Tariffazione dell’uso delle infrastrutture stradali da parte dei veicoli pesanti: la valutazione d’impatto di politiche a scala europea

La Direttiva Eurovignetta (1999/62/EC e sue successive modifiche) definisce a livello europeo la politica di tariffazione stradale attraverso la regolazione dell’applicazione di tasse, pedaggi e diritti di utenza ai veicoli commerciali che utilizzano la rete di trasporto trans-europea e altre autostrade. Nonostante la Direttiva si collochi lontano nel tempo, il panorama europeo delle tariffe autostradali è ancora oggi discordante e necessita di essere armonizzato. Quest’articolo illustra i principali risultati di un’analisi ex-post sugli impatti della Direttiva Eurovignetta e descrive la metodologia di valutazione seguita per l’analisi ex-ante d’impatti derivanti da future proposte legislative europee

Background model systematics for the Fermi GeV excess

The possible gamma-ray excess in the inner Galaxy and the Galactic center (GC) suggested by Fermi-LAT observations has triggered a large number of studies. It has been interpreted as a variety of different phenomena such as a signal from WIMP dark matter annihilation, gamma-ray emission from a population of millisecond pulsars, or emission from cosmic rays injected in a sequence of burst-like events or continuously at the GC. We present the first comprehensive study of model systematics coming from the Galactic diffuse emission in the inner part of our Galaxy and their impact on the inferred properties of the excess emission at Galactic latitudes $2^\circ<|b|<20^\circ$ and 300 MeV to 500 GeV. We study both theoretical and empirical model systematics, which we deduce from a large range of Galactic diffuse emission models and a principal component analysis of residuals in numerous test regions along the Galactic plane. We show that the hypothesis of an extended spherical excess emission with a uniform energy spectrum is compatible with the Fermi-LAT data in our region of interest at $95\%$ CL. Assuming that this excess is the extended counterpart of the one seen in the inner few degrees of the Galaxy, we derive a lower limit of $10.0^\circ$ ($95\%$ CL) on its extension away from the GC. We show that, in light of the large correlated uncertainties that affect the subtraction of the Galactic diffuse emission in the relevant regions, the energy spectrum of the excess is equally compatible with both a simple broken power-law of break energy $2.1\pm0.2$ GeV, and with spectra predicted by the self-annihilation of dark matter, implying in the case of $\bar{b}b$ final states a dark matter mass of $49^{+6.4}_{-5.4}$ GeV.Comment: 65 pages, 28 figures, 7 table

Impact of the COVID-19 pandemic on paediatric otolaryngology: a nationwide study

Objective: The COVID-19 pandemic profoundly modified the work routine in healthcare; however, its impact on the field of paediatric otorhinolaryngology (ORL) has been rarely investigated. The aim of this study was to assess the impact of COVID-19 on paediatric ORL. Methods: A questionnaire was developed by the Young Otolaryngologists of the Italian Society of ORL-Head and Neck Surgery (GOS). The questionnaire consisted of 26 questions related to workplace and personal paediatric ORL activities. The link was advertised on the official social media platforms and sent by e-mail to 469 Italian otolaryngologists. Results: The questionnaire was completed by 118 responders. During the pandemic, the main reduction was observed for surgical activity (78.8%), followed by outpatient service (16.9%). The conditions that were mostly impacted by a delayed diagnosis were respiratory infections in 45.8% of cases and sensorineural hearing loss in 37.3% of cases. Conclusions: Paediatric ORL was highly impacted by the COVID-19 pandemic, with a significant reduction of surgical and outpatient activities and a delay in time-sensitive diagnosis. Therefore, the implementation of new strategies, such as telemedicine, is recommended

Molecular mechanisms and physiological changes behind benign tracheal and subglottic stenosis in adults.

Laryngotracheal stenosis (LTS) is a complex and heterogeneous disease whose pathogenesis remains unclear. LTS is considered to be the result of aberrant wound-healing process that leads to fibrotic scarring, originating from different etiology. Although iatrogenic etiology is the main cause of subglottic or tracheal stenosis, also autoimmune and infectious diseases may be involved in causing LTS. Furthermore, fibrotic obstruction in the anatomic region under the glottis can also be diagnosed without apparent etiology after a comprehensive workup; in this case, the pathological process is called idiopathic subglottic stenosis (iSGS). So far, the laryngotracheal scar resulting from airway injury due to different diseases was considered as inert tissue requiring surgical removal to restore airway patency. However, this assumption has recently been revised by regarding the tracheal scarring process as a fibroinflammatory event due to immunological alteration, similar to other fibrotic diseases. Recent acquisitions suggest that different factors, such as growth factors, cytokines, altered fibroblast function and genetic susceptibility, can all interact in a complex way leading to aberrant and fibrotic wound healing after an insult that acts as a trigger. However, also physiological derangement due to LTS could play a role in promoting dysregulated response to laryngo-tracheal mucosal injury, through biomechanical stress and mechanotransduction activation. The aim of this narrative review is to present the state-of-the-art knowledge regarding molecular mechanisms, as well as mechanical and physio-pathological features behind LTS

