Virtually Coupled Train Sets - A Comprehensive Analysis

In the X2Rail-3 project of the Shift2Rail Joint Undertaking, a detailed virtual coupling concept is developed and analysed in an extensive theoretical framework. Based on the paradigm shift from absolute to relative braking distance, various operational scenarios and potential hazards are identified. According to these scenarios and the general functional architecture, the project provides a first definition of the system requirements, detailing both the virtual coupling components as well as the interfaces and interactions with external systems. The subsequent analysis shows that virtual coupling can enable multiple performance benefits for railway operation. Beside the significant increase in capacity through shorter headways and reduced coupling times, additional flexibility and robustness are gained with situationally appropriate, dynamic coupling manoeuvres with a free choice of vehicles. Moreover, virtual coupling can contribute to reducing costs and delays by replacing the mechanical coupler. Aiming for technology readiness level 3, the results of the project illustrate that the concept is feasible from a technological and operational point of view, highlighting the most critical implementation parts in sensors, control and communication. A two-stage implementation approach is proposed to facilitate the introduction of virtual coupling. This is based on a minimum-complexity first stage to introduce the core functionalities and a second stage with incremental implementation of additional virtual coupling functionalities to further improve the operation. This stepwise approach is also corroborated by the results of the impact analysis, which shows a reduced impact for the first stage. The impact analysis illustrates that the fundamental principle of the external systems remains untouched and a full rework is not required. This also implies that virtual coupling will not interfere with the progress of the European Train Control System (ETCS) development and deployment. Therefore, the X2Rail-3 virtual coupling concepts provides a feasible, non-disruptive solution for a more efficient railway transport

Reshaping ophthalmology training after COVID-19 pandemic

Background The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on practical activities and didactic teaching of residents and fellows. This survey aimed to propose long-term changes for ophthalmology training based on the changes experienced by trainees and their perception of new training opportunities. Methods An online survey was distributed to ophthalmology trainees in multiple countries. Descriptive statistics were used to analyse the data. Results A total of 504 analyzable responses were collected from 32 different countries. The current impact of COVID-19 pandemic was described as "severe" by most trainees (55.2%); however, the future perspective was more optimistic as demonstrated by the greater number of responses reporting a presumed "moderate" (37.3%), "mild" (14.1%) or "slight" (4.2%) long-term impact. The vast majority of trainees reported a decrease >= 50% of clinical activity (76.4%) and >75% of surgical activity (74.6%). Although an initial gap in didactic teaching has been experienced by many (55.4%), regular web-based teaching was reportedly attended by 67.7% of the respondents. A strong agreement was found regarding the worthwhile role of web-based case-presentations in clinical training (91.7%), web-based discussion of edited surgical videos (85.7%) and simulation-based practice (86.9%) in surgical training. Conclusions This survey, focusing on trainees' perspective, strongly reinforces the need to promptly include new technology-based training tools, such as web-based teaching, virtual surgical simulators, and telementoring, in long-term reorganisation of ophthalmology training to ensure its continuity and effectiveness, which would remain available even in the face of another unpredictable crisis within the health system

Reshaping ophthalmology training after COVID-19 pandemic

Background: The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on practical activities and didactic teaching of residents and fellows. This survey aimed to propose long-term changes for ophthalmology training based on the changes experienced by trainees and their perception of new training opportunities. Methods: An online survey was distributed to ophthalmology trainees in multiple countries. Descriptive statistics were used to analyse the data. Results: A total of 504 analyzable responses were collected from 32 different countries. The current impact of COVID-19 pandemic was described as “severe” by most trainees (55.2%); however, the future perspective was more optimistic as demonstrated by the greater number of responses reporting a presumed “moderate” (37.3%), “mild” (14.1%) or “slight” (4.2%) long-term impact. The vast majority of trainees reported a decrease ≥50% of clinical activity (76.4%) and >75% of surgical activity (74.6%). Although an initial gap in didactic teaching has been experienced by many (55.4%), regular web-based teaching was reportedly attended by 67.7% of the respondents. A strong agreement was found regarding the worthwhile role of web-based case-presentations in clinical training (91.7%), web-based discussion of edited surgical videos (85.7%) and simulation-based practice (86.9%) in surgical training. Conclusions: This survey, focusing on trainees’ perspective, strongly reinforces the need to promptly include new technology-based training tools, such as web-based teaching, virtual surgical simulators, and telementoring, in long-term reorganisation of ophthalmology training to ensure its continuity and effectiveness, which would remain available even in the face of another unpredictable crisis within the health systempublishersversionPeer reviewe

