A Zero-Order Flood Damage Model for Regional-Scale Quick Assessments

Quantitative data on observed flood ground effects are precious information to assess current risk levels and to improve our capability to forecast future flood damage, with the final aim of defining effective prevention policies and checking their success. This paper presents the first collection and analysis of flood damage claims produced in Italy in the past 7 years since a homogeneous national procedure for damage recognition became available. The database currently contains more than 70,000 claims referring to significant events and shows good homogeneity on the intensity of the related phenomena. We then propose an empirical model, based on observed data, to allow for a quick estimation of direct damage to private assets (i.e., residential buildings), based only on the knowledge of the perimeter of the flooded area. Single model calibration was performed at the multi-regional scale, focused on southern Italy. Model validation shows encouraging performances, considering the considerable natural uncertainty that characterizes this type of estimate. The procedure is of great interest when there is a need to evaluate, however roughly, flood damage in the immediacy of the event to assess the extent of the flood effects and to plan support actions for the affected communitie

Conceptualization and Prototype of an Anti-Erosion Sensing Revetment for Levee Monitoring: Experimental Tests and Numerical Modeling

The problem of levee embankment control during high flows is crucial for flood risk management in floodplains. Levee defense lines are often hundreds of kilometers long and surveys during emergencies are not easy tasks. For these reasons, levees monitored with in situ sensors and a suitable Information Technology (IT) real-time data communication and integration infrastructure, so-called “smart levees”, are gaining increasing interest as a crucial protection technology in floodplains. The paper presents the conceptualization of a prototype of a levee smart revetment, based on the integration of an optical fiber (OF) cable into a steel double-twisted wire mesh. In this paper the feasibility of this kind of revetment is firstly assessed. The flow pattern of overtopping water on the embankment is discussed, thus producing a raw estimation of the shear stress acting on the revetment in the field. A sample case is then analyzed in both numerical and laboratory tests. For this purpose, a numerical Finite Element Model (FEM) to describe the mechanical behavior of a double-twisted wire mesh when loaded along its own plane is presented. Numerical results indicate that the related strain, relatively low as compared to the steel wire yield stress, can be fully detected by the optical fiber continuous Brillouin sensor. This has been validated by the experimental activity performed and a digital twin of the prototype of the smart revetment, suitable for virtually testing the product under any load and constraint conditions and tailoring the production process, has been created

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London