Deep Broadband Observations of the Distant Gamma-ray Blazar PKS 1424+240

We present deep VERITAS observations of the blazar PKS 1424+240, along with contemporaneous Fermi Large Area Telescope, Swift X-ray Telescope and Swift UV Optical Telescope data between 2009 February 19 and 2013 June 8. This blazar resides at a redshift of $z\ge0.6035$, displaying a significantly attenuated gamma-ray flux above 100 GeV due to photon absorption via pair-production with the extragalactic background light. We present more than 100 hours of VERITAS observations from three years, a multiwavelength light curve and the contemporaneous spectral energy distributions. The source shows a higher flux of (2.1$\pm0.3$)$\times10^{-7}$ ph m$^{-2}$s$^{-1}$ above 120 GeV in 2009 and 2011 as compared to the flux measured in 2013, corresponding to (1.02$\pm0.08$)$\times10^{-7}$ ph m$^{-2}$s$^{-1}$ above 120 GeV. The measured differential very high energy (VHE; $E\ge100$ GeV) spectral indices are $\Gamma=$3.8$\pm$0.3, 4.3$\pm$0.6 and 4.5$\pm$0.2 in 2009, 2011 and 2013, respectively. No significant spectral change across the observation epochs is detected. We find no evidence for variability at gamma-ray opacities of greater than $\tau=2$, where it is postulated that any variability would be small and occur on longer than year timescales if hadronic cosmic-ray interactions with extragalactic photon fields provide a secondary VHE photon flux. The data cannot rule out such variability due to low statistics.Comment: ApJL accepted March 17, 201

ASSESSING THE COSTS AND BENEFITS OF THE SUSTAINABLE URBAN MOBILITY TRANSITION IN A EUROPEAN CITY

&lt;p&gt;Managing urban mobility is one of the most complex challenges facing city governments. Scarce resources make it necessary to adopt an integrated strategy, able to apply sustainable mobility policies evaluated in a scientific and measurable way and flexible enough to accommodate for future changes. In this context, this paper assesses the magnitude and the impacts of the transition to sustainable urban mobility, by providing the preliminary quantification of its costs and benefits in the city of Munich by 2030 and 2050. This example has been selected among the European cities considered within the 2021 EIT Urban Mobility study (Borgato et al., 2021).&lt;/p&gt;&lt;p&gt;The paper illustrates through transport, environmental and economic indicators the impacts of the mobility transition in three potential scenarios simulated with the MOMOS assessment tool. Additionally, the paper focuses on the effectiveness of sustainable policies' clusters. It provides an understanding of how intensively policies should be implemented to reach the Green Deal target and the EU objectives in the field of sustainable urban transport.&lt;/p&gt;&lt;p&gt;Results shows that in Munich – as in most of the European cities considered in the EIT Urban Mobility study – the Green Deal CO2 emission reduction targets for the year 2050 (-90%, compared to 1990 levels) can be achieved in all three policy scenarios thanks to the implementation of sustainable policy measures as well as to an ambitious road vehicle fleet decarbonisation in line with the assumptions of the EU "Fit for 55" strategy. On the other hand, the 2030 target (-55%) can only be reached with drastic changes in people's mobility behaviour and very significant reduction of private motorized modes.&lt;/p&gt

High Oil Price, the Transport System and the European Economy: Some Results from a Model-Based Analysis