Chronic constipation diagnosis and treatment evaluation: The "CHRO.CO.DI.T.E." study

Background: According to Rome criteria, chronic constipation (CC) includes functional constipation (FC) and irritable bowel syndrome with constipation (IBS-C). Some patients do not meet these criteria (No Rome Constipation, NRC). The aim of the study was is to evaluate the various clinical presentation and management of FC, IBS-C and NRC in Italy. Methods: During a 2-month period, 52 Italian gastroenterologists recorded clinical data of FC, IBS-C and NRC patients, using Bristol scale, PAC-SYM and PAC-QoL questionnaires. In addition, gastroenterologists were also asked to record whether the patients were clinically assessed for CC for the first time or were in follow up. Diagnostic tests and prescribed therapies were also recorded. Results: Eight hundred seventy-eight consecutive CC patients (706 F) were enrolled (FC 62.5%, IBS-C 31.3%, NRC 6.2%). PAC-SYM and PAC-QoL scores were higher in IBS-C than in FC and NRC. 49.5% were at their first gastroenterological evaluation for CC. In 48.5% CC duration was longer than 10 years. A specialist consultation was requested in 31.6%, more frequently in IBS-C than in NRC. Digital rectal examination was performed in only 56.4%. Diagnostic tests were prescribed to 80.0%. Faecal calprotectin, thyroid tests, celiac serology, breath tests were more frequently suggested in IBS-C and anorectal manometry in FC. More than 90% had at least one treatment suggested on chronic constipation, most frequently dietary changes, macrogol and fibers. Antispasmodics and psychotherapy were more frequently prescribed in IBS-C, prucalopride and pelvic floor rehabilitation in FC. Conclusions: Patients with IBS-C reported more severe symptoms and worse quality of life than FC and NRC. Digital rectal examination was often not performed but at least one diagnostic test was prescribed to most patients. Colonoscopy and blood tests were the "first line" diagnostic tools. Macrogol was the most prescribed laxative, and prucalopride and pelvic floor rehabilitation represented a "second line" approach. Diagnostic tests and prescribed therapies increased by increasing CC severity

How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice

The Mechanical Impact of Water Affected the Soil Physical Quality of a Loam Soil under Minimum Tillage and No-Tillage: An Assessment Using Beerkan Multi-Height Runs and BEST-Procedure

The multi-height (low, L = 3 cm; intermediate, M = 100 cm; high, H = 200 cm) Beerkan run methodology was applied on both a minimum tilled (MT) (i.e., up to a depth of 30 cm) and a no-tilled (NT) bare loam soil, and the soil water retention curve was estimated by the BEST-steady algorithm. Three indicators of soil physical quality (SPQ), i.e., macroporosity (Pmac), air capacity (AC) and relative field capacity (RFC) were calculated to assess the impact of water pouring height under alternative soil management practices. Results showed that, compared to the reference low run, M and H runs affected both the estimated soil water retention curves and derived SPQ indicators. Generally, M–H runs significantly reduced the mean values of Pmac and AC and increased RFC for both MT and NT soil management practices. According to the guidelines for assessment of SPQ, the M and H runs: (i) worsened Pmac classification of both MT and NT soils; (ii) did not worsen AC classification, regardless of soil management parameters; (iii) worsened RFC classification of only NT soil, as a consequence of insufficient soil aeration. For both soil management techniques, a strong negative correlation was found between the Pmac and AC values and the gravitational potential energy, Ep, of the water used for the infiltration runs. A positive correlation was detected between RFC and Ep. The relationships were plausible from a soil physics point of view. NT soil has proven to be more resilient than MT. This study contributes toward testing simple and robust methods capable of quantifying soil degradation effects, due to intense rainfall events, under different soil management practices in the Mediterranean environment