación de sistemas de monitorización de obras basados en sensores tipo MEMS (Micro Electro Mechanical System), de precio asequible y razonablemente precisos, que permiten tomar medidas múltiples con aportes de energía mínimos y pueden transmitir gran cantidad de información en tiempo real. En particular, se presentan dos prototipos de sistemas de control basados en estos sensores. El primero de ellos mide la pre-convergencia en túneles, permitiendo obtener los desplazamientos del terreno en un sondeo situado a la altura del techo de excavación y por delante del frente de la misma, lo que contribuye a identificar en fase temprana posibles problemas de la excavación y correlacionar las medidas con cálculos previos. El segundo monitoriza la respuesta de barreras flexibles para el control de desprendimientos, controlando la inclinación de postes y la elongación de la malla, por lo que permite conocer en tiempo real la situación de la barrera sin acceder a la misma

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Internet-of-Things principles applied to geotechnical monitoring activities: The Internet of Natural Hazards (IoNH) approach

Internet of Things (IoT) represents a technology approach where sensors and actuators are embedded into physical objects and interconnected through a network, allowing for information sharing and interaction between single components. The integration of these principles in different fields and scenarios, like logistics, healthcare and home automation, has significantly improved the processes overall performances. This paper presents an application of these concepts to the geotechnical field, involving the integration of innovative monitoring tools with remotely controlled devices, deep machine-learning algorithms and interactive visualization platforms. The result is an IoT-based approach to geotechnical monitoring, defined as Internet of Natural Hazards (IoNH)

Monitoring of a retaining wall with innovative multi-parameter tools

Retaining walls are geotechnical structures that frequently interacts with roads, railway lines and motorways, playing a key role in the safety of transport networks in mountain areas. For this reason, monitoring activities aimed to assess the stability condition of these works are extremely important to guarantee the practicability of communication lines, especially during adverse meteorological conditions. In particular, the integration of automatic devices and advanced deep learning algorithms permits to implement early warning measures characterized by high accuracy and the reduction of uncertainties due to a statistical approach to the measure, which significantly improve the system performances. Finally, the remote control of physical entities through a web based platform permits to apply an all new Internet of Natural Hazards (IoNH) approach, which is to be intended as the implementation of IoT (Internet of Things) in the geo-related Hazard field. This paper presents a case study where a reinforced soil retaining wall was instrumented with innovative monitoring tools based on Modular Underground Monitoring System (MUMS) technology in order to control the displacements of the geotechnical structure together with the pore pressure and the temperature, applying Early Warning Procedures at the overcoming of predefined thresholds. In particular, two 15-meter long automatic inclinometers were installed on-site 3 meters apart, each of them composed of 15 multi-parametric tilt sensors spaced 1 meter along the vertical direction and one piezometer at a predefined depth. Among the several features presented by the innovative system selected for this case study, one of the most relevant was the synergic integration of two tilt sensors featuring different resolution and sensitivity, thus obtaining a redundant system, which has been fundamental in the correct evaluation of the results. Should this IoNH approach become diffusely applied, the costs of its implementation would reduce significantly and its valuable support would be beneficial for the whole geotechnical field