The fast growth of the oil price is increasingly seen as a structural element rather than a short-term phenomenon. Expanding oil supply is becoming more and more problematic and, even assuming the availability of new resources, their exploitation requires massive investments. On the other side, oil demand is significantly growing in countries like China and India. Given their size and their current level of consumption and economic activity, such countries could easily sustain oil demand for a long future. A pressure is exerted on both on the supply and on the demand side and, therefore, on oil price. The HOP! research project has been co-funded by the European Commission DG Research to provide quantitative and qualitative analysis of direct and indirect impacts on the European economy of long term oil price escalation. The study has been undertaken by three partners, with TRT Trasporti e Territorio (Italy) taking the lead and collaborating with Fraunhofer Institute Systems and Innovation research (Germany) and the Institute for Prospective Technological Studies of the European Commission Joint Research Centre (Spain). Impacts of high oil prices can be separated into direct effects on the energy system and the transport system as well as indirect effects on the overall economic system. Of course, changes taking place in one system also affect the other systems . For instance, if alternative transport fuels enter the market to a large extent, the composition of the vehicle fleet and the transport costs of different transport modes will be affected. As a consequence, the increase of transport costs has an impact on the production costs and, hence, on GDP. Changes in GDP, investments and trade volumes would then change energy and transport demand . Given the numerous direct and indirect impacts of high oil prices and their linkages, the final result of an oil price peak can hardly be predicted on a qualitative basis and is likely to change over time. For this reason, in HOP! an analytical toolbox consisting of the two interconnected models ¿ POLES (in an adapted version for the HOP! project including the Biofuels model BioPOL) and ASTRA ¿ is applied to simulate the effects of various scenarios assuming high oil prices, taking into account various feedback loops and the dynamics of impacts. The time horizon of the simulations ends in 2050, the assessment being focused on the EU.JRC.J.2-The economics of climate change, energy and transpor

Trattamento dei carcinomi laringei con deficit di motilità aritenoidea: risultati preliminari dello studio ARYFIX

Trattamento dei carcinomi laringei con deficit di motilità aritenoidea: risultati preliminari dello studio ARYFIXFrancesca Mularoni (1) - Erika Crosetti (2) - Alperen Vural (3) - Piergiorgio Gaudioso (1) - Matteo Fermi (4) -Stefano Taboni (1) - Andrea Luigi Camillo Carobbio (1) - Nausica Montalto (1) - Francesco Rigoni (1) - TommasoSaccardo (1) - Alessandra Ruaro (1) - Chiara Varago (1) - Maria Baldovin (1) - Luigia Bandolin (1) - Alfredo LoManto (5) - Filippo Marchi (6) - Marta Filauro (6) - Francesco Missale (6) - Alessandro Ioppi (6) - Filippo Carta (7) -Cinzia Mariani (7) - Valeria Marrosu (7) - Melania Tatti (7) - Sedat Cağlı (3) - Imdat Yüce (3) - Mete Gündoğ (8) -Serap Dogan (9) - Francesca Del Bon (10) - Alberto Paderno (10) - Davide Lancini (10) - Giuseppe Anile (11) -Chiara Gottardi (12) - Fabio Busato (13) - Alberto Vallin (6) - Simone Caprioli (14) - Francesca Gennarini (10) -Gino Marioni (1) - Cesare Piazza (10) - Paolo Bossi (15) - Francesco Mattioli (5) - Roberto Puxeddu (7) - MariaGrazia Ghi (11) - Livio Presutti (4) - Marco Lionello (16) - Andy Bertolin (16) - Giovanni Succo (2) - Giorgio Peretti(6) - Piero Nicolai (1) - Marco Ferrari (1)Università degli studi di Padova, Dipartimento di Neuroscienze, Otorinolaringoiatria, Padova, Italia (1) -IRCCS Istituto di Candiolo, Dipartimento di Otorinolaringoiatria, Torino, Italia (2) - Erciyes University,Department of Otorhinolaryngology, Kayseri, Turchia (3) - Università degli studi di Bologna, Dipartimento diOtorinolaringoiatria, Bologna, Italia (4) - Università degli studi di Modena, Dipartimento di Otorinolaringoiatria,Modena, Italia (5) - IRCCS Ospedale Policlinico San Martino, Dipartimento di Otorinolaringoiatria, Genova,Italia (6) - Azienda Ospedaliero-Universitaria di Cagliari, Dipartimento di Otorinolaringoiatria, Cagliari, Italia (7)- Erciyes University, Department of Radiation Oncology, Kayseri, Turchia (8) - Erciyes University, Departmentof Radiology, Kayseri, Turchia (9) - Università degli studi di Brescia, Dipartimento di Otorinolaringoiatria,Brescia, Italia (10) - Istituto oncologico Veneto IRCCS, Oncologia 2, Padova, Italia (11) - Università degli studidi Padova/ Istituto oncologico Veneto IRCCS, Oncologia 2, Padova, Italia (12) - Istituto oncologico VenetoIRCCS, Dipartimento di Radioterapia, Padova, Italia (13) - IRCCS Ospedale Policlinico San Martino,Dipartimento di Radiologia, Genova, Italia (14) - Università degli studi di Brescia, Dipartimento di Oncologia,Brescia, Italia (15) - Ospedale di Vittorio Veneto, Dipartimento di Otorinolaringoiatria, Treviso, Italia (16)Razionale: Il deficit della motilità aritenoidea è un elemento rilevante nei pazienti affetti da carcinomalaringeo. Può essere classificato come ipomotilità o fissità ed è attribuibile a vari meccanismi legatiall’estensione della neoplasia verso la porzione posteriore dello spazio paraglottico inferiore. Tale estensionecomporta un peggioramento della prognosi nei pazienti sottoposti a chirurgia parziale (OPHL), mentre alcunistudi sembrano indicare che la prognosi dei pazienti trattati con laringectomia totale non risulta influenzatadallo stesso pattern di crescita. Lo scopo dello studio è identificare il miglior trattamento nei pazienti affetti dacarcinoma laringeo con compromissione della motilità aritenoidea.Materiali e metodi: È stato condotto uno studio retrospettivo multicentrico, includendo pazienti affetti dacarcinoma laringeo con compromissione della motilità aritenoidea. In questa analisi preliminare sono stativalutati l’overall survival (OS) e la severe laryngoesophageal dysfunction-free survival (SLEDFS). I dati sonostati analizzati mediante un’analisi univariata con il metodo di Kaplan-Meier e il log-rank test.Risultati: Lo studio ha incluso 391 pazienti, con età media di 64 anni. 25 (6,4%) tumori sono stati classificaticome T2, 225 (57,5%) come T3 e 139 (35,5%) come T4. Sulla base della valutazione endoscopicapreoperatoria 209 pazienti si presentavano con ipomotilità aritenoidea e 182 con fissità. I trattamentieffettuati hanno compreso: laringectomia totale (n=179, 45,8%), OPHL di tipo II (n=110, 28,1%), OPHL ditipo III (n=32, 8,2%) o (chemio)radioterapia preceduta o meno da chemioterapia neoadiuvante (n=70,17,9%). Il trattamento adiuvante è stato eseguito in 141 casi (44,2%). L’OS a 5 anni è risultata del 71,8%. Ilgrado di ipomotilità aritenoidea è risultato significativamente associato all’OS a 5 anni (fissità aritenoidea61,6%, ipomotilità 79,2%; p=0,007). Nei pazienti trattati con preservazione d’organo l’OS a 5 anni è risultatadell’81,0%, rispetto al 57,7% dopo laringectomia totale (p=0,0004).Nei pazienti con preservazione d’organo la SLEDFS a 5 anni è risultata dell’85,4%. L’OPHL di tipo II èrisultata associata a SLEDFS a 5 anni superiore (91,6%) rispetto a OPHL di tipo III (73,9%) e trattamenti nonchirurgici (79,9%) (p=0,042). La radioterapia esclusiva è risultata associata ad una riduzione della OS(p&lt;0,0001) e della SLEDFS (p=0,071).Conclusioni: Il deficit di motilità aritenoidea ha dimostrato un ruolo prognostico negativo nei pazienti affettida carcinoma laringeo. I trattamenti di preservazione d’organo non hanno comportato un peggioramentodella prognosi rispetto alla laringectomia totale. La funzione laringea post-trattamento è risultatasoddisfacente, specialmente nei pazienti sottoposti a OPHL di tipo II. I pazienti trattati con radioterapiaesclusiva hanno presentato risultati oncologici e funzionali peggiori rispetto alle altre strategie dipreservazione d’organo.</p

Comparative Anatomy and Radiology: Human vs. Ovine Model

An accurate knowledge of comparative anatomy and radiology between ovine and human is mandatory and a preliminary requirement to start the training in endoscopic ear surgery on the ovine model in the proper way. Indeed, the comprehension of the differences and similarities regarding the anatomical structures and radiological findings allows performing all the surgical procedures with a more precise and better surgical point of view. By the means of the endoscope, some of the areas of the middle ear cavity simply inaccessible by microscope have been described, and thanks to the capability of the endoscope to “look around the corner” almost every space of the middle ear cavity has been explored. In addition, angled lenses (i.e., 30°, 45°, 70°) might help to assess even deeper recesses (i.e., type B facial sinus, type B sinus tympani). In this chapter the anatomic details of the ovine model are highlighted and compared to those of the human. A specific knowledge of the ovine model’s anatomy is obvious prerequisite to start this training program. The middle ear anatomy of the ovine is quite similar to the human one and is suitable to perform endoscopic surgical procedures